Fears for tobacco control strategy

A LEADING physician has sharply criticised the Government over its work in disease prevention and accused it of abandoning key components of tobacco control.

“Their credibility in prevention is low,” said consultant respiratory physician Prof Luke Clancy. “Prevention as a whole gets a very poor show and that’s exemplified by the attitude to vaccination, which we know works, and which would have been a once-off price of €7 million, yet we can pay €54 billion and say it’s necessary to keep the banks happy.”

Recent decisions by Health Minister Mary Harney about tobacco, which is linked with about 6,000 deaths in Ireland each year, also indicate little interest in disease prevention, said Prof Clancy, director general of the Research Institute for a Tobacco Free Society, which was set up to study tobacco use and control but has had its state funding cut.

“The present Minister has abandoned the research institute,” he said, adding that he also considered plans to wrap the Office of Tobacco Control into a larger organisation would “emasculate” the agency.

“So the two pillars of the implementation of the Government’s own policy of creating a tobacco-free society have been taken apart by the present Minister, and this was before Bord Snip. In my opinion, she has not shown any interest in prevention.”

Tackling tobacco dependence is recognised as a cost-effective exercise, explained Prof Clancy. “International figures show that to add one year of quality life by treatment of smoking dependence costs €3,000,” he said. “To add one year by mammography is about €45,000, and to add one year by cholesterol control costs about €100,000.”

Despite strong legislation, the prevalence of smoking in Ireland still remains at around 27 per cent, and more resources now need to be put into a range of measures, including training of doctors in smoking cessation, said Prof Clancy, whose institute recently secured a €3 million European Framework grant, the largest award the funding programme has given to tobacco research.

“We have to do something about the people who smoke now,” he said. “Ireland has a very high reputation for its legislation on tobacco, but the prevalence of smoking has to be brought down.

“If people who smoke now don’t stop, there will be no reduction in lung cancer for 25 years, even if not one new person starts.”

Prof Clancy said current spending on smoking cessation in Ireland falls short of what has been shown to be required internationally. “They have looked at what it costs to get prevalence down in other countries and the best evidence is that you would need to spend about $20-$25 (€14-€17) per head, and the more you spend, the more you lower the prevalence,” he said.

In Ireland, less than €1 per head per annum is spent on tobacco control, according to Prof Clancy. He said the price of tobacco products here is high, but he would like to see it raised further.

Meanwhile, banning the sale of cigarettes completely is not on the cards at present, he said.

“We should aspire to be a tobacco-free society, but it isn’t a matter of just waving a wand and saying let’s ban cigarettes and there will be no smoking,” he said.

“Of course I’d like to see it, but it wouldn’t work at the moment. Tobacco use is an addiction, and even with the best will in the world most people wouldn’t be able to stop, and they would break the law.

“So I wouldn’t expect Ireland to move on the banning of tobacco at present. It doesn’t mean it will never be banned.”

Prof Clancy will address the conference, A Blueprint for the Future – Prevention is the Cure, at Dublin Castle this weekend.

The meeting will also hear from one of the pioneers of the “polypill”, an inexpensive formulation that combines several heart-protective agents to help reduce cholesterol levels and blood pressure, and that could stand to reduce the risk of heart attack or stroke by about 75 per cent in people over 55 years old who have a risk factor.

Malcolm Law, professor of epidemiology and preventive medicine at the Wolfson Institute of Preventive Medicine, Barts, and the London School of Medicine, Queen Mary University of London, will speak about the concept of the polypill, which is currently undergoing clinical trials in India.

For details of the conference, e-mail bdeegan@ mandcgroup.ie