No spitting, no smokingBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7406.0-g (Published 10 July 2003) Cite this as: BMJ 2003;327:0-g
- Richard Smith, editor
One of the joys of being old is that you can spot long term social trends. When I was a boy the world was full of signs saying: “No spitting.” People do still spit in the street, but it's now highly deviant. The signs have disappeared. Smoking is slowly following spitting into profound deviancy, and Liam Donaldson, England's chief medical officer, last week hastened the trend by calling for a ban on smoking in public places and at work (p 69). This has, of course, already happened in many places, including Los Angeles, New York, and the Republic of Ireland.
In the 1950s my doctor would smoke while examining me. When I was a medical student in Edinburgh in 1970 you could smoke in the medical reading room but not in the university library. Headbanging (a colloquial term for “crazy, foolish, fanatical”) sociologists would thus make for the medical school, squeezing out the puritanical medical students. History may be repeating itself in that the Royal Hospitals in Belfast (p 104) are providing “controlled smoking facilities for patients” at a cost of £390 000. A complete ban, argue the chief executive and others, would be inhuman and impractical. Perhaps once the chief medical officer has strutted his stuff (recognising that his influence doesn't extend to Ulster) people will be popping into the hospital for a smoke while out shopping.
I arrived at the BMJ in 1979 and spent the first two weeks in a small room with an editor who smoked. The BMA finally banned smoking about 10 years ago, but arriving at BMA House you will still be greeted by charming recidivists smoking at the gates and surrounded by dog ends. The Department of Health, points out the chief medical officer's highly attractive report, became smoke free on 1 April 2003—just presumably as Professor Donaldson was preparing his report and imagining himself answering a question at his press conference on when the department banned smoking: “Ah well, we haven't yet.”
In 1981 I interviewed the director of Action on Smoking and Health to mark its first 10 years. David Simpson, the then director, had a vision that seemed unachievable: “I want people's assumption to be that they can't smoke unless they see a sign saying they can.” Twenty years later we are there, and one of the perverse pleasures of Singapore airport is to ogle at smokers in a horrible glass box filled with smoke. It's like a fetid aquarium with intercontinental smokers gasping like groper fish as they suck smoke into their nicotine starved lungs.
Banning smoking in workplaces, says the chief medical officer, will reduce the prevalence of smoking among adults from 27% to 23%. This would be a major step for public health, reducing Britain's 120 000 deaths a year from smoking. Ambivalence about smoking is, however, still embedded in British society. Last week I sat in a London taxi that had a sign saying “Thank you for not smoking” and watched the driver smoke. Being British, I was appalled but said nothing. Thank you, Professor Donaldson, for speaking up.
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