I still remember the harrowing first time I told a smoker he was going to die of lung cancer

Lee Hudson: 'The reality is that hardly anyone starts smoking after the age of 20, so banning young people is a clever strategic approach'
Lee Hudson: 'The reality is that hardly anyone starts smoking after the age of 20, so banning young people is a clever strategic approach'

One of the first ever patients I looked after as a doctor was someone who had just been diagnosed with lung cancer. They were in their 50s, which to a 24-year-old at the time seemed a long way away. Being 50 doesn’t feel old to me anymore.

Those were the days where the youngest, most inexperienced person in a medical team was often left to tell someone they had very bad things. I will always remember their tears, and those of their spouse as I told them that they had lung cancer. I can still remember their faces, what they were wearing and even the colour of the curtains in the room. Their spouse asked me the awkward question about whether it was their smoking that had caused the cancer. They said that there was always an effort to give up but it had been impossible – they wished they’d never started. I wriggled in my chair and sort of nodded and fudged a way to agree with them both.

I was 24 and they were in their 50s. They had children and were proper grown-ups. Looking back, of course it was because they’d both started a lifetime of smoking as young people, but that wasn’t going to change things for my patient in their 50s, it was just too late. Outcomes from lung cancer are still very poor, and there was no cure for my patient. Tragically, they died within a few months.

As someone who looks after young people, what has really stayed with me is that it was their younger selves starting smoking that set off a pattern that once they had started, they couldn’t stop. The reality is that hardly anyone starts smoking after the age of 20, so banning young people is a clever strategic approach.

I was never a smoker, but as I have got older, I have had it confirmed to me that smoking is a scourge. The personal freedom and choice argument is interesting and important – and I’m generally not for banning things. But the idea that people “choose” to smoke, and certainly continue to smoke is rubbish to me.

Why do so many people struggle to quit? Tobacco is addictive and there’s a billion-pound industry that does its best to get people to smoke and to keep smoking. Encouraging smoking is the original great social influence stretching back for centuries including soldiers in both the First and Second World Wars. If it were something so harmful you naïvely signed up to on the internet you would rightly feel duped later on. In that situation, your bank might give you your money back. But you can’t give lung function and years of life back.

There is no such thing as harmless, social smoking. Every cigarette harms. In my job as a children’s doctor, I particularly see the impact of passive exposure to children. You can tell when someone smokes – there’s a smell from the dust and that gets distributed to everyone around you. There’s really good evidence that exposure to smoking in children impacts hugely on their health – that isn’t just lung disease but a range of illnesses including sudden infant death. To go back to the liberties and choice argument, children don’t get the freedom of choice of who smokes around them and contributes to making them sick.

The maths on the tax argument versus health impact is also incorrect. Smoking by far takes more out of the coffers than would be there if it were banned. Some of the commentary I have heard about a reduction in lifespan as a result of smoking being a solution to the disadvantages and pitfalls in old age is deeply disrespectful and is frankly sad and frustrating. Challenges for people who are old such as dementia, and provision of care shouldn’t be used as an argument for reducing longevity via smoking as a form of early death, or assisted dying.

Yes, a ban will have challenges. Yes, your friend who’s a bit older might give you a cigarette. Any new approach will have its challenges. But it will drive a change and tackle the influencers. Moreover, with all the crises we are tackling, for me it’s a simple issue.

A recent YouGov poll showed that 54 per cent of people have never smoked, 31 per cent did once and gave up, and only 8 per cent smoke everyday. The majority of smokers eventually go through the arduous process of quitting. I will gamble here that for most reading this, those who have never smoked are relieved they never started; those who gave up and many of those who still do wish they’d never been allowed to in the first place – and that’s what this law is really all about. Like so many important health interventions, when people look back in a decade or so, they will wonder what we were even arguing about.


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