8 million smokers in Poland. Who will finally help us quit? Episode 109

Magdalena Cedzyńska
Nobody starts smoking, Monika, in order to die. After all, it's not like I'm smoking to die.

Monika Rachtan
And I remember the rooms you would go into and there were these yellow curtains from the smoke. It just stank horribly in there.

Magdalena Cedzyńska
They don't need legislative processes, they respond immediately. They also have great specialists. Let's not kid ourselves, they have great lawyers, great marketers. Increasing the price of a packet of cigarettes has the best effect in terms of reducing smoking prevalence in the population. Historically, we smoked a lot. We were the country that had one of the highest smoking rates in the world.

Monika Rachtan
I have said many times in this programme, Magda, that if we eliminated smoking and eliminated obesity, doctors would have to retrain because there would be nothing to do. Hi, Monika Rachtan, I would like to welcome you to the next episode of the Patient First programme. In Poland, as many as 8 million people reach for cigarettes every day, and some reports say that even 10. Can a pharmacist be an effective help in quitting smoking? This is what I am going to talk about today with my guest, Dr Magdalena Cydzyńska. Hello very warmly, Doctor.

Magdalena Cedzyńska
Good morning.

Monika Rachtan
Why do so many people in Poland still smoke, even though we know that cigarettes cause cancer, kill and are a major cause of cardiovascular disease.

Magdalena Cedzyńska
And the respiratory system on top of all that. The answer to this question is not so simple, I think it contains many aspects, because first of all, historically, we smoked a lot. We were the country that had one of the highest smoking rates in the world, in the 1980s. So even if we were shedding those few million, it is still a lot. We were 15 million smokers, now we are 8, so the progress is big. But we were coming down from such a big threshold.

Monika Rachtan
And just as I remember, maybe not in the 1980s, because I don't remember those years, but the 1990s I remember quite well and I remember the rooms you went into and there were these yellow curtains. It smelled just awful from the smoke in there and there was a man sitting there. There was an ashtray next to him and he also looked and smelled like that ashtray, which is to say he stank and in general in nobody's ....

Magdalena Cedzyńska
No one was impressed.

Monika Rachtan
Yes, that something is happening.

Magdalena Cedzyńska
This was the norm. We were behind the Iron Curtain and also this information about the harm of smoking, which had already been discovered in the world, did not reach us. In fact, it was only when the system changed and this information could reach us that it began. A trend began in Poland to stop smoking. There was a campaign known as Quit Smoking with Us, which Professor Zatoński initiated. And it was such a good climate in Poland at that time to quit smoking. And a few million of those Poles quit smoking. This is one aspect of the fact that we started from a very high level. The second aspect is that we have to remember that this is an addiction and some people simply find it very difficult to give up. There is a group of people who have quit smoking on the wave of that time, but a large group of those most heavily addicted find it very difficult to do so. This is probably the second reason. The third reason is that we are fighting a very unequal battle with those who are producing these cigarettes or e-cigarettes now, all these products that are addictive, and this battle is unequal. The reason I say this is that it always takes a long time to legislate, as it were, and all those who produce it react very quickly. They don't need legislative processes, they react immediately. They also have great specialists, let's not kid ourselves, they have great lawyers, great marketers.

Monika Rachtan
And a huge amount of money.

Magdalena Cedzyńska
Huge money. That's why they have these top specialists, because they have huge money. That's exactly right.

Monika Rachtan
I wonder if this kind of explaining, educating, talking about the fact that smoking is harmful, this happens all the time in the media, Because in my programme we also talked more than once about why it's not worth reaching for cigarettes or why it's worth quitting smoking. Does that still make sense? Do we need such top-down regulations that in Poland a packet of cigarettes will cost 100 zlotys and hardly anyone will be able to afford to spend 700 zlotys a week on cigarettes.

Magdalena Cedzyńska
Here, too, the answer is not so simple, because education is of course needed, because education changes awareness. Only, of course, we should tailor education to the target groups. There is a completely different way of educating people over 50, who are already a bit fed up with smoking because they feel its effects, and a completely different way of educating young people. So this education is needed. But it's never the case that education alone is enough. There is a package, it's the WHO that has created such a package of such steps that need to be done to bring the smoking epidemic under control. It's called MPOWER, and there education is one of those, of those, of those steps. But there we also have offering help to smokers, i.e. treatment for nicotine addiction. We have there, of course, increasing excise duty on cigarettes, that is, increasing the price of a packet of cigarettes. We know that this is the strongest motivator. It turns out that increasing the price of a packet of cigarettes has the best effect in terms of reducing smoking prevalence in the population. So, as I say, there is no simple answer. All these measures have to be comprehensive. We have to have legislation, we have to have education, we have to offer help to smokers. We have to raise taxes, that's what you have to do to have an effect.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan. Invited. And how do you assess the results of the work of those in power so far? Looking at, for example, the fact that 15-year-old children are walking around with a device the size of a tube, inhaling something and exhaling such a cloud of smoke that rises behind them? Then where is our government?

Magdalena Cedzyńska
Well, politically correct I should be. I should be politically correct. Changes are being implemented, but it is being done too slowly. We are unfortunately the last country in the Union to implement this flavour directive, and unfortunately it is happening too slowly.

Monika Rachtan
Why?

Magdalena Cedzyńska
This is a question for politicians as to why? I think that in Poland, unfortunately, the cigarette industry and vaping devices are allowed in. It is allowed, for example, to come to the table and to talk about legislation, which very much slows down the process, very much disrupts it. This should absolutely be excluded. In fact, even the convention we signed a long time ago, which is called the Framework Convention on Tobacco Control, which is a WHO convention, obliges us not to allow discussions about public health, because they have other interests of producers. But this happens all the time in Poland and it is very disruptive. After all, the last law, the Flavour Directive, which was finally adopted, was covered by an anti-corruption umbrella, because there was a lot of talk about these various influences.

Monika Rachtan
Do you think Poles are pissed off that there are still people sitting and smoking at bus stops? That they still have to eat pizza in gardens, in restaurants, when someone sits and blows on my plate? How do you feel about that? Because I am annoyed that this is the case. It bothers me, it annoys me. What is the mood in our country?

Magdalena Cedzyńska
I don't really know, because there are no surveys that examine attitudes on this issue. I surround myself with people who don't smoke, so they're also annoyed if someone smokes. But I don't know, it's hard for me to say on that question. But what I do know for sure is that when this law on banning smoking in public places came in, I don't know if you remember, but there was a huge, huge resistance from the public I would like to say, but it was filmed by the media, which was in turn filmed by the manufacturers and this industry that fosters. And then it turned out that everybody was happy, because that's what the research was. It turned out that when the smoking ban came in, it wasn't at all. First of all, restaurateurs didn't lose revenue. Nobody lost their job. Everything was going in the right direction and society was happy. And even you, I remember the survey results. I don't remember the percentage anymore, but also a very high percentage of those who smoked themselves were satisfied that they didn't have to inhale that smoke in public places additionally. So it seems that this annoyance is quite natural and hopefully widespread. I hope.

Monika Rachtan
Probably all of us have once got into a taxi in which someone has just smoked, or someone who was a previous passenger was a smoker. And the stench that rises in that taxi is unbearable. Sometimes when I get in, especially here in Warsaw, I feel like asking the driver to stop halfway, because I can't stand it any more. But on the other hand, there are places, such as the National Institute of Oncology, where you can smoke without any restrictions. There is not a sign hanging there that says 500 zloty fine for smoking. And now I am asking myself what exactly are the attitudes to change, to restrictions, to banning rather than to showing the right way. Because if you could smoke on the bus 20 years ago, nobody bothered. Or in the smoking compartments on the train. Now, on the other hand, you can't smoke on the bus, but you can outside the National Cancer Institute.

Magdalena Cedzyńska
In theory, you can't, because the law says that you can't smoke on the premises of healthcare facilities. And indeed there are penalties for this. The problem is that we can't just penalties work on a certain group of people. They certainly don't. And it is that we should also offer these people help. And we even have an outpatient clinic, one at the Institute of Oncology there, but I don't know if the doctors speak frankly and honestly, I don't know if the doctors inform patients that they can stop smoking and it will be to their benefit.

Monika Rachtan
And it is these clinics, because the one in Warsaw at the NIO is one somewhere there are supposedly others in Poland. There are conflicting reports, I've heard of five, but everyone says there are three.

Magdalena Cedzyńska
I think there are three or four.

Monika Rachtan
Hmm, I think I'll investigate that.

Magdalena Cedzyńska
I mean there certainly is. Certainly Mrs Czajkowska-Malinowska, who is a national consultant in lung diseases, she has always been leading there, at the Bydgoszcz Pulmonology Institute. She is certainly at Professor Balwicki's GUM-ed and she is certainly ours. I know she was in Krakow, that's why I say three or four, because I don't know if it still exists in Krakow. And I don't know the data on the National Health Fund's website is not always accurate, so it's difficult to use it, to suggest it, so I don't really know. I think there are three for sure. So that's it. Out of these 8 million smokers.

Monika Rachtan
For 8 million smokers, that is 2.5 million smokers per dispensary.

Magdalena Cedzyńska
But not everyone wants to throw, say, a million and two hundred.

Monika Rachtan
And I would argue a little bit here about the fact that not everybody wants to quit. Because when I talk to people who are smokers, and I'm not thinking of children, for me children, in their twenties, but people who are, let's say, over 25, over 30. They are the ones who very often talk about the fact that. You know, I smoke because I like it, but if I could quit, I would quit because I wouldn't want to smoke. And a lot of people would really like to quit smoking.

Magdalena Cedzyńska
But the thing is that people don't make these attempts, because it's quite a difficult process and it's not easy to quit smoking and many people who smoke would like not to smoke but don't necessarily make the effort to quit. We would like everything to come easily to us. We don't get calls from various patients, smokers, saying I have a method where someone will hypnotise him, conjure him up, he'll want to smoke, or can we lock him up somewhere so that when he wants to smoke, he'll stop after a while. Do we have such ways, well, because people would like to.

Monika Rachtan
Magical this dispensary.

Magdalena Cedzyńska
Well people ask me, but I have to disappoint everyone. Well people would like it to be easy and fun and it's not. That's why we love these headphones so much, what you put on and you can learn a language in your sleep or I don't know, some miracle diet that's supposed to help us reduce weight. It doesn't work like that. That quitting smoking is an effort. And that's why I say not everyone is ready for that effort. And that's why sometimes some people say I don't want to quit, I don't want to quit. It's not that they want to smoke, it's just that they, for example, have so many attempts behind them that they don't know quite how to approach it so that they don't turn out to be hopeless once again. I don't know how to stop smoking, so. But yes Ms Monika, yes 50% declare that they would like to make an attempt. And that's more or less how many of those smokers take it up each year.

Monika Rachtan
I read some data that 17 times the average Pole tries to quit smoking in his life and 16 times he fails. I don't know if that 17 succeeds.

Magdalena Cedzyńska
There is data that, on average, people have 7-8 attempts. Those over a dozen are the most heavily addicted, but the average smoker has 7-8 attempts. That's the way it is, it's a disease with relapses. It's like a natural part of the recovery process that relapses occur, because nicotine is the same drug as all other drugs. When people try to quit drinking or other drugs, they often experience relapses and nicotine, for one thing, has a similar effect. The mechanism of addiction is similar, because it's all about the pleasure we regulate for ourselves, the pleasure centre. With nicotine, as with other drugs, there are withdrawal symptoms as you try to reduce or stop, as if these withdrawal mechanisms, these cognitive distortion mechanisms are very similar. Hence there are these relapses to smoking. I know that smoking is very widespread. But nicotine is a very powerful drug. Simply put.

Monika Rachtan
It seems to me that we put nicotine cigarettes on the side of such an addiction all the time, which smells a bit bad. Everyone knows it's bad for your health, but generally sits, smokes, lives.

Magdalena Cedzyńska
Because it doesn't kill as quickly as heroin, for example. Heroin addicts finish themselves off quickly, while nicotine kills slowly.

Monika Rachtan
But it also seems to me that there are no such behavioural symptoms associated with someone having smoked ten cigarettes in one hour. Well, because if someone drinks two litres of wine in one hour, that person is not able to move, is not able to stand.

Magdalena Cedzyńska
Yes, because acutely nicotine is so much better in this respect, but more insidious in that when it comes to intoxication, it has the least effect really.

Monika Rachtan
And here it seems to me that this problem is being underestimated by us. Because who is harmed by this Mr Jasiu, who sits on a bench and smokes? Let him smoke, he is harming himself. But it doesn't only harm himself, it also harms everyone around him. It harms the environment, because this cigarette smoke is not indifferent to us either.

Magdalena Cedzyńska
Plus cigarette butts.

Monika Rachtan
Plus cigarette butts, which, yes, many people just throw away.

Magdalena Cedzyńska
This is a common occurrence. Just a man stands at a bus stop, a bus pulls up and he throws his cigarette on the ground. Through the window in the car. I see it often.

Monika Rachtan
Yes, me too. It also always surprises me when someone is just driving, driving a car and smoking. And I wonder God how he can.

Magdalena Cedzyńska
And it seems to him that a cigarette butt can be thrown into the street. Because what?

Monika Rachtan
But that He is staying in this place at all? That's scary to me. In that car, in such smoky fu just fu.

Magdalena Cedzyńska
You are very much against smoking.

Monika Rachtan
Well, it is terrible. Of course, I have one more problem, Mrs Magda. Maybe I shouldn't even talk about it as a medical journalist, because I'll come across as biased and prejudiced. What upsets me terribly is that someone makes the choice to smoke and then has this lung cancer. And we know how expensive lung cancer treatment is. And now the question arises: if they've been harming themselves for 30 years, then someone who lives a super-healthy life, moves around, doesn't smoke, doesn't drink. Unfortunately, he has to pay for his treatment.

Magdalena Cedzyńska
But that's the way it is, that's the society we live in. People get sick because of obesity, overweight too, you could say don't eat. That too is a disease. Nicotine addiction is also a disease, Mrs Monika. It is not.

Monika Rachtan
I am of course aware of this and absolutely here people are starting to smoke.

Magdalena Cedzyńska
Nobody starts smoking, Ms Monika, in order to die. After all, it's not like I'm smoking to die.

Monika Rachtan
Well, no.

Magdalena Cedzyńska
That is right. And you should also see that this choice to start smoking is made at a very young age. I know a few people, yes, from our patients, but I do not know many people who started smoking in their 20s or 30s, or even in university, most people start their addiction much earlier, when the brain is still immature, because it develops up to the age of 25. Especially those areas that are responsible for making decisions, for anticipating consequences. So these areas take the longest to develop. Well, and these decisions are made at such a young age, And nicotine, as I said, is highly addictive. It's a disease and then it's not always just a choice. It's all these aspects of addiction that come into play, this whole, whole battery of different defence mechanisms, these cognitive processes that are designed to protect us from this knowledge. Because it's not like, and I smoke to myself, I think to myself I'm going to get cancer, yet I smoke, that's how stupid I am. It's not like that. It's not like that at all.

Monika Rachtan
But on the other hand, do politicians, for example, know that the brain develops until the age of 25? Well, do they know that? Because if they do know that, then how can it be that cigarettes are sold from the age of 18.

Magdalena Cedzyńska
In the States from 21 onwards, no? After all, alcohol and cigarettes are illegal until the age of 21.

Monika Rachtan
Well, at Nas they are from 18. ba, a whole range of different nicotine junkies are available. Yes, because recently I was talking, we were talking and someone said innovative devices, I thought you were going to murder him. No no, nicotine junk that poisons and kills our bodies is available on the internet actually without age restrictions.

Magdalena Cedzyńska
Well supposedly from the age of 18, but as if acquiring it is mega easy. All you have to do is click. I hope I'm not suggesting this to anyone here. But just click. I'm 18 and I just buy everything into a packet. Nobody knows, took it out of the parcel machine, parents don't know, nobody knows. So it's very simple. But just to come back to it for a moment, it's a bit of an uneven fight because, as you say, it pisses me off that they smoke even though I then have to pay for theirs. Well, yes, but we start smoking as young people who are also fighting an unequal battle. Well, because they do. At that time we love to try different things, we love to try different forbidden things. It's written into such a developmental norm. And the industry tempts us. See what electronic cigarettes look like or what those nicotine sachets look like. Go online and see the packaging, the flavours, the aromas. We should take an example from the Kingdom of the Netherlands, in the sense of the Netherlands. They, from 2023, have a ban on adding flavours to electronic cigarettes. You can buy this tobacco-flavoured electronic cigarette. They have a ban on names like chilling fuel or some badboy flavour or such to encourage young people.

Monika Rachtan
Well, what is wrong with us parents that our children reach for all this stuff and we don't see it, even though we know it is wrong.

Magdalena Cedzyńska
What's more, I will tell you that some parents sometimes say this, it's not the first time I've said this, but I was once at such a focus study where kids talked about their smoking and it turned out that parents are happy that they are using e-cigarettes because at least they are not smoking traditional ones. There are homes where the child is allowed to vape because it's better than smoking that rubbish, because we've been fooled by this marketing that it's better, healthier. And then the parent thinks, well, that's a victim of the money that the e-cigarette industry has, for example, and they're being told from the very beginning that it's healthier and better. And such thoughts of God, thank God not normal cigarettes those stinkers, let him smoke that already. How is he supposed to smoke those.

Monika Rachtan
Frightening.

Magdalena Cedzyńska
But there it is.

Monika Rachtan
But I once witnessed such a situation in a restaurant. It was fresh from the ban on selling energy drinks to kids.

Magdalena Cedzyńska
A great move by the way.

Monika Rachtan
And you could, and you did. And a family was just sitting there. And there's a child there ordering and saying they would like this drink pointing it out to the waitress, and the waitress says I can't sell it because you're not 18, so it's absolutely forbidden. You just don't get the drink. To which the mother says, it's for me. I say, what a mother. And in fact it was like these ladies argued, because the waitress said, absolutely not, I know you're buying it for your child after all, But are you undermining my choices? I am buying it for myself. You are not going to hold me accountable for who is going to drink from this cup, and an argument ensued. Then the family left the restaurant. But as you have now just said about parents allowing their children to vape at home, this is unthinkable to me. And I wonder how much we have been deluded by these corporations that parents can hold such views, that they can give their children such permission.

Magdalena Cedzyńska
But I will not be myself if I do not say that the medical community also contributes to this. After all, how many supporters of electronic cigarettes are there who come straight to the Parliamentary Health Committee, who talk in the media about electronic cigarettes being a charm reduction strategy for less health harm. Well, no, no, and these are not people who believe that it is as if I find it hard to believe that an educated person and, moreover, a medical person, first of all, does not read the literature and see that even if these substances are less, they are still harmful to the respiratory system.

Monika Rachtan
I often hear that there is no research.

Magdalena Cedzyńska
No well there are studies, of course there are. There are studies which sometimes show contradictory results, but it is also a question of whether we can read the results of the studies. Because if, for example, someone shows that, I don't know, something, there is, for example, 30 per cent of some substance in relation to a traditional cigarette, well, everyone thinks, well, yes. And now the question is who is going to present these results. So it's less. Well, yes, but is it safe? You need a bit more specialist knowledge. Well, not all of us know what the safe level of acrolein is for our bodies, for example, no? This is such a problem. This is why I think that people who are connected with medicine and who promote e-cigarettes as harm reduction and do not look at the broader perspective of public health and the fact that people are starting to smoke from e-cigarettes, young people, well, in my opinion, this is simply irresponsible. It may not be popular what I'm saying now, but I think it's just irresponsible.

Monika Rachtan
It's just that if such words are still coming from the mouths of medics, the more the public starts to believe it. And that is exactly so, I would say immoral and unethical.

Magdalena Cedzyńska
I think it is unethical.

Monika Rachtan
Ms Magda, please tell me, if already a patient, because a person who is ill goes to an outpatient clinic, there is a long queue to the outpatient clinic.

Magdalena Cedzyńska
Well, I don't know, we are now saving for May.

Monika Rachtan
Well that's great. I tried to register with a specialist, I heard December 2025. But no, it's quite nice. But if I don't live in Warsaw or Bydgoszcz, am I right?

Magdalena Cedzyńska
Bydgoszcz or Gdańsk. Only in Wrocław? Well, there is no counselling centre in my place. Despite the fact that we have a large hospital dealing with lung cancer patients. Probably one of the largest in Poland, there is no outpatient clinic.... So where should I go?

Fortunately, we still have a telephone helpdesk for smokers. Fortunately, teleportation has already become quite popular since we had the pandemic. We have such an outpatient clinic, which has been operating at our institute since 96. It is funded by the National Health Programme. Fortunately, its number is on every packet of cigarettes. That's great too. Well, and there are therapists there, psychologists who, over the phone, help you put together a plan to stop smoking. Talk about previous attempts, what didn't work, so you don't repeat the same mistakes. I am currently preparing a new plan. They talk about the drugs, what works, what doesn't work, what the side effects might be. Everything. You can give them a call.

Monika Rachtan
By telephone, and the primary care physician, because on the other hand. Well, precisely, because it seems to me that the primary care physician, not even from the history but the time spent with the patient, should notice that he is a smoker.

Magdalena Cedzyńska
He should be able to offer him help. It's just that we struggle all the time with the fact that I'm not saying that doctors don't tell patients that they should stop smoking. It's just that if you understand a little bit about the nature of addiction and all these defence mechanisms, telling a person just to think I smoke because I like it or I don't know how to stop smoking. Saying well, you should stop smoking is a bit low. Some people will hear and get help. They will seek, but some should not be offered help. This significantly changes that dynamic between patient and doctor.

Monika Rachtan
But this is exactly the same advice as to people struggling with obesity is more or less move lose weight. Right, so here. But why is this the case with these primary care doctors? They don't have the tools, the knowledge, the confidence to help. After all, they would have half as much work to do if these people stopped smoking.

Magdalena Cedzyńska
And how many less patients at the Institute of Oncology would there be. You know that 44% cancers in men are tobacco-dependent cancers, 44%.

Monika Rachtan
I, Magda, have said many times in this programme that if we eliminated smoking and eliminated obesity, doctors would have to retrain because there would be nothing to do. So it seems to me that it should be the responsibility of primary care doctors to convince that patient. But I asked the question as to why it doesn't work for them. Do you know the answer to that question? Maybe there is a lack of incentives.

Magdalena Cedzyńska
It's probably also everyone who would like to use some incentives. There are even studies that show that if you give smokers incentives, they quit. Believe me, so-called incentives in the form of financial vouchers to some supermarket or something increase the quit rates.

Monika Rachtan
But we can make these vouchers ourselves, after all, because the moment a person doesn't spend £30 on cigarettes.

Magdalena Cedzyńska
But people love to get and I even had a conversation recently. We'll come back to your question in a moment. Just yes. I kind of did. I know I'm digressing, but I had a conversation recently. I just had this meeting with specialists from Europe. They have these telephone counselling centres and I was just shown to them by an Irish lady, because they have great facilities there in Ireland, really great. They have it there, they are very much ahead of us. And she showed me just such a programme where patients were given a voucher for every, I don't remember a dozen or so of these visits over the course of a year, and at the end I think they got EUR 140 for staying abstinent. And I say to her, Elene, but they also had their medicines reimbursed. Well yes, they had everything completely for free. So they had everything completely free and they were getting money. But you know, we can bemoan how to give that money, how they started smoking themselves, but on the other hand it works. It's supposed to have an effect, so why not?

Monika Rachtan
But what a saving for the system, that they don't get cancer, that they don't get heart attacks. So I think it's justified as much as possible.

Magdalena Cedzyńska
If it works then why not, we should look at what works at all.

Monika Rachtan
And whether a pharmacist. Because that's how I got my beloved pharmacists in the first place. Anyway, viewers of the programme know that I'm simply behind pharmacists wholeheartedly. Are they the people who are qualified to talk about quitting smoking at all?

Magdalena Cedzyńska
In my opinion, yes. In my opinion, yes.

Monika Rachtan
And is it that the system is reducing pharmacists to a sales role, rather than realising their potential?

Magdalena Cedzyńska
I don't know if this question is for me, I mean to me but I think it is. We are not fulfilling the potential. That is certainly the case. I don't know if it's reducing them to salesmen, I don't know. But I know with certainty that with certainty. I know they're not realising the potential and I know that and it's not some kind of my opinion either, I'm just also looking at what's happening in other countries and there are countries where these programmes that involve pharmacists in helping people quit smoking are successful.

Monika Rachtan
Well, what is it like in other countries? Mrs Magda, because you mentioned Ireland and these vouchers. I know that the UK is also doing very well here.

Magdalena Cedzyńska
There was a girl in our telephone counselling service who was just such a therapist for years, and she's not a doctor either, she was such a qualified health educator for smoking cessation, she ran such counselling centres for Poles in the UK. And they were giving away the drugs for free and there was a programme in pharmacies too. Admittedly, the Brits have gone a bit astray, because they are now giving away vaporisers in pharmacies, well that's a bit of a different topic, because that's also proper control, so I'm not going to go into that here, but they have had programmes over the years that have been run in pharmacies. There was a government-funded drug reimbursement programme and that pharmacist would give advice. He was doing this kind of minimal intervention and handing out medication. We also have a partnership with the University of Virginia in the States we also have a great programme for pharmacists and we thought we could do it with them. In Poland, it hasn't worked out for us so far, but we are not losing hope. Well, and there are scientific publications from this project. So it's kind of working.

Monika Rachtan
Mrs Magda, and will such a Mr Joseph from our proverbial bench, who smokes, go to a pharmacist today I know he won't get medicines for free, because unfortunately not. But he will get the knowledge, he will get a sort of know how on how to do it.

Magdalena Cedzyńska
I hope so. I don't know. I think they have a huge capacity. Pharmacists and as you see, for example, in pharmacies sometimes these dermo consultants who find the time and take the time to help someone choose the right cosmetic for their skin problems, I think to myself you might as well do that when it comes to smoking. Are they doing it? I don't know.

Monika Rachtan
You are also constantly involved in discussions with decision-makers? The decision-makers are changing, the topic is the same all the time, they need to be educated again and again, to return to certain topics. But is this conversation about pharmacists specifically, is it open somewhere.

Magdalena Cedzyńska
It is only just beginning, in fact, because we have seen the potential of pharmacists based on these examples from other countries. We see that it works. So we have started to have some of these conversations, they have also started to reduce the number of pharmacists. I've actually been in the school of pharmacists for a few years now, thanks to cooperation with various companies that, among other things, produce medicines, so I hope that they are doing it a bit more often now than they used to, because they feel more competent. But these conversations like this already at this level of deciding whether regulations are actually just starting. And I'm putting a lot of hope into it, to be honest, that something will come out of it here.

Monika Rachtan
Me too, because, as I said pharmacists, I'm big and I think not only on smoking cessation but also on vaccination. It's already happening, but it could happen on a bigger scale.

Magdalena Cedzyńska
But it's happening and that's great. It also showed, It was such a bit of a game changer. It showed that you can go into pharmacies with medical services simply.

Monika Rachtan
And I even just used the pharmacist's service myself this year when it comes to vaccination. Super. And I'll be honest, it's good. I went to my colleague, the expert, who by the way you had the opportunity to see in this programme, because I'm talking about Martyn Szaniawska, M.D. I went to see her. But what a nice meeting it was in general, because she had a lot of time for me, it's also important that, however, people with a master's degree in pharmacy are authorised to perform these pharmaceutical services. And it's very often the case that these are not the people who are at the frontline, that is, who stand at the window and serve patients. It's just that these are the people who work more in the back and by that I mean they don't have as much contact with patients on a daily basis.

Magdalena Cedzyńska
Maybe they have that time a little more.

Monika Rachtan
Yes, this is where they have a lot of time and such a huge desire.

Magdalena Cedzyńska
In general, maybe we don't say 'a lot', because they'll still be offended that we say they don't work much, but they certainly have more, more time.

Monika Rachtan
They just have such a desire that these competencies of theirs can be used, that what they've studied for many years at university, that they can finally talk to someone about it in a relaxed way and tell them. And it was such a nice meeting that I immediately after meeting Martyna say to my mum, you know what mum, and you know you can get vaccinated at the pharmacist. Mum says, well I know, I know, but I say somehow I've never had the courage, because I say you know, well the doctor, though, when he examines, he has more time and so on.

Magdalena Cedzyńska
The doctor simply takes a history.

Monika Rachtan
Yes.

Magdalena Cedzyńska
So does the pharmacist.

Monika Rachtan
She says mum, there's more time there, go absolutely. And mum went and said it was really great too. So harnessing the potential of pharmacists I think is really key. And here, when we have these shortages in medical staff, when we know that doctors are in short supply or they're short of time, because here also saying they're short of time or not.

Magdalena Cedzyńska
This is often the kind of argument that is made. Although I always think, I talk about it all the time, that it doesn't have to be treatment for addiction to it. It does not have to be at another appointment, because it is a disease, it has its own statistical number in the International Classification of Diseases. After all, we are the ones who can make the patient an appointment for nicotine addiction treatment.

Monika Rachtan
But, Ms Magda, do they enter a primary care physician at all, then.

Magdalena Cedzyńska
They write that they smoke often, I don't have that knowledge in terms of test results either, but as I often see somewhere in the documentation, for example in our hospital, it is usually written that someone smokes, and they don't write, for example, the statistical number of the disease, or they write the name of the disease like nicotine addiction. Sometimes it happens that someone writes nicotinism, but most often people write, doctors write that they smoke, which is a bit different. How do you write the name of a disease, right?

Monika Rachtan
Also yes. More striking to the patient it seems to me. It's usually said, new year, new me, but the middle of the year is about to be here. Not bad for quitting smoking either. Ms Magda, where do you go and how do you get started?

Magdalena Cedzyńska
Firstly, every moment is good. This is absolutely true.

Monika Rachtan
That's why I've just said that mid-year is also doable and even.

Magdalena Cedzyńska
There is no need to wait until Monday. I think there is. It depends on who is from where. If you are in Warsaw, you are welcome to come to our clinic. If you are from Gdańsk, you are also welcome to come to Professor Balwicki's clinic. But if you are not from Warsaw or Gdańsk, you are welcome to our telephone helpdesk for smokers. And that is a good, good start. A very good start, because there our therapists also have as much time and therapists, sorry, we have two men, they have as much time as necessary. I mean this conversation can last 5 minutes, 10 minutes or it can last 25 minutes. And these talks can also be as many as we need. I mean, we can make an appointment, for example, if we like the therapist and we feel that there is chemistry and something is going on here, that maybe something will work out, then we can make an appointment for her to call us back and we have our therapist on the phone for free, who will call as many times as we want. And that's a good start, because we'll talk about motivation, about how to get started, about what previous attempts have been like. Because it's often the case that people say yeah well I've tried so many times, I've tried so many times, it's not going to work for me anymore because I just can't do it anymore. I've tried so many times. How did you do it? I used to get up in the morning and say I don't smoke. Definition of insanity Not to do the same thing over and over again and expect a different result. So we say ok, well maybe let's do it differently now. Let's think about what would help now. Or was there a period of abstinence so that we could see what wasn't working, but what was working? Because it's known that it's better to do more of what works and not do what doesn't work. So that's what therapists are there for, to talk about just how to prepare that trial. Right. And that is in my opinion also talking about medication. That's a good, good lead in. And then you can go to the pharmacy and ask the pharmacist about what they have on offer for the smoker.

Monika Rachtan
Well, it seems to me that here the benefits of quitting smoking are so great. For health, for the wallet, for the environment, for our loved ones, that I don't think there's much to think about and wait. Like you said, it's a good time to wait until Monday or the new year or whenever just to reach for that phone and take advantage of the specialists who are at the Warsaw centre. I would still like to say that the fact that there is not this counselling centre in our hometown is not an excuse, because you can really use the help of the National Cancer Institute, a counselling centre that helps you to stop smoking.

Magdalena Cedzyńska
And my understanding is that we're going to let the number go down here so that everyone who's watching can see the number for themselves.

Monika Rachtan
So now this number is displayed for you to call if you want to make an effective attempt to quit smoking, which I strongly encourage you to do, along with my guest. And that was Dr Magdalena Cedzyńska. Thank you very much to you.

Magdalena Cedzyńska
Thank you for your kind conversation.

Monika Rachtan
My dear friends, this was the First Patient programme. My name is Monika Rachtan. Thank you very much for today and I invite you to follow me on my social media and see you next week.