European Stars And Stripes (Newspaper) - March 14, 1988, Darmstadt, Hesse                                Now Yahk to Tina photo or John j. Gannett with Hitman Skeleton decorated As an anti smoking warning in his office in Beaver . One physician takes a novel stand against patients who smoke by Lawrence k. Altman new York times Ohn j Cannell eme bots How. At the age of 6 he watched his father a cigarette smoker die a i Olches death irom lung cancer. Now Cannell is a 39 year old family physician in Beaver. W a. And the vivid memory of his father coughing up blood As he was dying in his Mother s arms has driven him to an unusual policy that has shocked some people bit gained Praise in nol imitation from medical colleagues through an advertisement in a local newspaper Cannell urged prospective Patin is who refuse to give up smoking to seek Caie from some other doctor. To said to did not want Hern As patients he pledged to treat any patient Lor an emergency and did so recently Lor a smoker who was about to suffocate he also promised to continue caring Lor those already in his practice who ignored his warnings about smoking he said he would feel triumphant it he could persuade one patient to quil smoking each week. Abou25 a aliens have stopped smoking since the and appeared last summer Cannell said in an interview. Taking the stance was a personal thing i did t want to see any More people in the terminal stages of illnesses that were self induced and that i could t do anything  the West Virginia physician said he was not urging other doctors to adopt his policy the two physicians with whom he practices and the 50 other physicians who Erma Bombeck solve 30.000 people in the Beaver area do not share it. He also said he did not extend his policy to alcoholics and the obese because they often Are strongly influenced by genetics. Nevertheless critics have said Carmen was playing god. Making pariahs of smokers persecuting a segment of the population and encouraging doctors to use personal habits As criteria Lor selecting patients. Some foresaw thorny practical and ethical problems in Many doctors adopted Cannell s policy or extended it to alcoholics and the obese. Who would treat the rejected Cannell in turn defends his unusual stance by citing the tradition of allowing doctors and patients to choose each other. Putting a novel twist on the ethical obligations of physicians to treat patients he also cites Hippocrates who warned physicians that their primary duty was to do no harm. Cannell argues that by treating smokers for tobacco related problems he is. In effect encouraging them in their deadly habit. On this logic Cannell has received support from an expert in ethics. Cannell is not going against any kind of ethical practice i know of said or. John h Burkhart who Heads the american medical association s Council on ethics and judicial affairs. In an interview Burkhart said he admired Cannell Lor not wanting to be a co conspirator with smoking patients. Burkhart recalling How the ashtrays that he had once placed throughout his office have Given Way of antismoking signs said he would consider adopting Cannell s policy in his own family practice in Knoxville Tenn. Yet he said he doubted Cannell s policy would become a National trend. Cannell s announcement provides an unusual insight into he Way physicians think the frustrations they lace in practising Medicine and the unspoken contract Between patients and doctors As both strive to make the patient Well. Doctors know that a patient s will to live is As potent a Medicine As any therapy they can provide which is one reason Why successful physicians do everything in their Power to gain a patient s cooperation. Doctors also know that compassion is an indispensable element in speeding the Healing process although physicians vary in their ability to express it. The act that physicians differ in their approaches is one reason Why savvy patients interview physicians before selecting one. But patents often do not act in their own Best interest. When patients persist in behaving dangerously physicians must strive to retain compassion by overcoming Trie feeling thai they Are performing exercises in futility. This problem often arises among patients who suffer from incurable ailments due to smoking and drinking alcohol to excess. Physicians Are Well aware that Many such patients move from doctor to doctor until they find one who does not criticize their behaviour. Cannell smoked briefly at age 17 but slopped because inhaling made him sick. He attended medical school in the Early 1970s at the University of North Carolina in Chapel Hill in the heart of tobacco country and recalls being appalled at one lecture on tobacco related diseases a spokesman for die tobacco companies was Given equal time and told us none of the dangers were proven and tobacco is a great thing Cannell said. It was  tobacco Industry representatives no longer Are invited to talk in these lectures at the University of North Carolina he added. The University for its part says ii has never had a policy encouraging or forbidding speakers from the tobacco Industry. Cannell said he never allowed smoking in his office and never hired anyone who smoked he developed his convictions about educating smokers during 10 years of treating emphysema lung cancer heart attacks and other tobacco related diseases. The turning Point was he death of a 40 year old Mother of three a smoker. Iron lung cancer. Several patients had severe lung cancer damage from smoking to the Point where they could no longer inhale because they were severely Short of breath due to chronic infections. They would get better in fact so much better that they went Back to their regular cigarette habit Cannell said. I thought what did i do i Haven t helped this patient. My actions have Hurt  Cannell also was disturbed about the ethics of giving a clean Bill of health to a smoker who comes for a Check up has a Normal Chesl a Ray and Normal breathing test results and Normal heart unction. The message you give is that cigarettes Haven t Hurt you at least  to Cannell cigarette smokers Are tobacco drug addicts. Only a rare doctor would continue to treat a heroin or cocaine addict if the patient did not agree to enter a detoxification program so i just wanted to be  although Cannell said he had received a few angry Calls he believes his policy has been successful. Diehard smokers just Don t Call me anymore. And i am amazed by How Many people said i finally kicked the habit doctor and i wanted to thank you because i never thought about it like i was a drug addict before and i am that makes me fed  what Are you making Lor dinner Loughl if you Are like one third of the women in this country you Are making reservations if you belong to another one third you re making tracks to the nearest test food carry out. Less than the remaining third of you will tear along a dolled line and add water to something leaving a few traditional Cooks who View their ovens As something More than an elaborate clock. There is probably no social custom thai has changed so dramatically in this country Over the last 10 years As How we eat what we eat and who Cooks it. Ask a woman for her recipe anymore and Shell slip you an empty Carton. Some of the women who stiff make crackers from scratch deplore these Lime savers. They la Tell you Frozen pie crust was invented by daughters in Law who Don t want to get dough under their fingernails. You know whal i think i think women found something belter to do than serve up 1,260 meals a year to kids who held their breath when they ate it husbands who had it for lunch and dogs who sniffed at it and went Back to sleep. Given a Choice Between climbing the corporate ladder and straining Chicken Buralli through a piece of cheesecloth to make Chicken soup they chose the former. They found a Way to Cut Comers and there were a lot of people to help them Sara Lee at the ovens. Orville Redenbacker at the microwave and Juan Valdez picking those Little Coffee Beans one at a time for instant Coffee today there in t anything technology can t do for us. Recently. I picked up a Large Flat piece of Frozen icing the size of a pizza. All you had to do was slip it out of the package and plop it on top of a cake like a record on a phonograph. You did t even have to spread it. You say you miss the Good old Days when you sifted the flour three times and it took longer for your pizza dough to Rise than it does to have one delivered now then you should have been the Mother of a Reader whose daughter had her baby sit her slam tar dough for bread when she went out of town. All mama had to do was feed tha starter at 6 am on Friday with sugar instant potatoes and warm water add a cup of the starter to a bowl of dry and liquid ingredients that had been combined and let sit. Then at 6 am. On saturday punch it Down knead it Divide in into three equal parts flour and put in Well greased loaf pans and put Back into the oven Lor 12 hours. Remove preheat Ovon to 350 and bake for 30 minutes before removing to Brush Butler on top. Frankly i m ready Lor Yel another breakthrough. How about boxes of pro mix that come  a Large fake Fingernail attached so you Don t have to Chip your polish tearing along the dotted line a i9u. I an gum tip syn Cau Page 16 the stars and stripes monday March 14.1988