Hi Amira, Thanks for the questions, they’re very interesting and really made me have to think. How many patients do you treat a month from smoking related illnesses? As a medical student I don’t treat patients (yet) but I’ve already seen a number of people at the GP surgery who have ‘chronic obstructive pulmonary disease’ (COPD). This is actually a way more important disease than lung cancer. It makes it incredibly difficult to breath and can lead to death. It is mainly caused by smoking usually starts in your 40s effecting a massive three million people in the UK. Smoking also contributes to a load of other diseases such as heart disease, stroke and multiple cancers. Most of the patients I talk to who have these conditions used to smoke (although not all). However with conditions such as these lots of other factors play their part, such as eating too much fat, being overweight, and not exercising;so you can’t say smoking is the only cause (even though it definitely played a part)

As a medical Professional what is your view on smoking? This is a tricky question as I have been an occasional smoker in the past, having completely kicked the habit this year. I used to think it was slightly cool (despite the government warnings). However since seeing so many patients needing a machine to breath, due to smoking, I’ve changed my mind. From a scientific point, smoking is one of the worst things you can do to your body as unlike other legal substance (alcohol included) even a little amount is bad for your health and increases your chances of dying (if not early then in a more horrible way).

As a medical professional do you think that the NHS should pay for the treatment of smoking related diseases? Hmm very controversial question, especially with budgets needing to be cut and waiting times increasing for everyone. However, I think it’s a very slippery slope to start denying people treatment based on their lifestyle. The other issue with smoking is that a lot of people who smoke want to quit but have become addicted from a very early age. Peer pressure and culture also plays such a major part in whether people take up smoking and I don’t think we should be punishing people for circumstances beyond their control. Growing up in an environment where the parents smoke makes the child statistically way more likely to smoke. Furthermore, the poor are much more likely to be smokers than the rich. So by denying smokers treatment we would overall be benefiting the rich and disadvantaging the poor. Lastly I just don’t think its good to let doctors decide who they treat and who they don’t. No one should play God and decide who lives and who dies. Doctors must treat everyone regardless of their circumstances or whether they like or not! Do you think that there's a difference between paying for smoking related illnesses and alcohol related? Hmm a good question again. As I’ve mentioned before I think tobacco is actually worse than alcohol as drinking a small amount of alcohol does not damage your health (although it can damage the health of a child as it affects brain development) However there is no safe level of tobacco to smoke, as even one cigarette can cause a cell mutation which leads to cancer. However, I don’t think it’s up to the NHS to make judgements about who to treat based on their previous lifestyle. I do however think that patients need to prove that they have quit smoking if they need a lung transplant and quit alcohol is they need a liver transplant. This is because both operations are going to have a much higher chance of failing if they have not quit. So inclusion their should be no difference. George Best is an interesting case to look at for this BTW. Do you think that the burden on the NHS impacts community cohesion? This again is a very tricky (and good) question. Personally I don’t think community cohesion is a big issue at the moment as the NHS is still one of the best and most efficient health care systems in the world. However I do think this will change as the population ages and the NHS budget struggles to meet all these challenges. There have already been a lot of questions raised about the cost of smoking and drinking on the NHS (and society in general). I think the tax on smoking is a great thing as this helps to pay towards the huge costs of smoking, discourages people from starting, or reduces the amount they smoke. Furthermore the tax makes non-smokers feel happier that smokers are contributing towards the cost of their habit on the NHS. I hope the tax continues to rise as the evidence shows this is one of the biggest factors in making people quit. I do think more needs to be done about alcohol however. Many A&E units are at bursting points on Saturday and Friday nights with many patients dying due to waiting too long to see a doctor. The reason for this is they are filled with loads of people with alcohol related problems, from alcohol poisoning to broken bones from drunken fighting. The cost to society is estimated to be 21 billion pounds!!! I therefore agree with the view of the British Medical Association (BMA) that there should be a minimum price for each unit of alcohol to stop supermarkets shops and clubs selling alcohol at ridiculously cheap prices. Furthermore clubs and pubs should contribute more towards the cost of policing and health services if they are not being responsible by serving alcohol to people who are already drunk.
This would hopefully reduce the strain on the NHS and reduce the risk of community problems as A&E wards are as essential for all the community.

Thanks for your questions Amira, they gave my brain a good workout. I hope you continue to work hard as it will pay off in the lung run! Best Wishes, Mr Des Clayes
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