Tuesday, February 21, 2012

A quick thought on smoking cessation

Two interesting tweets crossed my timeline this morning. The first was this one from Laura Newman pointing to this blog post about intimidating tactics used by public health campaigns to try to persuade people to stop smoking.
The second was this from Simon Chapman about a Croakey blog post on the medicalisation of smoking cessation.
Both these blog posts make really sensible points about the ways we often think about persuading people to stop smoking. And trying to do this by thinking of people as inadequate moral failures or as products of imbalanced brain chemistry misses part of the picture - the context.
Iona Health puts it brilliantly in The Mystery of General Practice:
"I believe that all my patients are now fully informed of the dangers of smoking. Sadly many continue to smoke because they lead lives that are so materially and emotionally constrained that cigarette smoking is one of pitifully few sources of pleasure and relief."
I recognise that picture in my own clinical work. Pretending that people just need a bit of medicine or a scary advert or counselling without any effort to create societies that value people and give them opportunities to "live the lives they choose to live" is choosing not to solve the problem.
In passing, I'll also just pause to note that the same issues arise with pokie reform in Australia (where the clubs believe in Counselling for individuals) and (perhaps slightly less so) in treatment for depression where drug companies focus on neurochemical problems (which need medication) as opposed to social justice problems (which don't)
I'm not arguing that we don't need medication or individual approaches, but that if we only use these approaches we don't allow health professionals to be effective.
Heath aptly quotes Shelley:
"The rich grind the poor into abjectness and then complain that they are abject"