SMOKING

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Smokers are up to four times more likely to go blind in old age, according to research. A study in the British Medical Journal says cigarettes increase the chances of developing age-related macular degeneration. Cigarette packets already carry severe health warnings about the dangers of smoking. The researchers, from the University of Manchester, say the risk of going blind should be added to the list. Age-related macular degeneration (AMD) is the leading cause of adult blindness in the UK, affecting about 500,000 people. It results in severe and irreversible loss of central vision, especially in people over the age of 60. Ophthalmic surgeon Simon Kelly and his team claim around 54,000 people in the UK have AMD as a direct result of smoking. Of these, they said 17,800 are completely blind.

The researchers are calling for a sustained public health campaign to raise awareness of the link between smoking and blindness, as well as more commonly known risks such as cancer. Mr Kelly said, "Evidence indicates that more than a quarter of all cases of AMD with blindness or visual impairment are attributable to current or past exposure to smoking. Patients, health professionals, and the public will benefit from greater awareness of this causal association." Researchers said evidence suggests that giving up smoking helps reduce the risk of AMD in later life. Quitting can also affect the long-term response to treatments such as laser therapy.

The Royal National Institute for the Blind (RNIB) agrees that greater publicity is needed to highlight the link between smoking and eye damage. "People fear losing their sight more than any other sense, said Anita Lightstone, RNIB Head of Eye Health. Therefore the fact that smoking does significantly increase a person's chances of losing sight from AMD should be more widely publicised. Awareness needs to be raised and an eye health warning included on all cigarette packets, to help lower the number of people losing their sight from AMD."

The pro-smoking organisation Forest has reacted angrily to the research branding it as "scaremongering". Forest director Simon Clark said, "These health scares are getting out of hand. I think people have to ask how many people do they know who have gone blind through smoking. We have health scares on a daily basis and I think it is counter productive. We are getting to the stage where people are so cynical that not only won't they listen but they will start to laugh at scientists and the medical establishment, which could have serious consequences in the future."

Smoking causes lung cancer, but is also associated with more than 50 different diseases and disorders, many fatal. Around 13 million Britons smoke and half of all smokers will die prematurely. There are 120,000 smoking-related deaths each year and smoking-related diseases cost the NHS £1.5bn annually. But the government receive in the region of £14bn each year by way of tobacco tax. The government is currently under pressure for delaying the implementation of guidelines from the National Institute of Clinical Excellence, which say that a treatment known as photodynamic therapy should be made available to treat AMD.

A mother who was criticised by a doctor for nipping out for a cigarette moments before her caesarean operation has won more than £44,000 for her 'hurt feelings'. The smoker claimed that she developed severe post-natal depression after the anaesthetist told her off. The patient delayed the operation by leaving the ward in the private clinic to get her nicotine fix and the anaesthetist claimed her coughing made it difficult to give her an epidural before surgery. The patient complained that the doctor had harassed her and was awarded £44,500 for 'pain and psychological distress'. Her legal fees were also paid for. She also claimed that the doctor failed to provide proper pre-anaesthetic care but experts ruled it was appropriate. (Source: Mail on Sunday, Dec/06)

There are nearly 7,000 full-time, direct employees in the UK tobacco industry and it supports over 80,000 jobs amongst suppliers and retailers. The Treasury receives £10bn in tobacco tax. This compares to the cost to the NHS for treating smoking related diseases of £1.7bn. The debate about passive smoking also needs to be put into context. A commonly used measure for making comparisons is relative risk (RR). For a non-smoker in a non-smoking household, the risk of contracting lung cancer, the RR is 1.00, which is a 10 in 100,000 chance, unlikely.

For a non-smoker living with a smoker, i.e. living in an environmental tobacco smoke (ETS) situation, the RR rises to 1.25, very little difference! Traffic and related pollution in Derby's Five Lamps area has been a source of controversy recently. It's interesting to note that the RR for diesel exhaust and lung cancer is 2.6, twice that of ETS. Let's have a balanced debate about practical options and come to a sensible conclusion to everybody's satisfaction. David Trigg