Smoking ban fails to curb the habit: Figures reveal men are smoking MORE

The ban on smoking in public has failed to increase the number of people quitting, a report revealed yesterday. The proportion of men who smoke has actually risen since the ban in July last year while there was no change at all among women. The figures, coming after years of declining smoking rates, are a massive blow to Labour's public heath policy. According to the report, the average number of cigarettes smoked each day did not fall significantly

A survey of almost 7,000 across all age groups found on average there was no change in the number of cigarettes that smokers said they had. But in men aged 16 to 34, the number rose, by one and a half cigarettes a day. It had been hoped the ban would help reduce smoking rates among the poor in particular, but instead the number of cigarettes smoked by working class men has gone up. Off the shelf: Other anti-smoking plans include selling cigarettes under the counter to cut smoking rates among children

The Health Survey for England, carried out by the NHS for ministers, has raised fears that smokers are simply lighting up at home rather than in pubs and restaurants  -  potentially putting children at risk. Liberal Democrat health spokesman Norman Lamb said: 'These are pretty stark figures which demonstrate forcefully that the Government's strategy on smoking has not been successful. 'It's yet another case of the Government pursuing tough eye-catching initiatives which in the end don't succeed in tackling the real problem.'

Pro-smoking groups called the smoking ban 'an unmitigated failure' The smoking ban was introduced in England on July 1, 2007, to improve the health of those working in bars, restaurants and other workplaces through passive smoking. However, ministers also hoped it would help them meet targets to reduce smoking rates, particularly among those from more deprived backgrounds.

When she introduced the ban, the then health secretary Patricia Hewitt said: 'This is an enormous step forward for public health. It is going to make it easier for people who want to give up smoking to do so. Over time it will save thousands of lives.' But polls carried out before and after the ban show it has not had that impact.

The number of cigarettes smoked by men aged 16 to 34 has increased by one and a half cigarettes a day, from an average of 10.9 to 12.5 a day. The percentage of females who smoke remained constant at 21 per cent, while male smokers rose from 23 per cent to 24 per cent.

One in three smokers said the ban had encouraged them to stay at home, where they could still smoke. The numbers saying the ban would encourage them to quit dramatically fell after it came into force. A spokesman for the pro-smoking pressure group Forest said: 'These figures show that the smoking ban has been an unmitigated failure.' A spokesman for the Department of Health said: 'Smokefree laws were introduced to protect employees and the public from the harmful effects of secondhand smoke. 'The legislation was never intended to be a measure to reduce smoking prevalence.' 15.12.08

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Rise in young adult smokers

The number of young adult smokers in Scotland has risen in the last three years, new data shows. A report by NHS Health Scotland and the Scottish Public Health Observatory placed smoking rates among 16 to 24 year olds at 30% in 2007, compared with 25% in 2004.

The analysis, based on figures from the Scottish Household Survey, found the smoking rates of those aged 16-24 had decreased from 31% to 25% between 1999 and 2004, but rose to nearly one third in 2007. 19.12.08

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Champix anti-smoking drug linked to 10 British suicides

Health chiefs have revealed that ten people have committed suicide after taking a controversial anti-smoking drug linked to depression. The disclosure by the Government's drugs watchdog is the first time officials have revealed the link between Champix and suicide in this country. Earlier this year, US authorities announced they were investigating 37 similar cases there.

The Medicines and Healthcare products Regulatory Agency (MHRA) website says a total of 24 people taking the nicotine-replacement have died, of whom ten took their own lives. A further 213 claimed they had experienced suicidal thoughts and 407 said they were suffering depression.

There is no evidence that Champix has been a factor in any of the deaths. However, some experts are concerned that the drug, used by almost half a million people in Britain, may cause depressive thoughts and mood swings. The MHRA says the number of users reporting adverse side effects while using Champix, also known by its generic name varenicline, has doubled in the past seven months – up from 1,811 in February to 3,541 in September.

The figures are on the MHRA's website, which holds regularly updated information about the reported effects of drugs licensed for use in the UK. The information is provided by doctors, nurses and patients. The watchdog is now warning doctors and nurses to monitor the effects of the drug on smokers over the New Year, when many will try to kick the habit.

Its latest bulletin states: 'We continue to receive reports of suspected adverse reactions associated with varenicline, the most frequently reported of which are psychiatric disorders. As Christmas and the time for New Year's resolutions approach, we remind you to highlight to those taking varenicline the possibility of adverse psychiatric effects.'

Last April an inquest heard how TV producer Omer Jama, 39, slashed his wrists eight weeks after starting a course of pills. A toxicologist told the hearing: ‘There is a possibility he could have been influenced by the side-effects of the drug.' In November 2007, father of two Wayne Marshall, 36, from Doncaster, was found hanged shortly after completing a 13-week course of Champix.

Karen McGhee, 38, from Greenock in Scotland, tried to hang herself following a course of the drug. She said: ‘I don't have any doubt Champix is what caused me to try to take my own life.' Bob Rappaport, of the US Food and Drug Administration's drug-evaluation centre, has said: ‘A number of compelling cases look like they are the result of exposure to the drug itself and not other causes.'

Earlier this year all pilots and air traffic controllers in the US were banned from taking the drug because of fears about potential side effects. Champix was launched in the UK in 2006. It works on the brain's receptors to reduce the cravings and withdrawal symptoms associated with quitting. In trials, nearly a quarter of those taking Champix had given up smoking after a year compared with 16 per cent using nicotine patches.

But after monitoring adverse effects, the European Medicines Agency ruled last December that the safety leaflets in boxes of Champix be updated to include warnings about suicide and depression. Manufacturer Pfizer added the warnings in February and updated them in July. It advises patients who suspect they are experiencing side effects to stop taking the medication.

Pfizer said: ‘Stopping smoking, with or without treatment, is associated with nicotine withdrawal symptoms and the exacerbation of underlying psychiatric illness. ‘Pfizer rigorously tested varenicline in a comprehensive clinical trial programme lasting many years and involving thousands of patients. ‘Based on the results of those clinical trials, regulatory agencies in Europe, the US and elsewhere have recognised the safety and efficacy profile of varenicline and approved the medicine for use in smoking cessation in adults.' 10.11.08

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Stop smoking drug 'Champix' concerns raised

It was launched as a wonder drug. A tablet to take the pain out of kicking the killer weed. Since it appeared on the market two years ago in the UK , almost 400,000 prescriptions for Champix have been written. Across the world, that figure is currently sitting at nine million. Champix, or varenicline, to give it its clinical name, was first licensed here in December 2006.

It mimics the effects of nicotine on the body so it both reduces the urge to smoke and relieves withdrawal symptoms. In clinical trials, it proved more effective than alternative remedies at getting people to quit. For its makers - Pfizer - Champix has been a huge success.

In its first full year on the market, the drug brought in a staggering $883m for the company. But about a year ago, I became aware of stories emerging in the media in which people who had taken Champix were said to have suffered severe depression. I learned of a woman, Karen McGhee, from Greenock , who tried to kill herself just a few days after taking Champix. Her husband Robert told me of the night he found his wife hanging from the hall stairs.

Robert McGhee said: "I just got woken up with my daughter dragging me out of my bed to come downstairs. She was shouting, 'Dad, my mum's hung herself. She's hung herself'. And I just couldn't comprehend it, I thought I was dreaming.

"I ran downstairs and Karen was on the floor on her knees with a pelmet round her neck. I tried to lift her up to free the knot, but I couldn't get it loosened. I managed to cut her free and take the noose off her neck."

'Suicidal tendencies'
After several days on a ventilator, Karen McGhee pulled through. She is convinced it was Champix which led to her suicide attempt. She said: "I'll never put myself through that again and never put my family through it again. I'll always be a smoker, or, if I quit, then I'll quit naturally."

I heard of another case - Omer Jama - a young Manchester man who had killed himself while taking Champix. His brother, Ali, said: "He'd slashed his wrists. They'd found him on the floor in the landing and it was a shocking scene. There was no suicide note. It was just a random act, completely out of character, that took an instant." Omer had clearly taken his own life. But surprisingly, at the inquest, the coroner did not record his death as suicide.

Ali said: "The coroner recorded an open verdict because she couldn't record a verdict of suicide, because on the evidence of the forensic toxicologist she found that Champix was still in Omer's bloodstream and she had researched that it had possible links to suicidal tendencies. So she couldn't rule out that it didn't play a part in his suicide."

I discovered that across Britain , more than 3,000 people have complained about adverse reactions to Champix. About 260 have reported suicidal-related reactions to the drug. Of these, 16 had attempted suicide and 10 had killed themselves. But 260 reported bad reactions, no matter how severe, sounds like a drop in the ocean compared to millions of Champix prescriptions. I wanted to know whether these extreme reactions were just isolated cases.

I went to the US where the drug - marketed there as Chantix - was developed and first launched. I met James Elliott, a veteran of the war in Iraq , who had been given the drug by the US Government's department of Veterans Affairs, as part of his treatment for post-traumatic stress disorder. One night, a few days into the Chantix course, he fought with his girlfriend, grabbed a handgun, walked into the Washington DC night, and forced the police into an armed stand-off.

James told me: "I think there were nine officers there. And two of them had rifles trained on my head. Those guys would not have missed. I antagonised them. You guys got guns. You tough guys. Shoot me. It'll be alright." The police used a taser gun to subdue him, and he's lucky to be alive today.

'Psychiatric problems'
His story prompted an investigation by the US Congress. Giving evidence, he told them he was never warned about the possible side effects. He is adamant Chantix played a part in his actions that night. He said: "I put the whole community at risk. I did. The doctors did. Chantix did."

During my investigation, I also met one of the country's leading personal injury lawyers. Marc Grossman has launched five law suits against Pfizer and has 20 more cases ready to go. He said: "We have a 40-year-old man with three children who has no prior history of psychiatric problems who, out of the blue, went and put a shotgun to his mouth and killed himself. "And another case is of a man who shot himself in the head. "We have a woman with kids who hung herself. "All the cases are just the most shocking, bizarre scenarios where someone just out of the blue commits suicide without any prior depression."

I suggested to him that it wasn't unusual for people to commit suicide out of the blue with no history of depression. He told me: "It doesn't happen as often as with the people taking Champix. It happens far more often that you'd ever expect and far more often than is acceptable."

Champix is big business, but it is also designed to be the answer to one of the most serious health issues facing the world, and especially Scotland . Here, 13,000 people die every year from smoking-related illnesses, and it's the single biggest preventable cause of death. Against that backdrop a drug which stops people smoking would be welcomed, and even a small decrease in smokers would loosen up resources across the Scottish health service.

Pfizer declined to speak to the programme, but a statement from the company said the packs carry warnings about the reported side effects, and point out that there's no proof the drug has any links with suicidal behaviour. The body which licenses pharmaceuticals for use across the whole of the European Union tells us it's monitoring the drug closely, but at the moment feels the benefits of Champix far outweigh any current potential risks.

Monitoring programme
Dr Hans-Georg Eichler, senior medical officer with the European Medicines Agency (EMEA), told me: "This drug is designed and has been shown to be effective in helping patients quit smoking. "Now we all know that there are several hundred thousand premature deaths across the European Union every year. "This is a major public health issue. We know that a large proportion of smokers want to quit but they find it difficult.

"So against that background any drug, and I emphasise any drug, that has a positive benefit risk profile is valuable and welcome. "I think the public is justified to be concerned and we're extremely concerned. "But being concerned is not the same as being convinced that there is a causal relationship. "So that's why we have implemented a high alert monitoring programme.

"We have here in the agency weekly meetings where we would analyse all the incoming data, and would alert the committee that is relevant, the working party, that is charged to specifically look at these events and see what action is required.' 26.11.08

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'Smoking police' hit the streets to shock people into quitting

Smokers will be stopped in the street and asked to take a carbon monoxide test in London's most hard-hitting anti-smoking campaign. 'Smoking police' will target people at betting shops, bus stops and shopping centres to shock them into giving up cigarettes. They will be asked to breathe into a monitor to show how much carbon monoxide is in their bodies, and could then be signed up to local stop-smoking services and given access to counsellors.

Pro-smoking group Forest described the campaign as a humiliating infringement of civil liberties. Ealing Primary Care Trust, which is funding the £75,000 scheme, said it could help 2,400 people to give up. A team of 11 young people have been employed to approach smokers, in a similar way to charity fund-raisers  -  nicknamed 'chuggers'  -  who ask passers-by for donations.

Project spokeswoman Fran Pearce admitted: 'They will have to be careful when approaching smokers in case they become aggressive, but we are interested to see how it pans out. If someone says no, they will not pressure them to take the test.' Project manager Phil Robinson of Ealing Stop Smoking-Service said: 'The law to ban smoking in public places was hugely effective, but since then some focus has been lost.

'We want to put stopping smoking back on the agenda, so 50 per cent of our current activity is about personalising and localising our campaign and taking our message direct to smokers.' He added: 'We will be focusing on betting shops, transport stops, walk-throughs, shopping centres and leisure areas where most smoking takes place.'

There are 75,000 smokers in Ealing, and it is hoped 7,500 will take the new test, with 2,400 going on to quit completely. Forest spokesman Neil Rafferty said: 'It shows the authorities think they have a blank cheque to treat smokers how they want  -  to harass, humiliate and victimise them. 'This is an outrageous abuse of freedom and privacy. It is the health Nazi equivalent of chuggers.' 17.9.08

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NHS suspects fraud in £61m stop smoking programme

Counter-fraud specialists are investigating claims that pharmacists are stealing money from the NHS by fiddling figures on the number of people they have helped to give up smoking. The Guardian has learned of inquiries in five primary care trusts in London into allegations that chemists have fraudulently claimed thousands of pounds, claiming cash rewards of up to £85 for each patient they help to stop smoking for at least four weeks.

The NHS counter-fraud team is considering a nationwide exercise to establish the extent of the problem. The Liberal Democrat spokesman for health, Steve Webb, said fraud was now a multi-million pound problem for the NHS. At one trust the fraud being investigated is estimated at more than £15,000. If the inquiries confirm fraudulent activity police will be called in to prosecute.

Anti-smoking charities have written to the chancellor to lobby for a simple monitoring system to scan pharmacists' claims and protect the government's £61m programme to help people give up cigarettes. The five areas cannot be named as in some cases the pharmacists do not know that they are being investigated. But it is understood that one pharmacist in north London had claimed nearly 100% success rates when research suggests that the best rates that can be expected is 55% of smokers continuing to abstain after four weeks.

An NHS counter-fraud service spokes-man said: "Our pharmaceutical fraud team is also exploring the possibility of undertaking an exercise to uncover similar fraudulent behaviour throughout England and Wales." Mr Webb said: "There is already evidence of serious fraud in the NHS. To lose even a small percentage of the NHS's £80bn budget is big money. I have no doubt that there's much more fraud in the NHS than we've learned about today."

The quit smoking programmes provide support groups and access to nicotine replacement therapies to encourage people to quit smoking. Some areas opt to have pharmacists deliver the programmes which include monitoring of carbon monoxide levels in blood to prove they have quit. Typically they provide six meetings, providing patches and testing carbon monoxide levels each time to make sure people are not slipping.

Pharmacists receive cash bonuses of between £50 and £85 for every person who has continued to abstain from smoking four weeks after starting the programme, as proved by two consecutive low carbon monoxide readings. A pharmacist who treats 600 patients in a year stands to make up to £85,000 gross profit.

A Royal Pharmaceutical Society spokesman said: "Any person found guilty of misconduct by the society's disciplinary committee will be removed from the register and prevented from working as a pharmacist." 28.12.06

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Report says smoking costs NHS £2.7 billion pounds a year

Smoking costs the NHS £2.7 billion pounds a year, one billion more than a decade ago, according to a report by an anti-smoking group. Action on Smoking and Health (ASH) said the cost would have risen to more than 3 billion pounds annually had action not led to a fall in the number of smokers from 12 to nine million.

The report called for the government to take more action in health legislation to be unveiled in December, with demands for plain packaging of tobacco products and a ban on shop displays. Since 2003 it has been illegal for manufacturers to use any trademark or sign to suggest that one product is less harmful than another but ASH said more needed to be done to curb misleading branding and messages being given to young people.

It cited research from the University of Nottingham which found that using the word "smooth" or lighter coloured branding misled young people into thinking the product was not as bad for their health. "The government could save thousands of lives and hundreds of millions from the NHS budget with an ambitious new tobacco control strategy," said Deborah Arnott, director of ASH.

"More than anything we need to protect young people from the aggressive marketing techniques employed by the tobacco industry." Pro-smoking groups argue that measures such as banning tobacco displays and vending machines would not work. Instead, they advocate stronger enforcement of a ban on selling tobacco to those under 18. "Far from being a drain on society, smokers make an enormous financial contribution," said Simon Clark, director of the lobby group Forest told the BBC.

"Each year smokers pay over £9 billion pounds in tobacco taxation, a figure that dwarfs the alleged cost of smoking to the NHS." According to figures from ASH, over 80,000 people die from smoking related diseases every year, while one in seven 15-year-olds was a regular smoker. 7.10.08

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Health chiefs axe 200 beds... then fork out £350,000 on 'stop smoking' advisers

Health service chiefs have been attacked for hiring 12 ‘smoking cessation' advisers and managers on salaries of up to £38,300 only a year after it was announced that as many as 200 hospital beds were being cut to save money.

Nine counsellors and three administrators are being paid a total of up to £350,000 a year to encourage Leicester's estimated 68,000 smokers to quit. But critics say much of their work could be done far more cheaply by GPs, health visitors and district nurses who come into daily contact with smokers as part of their normal duties.

Among its counsellors the stop-smoking unit – run by the primary care trust NHS Leicester City – has one specialist adviser for pregnant women, another for people with mental health problems and another for young people and families. They are backed up by a team manager, administrator and office manager plus a varying number of part-time staff brought in when required.

Specialist advisers in the NHS are in the £24,103-£32,653 salary band while team managers get between £29,091 and £38,352. Leicester's programme – called STOP! – is expected to cost £476,844 in the current financial year. But one GP who has a long-established practice in the city said smokers should have to do more to kick the habit themselves.

‘Willpower costs nothing. It would be better to cut out all this bureaucracy and free up the cash to care for cancer patients,' he said. Michael Summers, vice-chairman of the Patients Association, said: ‘The NHS constitution states that it is down to patients who drink to excess or smoke to take responsibility for their own health. I am all for anti-cigarette advertising and health warnings on packets.

‘But it cannot be right for a trust to be spending nearly half-a-million pounds on a project which has little to do with front-line patient care when bed closures are announced.' The cutbacks are being made in an attempt to tackle a predicted £32million shortfall by health organisations across Leicestershire.

They were announced by University Hospitals of Leicester Trust – which runs Leicester Royal Infirmary, Leicester General and Glenfield Hospital – and include the axing of up to eight wards and 900 jobs. Despite the financial crisis, NHS Leicester City – which is responsible for non-hospital health issues – also employs an £85,000-a-year director of equality and human rights and two people with the intriguing job titles of ‘cause for concern manager' and ‘cause for concern administrator'.

Some other trusts do have quit-smoking advisers, but far fewer. Heart of Birmingham Teaching Primary Care Trust has five counsellors while Liverpool Primary Care Trust has none and relies instead on a community-based organisation called Fag Ends. Smoking is the main cause of preventable and premature death in Britain and the Department of Health encourages NHS trusts to run anti-smoking programmes. A spokesman for NHS Leicester City said: ‘Smoking cessation is one of the most cost-effective interventions to promote better health.

‘Last year the STOP! service exceeded its annual target, helping more than 2,400 people to give up smoking. The team has been strengthened recently to focus on several key areas, including smokers in vulnerable groups. ‘A considerable part of the team's time is also spent on training healthcare workers and others about how they can contribute to reducing Leicester's smoking rates.' 22.8.08

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Drug taken to stop smoking is linked to traffic accidents

WASHINGTON -- Daniel Williams hoped Chantix would help him quit smoking and become healthier. Instead, he believes, it nearly killed him. Daniel Williams was driving his pickup on a country road in Louisiana when, according to his passenger, his eyes rolled back in his head and he swerved left — into a bayou. His doctor later made the connection to Chantix, which Williams had just begun taking.

Daniel Williams decided he'd listen to his girlfriend and his 8-year-old son and finally quit smoking, with the help of a new prescription drug called Chantix. He started taking the medication, and a couple of nights later, as he was driving his pickup truck on a country road in Louisiana, Williams suddenly swerved left.

His girlfriend, Melinda Lofton, who was with him, later told him that his eyes had rolled back in his head and that it had seemed as if he was frozen at the wheel, accelerating. Moments later, they were in a bayou, struggling to escape the murky water, Williams said.

"Since I was a kid, never had anything like this ever happened before," he said. "It never happened before, and it hasn't happened since. And all the tests I've taken say I have nothing wrong with me at all."

The nonprofit Institute for Safe Medication Practices last week linked Chantix to more than two dozen highway accidents reported to the Food and Drug Administration, saying the mishaps may have resulted from such drug side effects as seizures.

The FDA had earlier issued a warning about suicidal thoughts and suicides among patients taking Chantix and is now evaluating whether it needs to expand and strengthen that precaution. Pfizer, the drug's manufacturer, said that as early as May of last year, it had added a warning to the prescribing literature for Chantix that patients should exercise caution when driving or operating machinery until they know how the medication affects them.

But such admonitions apparently didn't get much notice from busy doctors. Even some government transportation agencies missed them. The Federal Aviation Administration continued, until last week, to list the drug as approved for pilots. The federal truck safety agency was also unaware of the risk.

"That is a problem," said Janet Woodcock, head of the FDA's drug evaluation center, adding that her office needs to find ways to communicate safety information more effectively.

The military, which bans Chantix for flight and missile crews, is considering whether other precautions are needed, Pentagon officials said. Woodcock said the FDA believes the medication should remain on the market as an option for smokers trying to quit.

Approved two years ago, it differs from other smoking-cessation drugs by acting directly at sites in the brain affected by nicotine, blocking the pleasure that comes from smoking as well as the cravings. But Williams, 28, said he was surprised that a drug he had hoped would help turn him into a healthier person instead, he believes, caused an accident in which he could have been seriously hurt, even killed. Lofton is still struggling with a neck injury she suffered.

Williams, a telephone service technician, lives near Rayville, La., between Shreveport and the Mississippi River. He said he went to see his doctor last year for help quitting his nearly two-pack-a-day habit. He'd started smoking in high school and had failed in previous attempts to quit. But he knew people who recommended Chantix. 27.5.08

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Sky Sports executive slashed wrists after taking controversial stop-smoking drug - Champix

A television executive killed himself just weeks after starting to take a controversial smoking cessation drug linked to depression. Omer Jama, 39, a Sky Sports editor who had no history of mental illness, was found dead at his home just two months after he began a course of drugs to help him quit his 20-a-day habit. Mr Jama, a video editor with Sky Sports, had slashed both his wrists and stabbed himself in the thigh and stomach.

Julie Evans, a forensic toxicologist, told the inquest into his death: "There is a possibility he could have been influenced by the side effects of the drug." Fears are growing over the safety of the so-called "wonder drug" which has been used by more than 200,000 people in the UK .

Now the family of Mr Jama from Bolton called for more investigations into its safety of the drug after a coroner returned an open verdict into his death. His brother, Ali Jama, 41, said: "It is clear from the evidence of the toxicologist that Champix's influence could have played a part.

"I would like to see more investigation done." Catherine Jama, his wife of 12 years, told the inquest the couple had recently separated on a trial basis but they met regularly and he was his "usual self" and friends said he was happy in the days before his death. He had booked a holiday to Cuba with a friend just days previously to celebrate is 40th birthday and the keen amateur golfer was still on a high after winning a trophy.

"They just weren't the actions of a man who was contemplating suicide," said Mr Jama, aged 41, of London . "He's got no history of depression and was never the sort of person you would see feeling sorry for himself." Coroner Jennifer Leeming said she would be writing to the Committee for Medicinal Products for Human Use which has been monitoring the drug since it was first authorised in September 2006.

Last year the body received 839 reports of adverse reactions and figures showed 46 were linked to depression and 16 patients claimed to have suffered suicidal thoughts. She said she would register Mr Jama's death as an "adverse event" but was satisfied he inflicted the injuries on himself.

She said: "For me to register he took his own life I would have to be satisfied he did the act which led to his death and he knew what he was doing. "On the evidence before me I cannot say that was the case."

The European Medicines Agency, the drug's licensers, issued guidance on Champix's active ingredient varenicline to doctors two months after Mr Jama's death that "updated warnings" were needed to increase awareness of cases of suicidal thoughts.

Champix is the first non-nicotine anti-smoking treatment and works on brain receptors to relieve cravings and nicotine withdrawal symptoms. Manufacturer Pfizer has insisted a direct link between Champix and psychiatric problems has not been officially established and that nicotine withdrawal can lead to mood swings and behavioural changes. A spokesman for Pfizer said: "Depression, rarely including suicidal ideation, has been reported in patients undergoing a smoking cessation attempt.

"These symptoms have also been reported while quitting with varenicline. "A relationship between varenicline and the reported symptoms hasn't been established, but in some reports a link couldn't be excluded."

Anti-smoking drug, Zyban, which is made by GlaxoSmithKline, has also been linked to a number of suicides among patients. 15.4.08

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Council sparks fury as it becomes first in Britain to ban smoking outside pubs

The first town in Britain looks set to ban smoking outside pubs and cafes but furious landlords have vowed to fight the extreme council plans. Bar and cafe owners have said they are prepared to go to court if the local authority's decision to ban smoking on pavements outside their businesses goes ahead.

By April, smokers in Barnsley , South Yorkshire may find there are few places where they can light up. Under the new regulations smoking will only be allowed outside in private beer gardens. The move has caused uproar among the town's licensees who have seen trade dwindle since the indoor smoking ban came into force. Publican Paul McNicholas, chairman of the town centre Pubwatch scheme said: "I feel so strongly about this I would be prepared to go to court. "There is no other place in the country even contemplating it. It would be difficult to enforce."

Mr McNicholas has spent £9,000 on awnings, tables and heaters so customers can sit outside his Irish pub and enjoy a pint and a cigarette. He said: "Having the outside area has compensated me and evened things out since the smoking ban. These new guidelines could be the difference between bars surviving and not." Walkabout bar manager Greg Harding said: "I think it is ridiculous." He has a street drinking area in front of the town-centre premises and was offered the lease of the land by Barnsley Council. He said: "It gets people out front and brings a bit of colour to the town. This rule would make it untenable for us to continue taking this space from the council."

Barnsley Council's environment department came up with the scheme in a document entitled "Guidelines for street cafes" in Barnsley town centre. The new rule states: "As of April 1 the licensed cafe area will be a no-smoking area. "It will be the responsibility of the applicant to ensure that customers are reminded of this. "If it is noted that on three separate occasions customers are witnessed to be smoking, then the licence will be revoked."

Councillor Roy Miller, Barnsley 's environment committee head said consultations were still taking place and input would be welcomed from licensees. He said: "We are awaiting the responses and I am having a meeting with several landlords."

The move has been attacked by the pro-smoking organisation FOREST which says the scheme is "dubious, difficult to enforce and a potential death knell for businesses without space for a beer garden." Director Simon Clarke said: "It is the first time we have heard of such a plan anywhere in the country. "If the council wants smokers off the streets it would be more productive to use resources for smoking rooms. "If this is brought in I will come to Barnsley myself and light up even though I don't smoke." 22.2.08

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Woman tries to kill herself while taking Champix: Is this smoking pill safe?

When Karen McGhee woke up in a hospital bed and saw her teenage daughter looking anxiously at her, she was completely flummoxed. "My arm was bandaged and the left side of my mouth and neck felt numb, as if I had been to the dentist - but I had no idea why I was in hospital," says the 38-year-old.

"Then Jenna told me I'd tried to kill myself. She said her nine-year-old sister, Aynslie, had found me in the middle of the night hanging from the banisters with the pelmet from the curtains tied around my neck." Karen listened in horror as her daughter recalled how she had turned blue through lack of oxygen, and her heart stopped five times in the ambulance on the way to hospital. The doctors were convinced Karen had brain damage, and after three agonising days her family had decided to turn off her life support machine. She was expected to die within minutes, but instead miraculously began to breathe on her own. With absolutely no memory at all of what she'd done, Karen says her daughter's account of what had happened was like hearing about another person. "My last recollection was of being extremely happy," she says.

In fact, the mother-of-three from Greenock , Scotland , had developed severe depression and tried to hang herself after taking Champix - a pill designed to help reduce nicotine withdrawal symptoms and stop cravings. Yesterday, the Mail reported how Wayne Marshall, a 36-year-old father-of-two from Doncaster , was found hanged shortly after completing a 13-week course of the same drug. Last October, TV editor Omer Jama, 39, committed suicide after starting using Champix.

Medical watchdogs are being urged to investigate the drug to ensure it is safe to use. The drug works by binding to nicotine receptors in the brain. Nicotine stimulates the production of dopamine, which is the "pleasure" chemical in the brain. By attaching itself to the receptors normally used by nicotine, Champix fools the brain into thinking it's had nicotine - so satisying the craving for a cigarette.

The drug has modest success rate. After 12 weeks, 22 per cent of those taking Champix have given up smoking. However, since the drug's launch in Britain in December 2006, the Government's drug safety watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), has received 1,513 reports of adverse reactions, including 62 reports of suicidal feelings.

As Jenna told her mother what had happened, Karen began to wonder if the medication she'd been taking in the weeks up to the fateful event had played a part in it. "After Robert's heart attack last July, his consultant recommended Champix to him," she says. "He smoked 60 a day and had never been able to quit. "I decided I would also try to quit my 20-a-day habit. My husband's heart attack had hammered home to me just how dangerous smoking can be."

The couple were given a standard 12-week course of Champix tablets and told to try to give up cigarettes ten days into the course. However, just days after starting on Champix, Karen realised something wasn't quite right. "I started to feel really grouchy all the time, and would shout and scream at my family for no good reason, which is totally out of character."

Indeed, she became so moody that even her mother-in-law noticed something was wrong and suggested she should stop taking the pills. But Karen thought it was probably nicotine withdrawal that was causing the problem - and so continued. However, she began to feel even worse. "I started being sick about three times a day," says Karen. "Looking back, I was stupid to think it was because I'd quit smoking, but I'd had no idea what to expect.

"I also became really depressed. I felt so low that I couldn't see the point in doing anything. Normally, I am an active person, but I started spending the whole day slumped on the sofa. I had no enthusiasm for anything." Karen had suffered from mild depression on and off for the past 20 years and started taking antidepressants in 2005. However, she says Champix made her feel lower than ever.

In September, just under two months after she'd started taking the drug, her husband became very concerned. "Robert said he wanted his wife back - and pleaded with me to stop taking the tablets," says Karen. He was so worried by the effect the pills were having on his wife that he had stopped taking them himself. He had also become irritable. Despite this, Karen was still convinced the pills were not the problem, and put her symptoms down to nicotine withdrawal. "I was so low that my mother said to me: 'I would rather you started smoking again than continue like this'." she says.

"Robert kept trying to do things to cheer me up, such as taking me out for dinner, but I could not shift this deep depression. I did not bother talking to my GP about it because I thought it was just something I had to endure after giving up smoking."

On October 17, following a meal out, the family went to bed as normal. The next thing that Karen remembers is waking up in hospital. The following day a psychiatrist came to see her. Karen says: "Robert showed him the Champix and said : 'Do you think this made her do what she did?' The psychiatrist said: 'It won't have helped'." Karen stopped taking the pills immediately. She was kept in hospital for a week, where her mood improved drastically. Her husband said he felt as if the "old" Karen had come back.

She now has a six-inch scar on her arm where it was burnt on the radiator during her suicide bid. But the mental scars are much deeper. Her daughter Aynslie is so traumatised by what happened that she refuses to go up the stairs alone. "I try each day to be as nice to my children as possible, to make up for what I put them through," says Karen.

"Aynslie said to me recently: 'Don't feel guilty about what happened, Mummy. It wasn't you - it was the pills'. "I am convinced Champix is to blame for what happened to me. "A week after my suicide bid, I opened the paper to read about Wayne Marshall, who did kill himself after taking Champix.

"It sent chills though me. It could so easily have been me, and the idea of leaving Robert and the children is just unthinkable. "I am ashamed to say that a week after leaving hospital, I started smoking again. No one has criticised me for it. They would all rather have me smoking than dead. "I suspect I will smoke for the rest of my life. After everything that has happened, I am just too frightened to give up."

Dr Alex Bobak, a GP from Wandsworth, is the only doctor in the country to have a specialist interest in smoking cessation and has helped conduct trials on Champix (though he is not paid by the makers). He believes the drug is safe. "I am convinced it is giving up smoking, and not the effects of Champix, which have caused some people to feel suicidal," he says.

"Without nicotine, many people do become irritable, grouchy and depressed - even suicidal. "This is because nicotine stimulates the production of dopamine in the brain, a chemical which induces feelings of happiness. Without it, some people can become down. "Interestingly, in trials on people trying to quit smoking, those taking Champix reported feeling much less irritable and depressed than those taking a placebo pill.

"I think that for most people Champix does help reduce all the bad feelings, but for some people - and I believe only a small minority - it does not do this enough. "I would urge people not to be put off taking this drug. Remember, more than 50 per cent of long-term smokers will die prematurely as a result of a smoking related disease."

Pfizer, the makers of Champix, said in a statement: "We are working closely with the EMEA ( European Medicines Agency) to review reports of depression and suicidal thoughts in patients attempting to stop smoking and taking Champix. "There is no scientific evidence establishing a casual relationship between varenicline (Champix) and these reported events."

However, Pfizer, who make the smoking cessation drug Champix (varenicline), have updated the drug's labelling in the United States to reflect the fact patients may experience "serious neuropsychiatric symptoms", including suicidal behaviour. 23.1.08

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Widow claims father-of-two driven to suicide by 'quit smoking' drug champix

A widow claimed yesterday that a drug designed to help smokers quit may have played a role in her husband's suicide. Father-of-two Wayne Marshall, 36, was found hanged shortly after completing a 13-week course of Champix, which it is feared may have depressive side effects. His death is the second in the UK to be linked to the newly-licensed drug.

Mr Marshall's widow Emma said he was prescribed the drug by his GP last August to help him quit his 20-a-day habit, but quickly went downhill, cutting himself off from his family and friends. Mr Marshall, a welder, from Rossington near Doncaster, died in November. Last month, an inquest in Doncaster recorded a verdict that he killed himself.

Mrs Marshall, 28, said she believed the drug had played a part in his death and has reported the case to the Medicines and Healthcare Products Regulatory Agency. "I don't want anybody to go through what myself, his children and his family and friends are facing," she said. "It is horrendous. "People need to think about going on this drug, particularly if they have a history of depression.'

After her husband's inquest, Mrs Marshall, a distribution coordinator, discovered Champix has been linked to depression. Mrs Marshall, who said her husband had once before attempted suicide when he was a teenager, had moved out of the couple's home a month before the tragedy.

His previous attempts to give up smoking had failed, but he did not smoke while taking Champix. He became quiet and withdrawn, however, and one day she found him sobbing uncontrollably. "I don't understand how he went downhill so quickly," she said. "He was not the type of person who needed picking up but his whole personality changed. He closed himself off completely from everybody. "These tablets did seem to be working. It was just his moods."

He had finished the drug course a week before she last saw him, but had started smoking immediately. "He was more positive than when I saw him previously," she said. "Never ever could I have dreamt he would have done something like that." Last October, TV editor Omer Jama, 39,was found dead at his home in Bolton. He slashed his wrists weeks after starting a course of Champix. Mr Jama had just booked a foreign holiday and had no history of depression.

The European Medicines Agency last month ordered improved warnings to patients over the twice-daily prescription medicine following reports it could lead to depression. Figures from the MHRA show one patient has taken his life while on the drug, two others have attempted suicide and there have been 60 other "suicidal-type suspected adverse reactions" reported.

About 200,000 patients have been prescribed the drug in the UK since December 2006 and it was approved by the Health Service last July.

An MHRA spokesman said Champix, which is made by Pfizer, was being closely monitored. He said: "Giving up smoking can be very stressful. The side effects are suspected. It does not necessarily mean the drugs caused the reaction." 21.1.08

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15% success rate for NHS stop smoking clinics

NHS "stop smoking" clinics have been hailed a success after figures showed particular progress in deprived areas. The study found 8.8% of smokers in poorer areas had quit at the four-week mark (4 weeks is the date when the information is compiled, 2 weeks is the period in question), compared with 7.8% elsewhere. The comparison is particularly relevant as smoking is a key factor in health inequalities with those from deprived backgrounds more likely to smoke. The Bath University-led team compiled the data from the 1.5m people using the clinics in England from 2003 to 2006.

Smoking cessation clinics, offering counselling and treatment in the form of nicotine replacement therapy, were set up in 1999. Lead researcher Dr Linda Bault, who worked with experts from Edinburgh University , said: "Our study shows that the NHS stop smoking services are helping to reduce the health gap between rich and poor, which is good news for the overall health of the nation." But she added stop smoking services had to be accompanied by the continued successful implementation of smoking bans and rises in tobacco prices to have a wider effect.

The study, published in the Tobacco Control journal, compared data from smokers who accessed services in officially designated disadvantaged areas, called spearhead areas which have received extra funds and cover just over a quarter of the population, and compared them with other areas of the country. The study found that quit rates were slightly lower for smokers from spearhead areas, at 53% at four weeks compared with 58% elsewhere.

But it added the services were treating them in larger numbers as a proportion of overall smokers than their more affluent neighbours, 17% compared with 13% elsewhere. The overall effect was that a higher proportion of smokers in the more disadvantaged areas were successful in quitting. Although previous research has shown that of those who quit after a month, less than one in four were still not smoking by the year-mark.

Tim Crayford, of the Association of Directors of Public Health, said: "This study shows that extra NHS cash really has managed to get more people to stop smoking. That is good news for the health of the country. "Better still, the NHS has worked with smokers from deprived communities, and this will reduce health inequalities." He called for more money to be put into NHS services after recent predictions show the health service was heading for a £1.8bn surplus this year.

A Department of Health spokeswoman said NHS smoking cessation services had been "highly effective". And she added: "Narrowing the inequalities gap is a major challenge, but it is achievable." 5.12.07

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Smoking at the wheel could lead to conviction

Drivers who smoke at the wheel could face prosecution under changes to the Highway Code. Lighting-up at the wheel has been added to the list of "distractions" which police and lawyers can cite in court when seeking a conviction for a traffic offence. It joins eating and drinking, "inserting a cassette or CD or tuning a radio", "arguing with your passengers or other road users", trying to read maps, and - even playing loud music - most, if not all, of which have featured in successful prosecutions. High-profile cases have involved motorists eating apples, Kit-Kats and sausage rolls. Up to one in four UK adults smoke, which could mean more than eight million of the nation's 33 million motorists are at risk.

Brian James, road traffic chairman of the Magistrates Association, said that although the code carries no legal force, failure to observe its advice could be used as evidence that an offence had been committed. The new Highway Code, the first for eight years, has increased in size by about 50 per cent and contains 29 more rules. There is also a new section for novice drivers. Andrew Howard, the AA's head of road safety, said last night: "The Highway Code is the definitive guide to safe and lawful road use. "It has grown since 1931 from 18 pages to 135, reflecting the complexities of modern motoring. "A major change is the inclusion of smoking at the wheel as behaviour that police may interpret as a distraction and failure to be in proper control of the vehicle. "It can - and no doubt will - be used in court as corroborating evidence." A recent report by academics at Brunel University warned that car crashes could rise as the ban on smoking in public places leads more people to take a drag at the wheel. It said smokers drive 23 per cent faster and are more inconsistent than non-smokers. The report for insurance company Privilege reinforced growing calls for smoking while driving top be made a criminal offence like using a mobile phone, which now attracts three penalty points and a £60 fine. Supporters say holding a cigarette is equally dangerous. The code's new section for novice drivers tells them: If you are driving with passengers, you are responsible for their safety; Don't let them distract you or encourage you to take risks; Never show off or try to compete with other drivers, particularly if they are driving badly. Only one in 20 accidents are caused by drivers breaking the speed limit, Government figures showed yesterday. A failure to look properly at the road and traffic is a bigger reason. It was a contributory factor in more than a third of accidents and one in five deaths last year, according to the Transport Department. 28.9.07

Cannabis use among young offenders rockets by 75 per cent in just three years

The number of young criminals using cannabis has shot up since Labour downgraded the drug's legal status. Figures suggest that use of cannabis among juvenile offenders has roughly doubled in three years.

In some parts of the country that means nine out of ten teenage criminals have been using the drug. Links between cannabis and crime have been causing concern since former Home Secretary David Blunkett decided to label it a Class C drug rather than Class B - a switch that meant police are highly unlikely to arrest anyone caught with it.

That 2004 decision appears to have intensified use of cannabis among the youngest criminals. Yesterday's figures come from a survey for local Youth Offending Teams, which run probation and attempt reform of teenage criminals.

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Doctors refuse to fix builder's broken ankle unless he quits smoking

A man with a broken ankle is facing a lifetime of pain because a Health Service hospital has refused to treat him unless he gives up smoking. John Nuttall, 57, needs surgery to set the ankle which he broke in three places two years ago because it did not mend naturally with a plaster cast.

Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation. They have told him they will treat him only if he gives up smoking. But the former builder has been unable to break his habit and is now resigned to coping with the injury as he cannot afford private treatment. He is in constant pain from the grating of the broken bones against each other and has been prescribed daily doses of morphine.

Mr Nuttall, of Newlyn, Cornwall, broke the ankle in a fall in 2005. Initially he refused surgery because he had caught MRSA at a different hospital four years earlier, and was terrified of history repeating itself. He hoped the fractured bones would knit together with a standard plaster cast to immobilise his ankle. But six months and three plaster casts later, it became clear that an operation to pin the bones was the only solution.

However, the hospital told Mr Nuttall, who no longer works because of smoking-related chest problems, that he would have to give up smoking before an operation could be carried out. Mr Nuttall said: '"I am in agony. I have begged them to operate but they won't. I have tried my hardestto give up smoking but I can't. I got down to ten a week at one point but they said that was not good enough. "I spent 12 months trying to give up and used patches and everything, but nothing works. "I have smoked for over 40 years and it's not going to happen. "We were brought up at a time when cigarette advertisements were everywhere and there were no warnings.

"I want to warn other smokers that they could be denied medical treatment and there is nothing we can do about it. "I have paid my dues as a taxpayer-and now the NHS won't treat me." Mr Nuttall, who is single, uses a walking stick to get around and fears his bones will now be so 'calcified' that an operation would not work even if he were allowed to have it. "It is very painful," he said. "If I walk more than a few steps I can feel it grinding."

A spokesman for the hospital trust said: "Smoking has a very big influence on the outcome of this type of surgery, and the healing process would be hindered significantly." 14.9.07

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Dramatic fall in heart attacks in wake of smoking ban in Scotland

The number of people rushed to hospital with a heart attack has fallen sharply since the start of Scotland's smoking ban, a report has found. Researchers have found a 17 per cent fall in hospital admissions for heart attacks in the first year of the ban. Before it came into effect in March last year, the annual reduction over the preceding decade had been just 3 per cent.

The figure was published in research papers discussed today at a conference studying the impact of the ban on smoking in enclosed public spaces. Organisers said a national evaluation also found a 39 per cent reduction in second-hand smoke exposure in 11-year-olds and among adult non-smokers.

There was no evidence of smoking shifting from public places into homes, and there was high public support for the ban even among smokers. The two-day conference at the Edinburgh International Conference Centre has attracted an international audience of health experts and policy-makers.

Scotland's Deputy Chief Medical Officer, Professor Peter Donnelly, said research presented at the conference showed the "significant" public health benefits the smoking ban was already having. "It provides evidence that the legislation is improving the health of everyone in Scotland - including smokers, non-smokers, children and bar workers," said the professor. "One of the most important findings is the reduction in heart attacks. We believe that the smoking ban was a large contributory factor to this drop. "I am confident that we will continue to see the positive effects of the ban in years to come."

The evaluation was said to be the most comprehensive yet conducted into the impact of anti-smoking legislation. Heart attack admissions to the nine hospitals studied accounted for nearly two-thirds of all Scottish hospital heart attack admissions.

Public Health Minister Shona Robison, who will close the conference tomorrow, said: "I am delighted that public health experts from across the world have come to Edinburgh to hear first-hand how the ban has benefited the nation. "More and more countries in Europe and across the rest of the world are now following suit by banning smoking in public places and I am proud that Scotland led the way in the UK.

"We want to continue the work to make Scotland a smoke-free society and that is why next month, subject to Parliamentary approval, we will be raising the age of cigarette sales from 16 to 18." 10.9.07

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Tenants who can't light up at home

Smokers could be banned from lighting up in their own homes under plans drawn up by bureaucrats. Those who live in council-run housing in Liverpool will be asked to stop smoking at least half an hour before official staff such as social workers and carers visit their homes.

Town hall bosses hope the policy - due to be debated by the Liberal Democrat-run council tomorrow - will help protect all their staff in line with the ban on smoking in public places from July 1. They claim the ban is voluntary and that those who insist on smoking will not be denied access to vital council services.

Last night the pro-smoking pressure group Forest condemned the policy. Its director, Simon Clark, said: "It is a cheek to expect people to stop smoking in their own homes. "The idea that staff could be at risk from going into the home of someone who smokes is utter nonsense and is scaremongering."

One of those affected by the ban, 27-year-old Craig Hesketh, reacted angrily. "Next thing they'll be telling us not to mow the lawn when there is a council official visiting in case they suffer from hayfever," he said. 19.6.07

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Third of bosses to axe cigarette breaks when smoking ban arrives

More than a third of employers are planning to axe cigarette breaks when the smoking ban comes into force in England next month. Lighting up in an enclosed public places will be illegal from July 1, with those caught flouting the law facing a £50 on-the-spot fine or being summoned to court. Premises that allow smoking - including 200,000 pubs and restaurants - will be fined up to £2,500. It will bring an end to 'smoking rooms' in the workplace, with staff ordered outside if they want to have a cigarette break.

But many bosses will use the ban as an opportunity to end the practice, stopping their employees from taking time out during the working day to get their nicotine fix. A survey of over 250 firms revealed that 36 per cent planned to axe smoking breaks when the ban becomes law. But business leaders said such a move would be 'excessive', while trade union officials warned it could spark unrest and encourage staff to break the law.

TUC General Secretary Brendan Barber said: "Lots of smokers see the ban as an opportunity to quit or cut down, but hardened nicotine addicts might not find giving up so easy. If employers decide to crack down on fag breaks, the danger is that some hardened smokers may try to find ways of flouting the ban. "If going outside to smoke isn't an option, they may be tempted to smoke in secret on company premises.

"Employers should take a sensible approach to the ban and not use 1 July as a stick with which to beat their employees who smoke. Bosses should be thinking about ways of helping their staff stop smoking. Banning them from going outside for a quick puff is not the answer." The ban, which will also apply to outdoor areas where bystanders are affected - such as bus shelters, football grounds, and train platforms - means staff must smoke in the open, outside their workplace.

A spokesman for the British Chambers of Commerce (BCC) said: "There is a danger that the new smoking legislation could become more onerous than it needs to be. "It is not illegal to smoke outside and, although non-smokers may find it annoying to see their colleagues nip out for a quick ciggie, it seems excessive to actually ban people from going to smoke." The report, by employment law advisors Consult GE, says there is little the nation's 12 million estimated smokers can do if their employers end cigarette breaks as they are not protected by law.

Stuart Chamberlain of Consult GEE said: "Although there has never been a contractual right to smoke at work, companies seem keen to eradicate smoking among staff, and the ban is giving them the impetus to do just that. "Employees will struggle to fight any bans on their smoking breaks because they are not entitled to them." Smoking is the biggest cause of death and illness in the UK, with more than 120,000 people dying every-year from smoking-related diseases. It is estimated one in five smokers will try and kick the habit once the ban is introduced next month.

Despite widespread backing, not everyone supports the smoking ban. Antony Worrall Thompson, celebrity chef and patron of smokers' lobby group Forest, said: "July 1 will be a sad day. Supporting smokers is worth doing. Nobody else wants to because they want to be politically correct." He has said previously: "When you're an adult, life is about the freedom to choose. I think we're becoming more and more nannyish." 18.7.06

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Smokers told to quit or surgery will be refused

Smokers are to be denied operations on the Health Service unless they give up cigarettes for at least four weeks beforehand. Doctors will police the rule by ordering patients to take a blood test to prove they have not been smoking. The ruling, authorised by Health Secretary Patricia Hewitt, comes after medical research conclusively showed smokers take longer to recover from surgery. It is thought that 500,000 smokers a year will be affected.

However patients' groups argue that the move is about the NHS saving money rather than improving patient care. They claim that health trusts do not want to operate on smokers because they stay in hospital longer, blocking beds and costing more to treat. The ruling applies to routine operations such as hip replacements and heart surgery for conditions that are not immediately life-threatening. If smokers refuse to give up, they are still likely to be treated but may have to wait longer.

Leicester City Primary Care Trust will become the first health authority to introduce the "quit or wait" rule this summer. Other health trusts are consulting on the idea. Rod Moore, the trust's assistant director of public health, said: "If people give up smoking prior to planned operations it will improve their recovery. It would reduce heart and lung complications and wounds would heal faster. "Our purpose is not to deny patients access to operations but to see if the outcomes can be improved."

Patricia Hewitt has described the ruling as "a perfectly legitimate clinical decision". Yesterday her spokesman explained: "Trusts commission surgery services based on their assessment of the needs of their local population and availability of service capacity. "The provision and availability of a particular surgical intervention should be dependent on the clinical needs of the individual patient."

The European Commission is considering a proposal to extend the forthcoming ban on smoking in enclosed public places to cover doorways. Officials have been studying the Canadian province of Quebec, where smoking is banned within nine metres of the doorway into any healthcare-related building, school or social services building. The experiment is thought to have shown positive health benefits.

A spokesman for the Department of Health said the Health Act 2006, which covers the July 1 ban, contains reserve powers to extend the law to outside areas. Sports stadia, bus shelters and train platforms are already classed as enclosed public spaces under the Act and it would not have to go back to Parliament to be extended to doorways.

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Smokers face £80 fine for dropping butts in the street

Smokers were warned today that they face on-the-spot fines for littering if they drop cigarette butts in the street. It means that smokers trying not to be penalised for breaking England's ban on smoking in enclosed public places from next month could be hit by a different fine. Alan Woods, Chief Executive of Keep Britain Tidy, said: "Smokers will think they are avoiding a fine by lighting-up outside. "If they don't dispose of their cigarette stub responsibly, by putting it in a bin or portable ashtray, they are risking being issued with a fine of up to £80 for littering instead."

Nearly 80 per cent of streets are blighted by cigarette stubs - 20 per cent more than five years ago, according to KBT. The annual clean-up bill stands at £200 million just for cigarette ends. An estimated 122 tonnes of cigarette ends, matchsticks and other bits of smoking litter are dropped every day. KBT is now urging smokers to bin their butts.

Tesco is to start selling portable ashtrays.The Ashcan, is the size and shape of a cigarette, fits into a cigarette packet where it can be used to extinguish stubs. From 1 July it will be against the law to smoke in virtually all enclosed and substantially enclosed public places and workplaces.

Premises will be considered enclosed if they have a ceiling or roof and are wholly enclosed either on a permanent or temporary basis. The law also applies to public transport and work vehicles used by more than one person. "No Smoking" signs will have to be displayed in all smoke-free premises and vehicles.

Managers of smoke-free premises and vehicles will be responsible for preventing staff and customers from smoking. Failing to comply with the law is a criminal offence. The fixed penalty notices and maximum fine for each offence are:

Smoking in smoke-free premises or vehicles: fixed penalty notice of £50 - or a maximum fine of £200 - imposed on the person smoking.

Failure to display "No Smoking" signs: fixed penalty notice of £200 or maximum fine of £1,000 imposed on whoever manages or occupies the premises or vehicle.

Failing to prevent smoking in a smoke-free place: a maximum fine of £2,500 imposed on whoever manages or controls the premises or vehicle. 1.6.07

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Anti-smoking pill has been approved by drugs watchdogs despite clear evidence of low success rates

Champix, described as the most effective treatment yet to help people quit, was cleared after trials showed almost half of those who took it managed to give up. The draft approval comes just weeks before England goes smoke-free on July 1, when there will be a ban on smoking in virtually all enclosed work and public places.

The prescription only twice-daily pill received approval from the National Institute for Health and Clinical Excellence (Nice), which advises the NHS on which drugs it should supply. Champix tablets contain the active ingredient varenicline, which is a medicine used to help people who are addicted to nicotine to give up smoking.

It works by providing relief from cravings and the withdrawal symptoms experienced by smokers. It also reduces the satisfaction a smoker will get from further cigarettes if they have a relapse. Trials have shown the drug was effective after a 12-week course, with 44 per cent of smokers managing to stop.

A spokeswoman for Nice said: 'Having looked at all the evidence, our independent committee have concluded that varenicline appears to be a good way to help people who want to quit smoking. The draft guidance also recommends that varenicline should normally be provided in conjunction with counselling and support, but if such support is not available, this should not stop smokers receiving treatment with varenicline.

'Nice follows an open and transparent process which includes genuine consultation so changes in draft recommendations can occur. Stakeholders now have the opportunity to appeal against the draft guidance. Subject to any appeal, final guidance is expected to be issued to the NHS in July 2007.

However the evidence supplied to NICE is in direct conflict to that of the trials conducted in the States where Champix tablets were tested for 12 weeks with an average success rate of 22%, which was follow by another 12 weeks course with another 22% success rate, the combined success rate is then claimed to be 44% (2 x 22%) after nearly 6 months and not 12 weeks as reported in the media.

In addition over 1,000 hardened smokers were denied access to the trials while those who did participate also received 16 counselling sessions and a course of NRT following the 12 week use of champix which then achieved the claimed 20% (1 in 5) success rate. Critics claim it's another example of drugs being approved when all the evidence is not disclosed, information suppressed and PR is being used to create public interest in drug which does not live it up to public expectations. 31.5.07

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Give smokers paid time off work to quit

Businesses are being urged to give workers extra time off to attend stop smoking clinics ahead of Enland 's ban on July 1. The guidance body on public health recommends workers - many of whom already enjoy cigarette breaks throughout the day - should not lose pay if they need help in giving up. The National Institute for Health and Clinical Excellence ( Nice ) believes that businesses will benefit by a subsequent boost in productivity.

"For example, a business with 20 employees, of which typically five would smoke, could spend just £66 on providing brief advice (including employees' time) and see an overall saving of around £350 based on improved productivity," a spokeswoman for Nic said.

Currently, smoking costs the NHS an estimated £1.5 billion each year, and costs industry an estimated £5 billion in lost productivity, absenteeism and fire damage. Andrew Dillon, chief executive of Nice , said: "Going smokefree is a win-win situation for both employers and employees, and our advice sets out the best approach to making it happen."

He added: "Our advice is based on the best evidence of which workplace approaches are effective for smokers and make business sense for employers." But Simon Clark, director of Forest, the Freedom Organisation for the Right to Enjoy Smoking Tobacco, said it was "absolutely ridiculous" that workers should attend stop smoking clinics during working hours .

"It's wrong to expect employers to accept employees taking time off, and I imagine their non- smoking colleagues will be very unhappy about it," he said.

"It's generally acknowledged these quit smoking courses are not very successful - it's a matter for willpower. And they are likely to be open to abuse - people will take advantage as they have an excuse to take time off work". 25.4.07

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Smoking ban meets resistance in "tolerant" Germany

By Noah Barkin

BERLIN (Reuters) - When a German magazine ran a story about new efforts to ban public smoking, the reactions of many of its non-smoking readers were fierce -- and surprising. "I don't want to be deprived of the relaxed company of smokers in restaurants and bars," wrote David Harnasch of Freiburg in a letter to Der Spiegel weekly. "If my clothes stink of smoke, I can wash them -- where exactly is the problem?"

Yvonne Deim from Munich wrote: "Sitting in a smoke-filled room for a few hours bothers me less than it would if smokers were forced to get up every few minutes to go smoke outside." Governments across Europe are cracking down on smoking in public places. But resistance to new limits is strong in Germany, where the right to smoke became a cherished mark of tolerance and freedom after World War Two. Polls show a majority of the population and one in two non-smokers opposed a proposed ban on smoking in restaurants and bars.

Some politicians have said the proposals are too draconian, and Germany's powerful cigarette, restaurant and hotel lobbies are working to ensure they never see the light of day. Der Spiegel made clear where it stood by putting a picture of a broken cigarette on its cover alongside the title "Smoking -- The End of Tolerance".

Lother Binding, a member of the parliament and a former smoker, stoked the debate by pressing for a new law that would ban smoking in all public places. Binding, 56, told Reuters he felt compelled to press for stricter laws after reading a study from the Heidelberg-based German Cancer Research Centre, which laid out in stark terms the dangers of "passive smoking" or second-hand smoke. "That convinced me that the current law simply doesn't go far enough," he said, referring to a two-year-old measure to phase in no-smoking zones in hotels and restaurants.

26.6.07
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£50 Million bill for nicotine patches 'that keep smoker addicted'

The NHS is spending more than £50 million a year on nicotine patches and gums despite alarming new evidence that they do not help smokers quit the habit. A Treasury report into public health spending questions the success rates that supposedly justify the use of nicotine replacement therapy (NRT) in clinics and a leading anti-smoking expert is urging smokers to sue the NHS for the poor quality of advice. Clinics using the NRT claim that more than 100,000 smokers who attended last year managed to quit.

'Only a fraction give up' But the report last week by former NatWest bank chief Derek Wanless reveals that a smoker has to stop for only two weeks in the first four to be defined as a quitter. Mr Wanles says this is an unreliable test of whether a smoke has genuinely given up.

He adds: 'Given the addictive nature of tobacco, only 30 to 40 percent of smokers truly abstinent at four weeks are likely to be abstinent at one year.' This supports the views of NRT critics, who say that nicotine patches, gums and lozenges make hundreds of million of pounds a year for drug companies but help only a tiny fraction of smokers give up. A renowned quit-smoking guru is urging smokers prescribed NRT to sue the NHS.

He said yesterday: 'Nicotine patches and other forms of NRT don't replace nicotine - they are nicotine. All these products do is help keep many smokers physically and psychologically addicted to the substance that's causing their problems in the first place 'Giving them nicotine in another form just subtly reinforces the idea that they really can't manage without it - which is why NRT rarely works". 'Staggering 94% failure rate'

Manufacturers say NRT is clinically proven to 'double' a smoker's chances of giving up. But critics point out that this is still only an improvement from three percent with no assistance at all to six percent with NRT. Despite this high failure rate - 94 per cent - the NHS has paid Novartis, Pfizer and GlaxoSmithKline around £80 million for patches and other forms of nicotine therapy since they became available on the NHS prescription four years ago, and spent a further £90 million on smoking clinics that rely heavily on NRT.

'Public funding to increase by £138 million for a product that produces a 94% failure rate'. Over the next three years the Government plans to increase funding to these clinics by £138 million however this is an insignificant amount when compared to the £13 billion raised in tobacco duty.

Health Secretary John Reid, the Government-funded QUIT campaign and the anti-smoking lobby group ASH all defend the use of NRT as the centrepiece of all publicly funded quit-smoking programmes.

'Despite £50 million a year spent on NRT the number of smokers remain the same at 27%.

But the Wanless report says that despite all the efforts to tackle the problem, including heavy investment in NRT, the number of smokers has remained relatively stable over the past ten years, at around 27 percent of the population, and anti-smoking efforts have not been successful.

The Mail on Sunday March 7, 2004

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Government considers raising smoking age

The Department of Health (DoH) announced on Monday it was considering whether to raise the age limit for buying cigarettes or tobacco from 16 in a bid to cut the level of smoking among teenagers. A consultation exercise has been launched to look at whether the age limit should be increased to 17 or 18, which would bring it into line with the sale of alcohol.

The government is also looking at whether there should be tougher measures introduced at shops that sell cigarettes to under-age children. "Smoking is dangerous at any age, but the younger people start, the more likely they are to become life-long smokers and to die early," Health Minister Caroline Flint said.

"Someone who starts smoking aged 15 is three times more likely to die of cancer due to smoking than someone who starts in their late twenties." The government said about 9 percent of children aged between 11 and 15 smoke. Raising the age limit to the same required to buy alcohol would bring Britain into line with the likes of Canada, Australia and the United States.

It is also pondering new sanctions including banning shops that regularly sell cigarettes to children from being allowed to sell tobacco at all. The DoH said there was evidence that nearly 70 percent of underage smokers bought cigarettes from small local shops and newsagents.

"Access to cigarettes by under-16s is not as difficult as it should be and this is partly due to retailers selling tobacco to those under the legal age," Flint said. "If a particular shop is known locally as the place for children and teenagers to easily buy tobacco, we want to stop that shop selling it."

Anti-smoking campaign groups welcomed the proposals but warned they might not have much effect. "I don't think it will affect the number of young smokers as children smoke because it is seen as an adult habit, so in a way you are giving children even more incentive to start," Ian Willmore, of Action on Smoking and Health (Ash) told the BBC.

The consultation comes after MPs voted in February to ban smoking in pubs, restaurants and work places from the middle of next year.

The ban has already been introduced in Scotland and Ireland. 3.7.06