Dr Phil Button is an NHS anaesthetist. (No, that's not him above.) He's a smoker and has his own blog, Pro-Choice Smoking Doctor. A colleague, Marion Finlay, interviewed him in 2006 but the article was never published. I can't remember why.
Yesterday, having typed the name "Ken Denson" (another pro-choice smoking doctor) into my computer (see earlier post), up popped the "lost" interview. I thought you might like to read it. Note: I have checked and Phil is happy for it to be published. Better late than never!
TRUST ME, I'M A DOCTOR
“I think if you go to your doctor for advice, you should be given advice. Not be told what to do. People are bombarded with health advice from the media. If you haven’t heard the publicity that says smoking is bad for you, then you must have been living on another planet.”
That’s a view most sentient people would agree with. What’s unusual is - it comes from a doctor.
The doctor is Phil Button, a 47-year-old anaesthesiologist at a NHS Trust hospital in North Hampshire and a former GP. He’s decided to come out of the smoking closet – despite the inevitable attacks on his professional reputation – because he says we are not being given accurate information about smoking in general and ETS (environmental tobacco smoke or “passive smoking”) in particular. “It’s very politically incorrect to be a smoker and very politically incorrect to talk about it,” he says.
He’s also angry about the increasing “demonisation” of smokers. “Smoking, once labelled as something that is bad for you, has now been transformed by the anti-smoking lobby into being more than just bad for you, but into a bad thing – that smokers are in some way lesser people. They have been demonised, and are considered either weak or somehow substandard.”
Dr Button is also unusual in that he started smoking at the age of 40. “I think I’d always been a ‘closet smoker’ or ‘tempted smoker’, wondering what it would be like. Once I tried it I thought ‘I like this’ and decided to carry on.”
But isn't he concerned about his health? “It’s quite a complex question to answer,” he says. “I’ve always been a great believer in the quality of life rather than the extension of life. Ultimately, I have no control over what is going to happen to me and I don’t regard me smoking as being the one single overriding factor that’s going to cause my demise. There are so many other factors involved.”
He says he smokes – about 30 a day - because he enjoys it. “I like the flavour, smell and I enjoy the contemplative moments. When I’m smoking I’m usually thinking about something else. It helps me to concentrate. Certainly that applies to when I’m driving. If I find myself nodding off, if I have a fag I concentrate again. I just enjoy doing it. I don’t believe I’m doing anyone any harm.”
Undemocratic
Dr Button argues that the dangers of second-hand smoke have been wildly exaggerated and that “I can see only one reason we should be talking about smoking being a problem and that is the smell. Some people - and I include smokers in this group - don’t like the smell of smoke in the atmosphere or on their clothes. Ventilation would clearly go a long way to solving this problem.
“As far as I’m concerned, there is no other issue with regards to smoking in public. To push through heavy-handed legislation, and implement anti-smoking policies on hospitals on the basis of smell, is petty and undemocratic.”
Having read studies about the effects of ETS he says: “If you examine the statistical analysis and look at the methods they all - without exception - do not prove a link between ETS and harm to non-smokers.” More controversially he says, “I also believe that the effects of smoking on the smoker as been exponentially exaggerated over the years.”
Then why do doctors say second-hand smoke is so dangerous? “Doctors believe that smoking is bad for you. They believe it with fervour. And that no one should smoke – except them occasionally – and it’s perfectly reasonable to not do anything about an ETS scare as they don’t want to be seen to condone smoking.
“My experience of my medical education is very much about brainwashing. You really are taught every day that smoking is bad for you, further reinforced by anecdotal information in the media,” he says.
How many doctors smoke at your hospital? “I don’t have an accurate figure as to the percentage of hospital staff that smoke. I would say over 25% of the doctors in my department smoke, which is higher than the average number of smokers in the general population. They are the ones I know that come down into the smoking room and smoke openly.
“In the NHS the job, at whatever level you do it – nurse, health care worker, doctor – is very stressful because you are dealing with people’s lives. And some members of the health service take a break to have a cigarette to calm their nerves, keep themselves together, collect their strength.”
Indoctrinated
So why is he speaking out? “I’ve been through a medical education so have been indoctrinated in the medical story of smoking as it is believed to be by the medical profession. But increasingly, since about the age of 35, I’ve been more inquisitive and questioning. And I have become convinced that the truth about the harm caused by smoking is not as bad as it’s been made out.”
He says, “I don’t have a real issue about smoking. The wider issue is, why do we only see one side of the story and no one ever speaks out on behalf of the other side?
“There is terrible media bias towards the publication of opinions about ETS which sides with the anti-smokers. And the anti-smoking lobby has become an enormous machine. As a result, I treat all media health information as fundamentally flawed.”
Dr Button says he is more concerned about the ill effects caused by stress and the rising incidences of anxiety and depression-related illnesses. “I believe the pressure people are under to live healthy lives is likely to be adversely affecting their mental lives. For example, putting pressure on people who are depressed to quit smoking will add stress. I suspect stress is a bigger killer than anything else as it clearly has obvious physical affects on your cardiovascular system - you sweat, your pulse goes up.
“I attempt to run my life without stress. I don’t believe I’m addicted to cigarettes. I smoke because I like it. If it’s not convenient to smoke, I’ll be happy where I am. Personally, I don’t feel comfortable smoking in front of no smoking signs, particularly if it says you might be removed from the building. I want to relax with a cigarette.”
What about hospital smoking bans? “I understand that hospital managers don’t want to be seen to condone smoking. But I don’t believe that the actions they are taking will deal with that. All the people I meet in the smoking room are going to go to the perimeter of the hospital twice a day or so. I’m sure it will have no effect on the number of people who smoke.”
Dr Button is extremely angry about the murder of a nurse while she was having a cigarette break outside the hospital grounds. “It is not in anyone’s interests to expose people to this level of harassment whereby they are hounded to unsafe places to smoke a cigarette.”
He also thinks the policy is callous towards patients and visitors: “They are potentially abusing the patients’ relatives because they are the people most affected by a patient’s admission. Often they will have to visit the hospital for long periods of time, and while they’re there they don’t want to leave the relative for any length of time. I think that’s cruel.
“And it’s also cruel to patients. I’ve been to hospitals with smoking bans and you still see patients with their catheters and drips smoking outside the entrance. And I defy anyone to tell them not to.”
Question
Of course Phil Button is not the only doctor to stick his head above the parapet and question some of the claims of the powerful anti-smoking lobby. Dr Ken Denson of the Thame Thrombosis and Haemostasis Research Foundation in Oxford is one of Britain’s top experts on the effects of tobacco. He has published two major review articles, together with many letters in leading medical journals, criticising the evidence about the alleged effects of second-hand smoke.
Dr Denson was quoted in the House of Commons Health Select Committee report 2005-06 Smoking in Public Places as saying: “The scientific evidence for any deleterious effect of ETS is wholly false. The hard evidence for any deleterious effect of second-hand smoke is so tenuous and equivocal, that similar evidence would not be seriously considered, let alone published, in any other field of medicine.”
Dr Mike Fitzgerald, a London GP and author of The Tyranny of Health: Doctors and the Regulation of Lifestyle, has questioned whether smoking is an addiction. He has written in the online magazine Spiked about how the smoker has become a pariah, the failure of coercive anti-smoking policies and how anti-smoking propaganda directed at adolescents has proved counterproductive, and the increasingly childlike character of political discourse about smoking.
Dr Theodore Dalrymple, a columnist in the Spectator and other national media, wrote about the ban on smoking in public places in The Times: “The pettiness of this official persecution of smokers (who are not prevented from paying a lot of tax) can hardly be exaggerated.”
While Dr Button is willing to go on the record to voice his concerns about anti-smoking campaigns, he says he doesn’t “evangelise” at work. “It’s not the right forum and I have work to do.” As for anti-smoking policies at his hospital he says, “increasingly NHS Trusts have indicated that disobeying smoking policy would involve disciplinary procedures. If it came to that, I think I might have to back down because ultimately my job is too important.”
In the meantime he says, “My joy in life is very simple: going into town with my wife and doing a bit of shopping then going to a café and having a cigarette. In future, I won’t even be allowed to do that. And for no good reason.”
Tuesday, April 13, 2010 
