British medical bulletin
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The tobacco industry's strong-arm tactics have been used consistently over many years. These tactics include: using the industry's size, wealth, and legal resources to intimidate individuals and local governmental bodies; setting up 'front groups' to make it appear that it has more allies than it really does; spending large sums of money to frame the public debate about smoking regulations around 'rights and liberty' rather than health and portraying its tobacco company adversaries as extremists; 'investing' thousands of dollars in campaign contributions to politicians; and using financial resources to influence science. These tactics are designed to produce delay, giving the nicotine cartel more time to collect even more profits at the direct expense of millions of lives around the world.
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Smokeless tobacco practices are common in some parts of the world and the use seems to be increasing. Nicotine exposure is similar in smokeless tobacco users and smokers, often leading to strong physical dependence. As a rule, smokeless tobacco products contain high levels of nitrosamines with carcinogenic potency in experimental animals. ⋯ A recent study suggests that smokeless tobacco use is related to cardiovascular disease, which could be of great public health importance. The known and suspected health risks associated with the use of smokeless tobacco provide a basis for preventive action. In particular, efforts are needed to limit the introduction of such practices among young people, which may serve as a gateway to smoking.
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British medical bulletin · Oct 1995
ReviewRationing in the NHS: the dance of the seven veils-in reverse.
The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This has not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. ⋯ And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.
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The politics of rationing are messy and treacherous. As long as rationing remained implicit, politicians were shielded from the impact of decisions about who to treat and who not to treat. Explicit rationing changes all this by making the process of reaching choices more visible. ⋯ There is, nevertheless, scope for improving the process and making it more open and accountable. While efforts to terminate ineffective treatments are welcome and overdue, they are not a substitute for rationing. Finally, while politicians are being called upon to set national priorities and guidelines for rationing care, there is resistance to doing so when the decisions are so context specific and can only be made effectively at a micro level.
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British medical bulletin · Oct 1995
ReviewChoices in health care: a contribution from The Netherlands.
In this paper it will be argued that choices in health care are necessary, desirable and just. An important choice that each society has to make, is: what basic services should be available to everybody independently of an individual's purchasing power? The Dutch Government Committee on Choices in Health Care advised the use of four criteria: basic care must be necessary, effective, efficient and cannot be left to the individual's responsibility. Because important decisions with respect to the second criterion-the effectiveness of care-are made by physicians in the consulting room or at the operating table, physicians do have a primary responsibility in making the right choices.