From Jennifer Saunders to Stop Before Your Op
Thursday, January 16, 2014 at 9:14 There was a discussion about Jennifer Saunders and smoking earlier in the week.
The Telegraph Health section had a picture of her with a cigarette. The headline read 'Did this picture of Jennifer Saunders smoking shock you?' and the feature consisted of two articles, one by Linda McDougall (yes), the other by Cindy Blake (no).
The point is that all three women have suffered from cancer, so it's a bit more complicated than the headline suggests, and I would recommend that you read McDougall's piece before condemning her.
Nevertheless, I was in fire-breathing tabloid mode when I discussed the subject on LBC. (I should add that I was driving to Edinburgh and had to pull off the motorway and do the interview from a Travelodge car park.)
After telling presenter Iain Dale that, no, I wasn't shocked by the picture, I added that I felt "dirty" even discussing it.
"It's none of my business, or yours, or anyone else's," I said. "This is a gross invasion of privacy."
Iain sounded a bit surprised because he responded by saying, "OK, let's move on ..."
The second story he wanted me to comment on was a report that Guy’s and St Thomas’ hospital staff face sack if caught smoking in uniform.
(Have I mentioned I was born at St Thomas'? My uncle worked there which is why my mother had to travel 20 miles in the back of an ambulance before she could give birth.)
Anyway, according to the London Evening Standard, "Workers who flout the rules could face disciplinary action, and repeat offenders may be sacked."
I railed against that too. The problem with being interviewed by Iain, however, is that he and I tend to agree on most things so we end up sounding like a couple of grumpy old men in a pub.
Yesterday I was invited to discuss the Saunders' 'story' on BBC Humberside and Lincolnshire, this time with Linda McDougall.
We were joined by Dr Sean O'Connell who was there to defend a local initiative reported by the Yorkshire Post, 'Defiant smokers asked to sign waivers before routine surgery'.
This is the funny part.
Having been "shocked" by the picture of Saunders smoking, McDougall thought the Stop Before Your Op programme was "disgraceful".
I, on the other hand, didn't.
Frankly, I've read about far worse initiatives, like hospitals or surgeons refusing (or threatening to refuse) to operate until patients have given up smoking completely.
In this instance people have a choice: go on a quit smoking course prior to the operation (which may be delayed as a result) or say, "No, thanks, I'll keep smoking and I'll have the operation as soon as possible, if you please."
The programme doesn't deny anyone an operation. All they're being asked to do is sign a waiver in case there are any complications. I don't see a problem with that.
PS. The Sun asked me to comment on the Stop Before Your Op programme too. I gave them the same line – which surprised them, I think – and to the best of my knowledge they haven't run the story.
That's what happens when you're nice and conciliatory. It's not news!
PPS. McDougall had an interesting slant on the Jennifer Saunders picture that hadn't occurred to me.
If I understood her correctly she was implying that Saunders was effectively posing for the camera - that this was no paparazzi style photo of a celebrity caught off guard and that Saunders was sending people a message of some sort.
Personally I thought we were in danger of over-analysing the whole thing, but judge for yourself.
Reader Comments (12)
The Stop Before Your Op initiative may not deny anything, but it's another step in the vilification of smokers, singling them out. What complications arise from being smokers anyway? Healing times are usually faster and recovery tends to be better in smokers following strokes and such like. I don't deny that there are more draconian measures floating about, but, to me, that doesn't make this one any more defensible. I would think a bit differently if it included a range of factors, of which smoking was just one, (the standard suspects: obesity, drinking etc), but it isn't, it's just smokers. Which gets me thinking, why is 'smoker' an umbrella term? Smoking two a day is hardly comparable to smoking two packs a day, but the NHS treats both the same. I've even heard doctors say 'if you smoke 3 you may as well smoke 30'
As far as I'm concerned, smokers, like others, have paid in advance for their medical coverage. That's what the NHS is. That service is not dependent on lifestyle decisions.
Rich, I don't want to sound like an anti-smoker but do you have any evidence for the claim that "Healing times are usually faster and recovery tends to be better in smokers following strokes and such like"? It's news to me!
Not off hand unfortunately, but if memory serves, the nicotine helps new blood vessel growth (this has long been known), which is an obvious benefit when someone has blocked arteries. It may be why smokers have better chances in angioplasty surgery. As for strokes, low levels of carbon monoxide, such as those found in smoke, have been shown to protect nerve endings from damage, which in turn reduces overall brain damage.
Not that lighting up a Marlboro is any substitute for going to the hospital of course, but it's just more anti-smoker propaganda that they have to sign waivers for surgery on the pretense that they're at so much more risk. It's just saying 'hey, your habit is SO dangerous that this life-saving procedure can kill you'
They've not done this for any other factor, including actual health status, and it fails to consider objective evidence towards smoking. As usual, they've swallowed the weak anti-smoking results and have tried to apply it in yet another way that will demonise smoking.
The story implied a link between smoking and breast cancer, but there is no evidence for such a link. I think it emanated from the California EPA, which is a political and not a scientific body. Responsible medical and breast cancer websites do not suggest such a link exists.
Young soldiers tend to smoke, so there is plenty of data available from Iraq and Afghanistan concerning wound healing. I doubt they are ever asked to sign waivers.
Simon
Richard may not have those links to hand but I do.
nicotine helps new blood vessel growth
Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850685/
As for strokes, low levels of carbon monoxide, such as those found in smoke
A short selection
"2005
"Scenarios in which low dose carbon monoxide may be tested might include lung transplantation, stroke, heart attack, severe bacterial infections or before surgery when there might be an interruption in blood flow, such as coronary artery bypass grafting, he added."
``Carbon monoxide significantly reduces the body's production of this suppressor protein, and therefore, promotes dissolution of the clot,'' he said. ``This relieves the obstruction in small blood vessels and permits blood flow to be re-established to the organ.''
The body's own production of carbon monoxide probably evolved to protect the blood flow to vital organs, and providing extra carbon monoxide by inhalation seems to give an added boost, Pinsky said"
http://web.archive.org/web/20050110161437/http://www.intelihealth.com/IH/ihtIH/EMIHC000/333/20792/317857.html
Harvard and University of Pittsburgh researchers explain carbon monoxide's anti-inflammatory effects - 2007
"In a study appearing in the April 2007 issue of The FASEB Journal, scientists from Harvard University and the University of Pittsburgh have shown for the first time that the anti-inflammatory effects of carbon monoxide originate within cells' own molecular engines, mitochondria. Specifically, mitochondria react to low levels of carbon monoxide by releasing chemical signals that reduce or shut down the body's inflammatory response, raising the possibility for the development of new anti-inflammatory therapies, one of which may be low levels of inhaled carbon monoxide."
http://www.i-newswire.com/harvard-and-university-of-pittsburgh/a94516
Research to spotlight carbon monoxide benefits - 2007
"Scientists at the University of York have won a grant of £110,000 to investigate potential uses of carbon monoxide in treating disease.
Dr Jason Lynam and Dr Ian Fairlamb, of the University’s Department of Chemistry, have been awarded the funding by the Leverhulme Trust for a three-year study into the use of metal compounds for the controlled release of carbon monoxide into the bloodstream."
Dr Fairlamb said: "You can use certain carbon monoxide molecules to elicit a whole range of biological effects. Carbon monoxide causes vasorelaxation and is produced naturally as a result of the breakdown of haemoglobin. This can be seen in the healing process of a bruise, where various colour changes indicate the degradation of haemoglobin and release of carbon monoxide."
http://www.york.ac.uk/news-and-events/news/2007/carbonmonoxide/
Another gas found in tobacco smoke.
How Nitric Oxide Maintains Health
“In the heart, nitric oxide is the body’s way of protecting against cardiovascular disease,” Ignarro said. “The arteries make nitric oxide to lower blood pressure and improve blood flow to organs because it is a vaso-dialator, which means it widens or relaxes the arteries so that more blood can flow through, therefore lowering the pressure within the arterial system.”
When nitric oxide becomes deficient, Ignarro said, barriers break down and protection is lost, making people more susceptible to high blood pressure, arteriosclerosis and heart disease.
“It’s the body’s natural way of preventing strokes and heart attacks – provided we make enough of it.”
http://www.usc.edu/uscnews/stories/16315.html
Septic Shock: Nitric Oxide Beneficial After All
"Scientists at VIB and Ghent University in Flanders, Belgium have found an unexpected ally for the treatment of septic shock, the major cause of death in intensive care units.
By inducing the release of nitric oxide (NO) gas in mice with septic shock, researchers Anje Cauwels and Peter Brouckaert discovered that the animal's organs showed much less damage, while their chances of survival increased significantly. That's contrary to all expectations, since it is generally assumed that nitric oxide is responsible for the potentially lethal drop in blood pressure in septic shock.
Septic shock, or sepsis, is a medical condition in which acute inflammation, low blood pressure, and blood clotting cause a dangerous decrease in the delivery of blood to the organs.
Because of the lack of oxygen, the patient's organs start to fail, one after the other.
Currently, only supportive treatment is available."
http://www.redorbit.com/news/health/1799998/septic_shock_nitric_oxide_beneficial_after_all/
Luckily systems for inhalable nitric oxide will soon be available .
http://www.prnewswire.com/news-releases/geno-llc-receives-four-additional-patents-for-inhaled-nitric-oxide-delivery-166879416.html
It is some time since I last had occasion to visit my local hospital. When I was there last time, I noticed that the WVS shop stocks NO drinks which are not 'diet' drinks - no standard coke, no standard orange juice.
I was surprised that the cafe still supplies sugar to be taken with tea and coffee, which shows the hypocrisy of the Health Zealots. They always seek big, easy targets.
The demand to sign a waiver is nonsense - all patients have to sign one anyway whether or not they're smokers because all surgery carries risk. If they're presenting this as something for smokers only then I think it's an underhand way of trying for targets/bullying smokers when many will be feeling vulnerable.
I'm concerned by the "waiver". Will it give doctors a license to point to the waiver if staff make an error and the surgery goes wrong?
I wonder if there was salt on the tables. One man's meat is another man's poison. Some may need sugar, others salt, or both, in varying ways. Some may not. 'Public health' seems to treat people as if they are factory chickens, not unique human beings. Where will its arrogance end?
I was the first to reply to that article. Having had cancer surgery 3 years ago and having no wish to stop smoking I was one of the few to say I was an adult who had smoked for over 50 years and it was my life. I can only speak for myself but I am an exceptionally quick healer, have very good skin for my age and had one minor stroke seven years ago, they run in our family, I recovered within 24 hours. My mother, who neither smoked nor drank had two major strokes which led to vascular dementia and her eventual death at 72. Maybe there is something in it after all! my own GP hates all this nonsense which takes time from patient care, he will advise, no choice now, but said he did not go into medicine to tell people how to live their lives. I have not had problems with surgeons or Drs. yet and I would think there would be a good case if surgery was refused because of smoking to take it to court. I have paid, and am still paying a lot of tax and I would not take kindly to such a suggestion at all.
@E1
I'm pretty sure that legally speaking such a 'waiver' is just so much toilet paper! You cannot consent to being harmed and you cannot release a doctor from his Duty Of Care nor his Hippocratic Oath.
I'm no lawyer but that's what the GP told me when I offered to sign a waiver so he could prescribe me certain medication.
All a waiver does -if it does anything at all- is give insurers a reason not to pay out.
I'm also concerned with the waiver. As with all tobacco control measures, you give them an inch, they will take the piss. All things like this need to be fought, even the ones that appear benign on the surface.
And is there actually is any extra possibility of complications due to smoking, of have they just made that up?
I went for a consultation for a minor op last week (Queens Park Hospital Blackburn). I will need to be put to sleep for the op. They asked if I smoked and how many but didn't say a thing about it after that. Nothing about complications or any other effect on the op. They just asked the question.
I've read a hell of a lot about smoking, everything I have been able to lay my hands on, but I've never read anything that spells out possible complications during routine ops, from smoking.
Sounds like targeted bullying and scaremongering to me. Typical tobacco control.