White Coat Notes

Will graphic cigarette warnings help — or hurt?

November 15, 2010

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As anti-smoking ads go, these are pretty harsh. Smoke flowing from a hole in the throat of a man holding a cigarette. A corpse on an autopsy table. A screaming baby in an incubator. A cartoon showing a cigarette jabbed into a vein, like a hypodermic needle.

Warnings on cigarette packages and in advertisements are going to get bigger and bolder, the federal government said last week, the first significant change to warnings in 25 years. Two Boston specialists in anti-smoking campaigns say the proposed warnings may backfire.

Gregory Connolly of the Harvard School of Public Health, who used to be the state’s director of tobacco control programs, was responsible for an unforgettable television ad of a man who breathed through a hole in his neck and spoke using a machine after throat cancer blamed on smoking. That message and others like it struck a chord with smokers because they made an emotional connection with the people in the ads and connected viewers to quit-smoking resources in their communities. The new candidates for warning labels, which look strikingly similar to images now used in Canada, only shock, he said in an interview.

“In Massachusetts we never insulted smokers, we never called them stupid,’’ Connolly said. “You don’t go over the top and try to scare the smoker. You have to communicate in a really empathetic way.’’

In Canada, the warning labels produced two results, he said. They got noticed and people bought little sleeves to put over their cigarette packets. But smoking rates did not go down.

Dr. Michael Siegel of the Boston University School of Public Health says Connolly makes a good point. “While I certainly think it’s a good idea to have these graphic warning labels, I do not actually think it’s going to have much of an impact,’’ he said.

First of all, they’re too late, Siegel said. Smokers have already decided to buy a pack of cigarettes and won’t change their minds because of what they see on the package, even if it does take up half the label. Warning labels are late in another sense, too. People already know smoking is bad for them.

The shock factor will also wear off, he said. In its place might come an unintended consequence.

“Neurobiological studies show that over time, the warning labels themselves can become a stimulus to smoke, actually lighting up the part of the brain that controls cigarette cravings,’’ Siegel said.

ELIZABETH COONEY

Flu vaccination rates up among hospital workers, but short of goal

For people who work in hospitals, getting a flu shot should be like washing their hands, public health specialist Dr. Al DeMaria says.

“There’s no logical reason to decline it, just like there’s no logical reason for health care workers to refuse to wash their hands,’’ said DeMaria, who is the state’s epidemiologist.

But Massachusetts hospitals fall short of the public health goal of vaccinating every health care worker, according to a report on immunization rates released by the state last week.

A little over two-thirds of the state’s hospital workers involved in direct patient care — 68 percent of employees, contractors, and volunteers — were immunized against the seasonal flu last winter. That’s the same as the national average.

Health care personnel always top priority lists for vaccine, DeMaria said. Their work exposes them and their families to the flu and they can potentially harm the patients they care for if they transmit the virus to them.

“It’s a wake-up call to hospitals that perform below the 68 percent average,’’ said DeMaria.

Hospitals must offer seasonal flu vaccine and education to their workers by an order of the state Public Health Council. This is the first year of tracking how many workers accepted or declined the offer. E.C.

Surgical checklist passes rigorous test

Dr. Atul Gawande, a Brigham and Women’s Hospital surgeon, has been an evangelist for the aviation-inspired checklist for surgery. He has preached adoption of a simple set of questions that should be asked before any surgical team starts an operation. When tested in a pilot program at eight hospitals around the world, from Seattle to Tanzania, it cut deaths and other serious problems almost in half.

Last week he was gratified to see a larger trial in the Netherlands deliver similar results. Writing in last week’s New England Journal of Medicine, Dutch authors say complications fell from 27 to 17 per 100 patients and deaths dropped from 1.5 to 0.7 percent at six high-standard hospitals after the checklist was used. They compared results to six similar hospitals not using checklists at all.

“It’s huge,’’ Gawande (inset) said in an interview. “They independently validated the finding that safe surgical checklists can make a massive reduction in complications and deaths.’’ He was not involved with the Dutch study. E.C.