Report and recommendations of the TCRC tobacco control
workshop at the EFMA plenary
Thursday 16 March 2000 - Forum Hotel, Warsaw, Poland
On Thursday 16 March 2000, the Tobacco Control Resource
Centre held its first workshop for European medical
associations in conjunction with the annual meeting
of the European Forum of Medical Associations and
WHO in Warsaw, Poland.
Earlier in the day, journalists from both the local
and international press attended a press conference
to launch the book 'Doctors and Tobacco: Medicine's
Big Challenge' by David Simpson. The book, an action
manual on tobacco for medical associations and doctors,
was commissioned by the TCRC especially for European
doctors, and is available in six languages (go
to the resource section). During the press conference,
137 candles were lit to commemorate the 137 Europeans
who die every hour from diseases caused by tobacco.
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Spring 2000 Report
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Recommendations
presented to the EFMA forum Activity
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Appendices
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- Press release
- List of participants
- Programme
- Suggestions received for action by the TCRC
- Group photo
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Report
Introduction
The TCRC workshop was introduced by Dr Alan Rowe,
Secretary of EFMA, and by Dr Jacek Piatkiewicz of
the Polish Chamber of Physicians and Dentists. Dr
Witold Zatonski represented the World Health Organization
European Regional Office. The meeting was chaired
by Sir Alexander Macara, Chairman of the EFMA Tobacco
Action Group.
Delegates from 13 of the 28 medical associations
attending the forum participated (see Appendix 2).
The workshop focussed on three main concerns: smoking
among doctors; smoking cessation; and campaigning
for effective public health policies to combat tobacco
(see Appendix 3) This report summarises briefly the
presentations, discussions and recommendations of
the workshop. Additional materials, including slide
shows and photographs, will shortly be available on
this website.
Activity 1 Surveys of smoking among European
doctors
Dr Sinéad Jones of the TCRC presented an overview
of the TCRC-coordinated study of smoking among doctors
across the European region. Data on the prevalence
of smoking among doctors are now available for 22
countries. For 15 countries, the data are from studies
carried out by national medical associations using
the standardised protocol developed by the TCRC. For
the remaining six countries, reliable data are available
from national surveys. In addition, 11 national medical
associations have given a firm commitment to carry
out the TCRC survey, or are already in the process
of doing so. Nine associations are considering the
invitation to participate, while three have so far
declined to carry out a survey.
Four collaborating partners presented a brief summary
of the surveys carried out and underway in their countries:
Dr Fenton Howell of the Irish Medical Organisation,
Dr Ivan Bakran of the Croatian Medical Association,
Dr Mome Spasovski of the Macedonian Medical Society,
and Dr Claudio Cricelli, representing the Italian
Federation of Doctors and Dentists.
Summary
The workshop recognised that doctors' own smoking
habits both reflect and influence their attitudes
to tobacco. It also noted that doctors who smoke are
less likely to intervene to help their patients stop
smoking. The workshop emphasised the value of carrying
out periodic surveys of smoking prevalence among doctors,
and of collecting high-quality and comparable data
across the European region. The crucial importance
of giving due consideration to selecting a representative
sample of the membership and to the method of distribution
was stressed. The workshop urged national medical
associations which have not yet undertaken the TCRC
survey to do so, and asked that all associations make
a commitment to carrying out a survey every 3-5 years.
It was agreed that the data collected to date be prepared
for a summary publication, with an indication of the
statistical reliability of each individual survey.
Activity 2 Smoking cessation
Dr Dorota Gorécka of the Institute for Tuberculosis
and Lung Disease in Warsaw gave a presentation on
smoking cessation. Smoking cessation has been identified
by the World Health Organisation as a high priority
for public health action in the European region. Doctors
are in a unique position as regards helping smokers
to give up tobacco. Evidence was presented to show
that even very brief interventions in a clinical setting
can be effective. It is recommended that doctors follow
'the four As': to ask patients whether they smoke
and record this information; to give personalised
advice on stopping smoking; to assist those who are
ready to quit, including recommendation of nicotine
replacement therapy where appropriate; and to arrange
a follow-up visit. The effectiveness of various forms
of NRT and of other tobacco dependency treatments
was also discussed. Methods for assessing the dependence
of smokers were presented.
It was noted that while intensive counselling had
higher success rates per individual, the same time
spent making brief interventions with a number of
patients yielded higher success rates in terms of
the number of non-smokers resulting. Certain interventions
are very simple: for example, it has been shown that
simply asking patients to complete a questionnaire
on their smoking habits can reduce the number who
continue to smoke. Issues of doctor training and of
whether smoking should be routinely raised at every
interview with the patient were also raised.
Summary
The workshop noted the importance of smoking cessation
and treatment of nicotine dependence for curative
medicine, preventive medicine and public health. It
identified the unique roles and responsibilities of
doctors in helping their patients to stop smoking.
It recognised the importance of evidence-based guidelines
for intervention, noting the importance of appropriate
use of nicotine replacement and other proven tobacco
dependency treatments in helping patients to stop
smoking. It urged medical associations to encourage,
facilitate and support the implementation of proven
smoking cessation strategies in their countries, and
to educate their members about the importance of the
doctors' role in smoking cessation.
Activity 3 Campaigning: the doctor's voice
David Simpson, author of the TCRC book 'Doctors
and Tobacco: Medicine's Big Challenge' presented an
overview of how doctors can campaign for effective
tobacco control policies. He began by outlining the
changes in tobacco consumption among doctors in the
United Kingdom which followed the publication of the
first study showing that smoking caused lung cancer.
He emphasised the potential for prevention of disease
by comparing the rates of overall disease among doctors
and other men in the years that followed - disease
rates dropped dramatically among doctors while remaining
high among other men. The difference was for the most
part due to doctors giving up smoking.
Detailing the action that national medical associations
can take to combat tobacco, he emphasise the importance
of working for high rates of tobacco taxation and
bans on advertising. The need for strong, effectively
enforced legislation was stressed. The potential effectiveness
of any measure is best assessed by the level of industry
opposition - the greater the opposition, the more
effective the measure is likely to be.
In discussion, it was stressed that initiatives by
the tobacco industry - such as campaigns against smoking
among young people are to be opposed. They are intended
only to increase the industry's credibility and designed
to portray smoking as an adult activity, making it
more attractive to teenagers, who wish to appear more
mature. As rule, the tobacco industry supports only
those tobacco control measures that are likely to
be ineffective.
The implication of having tobacco included in the
basic cost-of-living index was also raised. It was
agreed that where tobacco prices were taken into account
in calculating the cost of living, this could create
a downward pressure on taxation. It was suggested
that TCRC might co-ordinate a campaign calling for
the removal of tobacco from the basic baskets of goods.
Attention was drawn to the World Bank report 'Curbing
the Epidemic: The Economics of Tobacco Control', which
analyses global data to conclude that taxation is
an effective measure to curb the tobacco epidemic
and that its impact is greatest in groups with the
lowest level of disposable income, such as young people.
The summary of the report is available online at:
http://www.who.int/toh/
Summary
The workshop commended the book, emphasising its usefulness
as a practical step-by-step guide for national medical
associations and their members. EFMA member associations
are asked to bring the book to the attention of their
members and staff. Associations should carefully consider
the recommendations for action contained therein,
with a view to reporting back to the Forum in future
years on the progress made towards their implementation.
The Russian translation being carried out by WHO European
Regional Office is welcomed and eagerly awaited. The
workshop noted that much of the information contained
in the book is relevant and applicable to medical
associations outside the European region, and suggested
that mechanisms for making the material available
to medical associations elsewhere should also be explored.
Medical associations and other appropriate partners
interested in translating the book are encouraged
to contact the TCRC.
TCRC: how can we help?
Lucien Rivière of the TCRC gave a concise overview
of the services offered by the TCRC. Suggestions and
priorities for action were invited from delegates
using a feedback form, and are presented in Appendix
4. All feedback forms received were entered in a draw
for a free year's subscription to the BMJ (kindly
donated by the BMJ publishing group): the winner was
Dr Erzsebet Podmaniczky from Hungary.
Final summing up
Summing up the workshop, Dr Klas Winell, a member
of the TCRC advisory group, recommended that all national
medical associations that are members of EFMA prepare
to carry out a survey of their members, with a view
to presenting the results to the forum in 2003. Given
the indications that doctors may start to smoke while
still students at medical school, it was important
that medical education on tobacco be given special
attention.
He emphasised the need for national and international
guidelines on smoking cessation and treatment of tobacco
dependence, and stressed that these should be based
on sound scientific evidence.
He commended the book 'Doctors and Tobacco: Medicine's
Big Challenge' as a very valuable document. He expressed
the hope that national medical associations would
incorporate the suggestions for action in the book
into their policies and strategies on tobacco. Emphasising
the central role that medical associations can play
in effective tobacco control, he urged EFMA member
associations to be proactive in campaigning against
tobacco.
Acknowledgements
The TCRC would like to thank all those who participated
in the workshop, and all those who helped organise
the event. Special thanks go to Justyna Chusc and
colleagues at The Polish Chamber of Physicians and
Dentists, Dr Bill O'Neill, BMA, BMA International
Department, Ruben Israel at UICC GlobaLink, the BMJ
publishing group, BMA marketing, and Jill Conway-Fell
at WHO EURO. Thanks to Ewa Sabala and the staff of
the Forum Hotel Warsaw, to Krzysztof Stefanski, and
to Wojciech Gilewski and colleagues for their services.
Recommendations
The following statements were presented to the EFMA
forum on Saturday 18 March 2000.
Activity 1. Surveys of smoking among European doctors
THE TCRC WORKSHOP ON TOBACCO CONTROL:
Recognising that doctors' own smoking habits
both reflect and influence their own attitudes to
tobacco;
Concerned that doctors who smoke are less
likely to intervene to help their patients stop smoking;
Noting that data on the prevalence of smoking
among European doctors are now available for 22 European
countries, in 15 of which TCRC-coordinated studies
have been carried out by national medical associations
using the standardised protocol;
Noting that a further 11 national medical
associations have given a firm commitment to carry
out the TCRC survey, or are already in the process
of doing so; that 9 medical associations are considering
the invitation to participate; and that 3 have so
far declined to participate;
-
1. Reiterates the importance of carrying
out periodic surveys of smoking prevalence among
doctors, and the importance of collecting high-quality
and comparable data across the European region;
-
2. Urges national medical associations
which have not yet undertaken the TCRC survey
to do so, and encourages all member associations
to endeavour to carry out a survey every 3---5
years;
-
3. Requests that agreement be sought from
national partners to prepare the data collected
to date for a summary publication;
-
4. Requests that a final report of the
surveys carried out in the period 1997 - 2000
be submitted to the EFMA forum in 2001;
-
5. Recommends that all associations make
a commitment to and prepare to carry out a survey
of tobacco use among their members for presentation
to the EFMA forum in 2003.
Activity 2. Smoking Cessation
THE TCRC WORKSHOP ON TOBACCO CONTROL:
Noting the vital importance of smoking cessation
in curative medicine, preventive medicine and public
health;
-
1. Calls on national medical associations
and their members to accept the roles and responsibilities
of doctors in helping their patients to stop smoking;
-
2. Welcomes the evidence-based guidelines
for intervention proposed by the World Health
Organisation;
-
3. Notes the importance of appropriate
use of nicotine replacement and other proven smoking
cessation treatments in helping patients to stop
smoking;
-
4. Urges national medical associations
to encourage, facilitate and support the implementation
of proven smoking cessation strategies in their
countries, and to educate their members about
the importance of the doctors' role in smoking
cessation.
Activity 3. Campaigning for effective tobacco control
policies
THE TCRC WORKSHOP ON TOBACCO CONTROL:
Commending the book 'Doctors and Tobacco:
Medicine's Big Challenge' as a practical and comprehensive
step-by-step action manual on tobacco for national
medical associations and for doctors;
Noting that EFMA member associations have
been asked to bring the book to the attention of their
members and staff;
Noting the urgent need for international action
in curbing the tobacco epidemic;
-
1. Requests that associations consider
carefully the recommendations for action contained
in the book, with a view to reporting back to
the EFMA forum on a regular basis on the progress
made towards their implementation;
-
2. Welcomes the Russian translation being
carried out by WHO European Regional Office;
-
3. Encourages approaches from medical
associations and other appropriate partners interested
in translating the book into additional languages;
-
4. Recognises that much of the information
contained in the book is relevant and applicable
to medical associations outside the European region,
and agrees that mechanisms for making the material
available to medical associations elsewhere be
explored;
-
5. Expresses its support for the World
Health Organisation Framework Convention on Tobacco
Control;
-
6. Requests the TCRC to inform EFMA member
associations of the progress of negotiations towards
the establishment of the Convention and to co-ordinate
support for the FCTC by medical associations that
are members of EFMA.
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