‘The only function of public health,’ JK Galbraith might have said, ‘is to make cranial osteopathy look respectable.’
Such a thought occurred to Dr No as that tiresome quango, the National Institute for Health, Clinical and Anything Else Anybody Will Pay Us For Excellence dumped not one but two unwelcome coils of public health ‘guidance’ on an unsuspecting public this week. One was old hat – salt and saturated fat are bad for you, flogged into new life in NICE’s inimitable way (‘Tens of thousands of lives could be saved, and millions of people spared the suffering of living with the effects of heart disease and stroke, simply by producing healthier food says new NICE guidance’). The other was something altogether different. Pregnant women who smoke, NICE declared, can’t be trusted to tell the truth, and so the truth must be forced out of them, if necessary by coercion:
‘Helping pregnant women who smoke to quit involves communicating in a sensitive, client-centred manner, particularly as some pregnant women find it difficult to say that they smoke. Such an approach is important to reduce the likelihood that some of them may miss out on the opportunity to get help…
Some women find it difficult to say that they smoke because the pressure not to smoke during pregnancy is so intense. This, in turn, makes it difficult to ensure they are offered appropriate support. A carbon monoxide (CO) test is an immediate and non-invasive biochemical method for helping to assess whether or not someone smokes…
Who should take action?
Midwives (at first maternity booking and subsequent appointments).
What action should they take?
Assess the woman’s exposure to tobacco smoke through discussion and use of a CO test.’
Forget the client-centered waffle: what NICE is saying is: pregnant smokers lie; so use a CO test to smoke (sic) the answer out of them.
No doubt many pregnant smokers (as do many other smokers) ‘forget’ their habit from time to time; and no doubt smoking is bad for both mother and baby: but this Reich style ‘guidance’ is hopelessly misguided. It is both morally objectionable – because, whether we like it or not, smoking is legal, and neither the State nor well-intentioned but hopelessly misguided ‘professionals’ have a mandate to assume that pregnant smokers lie, and so must have the truth forced out of them, and practically unsafe, for it risks alienating the very women who are most at risk.
Dr No has no doubt that many worried well will blow into their CO monitors to protest their smoking innocence, just as he is equally sure that many of those who do smoke, often in poverty and deprivation, knowing full well that they are benefiting neither themselves not their baby, will feel accused and abused by those whom they should be able to trust; and that for some, that erosion of trust will tip the already finely balanced scales into mistrust; and so into alienation, and so into less effective antenatal care. Bad news for the mother – and – just as importantly – bad news for baby.