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Smoking Cessation Initiative
Task Force: Why?
We read with interest the article
“How Anesthesiologists
Can Help Beat Joe Camel …”
by David O. Warner, M.D., in the October 2006 NEWSLETTER.
There is no doubt that smoking cessation is a laudable
goal for all smokers both in terms of improving quality
of life and extending life expectancy. There is also
substantial evidence suggesting that perioperative
outcomes can be improved with preoperative cessation
of smoking.
We agree that anesthesiologists, like all health care
providers, should avail themselves of every opportunity
to encourage their patients to stop smoking. Dr. Warner’s
steps that every anesthesiologist can take to help
in this matter are well formulated and should become
widely utilized. They “require minimum time
and expertise” and expense.
We do, however, question the decision by ASA to form
the Smoking Cessation Initiative Task Force. Has the
cost/benefit ratio of this endeavor been considered?
Expenses will likely include the costs of the meeting(s),
the members’ “time,” administrative/secretarial
help and office/mailing supplies. ASA will bear much
of these costs.
And is it truly realistic to expect the task force
to have significant benefit? In this country, anesthesiologists
garner less respect than most other specialists, both
within the medical community and from the general
public. Indeed Dr. Bacon’s editorial in the
same NEWSLETTER discusses the trend toward
chairs of anesthesiology departments being replaced
with nonanesthesiologists. We are all reminded of
our relative lack of respect and authority every time
we are forced to justify to a surgeon our choice of
anesthetic or when to extubate a patient. How then
can our specialty expect to have a significant impact
on an issue that is only peripherally related to anesthesia?
Surely there are more directly-anesthesia-related
issues that have yet to be fully explored. ASA should
focus its resources on those areas where it can actually
anticipate having an impact.
M. Denise Daley, M.D., MSc.
Peter H. Norman, M.D.
Houston, Texas
Dr.
Warner Responds to Drs. Daley and Norman
Thanks for your comments. The meetings of the ASA
Smoking Cessation Initiative Task Force are being
funded by the Smoking Cessation Leadership Center,
an office of the Robert Wood Johnson Foundation that
aids professional societies such as ours in developing
smoking cessation programs. Thus the investment of
ASA resources has been minimal for what we believe
to be the potential for substantial benefit.
A recent survey of the ASA membership revealed that
a majority wishes to learn more about how to help
their patients quit smoking (Anesth Analg.
2004; 9:1766), and multiple studies show that physician
advice increases quit rates. And it is sad to think
that we should ever be discouraged from pursuing new
ways to help our patients because of a perceived lack
of respect (or perhaps self-respect). I can think
of no better way to earn respect than to go beyond
our traditional roles and develop new opportunities
to improve the health of our patients.
We can take a leadership role in this area among surgical
specialists, as no other surgical subspecialty society
has yet addressed this issue. Recognizing that this
will be a challenging task (as is almost everything
that is worthwhile), we should still never underestimate
our ability to make a difference in this or any other
area.
David O. Warner, M.D.
Rochester, Minnesota
Future
Patient Safety Initiatives Standing on Shaky Ground
Although superficially appealing, an attempt by Robert
K. Stoelting, M.D., to reify the current style of
anesthesia practice is logically flawed in his “Anesthesia
Patient Safety Initiatives and Evidence-Based Medicine”
(ASA NEWSLETTER November 2006). To claim
that since complications are so rare that we don’t
have enough to go around for a decent controlled study
— hence what we do now must be great —
is begging the question. Lacking hard evidence, it
is just as easy to posit the converse. We may easily
argue that the complexity of modern over-engineered
anesthesia machines and monitors with their jumble
of wires and beeps obviously create a dangerous distraction
from appropriate vigilance.
Scientific facts are always changing, and “truth”
is often counterintuitive. What makes science an epistemically
privileged activity is that it tries to experimentally
substantiate theory with as much certainty as possible.
Absent that we are only left with art, which is essentially
personal opinion.
Steven S. Kron, M.D.
New Britain, Connecticut
Learn About
ASAPAC and Become Politically Active
The Rovenstine Lecture [at the ASA 2006 Annual Meeting
in Chicago] was again a wonderful example of a truly
insightful individual. Jerry Reves, M.D., deserves our
thanks in pointing out a glaring deficiency in the resident
training and the lack in education in research training
of future anesthesiologists. Our specialty deserves
the consideration of his lecture. Researchers in anesthesia
are not born, they are trained.
BUT
I was sitting in the lecture room in Chicago thinking
about solutions for the problems he identified.
AND
After considerable thought, I came to the conclusion
that almost all of the problems now presented could
have been helped over time had he included the final
statement to his bullets: “Learn about the ASA
Political Action Committee and become politically active.”
Had the educators in the university systems included
a continuum of courses in the political ramifications
of the government intervention in medicine 20 years
ago, and had the educators themselves participated in
the ASAPAC system at its foundation in 1991, maybe we
would never have lost the payment system for the residents
that is now plaguing the systems that Dr. Reves has
identified in the Rovenstine Lecture. “Learn about
ASAPAC and become politically active.”
The level of participation in the political process
is not limited to only educators; the general membership
is expecting someone else to step up to the plate and
fix the problems of medicine. We need and deserve everyone
to help with the process. Politicians believe that only
about 10 percent of anesthesiologists are worried about
the interventions by the government in organized medicine
because they look at the participation level in ASAPAC
and feel that is a representation of the whole of the
profession. Are you worried about the decreased reimbursements
in Medicare and other government insurance programs?
“Learn about ASAPAC and become politically active.”
I challenge you to reread Dr. Reves’ wonderful
lecture, but to add the following statement to each
bulleted item: “Learn about ASAPAC and become
politically active.” I think it will offer a solution
that will ultimately serve to solve the problems identified.
Remember, too, that it has taken us more than 20 years
to lose control of research and resident billing. “Learn
about the ASAPAC and become politically active.”
Congratulations to the residents of the University of
Alabama-Birmingham on their 100-percent participation
in ASAPAC; they have demonstrated that they are the
ones to figure out a solution for the long-term problems
identified by Dr. Reves. “Learn about ASAPAC and
become politically active.”
We need to have all the training programs work on identifying
mechanisms to educate residents and their staffs on
the need to be politically involved with the government’s
involvement in medicine. Otherwise I can see a Rovenstine
Lecture 20 years from now presented by Dr. Reves using
the same bullets, with the addition of the comments:
“Learn about ASAPAC and become politically active.”
It has been 13 years since we had a president of the
United States with a mother who was a CRNA, and history
will recall what effect the Clinton legacy has had on
anesthesiology training and the funding for National
Institutes of Health grants and other research.
“Learn about ASAPAC and become politically active.”
Peter C. Loux, D.O.
Huntsville, Alabama
The views and opinions expressed in the “Letters
to the Editor” are those of the authors and
do not necessarily reflect the views of ASA or the
NEWSLETTER Editorial Board. Letters submitted for
consideration should not exceed 300 words in length.
The Editor has the authority to accept or reject any
letter submitted for publication. Personal correspondence
to the Editor by letter or e-mail must be clearly
indicated as “Not for Publication” by
the sender. Letters must be signed (although name
may be withheld on request) and are subject to editing
and abridgment.
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