Wednesday, 3 June 2015

PoliticalSpeak: preventing MS - teenage smoking

Calling all parents with teenage children; I need your help #MSPolitics #MSBlog #MSResearch

“Preventing, or at least reducing the incidence of, MS and other autoimmune diseases sounds relatively easy. Simply identify the risk factors and get the population to avoid them. Take smoking for example; it increases your risk of getting MS by approximately 50%, not to mention rheumatoid arthritis and a whole lot of other allergic diseases. Why then do people still smoke despite the negative publicity? My wife would say marketing, the power of branding and money. I note the Canadians have just given BAT (British American Tobacco) a whopping CAD$10.4bn (£5.5bn) fine; it was large enough to wipe 2.5% off the stock market value of BAT. Good on the Canadians. But is it enough?

I was doing an end-of year assessment with one of my academic trainees yesterday and said to him that the most important thing doctors can do is practice what they preach. You can’t tell your patients to exercise and lose weight if you are obese and a couch potato. You can’t tell your patients to stop smoking , and to try and stop their kids from smoking, if you smoke and your children smoke. This is why I am so disappointed that my daughter who is 18 smokes, and so do all her friends. Why? You don’t have to look too far to find out. It is cool to smoke; a large number of the role models that teenage girls idolise smoke. Girls also smoke to lose weight and stay thin. Smoking is an appetite suppressant; if you smoke you will be thinner. As Kate Moss says ‘nothing tastes as good as thin feels’. The corollary is nothing tastes as bad as kissing a smoker, when you are a non-smoker. 


Kate Moss - pretty, young and skinny; a smoking icon! 
My daughter is well educated; she finished A-levels last year with stunning marks and has just finished first year University. She knows a lot about the effects of smoking on health. She is aware about the link between smoking and MS; I have drummed it into her for years. She also has first-hand experience with MS and has seen what MS can do to someone. She has attended one of our MS research days and has spoken to and seen many MSers. She attended my inaugural lecture and heard about MS. One of our neighbours has MS. When we moved into the area 12 years ago he was walking. He is now wheelchair bound, disinhibited with a severe speech impediment. When you speak to him now, it is hard to have a meaningful conversation; his speech is very slurred and laboured. Prior to his wheelchair we saw him fall several times in public. I have even seen him being incontinent in public once. He always used to be accompanied by friends; both girlfriends and boyfriends. When you see him now, you only see him with one of his carers. Social isolation has struck. My daughter knows him well; they are alumni of the same school. Surely the image of him has imprinted itself on my daughter’s brain. How could my daughter ignore my advice regarding smoking and MS? I suspect the attitude that 'it won’t happen to me' is hardwired into the teenage brain. 

The public health figures regarding teenage smoking are sobering. Interestingly, teenage boys seem to be smoking less, but the trend in girls remains upwards. 

Source: http://www.hscic.gov.uk/catalogue/PUB14988/smok-eng-2014-rep.pdf

Source: http://www.hscic.gov.uk/catalogue/PUB14988/smok-eng-2014-rep.pdf
One of the reasons we launched digesting science (www.digestingscience.co.uk) was to educate children of MSers about environmental risk factors linked to MS; in particular the link between low vitamin D levels and MS. We have always planned to add smoking to the mix, but have always wondered how responsive 6-12 year olds would be to an anti-smoking message. A better plan may be to finesse digesting science to cover teenagers? However, the coverage of digesting science is small and the message is unlikely to get to the general public.

On reflection the fine imposed on the BAT by the Canadians did not go far enough. May be the Canadian Government should have linked the fine to a defined target, for example if the rate in teenage smoking does not drop below 10% by 2025 they will double, triple or quadruple the fine. Nobody knows the black art of marketing to teenagers better than the tobacco industry; we should harness that expertise. A one off fine is unlikely to change their behaviour. Simply reducing teenage smoking to less than 10% will reduce the incidence of MS by 10-20% and in some countries by more; not to mention the impact on other autoimmune diseases.

Can anyone help? We need a prevention strategy that works. I hope there are some politicians reading this post.”

28 comments:

  1. You won't be able to shift your daughter on this issue. Why? Because the evidence isn't that convincing. I am as anti-smoking as you can get. Never smoked, yet diagnosed with RRMS in mid-30s. The 30 or so smokers who hang around the backdoor of my office walk faster that I can. What about my 85 year old uncle or 83 year old father-in-law? Both smoked for over 40 years and both are fully mobile - the latter plays two rounds of golf a week. Neither have MS. Smoking has reduced substantially since the peak in the 1930s. The percentage of people who smoke now is c20 per cent and 50-60 per cent in the 1930s. If smoking was such a factor, why didn't the neuros report an epidemic of MS in the 40s, 50s and 60s - these were the times when smoking in cinemas and on public transport was the norm. MS incidence now is higher than ever - EBV infection in adolescence, lack of Vit D, our ultra-clean environment and something about the flora in our gut are the main factors. Don't worry too much about Ms G and her smoking. The evidence of a relationship between MS and smoking is very weak. I recall that Mouse was a smoker - look at him now (no MS and in robust health).

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    1. I'm no doctor but smoking can cause malabsorption of vitamins. Including vit D, iron, vit C, vit A and calcium. Malabsoption is impaired absorption of nutrients from food in the gut.
      If there is something about the flora in our gut in MS then who knows what's going on.
      I'm not saying smoking is a cause of MS but smoking could be effecting the gut in a negative way in MSers.

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    2. Agree with anon that the link between smoking and MS is weak. The questions which need to be answered are why many non-smokers get MS and why most smokers don't get MS. The evidence for ebv is much more convincing. Telling your daughter not to kiss anyone infected with ebv would be much more effective to protect her against ms.

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    3. Glandular fever can be caused by :

      kissing – glandular fever is sometimes referred to as the "kissing disease"
      sharing food and drinks
      sharing toothbrushes
      exposure to coughs and sneezes
      http://www.nhs.uk/Conditions/Glandular-fever/Pages/Causes.aspx

      My friends niece recently caught it from sharing lollipops.

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  2. I have MS, am aged 40 and was passive smoking when I used to go to pubs and night clubs before the smoking ban changed things.
    I used to go night clubbing or the pub often and my hair and clothes used to smell so strong when I got home after, it was gross.
    I used to work in an office and a colleague who smoked would come over to my desk, breath and talk over my shoulder. The breath smelling of smoke was gross and made me feel sick.
    I could not kiss a smoker.


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    1. On passive smoking:

      Secondhand smoke causes estimated 11,000 or more deaths in the UK each year. Around four-fifths of these deaths are due to secondhand smoke at home, with the rest due to secondhand smoke in the workplace.

      http://www.ncbi.nlm.nih.gov/pubmed/22345230
      Tob Control. 2012 Mar;21(2):96-101. doi: 10.1136/tobaccocontrol-2011-050294.
      Stages of the cigarette epidemic on entering its second century.

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  3. I'm no politician but share your concern - I was your daughter at one point, but growing up smoking in my adolescent years was way too cool to not do. Next to nothing was said in the 1960's and 70's about hazards. I try not to dwell too much on whether my smoking contributed to my MS because I can't change that, but we sure need to find a way to change it for those young people who don't have MS and know every warning about the hazards of smoking. I want them to think about it.... Being young and believing we are invincible has its downside, at my age that is easy to say. I hope we find a way to change that perspective about lighting up, the challenge obviously goes much deeper than just the use of tobacco.

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  4. You can’t tell your patients to stop smoking if you smoke : True

    "You can’t tell your patients to stop smoking ... if ... your children smoke" : NOT TRUE

    Because children are individuals too and they will eventually make their own decisions. I thought all parents knew that!

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  5. Not sure that preventing MS is ever going to be a strong motivation for smoking cessation. The likelihood of any given smoker developing MS is tiny, so the other health benefits (cancer, heart disease, etc) are going to be much more of a motivation. And if they weren't already enough for someone, knowing about a very small risk of getting MS isn't going to make any difference.

    More important is the health benefits of smoking cessation for people who have MS. As well as the general health benefits, there seems reasonable evidence that it will have a specific impact on someone's MS (for example progression seems to be faster in people with MS who smoke). A summary of the evidence for the benefits of stopping smoking for people with MS might be powerful - an area where a systematic review might help?

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    1. The threat of cancer makes no difference. Went back to work following surgery for lung cancer(never smoked) and all the youngsters say is they don't like smoking around me. They have no concern for their own health. I've tried my hardest to persuade them to give up.

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  6. Perhaps the link between a disease like MS and smoking is less tangible, has less psychological impact. One of my grandfathers smoked for much of his younger life and suffered a lot with shortness of breath and laboured breathing in his latter years. That was one of the major reasons I never even tried smoking.

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  7. Oh, Prof. G., I know that must torture you. On a policy level, the solution I prefer is to have insanely high 'sin' taxes on tobacco. Tax it high enough to cover their entire NHS costs, and then some. More than 4-5 times higher per box than what it costs now.

    While I can understand if you reject any unsolicited parenting advice--and I apologize in advance if you do--I have a painful suggestion for your situation with your daughter.

    I think that you should sit down with her and tell her something no father ought to: That while your love for her is unconditional, your relationship with her as a smoker is not. Tell her how exactly she can find any help that you can think of. Tell her when and where she can take the nicotine/cotinine/anabasine tests needed to prove she succeeds.

    Then tell her that you cannot be part of her life in any way until she quits. No visits; no phone calls; no texts; nothing. In my experience, convincing others to quit is not an intellectual exercise; it's an emotional one--and emotional enough that both of you end up sobbing uncontrollably until you finally fall asleep the next sunrise.

    I wish that I could offer a more helpful and painless option. Others may. And if you do tell me to bugger off, I wouldn't blame you. Whichever new way you try how to convince her to quit, I sincerely and respectfully hope that it works. Good luck.

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    1. Aren't the taxes insanely high already and the tax amply rewards to the NHS

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    2. Tax on cigarettes just incentivises the black market and parallel imports from the EU. I agree they are too high already.

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  8. I thought you have an international study doing this? How many cases of MS could you prevent by doing this? I suspect not many

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  9. Yup, very tricky to get the message across. I'm also highly educated (Cambridge degree etc, etc) so I should know better. But I didn't start smoking until my late twenties -work stress more than anything (and yes I know smoking isn't suppose to help with this). Fortunately my MS has moved very slowly over a very long time. I also have excellent cholesterol levels, I do aerobic exercise every day, my blood pressure is on the very low side of normal etc etc. So I haven't found a good reason to stop yet! And I know this is insane.

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  10. Way to go defaming me in public, Dad!

    Joking aside, you're only young once. Let your daughter be. She'll most likely grow out of It.

    Peer conformity and social pressures are things adults forget about. No-one is that bothered if poor urban kids smoke like idiots, but it seems all the more disturbing if an upper middle-class, doctor's daughter takes up the habit. It's double standards.

    Let the kid be herself and figure it out. She's a young woman now, a smart one no doubt. Kids rebel and that is a good thing. We need a cultural generation gap.

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  11. It's not just about preventing disease it's about being fit enough to fight it once you've got it. imagine having an operable illness and not being well enough to have anaesthesia just because you smoke. Young people think it will never happen to them.

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  12. There's loads of social science research on this in the health communication field. I know a couple people doing this research and they are focusing on issues of identity as well as social marketing (using traditional marketing techniques to create positive change). It might be easier to find a cure for MS than to get people to quit smoking in the long run.

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  13. Naughty Miss G. On the positive side, she'll get quick / best treatment if ms came knocking. Heart bleeds for the guy in your neighbourhood - sad that medics can't help in these dire situations.

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  14. My father in law has just died of progressive lung disease caused by smoking - even though he gave up 40 years ago. Teenage smokers should be brought to these wards and watch the people gasping for breath because their lungs are black with tar. My daughter is at University too and thankfully does not smoke but does find it very strange that a lot of student medics smoke - in fact more so than anny other subject group !

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  15. I'm surprised no one has yet commented that nicotine is highly addictive, and that is a major reason people continue to smoke after trying it out. I do hope your daughter decides to stop soon, and is able to stop. I really feel for you - I would be heartbroken if either of my 2 children took up smoking. It was bad enough when one of them had a boyfriend who smoked, which meant exposure to the smoke but was also a worry to me that my daughter would be influenced to take up smoking.

    Like some of your other posters, I too have never been a smoker though I was exposed to a lot of passive smoking in public places and in the workplace in the last part of the 20th century.


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  16. Your daughter is now an independent young adult, Prof G. You have to respect her decisions. How would you feel if she decided to become a Muslim? or chose to get covered head to toe in tattoos?

    Both the above have happened to our family.

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  17. How does smoking cannabis compare to that of a cigarette in terms of getting the disease as well as progression?

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  18. One arena that is being vastly debated lately is the trend of youth taking up "vaping" in lieu of smoking actual cigarettes. I've often wondered whether or not these heated solutions of propylene glycol/vegetable glycerin, nicotine, and flavorings will present themselves as being in the same class of an MS risk factor that cigarettes are.

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  19. Tell her a horrible truth: her teeth are going to rot in time, but for now they're just going to get yellow.
    And her breath is going to stink so bad, no perfume is going to cover that up

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  20. I repeatedly told my kids, before they got into their teens, that smokers were losers - tied in to an addictive drug that cost a fortune, makes the person and their clothes stink, had no positive health benefits and more than half of smokers would die early in a variety of nasty ways after having years of poor health.

    I warned them that their friends might put pressure on them to try cigarettes (and how addictive nicotine is so that even one or two cigarettes could get them hooked) - but if they were true friends they would accept it if my kids declined. We discussed the peer pressure to be one of the "cool kids" and how ridiculous it is to think that sticking a cigarette in your mouth and blowing toxic smoke at people is supposed to be something to admire and aspire to. I also talked about the risk to children's health through their parents smoking.

    It might be seen as an over the top approach but I love my children deeply and have always been transparent about my personal values.

    Neither of my young adults has so far become addicted to nicotine

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  21. I am staggered today at the number of young people I see smoking as I walk around the streets. My parents tried to bribe me not to smoke. In 1972 £100 was a lot of money but I started smoking.

    There are a multitude of reasons why young people smoke today. Basically its cool and at that age you are immortal so you are deaf to the pleas of the older people. As you become more mortal so you become more aware of the risks of smoking.

    I'm not too sure what the solution is. The fact that it is considered anti-social is a start. Restricting places where people can smoke is another good move.

    Now what about 'Vaping'?

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