Smoke Out Doctors Who Neglect Their Smoking Patients

Gilbert L. Ross, MD


Thursday, November 17 was the Great American Smokeout -- but many not-so-great American doctors are neglecting to tell their patients to quit smoking.

The US Centers for Disease Control and Prevention recently released the latest statistics on smoking rates.[1] The tone was generally self-congratulatory, and indeed, when matched against the marketing might of Big Tobacco, a decline in smoking from 21.6% in 2003 to last year's 20.9% is an accomplishment, even if some 44 million Americans remain smokers.

But amid the celebration, a surprising report issued in October by a division of the Agency for Healthcare Research and Quality (AHRQ) should have received more notice. Their survey of medical care covering the period of 2000-2003 (in "Statistical Brief #101") contained this incredible piece of information: Although almost half of all smokers had a routine medical checkup in 2003, only 63.6% of those were counseled by a physician to stop smoking -- and this is an improvement from 2000's rate of 57%![2]

What gives? We are not talking about invasive or expensive procedures, after all. To repeat, less than two thirds of smokers were advised by their doctors to quit. However, most smokers want to quit and need all the help that they can get. Smoking cigarettes is at once both the most unhealthy activity that we can indulge in and the most difficult to stop. Both the addictive substance, nicotine, and the many behavioral habits associated with smoking make smoking extremely hard to abandon -- a fact exploited mercilessly by the tobacco marketers, despite all their assurances to the contrary.

But the fact that the merchants who live by selling death and disease are still getting away with it is hardly an excuse for medical professionals to behave so thoughtlessly and unprofessionally -- even, dare I say it, negligently -- when it comes to advising their smoking patients to quit.

Approximately three quarters of smokers want to quit. Each year, around half make the effort to try.[3] Unfortunately, given the current state of cessation aids, only a minority succeed. But the success rate -- the rate of long-term abstinence -- goes up with each and every attempt. And one of the most potent stimuli for a person to quit is being advised to do so by a physician.

Doctors should also describe the many cessation aids that are now available, including nicotine patches and gum, nicotine inhalers and nasal spray, and medications, such as bupropion. Some evidence from abroad suggests that smokeless tobacco may also serve as a harm-reducing tactic for those who cannot break the smoking habit. Adequate support and follow-up are helpful as well. Even with all such assistance, the quit rate per attempt remains abysmally low; multiple attempts are usually required to succeed. The smoker must be educated to expect some relapses and encouraged to keep on keeping on.

It's true that millions of smokers have quit successfully; indeed, there are now more ex-smokers than smokers in the United States.[4] But ask any former smoker about 2 things: the difficulty of quitting and the desire, even years later, to smoke again. (I quit in 1990, and I still reminisce about that cigarette after coffee).

Every bit of aid and encouragement is needed, but it won't be found if doctors don't even broach the subject with smoking patients. Doctors who fail to do so risk sending 1 of 2 messages: "I know you smoke, but I don't care" or "I don't think your smoking is a real concern for your health." Who needs a doctor like that?

On the 29th Great American Smokeout, I have a message for my fellow MDs: The simplest way that we can help a smoker live longer and healthier is to advise quitting and to do so at every opportunity. Smokers do not consider such advice to be nagging -- au contraire, even those who aren't ready to quit appreciate it. Eventually your words will have an impact, hopefully before the cigarettes have done their deadly work.

For more information, see the American Council on Science and Health (ACSH) and ACSH Health Facts and Fears.

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