Category Archives: Smoking harm reduction

The perfect ‘product’ for nicotine addiction

The US Food and Drug Administration (FDA) recently announced it has awakened to the interesting idea that the way to help people quit smoking is for them to have a wider range of ‘products’ available in addition to so-called nicotine replacement therapy (NRT).

The FDA recognises that NRT (nicotine-containing gum, patches and lozenges) is of limited effectiveness and so it now wants the smoking public to have access to more options, in particular, e-cigarettes. Further, it wants to have NRT and e-cigarettes approved as medical products and possibly even have them covered by health insurance.

Let’s pause for a moment to consider this curious situation. In the US cigarettes are freely and legally available for sale to anyone over 18 (21 in some states). As a result many people become addicted to smoking and because of this there are about 480,000 deaths from smoking-related diseases in the US every year. And the way the government is trying to deal with this is that when people are already addicted to the nicotine in cigarettes and find it difficult to stop smoking, they should be offered nicotine in some other form as a ‘therapy’ to help them. But because NRT doesn’t work very well they need to have other products or options available as quit smoking aids.

Isn’t there something a bit odd about this? Either nicotine-containing consumer products (especially cigarettes) should cease to be available, in which case the problem wouldn’t arise for those who don’t yet smoke, or we need a radical new approach to treating nicotine addiction for those already in this unfortunate position.

It gets worse. The FDA is contemplating new measures that would enable cigarette companies to get non-cigarette nicotine-containing products approved as medicines to treat the nicotine addiction that their primary product, cigarettes, caused in the first place.

Big Tobacco must love this. They can present themselves as part of the solution to the smoking problem – a win-win situation for them because they can anticipate their income will be protected as sales of cigarettes fall while sales of alternative nicotine products rise. This might just about be acceptable if they were to announce, for example, that at the stroke of midnight on 31st December 2020 all cigarette production in the US will cease. Of course they won’t commit themselves – any suggestion of phasing out combustible tobacco products is projected to some vague time in the fairly distant future.

Tobacco companies should be seen for what they are: the whole of the problem. And the only role they can have solving it – and it would be a very big role which would virtually eliminate the problem – would be to stop making cigarettes.

Instead of pushing for this obvious measure, or even mentioning it, the FDA Commissioner, Dr Scott Gottlieb, verbosely talks about ‘what we can do to create additional pathways to bring additional nicotine replacement therapies to the market’.

By the time smokers are addicted to nicotine it’s too late. Dr Gottlieb is pursuing a non-existent goal. You have to remove the cause of nicotine addiction, not treat it when it’s happened. Why aren’t smokers clamouring for relief, for a ‘product’ or even for a range of options to help them escape their thraldom to nicotine?

Because the tragedy of nicotine addiction is that many sufferers don’t want to escape.

Text © Gabriel Symonds

Oyez! Oyez! Learn to love your lungs!

The Nursing Times (13 November 2017) brings us news of a great way to raise awareness of lung cancer for the citizens of the historic city of Leicester in England.

Specialist nurses will run a stall at a shopping centre where they ‘will be promoting e-cigarettes to the public…as part of efforts to boost smoking cessation.’

One of these highly skilled nurses, Sharon Savory, says: ‘We want to show the public what to look for, who (sic) to see and to learn to love their lungs.’

The key message, we are informed, is that ‘using e-cigarettes are (sic) a “great way” to reduce the harm caused by smoking tobacco.’

Then there’s the cheerful news that on the appointed day, ‘Everyone is invited to take a break from their shopping to learn about the early signs and symptom recognition of lung cancer.’

We also hear from the well known Leicester e-cigarette enthusiast, Louise Ross: ‘We know that vaping is at least 95% safer than smoking, and that people who switch to vaping do very well with their quit attempt.’ I have written about this down-to-earth lady before: http://nicotinemonkey.com/?p=1620

The advice given by Ms Savory, bless her cotton socks, is somewhat restricted. Why should you learn to love just your lungs? What about the rest of your anatomy? The marvel of the human body is that, in health, everything works in perfect harmony with everything else. And smoking, though it obviously affects the lungs, also has widespread harmful effects on the blood, heart, brain, stomach and indeed every organ and system of the body.

What she says is just a slogan, of course, but it would be a better slogan, surely, if the intention is to discourage smoking, if it was something like: ‘Love your life’, ‘Respect your body’ or ‘Your body is the temple of God. Don’t desecrate it by smoking.’

Apart from this, there’s something unseemly about nurses trying to promote e-cigarettes. To start with, it’s incorrect to say ‘we know vaping is at least 95% safer than smoking’. Nobody can say they know this; it’s merely an unproven assertion.

The specialist nurses should be more aware than most people that to inhale e-cigarette vapour many times daily for years on end, as vapers typically do, could be a disaster; we just don’t know what the long term effects will be, and can’t know, until probably another twenty years.

And to say ‘people who switch to vaping do very well with their quit attempt’ is paternalistic and meaningless.

By all means let nurses and anyone else so inclined try to boost smoking cessation. But why do they think the best way to do this is to encourage the use of e-cigarettes? Are other methods no good? Or, if they really believe in this defeatist position, at least let them be open about what it is they’re offering.

What they will be saying at their shopping centre stall to the smoking public on the appointed day, although they appear to be unaware of it, in effect is this:

Oyez! Oyez! All persons having business with smoking come hither. Smoking puts you at serious risk for getting the horrible disease of lung cancer. If you stop smoking you will greatly reduce this risk. You need to understand that the only reason you smoke is because you are addicted to the nicotine in tobacco. If you feel you cannot do the obvious sensible thing and quit smoking forthwith, however, you might consider an alternative way of continuing to be addicted to nicotine that is, we hope, safer than smoking, namely, using e-cigarettes.

There’s a further unfortunate aspect to Ms Savory’s words: it’s reminiscent of the advertisement for ‘LeoLites’ e-cigarettes (illustrated), which was banned in Britain in 2014 because it was deemed to imply that e-cigarettes were beneficial to the users’ health.

Before our specialist nurses get carried away by their eagerness to encourage these new drug delivery devices, apart from the unknown risks of using e-cigarettes, perhaps they should consider whether anyone needs to be in a drugged state with nicotine at all?

Text © Gabriel Symonds

The attempt and not the deed, Confounds us

The 2017 version of Stoptober, as they call it, finished on 28th October. The idea was that if smokers could be encouraged and supported not to smoke for twenty-eight days, they would be ‘five times more likely to quit for good’.

Those who signed up received daily messages of the following kind:

If you’re using stop smoking aids, including e-cigarettes, remember to keep using them.

Count up how much money you’ve saved so far, since quitting smoking

Write down the times when you’ve beaten a craving, or turned down a cigarette. You did it then, so you can do it again, and again.

Keep reminding yourself of all the reasons why you decided to stop smoking.

Having trouble sleeping? Try introducing some activity into your day. A kick about with the kids, a Zumba class, or a brisk walk could really help.

As I said in an earlier post, it’s not my intention to knock the campaign – any way that helps smokers to quit is to be welcomed.

However, is such a campaign the best way to go about it? If this approach were directed to, say, weight reduction in overweight people, it would make some sense. It’s not fully understood why people become overweight and slimming is difficult. Even so, daily encouragement to stick to a diet could be helpful.

With smoking, on the other hand, as far as I recall, the word ‘addiction’ isn’t mentioned and the approach of the campaign implies that people smoke for lack of motivation in stopping.

They claim that

Stoptober has driven over 1 million quit attempts to date and is the biggest mass quit attempt in the country. It is based on research that shows that if you can stop smoking for 28-days, you are five times more likely to stay smokefree for good.

What’s the good of a quit ‘attempt’ and what does it mean anyway? A little thought shows that it’s meaningless. Someone either smokes or they don’t. The idea of a quit attempt – as I have said before but it’s worth repeating – colludes with smokers that as long as they’re ‘trying to stop’ everything is fine. But it’s worse than that. The concept of trying to stop implies it’s going to be difficult – you have keep trying, as in the story of Bruce and the spider. Such an idea is reinforced by the advice to use a ‘stop smoking aid’ (it’s too difficult to do on your own) and that you will need support to overcome ‘cravings’ (scary).

And what’s all this about being five times more likely to stay smokefree (sic) for good if you can stop smoking for 28-days? Five times more likely than what? What research they are referring to? I wrote and asked them; I am still waiting for a reply.

This doubtless well-intentioned campaign does nothing to help smokers understand why it seems so difficult to quit. Further, it’s discouraging, because it reinforces the notion that a tough time lies ahead and that smokers need to use willpower to refrain from smoking for twenty-eight days. And then what’s supposed to happen? You will have to continue to use willpower for the rest of your life?

It’s even more unfortunate that this year e-cigarettes are recommended as a way of stopping smoking. As I have also pointed out before, this is misleading or at best a half-truth. E-cigarettes provide an alternative way of taking nicotine into your body that, it is hoped, will be safer than smoking. But people who take this route to smoking cessation continue to be addicted to nicotine. It’s defeatist and almost insulting to smokers to suggest they use e-cigarettes. At least with other stop smoking ‘aids’, such as nicotine patches and chewing gum, there’s a limit to the time one’s expected to continue with them – though not a few use them long-term.

On the other hand, if you go about it the right way you can stop smoking easily without any so-called aids and even willpower is not required.

Text © Gabriel Symonds

(The title is from Macbeth.)

Can’t see the wood for the trees – or the nicotine for the e-cigarettes?

A headline in today’s online BBC news (so it must be true) announces ‘E-cigarettes: Cross-party group of MPs launches inquiry’.

The main point of this exercise is to try and fill the ‘significant gaps’ in what is known about e-cigarettes including how effective they are as a stop smoking tool and how they are (or should be) regulated. But it’s curious that these ideas are put forward as a reason for an inquiry – because what is already known about e-cigarettes together with what can be reasonably surmised is enough to make such an inquiry unnecessary.

E-cigarettes should first of all be seen, not as a stop smoking tool, but for what they are: a supposedly safer way for smokers to continue their nicotine addiction.

There are almost three million vapers in the UK and about half of them smoke as well. In other words, for these people vaping is an alternative or additional means of taking nicotine into their bodies. But why is it assumed, for smokers concerned about the dangers of smoking, that an alternative is needed at all? Recommending e-cigarettes is becoming almost a knee-jerk response for those seeking help to stop smoking.

The enquiry might better look into these questions: Why do people smoke? Why does it seem so hard to stop? Do smokers really want to stop anyway, and if not, why not? Is it or should it be public policy that millions of vapers in the UK are in the thrall of long-term nicotine addiction?

E-cigarettes are supposed to be safer than smoking, but it’s patronising and almost insulting   to encourage smokers to use them. It amounts to saying, ‘There, there, you poor smokers, it’s too hard for you to quit. But never mind, you can carry on being addicted to nicotine in a way that we hope will be less damaging to your health!’

Now, suppose we could anticipate the result of our cross-party group of MPs’ inquiry over the next few years or decades (because this is how long it will take for a definitive answer  into the health effects of e-cigarettes) and that this will be: vaping is completely harmless! That is to say, it will be found that e-cigarette vapour, which consists of nicotine, water, flavourings, propylene glycol and glycerin, as well as trace amounts of cancer-causing chemicals and heavy metals, even when inhaled into the lungs many times daily for years on end, poses no danger whatsoever to the vaper or those around him or her including babies, children and pets.

Further, let’s anticipate that the originators of the slogan ‘E-cigarettes are 95% safer that smoking’ were over-cautious in arriving at this figure and now it can be said with complete certainty that e-cigarettes are 100% safer than smoking!

These statements of course are fantasies. But let us assume for the sake of argument that these conclusions are true. Therefore, if e-cigarettes are to be promoted as a stop-smoking tool, putting aside the question of whether they should be allowed at all, then it follows that since ordinary cigarettes are certainly not safe (they kill around half of all smokers) the action that needs to be taken on public health grounds is obviously to ban ordinary cigarettes at once.

And if we further suppose for the sake of argument that the results of future research will show that e-cigarettes are, indeed, 95% safer than ordinary cigarettes, or that they are, say, only 50% safer, then the argument to abolish ordinary cigarettes forthwith still would apply.

Even to a sceptic such as I it’s unlikely that e-cigarettes will turn out to be equally or more dangerous to users’ health than ordinary cigarettes – but they could be. See my post on ‘vaper’s lung’ (http://nicotinemonkey.com/?p=1406).

Now let’s consider the second reason why our parliamentary representatives feel the need for an inquiry into e-cigarettes: how they are regulated.

Current regulations limit the concentration of nicotine in the e-liquid, the size of the refills and the requirement that a label must be affixed to the product warning purchasers it contains nicotine which is highly addictive. So far so good, or bad, but in addition, in the UK only people over 18 years of age are permitted to buy e-cigarettes. However, just as with ordinary cigarettes, that won’t stop any enterprising youngster who wants to vape from obtaining the kit and doing so – indeed, it’s a serious problem that so many children vape and smoke and thereby become addicted at a vulnerable age and go on to become regular users of nicotine. So, regulation with the intention of preventing people under 18 from vaping or smoking or both, is largely ineffective. With this in mind, it’s relevant to ask how does our group of parliamentarians anticipate changing or tightening the regulations, and why?

There’s a much more effective way of stopping smoking than turning to other nicotine products. It needs to be remembered that smoking is largely a psychological problem. This was recognised in the US as long ago as 1964 in the seminal Report of the Surgeon General on The Health Consequences of Smoking:

The overwhelming evidence points to the conclusion that smoking—its beginning, habituation, and occasional discontinuation—is to a large extent psychologically and socially determined.

How to use this knowledge to achieve simple smoking cessation has been set out in my books, available the publisher and Amazon.

Text © Gabriel Symonds

How not to solve the smoking problem

There’s no shortage of ideas, particularly from people who appear to have no experience in actually treating smokers, about how to solve the smoking problem.

For example, let’s take a look at an article in the online Dorset Echo of 29 September 2017 written by a trainee reporter.

To set the mood there are two large illustrations: ‘A Generic (sic) Photo (sic) of someone smoking a cigarette’ and an ‘Undated file photo of a cigarette stubbed out in an ashtray’. How very interesting!

The piece quotes a report in which an unnamed expert says, ‘There’s never been a better time to stop smoking’. So last month wasn’t a good time but today is a good time? The best time to stop smoking is right now. Perhaps the expert means that these days it’s easier to quit because of all the support that’s supposed to be available. But even this doesn’t make sense. Every smoker desirous of quitting – and this very phrase begs the question that smokers actually want to quit – has himself or herself ultimately to confront the reality of never smoking again.

Then we’re told, ‘For the first time, any smoker – no matter their background or job, sex, age or where they live – has virtually the same chance of quitting successfully as the next person.’

How marvellous! But who is this mysterious next person? And what is meant by ‘the same chance of quitting’? Is quitting a matter of chance?

This is followed by the information that ‘The report coincides with the launch of Stoptober quit smoking challenge, which has inspired over one and a half million quit attempts since 2012.’

Allow me to ask, what’s the good of a quit attempt, and what does it mean anyway? You either smoke or you don’t. The idea of a quit attempt is meaningless. It’s a fantasy that colludes with smokers to feel less bad about their nicotine addiction: they’re trying to stop – while they merrily carry on smoking – so that’s all right then.

Finally, we get the curious news that ‘E-cigarettes are now the most popular way to quit in the country with half of all those taking part in Stoptober last year using an e-cigarette. The evidence is clear – vaping is at least 95 per cent less harmful than smoking – a fraction of the risk.’

Unfortunately, our trainee is poorly informed. There’s no evidence that vaping is at least 95 per cent less harmful than smoking; this was merely the opinion of a group of people with no recognised expertise in what is called tobacco control and was based on arbitrary, theoretical criteria. The figure was released at the end of a weekend conference in London in 2014 and has been heavily criticised in the medical literature, not least because of potential conflicts of interest of some of the participants. More details can be found in my blog at http://nicotinemonkey.com/?p=1267

The reality is that no one knows what the effect will be of sucking into your lungs e-cigarette vapour many times a day for years on end. But common sense tells you it won’t do you any good.

Another example is a press release (2 October 2017) about an Australian billionaire, Andrew Forrest, who is rather upset, as well he might be, that his government is not doing enough to deal with the smoking problem and is preparing to launch a campaign to raise the legal smoking age from 18 to 21.

This is based on the idea that since most smokers start in their teens or younger, if they can refrain or be prevented from smoking until they reach 21, fewer will start.

Professor Sanchia Aranda of Cancer Council Australia speaks approvingly of this idea, noting that the smoking rate among 14 to 18-year-olds is at an all-time low, with 80 per cent of young Australians in that age group having never smoked.

What the good professor doesn’t seem to understand is that the problem is not with the 80 per cent of young Australians who’ve never smoked, but with the 20 per cent who have tried smoking or currently do smoke, in spite of being below the legal age.

Any enterprising youngster will always find ways to obtain cigarettes if he or she wishes to. The problem is not the age at which cigarettes may legally be purchased, but the fact that they are available at all. And in the somewhat unlikely event that suddenly all young Australians will become models of compliance with all rules and regulations, it will take decades – assuming such an ill-conceived plan works at all – until a smoke-free generation appears.

Mr Forrest, more sensibly if still impracticably, also wants to sue tobacco companies for the damage their poisonous products cause. Predictably, a spokesman for the tobacco giant Philip Morris, alarmed at this idea, patronisingly says, ‘Instead of promoting costly litigation, we would encourage Mr Forrest to focus his attention on product developments that have the potential to substantially reduce the harms associated with smoking.’

Why should Mr Forrest collude with the likes of Philip Morris? The problem is not the lack of what are cynically called ‘potential reduced risk products’, but the fact that tobacco is available at all, to anyone of whatever age.

If Mr Forrest nonetheless really wants to make an impact on the smoking problem, perhaps he would consider using some of his wealth to promote the abolition of cigarette sales in Australia.

Text © Gabriel Symonds

Inhale Poison to Stop Smoking: Official

Since I’m on the mailing list, I’ve once again started receiving notices of the forthcoming 2017 version of the so-called Stoptober anti-smoking effort put out by Public Health England (part of the UK Department of Health).

It’s not my intention to mock this campaign. Smoking is a serious problem and anything that helps people to quit is to be welcomed. However, as in previous years, the approach used lays itself open to parody.

The first message encourages me to ‘keep motivated’ to stop smoking. (I am of course a non-smoker and have signed up purely for professional purposes.)

Let’s have a look at this phrase, because it contains within it one of the many paradoxes of the current official attempts to deal with the smoking problem.

Encouragement to keep motivated suggests that smokers are in a similar position to middle-aged couch potatoes who should get off their backsides. One certainly needs motivation to overcome one’s natural resistance to exercise and start on the road to fitness.

Smokers, however, are not in this situation at all. Is the reason they smoke because they lack the motivation to quit? Is it believed that if only smokers could increase their motivation to a certain degree, this would tip the balance so they would actually quit? Most smokers have plenty of motivation already – they don’t want to get lung cancer after all – but they seem to be unable to act on it. Why is this? Insufficiency of motivation is not the problem.

Stoptober seems to be trying to persuade smokers they ought to stop, as of course they should. But is this the best way to go about it?

The sub-text is that if only smokers realised the risks they run by continuing to smoke, and if only they could appreciate the benefits of quitting, then they might be sufficiently motivated to make a quit attempt. This approach is based on logic, common sense and the need to use willpower to refrain from the apparently irresistible urge that smokers have to keep smoking. Then, with the increased motivation to be provided by the twenty-eight daily inspirational  sound-bites (or whatever they will turn out to be) of this year’s Stoptober campaign, the participants – if they can only hold out for twenty-eight days – will find themselves in the fortunate position, like the chance to be entered into a lottery, of being five times more likely to quit! This curious statement is from the Stoptober 2016 version, of which my critique can be found at: http://nicotinemonkey.com/?p=842

The next message asks, ‘Have you got a Quit Buddy?’ This means ‘Someone you can call on when you need help’. There we go again: stopping smoking is too difficult to do on your own, so you need someone to call on when (not if) you need help. How encouraging! And what is that someone supposed to do? Say ‘There, there, don’t worry, the horrible cravings and urges will soon pass! Stay strong! You can do it! Remember, if you can survive for twenty-eight days, you’ll be five times more likely to quit for good!’

Today’s message is as follows:

Have you thought about using a stop smoking aid? There are lots of aids to help you quit, including prescription tables (sic), NRT (such as patches, gum, lozenges) and even e-cigarettes. Talk to your GP, pharmacist, local stop smoking service or vape shop to find out more.

Why should a smoker need an ‘aid’ to quit? Again, the implication is that it’s too difficult to do on your own. However, the suggested aids for 2017 are not just the same old nicotine products and prescription drugs, but now we even have e-cigarettes! One way to find out about these is to pop along to your local vape shop.

This is where I must part company with Stoptober. It speaks of the ineffectiveness of the previous Stoptober campaigns (they started in 2012) that they have to throw in a new way of keeping your nicotine addiction going. And vape shop owners must be rubbing their hands in anticipation of juicy profits at this now official endorsement of their products. I think it’s highly irresponsible.

As I have said before, proffering e-cigarettes as a stop-smoking aid is misleading. For many smokers who take up vaping, it merely amounts a new way of continuing their nicotine addiction, maybe indefinitely. Whether it’s really less harmful than smoking only time will tell.  See http://nicotinemonkey.com/?p=1406

Text © Gabriel Symonds

Yummier Than Fruit

There is no doubt that e-cigarettes are big business.

The flyer I received recently about the forthcoming Vapexpo conference in Paris lists around two hundred brands of e-cigarette liquid from sixteen countries.

Promoted on the misleading meme that e-cigarettes help smokers quit, if anyone has any doubts that vaping is drug addiction by other means, they only need to look at the two-minute promotional video for a variety of e-cigarette liquid, produced in Malaysia, with the apt name of  Nasty Juice.

It opens with disconcertingly close-up and slow-motion views of a young man biting into an apple, a strawberry and a mango, in that order, while his eyes roll back in ecstasy. Then the tempo changes as he appears to be in some distress with his hands on his head and the voice-over asks, ‘What if, what if we can make it yummier?’ The answer seems to descend from heaven as, with a look of bliss on his face, he reaches up to grasp – a can of Nasty Juice! This, the voice-over intones, has ‘more flavour, more sweetness and more juiciness, just for you’. And finally the punch-line: ‘Quitting smoking cigarettes is possible than ever (sic)’.

If you wish to enjoy eating apples, strawberries or mangos, you merely need to visit your local fruit shop and buy them, provided they are in season. I often do this myself. But you would have to be out of your mind to buy synthetic chemical essences of these flavours and inhale them into your lungs. Yet this is what e-cigarette users do, and not just occasionally, which would be bad enough, but many times every day for years on end. Nasty juice indeed.

Is vaping safe? The obvious answer is ‘No’. The function of our lungs is to absorb oxygen and to exhale carbon dioxide produced by the body’s metabolism. Therefore, normally only clean air should be inhaled. E-cigarette vapour typically contains nicotine, water, propylene glycol, glycerin, flavourings and traces of heavy metals and other nasty chemicals.

How can one prove that vaping is, or is not, safe? You can’t. There is no reliable way of speeding up the process of long-term exposure to e-cigarette vapour to produce in a few weeks or months what the effects of daily vaping would be in humans after, say, twenty years. This doesn’t prevent scientists from trying, though.

There was a report in the doughty Mail Online (12 September 2017) of a study carried out by intrepid researcher Dr Pawan Sharma from the University of Technology, Sydney. The headline breathlessly informed us: ‘Vaping in pregnancy increases a child’s risk of asthma even if the e-cigarettes are nicotine free.’ In mice, that is.

Isn’t it enough on common sense grounds that vaping is likely to be bad for your health and even more so for pregnant women and their babies? But suppose Dr Sharma’s study had found no harmful effects of vaping in mice, would that mean it’s safe for pregnant women to vape away as much as they like? Obviously not – mice are not the same as humans and it’s an absurd and groundless assumption to regard animals as valid ‘models’ for human illnesses.

Dr Sharma admitted as much because, when I wrote and asked him to please tell me what is the scientific basis for believing that the results are applicable to humans, he was honest enough to reply: ‘These results can’t be extrapolated to humans right away.’

Then why did he do the experiments in the first place? Nonetheless, does he think the results might be extrapolatable (able to predict what happens in humans) in the future, and if so, when, and why? Of course I heard nothing further from this seeker after the truth.

Researchers working for Big Tobacco, on the other hand, are striving to prove the opposite: that tobacco products such as heated (not burnt) tobacco ‘sticks’ (for example, iQOS and ‘glo’) are potentially less harmful than smoking in humans. See http://nicotinemonkey.com/?p=1642. At least Philip Morris, the subject of this post, are cautious enough in their lawyerly fashion only to refer to this new-fangled way of poisoning yourself with tobacco as a potentially reduced risk product.

You can ‘prove’ anything you want with animal experiments. They should be seen for what they are: crude, cruel and useless for understanding human diseases.

Vaping should also be seen for what it is: a way of continuing nicotine addiction that it is hoped will be safer than smoking.

Text © Gabriel Symonds

The Great E-cigarette Confusion

Action on Smoking and Health (ASH) with its punny acronym of a name seems reluctant to embrace the only action that would solve the smoking problem once and for all: calling for banning tobacco. I recently asked their Chief Executive, Ms Deborah Arnott, by email, twice, whether this is ASH’s policy, and if not, why not. The answer was no reply. Or the reply was no answer.

Instead, the action that this organisation seems to favour is of the following kind.

Deborah Arnott:

There are currently 2.9 million e-cigarette users in Great Britain, over half of whom have quit smoking. E-cigarettes are playing an important role in supporting smokers to switch from tobacco smoking…As the market continues to develop we hope to see products go through the more stringent licensing process and become licensed as medicines and available on prescription. (Source: ASH Daily News 4 July 2017)

The sentence ‘E-cigarettes are playing an important role in supporting smokers to switch from tobacco smoking’ is muddled.

Presumably Ms Arnott means ‘E-cigarettes can help smokers switch from tobacco smoking to e-cigarettes’ but this isn’t very satisfactory either. Let me try again. ‘E-cigarettes have a role (we can forego the ‘playing an important role’ cliché) in helping smokers switch from smoking to other, allegedly safer, ways of satisfying their nicotine addiction.’

The end of the paragraph is more promising but likewise doesn’t seem to have been properly thought through.

If alternative nicotine products (alternative to cigarettes, that is) become licensed as medicines and available on prescription, that implies they won’t be available for the general public to buy in every corner-shop and supermarket. And they will, presumably, be prescribed only for a limited time – the time that it will be deemed sufficient for a smoker, having switched to an alternative product, then to stop using that product in the same way that patients stop using a prescribed drug when the have recovered from the illness for which it was prescribed.

This same sentence also shows confusion about the idea of products being licensed as medicines. Although it certainly has effects on the human body, nicotine has no current orthodox medical use – unless one stretches the concept to include treatment of nicotine addiction. But this would be contradictory because it would mean using nicotine for a limited time to treat nicotine addiction!

But if it is accepted, as it seems to be by the likes of Ms Arnott, that medicinal nicotine can legitimately be used as an indefinite treatment for cigarette-induced nicotine addiction, then we shall have the situation where doctors – presumably the burden will fall on GPs, who already have more than enough to do – will have to take on the new task of treating nicotine addicts, that is, smokers, who will likely flock to them for prescriptions for cigarette replacement therapy.

This defeatist and muddled thinking over using e-cigarettes to stop smoking is all too widespread. Even as far away as India, where a number of states have banned e-cigarettes, The Indian Express (3 September 2017), quotes unnamed experts as saying: ‘E-cigarette ban wipes out less harmful alternative for smokers.’

It does not appear to have occurred to these experts that not only is there a less harmful alternative for smokers, there is a completely harmless alternative for smokers: not smoking at all. And no one needs any nicotine product as an alternative for smoking!

In any case, are e-cigarettes really so much less harmful than ordinary cigarettes?

Other Indian experts think not. I quote again from The Indian Express:

…the Union Health Ministry has recently ruled out acceptability of e-cigarettes in the light of research findings by experts who concluded that they have cancer-causing properties, are highly addictive, and do not offer a safer alternative to tobacco-based smoking products.

So there. Ms Arnott please note.

Text © Gabriel Symonds

Photo credit: Wikimedia

Stigmatization and the Corner Shop

When I used to work in obstetrics (care of pregnant women) certain routine tests were carried out at each attendance, such as checking the urine and measuring the blood pressure. The reason was that these tests can give early warning of serious problems such as diabetes and high blood pressure, and then the appropriate action could be taken.

Of course, medical practice doesn’t stand still; sometimes new tests are added and old ones discarded. The latest development in obstetrics, in Britain at any rate, is that at the first and possibly subsequent ante-natal appointments, as part of the routine, a woman should now expect to be breathalysed (unless she opts out) for carbon monoxide (CO). This is to detect pregnant women who smoke and may try to conceal the fact.

What if the test is positive? Assuming the machine is accurate it could be due to a faulty boiler at home or living near a main road, but the most common reason is, of course, smoking. So what is the midwife supposed to say? ‘You naughty girl, you’re a smoker aren’t you? I know you are, the machine proves it! Well, don’t worry, we’ll refer you to your friendly local stop smoking service and they’ll help you to be cured of your nicotine addiction by using a nice nicotine patch or delicious nicotine chewing gum, even though they won’t work very well, instead of smoking those horrid ciggies!’

In the past, if I came across a pregnant woman in my clinic who smoked, I would tell her plainly though politely, that she had to stop smoking today because otherwise she would harm her baby. Paternalistic? Yes. Authoritarian? Yes. Did it work? I hope so.

These days it seems paternalism and authoritarianism are politically incorrect, and instead so-called nicotine replacement therapy is offered. Is it safe in pregnancy? At present there is no evidence that it isn’t safe, which is not the same thing as saying there is evidence that it is safe. And if pregnant women are not wild about using nicotine patches or gum, what about e-cigarettes? Again, although there is widespread belief that these are safer than smoking, there is so far no evidence that this is so.

Now, a professor of health policy at the University of Stirling in Scotland, Linda Bauld, who is also the deputy director of the UK Centre for Tobacco and Alcohol Studies, is quite enthusiastic for pregnant women, if they can’t or won’t stop smoking, to switch to nicotine replacement therapy or to e-cigarettes. Nonetheless, in a recent video talk she rightly sounded a note of caution: ‘What do we know about vaping in pregnancy? Very little, at the moment.’

With her impeccable credentials – although it’s unlikely she has personally treated a single smoker – you would think she would know a thing or two about smoking, but a tiny doubt arose in my mind when, in the same video, she said this:

Pregnant women universally, despite the fact that they find smoking beneficial and enjoyable perhaps before they’re pregnant and still smoke to cope, experience a significant degree of stigma [because others disapprove of their smoking]…we think women [in pregnancy] should be supported to vape if they find it difficult to stop smoking…

It’s regrettable that the bearers of the next generation should be stigmatised in any way, but would Professor Bauld be so good as to tell us why she thinks pregnant women find smoking beneficial, what exactly is enjoyable about smoking for them, and how and with what does smoking enable them to cope? Further, Professor Bauld is evidently unaware that all smokers find it difficult to stop – that’s why they smoke.

If the reason smokers, pregnant or otherwise, smoke is so profoundly misunderstood, what hope is there for getting them to stop? And why should she refer approvingly, as she does, to the new regimen of routine CO breath tests in ante-natal clinics? Does she think that shaming pregnant women who smoke by presenting them with their CO read-outs is the way to reduce their universal stigmatization?

Unless the real reason for smoking is recognised and confronted, the present ineffective and little-liked proffering of medicinal nicotine products and, as Professor Bauld hopes in the near future, prescribing e-cigarettes, will allow the present scandalous situation to continue where any pregnant woman is free to smoke as much as she likes or feels compelled to do.

In her enthusiasm for vaping, Professor Bauld even jumps into the controversy over e-cigarette users having their life insurance premiums loaded in the same way as smokers.

In response to a piece in the online Sunday Post (6 August 2017) that complained that ‘Insurance companies are still hitting e-cigarette users with a “smoker’s surcharge” despite…reports which claim vaping is far less dangerous than using tobacco’, she said ‘Insurers classing people who use e-cigarettes as being the same as smokers is “fundamentally wrong” [and] it is just not fair.’ She added:

As well as being financially punitive to people who vape, it can also send negative messages to those who want to stop smoking…If vapers are regarded as being the same as tobacco smokers it could lead to an attitude of ‘why bother’ and before you know it they are back at the corner shop buying cigarettes.

Here we have it again: the lack of understanding of why smokers smoke and vapers vape. She apparently thinks vapers only vape because they may find some financial advantage in doing so, but if they’re going to be treated in such an unfair way by their insurance companies there’s no point! Why should I stop smoking – that beneficial and enjoyable activity that helps me to cope! – for the sake of my health if I’m going to be hit with extra charges for doing so? I’ll show them! Back to the corner shop!

Even if e-cigarettes are eventually proven to be safer than smoking, in the meantime I can’t say I blame the insurers for loading the premiums of people who suck poison into their lungs all day.

But there’s a win-win situation for would-be non-smokers and all who have switched to e-cigarettes as a less harmful way, they hope, of continuing their nicotine addiction: stop smoking and all use of nicotine products.

The gimmick-free way to do this is easier than you might think.

Text © Gabriel Symonds

Mrs May to the Rescue!

My blog Mrs May – Save Us! was a critique that I wrote in January 2017 of an appeal by a group of 1000 doctors to the UK Prime Minister and Health Secretary to publish a new Tobacco Control Plan: http://nicotinemonkey.com/?p=1175.

The government did so, in rather a hurry it seems, in July 2017. The details are set out in a paper called Towards a Smokefree Generation. It’s self-congratulatory, repetitive, contradictory and, alas, contains nothing new.

Let’s start with the Foreword by one Steve Brine, Parliamentary Under Secretary of State for Public Health and Primary Care.

He proudly notes:

Since the previous Tobacco Control Plan, smoking prevalence has substantially reduced; from 20.2% of adults smoking at the start of the plan to just 15.5% now, the lowest level since records began.

And then he goes on to boast of  ‘world leading public health measures’ and that ‘The UK now has comprehensive tobacco control legislation which is the envy of the world.’

Set against this, however, are some dismal figures:

Over 200 deaths every day are still caused by smoking…8% of 15 year olds…[and] 10% of pregnant women still smoke.

To deal with this dreadful situation, Stevie boldly declares:

Our vision is nothing less than to create a smokefree generation. To do this we need to shift emphasis from action at the national level – legislation and mandation of services to focused, local action, supporting smokers…to quit.

In his visionary enthusiasm he’s even invented a new word, ‘mandation’. I couldn’t find it in any dictionary. Not to worry. Focused, local action to support smokers to quit is the way to go!

I like a man with self-confidence:

…the government will…ensure (sic) that the new legislation is implemented well and that organisations with national responsibilities are joined up (sic)

Now let’s get to the contradictory bit:

Our vision is to create a smokefree generation. We will have achieved this when smoking prevalence is at 5% or below.

Surely a ‘smokefree’ generation means that nobody will smoke, but if up to 5% of the population smokes that’s hardly smoke-free.

The paper also mentions what they call National Ambitions, which include reducing the prevalence of smoking in 15 year olds from 8% to 3% or less, in adults from 15.5% to 12% or less, and in pregnant women from 10.7% to 6% or less, respectively.

It seems to me that if the notion of a ‘smokefree generation’ has any sense at all, then one of the National Ambitions should be reducing the prevalence of smoking for everyone to 0%.

The problem, however, is not with smokers who have quit or people who never start smoking; the problem is with those who don’t quit or who take up smoking ab initio.

Then the vision gets a bit cloudy. They want to:

Help people to quit smoking by permitting innovative technologies that minimise the risk of harm [and] maximise the availability of safer alternatives to smoking.

Why aim so low? If they merely minimise the risk of harm there is still a risk of harm. Why should anyone need ‘safer alternatives to smoking’ when there is a completely safe alternative, namely, not using any tobacco products at all?

As for the laudable aim of getting pregnant women to stop smoking, ‘These [measures] include regularly using Carbon Monoxide (CO) monitors to assess whether [pregnant] women are smoking…’ In other words, they don’t trust them. And these women, unless they opt out, will automatically be referred to stop smoking services through the ingeniously named ‘Saving Babies’ Lives Care Bundle (sic)’.

They really are stuck in discouraging mode:

Tobacco dependence is one of the hardest addictions to break. A smoker will typically have many failed quit attempts before they manage to successfully quit smoking.

Wrong on both counts. If you go about it in the right way it’s easy to stop smoking without using any nicotine products. And the concept of a quit attempt is meaningless – see http://nicotinemonkey.com/?p=683

As for stop smoking services, ‘Smokers who use  them are up to four times as likely to quit successfully as those who choose to quit without help…’ This is misleading because the actual success rate is 20% at best – or an 80% failure rate.

In spite of acknowledging that:

Tobacco is the deadliest commercially available product in England…[and] there is a fundamental and irreconcilable conflict between public health and the interests of the tobacco industry

all that our Steve can offer is a platitude:

The best thing a smoker can do for their health is to quit smoking

It’s clear the government doesn’t really know what to do:

We welcome innovation that will reduce the harms caused by smoking…The government will…continue to evaluate critically the evidence on nicotine delivery products, providing clear communication about what is known and unknown about the short and long term risks of using different products relative to smoking and the absolute risk to children, non-smokers and bystanders.

Perhaps Mr Brine and his colleagues at the Department of Health would allow me to make a suggestion that would, if implemented, solve the smoking problem once and for all.

It should be an explicit government policy to get rid of ‘the deadliest commercially available product in England’ by enacting legislation to phase out and abolish within, say, five years, the manufacture and sale of cigarettes and all other tobacco products.

Text © Gabriel Symonds

Feebleness, duplicity and futility

Why should you need willpower to refrain from poisoning yourself?

We do not need to read very far into the current (July 2017) edition of Tobacco Control to have demonstrated to us yet again the feebleness of the current official approach to the tobacco problem, the duplicity of the tobacco industry and the futility of academic research into smoking.

Turning over the cover of the journal with its curiously ambiguous name we arrive on the first page at an editorial headed, ‘It’s the 21st century: isn’t it past time to ban menthol cigarette sales?’ The reason for posing this question is:

Because menthol appears to make smoking initiation easier…and may be associated with greater addiction or difficulty in quitting, scientific groups have urged that policy-makers ban menthol in tobacco products.    

What these scientific groups, whoever they are, apparently fail to realize, apart from the cockeyed idea that there are degrees of addiction, is that the reason smokers are addicted is nothing to do with the presence or otherwise of menthol in cigarettes, but because they are addicted to the nicotine. It’s true that menthol cigarettes may make smoking initiation easier because it to some extent disguises the horrid taste of cigarette smoke, but if menthol were banned tomorrow, what difference would it make? Can you imagine a callow youth, foolishly thinking that smoking will make him appear more grown up, approaching a purveyor of tobacco, surveying the various poisonous products on offer and then saying to himself, ‘Nah, no menthol? Forget it!’ He would obtain somehow or other, even if underage, a packet of non-mentholated cancer sticks, likely proceed to become addicted to them (whether ‘more’ or ‘less’ addicted is immaterial) and carry on smoking for years or decades.

On to the next page, under ‘Worldwide News and Comment’, we are reminded of an appalling situation:

With over a billion deaths forecast this century if current trends continue, reducing tobacco use remains an urgent priority…(emphasis added)

Why aim only to reduce tobacco use? How many tobacco-related deaths this century would be acceptable? Half a billion? One hundred million? Why is it not an urgent priority, or even an ordinary priority, to abolish tobacco?

Then Ms Ashima Sarin and Mr Rajiv Janardhana, the authors, go on as if they are hurt in their feelings :

Despite the harm of its products, the tobacco industry continues to obstruct, delay and attempt to dilute the introduction of…measures…against the tobacco epidemic.

Of course the tobacco industry obstructs, delays and dilutes. Do they think the tobacco industry will do the decent thing and close down their factories as soon as practicable?

A more hopeful stance, however, is revealed on the same page by the news that the Danish Institute for Human Rights has recommended that ‘Philip Morris International (PMI) should immediately get out of the tobacco business’, noting along the way that:

Tobacco is deeply harmful to human health, and there can be no doubt that the production and marketing of tobacco is irreconcilable with the human right to health.

And how does PMI respond to this charge? Like this:

Acknowledging and acting on the societal harm caused by our products is central to our human rights commitment and to our vision for a smoke-free future to replace cigarettes with smoke-free products.

So that’s all right then? Well, it isn’t all right. It’s downright dishonest. Note that their acknowledgement of harm is diluted by calling it ‘societal harm’. No mention of the billion deaths this century to which PMI’s poisonous products will contribute. They merely proffer their ‘smoke-free products’ as if they’re the answer to the harm caused their ordinary ‘products’ – by which they presumably mean cigarettes. And their ‘vision’ for a smoke-free future is not a future without tobacco, but one where, at some unspecified time hence, their cigarettes will be replaced with a ‘product’ where tobacco is merely heated instead of being burned. A safer cigarette! These are already available – PMI calls them iQOS or IQOS. So what are they waiting for? Why don’t they stop making ordinary cigarettes right now?

Let’s press on through Tobacco Control to a research paper from New Zealand: Achieving the tobacco endgame: evidence on the hardening hypothesis…

I won’t bore my readers by quoting the title in full, but the intriguing neologism ‘endgame’ – which I suppose in this context means the happy state where nobody smokes anymore – appears nowhere but in the title, and by ‘hardening hypothesis’ they are referring to so-called ‘hardcore’ smokers who are ‘more addicted and less able or less motivated to quit.’ All clear?

I have already commented on the illogicality of degrees of addiction, but what do they mean by ‘less able or less motivated to quit’? Degrees of quitting ability or of motivation to quit are, likewise, nonsensical. Nonetheless, motivation is assessed by the number ‘quit attempts’ a smoker may make in a year, an ‘attempt’ being arbitrarily defined as an occasion on which a smoker has refrained from smoking for at least twenty-four hours.

All this is of no practical use whatsoever. There are only two states one can be in with regard to smoking: either you smoke, or you don’t. It is not as if motivation to quit can be increased, as this paper suggests, by greater exposure to information about the harms of smoking. The implication is that if only smokers realised the damage they were doing to  their bodies and the money they were wasting by smoking, they would all have sufficient motivation and ability to quit and, therefore, presumably would just quit.

Not to worry, because this learned six-page, five-author paper comes to a reassuring conclusion: tobacco control strategies that result in reduced smoking prevalence are not accompanied by an increase in ‘hardcore’ or ‘hardened’ smokers. What a relief!

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

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

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

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

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

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

Vaping for Fun

Smoking used to have a certain image. When Sherlock Holmes had a difficult crime problem to solve he would smoke shag tobacco in his pipe and think it through. He also used cocaine and morphine to escape from ‘the dull routine of existence’ as he put it. The creator of Holmes, Sir Arthur Conan Doyle, died in 1930, long before the dangers of smoking were recognised.

I used to smoke a pipe myself – a Petersen pipe – because I thought it looked impressive. And in the 1970s for a time I worked for Dr Peter Abbott. He discovered in the Sudan in 1956 the cause of a terrible disorder called Madura foot – a fungus infection. He used to smoke a pipe and grew his own tobacco in his garden, though he recognised he was addicted to it.

I remember a patient, a professional photographer, who used in his own publicity a photo of himself with his arms folded over his Hasselblad camera on a tripod. He was a smoker and said smoking was part of his image. Nonetheless, he agreed it wouldn’t look very appealing if his promotional material showed him with a cigarette in his mouth.

Times have moved on and the only image that smoking now has is an undesirable one. The prevalence of smoking is going down in most developed countries but the number of e-cigarette users is increasing: there are nearly three million in the UK.

And not just in the UK. The other day in my local neighbourhood in Setagaya-ku in Tokyo I noticed a young man walking along the road holding in one hand a metallic tube-like object. At irregular though frequent intervals he would discretely put one end of it into his mouth – and suck. This would be followed by the expulsion of a brief puff of mist into the air. Then I realised he was a ‘vaper’ (vapeur if you’re French) and what he was doing was inhaling into his lungs nicotine-laden fumes generated by his e-cigarette.

Most people who vape do it as an alternative to poisoning themselves with tobacco smoke – which they previously did as a way of getting their doses of nicotine. Vaping is said to be much safer than smoking. But do you really want to vape long term – or even for the rest of your life? Who knows what will happen if you do this many times a day, every day for ten or twenty years?

Why do people start vaping? In most cases it’s a continuation of the reason they started smoking cigarettes – which they did typically as teenagers because their friends or parents smoked. They then found they couldn’t stop, or thought they couldn’t. Now e-cigs have come along. Wonderful! They can continue to ‘enjoy’ the ‘benefits’ of nicotine without (most of) the risks of inhaling smoke from smouldering chopped up tobacco leaves.

What smokers didn’t realise when they started smoking was that they were buying into an image designed to appeal to young people who were fooled into believing it would make them appear grown up, sophisticated and confident. Big Tobacco has spent billions in advertising its false promises and has made vastly more billions from the unfortunate people who have been lured into believing them and as a result have continued – in spite of knowing the dangers – to buy pack after pack after pack because they became hooked on the nicotine in the cigarettes.

And now, if you’ve taken to vaping as an alternative to cigarettes or just for the supposed fun of it, you can continue your addiction without (most of) the dangers of smoking. But you’re still addicted! And what’s so wonderful about vaping anyway? Do you see a vision of heaven or experience an orgasmic sensation every time you take a suck?

What vaping does for you is – nothing. Nothing at all – except give temporary relief of the need to take another dose of nicotine. And now, just as with cigarettes, many vapers find they can’t stop so they say they don’t want to stop. The very suggestion has them up in arms. Hence organisations, just like Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco), such as the New Nicotine Alliance in the UK (where, incredibly, it’s a registered charity) and similar ones in Australia and Sweden, have sprung up to defend the right of their members to enjoy being addicted to e-cigarettes.

But what if the alleged enjoyment provided by nicotine were an illusion?

Text © Gabriel Symonds

Smoke-free but nicotine-trapped

I hope the copywriters of Public Health England’s ‘Smokefree’ campaign will forgive me for my satirical review of their efforts which I put in a chapter of my book, Smoking is a Psychological Problem. At least they were trying, however misguidedly, to help smokers to quit. Now the other day I wished to refresh my memory about a detail of this campaign and put ‘Smokefree’ into Google. I thought I must have mis-typed something because I landed up on a site that had me fooled for a moment. It was called, not ‘Smokefree’, but ‘GoSmokeFree’.

It seems to be a clever ploy to lure you into a site selling e-cigarettes and associated paraphernalia. For this purpose they include several pictures that suggest you’re in a chocolate shop.

Then they tell you:

Quitting smoking is not an easy task, there are numerous methods available to help you quit…One method more people are turning to lately, is the growing use of E Cigarettes (sic). If your goal is to remove nicotine from your body all together, then this option may not be right for you.

Is it just illiteracy, or are they trying to hide something with the careless wording? How do you remove nicotine from your body? If you cease to put any more in, it will over a few days remove itself. Then we have the ‘all together’ business. This means ‘all at once’ or ‘all in one place’. And if they’re saying ‘remove nicotine from your body’ in the same way that you might remove your overcoat when you get indoors and you do it all at once or all in one place, it makes no sense. Perhaps they’re trying to ask whether your goal is to get rid of nicotine altogether, that is, completely or totally. In this case, obviously, you don’t need e-cigarettes or any other ‘option’ to put more nicotine into your body.

I’ll give them the benefit of the doubt about illiteracy:

Becoming passionate about a new hobby is one way to take your mind off of (sic) smoking. There are dual benefits to a physical hobby as it will help you become healthier, and start to reverse the affects (sic) of smoking on your body, as well as take your mind off of (sic) cigarettes…Laws have been passed which bans (sic) smoking inside places such as bars, schools, cafe’s (sic), lunch rooms and shopping centres.

To show what good corporate citizens they are, they include advice on ‘The Benefits of Quitting Smoking’. To achieve this happy state, we are informed:

There Are 4 Key Steps To Going Smokefree. Join the millions of people of britain (sic) who have already gone smokefree! Every person is required (sic) to go through all 4 steps to achieve success.

This followed by the mysterious ‘Step 1: Interactive Body’. Although they tell you to ‘Download smokefree tools, along with videos and booklets’ where perhaps this is explained, there is no way I could find to do it.

They also make the controversial statement that ‘vaping has been advocated for by (sic) a number of agencies as a cessation device.’ I contacted them to ask who these agencies are. Answer came there none.

They do at least tell you, as they are required to do by law, that ‘Our products contain nicotine and nicotine is addictive’, and this is preceded by the word WARNING in red.

At no point, however, is it explained why anyone in their right mind would want put nicotine into his or her body at all.

Text © Gabriel Symonds

Ditch Tobacco Completely!

You can’t say they’re not trying. Here’s news of a campaign by an organisation with the pleasant name of Fresh, announced in the online News Guardian (24 February 2017), to try to get smokers to quit. Well, so they should, if they know what’s good for them.

Readers are reminded that cutting down on smoking leaves you still at risk for health problems and this is rubbed in with the slogan ‘Don’t be the 1’, the ‘1’ being the one out of two long-term smokers who will die of a smoking-related disease, they say. The article quotes Ailsa Rutter, the director of Fresh, as ‘urging people to think about quitting for their family. Cutting down can help people to quit, but taking the next step is vital.’

Yes indeed. She goes on: ‘We are urging people to ditch tobacco completely or if they aren’t ready to quit nicotine, to switch to a safer way of getting it, like an electronic cigarette.’

Here we go again – all the misunderstanding about why people smoke and how to help them. The assumption seems to be that smokers smoke because of ignorance of the harm of smoking. So let’s put them right about that. Then, the curious idea that ‘cutting down can help people to quit’. How does it do that?

What Ms Rutter, like so many well-intentioned people in the anti-smoking brigade, appears not to understand is why people really smoke in the first place. If smokers are urged to cut down to help them to quit, it implies they have a reason for not wanting to cut down, or at any rate not to quit. So there must be something nice about smoking that people don’t want to give up. But they should, for the sake of their families. Or, if that doesn’t make them do it, we’ll try and scare them into stopping by reminding them that they’re playing Russian roulette, if they continue to smoke, with a two-chambered gun containing one bullet. Or maybe it’s just because smokers haven’t had enough encouragement to quit, so she goes into urging mode as quoted above.

This is where the whole business falls down. There’s nothing wrong with a bit of urging, I suppose, but why does she say ‘if they aren’t ready to quit nicotine’? All smokers are in the unfortunate position of not being ready to quit nicotine – that’s why they’re smokers. Or, to put it another way, those who are ready, quit; those who aren’t, smoke.

And if those smokers who aren’t ready to quit nicotine are urged to switch to a ‘safe’ way of getting it, what does this mean? It disempowers and colludes with smokers to keep their nicotine addiction going, and Ms Rutter really can’t say that an electronic cigarette is safe. It may be safer than smoking but as yet it’s quite unknown whether it’s safe.

Apart from this, there’s a big question that’s overlooked or ignored: why should anyone in their right mind want to put nicotine into their body at all, ever? Are we non-nicotine users missing something?

Text © Gabriel Symonds

Australia Leads the Way: Vaping is Verboten!

What’s this? A smoking doctor? No, a vaping doctor! He has the unusual name of Attila Danko, which seems to be of Eastern European provenance, possibly Hungarian, and I hope he will forgive me for saying that this perhaps explains his passing resemblance to the actor Christopher Lee in his role as Dracula from next door Romania. He doesn’t look very happy. Is this what vaping does to you?

Dr Danko will now have an additional reason to feel unhappy. Australia’s drug regulator, the Therapeutic Goods Administration, has ruled that the already existing ban on e-cigarettes will continue.

In 2015 Dr Danko founded the New Nicotine Alliance Australia to push for e-cigarettes to be legalised. He admits he was a smoker for over thirty years and has ‘given up on giving up’ after switching to e-cigarettes. New Nicotine Alliance Australia’s mission, he says, is also to educate current smokers so they have the choice to switch. He thinks this would be a good move for ‘hardened smokers who can’t give up any other way’.

I don’t believe there’s such a thing as a hardened smoker or that any smoker needs to give up on giving up. The current orthodox approach to smoking cessation, however, may well encourage this nihilistic attitude, and it seems to me that what Dr Danko is saying, in effect, is that he’s mightily relieved to be able to continue in the thrall of his intractable nicotine addiction with allegedly safer e-cigarettes instead of ordinary cancer sticks.

Another part of the problem is shown in a view he expresses in a YouTube video: vapers should be able legally ‘to enjoy recreational nicotine’.

This is where the whole argument falls down. Nicotine is not enjoyable, nor it is a recreational drug.

If people who use nicotine are asked to say honestly whether they enjoy doing it, the answer is almost invariably ‘No’.

A recreational drug, of which the prime example is alcohol, is quite different. Unless you are an alcoholic, which most people are not, you can enjoy a drink as and when you choose, circumstances permitting. But virtually all people who use nicotine in any form feel compelled to do it many times a day, every day, for years on end.

If nicotine were a recreational drug, what is supposed to happen when you put it into your bloodstream and thereby cause chemical changes in your brain? Do you see visions of heaven? Do you experience some wonderful sensation? No. All that happens, though most smokers or vapers don’t realise it, is that the discomfort you were in before you smoked or vaped is temporarily relieved and this is perceived as enjoyable.

The Australian Medical Association’s sensible position on nicotine is very clear: it is highly addictive and there is no good reason to put it into your body in any form.

Note: The above comments are not intended as criticisms of Dr Danko. If he would care to contact me I should be delighted to prove to him (without charge) that he can easily abandon his dependence on nicotine.

Text © Gabriel Symonds

Calling out Philip Morriss

We have to thank the BBC for bringing us news of a major scandal (online 30 November 2016).

Andre Calantzopoulos, the CEO of Philip Morris, a tobacco company that turned out 850 billion cigarettes in 2015 from which it generated net revenue of about $74 billion, was recently interviewed on the BBC.

AC:  We produce a product that causes disease and I think the primary responsibility we have…is to develop products like this [the unpronounceable ‘Iqos’] and commercialize them as soon as possible. These products hold very great promise obviously for consumers and also for public health.

BBC:  Conventional cigarettes might eventually be taken off the market because of public health…aren’t you doing this because you’re concerned not about the consumer but because you’re concerned to have a future business?

AC:  First of all we are concerned about the consumer. Secondly even based on WHO projections there will be in 2025 still one billion plus smokers around the planet and there are 9.6 million smokers in the UK. Once we have the ability and innovation to offer these products to consumers we have to offer it to them.

BBC:  If you were concerned about the consumers you wouldn’t sell cigarettes.

AC:  I think consumers choose to use cigarettes. I don’t think Philip Morris has invented cigarettes. I think for us is to offer our consumers the best product we can in the category we all know is addictive and causes harm. Once we have the alternative and we have it today and I’m very happy…and we’ll do everything we can to convince them to switch to this product.

What an utterly breathtaking load of self-serving hypocrisy! I am sure Mr Calantzopoulos is very happy and concerned about the consumer, especially the amount of money he can continue to extract from those who are hooked on his company’s poisonous products. So he thinks consumers choose to use cigarettes, does he? They chose to use the first one, no doubt, but they didn’t choose to become addicted to them. Addiction is the only reason smokers continue to smoke and why they find it so difficult to stop. Does a heroin or cocaine addict choose to continue to use heroin or cocaine? It would be an insult and a lie to talk about these unfortunate people in such a way. What’s the difference between cigarette (nicotine) addiction and other drug addictions? The only difference is that heroin and cocaine are illegal but nicotine is legal. And it wasn’t Philip Morris who invented cigarettes. So that’s all right then? But it’s Philip Morris – the world’s second largest manufacturer of cigarettes – that chooses to continue to make and sell them (together with others in the Big Tobacco cartel). Then he says ‘…the best product…in the category [cigarettes] we all know is addictive and causes harm.’ So he’s contradicting himself: if cigarettes are addictive, how can he say smokers choose to use them?

If he were sincere (don’t laugh), he would forthwith arrange for his company to stop making cigarettes and instead concentrate on alternative products like ‘Iqos’ which, he says, they have today. What’s he waiting for?

Then we hear from Deborah Arnott of ASH:

DA:  On current trends smoking will kill a billion people in the 21st century mostly in poor countries. If Philip Morris really want to [inaudible] smoking then it has to stop promoting smoking to new young smokers around the world using methods which are quite rightly illegal in the UK. You know smoking’s coming to an end here, we’re seeing a smaller and smaller proportion of young people taking it up, and if these products can help adult smokers quit then all well and good but they still need regulating as tobacco products and we still need to be very cautious about what the industry’s up to.

BBC:  [Andre Calantzopoulos] extended an invitation for groups like ASH to come and check their science, would you take them up on that?

DA:  We’re not scientists, it’s not for us to do…but yes we need more independent verification…and that will take a lot of time and money.

What is it with ASH? Why does Ms Arnott think Philip Morris only needs to stop promoting smoking to new young smokers? What about Philip Morris stopping making cigarettes? As for her admission that ASH lacks the expertise to check out the scientific basis of the claims that ‘heat not burn’ and similar products are safer than ordinary cigarettes, do you need to be an Einstein to form a view on this? Nobody can know the effects of these new products, including e-cigarettes, until they’ve been in use for a long time, say ten to twenty years.

While this huge unregulated public health experiment is going on, what about banning conventional cigarettes in the meantime?

Text © Gabriel Symonds

What’s the Harm in Smoking Harm Reduction?

 

Smoking ‘harm reduction’ advocates seem to be working from the premise that some degree of harm is inevitable or unavoidable in relation to smoking. But this is manifestly untrue. The harm from smoking could be eliminated rather than just reduced – if there were the political will to ban tobacco products.

In the meantime the prevailing view seems to be that since some people will never want or be able to stop using nicotine, commercial interests should be allowed to supply it in the allegedly safer form of e-cigarettes. This line of reasoning supposes that smokers can be influenced through logic and common sense to switch to a less harmful way of absorbing nicotine into their bodies, but if this were true, why haven’t smokers abandoned cigarettes en masse in favour of e-cigarettes? Although many have, there are still 9.6 million smokers in the UK and 36.5 million in the US, for example.

A different picture presents itself if one looks at the question of whether anyone needs to use nicotine at all. The word ‘use’ in this context is the clue to what we are dealing with: drug addiction. The question, then, is whether it is or should be public policy for there to be millions of people walking around addicted to nicotine – in any form.

Many governments are working towards reducing smoking through what is called tobacco control, though this will be too little, too late for the nearly 6,000,000 smokers worldwide who die each year from smoking related diseases. (Source: the US Centers for Disease Control and Prevention.)

The dilemma is well put by Robert Proctor in his magisterial treatise on Big Tobacco, Golden Holocaust (2011):

Surveys show that most smokers want to quit and regret having ever started: tobacco is not a recreational drug, which makes it different from alcohol or even marijuana in this respect…smokers usually dislike their habit and wish they could escape it. (Emphasis in original.)

I would modify these statements slightly by pointing out that smokers may say they want to quit, but in practice they don’t really want to quit – not because they don’t dislike their ‘habit’ – but because they are addicted to the nicotine in tobacco smoke. And the reason they don’t really want to quit is because they have a fear of not smoking. Such inconsistencies are  characteristic of  addictive behaviour.

If smoking is seen for what it is – drug addiction – the question then becomes: why is the orthodox approach to the smoking problem only aimed at harm reduction rather than harm abolition? The former approach implies that nicotine use is here to stay, partly because there are benefits (pleasure, stress relief) people believe they gain from nicotine, of which it would be unfair to deprive them.

Part of this belief comes from the failure to appreciate that for practical purposes the only reason smokers smoke, or vapers vape, is to obtain relief from the discomfort of nicotine withdrawal; the alleged benefits are illusory. Unfortunately these simple facts tend to be obscured by doctors and others paying too much attention to research which seems to indicate that while smokers may indeed smoke to relieve the discomfort of nicotine withdrawal, they also smoke because of ‘triggers’ or ‘cues’ to smoke and because of the alleged release of dopamine stimulating the brain’s pleasure centre, etc. This kind of thinking, derived from laboratory studies or tick-box surveys, tends to support the erroneous idea that there are positive aspects of nicotine use. And this is one misguided reason why there is such an emphasis on tobacco harm reduction rather than abolition.

It’s also clear that the push to get smokers to change to e-cigarettes is largely commercially driven. For example, the ‘Third Vape Expo’ is scheduled to be held in Poland in March 2017. This is billed as:

The foremost professional vaping trade show. It is where industry players and experts showcase, share and incubate ideas. It is also where influencers and decision-makers seek and find solutions to propel their businesses…The Third Vape Expo Poland network now includes more than 2000 suppliers and buyers of vaping products from 15 countries worldwide.

There’s an interesting promotional video for this event featuring scenes from the September 2016 Expo: with catchy synthetic music in the background there’s no text or dialogue but the film shows hundreds of young people exploring the venue and visiting the different stands where vaping products are on sale. Many of them are merrily vaping away. It’s only too obvious that the purpose of this trade show is to entice young people to become long-term nicotine addicts.

Is this really the best way to deal with the smoking problem?

Text © Gabriel Symonds