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Dr Jenkinson's anguish is all to apparent and entirely justified.
But giving up on smokers can't be the answer.
It is certanly absurd that the government should be backsliding on
its 1998 White Paper on tobacco control policy, Smoking Kills, while
spending its funds on promoting and supporting smoking cessation, and
exhorting general practitioners to take an active role as part of their
regular business. What is the point of driving the NHS in this direction
if they allow the tobacco companies to spend £100 million per year pushing
in the other direction? We have a great tobacco policy on paper, it just
needs to be delivered in practice.
However, the government's shortcomings don't make the contribution of
GPs any less worthwhile. Even if it is not possible to get all 13 million
smokers to quit, for those that are persuaded and aided by their GP, it is
hard to imagine a better all-round health intervention. Even with the
tobacco companies in full flight, the economics of GP and other smoking
cessation interventions are extremely attractive. Recent NICE health
technology assessments appear to have been setting a benchmark of about
£30,000 per quality life-year saved (QALY) for approval of new
technologies and drugs for the NHS. The cost-effectiveness of smoking
cessation interventions is in the range £200-1000 per life-year,
representing terrific comparative value for NHS money.
So I think the government is letting the NHS down by not doing what
it said it would do to tackle tobacco. Surely, the answer is for the
government to ban tobacco advertising and promote smoke-free workplaces,
not for GPs to give up on helping smokers to quit.
All this is political - I hope that anyone involved in helping
smokers to quit will find a moment to write to Secretary of State Alan
Milburn asking for the ban on tobacco advertising to be brought forward
instead of delayed, and for the government to stop dithering over the new
'Approved Code of Practice' that would properly apply the Health and
Safety at Work Act to passive smoking at work. These measures were
promised in 1997 and 1998 respectively, and we are still waiting and
consulting respectively.
Don't lose heart! I have just read your letter in electronic BMJ.
Like you, I have advised people to quit smoking for many years, and some
have given up. I agree also that politics are very important in
controlling the tobacco menace (what problems might a man like Kenneth
Clarke, an astute QC who sees no moral objection to working actively for a
tobacco company, bring to the possible leadership of this country?).
But I also remember the many patients who were damaged by the
Thatcher policies on health, and the large number of times I must have
explained to them that the only remedy for these particular ills was
political. I like to think that this advice given by many health
professionals made some contribution to the 1997 election result. So
don't give up - your patients need your help. Love them, advise them,
and tell them to get political about it.
GPs in the front line let down by the government
Dr Jenkinson's anguish is all to apparent and entirely justified.
But giving up on smokers can't be the answer.
It is certanly absurd that the government should be backsliding on
its 1998 White Paper on tobacco control policy, Smoking Kills, while
spending its funds on promoting and supporting smoking cessation, and
exhorting general practitioners to take an active role as part of their
regular business. What is the point of driving the NHS in this direction
if they allow the tobacco companies to spend £100 million per year pushing
in the other direction? We have a great tobacco policy on paper, it just
needs to be delivered in practice.
However, the government's shortcomings don't make the contribution of
GPs any less worthwhile. Even if it is not possible to get all 13 million
smokers to quit, for those that are persuaded and aided by their GP, it is
hard to imagine a better all-round health intervention. Even with the
tobacco companies in full flight, the economics of GP and other smoking
cessation interventions are extremely attractive. Recent NICE health
technology assessments appear to have been setting a benchmark of about
£30,000 per quality life-year saved (QALY) for approval of new
technologies and drugs for the NHS. The cost-effectiveness of smoking
cessation interventions is in the range £200-1000 per life-year,
representing terrific comparative value for NHS money.
So I think the government is letting the NHS down by not doing what
it said it would do to tackle tobacco. Surely, the answer is for the
government to ban tobacco advertising and promote smoke-free workplaces,
not for GPs to give up on helping smokers to quit.
All this is political - I hope that anyone involved in helping
smokers to quit will find a moment to write to Secretary of State Alan
Milburn asking for the ban on tobacco advertising to be brought forward
instead of delayed, and for the government to stop dithering over the new
'Approved Code of Practice' that would properly apply the Health and
Safety at Work Act to passive smoking at work. These measures were
promised in 1997 and 1998 respectively, and we are still waiting and
consulting respectively.
Background is available on the ASH web site at http://www.ash.org.uk
Competing interests: No competing interests