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Press releases Saturday 4 February 2006

(1) CAN ISLAM HELP MUSLIM SMOKERS TO QUIT?

(Influence of Islam on smoking among Muslims)
http://bmj.com/cgi/content/full/332/7536/291

Muslim leaders should rule that smoking is prohibited under Islamic law to encourage Muslim smokers to quit, say doctors in this week’s BMJ.

Smoking rates are unacceptably high among Muslim communities globally. Even among Muslims living in Europe, smoking prevalence (particularly among men) remains high. In Western countries, smoking related disease is estimated to cost the NHS £1.7bn a year. Reducing smoking prevalence is thus a priority for many governments.

Researchers at the University of Edinburgh analysed data on smoking prevalence for the 30 countries with the highest proportion of Muslims.

Smoking rates in each of these countries is significantly higher among men than women. The highest recorded rates among men are in Indonesia and Yemen, where over two thirds smoke. Yemen also has the highest prevalence of smoking among women, where almost a third smoke.

Only Iran and Syria have a complete ban on smoking in public places, although Indonesia is considering such a ban, but legislation is often poorly enforced. Furthermore, only 14 of the countries studied have signed up to the World Health Organisation’s antismoking treaty, the Framework Convention on Tobacco Control.

Numerous religious scholars and institutions in Middle Eastern and North African countries have recently declared smoking to be haram (prohibited). However, the general view from the Indian subcontinent is that smoking is mukrooh (lawful though discouraged).

South Asian religious authorities need to follow the leadership shown by their Arab speaking counterparts, say the authors. But, despite calls for British Muslim leaders to clarify the religious unacceptability of smoking, no such position statement has emerged.

The authors believe that it is only a matter of time before South Asian scholars rule that smoking is prohibited and these rulings percolate through South Asian Muslim communities globally.

These rulings need to be backed up by advertising bans and support to stop smoking if they are to have much effect on smoking rates, they conclude.

Contact:

Aziz Sheikh, Professor of Primary Care Research and Development, Division of Community Health Sciences, University of Edinburgh, Scotland
Email: aziz.sheikh@ed.ac.uk

(2) DOES ALCOHOL LABELLING ENCOURAGE SENSIBLE DRINKING?

(Letters: People seem confused about sensible drinking messages)
http://bmj.com/cgi/content/full/332/7536/302

Clear labelling on shop-bought alcohol, showing the alcohol units contained and health advice, may not be effective in promoting sensible drinking, says a letter in this week's BMJ.

In a snapshot survey of 263 supermarket shoppers in Edinburgh, two university lecturers investigated whether information labels on alcoholic drinks influenced drinking awareness.

Although most of those surveyed could define what constitutes a unit of alcohol, less than a fifth of men and just a quarter of women used the information to monitor how much they drank.

Very few - just 8% of women and 5% of men - were aware of the current guidelines which outline sensible daily drinking levels (brought in to help people avoid drunkenness). Many instead estimated the maximum number of units per day from older guidelines defining weekly levels, while a third offered no suggestion at all.

Nearly half of the shoppers surveyed preferred wine, but a fifth of those gave no estimate on how many units are in a bottle. Another third thought the alcohol content to be less than it is - guessing seven units or fewer, when the right answer is closer to nine.

Most participants said they were in favour of alcohol labelling. However, the survey found price offers influenced buying more than label information.

Despite the enthusiasm for labelling amongst the participants, evidence from other countries on its effectiveness is not supportive, say the authors. This survey shows there may be "considerable confusion about sensible drinking messages in the UK," they conclude.

Contact:

Dr Jan Gill, Lecturer, Queen Margaret University College, Edinburgh, UK
Email: jgill@qmuc.ac.uk

(3) CONCERN OVER BRITAIN’S REFUGEE DETENTION POLICY

(Editorial: Detention of refugees in the UK)
http://bmj.com/cgi/content/full/332/7536/251

Experts in this week’s BMJ express concern over Britain’s policy of expanding detention centres for asylum seekers, despite evidence that it damages mental health.

Over 7 million of the world’s 17 million refugees remain “warehoused” under conditions of confinement, raising serious human rights issues about the treatment of people fleeing oppression.

Last year, Australia abolished mandatory detention for asylum seekers, admitting that the policy had failed and releasing all confined children and their families.

Yet Britain increasingly appears to be pursuing this policy. About 25,000 people have been held in 10 removal centres in the past year and the latest immigration bill seeks to expand detention facilities and the capacity to effect forced removals, write authors Mina Fazel and Derrick Silove.

Medical observations in Britain concur with those from Australia, with attending doctors noting that detainees, particularly those held for long periods, suffer from profound hopelessness, despair, and suicidal urges. Doctors face ethical challenges in balancing the responsibility to provide care without discrimination to a vulnerable group against the risk of becoming complicit in a system that by its very nature causes psychological harm.

Every nation has a duty and a right to monitor those who cross its borders, say the authors. Nevertheless, considerations of national security need to be balanced against our obligations to treat asylum seekers with justice, dignity, and humanity in the spirit of the UN Refugee Convention (1951).

It should be noted too that the UK has a relatively low intake of asylum seekers per head of population compared with Germany, the United States, Australia, and France.

Media claims that Britain faces a deluge of asylum seekers and that refugees may be terrorists serve only to increase the risk that “tough” but ultimately damaging measures will be implemented, aimed to allay public fears rather than to confront the genuine psychological needs of people fleeing persecution, they warn.

The lessons for Britain are clear. Australia has acknowledged the failure of detention policy. There is ample evidence that models of community accommodation for asylum seekers lead to better mental health outcomes and that humane but rigorous forms of monitoring can still be instituted in these settings.

By continuing to document the psychosocial impact of detention, the medical profession is well placed to add its expert voice in shaping humane immigration policies, they conclude.

Contact:

Mina Fazel, Lecturer in Child and Adolescent Psychiatry, Warneford Hospital, Oxford University, Oxford, UK
Email: mina.fazel@psych.ox.ac.uk

(4) CONSCIENTIOUS OBJECTION IN MEDICINE SHOULD NOT BE TOLERATED

(Conscientious objection in medicine)
http://bmj.com/cgi/content/full/332/7536/294

A doctor’s conscience should not be allowed to interfere with medical care, argues an ethics expert in this week's BMJ.

A doctors’ conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.

Imagine an intensive care doctor refusing to treat people over the age of 70 because he believes such patients have had a fair innings. Or imagine an epidemic of bird flu or other infectious disease that a specialist decided she valued her own life more than her duty to treat her patients. Such a set of values would be incompatible with being a doctor.

The argument in favour of allowing conscientious objection is that to fail to do so harms the doctor and constrains liberty. This is true, says the author, but when conscientious objection compromises the quality, efficiency, or equitable delivery of a service, it should not be tolerated.

He believes that doctors who compromise the delivery of medical services to patients on conscience grounds must be punished through removal of licence to practise and other legal mechanisms.

Values are important parts of our lives. But values and conscience have different roles in public and private life, he writes. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patients.

The door to “value-driven medicine” is a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own, he concludes.

Contact:

Julian Savulescu, Director, Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK
Email: julian.savulescu@philosophy.ox.ac.uk

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