Author Archives: Gabriel Symonds

Danger! Never Smoke While Using Oxygen!

Here is some good news for those unfortunate patients suffering from a serious condition  known as chronic obstructive pulmonary disease, or COPD. It’s a complex disorder but the main features are shortness of breath with cough, phlegm and chest tightness as the lungs are progressively damaged; the result may be fatal. The biggest risk factor for getting COPD is cigarette smoking so it’s obvious what a smoker should do if he or she has been given this  diagnosis.

Easier said than done! Or so it may appear. Here we have the absurd situation where smoking is literally killing these patients and they may say they can’t stop. Well, unless someone has a death wish – and respiratory failure is not a pleasant way to die – I don’t believe someone can’t stop smoking. I have had a number of patients with the COPD under my care and when they  realised the state they were in, even if they didn’t want to avail themselves of my method of smoking cessation, they just stopped. It’s similar to the situation of a smoker who gets a heart attack: they usually quit forthwith.

Now there has been a new study, reported in the journal Thorax in May 2017, undertaken by six researchers from the UK, Germany, The Netherlands and the USA, that shows, apparently, that giving the drugs varenicline or bupropion to smokers with COPD – those who by implication are unable to quit on their own in spite on of this serious diagnosis – is safe, in that these drugs ‘do not appear to be associated with an increased risk of cardiovascular events (heart attacks and strokes), depression or self-harm (suicide attempts) in comparison with (so-called) nicotine replacement therapy.’

Smoking is a voluntary activity. Yet the orthodox approach of medical workers involved in the care of these patients is that they can only offer nicotine products or drugs to help them stop killing themselves. But even if they use these drugs or nicotine products they still have to stop smoking!

It’s not generally realised that offering drugs or nicotine products as smoking cessation ‘aids’ is inherently discouraging and may make quitting more difficult. This is because these treatments imply that it’s too difficult to quit on your own. Even if you’re suffering from COPD, and obviously the smoke is going into the very place where the trouble is, namely, the lungs, there’s an unspoken collusion that these poor people can’t stop without medical intervention.

Psychologically this is a disaster: it gives the patient an in-built excuse for failure. Like all smokers, even though dying from this smoking-induced disease is a real possibility, they still don’t really want to stop. They can say, therefore, that they tried the drugs or nicotine products and they didn’t work, so in a sense they have permission to carry on smoking!

What, then, should be done?

First of all, it is a ludicrous situation, is it not, that people with a potentially life-threatening illness largely caused by smoking, are able to go into any corner shop or supermarket and buy a pack of cigarettes, no questions asked. Pictures of diseased lungs and patients with breathing holes in their throats (tracheostomies) do nothing to put off those COPD patients who continue to smoke. It is, therefore, not lack of information about the harmful effects of smoking that is the reason many people start or continue smoking.

Why, then do they do it?

Children and teenagers start smoking because they see other people smoking, either older people whom they wish to emulate, or their peers whom they wish to impress. Horrible pictures on the packs make very little impression. ‘Lung cancer happens to older people – it doesn’t apply to me.’ Or they think of themselves as invulnerable – which is understandable and even normal at that age. The ‘graphic health warnings’ may even act as an incentive to  smoke, as a dare. What is absurd is that cigarettes are on sale at all.

There’s a glaring inconsistency in that cigarettes, in packs emblazoned with warnings not to smoke, are nonetheless freely available. I have even had young people say to me, ‘If cigarettes were really so dangerous they wouldn’t be allowed!’ This is a good point, but how do you respond to it? By saying that government is either lying or being irresponsible?

And why do older smokers continue to smoke in spite of knowing the dangers? Because they are addicted to the nicotine in cigarettes. This statement, however, is not an adequate answer to the question. We can put it succinctly like this: the only reason smokers smoke is because they believe they are unable to quit.

Text © Gabriel Symonds

How many smoking deaths in the US would be acceptable?

You would think, would you not, that the US Food and Drugs Administration (FDA) Commissioner, Scott Gottlieb, MD, would understand a few basic facts about smoking and nicotine addiction. Yet, although he acknowledges that smoking is a pretty serious problem, causing more than 480,000 deaths in the US every year, in a press release of 28 July 2017 he said he wants to have ‘an appropriate balance between regulation and encouraging development of innovative tobacco products that may be less dangerous than cigarettes.’

Let us dissect this statement. If he wants to ‘regulate’ cigarettes, rather than abolish them, this implies there are some circumstances where smoking is legitimate or acceptable. And what, I wonder, might those be? Then he wants the regulation, such as it may turn out, to encourage the development of new tobacco products that may (or, presumably, may not) be less dangerous than ordinary cancer sticks.

And his idea to achieve this, as he somewhat clumsily puts it, is by:

Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources, needs to be the cornerstone of our efforts – and we believe it’s vital that we pursue this common ground.

Now, who are these adults who ‘need or want nicotine’? No one needs nicotine – except those who are addicted to it – and these are the very people who want it for that reason. So what the brave Dr Gottlieb envisages is:

…lowering nicotine levels [in cigarettes which] could decrease the likelihood that future generations become addicted to cigarettes and allow more currently addicted smokers to quit.

Let me lead Dr Gottlieb back to reality. If we wait generations for the decreased likelihood of people being addicted to cigarettes, how many will die from smoking in the meantime? All smokers are currently addicted (to nicotine) – that’s why they smoke. Further, they don’t need to be ‘allowed’ to quit; they just need to quit! And the only thing that will allow the happy state of universal non-smoking to come about within the foreseeable future is to abolish tobacco.

Instead, the envisioning goes on to:

…afford the agency time to explore clear and meaningful measures to make tobacco products less toxic, appealing and addictive.

Presumably it is not their intention to explore unclear and meaningless measures, but this is in effect what all the envisioning will amount to. In any case, I wonder what degree of reduction in toxicity, appealability and addictiveness they have in mind?

Even if such unspecified degrees of reduction in these three attributes were possible, how many people dying in the US every year from tobacco-related diseases would Dr Gottlieb find acceptable? All tobacco products are addictive because they contain nicotine. If the nicotine is somehow reduced so that cigarettes are ‘less addictive’ no one will want to smoke them. Or is that the idea? If so, this would in effect be the same thing as cigarette prohibition. Then why not say so?

Anyway, addiction is addiction; it makes no sense to talk of degrees of addiction. And even if this were true, someone who is deemed to be only lightly addicted may think he doesn’t have a problem and therefore has no need to quit, and someone who is regarded as being heavily addicted may think quitting will be too difficult so she won’t want to try to quit.

We are back to the basic problem: why envisage only reducing tobacco related disease and death rather than abolishing them by abolishing tobacco?

Text © Gabriel Symonds

Out with ASH – in with CAT!

Gentle reader, please bear with me until l come to the bit where I disclose the amazing revelation that recently came upon me in a dream.

Now, the following is from the website of ASH (Action on Smoking and Health), quoting the UK National Institute for Health and Care Excellence (NICE):

While recognizing that quitting smoking is always the best option for smokers, the NICE guidance supports the use of licensed nicotine containing products…to help smokers not currently able to quit to cut down and as a substitute for smoking, where necessary indefinitely.

Unfortunately, this doubtless well-intentioned advice is based on a fundamental misunderstanding of smoking and thus does smokers a disservice.

Here’s why. The talk of ‘smokers not currently able to quit’ fails to recognise that all smokers are unable (or think they’re unable) to quit – that’s why they’re smokers. Further, the qualification ‘currently’ implies smokers may be able to quit at some point in the future, but until they reach that happy state they have tacit official approval to carry on smoking for the time being – which often means a long time.

Today a smoker is unable to quit, but sometime in the future he has a Road to Damascus moment, the scales fall from his eyes and the cigarette from his lips – and suddenly he’s able to quit! So he does. Or does he?

In any case, on what evidence does NICE talk of smokers being ‘unable to quit’? Are there any? It’s indulgent and even collusive with smokers to characterize them in this way. ‘There, there, don’t worry if you can’t quit at the moment – I’m sure you’ll be able to quit sometime in the future!’ This merely gives smokers an excuse and a reason to feel less bad about smoking while they carry on doing it.

Further, NICE really ought to know better than to imply that cutting down the number of cigarettes smoked daily will do any good for a smoker’s health. It won’t. It merely creates a false sense of security: ‘I’m cutting down – so that’s all right then.’

But now we come to the real bummer, if you’ll pardon the Americanism.

NICE seems to think it’s fine for smokers to use, not just any old nicotine products, but licensed nicotine containing products (gum, patches, suppositories, etc.) as a substitute for smoking, where necessary indefinitely’.

You don’t need a substitute for smoking! And, under what circumstances, would NICE be so good as to explain, is it necessary to use licensed nicotine containing products at all, let alone indefinitely.

This nihilistic thinking seems to be, among the NICE people and many involved in so-called tobacco control, that it will never be possible to get all smokers to stop and so the best compromise is that those who can’t or won’t stop should be encouraged to continue their nicotine addiction, where necessary indefinitely, in a possibly safer way than smoking.

ASH’s policy contributes to this weak approach. As mentioned, the acronym means Action on Smoking and Health, but the only action that needs to be taken to deal once and for all with the smoking epidemic, it to abolish tobacco. Unfortunately, ASH doesn’t agree with this.

Therefore, I propose that instead of more and more effort going into ‘tobacco control’, a new organisation – of which I would volunteer to be the honorary secretary and president – should be set up, dedicated to closing down the cigarette factories.

I would call it the Campaign for the Abolition of Tobacco (CAT).

Text © Gabriel Symonds

The end of the world – or at any rate the end of China – is upon us!

How proud Dr Margaret Chan (Director-General of the WHO) and Helen Clark (Administrator of the UN Development Programme) must feel of their ringing rhetoric in warning of the catastrophe facing China! (Foreword to Health, Economic and Social Costs of China’s Tobacco Epidemic, WHO 2017)

Tobacco use kills six million people every year and is a threat to health and development…Tobacco use hurts families, impoverishes communities and damages economies and societies…

China – the world’s largest producer and consumer of tobacco – is the epicentre of this epidemic. A staggering 44% of the world’s cigarettes are smoked in China. One million people die of tobacco-related diseases in China every year…Tobacco use is killing or disabling the main wage earner in many Chinese families.. and plunging those already on the margins into poverty.

 If nothing is done…smoking-related diseases are on track to claim more than 200 million lives in China this century…

Splendid clichés and buzzwords abound:

…a huge step towards delivering on the vision articulated in the 2030 Agenda…a world transformed…and no one left behind…the WHO have (sic) joined hands to support realising the commitments…accelerate multisectoral and interagency responses to support full implementation…the broader goal of building a more sustainable and inclusive economy and society…we are united in an unwavering commitment to further the goals…to protect present and future generations from the devastating…consequences of tobacco consumption…in the name of the millions of victims already lost to tobacco, and the millions of lives that still hang in the balance. Amen. (Condensed and paraphrased.)

Then we move on, not just to the Summary, but to the Executive Summary! It, and the rest of the report, was written by the well-named Angela Pratt and her colleague Andrea Pastorelli with the help of no less than thirty-five other people who contributed to this noble endeavour. The Executive Summary, curiously, repeats much of what is said in the Foreword: ‘Tobacco is on track to claim 200 million lives in China this century…’ etc.

Finally we come to the Introduction where, once again, just to make sure we don’t forget, we are told ‘More than 1 million people die in China every year as a result of tobacco use’ and  that ‘This will grow to 2 million annually by 2030, and 3 million annually by 2050 without action to drastically reduce smoking rates.’

They do, at least, set out some of the reasons for this appalling situation:

Fuelling China’s ravenous appetite for tobacco products…is the China National Tobacco Corporation (CNTC), the largest tobacco company in the world and one of the Chinese Government’s most profitable state-owned enterprises…China grows tobacco on more agricultural land than several other large tobacco-producing countries combined…the Chinese Government profits financially from every step in the tobacco production chain…In 2015, the tobacco industry contributed…US$ 170 billion, to the central Government – around 7% of total central Government revenue.

And then they go on a rant against the rulers of China, asking

…whether it is appropriate and ethical for a government to profit directly from an industry that derives its revenue from a product that kills

There’s more:

Tobacco growing causes biodiversity loss from deforestation and land clearing, soil degradation as tobacco growing depletes soil nutrients more than other crops, and land and water pollution as pesticides leak into the soil. Tobacco manufacturing produces a large amount of manufacturing and chemical waste, and cigarette butts when disposed of improperly are washed into rivers, lakes and the ocean where they are eaten by birds, fish and animals. Globally, cigarette butts make up the largest percentage of waste collected during beach cleanups every year.

What to do about it? This is what:

  • Increase tax on cigarettes by up to 100%
  • Institute 100% smoke-free public places
  • Ban cigarette advertising
  • Put horrible pictures on cigarette packs
  • Start mass media campaigns to warn people of the dangers of tobacco use
  • Health care professionals should give smokers cessation advice

Plus this pie-in-the sky:

The conflict of interest inherent in the tobacco industry’s involvement in China must be removed in order for effective implementation of tobacco control policies to be achieved

Wonder of wonders! If all the above measures (known as ‘tobacco control’) are instituted then by various statistical manipulations apparently one can predict by how much the prevalence of smoking will fall within a given period of time. For example, they estimate that:

A 50% increase in the retail price of cigarettes alone could…prevent 20 million premature deaths over 50 years, and save 8 million people from being plunged into poverty because of tobacco-related medical costs. (Emphasis added.)

Of course, any reduction in smoking-related deaths is to be welcomed, but assuming their predictions are correct, what about all the other people who will still die? How are the tobacco controllers going to reduce smoking prevalence to zero? Is that their aim or hope? Then why don’t they say so?

But while all this is going on Big Tobacco and especially the China National Tobacco Corporation are not going to do nothing and (assuming the above-mentioned tobacco control measures are effective) wait for the demise of their industry as smokers buy fewer and fewer of their poisonous products until, perhaps in one hundred years’ time, nobody bothers to buy cigarettes at all.

Just to get a sense of proportion about this, let’s look at another cause of deaths in China: traffic accidents. They cause over 200,000 deaths annually according to the WHO.

How can these deaths be prevented? Abolish traffic! But that would be impractical. So people need education in road safety and traffic regulations must be enforced. That should bring the number down but it’s unlikely it will ever be zero.

But why can’t tobacco be abolished? It serves no useful, let alone essential, purpose.

If the China government is serious about saving the health and lives of a significant proportion of their people they should start by closing down the cigarette factories.

Text © Gabriel Symonds

Why nearly all stop smoking websites are unhelpful

I put ‘How to stop smoking’ in Google and this is what came up (emphases added) :

Readers’ Digest

The 23 Best Ways to Quit Smoking…Make an honest list of all the things you like about smoking…Then make another list of why quitting won’t be easy.

WebMD

So you’re ready to kick the habit. That’s great! Making that commitment is half the battle. It’s not going to be easy. But choosing the best way to quit is a good first step to ensure you stick with it

wikiHow

Nicotine is incredibly addictive and it will take determination to quit….Be prepared for nicotine-withdrawal symptoms…When you stop smoking, you might experience increased cravings, anxiety, depression, headaches, feeling tense or restless, increased appetite and weight gain, and problems concentrating….

helpguide.org

We all know the health risks of smoking, but that doesn’t make it any easier to kick the habit…quitting can be really tough.

kidshealth.org

…it’s true that for most people quitting isn’t easy…Everyone knows it can be hard to stop smoking..the nicotine in cigarettes is a powerfully addictive drug…You’ll need patience and, yes, willpower.

Mayo Clinic

10 ways to resist tobacco cravings…Tobacco cravings can wear you down when you’re trying to quit…tobacco cravings or urges to smoke can be powerful… when a tobacco craving strikes…Try nicotine replacement therapy [or] prescription non-nicotine stop-smoking medications such as bupropion (Zyban) and varenicline (Chantix).

Medical News Today

How to give up smoking: Ten tips…Nicotine in cigarettes is addictive, which is why people experience unpleasant withdrawal symptoms when they try to quit. Nicotine replacement therapy (NRT)…helps to ease some of the symptoms of nicotine withdrawal, such as intense cravings, nausea, tingling of hands and feet, insomnia, mood swings, and difficulty concentrating.

What is noticeable about all these – and they’re a representative sample of a large number of similar sites – is how discouraging they are! They tell you how difficult it will be to give up smoking, the unpleasant withdrawal symptoms and cravings (whatever that means) that would-be quitters will have to face and propose nicotine products (when the smoker is trying to escape from nicotine addiction) or prescription drugs which can only work by causing a chemical imbalance in the brain. No wonder quitting smoking seems to hard!

There is one site which appears fairly high on the list that I haven’t yet mentioned: Allen Carr. This comes nearest to what The Symonds Methods offers and, likewise, recommends no drugs or nicotine products but relies on a psychological approach. Incidentally, Allen Carr died in 2006, ironically from lung cancer, but his method is still available through the business he developed. The problem with it is that although he grasped intuitively why people smoke and therefore realised that a change of mind-set is enough in theory to get smokers to quit, he lacked the necessary medical and biological knowledge to explain clearly the mechanism of addiction, using instead crude similes such as ‘the little monster in your stomach’ and ‘the big monster in your head’.

Does the Allen Carr method work? This begs the question of whether any method of smoking cessation works. Smoking is a voluntary activity. If someone uses the X method and stops for, say, one year, and then a day later starts smoking again, does this mean X method has failed? No, it means the smoker has changed his or her mind about wanting to be a non-smoker. Nonetheless, a study was done in Holland in 2014 (https://doi.org/10.1186/1471-2458-14-952) which, in spite of methodological limitations, showed that in a company setting, 41% of participants were not smoking at thirteen months compared with 10% of controls – a four-fold difference. This is all well and good, but it still means that 59% failed to quit.

We now come to the method I have developed myself, which in all modesty I call The Symonds Method of smoking cessation. In theory, it should be 100% effective. Now hold on Dr Symonds, this is a bit over the top, isn’t it? Actually, no.

When a smoker sits down in front of me to learn how to be a non-smoker again, I ask them to give an undertaking that in the unlikely event they don’t happily stop after the first session, they will come back (without additional charge) for as many sessions as necessary until they do stop. The definition of success, therefore, is someone who doesn’t come back.

I have been accused of being self-serving by saying this, but I think it merely highlights the fundamental problem of smoking: in spite of being well aware of the risks, many smokers don’t want to stop or change to an allegedly safer way of continuing their nicotine addiction.

Text © Gabriel Symonds

The Twelve Worst Ways – and the One Best Way – to Stop Smoking

1. Fear

Horrible pictures on cigarette packs and emphasizing that smoking causes cancer and heart disease assume people smoke because of ignorance of the consequences. This is not so. Everyone these days knows smoking is harmful to health. Scare tactics have relatively little effect because they don’t take into account the main reason people smoke: nicotine addiction, which is so little amenable to logic.

2. Reminding smokers of the benefits of quitting

Reduced health risks, saving money and smelling better (in both senses) are what smokers are already aware of – that’s why they want to quit! So why don’t they?

3. Nicotine patches or gum

If you want to stop smoking you presumably wish to be rid of nicotine once and for all. So what’s the good of putting it into your body by a different route? Nicotine products merely keep the addiction going and make it harder to stop. The poor success rate of around 15% for nicotine patches and gum shows that smokers who quit using these products do so in spite of them, not because of them.

4. So-called Stop Smoking Medicines: bupropion (Zyban) and varenicline (Champix)

These work, if they work at all, by causing a chemical imbalance in the brain. Smokers already have enough of a chemical imbalance in the brain with their nicotine addiction; it makes no sense to increase it with prescription drugs. Many people feel unwell while taking them and a serious (though rare) side-effect is suicidal thoughts.

In any case, using these drugs, as with nicotine products, merely reinforces the fear many smokers have that quitting is too difficult to do on their own. Nothing could be further from the truth!

5. Combining nicotine patches or gum with stop smoking medicine

The same objections as above apply, only more so.

6. E-cigarettes

These are promoted in some quarters as a way to stop smoking. This is disingenuous. They are merely a means of continuing nicotine addiction in a supposedly safer way; it has been claimed that e-cigarettes are 95% safer than ordinary cancer sticks but there’s no proof that this is so. The fact is, no one knows what the effects will be of sucking into your lungs vapourised nicotine together with propylene glycol, glycerin, water and flavourings many times a day, every day for years on end.

Fortunately there is a simple, 100% safe alternative to cigarettes and e-cigarettes: not to use nicotine at all – in any form.

7. ‘Heat-not-burn’ tobacco products, variously called IQOS, iQOS, ‘glo’ and Ploom

It is misleading that these recently released products are presented as a way to stop smoking. They may not be quite as dangerous as inhaling tobacco smoke, but to inhale the fumes derived from heating tobacco without burning it cannot be anything but harmful to health.

8. Humour

There are a number of websites that appear to try to encourage smokers to quit through levity. Smoking is no laughing matter. The apparent difficulty in quitting is not due to lack of a sense of humour. See, for example, my critique of the nonsense put out by healthline.com: http://nicotinemonkey.com/?p=1587

9. Vulgarity

I am not making this up, but there is an NHS-supported website in the city of Leicester in the UK where this is actually their approach. I will not discomfit readers of a sensitive disposition by quoting the words used, but you can read them for yourself if you refer to my blog: http://nicotinemonkey.com/?p=1620

10. Willpower

This means forcing yourself not to do something you have a strong desire to do. Usually it is only a matter of a (short) time before the wish to smoke is greater than the wish to be a non-smoker and willpower loses out.

11. Hypnosis, acupuncture, laser-treatment, supplements and other gimmicks

These methods may work for some people but they are troublesome and time-consuming. If they work, they do so by suggestion. Also, as noted under number 2, they reinforce the wrong idea that quitting is so difficult you need some outside agency to help you.

12. Cold turkey

What does this curious expression mean? It was originally used when someone addicted to hard drugs stopped suddenly and experienced unpleasant or even dangerous withdrawal symptoms including the skin coming out in goosebumps – or should that be turkeybumps?

Many people regard ‘stopping smoking cold turkey’ as the same thing as stopping through willpower. You try to force yourself not to smoke while enduring awful withdrawal symptoms until the desire to smoke goes away. And how long will that take?

And the one best way to stop smoking?

Just stop!

Some smokers may be fortunate enough to wake up one day and say to themselves, ‘That’s it. I’m through with cigarettes.’ And they never smoke again. And they never want to smoke again.

But if you’re reading this blog you’re probably one of the many smokers who genuinely find it hard to stop. Fear not. If you can be helped through The Symonds Method to demonstrate to yourself  why you have continued to smoke in spite of knowing the risks, and why quitting seems so hard, then it will be easy!

Text © Gabriel Symonds

Philip Morris tortures animals

Yesterday

Today

The tobacco giant, Philip Morris International (PMI), has applied to the US Food and Drugs Administration (FDA) to market what they call ‘modified risk tobacco products’ (MRTP), in particular, their heated tobacco contraption with the unpronounceable name of IQOS, or iQOS.

They start by putting their cards on the table: ‘PMI recognizes that cigarettes are a dangerous product.’ Then why don’t they stop making them?

In the application they submit evidence to support their claim that if smokers switch completely (the word ‘completely’ is redundant) to iQOS they ‘can reduce the risks of tobacco-related diseases.’

But now the Oh-so-honest American global cigarette and tobacco company, PMI, makes a devastating admission:

It is well known that the best way to avoid the harms of smoking is never to start, and for smokers, the best way to reduce the harms of smoking and the risk of tobacco-related disease is to quit. (Emphasis added.)

Note how they say that if you want to avoid the harms of smoking you should never start, which is true indeed, but if you are already a smoker and you quit, then you can only reduce the harms to which you have been exposed, not avoid them.

This is because, even if you stop smoking, the damage may already have been done. Certainly the risk of getting cancer will decline steeply as a few years go by after quitting but, alas, the risk will not go down to what it would have been if someone had never smoked.

Just to rub it in, they go on: ‘Cigarette smoking [accounts in America] for more than 480,000 smoking-related deaths every year, and more than 16 million Americans live with a smoking-related disease.’

So what does PMI do in the light of these shocking revelations?

They present themselves as the good guys:

PMI…has recently announced its goal to lead a full-scale effort to ensure that MRTPs ultimately replace cigarettes. Indeed, PMI envisions a smoke-free world where a broad range of MRTPs fully satisfies the continuing consumer demand for tobacco and nicotine products.

So PMI wants to be a public health champion, envisioning a smoke-free world where products such as iQOS will ultimately replace cigarettes. Note the assumption that there will always be – happily for PMI and its shareholders – a ‘continuing consumer demand for tobacco and nicotine products’. How about envisioning a nicotine addiction-free world?

All this, however, is merely a prelude to what I want to say in today’s post.

PMI, in their great humanitarian efforts to develop tobacco products that they hope will be  less harmful than cigarettes, have applied to the FDA for a licence to market their iQOS product. And what evidence do they present in favour of their application?

They subjected rats and mice to cruel experiments in which they were forced to breath iQOS fumes for six hours a day, five days a week for months on end. The fumes were either pumped into the boxes where the animals were confined, or in ‘nose only’ tests, they were held immobile in a kind of funnel with their noses sticking out of the end to be exposed directly to the fumes. The reason for this refinement was to avoid messing up the experiment by the animals ingesting more of the poison in the fumes by licking their fur as they would do if the whole body was exposed. The animals were then then killed and their noses, throats and lungs examined to see how much damage had been inflicted. Very little damage. Therefore iQOS is (relatively) safe for humans, they say.

Apart from the fact that there is no scientific basis for assuming that what happens or doesn’t happen in experiments on rodents has any relevance for humans, these abhorrent tests are manifestly cruel, causing pain and distress to these animals.

This research is reminiscent of the ‘smoking Beagles’ scandal in Britain in 1975 when an undercover investigation led to the exposure of experiments being done on Beagle dogs in a futile attempt to develop a ‘safer’ cigarette. The work was done by Imperial Chemical Industries (ICI). The dogs were restrained and forced to breath, by a face mask, the smoke from up to thirty cigarettes a day for as long as three years. The subsequent public outcry led to animal experiments for tobacco products being banned in Britain and Europe – but not in America.

It’s not as if the experimenters were using animals in the hope of finding a cure for cancer. Their object was to find a new way, acceptable to the FDA, of keeping people hooked on nicotine and their profits healthy to make up for the decline in cigarette sales.

Text © Gabriel Symonds

Stopping Smoking through Vulgarity

‘Smokefree’ is a catchy neologism used by the NHS Smokefree campaign. It’s supported by Public Health England which is part of the UK government’s Department of Health. So it’s quite kosher.

But what’s this? The Leicester City Stop Smoking Service at a quick glance looks similar:

As we can see, it offers not just any old licensed products to assist your efforts to become smokefree, but traditional licensed products! Well, bless their cotton socks. The manager, Louise Ross, comments: ‘Every time I see someone vaping I think: that’s another person NOT smoking a cigarette.’

And if the gung-ho Ms Ross were to observe a member of the public going about their business who is neither smoking nor vaping, would she think: ‘That’s another person NOT smoking a cigarette’? It seems to her the normal state of non-smoking is regarded as remarkable and a matter for congratulations.

In either event she seems to have a lot to be pleased about. How does she do it? With vulgarity. I promise I am not making this up. On the redoubtable Leicester City Stop Smoking Service website you soon come across a YouTube video of which the first written words, I blush to tell you, are: ‘Have you got the balls to stop smoking?’ It’s narrated by Gerry Taggart who, you will be glad to know, is a ‘Former Northern Island and Leicester City Defender’ – and I hasten to add he speaks like the gentleman he is throughout the short film. However, there is even a page labelled ‘Balls to stop’. It seems this website caters only to men. Incidentally, Gerry Taggart tells us he just woke up one day and decided he didn’t want to smoke any more – and he hasn’t. Once he put his mind to it, it was easy – and he didn’t need e-cigarettes.

Leaving aside for the moment the question of why you should need any sort of product to stop smoking, let us look at this stop smoking service’s wording in a little more detail:

We offer all the traditional licensed products (patches, mouth-spray, inhalators, Champix and many more), and advisors are skilled in helping people choose the right product for them.

Presumably the products don’t include e-cigarettes because these are not licensed for smoking cessation.

But they are included – very much so. The service emphasizes that it’s ‘ecig friendly’. That’s rather obvious: almost every page of the website shows pictures of e-cigarettes or contains articles about vaping.

If you want to stop smoking, or as one might say, be smoke-free, this conjures up a picture of giving up smoking and thereafter carrying on with your life without the need to poison yourself all the time by sucking tobacco smoke into your lungs.

But with these sorts of stop smoking services it must be rather disappointing for potential clients. The message is that in order to return to the normal state of being a non-smoker, they will instead of smoking be encouraged to put relatively pure nicotine into their bodies by other means and this could go on indefinitely. Or they may be offered a chemical drug to take for weeks or months. Or maybe clients will be offered nicotine products and chemical drugs.

On the other hand, rather than using a product to stop smoking, one could approach it in a different way that might be expressed by paraphrasing Ms Ross: ‘Every time I see someone vaping I think: that’s another person in the thrall of NICOTINE ADDICTION!’

Surely, someone who wants to stop smoking wishes to be free of nicotine in any shape or form. In this case, is so-called nicotine replacement the best that can be offered, or is it just second best? Why should anyone have to settle for second best? The fact that smoking substitutes are offered at all merely reinforces the fear that smokers already suffer: the prospect of never smoking again is almost too much to contemplate.

You don’t need ‘products’, let along nicotine-containing ones, to stop smoking. You just need to understand why you’re in such a pickle in the first place. Or, as shown by Gerry Taggart, you need a different mind-set. Then quitting is easy.

Text © Gabriel Symonds

Up the Garden Path to Prove the Useless about E-cigarettes

 

Why not just eat a banana?

The latest breakthrough since lunchtime, if you’ll pardon the cliché, is revealed in the result of a study carried out at Penn State College in the US, styled Population Assessment of Tobacco and Health (PATH). Did they think of the acronym first and then juggle the words to find a match? (Report in Penn State News, 17 June 2017.)

It was another questionnaire type of study. Out of 32,320 people who responded to a survey, only 3,586 were found to fit the study criteria. The subjects were cigarette smokers and e-cigarette users. Or cigarette users and e-cigarette smokers.

Where did the PATH lead to? Let’s hear it from lead author Guodong Liu, assistant professor of Public Health Sciences at Penn State: ‘The findings indicated that e-cigarette users were relatively less dependent than cigarette users.’ Amazing! Putting it another way, he said: ‘No doubt about it, e-cigarettes are addictive, but not at the same level as traditional cigarettes.’ Well, fancy that.

How did they determine that vapers were less addicted than smokers? Like this:

Compared with cigarette smokers, e-cigarette users waited longer to start using their product after waking up. Vapers were less likely to consider themselves addicted, to have strong cravings or to feel like they really needed their product. They were also less likely to say they found it difficult to refrain from using their product in restricted places.

Very interesting, but so what? The reality for both smokers and vapers is that they ‘use’ their ‘product’ many times a day, every day, for years on end and find it difficult to stop. Ergo, both types of nicotine user are addicted. It matters not one jot or tittle whether someone is more, or less, addicted and the very notion of degrees of addiction, being based on the above-mentioned arbitrary criteria or in any other way that might be thought up, is groundless as well as pointless; either someone is addicted or they are not.

But wait – there’s more! ‘Planned follow-up studies will help determine if e-cigarettes could lead to traditional cigarettes dependence in the future’, says Professor Liu. The experimenters apparently see a need for these follow-up studies because, we are informed, ‘experts have raised concerns that e-cigarette use could cause nicotine dependence and lead to cigarette use, reversing hard-won public health gains.’

What is it with these so-called experts, and who are they anyway? Of course e-cigarette use causes nicotine dependence. Even Professor Liu recognises that. One might as well ask whether cigarette use causes and sustains nicotine dependence. (Dependence sounds nicer than addiction, doesn’t it.) Why else would anyone in their right mind want to suck chemical-laden fumes into their lungs all the time?

Eventually we come to the reason for the huge effort that went into the study:

The PATH study findings are expected to inform future tightening or loosening of regulations around vaping products. In May 2016, the US Food and Drug Administration began regulating e-cigarettes, ruling that they could not be marketed or sold to minors under eighteen years old.

That brings me to another point. Why is it that the regulations, with whatever degree of tightening or loosening is thought appropriate, are intended to shield only minors from the marketing or selling (what’s the difference?) of e-cigarettes? What about older people? Don’t they count?

Everyone needs to be shielded from the marketing or selling of an addictive drug delivery system (the cigarette) that kills seven million people every year worldwide (WHO figure).

But whether or not using e-cigarettes leads to people taking up smoking who otherwise wouldn’t, we still have the same problem: the continuing marketing and selling of ordinary cancer sticks.

If conventional cigarettes were no longer available – through being banned – the problem of whether e-cigarette use leads to smoking would be purely academic. And if e-cigarettes are indeed so much safer than conventional cigarettes – putting aside the question of why anyone in their right mind would want to use nicotine at all – then that would be a real gain for public health.

That is, as long as nothing bad will happen to you from sucking e-cigarette fumes into your lungs a hundred times a day, every day, for twenty years.

Text © Gabriel Symonds

They – Will – Cause – Death!

Dave Dorn is a trustee of the so-called New Nicotine Alliance (astonishingly, a Registered Charity in the UK). He claims that 80% of smokers who have taken up vaping have successfully switched from smoking because of what he calls ‘the pleasure principle’.

The gold necklace-wearing Dave gave a talk at the Global Forum on Nicotine in Warsaw in 2016. This was a ‘multi-stakeholder event [for those] with an interest in nicotine and its uses.’ The purpose of the conference seems to have been to promote e-cigarettes.

This is part of what he said:

The enjoyment that a smoker can have, the pleasure that a smoker can have from something which at the end of the day is not going to kill them. Something that presents less than 5% of the risk of smoking lit tobacco. The pleasure principle [holding up e-cigarette device] is what makes these things work. And this is why the Tobacco Products Directive in the EU, the FDA Deeming Regulations, all of which are concentrated on Quit! Quit! Quit! will fail. They – will – cause – death! They – will – cause earlier death because they do – not – allow for the pleasure principle. And that – for e-cigs – is the most important thing.

Death or pleasure – what a choice!

This is worth looking at in a little more detail. He also said, warming to his pleasurable theme, that some e-cigarettes taste absolutely gorgeous and give him more enjoyment than smoking did. The absolutely gorgeous taste presumably is not experienced through drinking the e-liquid – because it indeed could cause death if you did this – so presumably he must be referring to the taste of the vapourised e-liquid in his mouth as he sucks it into his lungs.

It is difficult to understand how you can perceive a taste in this way but it seems he has been doing this daily since 2009 instead of smoking. If you observe vapers, they suck at frequent if irregular intervals on their devices and a conservative estimate would be at least one hundred times a day. Now, is Mr Dorn saying that the reason he engages in this unnatural practice is because he gets pleasure from it? Does vaping produce in him a sense of bliss, a kind of ecstatic or orgasmic state so wonderful that he feels compelled to do it a hundred times or more every day for years on end?

In any case, he’s muddled about the idea of the pleasure principle. This theory was first propounded by Sigmund Freud, and he meant it as the instinct to obtain pleasure and avoid pain, particularly in babies and young children who seek immediate gratification of hunger and thirst. As the child matures this is tempered by the reality principle: the need to defer gratification and accept pain, if necessary. So Dorny means, not the pleasure principle, but merely pleasure.

Is pleasure in this context an illusion? And does it matter if it is? One patient said to me: ‘Maybe the pleasure of smoking is an illusion, but it’s a very nice illusion!’ But if smokers and vapers could understand why their perceived pleasure is illusory – and it’s easy enough for them to demonstrate this to themselves – would they be happy to carry on poisoning themselves for years on end?

My publisher, in the course of editing my book Smoking is a Psychological Problem, made the interesting observation that some people claim to enjoy whipping themselves, so who am I to say they’re wrong?

This is an valid point. I would respond that there is nothing wrong with self-flagellation if that is what adults wish to do. It may be harmful – the skin could be broken and infection set in – but the number of people involved is miniscule. I suppose there is a market for whips, but unlike smoking, it is not a multi-billion dollar enterprise resulting in seven million deaths per year worldwide.

Therefore, if vaping is (almost) harmless and vapers are deluded that it’s pleasurable why not just let them pretend to enjoy themselves?

Pleasure is also hyped by the purveyors of other alternative ways of gratifying the need for nicotine, such as with the new product called IQOS. I picked up a partially used pack of these things lying on the ground. It contained two ‘HeatSticks’. They looked like thin short cigarettes including a filter. The pack that I found was designated ‘Mint’ and indeed the things did smell like a combination of mint and tobacco. But it also said on the pack: ‘Tobacco enjoyment with less smell and no ash.’ So that’s all right then.

Well, it’s not all right. It’s very far from all right. The gloss on the IQOS packet ‘Tobacco enjoyment’ is false. Here’s why. There’s nothing pleasant or enjoyable about inhaling tobacco fumes. What happens is that when the nicotine in the fumes reaches the brain, the user is in a drugged state. Shortly thereafter, as the nicotine level starts to fall, he or she suffers (or is on the point of suffering) mildly unpleasant symptoms of drug withdrawal. It is the relief of these symptoms by the next dose of nicotine that provides the illusion of transient pleasure. Let poor Dave Dorn try a flavoured but nicotine-free vape liquid to experience his absolutely gorgeous taste and see for how long he wants to keep doing it.

Apart from that, take one hundred sucks of an e-cigarette or an IQOS gadget every day for twenty years and then let’s see what affect it has on your health.

Text © Gabriel Symonds

Smoking cessation and humour

Healthline does it again. They put up a website in 2014 entitled ‘29 Things Only a Person Who’s Quitting Smoking Would Understand’. Apart from the crudity and smugness of the writing, it’s another example of everything that’s wrong with the orthodox approach to the smoking problem. For a start, the very idea of ‘quitting smoking’ implies it’s a process. But it isn’t. There are only two states one can be in with regard to smoking: either you smoke, or you don’t.

Before we come to the first thing in the list, they cheerfully inform us, ‘Quitting smoking is no easy task. Learn to laugh along with your struggle.’ Are they trying to make a joke of it? Well, there’s many a true word spoken in jest. Or many a true jest spoken in words.

I’m not going to go over all the twenty-nine things; we’ll just look at a few representative ones.

  1. Someone suggested that you try baby carrots when you’re having a craving, which is clearly ridiculous. You can’t smoke a carrot.

Having a craving? What does that feel like? Or maybe there’s something ridiculous about the idea of having a craving. Or is it because of having a craving that quitting smoking is no easy task?

  1. Is there anything better than a cigarette with a cup of coffee? Is there?!?! (sic)

Yes, a cup of coffee without a cigarette.

  1. Two days after quitting, if someone said, “Pick one: A cigarette or incredible sex, right now,” it would be the toughest decision of your life.

It wouldn’t be tough at all – there would be no hesitation in choosing the cigarette. This just shows you how smokers are in the unfortunate position of not being able to enjoy anything in their lives unless their need for nicotine has been satisfied.

  1. When you set a date to quit smoking, it quickly devolves into a rough approximation of the month in which you might start to consider thinking about quitting.

This perpetuates the false idea that there’s something wonderful about smoking. See my blog about why setting a quit date is a bad idea (http://nicotinemonkey.com/?p=377).

  1. The pact you made with a friend to quit together means you have to turn on ninja mode anytime you sneak a cigarette.

Similarly to No 7, it implies the absurd idea of the allure of cigarettes.

  1. You heard that nicotine may slow the progression of Alzheimer’s, and you rationalize that it’s actually better for your health to smoke.

As Donald Trump would say, ‘Wrong!’ Smoking is a risk factor for getting Alzheimer’s disease.

  1. When your doctor tells you that you should quit, you begin to think that you really ought to find a different doctor.

Very funny. But what this means is that many smokers don’t really want to quit.

  1. Nicotine gum is just like regular gum, except it comes with side effects like dizziness and nausea.

True. You don’t need more nicotine to get off the nicotine in cigarettes.

  1. What do non-smokers do after a nap? After vacuuming? After doing anything?

They get on with their lives without poisoning themselves with tobacco.

  1. Friends have found you staring longingly at used cigarette butts on the ground.

Same as No 8.

  1. You’ve read this entire list and really feel like you deserve a cigarette as a reward for your dedication.

Very funny again. Except it isn’t. The reality that eludes smokers is that not smoking is its own reward.

All numbered lists of this sort – the x best ways to quit, or y things you never knew about smoking, etc., miss the point.

It’s not a lack of knowledge of harmful effects of smoking or lack of information about  different ways or techniques to quit that are the reasons for smokers’ apparent difficulties. The problem is lack of understanding of a) why one really smokes in the first place and b) why smoking seems so hard to quit.

It’s easy to make up for these deficiencies in a smoker’s understanding; then easy quitting will follow.

Text © Gabriel Symonds

Cancer Research UK’s failure to call for banning cigarettes

 

Why is this allowed?

As an example of the continuing official confusion in about smoking/vaping, here is a statement (9 Dec 2016) by Cancer research UK:

Harm reduction is a type of public health policy that aims to reduce the harmful consequences of substances, or actions, without necessarily reducing or eliminating the use itself. For example, condoms don’t completely eliminate the risk of sexually transmitted infections, but they reduce the risk of contracting one by about 99%. Same goes for seat belts and airbags in car accidents.

This is a false analogy. What they say about condoms, seat belts and airbags is true, but whereas sex and car transportation are normal or essential human activities, smoking is not a normal or essential human activity; it is drug addiction. And why do they say, in relation to the harmful consequences of substances, which must include smoking, ‘without necessarily reducing or eliminating the use itself’. Surely this is the whole point. Even if we allow that including the word ‘reducing’ here was unintended, and we have, then, ‘without necessarily eliminating the use itself’, why is Cancer Research UK apparently not concerned about eliminating ‘the use’, that is, smoking itself?

Again, they patronisingly say, ‘E-cigarettes aren’t 100% safe. But very few of the things we do each day, or the products we buy, carry no risk at all.’ This is the same false analogy in different words. Using e-cigarettes – an unnecessary and pointless substance addiction – cannot be compared with ‘the things we do each day, or the products we buy [in the course of normal human activities]’.

The conclusion is: ‘The evidence is showing e-cigarettes can help beat the tobacco epidemic. And when they have the potential to save millions of lives, should we just sit back and wait?’

Of course we should not just sit back and wait. But if they are so confident that the evidence shows e-cigarettes can help to beat the tobacco epidemic and have the potential to save millions of lives, why has it apparently not occurred to them that tobacco should be banned at the same time?

Note the emotional appeal: ‘save millions of lives’. It is not as if we are talking about  normal unavoidable risks, such as riding in motor cars or using ladders to change light bulbs. Smoking is a voluntary activity and the millions of lives that are at risk from this cause could be saved by smokers merely ceasing to smoke. So if Cancer Research UK believes the way to do this is for smokers to change their way of obtaining nicotine to e-cigarettes, it implies that they think nicotine addiction in some form or other is part of normal human life.

Another view of the unnecessary and pointless difficulties that are unwittingly put in the way of people wishing to stop smoking, in spite of the best intentions of stop smoking counsellors, is shown in a film put out by Cancer research UK, called ‘Trying to stop smoking – Brian’s story’.

Here, in the first word of the very title of the film, ‘Trying’, we have a spotlight on the wrong-headed orthodox approach to smoking cessation. I have argued before there is no such thing as trying to stop smoking; there is only failing to stop. See, for example, these blogs:

http://nicotinemonkey.com/?p=1435 and  http://nicotinemonkey.com/?p=683.

Brian tells us he’s forty-nine years old and has been smoking for about thirty years. He wants to stop because he’s afraid of dying prematurely. What stronger reason to quit could one possibly have? He’s tried (that is, failed) to quit about four times, but he just gave in, he says. Now he’s decided to access his local stop smoking service. They provide support from a trained advisor. So far so good. But now ‘[the clients] get their choice of stop smoking medication.’ Already we have reinforcement of the difficulties of stopping: it’s so hard to quit you need a drug to help you, for goodness’ sake! He’s going to take a drug called Champix which ‘blocks the nicotine receptors in the brain’. So there should be no problem then? Brian says, ‘Tomorrow’s the quit date. I shall have my last cigarette. The Champix – I’ve been on it six or seven days now, you can really feel it working – I feel ill.’  This is actually what he says.

Then the following encouraging words appear on the film: ‘The stop smoking services give you the best chance of stopping smoking, but it’s still hard and only half of people succeed.’ Brian continues: ‘When I woke up this morning I really, really needed a cigarette, but after a while I just forgot about it.’ Yes, that’s the point: if you have the right attitude you can just forget about smoking – without the need to feel ill from Champix. Then he has the carbon monoxide level in his breath measured – and it had gone right down after one day of not smoking. Wonderful – if entirely predictable. Next, he tells us he’s feeling ‘Kind of rough. Absolutely dying for a (expletive deleted) cigarette…is it working? No…The last four weeks have been pretty stressful.’ Nonetheless, his final words are that the counselling and the drug have ‘given me an extra chance…I feel good…Yeah.’ Let’s wish him luck to resist any temptation to smoke again.

Now, consider Brian’s struggle to give up smoking and his taking of a drug that made him feel ill to achieve this aim, to say nothing of the possible harm he has already done to himself by smoking for thirty years: what more does Cancer Research UK need to call for an outright ban on tobacco?

Text © Gabriel Symonds

Exploding e-cigarettes

Why bother with all this?

The doughty online publication, ASH (Action on Smoking and Health) Daily News, on 9 June 2017 carried a warning headline: ‘Safety advice given after e-cigarette fire’.

A woman called Leanne Williams had a potentially serious problem with an ‘88 Vape’ brand e-cigarette apparatus.

This is how 88 Vape advertises these contraptions on their website:

Here at 88 Vape we have two priorities: unrivaled pricing and high quality…Being such exceptional value for money is crucial to 88 Vape. We believe it gives everyone the taste of vaping freedom without compromising on flavour, quality and variety!

We have carefully selected the 15 most popular e-liquids so that you can find a delicious flavour to enjoy! Whether you choose our traditional tobacco blend, Rolling Leaf, or our wonderfully sweet Morello Cherry your vape will be bursting full of flavour!…Switch to 88 Vape today and you’ll never look back(Buzz-words and clichés emphasised.)

Also, note this:

Electronic Cigarettes are now one of the largest global markets worth an astounding £1.8 billion

Gentle reader, please keep this in mind as I warm to my theme.

The unfortunate Ms Williams takes up the story:

It was on charge on the landing. I heard a big bang, and my other half jumped out of bed. It was in flames and there were burns all over because it had blown up and the bits were also on fire. If anyone had been near it, it would have really hurt them.

A lucky escape. But Ms Williams didn’t want to let it go at that. She complained to the store from which she had bought her 88 Vape device, B & M Bargains in Standishgate. They responded:

The packaging on the item states it should be charged with a USB port and not using a wall charger as you have done. Due to this, we can confirm the product is not defective and the issue has been caused due to improper use.

Unfortunately, some people have actually been hurt by these kinds of accidents:

In October 2014, a man was rushed to hospital with horrific injuries after his e-cigarette exploded. The man in his forties was found seriously injured in his house in Scholes after the e-cig blast caused shards of metal to embed his legs. The explosion was so powerful that it even blew out the lenses in his glasses. He had thrown the brand-new e-cigarette on the floor after it suddenly became very hot, before it exploded and sent pieces of metal flying into the man’s legs

Now note this:

One of the man’s neighbours, Billy Baldwin, said he was shocked to think that such a small device designed to help you could cause so much injury. (Emphasis added.)

These devices are not designed to help the purchasers. They are designed to help the bank balances of the manufactures and sellers.

At least 88 Vape makes one thing clear: ‘Please note that 88 Vape products have not been designed to be a Nicotine Replacement Therapy.’

The implication, nonetheless, is that for people who believe they cannot stop putting nicotine into their bodies, these products are safer than smoking cigarettes.

This defeatist attitude is encouraged by conventional stop smoking counsellors: stopping smoking is too difficult, so the next best thing it to continue your addiction in a supposedly safer way. This only encourages smokers (synonym: nicotine addicts) in their belief that stopping smoking is, indeed, too difficult for them. Good! It’s officially sanctioned that continued nicotine use is OK!

So, e-cigarettes – provided you can avoid them blowing up and causing injuries, and if you want to go to the expense of buying a starter kit and the bother of plugging them in with a USB connection to re-charge them and then keep buying the e-liquid to generate the vapour – are a great way to increase the £1.8 billion market!

The problem can be seen from another perspective. This is a conversation I sometimes have with smokers who come to see me for an unrelated medical problem.  (Dr = doctor; Pt = patient.)

Dr:  If there were an easy way to stop smoking would you be interested?

Pt:  Yes, of course I would.

Dr:  All right, please make an appointment and I guarantee you will quit without difficulty.

Pt: I’ll think about it.

The dilemma this puts smokers in is well summed up by one patient who said to me: ‘Thank you very much, Dr Symonds, but I don’t want to come for your smoking cessation method because, if I did, I’m afraid I would succeed!

Text © Gabriel Symonds

Ooh! Ain’t it Wonderful!

Is smoking harmful, or isn’t it? Or is it, perhaps, good for you? In particular, the weighty question needs to be considered: is there any connection between passive smoking (breathing cigarette smoke-polluted air produced by other smokers) and dementia?

A headline in an online publication called ‘Care Appointments’ says: ‘[The University of] Wolverhampton secure (sic) funding to assess impact of passive smoking on dementia.’

Specifically, £153,976 – a nice round figure – has been secured to study the ‘Impacts of Environmental Tobacco Smoke on Incidence and Outcomes of Dementia’. The study will be led by one Professor Ruoling Chen from the University’s Faculty of Education, Health and Wellbeing, no less.

The plan, it seems, is to study groups of old people with and without dementia to see whether passive smoking increases the risk of getting it, and, if someone is unfortunate enough to suffer from dementia, whether passive smoking makes the course of the disease better or worse. Of course it is possible, though I doubt it, they may find that passive smoking is protective against dementia or that dementia patients fare less badly as a result of cigarette smoke exposure.

I can tell you now that this study will be a complete and utter waste of time – to say nothing of a waste of £153,976. Here’s why:

Whatever Professor Chen and his colleagues discover, what are they going to do with the result? If passive smoking is bad for dementia we shall have yet another reason to add the already existing numerous compelling reasons for stopping smoking, and, indeed for banning tobacco. And in the extremely unlikely event that they find smoking is good for dementia, what then? Should  everybody consider taking up smoking to prevent dementia or reduce its severity?

The opportunities for research of this kind are endless but we already know more than enough about the harmful effects of smoking. The £153,976 would be better spent on lobbying for the cigarette factories to be closed down.

Text © Gabriel Symonds

How to smoke without smoking!

Here is an interesting piece of news reported in the online Health News (Reuters Health) on  26 May 2017.

The headline is the alarming statement: ‘Heat-not-burn cigarettes still release cancer-causing chemicals.’ Shock, horror.

This is according to an investigation by Dr Reto Auer and colleagues of the University of Bern, Switzerland.

The heat-not-burn type of cigarette has recently been put out by tobacco giant Philip Morris. It has the unpronounceable name of IQOS that some wag has suggested may stand for ‘I quit ordinary smoking’.

If this is what it is supposed to mean it is misleading in the same way that e-cigarettes are misleadingly touted as a way to stop smoking. In both cases what it boils down to is that the user can get his or her nicotine fixes by a different and possibly safer way than through ordinary cancer sticks – and in many cases will carry on using the new gadget, instead of or in addition to smoking, indefinitely. Therefore, it would be clearer, as well as more honest, if IQOS and similar contraptions were promoted, not as a way to stop smoking, but as a way to continue smoking without the smoke.

The Swiss study found that the heat-not-burn devices produced 84% of the nicotine found in traditional cigarettes and they released chemicals linked to cancer including carbon monoxide, volatile organic compounds and polycyclic aromatic hydrocarbons! Not only that, but they also found they ‘released some of these chemicals in much higher concentrations that conventional cigarettes.’ Shock, horror again. And as if even that was not enough, they pointed out the unsurprising fact that ‘there is no safe minimum (sic) limit for some of the chemicals  in heat-not-burn cigarette smoke…and some of these chemicals may contribute to the high mortality rate of smokers.’

So IQOS is not safe. We might have guessed as much. Anyway, thank you, Dr Auer, and a very good morning to you.

But wait! He’s not content with merely underlining the obvious. Now he says, ‘We need more studies to find out about the health consequences of smoking heat-not-burn cigarettes…[and whether they] are safer for users or bystanders.’ Then comes the punch-line: ‘While more studies are needed to determine the long-term health effects of heat-not-burn cigarettes, their use should be restricted until more is known about them.’

What is he expecting to discover with more studies? Yet more ways in which IQOS is not safe? Or perhaps that IQOS is, after all, completely safe? And would Dr Auer be so good as to tell us in the meantime how and to whom the use of IQOS should be restricted.

Furthermore, for nicotine users to swap one way of taking the poison nicotine into their bodies for another, allegedly safer, way (assuming they switch completely) implies nicotine use is acceptable or necessary in some circumstances. And what circumstances might those be?

We have an attempt at an answer to this question in a recent issue of the online Vaping Post which clearly shows the confusion about why some people feel a need to keep putting the poison nicotine into their bodies:

Most smokers don’t really want to quit. They say they do when someone with a clipboard asks them, but they don’t really mean it. The fact is most smokers keep smoking because they enjoy it.

This is correct except for the last two words which should be replaced with: are addicted to nicotine.

A little open-minded discussion with smokers will soon reveal that they don’t in fact enjoy smoking. The only reason they feel a need to keep putting nicotine into their bodies by one means or another is because they believe they are unable to stop.

For any kind of nicotine use to be promoted, albeit indirectly, as enjoyable is itself underhand and even dishonest: it’s a false promise.

Here’s a random selection of quotations from e-cigarette-selling websites:

We vape for life: to both promote life and to vape as a lifestyle change for the betterment of society. We’re out to change the world and save lives by making vaping more fun…

Vaping has taken the world by storm in popularity, and the options and accessories have become even more fun and varied.

Our premium quality 100% USA-made e-liquids are offered in a large variety of flavors and are customizable for our customers’ enjoyment.

The NJOY Daily is our newest electronic cigarette that delivers an authentic, satisfying experience. New design, new technology, a whole new reason to NJOY yourself.

Why should current nicotine addicts be encouraged to change from a dangerous way of using nicotine to an allegedly less dangerous way? Why use nicotine at all? Contrary to what almost everybody seems to believe, getting free from nicotine addiction is easy – if you go about it in the right way.

Text © Gabriel Symonds

Tobacco is the Root of all Evil

A young girl ties tobacco leaves onto sticks to prepare them for curing in East Lombok, West Nusa Tenggara. © 2015 Marcus Bleasdale for Human Rights Watch

The desperate need to deal with the smoking problem by outlawing tobacco could not be more plainly made than in the six bulleted points of ASH’s (Action on Smoking and Health’s) online Daily News of 30 May 2017.

Here they are:

  • Tobacco kills more than 7 million people per year and is costing the world economy USD 1.4 trillion annually

The death toll has gone up from the previous oft-quoted figure of six million per year.

  • Disposed cigarette butts pose a potential ecological risk to the ocean
  • Essex: Dunmow flat fire caused by badly discarded cigarette
  • Tobacco production ‘breaches human rights laws’

These three speak for themselves.

  • Scotland: Scientists find that smoking harms livers of unborn babies

It was discovered in 1950 that smoking causes lung cancer. How many additional harmful effects on human health need to be found before cigarettes are banned?

  • Austria: Study shows increasing the price of tobacco reduces consumption

How far will the price of tobacco need to be increased so that no one can afford to buy it anymore?

Let’s return to the first point: the statistic of seven million people being killed every year at a cost to the world economy of $1.4 trillion. This is from a slickly produced fifty page Discussion Paper, funded by the UK government, entitled ‘The WHO Framework Convention on Tobacco Control: an Accelerator (sic) for Sustainable Development.’

It’s written in the WHO’s usual turgid prose, with the inevitable Executive summary (an ordinary summary wouldn’t cut the mustard, apparently) and patronizingly illustrated with photos of smiling people from what are euphemistically called low- and middle-income countries.

This is the cringe-making style of the writing:

…generate greater awareness of the different narratives and entry-points for effective engagement with non-health sector stakeholders…strengthening governance to address inequalities and social exclusion that drive poor health

We soon come to the point, and this is where I want to make my point:

The paper’s overarching purpose is to support the acceleration of tobacco control efforts as part of broader SDG implementation…

Heaven knows there are enough problems in poor countries – I’m sorry, I mean low- and middle-income countries – with corruption, pollution, repression of women and minorities, child labour, female genital mutilation, religious intolerance, droughts, famines, wars, terrorism, HIV-AIDS, cholera, malaria, tuberculosis, landmine injuries, etc. But now, to these horrendous and seemingly intractable problems in so many parts of the world, we have to add tobacco growing and smoking.

No doubt sustainable development goals (SDG) are important for the greater happiness of mankind and deserving of all the help that rich countries can provide, and it’s clear that poorer countries’ problems are only made worse by growing tobacco and people smoking. But what the writers of this report want to do is to attach the tobacco control agenda to the much broader one of sustainable development.

Of course, people in poor countries are just as worthy as anyone else of being encouraged to stop smoking by having taxes increased on cigarettes and of having the dangers of smoking pointed out to them by horrible pictures on cigarette packs and of reducing exposure to cigarette advertisements by regulating them, etc. But these and other ‘tobacco control’ measures in this context are drops in the ocean.

Now consider if the tobacco controllers campaigned instead, or as well, for tobacco abolition. If this were successful, the demand for cigarettes would go down dramatically, there would be a smaller and eventually no market for tobacco products and all the problems from this cause of damage to human health and environmental degradation would eventually disappear.

It’s not so simple as that, of course, but at least let this objective be clearly stated and let a working party be set up, funded by the UK and other governments and the WHO, to look into the best way to achieve this aim.

Because in the meantime it’s not just unacceptable – it’s outrageous – that a product as dangerous as cigarettes is allowed to be sold.

Text © Gabriel Symonds

The Great Smoking Paradox

The scholarly journal with the curious name of Tobacco Control, on the cover of the May 2017 issue shows a picture of an inflated balloon with a map of the world on it about to be burst by a lighted cigarette. The wording is ‘Tobacco threatens us all’ and ‘Say No to Tobacco’, among other slogans.

The dire situation of tobacco threatening us all is elaborated in the leading editorial:

…tobacco use is not merely a threat to individual health…[it] is associated with increased poverty and food insecurity…land formerly used to grow food crops is converted to tobacco growing…tobacco continues to be produced using child labour in unsafe conditions…tobacco is an environmentally destructive industry. In addition to deforestation for tobacco growing and curing, heavy use of pesticides contributes to water and soil pollution…the potential negative effects of leachate from billions of discarded cigarette butts on marine life.

Depressing reading. But in the last sentence they come to the point:

Eliminating the tobacco threat by implementing tobacco control measures…

Just a minute. How can you eliminate the tobacco threat by tobacco control measures? The only way you can eliminate the tobacco threat is by eliminating tobacco.

If tobacco is merely ‘controlled’, as opposed to being eliminated or abolished, it implies that there are some circumstances or situations where tobacco use in some form or other is legitimate or acceptable. And what circumstances or situations would those be? This is a continuation of the discussion of the problem of ‘regulating’ nicotine products mentioned in my post of 20 May 2017, http://nicotinemonkey.com/?p=1516

The regulation/prohibition problem can also be considered from the perspective of a group of parents afflicted by the loss of a child through drug use. Understandably they want to do something to prevent further deaths from this cause (BMJ 2017;357:j1876). Two such parents ‘blame their daughters’ deaths not on the illegal substances that they had taken but on the laws that did nothing to save them’ and ‘[They want] not only just to decriminalise the taking of heroin, cocaine and cannabis but also to regulate their supply.’ One of these mothers says of her daughter, ‘She wanted to get high, but she didn’t want to die.’

There is no safe way of taking addictive drugs – it’s a contradiction in terms. And why, I wonder, should a teenager want or feel a need to ‘get high’ anyway? The best ‘high’ one can possibly have is the experience of normal good mental and physical health – with one’s mind unclouded by chemical poisoning of the brain. No amount of regulation of addictive drugs will make them safe to use, nor will it significantly reduce the number of users within a reasonable time.

To see this in proportion, in Britain in 2015 there were nearly 2,500 deaths from illegal drugs; the number of tobacco-related deaths per year is 96,000.

The same confused thinking is evident in the debate about tobacco – I promise I am not making this up:

[Smoking is] a severe psychiatric disease that can only be solved by a complex, multi modular, and individual treatment including consideration of socioeconomic status/factors.

Thus sayeth Dr Detlef Degner, a psychiatrist at the University of Göttingen in Germany. This extraordinary statement appeared in The British Medical Journal (25 May 2017) as a comment on an editorial about the advent of standardised cigarette packaging in Britain. The editorial that gave rise to this comment is headed ‘Standardised packaging for cigarettes’ and has the Oh-so-clever subtitle, ‘Undressing a pack of wolves in sheep’s clothing’.

The writer, one Professor Joanna Cohen, is affiliated with the Institute for Global Tobacco Control whose mission is ‘to prevent death and disease from tobacco products’. So far so good. But the Institute proposes to do this ‘by generating evidence to support effective tobacco control interventions’, as their website circularly puts it.

After reminding us that ‘Tobacco industry products are responsible for six million deaths every year’, Professor Cohen laments that ‘There is no magic bullet to end the tobacco epidemic.’

But there is! The notion of tobacco control is based on the premise that tobacco is here to stay. Herein lies the problem. Allow me to repeat: you cannot prevent death and disease from tobacco products by controlling them; they need to be abolished.

A further contradiction is evident by Professor Cohen saying in her editorial, ‘Tolerating attractive packaging of a deadly product is indefensible.’ Indeed, but it defensible to tolerate the selling in any form of a deadly product?

As she points out, Big Tobacco are not merely going to stand by and do nothing while tobacco control measures are introduced; they do everything they can to delay and obstruct. And even if all current tobacco control measures were instituted tomorrow, there would still be left a substantial number of smokers for decades to come.

Why is there so little mention of tobacco abolition? Because it would drive smoking underground? Maybe it would but then there would be vastly fewer smokers. Because governments would lose revenue? Apart from huge savings in health costs from abolishing tobacco, governments have never lacked ingenuity in devising new ways of taxation.

It is not as if there is anything new in this. Readers of this blog will be well aware that I have called repeatedly for tobacco to be banned as the only realistic way to stop the smoking epidemic.

In order to bring this about the first step is for smoking to be seen for what it is: legalised drug addiction.

Text © Gabriel Symonds

A Right Charlie: Thoughts and Prayers from the GMC

Recently I received from the UK doctors’ regulatory body, the General Medical Council (GMC), a routine email. The subject was ‘Improving flexibility in postgraduate training’.

At top of the email, in purple print in a box (not even a black-bordered one), was a message from the GMC’s Chief Executive and Registrar whose name was stated as Charlie Massey.

Why do people writing in a formal business capacity feel the need to use diminutives in their names? I had to look it up to discover whether the writer was a Charlotte or a Charles – it was the latter.

This is the first part of what he said:

It was with great sadness that I learnt of the events in Manchester on the night of Monday 22 May [2017]. My deepest sympathies, thoughts and prayers go out to all those affected, as well as to their families and friends.

The ‘events’ – fortunately there was only one – refers to an atrocity when a suicide murderer detonated a bomb at a concert causing twenty-two deaths, and injuries to sixty-four people. This is horrible beyond words and one cannot but feel great sadness for the injured and their families and the bereaved.

But, I would ask, is this the right place, or the right way, for Charlie to express his  sentiments?

Does he mean that he actually got down on his knees and prayed – and if so, to what god, I wonder – for all those affected? Presumably he means, in the case of the dead and injured, that their souls may rest in peace and their bodies speedily recover, respectively, and further, that in his outpouring of prayer he entreated the divinity (who or whatever he, she or it may be) to comfort the friends and families of all those affected. Allow me to ask, how did his sympathies and thoughts go out to these unfortunate people? Were they attached to his prayers somehow or perhaps they were sent by telepathy?

After these meaningless clichés Charlie went on to say:

I particularly want to recognise the significant efforts of our emergency services personnel, hospital staff, doctors and nurses in dealing with the aftermath of such a horrific event. I have heard many accounts of doctors and other medical staff voluntarily attending hospitals in order to help patients and colleagues, and working tirelessly to treat the injured. The NHS’s response to this terrible atrocity is rightly being spoken of with great pride and deserved gratitude.

Since the GMC represents the UK medical profession, this is really self-praise. Is it up to him to ‘recognise the significant efforts…’ of people just doing their jobs? Apart from that, it’s nice to know Charlie has ‘heard many accounts of doctors…attending hospitals…’ and that ‘The NHS’s response…is being rightly spoken of with great pride…’  But by whom? He doesn’t say.

This stuff is almost as bad as The Queen, God save her, visiting some of the injured in hospital and saying to one young woman, Millie, ‘And you had enjoyed the concert, presumably?’

Mrs Lincoln must be turning in her grave.

Doubtless in due course the Mayor of Manchester will give a speech to commemorate the dead, praise the selfless efforts of the emergency and medical services and bestow medals in recognition of their skills and devotion.

In the meantime, perhaps Charlie could spare us this patronising guff.

© Gabriel Symonds

Vaping Forever!

Here is a fantastic piece of news about an undercover investigation by the Royal Society of Public Health, reported in April 2017. They found that nine out of ten retailers of e-cigarettes ‘are turning a blind eye to their use by non-smokers, and effectively pushing them as a lifestyle product.’ Very wicked!

What are vape shop staff supposed to do when a customer comes in who wants to buy this type of nicotine delivery device? Ask the customer to prove he or she is a smoker? Or say, ‘I’m sorry, I can’t sell e-cigarettes as a lifestyle product – you’ll have to become a smoker first, so when you’ve got a nice smoker’s cough and nicotine-stained fingers come back and I’ll sell you e-cigarettes to help you stop smoking!’?

Shops exist to sell their goods. Quite rightly there are age-related restrictions on alcohol and tobacco, but it’s one thing to ask a potential customer to prove his or her age and quite another to prove that they’re smokers. And why should the proprietors of vape shops be put in this invidious position? The Independent British Vape Trade Association, as it’s known, tries a bit of awkward fence sitting in its Code of Conduct, including the admonition, ‘Never knowingly market to anyone who is not a current or former smoker, or a current vaper.’ Anyone can say they are a former smoker, and I don’t blame them for casting the net a bit wide.

The government should make up its mind about how e-cigarettes and other nicotine delivery devices, and indeed ordinary cigarettes, should be regulated.

If e-cigarettes are supposed to be used only by smokers as an aid to quitting then they’ll have to be sold under licence or with a doctor’s prescription. But how long will this be for? Presumably, as long as it’s deemed necessary for the smoker to be cured of the desire to smoke cigarettes. And how long will that be?

The problem is in the concept itself of regulation of e-cigarettes. Regulation implies that nicotine use by some people under some circumstances is legitimate or appropriate. For example, e-cigarettes should be allowed to be sold to adult smokers as an aid to smoking cessation. But before starting to deal with the almost impossible practical problems of restricting sales to this group, one fact needs to be understood: the only reason people use nicotine at all is because of their perceived inability to stop.

I experienced an example of this the other day when I had occasion to ride in a taxi in Tokyo. It was raining and I hailed a taxi stopped at traffic lights. All the windows were open in spite of the rain. I got into the taxi and then realised why this was – there was a strong smell of tobacco. Smoking is not permitted in taxis but the driver explained: the previous passenger (or ‘honourable guest’ in the Japanese language) who had just got out, had been using a new nicotine delivery device with the unpronounceable name of ‘Iqos’ which has just been released in Japan.

This contraption, according to its promotional site, is ‘a smokeless cigarette that…uses real tobacco refills, but instead of burning it to produce hazardous smoke and tar, it heats it to produce tobacco-flavored vapor.’ So that’s all right then.

Incidentally, I have never understood how tobacco smoke or a vapour has a taste but it certainly has a smell – or rather, I should say, it stinks. As it was raining I resisted my impulse to get straight out of the taxi, and the stink gradually dissipated. Clearly, legislation on smoking hasn’t yet caught up with modern marketing developments.

There is already enough trouble with cigarettes. We don’t need new nicotine delivery devices. It is misleading that e-cigarettes or ‘heat-not-burn’ tobacco products such as Iqos should be promoted as ways to stop smoking: they are merely new – and potentially hugely profitable – ways of changing one way of feeding a smoker’s nicotine addiction for another.

Text © Gabriel Symonds

Controlling Tobacco with Horrible Pictures

The UK government is about to introduce legislation to require cigarettes to be sold in what is called standardised packaging. They claim this will discourage children from starting to smoke. Fine, but it’s rather a roundabout way of going about it. They’re saying, in effect, ‘Don’t buy this, it’s dangerous.’ Or are they trying to put people off buying cigarettes altogether? Then why not say so? If this is the case, the logical step would be to start the process of banning tobacco sales.

I’m no friend of the tobacco companies but it seems to me they have a point in that their right to display their brand images on the packages of their poisonous (but legal) products will be infringed. Already a large proportion of the pack is taken up with health warnings and horrible pictures. But from now on nearly all of the pack will be taken up with health warnings and horrible pictures and the name of the maker will be relegated to standard small type at the bottom of the front and at the underside of the pack. The background colour is described as Pantone 448C (a drab dark brown) but which I think could more accurately be called cow-shit green. So now, instead of smokers buying a pack of, say, Marlboro, L&M or Lucky Strike, they will be choosing between ‘Damages teeth and gums’, ‘Causes peripheral vascular disease’, ‘Causes blindness’, etc.

The anti-smoking charity, ASH, seems much pleased with this new law and on their current Briefing about it shows a video, put out by Cancer Research UK in April 2012, as evidence that standardised packaging works.

The video shows children, who appear to be aged between about seven and eleven, who are given empty cigarette packs to handle and comment on how they appear to them. This is a selection of what they say:

  • I like this one because it’s got red in it and red is my favourite colour
  • It reminds me of a Ferrari
  • It looks kind of like the sun
  • Is that a royal sign? It looks quite posh
  • It’s really bright colours and it would be quite fun to play with and it makes you happy just by looking at it
  • This one is actually quite pretty – Yeah, pink, pink, pink
  • The pictures actually look quite nice, like ice-cubes and mint
  • It makes you feel you’re in a wonderland of happiness

 The flim ends with the written statement:

Unbranding cigarette packs won’t stop everyone from smoking, but it will give millions of  kids one less reason to start.

Apart from the dubious ethics of allowing children to handle attractive cigarette packs – might it not encourage them to smoke if the hypothesis of the film is correct? – it seems to me this whole campaign for standardised packaging is a distraction from the real issue. Again, something is being done: the government is bringing in legislation to ‘protect our kids’ by making cigarette packs less attractive. Two cheers for the government.

Is the push to plain packaging based on the kind of research mentioned above? If so, it seems mightily unscientific to me. Do children start smoking because they see an attractive cigarette pack in a shop, even if it’s on the top shelf, and say, ‘Ooh, look at that, it’s like a Ferrari, it’s red – my favourite colour! I must try smoking!’ Or do they say, contemplating another pack, ‘I think I’ll try smoking – that pack makes me feel I’ll be in a wonderland of happiness!’ Do they? I submit that they don’t. Children want to smoke because they see other people smoking and wish to imitate it. So they have already decided to obtain cigarettes somehow. Do they then look at the pack, note with disgust and loathing the horrible pictures – and  change their minds? Where is the evidence for that? I think it will do little to put children off. They might even be more tempted to smoke to try to appear grown-up enough not be frightened by the graphic images.

Whatever the packs looks like, why aren’t children put off by their first experiences of smoking? When I ask my smoker patients to describe the effects of the first cigarette they tried behind the bicycle shed aged twelve or fifteen, they usually have no difficulty in recalling them, even decades later. They say things like:

  • It wasn’t pleasant
  • It made me cough and I felt dizzy
  • It was horrible. I felt sick and had to lie down

But that didn’t put them off – they were hooked from the first puff!

First it was the big debate about passive smoking: was it or wasn’t it harmful? Then it was the banning of smoking in public indoor areas: would it put pubs and restaurants out of business? Now it’s e-cigarettes and plandardised packaging.

It seems to me all these debates are nothing more than delaying tactics. Big Tobacco will argue and wheedle and lobby and engage expensive lawyers and pay for independent grass roots campaigns and for completely unbiased scientists to do studies to show (amazing!) that passive smoking is not harmful, pubs and restaurants will go out of business, standardised packaging will not work and anyhow is unnecessary because (would you believe it!) Big Tobacco does not target children and it will encourage cigarette smuggling – very wicked! – and what good corporate citizens the tobacco companies are to wish to uphold the law. All of this is obfuscation and a distraction from the real issue. While the pseudo-debate goes on about the desirability and effectiveness of standardised packaging, what does Big Tobacco do in the meantime – the meantime being measured in years and even decades?

It goes merrily on making and selling cigarettes.

Text © Gabriel Symonds

What the ’Eck! Journalism or Medical Advice?

My attention was drawn recently to a badly written ‘Ezine’ article from 2010 by the well-named so-called expert author Hayden Eck with the confusing title ‘Do Not Give Up – Smoking Cessation is Possible’.

At first glance it looks as if he’s telling you not to give up smoking, but he means you should not give up on giving up. And I’m glad to know he thinks smoking cessation is possible even though this implies some people may think it’s impossible. Well, that’s an encouraging start merely in the title.

The trouble with Mr Eck is that he has gleaned some superficial knowledge from Wikipedia and the like which he re-hashes and presents in an authoritative sounding manner. It’s as if he’s blinded himself with science and then proceeds to try to do the same with the lay reader. Worse, in some of the other medical areas into which he strays, he over-steps the bounds of journalism into giving medical advice. For example, in the treatment of what he calls ‘female sexual disorder’ he takes if upon himself to write: ‘[T]reating yourself with Intrinsa (testosterone) patches is one of the best alternatives for you. These patches can be bought online.’ This is inappropriate and potentially dangerous advice.

It hardly needs to be said that to qualify in medicine and gain a proper understanding of the mysteries of human ailments requires many years of study and experience – and then it will soon become apparent that the more one knows, the more there is yet to know.

 Back to the smoking piece. He says nicotine affects

reward, memory and learning centers [and causes] the release of dopamine, a neurotransmitter that is associated with pleasure…nicotine also influences other areas of the brain that control mood, energy levels and memory as well as cause long-lasting neurological changes.

This sort of thing is often stated but it should be noted that it’s entirely speculative. There is no way at present of measuring levels of dopamine or other chemicals in the living human brain. Such theorising is derived from animal and laboratory studies of unknown relevance to smoking humans. As for the alleged pleasure smokers may claim they experience, does inhaling nicotine into your lungs produce a state of bliss? Observe smokers and judge for yourself. All that smoking does is to help the smoker to feel less bad after smoking than he or she did before – and there is a reason for this.

The fact is that we know almost nothing about the workings of the brain. Wonderful inventions such as PET scans are no doubt very interesting but they are of not the slightest use in helping smokers to quit. As for the drugs that Mr Eck seems so keen on – though it’s obscure what his qualifications are to offer an opinion on the matter – how they work (if at all) is largely unknown. As with all ‘mind drugs’ they are empirical treatments – based on trial and error.

It would be tedious to critique the whole of this article, so I’ll just take a few more representative samples.

Smoking is a very dangerous addiction, yet people can’t give it up easily…What Should one do If He (sic) Wants to Give up Smoking?…Giving up smoking is the most difficult thing.

How can he presume to speak for ‘people’? One what basis does he claim ‘Giving up smoking is the most difficult thing.’?

Perhaps these views, nonetheless, explain Mr Eck’s ideas about how one should go about quitting: 

You must prepare to quit smoking. You must distance yourself from friends, situations or places that compel you to smokeIf you want to quit smoking and remain a quitter, you have to stay away from temptation and persistent nicotine cravings.

He mentions nicotine earlier, but now we have the additional curious reason that smokers are compelled to smoke because of friends, situation or places. Further:

Some people have a strong determination to quit smoking via the cold turkey method; this is achieved by sheer will power alone. However, most smoker’s (sic) find it difficult to quit in this way and therefore require treatment to help them quit smoking. Some men and women may become non-smokers through counseling alone but their numbers can be counted on the fingertips.

These are Mr Eck’s opinions; they are hardly proven facts. Who says unaided quitting requires willpower? Who says counselling alone helps only a very small number of smokers?

The he launches into a puff for pills but this is rather dampened by him cutting and pasting from some internet drug information site a list of alarming side-effects :

Success rates are much higher with Chantix smoking cessation drug as compared to that of Zyban smoking cessation pill; but, both the drugs have their share of side effects. While Chantix causes nausea, constipation, flatulence, insomnia, change in taste, increase in appetite, fatigue, dry mouth and bloated feeling, Zyban causes dry mouth, insomnia, changes in appetite, agitation, headaches, jitters, skin rash and seizures.

That’s bad enough but with Mr Eck’s amateurish approach he neglects to mention that both drugs can cause suicidal thoughts.

No wonder stopping smoking seems to be so hard!

Text © Gabriel Symonds

How to stop smoking (?)

Is this a statement or a question?

In either case it’s a strange idea. Where does the how come into stopping doing something? If people want to stop smoking why don’t they just stop? Why does it seem to be so difficult?

Many methods, ways, techniques, systems or ‘tools’ for smoking cessation are on offer on the internet and in books. But there is a huge assumption here: why should you need a method, way, technique etc., to stop smoking?

One method to be found on the internet is called Craving to Quit. The catchy name merely reinforces the idea that ‘craving’ is something a would-be quitter will have to deal with. Craving to Quit uses mindfulness, as it’s known, and involves a twenty-one day course. It was compared in a trial of smoking cessation with a course called Freedom from Smoking run by the American Lung Association – though since this lasts for six weeks it’s not really equivalent. A mere seventeen weeks after starting either method it was found, in the small numbers of participants (84 in total), that most were still smoking: 69% v 94%, respectively. In spite of these methodological flaws it’s claimed by the person who promotes Craving to Quit that it’s been scientifically proven to be effective in smoking cessation.

Smoking is a voluntary activity. Therefore it’s questionable that any method of smoking cessation can be properly assessed in a scientific trial at all. This is completely different from scientific trials in the treatment of disease. If someone is suffering from, say, a stomach ulcer, it can be objectively diagnosed and treatment A can be compared with treatment B. But a stomach ulcer comes unwanted and unbidden and if the patient is cured he or she would normally do anything to avoid a recurrence. With smoking, on the other hand, if a smoker stops after using method X for one year, and the next day starts smoking again, would this mean method X has failed? No, it means the smoker has changed his or her mind about wanting to be a non-smoker.

There are a number of other assumptions in many of the current approaches to quitting: that it’s very difficult to achieve on your own, you will need some method or technique to help you, ‘cravings’ are involved, you should prepare yourself for the great quit attempt day and it will take weeks or months to succeed, if it does. These ideas are copied from one internet site or book to another as if they are gospel truths – unarguable and unalterable.

It’s sometimes found that when a problem seems insoluble and there are many competing claims for effectiveness, one needs to reconsider the whole edifice on which the current approach is based.

When I became interested in smoking cessation I started with no preconceptions; everything I know about smoking I have learnt from my patients, that is, from the hundreds of smokers I have helped in face-to-face sessions. What has emerged from this is that almost everything most people believe about smoking is wrong.

Stopping smoking is easy, not hard; setting a ‘quit date’ is counter-productive; nicotine patches or drugs hinder quitting and should not be used; gimmicks such as hypnosis, magnets in your ears, laser treatment, twelve-steps, etc., are just that – gimmicks.

For easy quitting, smokers need to be helped to demonstrate to themselves two things: why they really smoke (as opposed to why they think they smoke), and why smoking seems so hard to stop.

But we have a further difficulty: many smokers, in spite of what they may say, don’t really want to quit. This is shown in the following situation in which I was involved.

Recently I met an old friend for dinner at a restaurant. I knew he used to smoke but decided it wouldn’t be appropriate to discuss this unless he raised the matter first.

We had an interesting and pleasant chat over good food and wine. Then we walked towards the main road to get a taxi. He was going in the same direction so I thought we could share the ride. But for some reason he didn’t want to go home straight away in spite of the late hour. He wanted to stretch his legs first. All right, let’s take a stroll together and continue our conversation. He wasn’t happy about that. Then he confessed. He wanted to smoke. Why? Because it would be so enjoyable after the meal! Was I missing something? I had had a pleasant evening with him and was perfectly happy – yet my friend wasn’t happy. He needed to replenish the nicotine in his brain to relieve the discomfort he was in – though it was so mild it wasn’t even recognised as such – and then he would feel he’d had a great evening.

The tragedy of smoking is this: even if smokers have it pointed out to them that inhaling burning tobacco fumes into their lungs is not inherently pleasurable – it’s an awful thing to do to oneself – but only relieves the discomfort of the withdrawal symptoms of the nicotine provided by the previous cigarette, they are so stuck in the illusion of pleasure that they can’t face letting it go. However, once the cycle is broken the discomfort goes away and all you are left with is the memory of an illusion. Staying stopped is then simply a matter of not lighting up again. Otherwise they’re in a similar situation to that of a wild bird kept in a cage for a long time: if the cage door is left open the bird doesn’t want fly away but will stay where it is.

What smokers don’t realise – and many of them don’t want to realise – is that the only thing they will lose by quitting is the desire to smoke.

Text © Gabriel Symonds

Over 600 Flavours!

The UK Ecig Store likes to make a splash: they boast of ‘Over 600 e-cigarette flavours’!

So much for e-cigarette regulation in Britain. If this sort of advertising is not to entice young people to ‘vape’ and get hooked on it I don’t know what is.

Now let’s go to the small print at the bottom of the opening page of their website

Electronic cigarettes are not suitable for use by…persons who should avoid using tobacco or nicotine products for medical reasons

If we remove the redundant words we have: ‘Electronic cigarettes are not suitable for persons who should avoid using them for medical reasons.’ But everyone should avoid them for medical reasons! E-cigarette vapour contains potentially harmful substances and the risks of long-term use are unknown. Therefore the UK Ecig Store should not be selling these products. Nor should anyone else.

Obviously, if someone has a heart or lung condition it would be particularly inadvisable for them to smoke, but these are just the people who, if they felt they could not cope without nicotine in some form, might be advised to use e-cigarettes instead of smoking. Not by me I hasten to add – I would offer to cure them of nicotine addiction in any form.

So the good old UK Ecig store is really contradicting itself or shooting itself in the foot by saying, in effect, that no one, because of medical reasons, should use e-cigarettes and the sooner they shut up shop the better.

Nonetheless, some doctors actively promote e-cigarettes as a new way to stop smoking!

There is something odd about this. E-cigarettes are not being promoted as a stop-smoking aid in the same way as other methods – nicotine gum or patches, prescription drugs, a course of acupuncture or some other gimmick. With these methods, or ‘tools’ as they are sometimes called (why should you need a ‘tool’ to stop smoking?), obviously the idea is that you use the gum or patches or take the drug or whatever it is for a limited time and then with reasonable luck you will have stopped smoking and will never want to do it again. Incidentally, how many people succeed with this kind of approach? At best it’s around the not brilliant figure of 20%.

Underlying the reason for the poor results of these methods is the assumption that you need a way, method, technique, system or ‘tool’ to stop doing something. Why not just stop? And if just stopping seems difficult or even out of the question, then one should ask why should it appear to be difficult, or very difficult, to stop?

It’s not as if you are on a bicycle with defective brakes going downhill: you want to stop but even pulling hard on the brakes doesn’t impede the bicycle’s progress very much. In such a case one could talk of trying to stop to avoid a crash at the bottom of the road.

So there must be some reasons for the alleged difficulty in stopping smoking. Three possibilities come to mind. Either the smoker, in spite of what she might say, doesn’t really want to stop and only says she does to appease the naggers or the doubts in her own mind.

Or there may be a genuine difficulty in refraining from picking up the next cigarette, putting one end in your mouth, setting fire to the other end and sucking the fumes thereof into your lungs.

A further possible reason that may be suggested for difficulty in quitting is that the smoker perceives some benefit or enjoyment from smoking that is so alluring he doesn’t want to give it up, but this is just another way of saying he doesn’t want to quit. Even so, a little thought and discussion will show that the idea of the pleasurable or helpful cigarette is illusory.

E-cigarettes are not promoted as a means of stopping smoking similarly to other cessation aids, but as a replacement for smoking that is often used long term. Therefore there is something underhand about promoting e-cigarettes as a smoking cessation aid. All that e-cigarettes achieve is to allow a smoker to continue her nicotine addiction in a supposedly safer way.

Nonetheless, promoted they are (except in a few countries that have banned them). You can see why this is: e-cigarettes are being endorsed and encouraged as alternatives to smoking because this is a multi-billion dollar industry. That is why every man and his dog in the nicotine business are plugging e-cigarettes for all they are worth. Customers are being lured with a promise of wonderful flavours – like cherry, apple or banana.

But if you really want to experience the joys of these flavours all you have to do is to eat a cherry, apple or banana!

Text © Gabriel Symonds

The Rubbish Way to Stop Smoking

If you were new to the piano and wanted to play Bach’s C major prelude you would need to practise. (There are a number of YouTube videos showing how to do this.) But if you decided to give up learning this wonderful piece – which would be a pity – all you would have to do is close the piano and walk away; there would be no ‘trying’ about it. It would be nonsense to talk of failing to stop playing the piano.

On the other hand, in relation to cigarettes, the concepts of ‘trying’ and ‘failing’ to stop smoking feature a great deal.

Dr Colin Mendelsohn, a ‘tobacco treatment specialist’ as he mysteriously calls himself (http://nicotinemonkey.com/?p=675), might be said to represent the mainstream medical approach to the smoking problem. He has set out his philosophy, or credo, in a published paper (Medicine Today 2011; 12(10): 35-40).

This paper is contentious from the first sentence:

Most smokers repeatedly fail to quit because they are addicted to nicotine and have lost control of their smoking behaviour.

This is either a tautology (they are addicted and have lost control of their smoking behaviour) or he implies that some people, in spite of being addicted to nicotine, are nonetheless in control of their smoking behaviour – a contradiction in terms.

The meaning of the opening phrase, ‘repeatedly fail to quit’, is obscure – or it could be taken as the defining characteristic of all smokers who repeatedly fail to quit all the time. Each cigarette stubbed out could be viewed as a quit attempt, but the attempt fails because it’s followed by another cigarette.

On his website (http://colinmendelsohn.com.au/posts/cold-turkey-effective-way-quit-smoking/) Dr Mendelsohn says:

We often hear that many smokers quit ‘cold turkey’ (without professional advice or support) and that this must therefore be the most effective way to quit. Of course this is rubbish! Research clearly shows that using willpower alone is the least successful method for quitting smoking. (Emphasis added.)

In support of the last sentence he cites a paper in the journal Nicotine and Tobacco Research (https://doi.org/10.1093/ntr/nts164) with the presumably humorous title, ‘The Most “Successful” Method for Failing to Quit Smoking is Unassisted Cessation’. The three authors of this paper, one of whom is the self-styled world expert on smoking and addiction, Professor Robert West, take issue with the claim that ‘unaided quit attempts are effective because many former smokers report to have quit without help’, adding that ‘This argument is based on a logical fallacy, which ought to be obvious, but clearly it is not.’

They then try to explain what they mean by this curious last sentence:

…the most popular method used by people who failed to quit smoking was unassisted cessation. To put it another way, the ‘most successful’ method for failing to quit smoking is to use willpower alone. What does this tell us about the best way to try to quit? Nothing.

The charge of logical fallaciousness applies to these authors rather than to those who conclude that their research shows unassisted quitting is the best way to stop smoking. Here’s why: to talk of a ‘method’ of failing to stop doing something is meaningless – you simply carry on doing whatever it was. Also, on what grounds do they assume that the alternative to assisted cessation is willpower? What about smokers who just get fed up with smoking and decide they are not going to do it anymore? You don’t need willpower to refrain from something you don’t want to do!

They continue:

The problem…is that effectiveness cannot be inferred from the number of individuals using a specific method to achieve a goal only amongst those who have already achieved that goal.

But this is just what can be inferred from taking a random sample of former smokers and asking how they stopped. In a paper of the sort so condescendingly criticised by the world expert on smoking and addiction and his colleagues, there appears this encouraging conclusion:

Research shows that two-thirds to three-quarters of ex-smokers stop unaided.

(Interested readers can find it at http://dx.doi.org/10.1371/journal.pmed.1000216. It’s called The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences by Simon Chapman and Ross MacKenzie, February 2010.)

The concept of a ‘quit attempt’ is hollow and pointless. If a smoker has stopped smoking and has no intention of starting again, that is someone who has successfully quit – not someone who has made a successful quit attempt. Even the word ‘successful’ in this context is redundant. If we allow it, however, then what is an unsuccessful attempt? The idea of attempting to stop smoking is an excuse that the smoker has handed to him on an plate, or rather on an ashtray, to indulge his unwillingness to quit: he’s trying, so that’s all right then. And in the meantime – which often means a long time – he carries on smoking!

Our world expert mentioned above even goes so far as to say in a book he wrote (see review http://nicotinemonkey.com/?p=75) that if you don’t stop smoking ‘you have not failed – there is no such thing as failure when it comes to trying to stop smoking.’ Really? All smokers could be considered as having failed to stop. Similarly, we could well say there is no such thing as ‘trying to stop smoking’. Those who stop, have stopped; those who are trying to stop, smoke.

If the experts don’t like this way of looking at it, would they please tell me what is the definition of a quit attempt? Is it the same as not smoking for a certain length of time? If so, how long and why? Such a criterion would be arbitrary. Suppose a smoker has ‘attempted’ to quit and manages not to smoke for a year, but the next day she starts smoking again. Does this mean the attempt has failed? Using the length of time of non-smoking as the criterion for successful quitting, therefore, means one would have to follow-up ex-smokers until they died, but this would be rather impractical.

I have pointed out before that when smokers say they are trying to quit, this is not the expression of a wish to stop smoking, but a statement of their intention to continue.

Therefore the concept of a ‘quit attempt’ in relation to smoking is unhelpful and should be abandoned.

Text © Gabriel Symonds

Vaper’s lung – the disease that will never be, I hope

There was an interesting article two days ago in the online Manawatu Standard titled: ‘Government legalises e-cigarettes in effort to make New Zealand smokefree by 2025.’

Why 2025? Because this is a nice round figure? Why not sooner, say 2019? Apart from the date by which the New Zealand government is trying to achieve this noble goal, it’s planning to do it, not in the obvious way by banning tobacco, but by legalising e-cigarettes.

What the New Zealand government hopes will happen, it seems, is that smokers will give up smoking or, if people haven’t yet started to smoke, they won’t, and, as a substitute for inhaling tobacco fumes, everybody who is desirous of ‘using’ nicotine will from 2025 do it with e-cigarettes instead.

The thinking goes that to save lives what is needed is a safe, or at any rate a safer, way of taking nicotine into your body. And keep taking nicotine into your body. Like many times a day, every day for years on end. Because this is what vapers, as they are known, do, or what a large number of them do.

A link from the venerable Manawatu Standard’s page leads to another site (stuff.co.nz) from a year ago where the questions ‘How safe are e-cigarettes and can they really help someone quit smoking?’ are posed and then answered thus:

Long-term safety studies are needed, but [this]…will take decades, during which time there is the potential for many thousands of smokers to be deterred from trying something that might help them to quit.

Why do they write as if nicotine in some form or other is a normal consumer product which it would be a hardship to do without? Why does anyone in their right mind need to use nicotine at all? Will somebody please tell me.

If smokers want to quit, why don’t they just quit? Why do they need ‘something that might help them’ to do this? Why is it implied that smokers are helplessly in the grip of their addiction and can’t do anything about it except grasp at straws?

The article continues:

If e-cigarettes are genuinely going to have a chance at replacing tobacco smoking, they need to provide nicotine in a similar way to regular cigarettes.

Why does tobacco smoking need to be replaced? Whence comes the idea that smokers are in the infantile position of being incapable of quitting unless they have an alternative to or substitute for regular cigarettes? What about not smoking and not using nicotine at all?

Could one of the reasons that smokers seem to find it so hard to quit be because articles like these encourage them in such a belief?

The same concern is expressed from Australia by Dr Colin Mendelsohn – about whom I’ll have more to say in a later post – who thinks smokers should be treated with nicotine before they even try to quit (‘pre-quit’).

Dr Mendelsohn laments that ‘the Australian Therapeutic Goods Administration’s recent interim decision (it has since been confirmed) to effectively ban nicotine-containing e-cigarettes is a harsh blow to smokers,’ and that ‘Australian smokers will be denied access to life-saving technology estimated to have helped millions of smokers to quit overseas.’

If smokers whose lives are in danger from smoking want to avoid dying from this cause, all they have to do is to stop smoking (unless they’ve left it too late). Why does Dr Mendelsohn apparently think so many smokers are incapable of quitting unless they use more nicotine?

It’s not as if e-cigarettes are used for some weeks or months as a treatment for smoking and when a cure is achieved the e-cigarettes are abandoned. What happens with many smokers is that they switch to e-cigarettes and continue their nicotine addiction in this way indefinitely.

E-cigarettes do not only contain nicotine. They also contain propylene glycol, flavourings, tobacco-specific nitrosamines, carbonyl compounds, trace amounts of metals, volatile organic compounds and phenolic compounds. Many of these are potentially poisonous. The effects of inhaling such substances in e-cigarette vapour repeatedly every day for years or decades are unknown but it would not be surprising if vaping were to be found to cause serious lung, heart and other health problems. I hope that a disease that might be called vaper’s lung will never occur – but it could.

To allow this e-cigarette experiment to be foisted on the public is not only unnecessary but also irresponsible.

Text © Gabriel Symonds

More BAT Duplicity

Fumatul ucide is Spanish for smoking kills

In my tireless efforts to bring you the low-down on the tricks of the tobacco trade let me tell you about this little gem I came across recently from British American Tobacco (BAT):

http://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO8GSFQT

Under the page header the eye is drawn to the large print: ‘Our Guiding Principles’.

So BAT has principles. How very reassuring! Below that, just to make it clear, they write: ‘Steering the values of our business and our people’ and, repetitively, ‘Our Guiding Principles provide certainty about what we stand for and act as a compass to guide our behaviour.’

Nice to know BAT’s Guiding Principles provide certainly etc. Below these words is a screen on which you can see a short video: ‘Strength from adversity: a case study in Japan’. Click on the Play button and we get the BAT logo and company colours, the title of the film repeated and the wording ‘Pulling together in the wake of the tsunami in Japan’. Well, good for them! BAT was involved in assisting recovery from the terrible tragedy in Japan in 2011, it seems. The film shows amid the awful devastation individuals and small groups of men wearing suits and ties who explain how they made every effort to assist those affected by this disaster. And whom, in  particular, did they assist? Their retailers, their employees living along the coast, vendors and shop owners, and we hear from the local representative and the Vice President of this company.

But just a minute – what company are we talking about? Was BAT so big in Fukushima? Actually, no. It’s nothing to do with BAT. Look closely and you will see the film is about the Toyota Motor Corporation’s dealerships.

Let’s take a look another of BAT’s so-called guiding principles on this site. This is what it says – I am not making it up:

Freedom through Responsibility 

…We always strive to do the right thing, exercising our responsibility to society and other stakeholders. We use our freedom to take decisions and act in the best interest of consumers.

So society is just a stakeholder? Perhaps they meant to say ‘We always strive to exercise our responsibility to our shareholders.’ At least that would be believable. And if they wanted to show concern about doing the right thing and exercising their responsibility to society, to say nothing of acting in the best interests of their consumers, perhaps they should consider stopping making cigarettes.

Not surprisingly, what BAT says elsewhere on this site about the health risks of smoking is also put in a way that could be considered misleading:

The health risks in groups vary by the amount smoked, being highest in those that smoke for more years and smoke more cigarettes per day.

This could be taken as implying that if you don’t smoke too much or for too long it’s not so risky. But any smoking – even one cigarette – damages your health.

Experts advise no smoking during pregnancy – and we agree.

Do pregnant women need BAT’s patronising comment that they agree with the experts? And what if you happen not to be pregnant, or if you’re a man, then do experts not advise no smoking?

The only way to be certain of avoiding the risks of smoking is not to smoke.

So that lets BAT off the hook. No mention, however, of the fact that no matter how much smokers may want to avoid the risks of smoking, many find it extremely difficult to quit because they’re in the grip of nicotine addiction.

More disingenuousness is to be found in the section headed ‘Can people quit smoking?’, the question implying that perhaps they can’t.

Smoking can be hard to quit. Any adult thinking of starting to smoke should consider that it may be difficult to stop later.

Do adults thinking of starting to smoke first visit BAT’s website where they find the advice that they should consider that it may be difficult to stop later? Or do they smoke because they’re lured by the false promise of pleasure that BAT offers and then they find they’re hooked?

Then we have:

There is nothing so powerful about the pleasure of smoking that prevents smokers from quitting…

Note the implication that smokers may be prevented from quitting because they don’t want to give up the wonderful pleasure of smoking. Once again BAT conveniently avoids mentioning the real reason smokers may have difficult in quitting: it’s nothing to do with pleasure but everything to do with drug (nicotine) addiction caused by their poisonous products.

Text © Gabriel Symonds

Lies, Damned Lies and Big Tobacco

How can Nic’otine’andro Durante face himself in the mirror each morning?

Let me put it another way. What are 10,000 deaths a year in the UK worth?

To work this out we need to remember that one of the warning labels appearing on cigarette packs amusingly states ‘Smoking kills’. More precisely, smoking kills about 100,000 people each year in the UK. Now, British American Tobacco (BAT), whose CEO is the above-named Mr Durante, has a 10% share of the market so that means BAT is responsible for the deaths of 10,000 people each year in the UK. And the answer to the above intriguing question is the widely reported figure of £7.63m – this being Mr Durante’s 2016 salary, or ‘compensation’ as they quaintly put it, for his company’s legalised drug (nicotine) peddling with the aforementioned hilarious result.

It seems to me there is a kind of battle going on between the forces of righteousness on the one hand and the powers of darkness on the other. I refer, of course, to the do-gooders in the tobacco control movement, those working in specialised stop smoking clinics and other anti-smoking nazis versus those pulling in the opposite direction, namely, Big Tobacco with the collusion of governments who haven’t got the bottle to ban cigarettes.

Let me quote from BAT’s website:

Along with the pleasures of smoking, there are real risks of serious diseases such as lung cancer, respiratory disease and heart disease, and for many people, smoking is difficult to quit.

BAT’s mention of the pleasures of smoking as if it’s obvious or indisputable, is an assumption if not a downright lie. Smoking is not pleasurable or enjoyable – but it may seem so  – and the implication is that smokers need to weigh the alleged pleasures they gain from smoking against the health risks. But in any case, since BAT is so honest as to spell out the dangers of smoking, let’s give them a medal – or at any rate give their CEO a £7.63m pay cheque.

Then they dig themselves deeper into the hole with their ‘four key marketing principles’ – these seem to be some kind of promises. Here they are, but these so-called principles are more honoured in the breach than the observance:

  1. We will not mislead about the risks of smoking.

Although they say ‘for many people smoking is difficult to quit’ I can find nothing on their website about nicotine addiction as the reason for this difficulty. This major omission could be taken as amounting to being misleading.

  1. We will only market our products to adult smokers.

What do they mean by market? Advertise? Promote in media targeted at adults? In reality it’s almost impossible to shield children from cigarette marketing even if it’s supposed to be aimed only at adults. In any case, there’s no better way of marketing cigarettes to children than for them merely to see an adult smoking.

  1. We will not seek to influence the consumer’s decision about whether or not to smoke, nor how much to smoke.

But they do! What is their marketing for if not to influence non-smokers to try smoking? And after that they don’t have to do anything because a significant proportion of people who try the first cigarette are thenceforth addicted to nicotine so they feel compelled to go on smoking for years or even for the rest of their lives.

  1. It should always be clear to our consumers that our advertising originates from a tobacco company and that it is intended to promote the sale of our tobacco brands. 

They would say that, wouldn’t they. But it doesn’t exactly fit with BAT’s key marketing principle number 3.

Tobacco companies claim that their marketing is not intended to encourage young people to start smoking but to persuade established adult smokers to change brands. So that’s all right then. This is disingenuous. Do smokers find themselves in a pickle, thinking, ‘That’s a very persuasive advertisement for brand Y, I’ll change to it from my usual brand X.’? And if they then see an even more enticing advertisement for brand Z, do they say to themselves, ‘I must try brand Z from now on.’? Are smokers forever chopping and changing in response to the blandishments of Big Tobacco’s marketing efforts? It’s well known that smokers tend to stick with the same brand. What the marketing does achieve, however, is to keep the idea of smoking in the public eye and therefore people who wouldn’t otherwise smoke may be lured into trying it.

Now what about the pleasure(s) of smoking? Oscar Wilde in 1890 put it like this:

A cigarette is the perfect type of a perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?

Time has moved on since then and any smoker can demonstrate to himself or herself that the pleasure of smoking is an illusion.

The exquisite state of being unsatisfied, however, is no illusion; it continues for the whole of a smoker’s smoking life. How to get out if it? That is the question!

Text © Gabriel Symonds

 

Those are my principles, and if you don’t like them…well, I have others.

The title is a quotation from Groucho Marx.

A further examination of JTI’s of website (see yesterday’s post) reveals more weasel words.

A major section is headed ‘Our principles’ and, more specifically, ‘Six core principles define JTI’s attitude to smoking’. (The word ‘core’ is redundant.)

The hypocrisy from start to finish is breathtaking. The very idea of a tobacco company declaring that it has any principles at all is a contradiction in terms. Tobacco kills around six million people each year according to the WHO. Therefore, if JTI and the rest of the Big Tobacco fraternity – and small tobacco companies too for that matter – had any decency or principles (don’t laugh) they would do the one and only proper thing: STOP MAKING CIGARETTES.

But that, alas, is not going to happen any time soon while governments are only concerned to ‘control’ tobacco instead of working to abolish it.

Back to the tragic reality of the six million deaths and JTI’s core principles, as they call them – so they must be really important! – in particular, to core principle number five: ‘Accommodation between smokers and non-smokers’.

Many people have concerns about exposure to environmental tobacco smoke. All smokers should show consideration for those around them, and should not smoke when children are present. JTI advocates tailored, practical and effective solutions that separate smokers and non-smokers while accommodating the legitimate interests of both.

So some people – they presumably mean non-smokers – do not have concerns about exposure to environmental (second-hand) tobacco smoke? And who might those be? Of course all smokers should show consideration for those around them but, it is implied by the wording, only when children are present. What about when non-smoking adults are present who hate the stink and object to being forced to breath air polluted by poisons in second-hand tobacco smoke? They have good reason to object on health grounds alone because second-hand smoke indubitably increases their risk (even though to a small extent) of lung cancer and heart disease. This applies a fortiori when children are present, and not just because of the stink and danger of inhaling the smoke – they are particularly sensitive to the adverse health effects including asthma – but because it is a terrible example for a child to see an adult smoking. Then, in order to accommodate the legitimate interest of both smokers and non-smokers, JTI talks, not just of solutions, but of tailored, practical and effective solutions! And just just what tailored, practical and effective solutions do they have in mind?

What are the legitimate interests of smokers and non-smokers? We’ll consider the latter first although it’s so obvious it hardly needs saying. As a non-smoker I never want to have to breathe tobacco smoke-poisoned air. Smokers’ rights end where my nose begins. Even the sight of someone smoking is distasteful.

And what of smokers’ rights? The Forest organisation’s answer is contained in their acronym: ‘Freedom organisation for the right to enjoy smoking tobacco.’ But should they have the right to smoke tobacco if they don’t enjoy it? This question leads to an important aspect of smoking I looked at in my blog of 16 March 2017, ‘Are smokers getting a raw deal?’

Apart from that, what are the legitimate interests of smokers? Presumably to be allowed to smoke whenever and wherever they feel like it, but of course they can’t do that these days in most civilized countries. Apart from in their own homes (assuming there are no children present and no one else there objects), smokers are restricted to smoking in designated smoking areas or, to the annoyance and even distress of the non-smoking public, in the street. So to talk of an ‘accommodation between the legitimate interest of both [smokers and non-smokers]’ in the sense meant by JTI is making an assumption that non-smokers must submit to breathing second-hand cigarette smoke under certain circumstances. This is a completely different situation from that of the accommodation of the legitimate interests of, say, motorists and cyclists on public roads where a certain amount of give-and-take is necessary for the safety of all road users.

Or is this accommodation meant to include the situation where a non-smoker, on encountering a smoker standing outside an office building (as is the case in many cities in Europe), is obliged either to hold his or her breath or to make a detour to pass by out of smoke range? Or should a non-smoker try to accommodate the legitimate interests of a smoker by saying to him or her, ‘Excuse me, does my non-smoking bother you?’

I say smokers have no legitimate interests that non-smokers must accommodate.

Furthermore, what smokers don’t seem to understand is that they are either in a drugged state (with nicotine) just after having smoked a cigarette or they are suffering from drug withdrawal the rest of the time. Therefore, if smokers could only grasp these facts and get rid of the illusion of the enjoyment of smoking, they would perhaps understand what inhaling tobacco smoke is doing to their bodies and minds. Then, one might hope, they would consider their own legitimate interests and stop smoking.

Text © Gabriel Symonds

Nothing much changed in thousands of years

German industrial cigarette machine – makes 10,000 cigarettes a minute

There are some individuals and organisations who have found a way to deal with awkward questions: ignore them!

Recently I cast my critical eye at the website of the venerable cigarette manufacturing company, Japan Tobacco International (JTI). In their ‘About tobacco’ section we find the amazing fact that ‘Smoking has a tradition that dates back thousands of years.’ So that’s all right then. Slavery, genital mutilation of children and dog-fighting also date back thousands of years. And another thing they say in the same section is that ‘The way a cigarette is prepared has not changed much.’ I suppose it all depends on what they mean by ‘much’ and from when they are considering change. Up to the late 1800s cigarettes were hand rolled but modern machine rolling can produce up to 20,000 cigarettes a minute. Seems like a pretty big change to me – to say nothing of all the sophisticated additives that can be found in cigarettes these days. So I hope JTI will forgive me for imagining that their site may not be quite straightforward – it’s rather smoke and mirrors, particularly smoke.

Now let’s come to my main concern. If you read the JTI  website carefully you can see how they try to justify continuing to be in the tobacco business – although they make a point of adding, rather obviously, that ‘If you want to avoid the risks of smoking, you should not smoke.’ So that lets them off the hook.

What they don’t acknowledge is how cigarettes themselves have created the problem, that is, nicotine addiction, whereby smokers find it difficult to stop.

This is what JTI says about addiction:

Many smokers report difficulty quitting smoking. The reasons they offer vary. Some say they miss the pleasure they derive from smoking. Others complain of feeling irritable or anxious. Others speak simply of the difficulty of breaking a well-ingrained habit. Given the way in which many people – including smokers – use the term ‘addiction’, smoking is addictive.

It is interesting to see how these comments, while seeming responsible and sensible, could be taken as self-serving.

‘Many smokers report difficulty quitting smoking.’ This is not true. All smokers (whether they report it or not) have difficulty quitting smoking – that’s why they smoke! Or at least one can infer as much.

But do smokers spontaneously report that they have difficulty quitting or is this elicited by the questioner? And what are the circumstances under which this question was asked? What was the question anyway? Did they approach a random sample of smokers and say, ‘Excuse me, do you have difficulty quitting smoking?’ It’s a loaded, not to say insulting question. Or did they say to someone smoking a cigarette, ‘Excuse me, if you have difficulty quitting smoking would you please tell me why.’ Same situation. Or perhaps they asked a sample of smokers attending a smoking cessation clinic who had agreed to take part in such a survey. These smokers would obviously be a select group and therefore can’t be taken as representative of ‘many’ smokers.

So I used the contact section on the JTI website to ask them whence these comments come from. Are they from a scientific paper reporting the results of a survey or are they just made up by the JTI copywriter? I am still waiting for a reply.

Let’s give them the benefit of the doubt and assume many smokers had somehow reported that they have difficulty quitting, and that they were then asked to say why they thought they were in this unfortunate situation. Let’s take the quoted alleged reasons one by one.

‘Some say they miss the pleasure they derive from smoking’. But if they say they miss the pleasure of smoking this means they have already stopped, so the difficulty is retrospective and these former smokers cannot therefore be included in the ‘many’ who allegedly currently have difficulty stopping smoking.

As for a habit, whether well-ingrained or merely ingrained, that smokers apparently have difficulty breaking, this is not why smokers smoke or why they find it difficult to stop. Habits are easy enough to make or break but drug (nicotine) addiction is another matter entirely.

Those who ‘complain of feeling irritable or anxious’ as a reason for having difficulty in quitting are nearer the truth, but why do they feel this? Because the irritability or anxiety is caused by the cigarettes themselves or, more specifically, by the withdrawal symptoms of nicotine.

Then we have:

But no matter how smoking is described, people can stop smoking if they are determined to do so. No one should believe that they are so attached or ‘addicted’ to smoking that they cannot quit.

Note how ‘attached’ is written as part of the normal flow of the sentence but ‘addicted’ is in inverted commas. This implies that smokers are not really addicted to smoking, only attached to it, and that if they really wanted to stop they would. Thus JTI reveal themselves: Don’t blame us if you think you can’t quit – you could if you wanted to!

What JTI does not admit, of course, is that the difficulties smokers may experience in quitting are an inherent part of the poisonous product they have provided for their customers to get hooked on – and to remain hooked on – for years or decades.

Text © Gabriel Symonds