David Simpson OBE, Hon MFPHM Director, International Agency on Tobacco and Health

1. 10th Annual Congress TURKISH THORACIC SOCIETY Antalya, 25-29 April 2007 Tobacco: health workers and institutions David SimpsonOBE, 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

2. Richard Peto & Richard Doll, 2004

3. ‘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 report1956: 2nd report Lung 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

5. 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;

6. UK: doctors’ reduction of smoking after publication of scientific evidence All men aged 35-59 Doctors aged 35-59 Doctors aged 60+ All men aged 60+ Source: Doll & Peto, 1976

7. UK: doctors health after quitting:changes in age-standardised death rates1954/59 to 1966/71  worse % change  better

8. Doctors' % daily smoking in WHO European region WHO Europe, 2005

9. 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

10. 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

11. 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

12. 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

13. Doctors can ask for change!

14. 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

15. 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

16. 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

17. 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 tcrc@bma.org.uk www.tobacco-control.org http://www.doctorsandtobacco.org/

18. 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

19. Often, politicians and others do not seem to listen Tobacco control…

20. It can be a long, hard, lonely journey … and there’s always someone trying to knock you down