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Press releases Saturday 6 January 2007

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(1) Voting begins for greatest medical breakthrough since 1840

(2) Should smokers be refused surgery?

(1) Voting begins for greatest medical breakthrough since 1840
http://www.bmj.com/cgi/content/full/334/7583/suppl_1

The BMJ today reveals the 15 medical advances that have made its short-list to find the greatest medical breakthrough since the journal was launched in 1840.

The project is a celebration of the most important medical milestones of the past 166 years to mark a complete redesign of the journal and its website.

The list has been compiled from over 100 nominations by BMJ readers and includes achievements that have transformed the lives of millions of people around the world, such as the discovery of antibiotics, the creation of the Pill, and the development of vaccines.

Fifteen leading doctors and scientists have been chosen to ±champion± each milestone. They include Professor Carl Djerassi, creator of the Pill, and Dr Stephanie Snow, descendant of John Snow who discovered anaesthesia in the 1800s.

Each champion has set out why they think their milestone should win and, over the next 10 days, visitors to bmj.com can read all the arguments and vote for their favourite. Although the BMJ is read mainly by doctors, anyone can log on and cast their vote.

Voting will close on Sunday 14 January and the winner will be announced by broadcaster Jon Snow at a celebratory event in London on Thursday 18 January.

Dr Fiona Godlee, BMJ Editor said: "Any of these milestones would make a deserving winner ± they have all made an enormous contribution to society and made a difference to millions of lives. It will be fascinating to see which one will come out on top.

It±s also an opportunity to consider how these milestones will develop medicine in the future. Will genetics deliver on its promise of real clinical benefit? Can computers help us achieve optimal health for all? And will the end game for smoking be just 20 years away, as one of our champions confidently asserts?

"It looks set to be an exciting competition and I urge everyone to join the debate and get voting!"

Contact:
Journalists wishing to attend the event should contact the press office (pressoffice@bma.org.uk).


(2) Should smokers be refused surgery?
(Head to head: Should smokers be refused surgery?)
http://www.bmj.com/cgi/content/full/334/7583/20

Last year a primary care trust announced it would take smokers off waiting lists for surgery in an attempt to contain costs. In this week±s BMJ, two experts go head to head over whether smokers should be refused surgery.

Denying operations is justified for specific conditions, argues Professor Matthew Peters from the Concord Repatriation General Hospital in Australia.

Professor Peters says that smoking up to the time of any surgery increases cardiac and pulmonary complications, impairs tissue healing, and is associated with more infections.

These effects increase the costs of care and also mean less opportunity to treat other patients, he writes. In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will therefore deliver greater clinical benefit to individuals and the community.

He believes that, as long as everything is done to help patients to stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective procedures.

But Professor Leonard Glantz from Boston University School of Public Health believes it is unacceptable discrimination. "It is astounding that doctors would question whether they should treat smokers," he says.

"Doctors should certainly inform patients that they might reduce their risks of post-surgical complications if they stop smoking before the procedure. But should the price of not following the doctor±s advice be the denial of beneficial surgery?"

Cost arguments are made to support the discriminatory non-treatment of smokers. But why focus our cost saving concerns on smokers? Patients are not required to visit fitness clubs, lose 25 pounds, or take drugs to lower blood pressure before surgery. And many non-smokers cost society large sums of money in health care because of activities they choose to take part in.

Discriminating against smokers has become an acceptable norm, he writes. It is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant. Depriving smokers of surgery that would clearly enhance their wellbeing is not just wrong ± it is mean, he concludes.

Contacts:
Matthew Peters, Associate Professor, Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
Email: matthew.peters@cs.nsw.gov.au

Leonard Glantz, Professor of Health Law, Bioethics, and Human Rights, Boston University School of Public Health, Boston, MA, USA
Email: lglantz@bu.edu

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