Smoking in Hospitals: Right Question – Half-Right Answer

In a recent edition of The British Medical Journal (11 February 2017, p 232), that doughty source of the latest medico-political developments, there is a blog by a Dr Mary Black about the problem of smoking in hospitals, titled ‘Is it time we stopped colluding with smokers?’

I felt moved to send a response; it was published in the online version of the Journal. This is what I said:

“Dr Mary Black is properly concerned that smoking still goes on in many NHS hospitals due, it seems, to collusion by the staff who are too soft-hearted on patients. She cites her father, a doctor who was born in 1924 and started smoking in his teens. He ‘tried but failed to stop his tobacco use’ and died of a smoking-related cancer at the age of seventy-nine.

“While it is regrettable that anyone should die of a smoking-related cancer, or of any kind of cancer for that matter, I would question the idea that he ‘tried but failed to stop his tobacco use’. With all due respect to Dr Black and the memory of her father, this is incorrect: he did not try to stop smoking; he only failed to stop, unfortunately for him.

“The very idea of a smoker ‘trying’ to stop is wrong-headed and a distraction from the real issue (https://www.nicotinemonkey.com/how-many-attempts-do-smokers-need-before-they-quit). A smoker could be defined as someone who has failed to stop, and this is demonstrated every time he or she lights another cigarette, or pipe as in the case of Dr Black’s father.

“She continues, ‘Misguided sympathy keeps the last vestiges of tobacco acceptability alive in the NHS…I now think that staff should focus their efforts on making sure that every smoker…gets nicotine replacement therapy and stop-smoking advice’. Then she states the obvious: that the NHS should be smoke-free.

“What would be wrong, then, with offering so-called nicotine replacement therapy to smokers who are admitted to smoke-free NHS hospitals?

“This is what is wrong: for a start, nicotine replacement therapy is incorrectly named: it is cigarette replacement or nicotine maintenance therapy. But why should smokers need a replacement for cigarettes? This is the real collusion, based on misguided sympathy which in turn is based on misunderstanding of the nature of smoking. It also sends the wrong message: stopping smoking is too difficult to do on your own, so you need a drug in the form of medicinal nicotine to assist you. This disempowers and even infantilises smokers.

“Of course the ‘stop smoking advice’ part is essential, but with the right sort of advice and understanding any smoker can stop easily—without nicotine. Many smokers actually dislike smoking (Proctor R, Golden Holocaust, University of California Press, 2011, p6) and may welcome the opportunity of enforced abstinence while in hospital. They would then be able to demonstrate to themselves that not only can they survive but also that they feel much better without poisoning themselves with nicotine in any form.”