I sometimes wonder whether the recently announced smoking ban in HUD dwellings in the USA, as well as the smoking bans proliferating in the grounds of NHS hospitals in the UK, set up stresses within the organisations involved.
After all, it seems reasonable to suppose that the people who work in HUD – Housing and Urban Development – are very likely to have the best interests of their residents in mind, whether or not they do a very good job about it in terms of keeping their housing stock in good repair, well lit, crime free, with working lifts, and so on. How are such people likely to feel when they are instructed to police smoking in their properties, forcing smokers out onto the streets, and in addition fining them and perhaps even evicting them? Doesn’t that contradict the whole ethos of public housing, which is to provide shelter for even the poorest members of society?
The same question may be asked about the doctors and nurses working inside the NHS hospitals in which draconian smoking bans are now multiplying. Doesn’t it contradict the whole ethos of medicine to force patients, often with drips and catheters, to walk hundreds of yards outside these hospitals to enjoy a smoke? How do surgeons who have just operated on patients, sewn up their incisions, and wrapped them in bandages, feel when they see the same poor fellows limping slowly out of the hospital grounds? None too pleased, I imagine.
In the UK, as best I understand it, these smoking bans don’t originate inside the hospitals themselves, but in central government – perhaps the Department of Health, or maybe even the WHO. And the doctors who work in these government organisations appear to mostly be non-practising doctors who, despite their medical qualifications, prefer to work in preventive medicine, trying to stop people getting sick in the first place, before they ever arrive in hospital, by enacting smoking bans, alcohol bans, dietary restrictions upon the general population.
It is in the nature of preventive medicine to try to prevent well people becoming sick, just as it is in the nature of standard hospital medical practice to try to make sick people well. And usually, once patients have have been discharged from hospitals, little or no further interest is taken in them. Or at least that has been my experience. But the preventive medical practitioners, who want to prevent the well from becoming sick, are essentially only interested in well people rather than sick people. Which is why they are always demanding smoking bans, alcohol bans, and any number of other public health measures to be enacted on people who are for the most part perfectly well.
And because of their opposite points of view, standard best medical practice (trying to make the sick well) would seem to be in conflict with standard best preventive medical practice (trying to prevent the well getting sick).
If nothing else, preventive medicine medicalises the whole world and everybody in it, whereas standard medicine restricts itself entirely to people who are sick, ignoring those who are well. So a standard medical practitioner in a war zone will restrict himself to simply treating people who have been injured by bombs or bullets. But a preventive medical practitioner in the same war zone would wish to prevent people getting injured by bombs and bullets in the first place, and would try to stop the war – perhaps by enacting gun controls, and denormalising military culture, and so on. The preventive medical practitioner must become, in effect, a politician (if he isn’t one already).
And if preventive medicine is concerned with preventing well people becoming sick, what interest should it have in the sick people inside hospitals? If preventive medicine and standard medicine operate in separate domains – the well and the sick – when someone becomes sick and enters hospital, shouldn’t they fall wholly within the remit of standard medicine – the care of the sick – for the duration of their stay, and only be returned to the jurisdiction of preventive medicine – the care of the well – when they have become well again? That is to say, what business does preventive medicine have inside any hospital? Surely it should restrict itself to the community of the well outside the hospital gates? Once someone enters a hospital, are they not testament to the failure of preventive medicine to stop them from smoking, drinking, eating, fighting wars, or whatever else made them sick?
These, and other similar considerations, suggest to me that standard medical practice and standard preventive medical practice must in many cases be in conflict with each other. And this should result in protests – and perhaps even resignations – by doctors and nurses inside hospitals against the incursion of preventive medicine inside them.
But that’s just my guess, as a distant outsider looking in. I don’t know any doctors. I’ve hardly ever known any during my entire life. My closest approach was perhaps with the antismoking Dr W, in whose house I once lived, and who has since become for me the personification of the bureaucratic busybodying preventive medical ethos, even though he is long dead now. Has anyone ever spoken to any doctor who is practising medicine inside a hospital, and asked them what they think of hospital smoking bans?
In this respect it’s interesting that Donald Trump seems set to appoint Dr Ben Carson to run HUD. I wonder what side of the fence this neurosurgeon belongs to. Is he one of those standard medical practitioners who merely want to make sick people well, or is he one of the preventive medical practitioners who want to prevent well people becoming sick? It may completely determine his attitude to smoking bans in HUD dwellings. Or perhaps there is no conflict at all between these radically different approaches to medicine, and I’m only imagining one?