We read the article by McCreadie & Kelly (Reference McCreadie and Kelly2000) with interest. The study indicates a high rate of cigarette smoking in patients with schizophrenia. It concluded that typical patients who smoke return 18-31% of their state benefits to the Treasury in the form of taxes on the purchase of cigarettes. However, the authors have not taken into consideration the cost of smoking-related diseases such as ischaemic heart disease and chronic obstructive airways disease. Inevitably, patients suffering from such diseases require expensive cardiorespiratory investigations and medication, which results in substantial expenditure by the National Health Service. Thus, perhaps the Treasury would be better off if patients did not smoke.

A review article by Felker et al (Reference Felker, Yazel and Short1996) has outlined various studies which indicate increased morbidity in psychiatric patients due to various medical conditions, including cardiovascular and respiratory problems. It is difficult to show the extent to which these diseases are caused by cigarette smoking, but we all know that there is a strong association between cigarette smoking and cardiorespiratory problems.