What is EMASH and what are its aims?

The European Medical Association on Smoking and Health

was founded In 1988 in the premises of the French Medical Association in Paris under the leadership of Prof. Paul Fréour. It is registered at the Prefecture of Gironde, in Bordeaux according to French law of 1^st July 1901 regulating voluntary, non-profit associations. Its legal domicile is located at Centre de Pneumologie, 2, rue des Treuils, 33000 Bordeaux, France.

Membership is open to physicians, biomedical scientists, pharmacists, nurses and other health professionals mainly from European countries, although health professionals from non-European countries are welcome as associate members. Membership is cost-free, and financial contributions are gratefully accepted for project support.

Readers who are interested in joining EMASH are welcome to contact the President at fax +4122 782 0266.

To attain these aims, EMASH:

• first and foremost, promotes the concept that health professionals, especially the doctors, should not smoke as a matter of professional ethics and because they play a most important exemplary role vis-à-vis populations and governments;
• encourages health professionals to become involved in primary and secondary prevention of smoking among their patients and the public at large, especially among the young;
• encourages health professionals to stimulate national action, including legislation, for the prevention and control of tobacco use;
• promotes dialogue with hospital and health care administrators to make these institutions smoke-free;
• stimulates professional health associations to introduce no-smoking policies among their members, and to make their congresses and other meetings smoke-free;
• encourages research and publications on smoking cessation and on smoking among health professionals and medical students, including monitoring of their smoking trends;
• advocates the introduction of aspects of smoking prevention and treatment into medical school curricula and into routine medical practice;
• organises seminars on smoking cessation and nicotine addiction and participates in relevant medical congresses;
• more important from a pragmatic standpoint, EMASH emphasises the need for health professionals to assist smokers quit the tobacco addiction through individual counselling and the use of modern pharmacological aids as advisable.

Since 1991 EMASH publishes a quarterly newsletter: the European Medical Newsletter on Smoking Cessation. It is produced and distributed to all members thanks to the support of Pharmacia&Upjohn. It welcomes articles, news and other written contributions on issues of smoking cessation, nicotine dependence and smoking and health issues in general.

EMASH also maintains contacts with international and national health bodies which are active in smoking cessation, prevention and control, including the World Health Organization (WHO), the European Union (EU), the International Union Against Tuberculosis and Lung Disease (IUATLD), the International Union Against Cancer (UICC), the International World Heart Federation, the International Non-governmental Coalition Against Tobacco (INGCAT), the European Network for the Prevention of Smoking (ENPS), the World Medical Association, the International Hospital Federation (IHF) and the International Network Towards Smoke-free Hospitals (INTSH). Of specific value are the two EMASH Scientific Collaborating Centres: the Pulmonary and TB Unit, Civic Hospital, Vittorio Veneto, Italy and the Institute of Social Medicine, University of Vienna and its subsidiary, the Vienna Nicotine Institute. Their objectives include: a) promotion of non-smoking policies in hospitals and other health centres and b) research in diagnosis and treatment of tobacco dependence.

Besides being present in numerous congresses, EMASH has held so far eight international seminars:

1. Health Professionals and Smokers, Royaumont Abbey (Paris), 21-23 November 1990;
2. Smoking and Health, Zandvoort (Amsterdam), 22-24 November 1991;
3. Economic Issues of Smoking and Smoking Cessation, Bari (Italy), 22-24 October 1992;
4. The Role of Health Professional Organisations in Anti-smoking Activities, Sitges (Barcelona), 18-20 November 1993;
5. Guidelines on smoking cessation for general practitioners and other health professionals, Helsingborg (Sweden), 29 Aug.-1 Sept. 1996;
6. Social and economic aspects of reduction of tobacco smoking by use of alternative nicotine delivery system (in collaboration with the UN and the ICAA), United Nations, Geneva, 22-24 September 1997;
7. Consensus seminar on the role of physicians in smoking cessation, risk reduction, and nicotine replacement therapy: the WHY, the WHAT, the HOW. Athens, 5-7 March 1998;
8. Smoking and smoking cessation – IUATLD Congress, Budapest, 12 April 2000.

EMASH has also received grants from the EU to carry out international projects: 1) the production of Guidelines on Smoking Cessation for Health Professionals and, 2) Health Professions in Public Education against Smoking.

According to WHO and other national and international bodies, the prevalence of smoking and mortality from smoking related diseases are still increasing in most countries. Some of the European countries experience among the highest smoking rates in the world. In the 1970s, WHO reckoned that about one million deaths per year world-wide were attributable to smoking. This figure became 3 million in the 1990s and will rise to 10 million by 2030s. It appears evident that the classical approaches thus far promoted over the past several decades by national and international health bodies and which included legislation, school-based education, public information, congresses, statistics, tar and nicotine levels and many such advocacy actions, failed to reduce the prevalence of smoking and of related diseases to a significant extent.

WHO’s International Classification of Diseases, in its 10^th edition, classifies the use of tobacco (F17.2 and 17.3) among the mental and behavioural disorders due to psychoactive substance use (F10-F19) together with alcohol, cocaine, opioids and similar drugs. Being a disease issue, a new and medically more pragmatic approach is, therefore, needed to tackle the smoking epidemic. Although the preventive approaches mentioned above are essential and must proceed, consideration should be given to medical treatment of smoking which includes therapy and assistance to smokers in giving up the addiction. Besides primary prevention of the onset of smoking i.e., preventing young people from starting smoking, cessation of smoking is also needed, i.e. counselling and treatment provisions to be available for the millions of adults who smoke and would like to stop. Already in 1988 WHO, in its Smoke-free Europe (Strategy No.5) emphasised the need to secure a vast availability of assistance to smokers wishing to stop. Stopping smoking is becoming evermore timely, as public and governments' attitudes against passive smoking are getting stronger and smokers are under rising social pressure not to smoke.

The main ingredients for stopping smoking are motivation and the will to stop. It has been proved that as little as a simple prompting and advice by the physician can convince a good number of smokers to quit. Giving up the addiction, however, usually entails a rather long and difficult process and one which may require professional advice especially by those health professionals with whom the smoker first comes into contact: the family doctor and/or the pharmacist.

Several methods have been proposed at various times which allegedly helped smokers stop smoking. However, only few such methods have been scientifically tested. Those which proved in many independent studies to be useful usually include nicotine replacement therapy (NRT) through pharmacological aids like nicotine-containing chewing-gums, trans-dermal patches, inhalers and tablets. The basic principle being that smokers smoke mostly because of the pharmacological and addictive properties of nicotine, it is possible to let them have access only to the alcaloid that they need without the many other and much more harmful substances present in tobacco smoke. This opens the way to gradually wean them out of the nicotine addiction. The nicotine replacement aids, of which there are several on the market, have been found to provide quantifiable help to strongly addicted smokers in overcoming withdrawal symptoms and in improving cessation rates. Their credibility rests not only on the extensive research carried out by very numerous and highly reputed independent investigators, but also on the acceptance contained in reports of the US Surgeon General and the W.H.O. More recently, non-nicotine replacement tablets have appeared in commerce, and seem promising. Therapy is more effective if followed up professionally, especially if personalised to the individual smoker. This is why the doctor's advice and involvement are important. Another relevant area of action is the promotion of no-smoking policies in hospitals and health centres. In most countries no-smoking policies do exist but are weak and need strengthening. In addition, hospital health personnel would be in a good position to provide smokers with professional guidance in stopping smoking and in using, if required, pharmacological therapy.

President: Roberto Masironi (Geneva);

President Emeritus: Paul Fréour (Bordeaux)

Vice Presidents:

Michael Kunze (Vienna)

Imre Vadasz (Budapest)

Helios Pardell (Barcelona)

Jiri.T. Kozak (Kutna Hora, Czech Republic)

Secretary: Lars Ramström (Stockholm)

Treasurer: Roberto Masironi (ad interim)