If you are a smoker shopping in a UK supermarket, you may be able spot a loaf of Allinson's bread . His essays outlined the best way to achieve good health - to eat less, exercise more, cut down drink and tobacco. Dr Allinson was a visionary Victorian but sadly his contribution to medicine was repaid by being struck off by the GMC, courtesy of medical opinion at the time. The Royal College of Physicians did not agree with his theories at the time. How opinions change. The medical fraternity has remained unapologetic for the manner in which Allinson was treated. Indeed, the Shipman Inquiry sports his case as the origin of "infamous conduct".
In modern medicine, Richard Doll's study on smoking being linked to lung cancer appears to have vindicated Allinson. Nevertheless, Lauren Colby wrote a fascinating analysis in defence of smokers. She writes
"Writing in the December, 2001, issue of the British Medical Journal, Doll explained that the study was "devised by Sir Austin Bradford Hill to achieve maximum publicity for the critical link between smoking and lung cancer". In short it was never intended as a serious scientific study to test the hypothesis that smoking may cause lung cancer. From the beginning, it was just propaganda - well intended, perhaps, but propaganda none-the-less"
Within a century, medical opinion has changed quite considerably considerably. Following the Doll study, the British Medical Association [BMA] decided upon running an anti-smoking dictatorship. This involves telling members of the public how they should lead their lives.The BMA's position on Dr Allinson is unknown. He appears forgotten by them. There is no statement concerning the injustice done to Allinson. Nevertheless, the BMA have taken up the anti-smoking dictatorship with supreme gusto.
The BMA is essentially a trade union for doctors. In their own words
"The BMA is the doctors' professional organisation established to look after the professional and personal needs of our members"
The media regularly portrays the BMA's opinion is representative of all doctors. This is not necessarily true. The majority of doctors may not subscribe to the BMA's viewpoint but the public are never informed of that.
While the BMA are dictating to the UK's population and urging everyone to cease smoking, we have to realise that this trade union has failed to get its own medical house in order. Addiction is at its all time high in the population of doctors . A recent Daily Mail article pointed to the numbers of functioning medical alcoholics . The ever increasing prospect of puffing doctors does not support the BMA way of life. You only have to attend a hospital to find out how many health professionals huddle outside having their fags away from prying eyes. How is the public meant to respect or pay heed to an organisation that clearly cannot practise what it preaches?
It is vital for us to appreciate that those who smoke, do it out of freedom of choice. The reason for smoking is also multifactorial involving a complex combination off psychosocial factors. We also live in a democratic society and it is important not to neglect the smoker's basic human rights.
It is up to the doctor to advise only - it is not up to the doctor to dictate or control. Public policy in relation to smoking has failed miserably over the years. It dictates to the public assuming that they are children. This paternalistic attitude is proving ineffective. The problem with smokers is this - they are all intelligent human beings, likely rebellious, unlikely to respond to control orders and dictatorships. The biggest flaw in the development of public policy in this area is the government's failure to understand the behavioural traits of smokers. In any event, if I was a smoker, I would dislike being told what to do. Indeed, as a doctor, I have never advised my patients to stop smoking. I have merely outlined the risks of smoking and left the decision to them with the proviso that as doctors we are always here to offer advice and information.
The worst policy to be developed was the denial of some NHS treatment to smokers . Those who have studied epidemiology will know that those who normally require NHS treatment may indeed be smokers as it is common knowledge that many diseases are linked to smoking [Doll et al]. The other issue is this, not only do smokers pay a hefty amount for a pack of cigarettes but they also pay their taxes to the government. They do have equal rights to NHS treatment. Nevertheless, denial of treatment serves to merely alienate smokers, rendering them non compliant and it also serves to affect the relationship between doctor and patient. Cessation of smoking cannot be achieved by ordering the public and issuing demands. It is important to respect autonomy and paternalism now appears outdated. Perhaps the government should go back to the drawing board to rethink policy in this area. It is clear that a system of that is based on penalties may not be as effective.