Tuesday, June 05, 2007

Britain's NHS tells smokers they're SOL.

see today's Daily Mail

In a move that makes tremendous sense and also foreshadows the growing influence of the government that will accompany any universal health care plan adopted here, the United Kingdom's National Health Service (NHS) is planning on refusing any elective surgery in smokers until they "pee in a cup" (to test for nictine metabolites) to prove they've quit prior to an operation.

When the feds own the purse string here in the United States (as they clearly are moving towards with some kind of Universal Heal Coverage), expect to see a lot of actuarial data and cold outcome data end up driving health care spending. It's not necessarily a bad thing, but Americans used to having an awful lot of discretionary health care spending (elective surgery, doctor visits, imaging studies, prescription drugs, etc..) will be in for a shock the first time they get scolded, are told to wait, or told flat out NO.

In this instance, the NHS has hit the nail on the head by asking people to take some personal responsibility for their behavior whose cost will ultimately be borne by everyone.

There (generally speaking) are 4 major risk factors for surgical wound complications.

  1. Diabetes
  2. Obesity
  3. Peripheral Vascular Disease
  4. Tobacco use

It's is hard to realistically make a dent in #'s 1-3, but smoking cessation is an easy target for interventions. It's not really the "smoke" per se, but rather the effect of the break down metabolites of nicotine, which have effects on micro-circulation in tissue. How you get the nicotine is irrelevant be it cigarettes, cigars, snuff, chewing tobacco, or nicotine patches and gum. It takes weeks for nicotine to clear you system and have your blood vessels react normally (ie. not spasm with normal stimuli).

In plastic surgery the effect on circulation can be profound as many common procedures (breast lifts/reductions, tummy tucks, face lifts among others) require many of the collateral sources of blood flow to be divided. This can put you at much,much higher risk of having skin slough or fat necrosis.

I have little sympathy for smokers who feel like they're being discriminated against in this instance. In a nutshell, if you don't care enough about yourself to quit smoking, why should the doctor (or health system in this case) be willing to make your problem their problem.



Anonymous said...

We should also start denying trauma care to the foolish people who roam our streets, refuse to set the broken radius of the kid that falls off the swing, and generally only provide healthcare to those who do not need it.

On a different matter, what makes diabetes easier to control than smoking? I _have_ quit smoking and found it easy; if I quit my insulin habit, I would be in DKA before the day was out.

Felix Kasza.

Anonymous said...

I agree with you on this, one. Why do people continue to damage their health but expect doctors to cure all their self inflicted health problems.