Smoking Article by Doctor Kenneth Prudhoe Club de Mar Medical Centre Palma de Mallorca

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"DOCTOR AT SEA" a monthly Column in The Islander Magazine

Smoking

The smoking debate has raged throughout my lifetime and has focused on the tension between the personal right to smoke and the rights of non-smokers to enjoy a smoke-free environment. I can remember as a boy reading the correspondence column in a newspaper and one letter writer had mused, more in hope than expectation, that they looked forward to a time when "No smoking" signs would be replaced by signs indicating "You may smoke here". It did seem very fanciful at that time when cigarettes were so much part of the fabric and the population studies linking smoking with lung cancer were in early days.

At long last the pendulum has finally swung in the direction of a smoke-free public environment and, on Sunday 1 July, England followed in the footsteps of Northern Ireland, Wales and Scotland and banned smoking from virtually every enclosed public place and workplace. Businesses will be held accountable if their staff smoke in public areas and restaurants will be required to enforce the ban on all customers. Local Council enforcement officers will have the power to enter any affected premises to ensure compliance. As an additional twist of the screw, designated smoking rooms are not allowed and it will be illegal to smoke in company cars that are used by more than one person. There will be a duty on employers to ensure that their staff are not exposed to cigarette smoke when visiting clients or patients in exempt premises such as their own home.

All very much more draconian than my letter writer ever imagined. This seems a million miles away from the position here in Mallorca where smoking in restaurants is made bearable by open windows and terraces and efficient extractor systems. Why all the fuss? It is because smoking does remain one of the single most significant causes of lifestyle-related ill-health. Before the 1914-18 World War, lung cancer was relatively uncommon. Following the smoking epidemic of the twentieth century lung cancer is the most common cause of cancer death in the UK and occurs almost entirely in people who smoke tobacco. In the mid-twentieth century researchers looked at 40,000 UK doctors, their lifestyle including smoking habits, and their future incidence of lung cancer. The results demonstrated the very strong link with lung cancer and many doctors stopped smoking so that, as an occupation group, they were the first to reap the benefit in terms of reduced incidence of lung cancer and cardiovascular ill-health.

According to the April newsletter from the British Heart Foundation, smokers are almost twice as likely to suffer fatal heart disease as non-smokers. This explains why insurance premiums are more favourable for smokers taking out a pension policy! Smoking shortens their lives due to heart disease, chronic lung disease and lung cancer and their actuarial burden on the insurer is reduced. Smoking has a pervasive effect on other body systems including premature wrinkling of the face - I became aware quite quickly in medical practice that it was often possible to guess which patients smoked just by looking at their face and checking their age.

Cigarette smoke offers the most effective delivery system of nicotine and quickly produces a nicotine addiction that can rarely be conquered by will-power alone. Nicotine replacement therapy (NRT) is an important aid to smoking cessation and moderates nicotine withdrawal to the extent that it is tolerable rather than extinguished but smoking cessation becomes within reach. NRT is available in patches or gum – the patches offer continuous background support and the gums helps at high risk moments, for example, on waking. Nicotine is not carcinogenic, unlike cigarette smoke tar, and NRT offers a valuable half-way house in smoking cessation. The statistical benefits of stopping smoking accrue immediately and are maximal in the early months after stopping.

At present the English land-based regulations do not apply on ships and there is to be separate legislation for ships. The Department of Transport has completed the first round of consultation on the principle of prohibiting smoking on ships and regulations are likely to be drafted early next year. It will be interesting to see how this affects seafarers around the UK and seafarers under the British flag elsewhere because interpretation of the rules in other parts of the United Kingdom has been variable. For instance, Scottish trawlers apply the smoking ban within the 12 mile limit but beyond this are free to do as their Captain permits. P&O Irish Ferries have had a complete non-smoking policy since January 2006. At the very least the UK legislation will send a clear signal to the rest of the world and, who knows, may reach us here. Perhaps now is the time for smokers to cross the floor and join the swelling ranks of ex-smokers and non-smokers out of choice rather than coercion.

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 639 949 125.