Wednesday, 4 November 2015

Tobacco Control Motto: First, Do Harm

On Wednesday next week - as I mentioned last month - Kings College London is hosting a debate entitled "This house believes that smoking should be banned in psychiatric hospitals". This is the preferred policy of Public Health England but is highly controversial so it is no surprise that tickets to attend have sold out.

Prior to that, leading mental health charity SANE has published a blistering blog post attacking the policy and accusing 'public health', quite rightly in my opinion, of abandoning decency and going against everything the health community stands for. It oozes common sense and incorporates knowledgeable analysis of mental health experiences, so I do urge you to read it in full.
The Madness of Banning Smoking in Psychiatric Units  
In my opinion, and as a former patient with schizophrenia, new public health policy may be in breach of the Hippocratic Oath that used to compel medical professionals to "first, do no harm". 
Forcing patients to quit smoking when they're in the middle of a mental breakdown is intolerably cruel.
Of course it is. It seems that only swivel-eyed tobacco control industry extremists can fail to see that it amounts to nothing less than torture.
It also appears as a form of vengeance from public health quangos since the indoor ban that developed from 2008 has done little to change patient's behaviour once they get better: after discharge, the majority resume their smoking habit.
Good that he realises the ban was nothing about protecting staff from secondhand smoke, because it wasn't. Tobacco controllers know that, and so do we. It's encouraging that this author understands it too, he's a clever cookie. The more who do, the better. 
Sadly public health types are now arguing more must be done to intervene post-discharge. Can patients never determine their own lifestyle choices?
Of course not. Everyone must make choices decided for them by the vilest and most interfering people in society these days, apparently. OK, admittedly this particular policy is more disgusting than most, but it differs from everyday 'public health' ideology only by degree. 

As is customary for the profession, SANE's blogger has identified statistical gerrymandering to produce lies being employed by 'public health'.
The average life expectancy in the UK is 79 for men, 83 for women. For those who smoke 20 or more cigarettes a day, this drops by an average of 10 years. For many long-term smokers, this decrease of 10 years is an acceptable trade-off for them continuing to indulge a habit they relish - so smoking can be a rational choice for them, whether PHE like it or not. But for the SMI group to suffer a 20 year decrease suggests that something else happens - not just the effect of their smoking habit that would only account for a 10 year decrease.
Of course. There is no way that tobacco controllers can claim mental health patients are physiologically different in their make-up than the rest of us, because they're not, they're human beings just like everyone else. 
An important point to stress is that the 20 year average decrease is a 'mean average', i.e. it locates an average point between someone who commits suicide in their 20s with someone with an SMI who lives to 90. It therefore produces a figure that is open to misinterpretation that can be used to scaremonger.
Well yes, that's what 'public health' does, it has very little other purpose in modern times. 
To blame the 20 year drop entirely on smoking, as PHE and NICE do, is therefore wrongheaded. It is also physically dangerous to the extent that smoking bans cause a misery that might increase suicide rates among those with SMI.
So the drive for "denormalisation" of smokers - which the tobacco control industry favours very much as a tool of coercion - might have negative consequences and increase feelings of alienation and guilt, leading to more mental health patients topping themselves? Hmm, what a novel idea. I wonder why no-one in 'public health' thought of it? 
It is worth asking why PHE and NICE are singling out the SMI group for an anti-smoking intervention when the evidence suggests it is no more harmful for that group than it is for any other part of the population.
Perhaps, I dunno, because they are like lab rats to any health nazi who just happens along? 
The invasion of public health policy into what was almost becoming a humane system of psychiatric care has created massive problems on the ward. Due to the role played by PAHs, total smoking cessation can be very dangerous when mixed with starting or increasing a course of anti-psychotics. The journal Current Psychiatry notes that symptoms that accompany this unholy alliance include extreme fatigue, myoclonus, orthostatic hypotension, seizure, sialorrhea, somnolence, tachycardia, and worsening psychiatric symptoms. Smoking cessation may therefore be in breach of the Hippocratic Oath for medical professionals that held 'first, do no harm'.  
In addition, since the indoor smoking ban came in, cases of self-harm have rocketed by 56% in the UK. Meanwhile in the USA, where state-run units in 35 of the 50 states now have some form of outdoor ban, patient-on-patient violence has risen by an average of 22% and up to a whopping 390% in Austin, Texas. Furthermore average durations of stay have increased by nearly 90%. 
Hmm, I'd call that tangible harm, wouldn't you? As opposed to the mythical kind smoking bans pretend to tackle, and the completely non-existent ones that outdoor bans - yes including in psychiatric hospitals - are designed for. 
The natural companion to the sense of freedom is friendship with other people. Thus sharing a smoke with other patients and staff used to be part of one's social activity. It had the massive benefit of breaking down barriers by being a shared experience. As such, it genuinely did aid recovery. It is therefore no surprise to those of us familiar with human nature that self-harm and patient-on-patient violence has risen since the bans: take away the cigarettes, and you inevitably turn people against each other. Tell them this is only a consequence of their diseased brain, and they increasingly hate themselves.
What fine upstanding citizens they are in tobacco control industry, eh? Still, they get paid for this stuff so don't hate themselves at all, and that's all that's important at the end of the day, isn't it?
To conclude, the goal of achieving 'health equality' through bans is clearly delusional. It is an 'end' that cannot be achieved, and it is folly to attempt it. Those with SMIs are clearly being discriminated against - their negative health consequences from smoking are no worse than for any other smokers. PHE cannot yet get away with imposing a total ban on the entire population. But what they have found is that by putting the SMI group on the frontline, they can take society down this road because this community is atomised, captive, and powerless to resist. The deluded behaviour of PHE and NICE is causing immense suffering and must be stopped. Mental health patients ought to be protected by society, not become the targets for the latest public health fad that wouldn't wash if deployed in wider society.
True. Mental health residents are being targeted because they are weak and unable to defend themselves, the very definition of bullying. 'Public health' is inflicting harm on them simply because they can, and for no valid health reason. It is bullying; it is discrimination; and it is pure evil. 

As I've said many times before, it is we who are on the side of the angels, not tobacco control. On Wednesday next week, ASH's Deborah Arnott will be defending the hideous policy in a debate at Kings College London. 

Personally I don't know how she and other rancid tobacco controllers like her sleep at night. 

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