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Key areas and groups
BEGIN
WITH YOURSELVES, HEALTH PROFESSIONS TOLD, IN FIGHT TO PREVENT
TOBACCO-INDUCED DISEASES
Physicians,
above all, medical associations urged to set example
The
medical profession is being asked worldwide to take a leading role in
preventing tobacco-related diseases in their communities - and to start by
cutting out smoking themselves.
"In
most countries, doctors in particular, and health professionals in general,
are respected members of society," says a report by Dr Martin Raw,
King’s College School of Medicine and Dentistry, London. "People are
influenced by their advice."
The
three-part report, entitled "The Physician’s Role," was
presented at the 1st European Conference on Tobacco Policy held
in Madrid under the sponsorship of the government of Spain, the Commission
of the European Communities, and the World Health Organization.
Tobacco-related
diseases take about 500,000 lives yearly in Europe. In countries where
smoking is long established, the report says, ‘it has been shown to cause
90 per cent of all deaths from lung cancer, 75 per cent from bronchitis and
emphysema, and about 25 per cent from heart diseases."
Moreover,
‘about a quarter of all regular cigarette smokers will be killed
prematurely by their smoking," dying from 10 to 15 years earlier than
they might have done had they not smoked.
Asserting
that smoking is more than a habit,’ the report goes on to state:
"Tobacco contains nicotine, one of the strongest known poisons used
commercially as an insecticide. Once cigarette smoking is in the lungs, it
only takes seven seconds for nicotine to reach the brain.
A first
task for physicians, and other members of the profession, is to set an
example of non-smoking among themselves. "Changes in the behaviour of
doctors have had a powerful effect," the report says, "in leading
to attitude and behaviour changes in the population as a whole."
A
second task for the health professions is to help patients break the habit,
and a third is to lobby, through medical associations, for measures that
promote the concept of tobacco-free societies, among them smoke-free public
places and work places, and warning labels on cigarette packages.
Though
tobacco is addictive, the report says, it is possible to give up. In the
United Kingdom alone, about ten million smokers have broken the habit over
the last ten to fifteen years, or about 2,000 daily.
Physicians
are advised to ask all patients whether they smoke, to probe but not to
bully, and to help smokers who want to quit. Measuring carbon monoxide
concentration in the breath of patients with a monitor "can have a
dramatic motivating effect." A number of machines are on the market
that weigh only about two pounds (1 kg), and are portable and easy to use.
Getting
down to about ten cigarettes daily "can be a reasonable strategy,"
the report says, but the evidence is that sudden stopping is easier. The
recommended approach: Stop "cold turkey." Tolerate an increase in
weight up to 3.5 pounds (1.5 kg.) for a year after stopping. Tackle the
weight gain later, after the smoker is a confirmed non-smoker.
"There
is no reason to discourage smokers from using anti-smoking aids," the
report adds, referring to acupuncture, hypnosis and nicotine chewing gum for
smokers who need further help. "If smokers really want to stop, the
aids may work,’
While
endorsing use of the gum, which is available in some 20 European countries
either by prescription or over the counter, the report warns however that
"it should be offered with careful instruction." The gum is
recommended to ease withdrawal pangs that smokers experience three to four
months after stopping. It is to be chewed from 20 to 30 minutes, used
instead of, not as well as, cigarettes. "It is rarely addictive,"
the report says.
In
addition to urging an exemplar role for the health profession and setting
out ways for them to help smokers, the report calls upon the medical
profession to campaign against smoking-induced diseases.
"A
medical association campaigning against tobacco, with the full support of
its membership ... will have a greater chance of persuading a treasury and
finance minister to increase the price of cigarettes," the report says
by way of example. Higher prices usually result in a decrease in smoking.
The
report defines issues as, for instance, the sale of tobacco to minors,
"Countries that allow children to buy tobacco products are allowing
children to buy a dangerous, addictive drug," it says. It sets goals
such as the enactment of laws prohibiting sales.
It
lists target groups who are able to effect change, for instance, editorial
writers, politicians, parlimentarians.
And it
recommends measures to be carried out, ranging from easy ones such as
leaving literature and posters conspicuously in waiting rooms, and others
which require time and organization. As an example of the latter, the report
suggests to physicians that they invite their "local political
representative to visit a ward in your hospital in which smokers are dying
of smoking-induced diseases."
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