New Survey Highlights Difficulties Physicians Face in Treating Smoking

-- Smoking Acknowledged as Chronic, Relapsing Medical Condition and
Cited as Most Harmful Activity to Affect Long Term Health of Patients

-- Survey Reveals Significant Differences in Attitudes Between
Non-Smoking and Smoking Physicians

A majority of physicians believe that smoking is the most harmful
activity to affect their patients' long-term health by a considerable
margin over lack of exercise, unhealthy diet, drinking alcohol and
over-eating/obesity, according to results from one of the largest
international surveys of physicians' attitudes to smoking and smoking
cessation, presented today at the World Congress of Cardiology /
European Society of Cardiology meeting in Barcelona, Spain. In fact,
an overwhelming majority - 81 percent - consider smoking a chronic,
relapsing, medical condition.
Despite this fact, over half of physicians surveyed do not have
time to help smokers quit and 38% feel inappropriately trained, while
46% say they have other higher priorities to focus on. An overwhelming
majority of physicians also agree that smoking is difficult to treat,
more difficult than high blood pressure or high cholesterol and on a
par with obesity. Although nearly all physicians acknowledge that
smoking is an addictive behaviour, most also say the smoker is the
individual with the most responsibility for quitting this addiction,
rather than GPs themselves.
"What this survey highlights is the practical difficulties doctors
face in helping their patients quit smoking," said Professor Robert
West, Cancer Research UK. "Whilst the considerable health risks
associated with smoking are now relatively well known, the realities
of enabling people to stop are proving more challenging. It is vital
that smokers receive practical support and advice for quitting smoking
from their doctors, so it is important that lessons from findings such
as these are learned."
Of note, there is a significant difference of opinion between
physicians who smoke and those who do not. Only 57% of physicians who
smoke stated "smoking" as the most harmful activity for their
patients, compared to 73% of non-smoking physicians, suggesting some
physicians who smoke may be underestimating the harmful effects of
smoking.

Doctor-Patient Dialogues

Though a significant percentage of physicians say they discuss
smoking with their smoking patients on every visit or occasionally,
their discussions generally focus either on repeating widely available
public health messages or information gathering rather than actually
facilitating the quitting process. Only 47% help the smoker develop a
plan to quit, 39% recommend an over-the-counter (OTC) medication and
29% prescribe a prescription medication. North American doctors are
more proactive with 76% helping the smoker to develop a plan to quit
and 57% prescribing a medication, compared to 43% and 21% respectively
in Europe.
Again, the difference between physicians who smoke and those who
do not is noticeable. While 43% of non-smoking doctors discuss smoking
with their smoking patients at every visit, only 33% of doctors who
smoke do the same. There are also significant differences globally,
with the number standing at 68% of North American physicians (both
smoking and non-smoking) compared to only 14% in Asia.
The vast majority of doctors understand why quitting smoking is so
difficult. Nearly all of them agree that smoking is an addictive
behaviour and 81% consider it a chronic, relapsing medical condition.
Indeed, 71% agree that smoking should be classified as a medical
condition and 64% believe that if this were to happen, it would
encourage more smokers to quit.
"To successfully combat deaths caused by smoking, everybody, both
physicians and non-physicians, need to reframe how we talk and think
about smoking," said Professor Serena Tonstad, Department of
Preventive Cardiology, Ulleval University Hospital, Norway. "Smoking
is not a manifestation of a weak will or character, but a chronic
relapsing medical condition caused by tobacco dependence. Many smokers
may require medical treatment for this condition, because most smokers
are addicted to inhaled nicotine. This addiction ultimately takes the
life of one out of two smokers prematurely."

Potential Treatment Options

Physicians feel smokers themselves are the most responsible for
quitting - this may be due to the fact that they do not have effective
treatment options to take action such as they do for high blood
pressure or elevated cholesterol. However, physicians may also be
underestimating how many of their smoking patients are trying to quit.
Physicians in the survey estimate that on average only 18% of their
patients who smoke are trying to quit. In reality, approximately one
third of smokers make a quit attempt each year.(1)
When asked what would make it easier for them to help smokers to
quit doctors were very clear. They agreed that they want more
effective medication (81%), additional coaching on how to communicate
and motivate smokers to quit (78%), and more widely publicised smoking
cessation success rates (77%).
"The current situation is a vicious circle - although doctors
recognise the problems associated with smoking, they are
underestimating the number of their smoking patients who are trying to
quit and feel they have ineffective solutions to address the problem
anyway," said Professor West. "As a result, they are putting the
responsibility on the smoker to quit and it is known that less than 5%
of smokers who attempt to quit unaided, remain abstinent at one year.
If we are to make serious inroads into combating the world's leading
preventable cause of premature death, we need to radically modify the
way smoking is perceived and treated worldwide."

About STOP

STOP (Smoking: The Opinion of Physicians) survey, sponsored by
Pfizer and conducted by Harris Interactive, is one of the largest
global surveys conducted of General Practitioners' (GPs) and family
physicians' attitudes to smoking and smoking cessation. Some 2,836
physicians from 16 countries were interviewed for the study.
Physicians in Canada, France, Germany, Greece, Italy, Japan, Korea,
Mexico, Netherlands, Poland, Spain, Sweden, Switzerland, Turkey, UK
and US participated in the survey.

STOP was funded by Pfizer.
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Definition of Regions

Asia = Japan, Korea
Europe = France, Germany, Greece, Italy, Netherlands,
Poland, Spain, Sweden, Switzerland, Turkey, UK
Latin America = Mexico
North America = Canada, USA
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References

(1) World Health Organization. Policy Recommendations for Smoking
Cessation and Treatment of Tobacco Dependence. 2003. Available
online at
http://www.wpro.who.int/NR/rdonlyres/8D25E4D3-BB81-479E-8DF5-7
BAF674DB104/0/PolicyRecommendations.pdf. Last accessed August
2006

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