Oscar Wilde, various members of the Yeats family, Brendan Behan and Jeremy Lewis have all loved and written about carousing in the pubs of Dublin. In their different days they might have found it difficult to recognise people through the thick clouds of acrid blue smoke that filled the bar. Dublin pubs were notorious for their tobacco laden atmosphere as well as for their noisy Saturday nights.

In Dublin last week the pubs were as crowded as ever. At first it was difficult to grasp what was different about them, but then the cause became obvious: the smell of tobacco had gone, and the pubs were devoid of their trademark smoke. Fortunately, the noise level and general banter are no less than they were a generation ago.

Doctors specialising in the treatment of lung and other chest cancers gathered in Dublin last week. These doctors are dedicated to treating unfashionable diseases that are starved of research funds and plagued by the judgmental attitude of the general public.

As delighted as the respiratory physicians were by the success of the authorities in ridding the restaurants and bars of smoke, there was one niggling doubt about the publicity it has attracted: in other circles these doubts would have centred on restrictions of an individual’s rights. The doctors’ worry was that, as could be expected, all discussions on lung cancer concentrate on its association with smoking.

This association has led many people to assume that in all patients with lung cancer the tumour has developed as a result of smoking. The judgmental have mistakenly adopted the attitude that these patients have only themselves to blame. In fact, of the 36,000 people who die of lung cancer every year, more than 5,000 have never smoked a cigarette in their lives. Only a small proportion of this number are likely to be suffering as a result of passive smoking.

Almost as many patients die of lung cancer, despite being non-smokers, as die of pancreatic cancer, and the same number as die of cancer of the oesophagus. More nonsmokers die of lung cancer than women die of gynaecological cancers.

Whether they are smokers or not, patients with lung cancer and other respiratory diseases deserve better treatment than they now receive. If past behaviour were taken into consideration before determining treatment, a great many of us wouldn’t receive the care that we do.

Would those who ignore appeals for research into respiratory disease because of smoking advocate neglecting heart disease in diabetic patients because many haven’t taken enough exercise, have eaten too much or haven’t had their blood pressure and blood sugar checked regularly? Would they refuse to treat sports injuries, and later the arthritis of games players, because these patients had preferred team sports over a brisk walk?

In Britain only 7 per cent of people with lung cancer live for five years, compared with 11.5 per cent in France and 13 per cent in the United States. In the UK survival can vary by as much as a factor of four depending on whether someone’s cancer was diagnosed in, for eample, Archers country near Borchester, or in Trollope’s Barchester. In some hospitals only 5 per cent of patients have surgery, whereas in others 20 per cent do. Nor do all hospitals offer the latest surgical techniques — there are wide variations in the way in which radiotherapy is used and in the likelihood of prescription of the latest chemotherapy. In certain centres a new drug, Navelbine (a form of vinorelbine), which can be taken by mouth, is now used in some forms of lung cancer almost immediately after surgery in conjunction with cisplatin. And whether in Borchester or Barchester, patients should watch out if they are over 75: in few branches of medicine is ageism as prevalent as it is in the treatment of cancer of the lung.

Appropriately, the Dublin conference was chaired by Dr Michael Peake, of the University Hospitals of Leicester, who is an expert on the organisation of lung cancer care. Leicester has a remarkable record of changing the outlook for patients with lung cancer. Ten years ago their five-year survival rates varied between 2 and 3 per cent for patients who had the disease diagnosed; by 1999 the five- year rate had risen to 8.86 per cent for newly diagnosed cases. Present statistics suggest that those who had the disease diagnosed in 2000 will have a five-year survival rate of more than 11 per cent, approaching that of France and catching up with the US.

In Leicester 95 per cent of patients are seen by a specialist team and are treated within 31 days. The number undergoing surgery has risen from 5.8 to 18 per cent in ten years, but the death rate after surgery has fallen.