Smushed Out
Okay, weird memory – when I was a kid, the smell of stale ashtrays was something that reminded me of the holidays or vacation, because there was absolutely no smoking in our home. The ashtray smell, along with the blue taxi ramp lights leading to the runway, were something I usually only experienced on airplanes when we were flying to see the grandparents (in a more civilized age, there were small ashtrays with little spring-flip lids in the armrest on airline seats). I was taught at an early age that smoking was bad, and never had the desire to start what seemed like a really stupid habit. Later in medical training, I learned exactly why smoking is so destructive and seized upon communicating the particulars I had learned to my patients with a reasonable amount of zealotry to save them from the cancer sticks. Smoking is bad for you, and I thought it might job to spread that word and explain why.
Across the pond, where most of our best bad ideas originate, the U.K. – unwilling to tackle any actual major problems – is back to targeting smokes. As with us, the U.K. has a ton of major problems they dare not substantively address, so it’s time to beat a favorite distraction drum.
The latest government scheme “would make it illegal to sell tobacco products to anyone born after January 1, 2009. If passed, the bill will give Britain some of the toughest anti-smoking measures in the world. Authorities say it will create modern Britain’s ‘first smoke-free generation.’”
“Under the Tobacco and Vapes Bill, children turning 15 this year or younger will never be legally sold tobacco. Once implemented – officials are aiming for 2027 – the legal age of sale that people in England can buy cigarettes will be raised by one year, every year until it is eventually illegal for the whole population.”
Do I have to say that I am against teenage smoking? Nonetheless, this absurd idea will of course decrease net government revenue, further limit individual freedom, and increase crime via black market sales. The entire farce reminds me of the far better written version, and episode of “Yes, Prime Minister” wherein the minister for health, a physician, attempts to ban all smoking. By the episode’s end, he has been promoted within the government to be bought off, and the new health minister is a chain-smoking former tobacco lobbyist.
And so, the government that sticks to un-fundable, impossible health care promises, and assaults its citizenry over a virus panic, now wants to further nanny its would-be smokers. And the UK health experts so willing to force patients to accept their interventions for their own good are going to be right on board:
“Professor Chris Whitty, Chief Medical Officer for England, said:
Smoking causes harm across the life course. This includes stillbirth, asthma, heart disease, chronic obstructive pulmonary disease, 15 different types of cancer, stroke and dementia.
If passed, this will be a major public health measure which will reduce illness, disability and premature deaths for children today and future generations.”
“Dr Ian Walker, Cancer Research UK’s Executive Director of Policy, said:
This legislation positions the UK as a world leader in tackling smoking. Raising the age of sale of tobacco products has strong public backing and is the boldest prevention measure in years.
Nothing would have a bigger impact on reducing the number of preventable deaths in the UK than ending smoking. We urge all MPs to vote in favour of this bill, and for it to be passed as quickly as possible.”
“Dr Camilla Kingdon, President of the Royal College of Paediatrics and Child Health, said:
The introduction of the Tobacco and Vapes Bill is a significant day for children’s health …
I strongly urge MPs to use the important responsibility they have and support this bill to protect children’s and our nation’s health.”
Of course, the BMJ and the Lancet will pile on shortly, if they can take a break from the other important topics that occupy them. And since the great majority of U.K. doctors work for the NHS, it’s pretty sure they will back the government position without question.
This continues the post-modern medical tradition of working, not for individual patients, but in their name via government edict. Of course, smoking is dangerous, bad for you, causes cancer, stains your teeth, gives you horrible breath, causes horrid vascular disease, and so many other bad things. OF COURSE, physicians should be against smoking.
But at what cost? It was wrong, rotten even when the federal government banned TV cigarette ads in 1970. I was 9 years old, had just lost a grandfather to smoking, and thought it was great. Now I see that it was a dictatorial, emotional move that principled physicians should have opposed due to the precedent, and what should have been the decent bounds of our profession. Instead, the AMA moved to ban all such ads in 1985. No one in medicine seems to care about the damage done in pursuit of forcing others to be healthy. Doctors should educate, should support, should encourage individual patients. But when we get behind government nannying and do-gooding, we shed any credibility left. What will the U.K. NHS, or our own DHHS/CMS, and all the toadying doctor’s groups say, when it’s time to ban beer ads, or potato chip billboards, or all-U-can-eat BBQ joints? What is the actual difference?
I don’t spend a lot of time talking to patients about smoking any longer, beyond the pro forma “Don’t smoke, smoking will worsen your _____________” so that I can honestly document the action. After too many years of telling the same people the same thing and getting no positive results, I’m tired of wasting my breath, and unlike too many of my colleagues, I don’t enjoy nagging.
I’m always going to be anti-smoking, but physicians should be anti-force even more.
Retired now but rarely had any success with getting anyone to quit smoking. Yeah, the quit rate went up after the M.I. but the cardiologists were hammering the patients along with me. Many post M.I. patients eventually went back to smoking and cost the healthcare system a butt load of money before they died. Some of the post M.I. patients once recovered still got lung cancer whether they stopped smoking or not. Still smokers were better off if they quit.
I agree with the poster above. Making it illegal is going to lead to criminality. Shoot, Illinois legalized pot a couple of years ago and the state gets the taxes. Probably squanders most of it. Last year state made $562 million in taxes from legalized pot. Pot smoking is probably as destructive to health as tobacco. Had a guy who smoked pot daily exclusively (no tobacco) for 35 years. Came in with S.O.B. and I showed him the massive COPD bullae in his CXR. I was surprised he actually quit when I told him to and was still doing pretty good on minimal COPD drugs 15 years later! That is a rare thing though.
My favorite smoking story is when, on St Elsewhere, the Docs and the patients would smoke together in the hospital room.
Loved that show.
“… the post-modern medical tradition of working, not for individual patients, but in their name via government edict…”
Not POST-modern, Pat, just Modern.
Begun in the Modern era by the ever so Modern NSDAP in Germany in the 1930s.
It was the entire Neue, Improved philosophical basis of Medicine (and you’d BETTER go along with it, Ja?) – the doctor’s patient was now the People, the Body of the entire country, which must be made strong.
Is it occasionally necessary to remove some part of the healthy body to keep it strong and healthy, say, a hangnail, or an abscess? Well, Ja, it is.
And so, to make the People stronger, there went the mentally retarded, then the schizophrenic, then the politically inconvenient, then the Jews, and many others.
But all was for the good of the body of the people, and all was supported, and supervised, by the doctors.
This is the path we travel when we begin to treat “all the people,” rather than our own individual patients. Beware.
[See Robert Jay Lifton, “The Nazi Doctors,” ~1978, if I’m not mistaken]