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Doctors Aren't Advising Most Smokers to Quit

April 14, 1987|ALLAN PARACHINI | Times Staff Writer

Though tobacco has long been identified as the most fatal, dangerous and dependency-inducing of harmful drugs, a new survey finds that doctors advise fewer than half the smokers they see to quit.

And that rate (44% of smokers seen as patients) doesn't vary much even when the patients in question are overweight or have high blood pressure or are women who smoked and took birth control pills. Men 18 to 34 who smoked were least often advised to stop--just 30% of the time. Blacks were generally told even less often than whites to quit--though smoking rates among blacks are higher. A report of the research appeared last week in the Journal of the American Medical Assn.

The findings--produced by a team led by researchers from the Michigan Department of Public Health--focused on nearly 6,000 men and women. The low rates of quit-smoking advice were at odds with the position of the AMA, which since 1980 has advised physicians to routinely counsel all smokers to stop.

Doctors did advise three-quarters of smokers who had survived a heart attack to quit, but the Michigan team found that, in general, physicians got very low marks in their attempts to get people to stop using tobacco. Doctors told 43% of white men and 47% of white women to quit, but gave the advice to just 32% of black men and 37% of black women. A total of 58% of men with diabetes--but just 39% of women--were told to quit, as well as 40% of overweight men and 41% of overweight women.

Even though experts agree that women taking oral contraceptives should not smoke, only 41% of those taking the Pill got that advice from their doctors.

The research team suggested that insurers consider paying doctors a fee to provide smoking cessation and other prevention advice. The researchers concluded that "physicians need to increase their efforts in counseling smokers to quit before smoking-related diseases result." Osteoporosis Myths

Promotion of centers purporting to predict development of osteoporosis--and sale of calcium supplements to prevent it--may have given women the disquieting impression they face the almost unavoidable prospect of broken bones in old age. But marketing efforts that imply that half--or more--of women will sustain fractures seriously overstate the actual risks, a geriatrics specialist says.

Despite the 50%-or-greater risk touted by some osteoporosis treatment and prevention entrepreneurs, the overall chance of having an osteoporosis-related broken bone is 25% or less--with many of those being minor wrist fractures that heal comparatively readily. Moreover, concluded Dr. John Meuleman, of the Gainesville (Fla.) Veterans Administration Medical Center's geriatrics center, a review of dozens of osteoporosis studies finds that the most dreaded of osteoporosis-related old age broken bones--fractured hips--occurs in only 15% of women at some time in their lives.

In a telephone interview, Meuleman noted that even a 25% fracture incidence could be considered high, but he said promotion of screening programs and calcium supplements--two issues of growing concern in geriatric medicine--may have instilled an undue sense of panic in older women. Meuleman published an article in the journal Archives of Internal Medicine summarizing three major misconceptions about osteoporosis.

He found there may also be a 5% to 10% chance of having a fractured vertebra for a woman between ages 70 and 80. But only 25% of women will ever have a broken bone related to osteoporosis, with many of those involving the wrist, he concluded.

Meuleman identified two other myths about the disease: the notion that most white women (who have a greater incidence of osteoporosis than blacks) should undergo X-ray screening to predict whether they will have the disorder, and the idea that women should routinely take calcium supplements to maintain bone mass. Meuleman said only women who consume less than 800 milligrams a day of calcium, recommended for a normal diet, should consider calcium supplements.

Aspirin-Reye's Link

For the fifth time since 1980, U.S. Public Health Service researchers have found clear evidence linking the taking of aspirin by children with incidence of potentially fatal Reye's syndrome. And at this point, a Cleveland expert said, the relationship is "definitive." Reye's syndrome is a viral infection often characterized by nausea and vomiting.

The researcher, Dr. Edward Mortimer of the Case Western Reserve University School of Medicine, criticized the aspirin industry as "irresponsible" for continuing to dispute the findings. But in Washington, the Aspirin Foundation of America Inc., a trade group, said the aspirin-Reye's relationship remains unproven and that Mortimer's comments were "disappointing."

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