Tobacco and health care
CMAJ 1997;157:133
See response by: D.J. MacKenzie
The CMA Policy Summary "Tobacco and health" (CMAJ 1997;156:240A-C [full text / texte complet]) is a welcome statement supporting the activity of many physicians across the country who are trying to work, in their practices and in the community, to develop a smoke-free society.
Although the statement is a helpful start, I feel that it has 2 glaring omissions. The first deals with physicians' overall concern for the health of their patients. To date, in BC and most other provinces, physicians are prohibited from billing the medical services plan or patients directly for counselling advice to help a patient to become a nonsmoker. We are expected to provide better health care with ever-decreasing dollars, yet we are often criticized for not being more active advocates of disease prevention. Failing to point out this deceitful paradox is a serious lack.
The second issue is one of regulation. It is known and proven that tobacco is an addictive and hazardous product. Therefore, even though our current government feels that it cannot legislate a complete ban of cigarette sales, it is unethical to allow Canada to export a potentially lethal substance to other countries. A very strong statement should be included in the CMA statement that the Canadian government should implement a policy to prohibit any sales or exports from Canada to other countries. An equally strong statement should be made to prohibit importation of any tobacco products into Canada.
William W. Arkinstall, MD
Kelowna, BC
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