Three more fined at Ninewells including on-call emergency nurse

An emergency on-call nurse has been fined for smoking during her break time at Ninewells Hospital, Dundee. The details are here.

In spite of a commenter declaring 'public support = 0', personally my support for this person is high, because she's on a hiding to nothing. The enforcement officers have issued a fine to someone who is contractually bound, as an on-call duty officer, not to leave the grounds. She was unable to comply with the smoking policy's requirement to go off the site. Such a person is supposed to accept a requirement to renounce smoking throughout her shift or face criminal sanctions. Had she gone off site to smoke she would also been in breach of her contract. . I also don't see why people should expect employees of a health service (especially one that is free at the point of need) to be walking exemplars of how to live healthily in all their break times. Are we expected to raid nurses' lunch boxes and extract anything with too much sugar or salt in it?

I don't see why the Health Board should be entitled unilaterally to change her conditions of service without issuing a new contract of employment, in pursuit of anti-smoking dogma.

Just give them a big, airy room with ash trays, tea and coffee facilities, and comfortable seating. That will solve the doorway smoking problem instantly. Oh sorry, have I said that before?

Four degrees of separation

Obesity gains ground in the fight for funding in the United States. The Robert Wood Johnson Foundation is now spending over ten times as much on obesity as on anti-smoking.

We learn two things:

The rationale for designated smoking areas was based on the stated premise that secondhand smoke is medically dangerous to nearby people who might inhale the fumes.

There is no question that secondhand smoke can be unpleasant; few nonsmokers want to sit in a cloud of tobacco dust or have tobacco smell on their clothing or hair. But is it dangerous to your health? A study of 35,561 spouses of smokers followed for 38 years published in the British Medical Journal in 2003 showed that second-hand smoke is an irritant, but does not cause life-threatening disease. Actually, "secondhand eating" may be more dangerous.

With it so far. But it continues:

When people with whom we are closely associated gain weight, such as a spouse, sibling, neighbor or friend, we are also at an increased risk of gaining weight. For example, if your friend becomes obese, you have a 177 percent increased risk of becoming obese. If your friend's brother becomes obese, your risk is still increased. The increased risk goes out to four degrees of separation.

Okay. But what happens if they lose weight? And why is your friend putting on weight if you're not putting on weight?

As usual with such absurdly focussed studies, this leaves more questions than answers.

Secondary smoke has allegedly left one thousand a year dead in Scotland and seventy-nine thousand in Europe, without us knowing with any certainty who any of these people are. It is nice that Dennis Gottfried points out that smoke is actually only an irritant, even if only to convey the idea that obesity is a more urgent problem than smoking these days.

If this is any indication of the quality of 'obesity-related science', it looks even more akin to witchcraft and/or guesswork than the 'science' of secondary smoke.

Newsnight: Worthies discuss health issues

I've just watched last night's Newsnight after a tip-off from a commenter over at Taking liberties (9 August, 23.53). Health was discussed by Professor Steven Field, Caroline Flint and an epidemiologist, who seemed to look forward to a day when warnings on cigarettes would read 'Smoking can seriously affect your access to the NHS'.

No opposition was offered to the combined view that people's bad habits are a serious problem, and patrician intervention was the only right course of action, if only we knew how to do it. The 'people' themselves might as well have been zoo animals, for all the insight they were allowed to offer.

I telephoned the BBC to complain the last time a smoking story appeared with only a spokesperson for the anti-smoking side. The person who answered seemed to struggle with the idea that the problem had at least two sides and that more than one view should be represented. Doesn't appear that they learned very much.

No smoking, or no treatment!

The text below is lifted from the comment thread in the blog of David Milliband. The post discusses 'bold plans to save Britain's pubs', which concern regulation of the beer tie. Arguments are advanced in the blog about whether this will help pubs. Milliband does not consider the smoking ban worth touching in this context.

Is this comment typical of modern medical professionals?

Just prior to the smoking ban being enacted in 2007, I and other like minded people got together and set up an anti-smoking patrol watch in our local community. I have organised and run this watch with much success to date.

We gather photographic and camcorder evidence of anyone flouting the law of smoking in public places. We approached our local dentists and GPs, who then told us that anyone who smoked illegally would be refused treatment should their names appear on their patients’ lists. We also have the full support of our local police Superintendent – who agreed that this strategy would help in time to reduce smoking within our community. So far we have had no come back about Freedom of Information.

After several prosecutions we have seen the tide turning, but still need to remain vigilant on behalf of all our residents, after all it’s their health that’s at stake.

You have to remember that over 30,000 people are killed each year by SHS (second hand smoke), and this figure is rising year on year. We are still unclear about how many are affected each year by THS (third hand smoke), although there is good epidemiological evidence to show how dangerous it is to the health of young children.

I wrote to the then health secretary at the time Patricia Hewitt, who fully supported our efforts and asked to be kept up to date with our progress, which of course we did. I would like to see this kind of programme being rolled out across the country.

We are also supported by ASH UK, ASH Scotland, BHF and of course CRUK.

Dr Steven Johnson GP

[emphasis added]

Is there any other crime in the criminal justice system judged so adversely that it would merit the withdrawal of medical treatment? It is just not ethical for medics to pick on a specific group of (alleged) lawbreakers and deny treatment. I find it absolutely shocking that this comment has gone uncensored on the blog of a contender to the Labour Party leadership.

This story relates the intentions of NHS Grampian to treat smokers similarly – to punish them for flouting the legislation.

Withdrawing treatment on any other than clinical grounds must be considered very dangerous territory.