Has the smoking ban had any effect on our health?

But now it seems the non-smokers are feeling left out of the gang, not party to the office gossip. There is once again a seedy glamour attached to smoking — brave souls picked on by society but who determinedly puff on in the rain.

Now, I have always been against banning things — it offends my basic principles. Even as a doctor I feel people have to be allowed to make their own decisions, my role being to educate them so that they can at least make more informed ones.

Some good has come from the smoking ban: researchers in Italy found that it resulted in a significant fall in hospital admissions for heart disease. In England, a similar trend has been noted. The Department of Health found a 10 per cent reduction in the number of hospital admissions for heart attacks in England in the year after the ban on public smoking was imposed in July 2007. This is good news as Britain is among the worst countries for deaths from heart disease — smoking, poor diet and lack of exercise being the main culprits.

As a doctor I should be delighted, but I do question if those results are indeed a true interpretation of the facts. The largest recent study (still ongoing) in the US has so far shown that smoking bans have no effect on heart attacks at all, and the main studies quoted in the press have been shown to be flawed, either in their methods of data collection, or in how their data was statistically analysed. I find it hard to believe that, given that smoking is claimed to increase the heart attack risk of lifelong passive smokers by 20 per cent, any noticeable drop in heart attacks as a result of the ban is yet to be seen. The numbers are just too small and the timescales too short.

Bars and pubs do seem like the proper grown-up places in which to do adult things like drink and smoke, but now the choice is either to sit on your own for half the night or party on outside with the smokers. We inevitably do end up outside, breathing in the fumes.

The Government's other arm of attack (which I rather like) involves the use of graphic health warnings, but I'm not convinced they are effective either. When patients come to me for advice about how best to quit I always start off by asking why they want to stop. Their reasons are rarely to do with having seen a gory picture on a fag packet. They usually say that smoking is becoming increasingly socially unacceptable and too expensive. They know the health aspects but don't include them in the equation. One survey even found that one in four smokers would be motivated to give up if they thought their habit was harming their beloved pets. (It can.)

Where the ban does seem to be effective is among the younger generations. Interviews with children reveal that the majority no longer see smoking as "cool" and do not expect to try a cigarette, especially if one or both parents smoke. This is good news as many current heavy smokers will never give up, no matter what government warnings are thrown at them, but if we can stop the next generation from starting, then we really will see encouraging changes.