Category Archives: Vaping

Four Professors and a Counterfactual

All the fun of the fumes

The long-windedly titled The National Centre for Smoking Cessation and Training (NCSCT) recently produced a video called E-cigarettes safety: The facts explained.

The trouble is that there are precious few facts available at the moment; but there are plenty of opinions.

The film features four Professors who are well known e-cigarette enthusiasts and a layman, Clive Bates, Director of Counterfactual Consulting, whatever that is.

The OED, interestingly, defines counterfactual as ‘Pertaining to or expressing what has not happened or is not the case’ which perhaps explains Mr Bates’s view as stated in the film.

First let’s hear from Professor Linda Bauld, a behavioural scientist, no less:

We know from studies that nicotine is relatively safe.

What studies? What does she mean ‘relatively safe’?

Next we have Professor Robert West, a psychiatrist:

They (e-cigarettes) don’t use tobacco at all.

This is almost true, except that the nicotine in e-cigarettes is derived from tobacco.

Then Ann McNeill, Professor of Tobacco Addiction, explains:

Most things we do in life carry a risk. So, for example driving cars. Cars cause lots of road accidents, lots of people killed on the roads. But we don’t stop people driving. We try to make them (cars) less harmful.

This is a false analogy. Driving is a normal and essential human activity whereas smoking and vaping are not normal activities; they are undertaken only by drug (nicotine) addicts.

Finally we have Professor John Britton, an epidemiologist:

If we try to put a figure on the relative risk of e-cigarettes compared to smoking, my view is that it’s going to be well under 5 per cent of the risk…so we can be confident that electronic cigarettes are much less hazardous than tobacco cigarettes.

His view? How can we be confident? Just because he says so?

Then he makes a curious statement:

Where their safety lies relative to not using anything is much harder to place.

This is nonsense. Obviously there is no risk at all in not using anything, compared to using  cigarettes or e-cigarettes.

He does at least say something sensible – up to a point anyway:

Inhaling a vapour many times a day for decades is unlikely to come without some sort of adverse effect…It would be better avoided, but from the smoker’s perspective it is a far better bet than carrying on smoking tobacco.

A bet? So it’s all a matter of chance? He doesn’t seem to know what his point of view is.

Back to Professor West:

E-cigarettes are substantially less harmful than cigarettes and the reason that we can reasonably infer this is because of the concentration of chemicals that are in e-cigarette vapour compared with the chemicals that are in cigarette smoke.

So he goes from asserting that e-cigarettes are substantially less harmful than ordinary cigarettes to saying that it’s something we can only reasonably infer.

Professor McNeill again:

Flavourings are necessary for electronic cigarettes because people wouldn’t use them if they didn’t have some sort of flavours added. We need to entice smokers to use electronic cigarettes.

Does she realise what she is saying? How about enticing smokers to stop smoking and stop using nicotine in any form?

Professor West:

Some concerns have been raised about…the risks [of] flavourings in e-cigarette vapour…these are flavourings that have been tested and the concentrations are sufficiently low that we wouldn’t expect them to pose a significant health risk.

More opinion, supposition and guesswork. What if his expectations are wrong?

Professor Britton:

The propylene glycol…in electronic cigarette fluid…is used to make theatre fog, it is mildly irritant to the airways but is doesn’t seem to have any lasting long-term effects.

More guesswork. For how long and how often are people exposed to theatre fog? When did you last attend a theatre when there was fog?

He adds:

Glycerol [also present in e-cigarette vapour], likewise, is widely used in food. And again there’s no evidence or reason to expect it will have a significant long term effect on the airway.

Yes, it’s eaten in foods, but this is a different matter entirely from it being inhaled into the lungs!

And continues:

There is evidence that if you [are in a] room with somebody using one of these products (e-cigarettes) that there is nicotine and perhaps other chemicals in the atmosphere around you but at tiny levels. Levels not to be concerned by at all.

How does he know? What is the evidence? I would be concerned about unnecessary eposure to any levels of poisons.

Then he says:

I think if you’re in an enclosed space and somebody’s breathing out clouds of vapour that’s just unpleasant and it’s intrusive and it’s discourteous.

Quite.

Professor McNeill has an extensive list of publications to her name but has she actually treated any smokers? One wonders, when she makes statements like this:

The most effective way of quitting is to use a medication such as nicotine replacement therapy or it could be electronic cigarettes combined with behavioural support.

What does she mean ‘the most effective way of quitting’. Smokers who quit without medication or e-cigarettes combined with behavioural support haven’t done it effectively?

Professor West again:

E-cigarettes [are] there for people who…just want to go out to a shop and buy a product which they can use to stop smoking without seeing a health professional.

Why do you need a ‘product’ to stop smoking? Why not just stop?

And what does our counterfactual consultant have to say?

E-cigarettes [are] an alternative to smoking.

You don’t need an alternative to smoking!

Professor Britton:

E-cigarettes…normalise electronic cigarette use.

That’s the trouble!

And if we could normalise electronic cigarette use for the nearly nine million people in the United Kingdom who are still addicted to tobacco that could only be good thing.

A good thing for whom?

This is a product that can transform health…health-wise [smokers] achieve pretty much what they’d achieve if they quit smoking completely.

A huge assumption.

Do we really want to have millions of people sucking on e-cigarette drug delivery devices many times every day for years on end to gratify their nicotine addiction?

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.)

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

1. Fear

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

2. Reminding smokers of the benefits of quitting

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

3. Nicotine patches or gum

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

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

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

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

5. Combining nicotine patches or gum with stop smoking medicine

The same objections as above apply, only more so.

6. E-cigarettes

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

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

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

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

8. Humour

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

9. Vulgarity

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

10. Willpower

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

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

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

12. Cold turkey

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

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

And the one best way to stop smoking?

Just stop!

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

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

Text © Gabriel Symonds

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

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

Exploding e-cigarettes

Why bother with all this?

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

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

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

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

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

Also, note this:

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

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

The unfortunate Ms Williams takes up the story:

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

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

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

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

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

Now note this:

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

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

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

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

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

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

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

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

Pt:  Yes, of course I would.

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

Pt: I’ll think about it.

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

Text © Gabriel Symonds

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

Are smokers getting a raw deal?

Tobacco is not an illegal substance yet the government is persecuting a minority. I think that’s a disgrace in a social democracy.

Sir Ronald Harwood
Playwright and screenwriter

There is in Britain a smokers’ rights group called Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco). The name tells you a lot. But are there people who want to be free to smoke tobacco even if they don’t enjoy it?

Forest paid for a survey to be carried out by the Centre of Substance Use Research. The subsequent report, published in December 2016, had the title and subtitle, ‘The Pleasure of Smoking’ and ‘The Views of Confirmed Smokers’, respectively.

It’s rather a good report and I’m glad I discovered it for the insight it gives into what’s going on in some smokers’ minds.

The problem, the report says, is that over the last thirty years tobacco control measures have changed smoking from ‘being a popular, socially accepted behaviour to…an anti-social, health harming, stigmatised behaviour [and that] smokers…have become increasingly marginalised.’

There is a difficulty here, it seems to me, in referring to smoking as a behaviour. I suppose this word is used in the sense of the way in which one acts or conducts oneself. I am not just being pedantic (although I am sometimes accused of pedantry), because the whole argument hangs on this word. As readers of my blog will be aware, I would characterise the activity of smoking as drug (nicotine) addiction rather than just a behaviour that one may engage in or not.

In a brief correspondence the first-named author of the report made the point that:

[T]o explain or reframe [smokers’] accounts of their pleasures [in terms of relieving nicotine withdrawal symptoms] seems to me to largely constitute the imposition of one interpretive frame (nicotine dependence) upon the views of smokers…many smokers did indeed perceive smoking as being pleasurable in ways other than having to do with the satisfaction of any nicotine dependence. (Emphasis added.)

 I’ll come back to this is a moment.

They surveyed 650 smokers who responded to an online questionnaire. Admittedly they were a self-selected group rather than a representative sample, but this didn’t matter for the purpose of the research. A significant finding was that ‘Nearly all participants (95%) cited enjoyment as their reason for smoking’ although ‘Over half (56%) of those surveyed said that they felt they were addicted to smoking.’

This implies there is such a state as an enjoyable addiction. Or is this a contradiction in terms?

Furthermore, ‘The majority of the smokers surveyed felt they were treated very unfairly (77%) or quite unfairly (14%) by government.’ I think they have a point. There is blatant inconsistency in the government’s attitude: cigarettes are on open sale, yet smoking is characterised as anti-social and disease-causing.

The claim of enjoyment as a reason for smoking is a recurring theme in the report. Smokers seemed well aware of the risks but nonetheless apparently decided to continue to smoke. Hence ‘many smokers themselves saw their smoking as a source of pleasure, a choice rather than an addiction.’ This is cited as one of the reasons that alternatives to smoking, particularly e-cigarettes, were not rated highly: they didn’t provide the same pleasure as ordinary cigarettes.

There are two assumptions that smokers and those in the tobacco control movement make. One is that smoking really is pleasurable, and secondly that if smokers are going to be persuaded to stop they will need a substitute for combustible cigarettes which will provide the same or a similar pleasure as smoking.

Both these assumptions are questionable.

First of all, what do smokers mean when they talk of the pleasure of smoking? And if we take them at their word, is this so great or important that it explains why they have a compulsion to do it twenty times a day, every day. Do they say, or think, forty minutes after smoking a cigarette, ‘By golly, that was marvellous! I must have another one!’?

It’s a strange kind of pleasure. There are many things I find pleasurable, for example eating chocolates. But I don’t eat chocolates every day and I certainly wouldn’t want to eat twenty in one day – I’d feel pretty awful if I did.

It’s also interesting that many smokers in the survey had withering criticisms of smoking cessation services and made the valid point that:

[I]f stop smoking services are going to succeed…they are going to have to be prepared to engage with smokers on the terms upon which those individuals view their own behaviour. This includes being willing to recognise the pleasurable elements of smoking.

This comes back to the question of whether smoking really is pleasurable. If one engages with and encourages smokers to say what, exactly, is pleasurable about it, we don’t get very far. Is it the smell? The taste? The sensation of the smoke going into your lungs? Do you experience some real pleasure every time you take a drag? It will soon become clear this doesn’t make sense. What other activity do you feel compelled to engage in twenty times (or more or fewer) every day and feel a rising panic if you’re not allowed to? With a little open-minded discussion, the reality soon emerges that in the normal sense of the word smoking is not pleasurable. Many smokers actually dislike smoking and wish they didn’t have to do it. Smoking seems pleasurable only because it gives temporary relief to the discomfort the smoker was in before he or she lit the next cigarette.

Some comments about the supposed enjoyment of smoking are very sad: ‘I enjoy smoking and there is very little in life that is enjoyable.’ ‘I suffer from lifelong depression and a sense of inadequacy. Smoking is the only thing that gets me through…smoking is my great source of comfort and peace. Without it there would be nothing.’ ‘My life has been difficult. Smoking has helped me survive.’

These unfortunate people clearly have serious problems. But rather than the methods currently being offered by stop smoking services, a different approach could be tried: they could be helped to demonstrate to themselves that, rather than their lives being almost unbearable without smoking, if they could recover from the drugged state that smoking induces, they would feel much better without smoking.

Text © Gabriel Symonds

Cigarette harm reduction? What about harm abolition?

I have just come across an interesting presentation by one Maciej L Goniewicz, PhD, who works at the Tobacco Dependence Research Unit of Queen Mary University of London and the UK Centre for Tobacco Control Studies. So he should know what he’s talking about. Oh, and he receives research funding from Pfizer, a pharmaceutical company that makes drugs to help smokers quit, varenicline (Chantix) and a form of inhaled nicotine called Nicotrol.

The presentation is a review of e-cigarettes’ ‘efficacy and potential for harm reduction’. Let us get straight to the conclusions:

  • E-cigarettes deliver nicotine
  • After switching from tobacco to electronic cigarettes, exposure to all tobacco smoke toxicants examined so far is substantially reduced
  • E-cigarettes may be useful in reducing the harm of cigarette smoking in those who are unable to quit

I think most people by now are aware that e-cigarettes ‘deliver’ nicotine, that is, they deliver nicotine into the lungs of people who use them. Then the good news: the fumes produced by these devices contain much smaller amounts of the poisons found in ordinary cigarettes. And the conclusion of the conclusions? E-cigarettes may be useful (or maybe not, presumably) in reducing the harm of cigarette smoking – obviously, only if cigarettes smokers switch completely to delivering nicotine into their lungs with e-cigarettes – in those smokers who are unable to quit [cigarettes].

I have emphasized the last few words because they show the great paradox in this kind of approach to the whole smoking problem: all smokers are unable to quit – that’s why they’re smokers. Apart from this oversight, Maciej L Goniewicz, PhD, can’t seem to see the wood for the trees.

Let me explain. He’s been busy estimating the quantities of ‘toxicants’ that smokers and users of e-cigarettes, respectively, take into their lungs and has found that the latter ingest much smaller quantities than the former. But let us suppose, for the sake of argument, that the fumes produced by e-cigarettes – apart from the nicotine which is their whole raison d’être – are entirely free of toxicants of any kind. If smokers could be persuaded by common sense and logic to abandon their pernicious habit of inhaling poisonous fumes from burning tobacco leaf in favour of inhaling pure nicotine by using our hypothetical ideal (but so far imaginary) e-cigarettes, would that be a good thing?

To put the question in a slightly different way, would it be a good thing for millions of people to be wandering around sucking on these new-fangled devices to deliver pure nicotine into their lungs all day, every day (for that is what they do)?

Also for the sake of argument, we’ll put aside the question – and it is a very big question – that long-term use of e-cigarettes to deliver nicotine into your lungs may not be quite so harmless in the long run – let us consider whether it is, or should be, public policy that millions of people will be in the thrall of legalised drug (nicotine) addiction?

It is all very well to talk of harm reduction, as if cigarettes are a permanent feature of everyday life, just as one may talk of harm reduction in car crashes by enforcing the use of seat belts because cars are a permanent feature of everyday life and crashes will inevitably happen. But there is no reason why cigarette smoking should be regarded as being in the same category. If cigarettes were abolished tomorrow, would anyone – apart from the tobacco companies and their shareholders – be any worse off?

If the government are serious about harm reduction, and if they go along with the results of  research such as the above, let them abolish cigarettes at the same time as e-cigarettes and other non-tobacco products are encouraged.

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