Cardiologists should do more for smoking cessation

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Last week the leading medical journal, “The Lancet” had a special focus on cardiovascular disease. One of the key research papers concluded that despite greatly increased prescribing of antihypertensive and lipid-lowering drugs we are still doing a poor job of treating and preventing cardiovascular disease because doctors are not addressing the underlying causes: smoking and unhealthy diet.

An accompanying editorial in the Lancet was entitled, “Cardiologists should be less passive about smoking cessation.” The editorial tried to identify some of the reasons for the lack of tobacco dependence treatment provided by cardiologists:

“Perhaps the advent of effective high-tech interventions for cardiovascular diseases has drawn attention away from secondary prevention. Some professionals might view smoking as a lifestyle choice rather than an addiction that needs treatment. Others cite a lack of time or lack of training in smoking cessation counselling.”

It also pointed out that tobacco treatment, even with realistic estimates of (low) quit rates and resources used, is far more cost-effective than other standard activities designed to prevent heart disease. For example, brief counseling plus nicotine replacement therapy costs about $3000 per quality-adjusted life year saved (QUALY), whereas medication for high blood pressure costs about $13,000 per QUALY.

I think the editorial hit the nail on the head. Part of the reason many countries (including the United States) have increasing healthcare costs for disappointing health improvements is that we don’t do a good job of prioritizing prevention as part of good clinical practice. Whether it be proper inclusion in medical school curricula, provision of post-graduation training for health professionals, or coverage of tobacco treatment by the healthcare system (government funded or private insurance covered), we need an increased focus on this key health intervention.

However, this is not just an issue for cardiology. Oncology, respiratory medicine, obstetrics, psychiatry, you name it…..all need to do a better job of addressing and treating tobacco addiction in their patients, rather than just saying, ‘its bad for you, you should quit.”

I'd be interested to hear from you how your doctor or healthcare provider helped you to quit smoking (or didnt!). Maybe a few more will get the message?
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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