Regular readers of this blog will know that I talk a lot about smoking, and believe anything that can be done to help smokers quit should be done. However, I'm also a realist, and recognize that sometimes harm mitigation is the best approach. If you can't stop the problem, sometimes you can at least lessen the negative effects of the problem. Now enter a big topic - smoking in pregnancy. In modern America, this is as near to sinful behavior as we get. Smoking is a bad habit, but smoking while pregnant conjures anti-smoking sentiment as well as sympathy for children; you're welcome to ruin your own health, we say, but at least think of the baby.
Even so, some people, despite their best intentions, can't quit smoking. So what's to be done? Are we to throw our hands up and admit defeat? Are we to simply shower scorn on the smokers we know? Well, a recent research study, conducted at the Oregon Health and Science University, suggests that there may be a middle path.
In this study, pregnant women unable to quit smoking were randomized to either receive a placebo pill or 500 mg of Vitamin C, and their newborns were then tested for lung function. Babies born to women who smoke are at a higher risk for asthma and lifelong problems in lung function, and the study was performed to determine whether this would help counteract the effect of in utero exposure to smoking. Giving vitamin C doesn't fix anything, per se, as it doesn't address the fact that smoking is the real problem, but it does aim to mitigate the damage caused by smoking, and the results were promising.
The researchers found that while smokers receiving a placebo had very low blood levels of vitamin C, smokers who received the vitamin C had blood levels of vitamin C that were nearly the same as non-smokers. This correction of a 'smoking-induced vitamin C deficiency', if you want to call it that, had important effects. The newborns of the smokers who received vitamin C had improvements in lung function as compared to their non-vitamin C counterparts, which from the outset puts these children in better standing for their long-term health. The authors note that this finding should have important repercussions in public health, and I would agree with them.
But of course, I have a few comments to make on the study. Critics of the study may say that this opens the door to loose attitudes towards smoking by providing a 'way out' to those who want to keep the habit but lessen its negative effects. This argument is often trotted out on any number of topics, including availability of condoms, needle-exchange programs, and the e-cigarette phenomenon. Whether or not it's a generally valid argument is a topic for another article, but in this case I think it's not. Social stigma is strong enough against smoking that we're unlikely to see a return to the days of Mad Men-level smoking, only this time paired with vitamin C consumption.
At the same time, I think this serves as an example of compassionate care for people who suffer from limitations and fallibility. I've said before that, though parents' failure to vaccinate their children has potentially devastating effects on personal health and public health, 'firing' patients over refusal to vaccinate only worsens the problem. Instead, I believe it's important to keep such patients in the system so that they can be monitored and hopefully convinced otherwise in the future. In the case of vaccination refusal and smoking, patients, fallible humans that they are, don't always make perfect choices, but that doesn't mean that they shouldn't continue to receive the best care that we can provide. This study offers insight on how to continue to serve patients when they need us most, and I hope it makes it into general practice guidelines.