David Simpson OBE, Hon MFPHM

Director, International Agency on Tobacco and Health

Visiting Professor, London School of Hygiene & Tropical Medicine

Honorary Fellow, Clinical Trial Service Unit, Oxford

Editor, News Analysis, Tobacco Control journal

Tobacco: health workers and institutions

10th Annual Congress

TURKISH THORACIC SOCIETY

Antalya, 25-29 April 2007

Richard Peto & Richard Doll, 2004

‘British Doctors Study’ – first results published:

1954: preliminary report

Doll R, Hill A B The mortality of doctors in relation to their smoking habits.  A preliminary report. British Medical Journal 1954;4877:1451-1455  

1954: preliminary report 1956: 2nd reportLung cancer and other causes of death in relation to smoking. A second report on the mortality of British doctors. British Medical Journal 1956; 233:1071-1081

British Doctors study: prospective study of > 50 years

- Started – wrote to British doctors - in 1951;

- preliminary report: 1954

- 2nd report: 1956

- 50-year follow up report: 2003

Important by-products of doctors being the subjects:

* doctors + first group to quit smoking;

* important evidence of health gains from quitting;

* made doctors press government for prevention;

UK: doctors’ reduction of smoking after publication of scientific evidence

0

2

4

6

8

10

12

14

1950 1955 1960 1965 1970

Ave

rage

no.

of c

igar

ette

s per

day

All men aged 35-59

Source: Doll & Peto, 1976

Doctors aged 35-59

All men aged 60+

Doctors aged 60+

UK: doctors health after quitting:changes in age-standardised death rates

1954/59 to 1966/71

-30-25-20-15-10-505

1015

All diseases Diseases notrelated tosmoking

Smoking-related diseases

All men

Male doctors

worse

% change

better

Doctors' % daily smoking in WHO European region

0 10 20 30 40 50 60 70

GeorgiaRomania

MacedoniaTurkeyFrance

ItalyCzech Rp

PolandEstonia

DenmarkSwitz'ldNorway

SloveniaIsrael

FinlandSwedenlreland

LuxembgIceland

UK

MaleFemale

WHO Europe, 2005

Potential of doctors

• Doctors & other health workers are in a uniquely powerful position to fight against tobacco

• In UK,

– Pioneering research & early political lobbying for tobacco control was undertaken by doctors

– Doctors led the way in realising that wide-ranging collaboration is required to solve the tobacco problem

Smoking cessation

• Doctors & other health workers have unique ability to help smokers to stop smoking

• Many smokers want to stop smoking, & others may be receptive to encouragement to stop

• A brief intervention by a doctor increases chances that a smoker will successfully stop smoking

• Nicotine replacement therapy (NRT) can increase the success rate of more dependent smokers

The brief intervention

• Offer information, advice, & encouragement to get the patient to consider making a firm commitment to quit

• Reinforce the decision to quit

• Give the patient a cessation leaflet, if available

• If appropriate, offer to prescribe NRT or other pharmaceutical, & give advice

• Advise the patient to plan a quit day in advance

• At the end, reinforce the patient’s decision to quit & offer further help

• inform patient of intention to follow up progress

Actions for doctors at local level

• Call in teenage patients to discuss health problems including tobacco

• Doctors can influence tobacco control policy at the community level

• Doctors can educate politicians & other decision makers about tobacco

• Many doctors have special opportunities as advisors to companies, local government & media

• Doctors can influence funding to support tobacco control efforts

Doctors can ask for change!

Doctors: role in education & training

• Training in tobacco control can increase success

• Exploit all opportunities:

– Smoking cessation

– Training medical students

– Put tobacco in Continuing Medical Education (CME) & continuing professional development (CPD) courses

– Media training, especially for tobacco group leaders & key representatives for news media

Increase doctors’ awareness: action for national medical organisations

• Survey of doctors’ smoking habits & attitudes to smoking

• Disseminate the results of the survey

• Set up a tobacco group in the national office

• Educate members about tobacco

• Make the organisation’s premises smoke-free

• Use medical publications for publicity

• Brief doctors about smoking cessation

• Support doctors’ cessation activities

• Review organisation’s investments to eliminate tobacco holdings

Tobacco control: action for national medical organisations

• Formulate a tobacco action programme• Work with other health organisations• Use the news media• Work with politicians• Campaign for smoke-free health care facilities• Influence medical education• Set up a tobacco control organisation• Prepare a baseline national tobacco report• Carry out regular surveys & evaluation

tcrc@bma.org.ukwww.tobacco-control.org

Doctors and Tobacco: Medicine’s Big ChallengeAn action manual on tobacco for medical associations and doctors

An action manual on tobacco for medical associations and doctors

http://www.doctorsandtobacco.org/

A few lessons learnt on the battlefield

• Tobacco control can be tough work

• At times, bravery and commitment are essential

• The tobacco industry always fights effective measures

• Measures it does not fight are ineffective

• Eventually, you can help save more lives and prevent more disease than all your country’s clinicians

Tobacco control…

Often, politicians and others do not seem to listen

It can be a long, hard, lonely journey …

and there’s always someone trying to knock you down