New Survey Reveals Doctors' Dilemma in Treating Smoking

New Delhi, Sep 13: A majority of physicians believe that smoking is the most harmful activity to affect their patients' long-term health by a considerable margin because of lack of exercise, unhealthy diet, drinking alcohol and obesity, reveals one of the largest international surveys of physicians' attitudes to smoking.

In fact, an overwhelming majority - 81 per cent - consider smoking a chronic, relapsing, medical condition, says The STOP (Smoking: The Opinion of Physicians) survey, sponsored by Pfizer and conducted by Harris Interactive.

The presentation was made recently at the World Congress of Cardiology/European Society of Cardiology meeting in Barcelona, Spain.

Despite this fact, over half of physicians surveyed do not have time to help smokers quit and 38 per cent feel inappropriately trained while 46 per cent say they have other higher priorities to focus on.

An overwhelming majority of physicians also agree that smoking is difficult to treat, more difficult than high blood pressure or high cholesterol and on a par with obesity.

Although nearly all physicians acknowledge that smoking is an addictive behaviour, most also say the smoker is the individual with the most responsibility for quitting this addiction.

''What this survey highlights is the practical difficulties doctors face in helping their patients quit smoking,'' said Prof Robert West, Cancer Research, UK.

''Whilst the considerable health risks associated with smoking are now relatively well known, the realities of enabling people to stop are proving more challenging. It is vital that smokers receive practical support and advice for quitting smoking from their doctors, so it is important that lessons from findings such as these are learned.'' However, there is a significant difference of opinion between physicians who smoke and those who do not. Only 57 per cent of physicians who smoke stated ''smoking'' as the most harmful activity for their patients, compared to 73 per cent of non-smoking physicians, suggesting some physicians who smoke may be underestimating the harmful effects of smoking.

Though a significant percentage of physicians say they discuss smoking with their patients on every visit or occasionally, their discussions generally focus either on repeating widely available public health messages or information gathering rather than actually facilitating the quitting process.

Only 47 per cent help the smoker develop a plan to quit, 39 per cent recommend an over-the-counter (OTC) medication and 29 per cent prescribe a prescription medication.

American doctors are more proactive with 76 per cent helping the smoker to develop a plan to quit and 57 per cent prescribing a medication, compared to 43 per cent and 21 per cent respectively in Europe.

Again, the difference between physicians who smoke and those who do not is noticeable. While 43 per cent of non-smoking doctors discuss smoking with their smoking patients at every visit, only 33 per cent of doctors who smoke do the same. There are also significant differences globally, with the number standing at 68 per cent of North American physicians (both smoking and non-smoking) compared to only 14 per cent in Asia.

The vast majority of doctors understand why quitting smoking is so difficult. Nearly all of them agree that smoking is an addictive behaviour and 81 per cent consider it a chronic, relapsing medical condition.

Indeed, 71 per cent agree that smoking should be classified as a medical condition and 64 per cent believe that if this were to happen, it would encourage more smokers to quit.

''To successfully combat deaths caused by smoking, everybody, both physicians and non-physicians, need to reframe how we talk and think about smoking,'' says Prof Serena Tonstad, Ulleval University Hospital, Norway.

''Smoking is not a manifestation of a weak will or character, but a chronic relapsing medical condition caused by tobacco dependence.

Many smokers may require medical treatment for this condition, because most smokers are addicted to inhaled nicotine. This addiction ultimately takes the life of one out of two smokers prematurely.'' Physicians feel smokers themselves are the most responsible for quitting - this may be due to the fact that they do not have effective treatment options to take action such as they do for high blood pressure or elevated cholesterol.

However, physicians may also be underestimating how many of their smoking patients are trying to quit. Physicians in the survey estimate that on an average only 18 per cent of their patients who smoke are trying to quit. In reality, approximately one-third of smokers make a quit attempt each year.

''The current situation is a vicious circle - although doctors recognise the problems associated with smoking, they are underestimating the number of their smoking patients who are trying to quit and feel they have ineffective solutions to address the problem anyway,'' said Prof West.

''If we are to make serious inroads into combating the world's leading preventable cause of premature death, we need to radically modify the way smoking is perceived and treated worldwide.'' Some 2,836 physicians from 16 countries were interviewed for the study. Physicians in Canada, France, Germany, Greece, Italy, Japan, Korea, Mexico, Holland, Poland, Spain, Sweden, Switzerland, Turkey, Britain and America participated in the survey.

UNI