Category Archives: Big Tobacco

Big Tobacco bashing

Tobacco company CEOs lying to the US Congress in 1994 that nicotine is not addictive

For today’s post, let’s hear it from the Tobacco Action Committee of the American Thoracic Society (ATS).

The Committee is charged with organizing and coordinating the [Society’s] tobacco control activities [which] will include…activities with the ultimate goal of minimizing the impact of tobacco on morbidity and mortality worldwide. The committee will strive to enhance the ability of the ATS to participate more fully in the investigation of the root causes of tobacco use; treatment of nicotine dependence; and advocacy efforts to eliminate its use… (Emphasis added.)

First they say their ‘ultimate goal’ (the word ‘ultimate’ is redundant’) is to minimize the impact of tobacco on morbidity and mortality (illness and death). And by the way, do they want to participate more, or participate fully, in the investigations?

Then, as they verbosely put it, (paraphrasing slightly) they will ‘strive to enhance the ability to participate in advocacy to eliminate tobacco use’. Perhaps they mean to say, ‘The committee will investigate the cause of tobacco use and strive to eliminate it.’

So what do they want to do: minimize the effects of tobacco or eliminate its use?

Even so, it’s unclear how ‘treatment of nicotine dependence’ fits in here. If tobacco use is eliminated then the treatment of nicotine dependence will take care of itself. The carelessness of the copywriter is also shown by the plural use of ‘root cause’. The root cause of something means the fundamental reason for the occurrence of a problem, so by definition there is only one.

This uncertainty about what they are trying to achieve is also reflected in the widely reported comment of Dr Harold Farber, Chair of the ATS Tobacco Action Committee, to the news that on 26 November 2017 the Tobacco Industry (sic) has to make ‘corrective statements’ in the US media of the following kind:

  • Smoking kills, on average, 1,200 Americans every day.
  • More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol, combined.
  • Smoking causes heart disease, emphysema, acute myeloid leukemia, and cancer of the mouth, esophagus, larynx, lung, stomach, kidney, bladder, and pancreas.
  • Smoking also causes reduced fertility, low birth weight in newborns, and cancer of the cervix.
  • Smoking is highly addictive. Nicotine is the addictive drug in toacco.
  • Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction.
  • It’s not easy to quit.
  • When you smoke the nicotine actually changes the brain – that’s why quitting is so hard.
  • Etc.

Dr Farber: ‘This is the first time tobacco companies are acknowledging the truth to the general public: tobacco is a product that is hightly addictive and as a direct consequence of its design, kills people when used exactly as intended.’

Give him a big hand for pointing out the obvious.

The origin of this dates back to 2006 when the US District Court of Columbia found that several major cigarette manufacturers were guilty of racketeering and misleading the public; publication of these statements was part of the punishment imposed on them.

The cigarette companies resisted this measure because, as they not unreasonably pointed out, they didn’t want to have to brand themselves as liars – even though they are.

Apart from that, what is point of publishing these statements? Is it to treat Big Tobacco  like a naughty school child being made to write out a hundred lines? Is it to tell the public stuff they don’t know? Is it to try to make smokers quit throught fear? (I would disagree with the statement that it’s not easy to quit.) One may speculate on all this but I think it misses the point.

How about calling for the US government to be brought to account for knowingly allowing a product to be sold which:

  • Kills, on average, 1,200 Americans every day – more than die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol, combined.
  • Causes heart disease, emphysema, acute myeloid leukemia, and cancer of the mouth, esophagus, larynx, lung, stomach, kidney, bladder, and pancreas.
  • Also causes reduced fertility, low birth weight in newborns, and cancer of the cervix.
  • Etc.

Further, I would seek to force the government to issue a corrective statement that it failed in its duty to protect the public by leaving it up to the consciences of those decent people who run tobacco companies to put themselves out of business.

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

He who sups with Philip Morris should have a long spoon!

The words that came to me as I read this piece in today’s Financial Times were disingenuous, self-serving, cynical and the like.

Philip Morris International has pledged up to $1bn over the next 12 years to an arm’s-length foundation that will fund scientific research designed to eliminate the use of smoked tobacco around the globe.

[Philp Morris]…last week registered the Foundation for a Smoke-Free World as a US charitable organisation, with the stated aim of making grants on ‘how to best achieve a smoke-free world and advance the field of tobacco harm reduction’.

How generous of them! That’s what we need – scientific research (of course they wouldn’t do unscientific research, would they) to eliminate the use of smoked tobacco! And what a noble cause: to ‘advance the field of tobacco harm reduction’!

Then we have the two-faced André Calantzopoulos, chief executive of Philip Morris Ineternational, telling the Financial Times (emphasis added of weasel words and clichés):

Our efforts are squarely focused on ultimately replacing cigarettes with smoke-free products, by offering the millions of men and women who continue to smoke a better alternative. We are standing at the cusp of a true revolution and look forward to the foundation’s objective review of our efforts and efforts of others.

Allow me to re-write this in plain English, saying what I think he really means:

For the millions of people who are addicted to the nicotine in our cigarettes and who therefore find they are unable to quit, we offer an alternative, iQOS, which may (or may not) be a safer way of inhaling tobacco fumes. If everyone were eventually to switch from cigarettes to iQOS our profits would be sustained or may even increase and into the bargain we can present ourselves as a public health champion! (The $1bn is, of course, a drop in the ocean for us.)

Well, I can tell them exactly what they need to do to achieve a smoke-free world and advance the field of tobacco harm reduction – and I won’t charge anything like $1bn for my services. In fact I’ll advise them for free. This is what they need to do, and should do in a much shorter time span than the next twelve years: stop making cigarettes. That will achieve, as least as far as Philip Morris are concerned, the first aim of eliminating the use of smoked tobacco. As for the second aim, that of advancing the field, as they put it, my suggestion will go a long way to achieving that too.

But, of course, what they really want to do, while they keeping merrily on making and selling ordinary cancer sticks, is to plug for all they’re worth their new product with the unpronounceable name of iQOS. For those of my readers who are unfamiliar with what this is, here is a picture of an advertising placard for it, conveniently placed at a child’s eye level in my local branch of Seven-Eleven.

iQOS (or should that be iQOSs?) look like little cigarettes. They are made of tobacco which is heated (not burnt), with the resultant poisonous fumes being inhaled into the lungs. Philip Morris claims this is potentially less harmful than inhaling cigarette smoke – so that’s all right then. And, Bingo! – the field of tobacco harm reduction is advanced!

The misleadingly named Foundation for a Smoke-free World is curiously described as ‘arm’s length’, by which I suppose mean independent. But will it be?

Our old friend Professor Linda Bauld (http://nicotinemonkey.com/?p=1823), however misguided her views on the use of e-cigarettes in pregnancy may be, at least strikes a note of scepticism about this set-up:

I’m very cautiousI’d prefer research completely independent from industry.

Quite right.

Why do I say the Foundation is misleadingly named? Because what they envisage is a world where, even if smoking disappears, millions of people will still continue in the thrall of nicotine addiction.

Text and photo © Gabriel Symonds

B*llsh*t from Philip Morris

It’s only a rat!

Perhaps in my post of 4 July 2017 (http://nicotinemonkey.com/?p=1642)  in which I accuse the tobacco giant Philip Morris International (PMI) of torturing animals I was being a little unjust. I had not at that time seen their proclamation, ‘Our standards for animal testing’.

In this document they reassuringly tell us ‘PMI takes to heart public concerns about animal research’. Note how they deviously say ‘concerns about animal research (in general)’, not concerns about Philip Morris’s animal research. At least animal research as normally understood is done with the hope of finding cures for human ailments, however unscientific and misguided the endeavour of experimenting on non-human species may be.

So why does PMI carry out animal research?

We conduct research to better understand the mechanism by which tobacco smoke-related diseases develop.

Let us indulge for a moment in a little science-fiction fantasy, where at some indefinite time in the future, PMI has somehow managed to gain a perfect understanding of the mechanism by which tobacco smoke-related diseases (presumably they mean all of them) develop, what then? They add, ‘This is important for assessing the aerosol of PMI’s RRPs (reduced-risk products).’

And when they have assessed the aerosol of these products by their repulsive animal experiments, they will no doubt claim that their reduced risk products do, indeed, pose less  of a danger to the users thereof than ordinary cigarettes. Never mind that these products are still risky, that animal experiments are of dubious, if any, relevance for humans, and that the only way we’ll know how much less risky, if at all, these products are, will be if people are so misguided as to buy and use them for, say, twenty years – then we’ll know. But by then it may be too late for such willing human guinea pigs.

PMI then parrots the attempted justifications offered by animal experimenters engaged in the usual kind of medical research.

But before we get onto that, it should be noted that whereas conventional medical research is done with the intention of finding cures for afflictions like cancer and heart disease, PMI’s products are indisputably involved in the cause of cancer and heart disease, and other diseases. Therefore, obviously, the best thing PMI and others in the Big Tobacco cartel could do right now, if they were really concerned about public health, is to stop making cigarettes.

Furthermore, any research that Big Tobacco may sponsor or carry out is obviously likely to be self-serving and for this reason has come to be regarded with suspicion by the medical profession. This is why in 2013 The British Medical Journal and other major medical journals decided they would no longer consider for publication research that is partly or wholly funded by the tobacco industry – and rightly so.

Now let us look at some more of the spurious excuses PMI makes for torturing animals.

…we restrict animal studies to situations where no alternatives are available…If we could do research without any animal studies, we would. At present, we cannot.

How about the alternative of not doing the studies at all? Of course they won’t countenance that. Nonetheless, the public is supposed to be reassured by this and statements such as the following:

All activities related to animal testing are performed in accordance with applicable laws…as well as internationally established best practices in laboratory-animal care, to ensure that the animals are treated humanely and responsibly.

So that’s all right then.

Next, they throw in the pseudo-scientific shibboleth of the ‘3Rs’.

We always follow the widely recognized principles known as the ‘3Rs’ of animal research: Replace, Reduce, and Refine.

This is based on an assumption: that animal experiments produce results that are relevant to humans, or that the concept of an ‘animal model’ of human disease or physiology is valid. Such notions are highly dubious, not to say false. Here’s why:

This is a mouse

and this is a man (not to scale).

Therefore, if animals are good models for human disease one should continue and even do more of them rather than reduce them. And if they are not good models, then certainly they should be replaced. As for ‘Refine’, by which they mean ‘We use least-invasive procedures to minimize pain and distress’, this is an admission that their ‘procedures’ do cause pain and distress.

Apart from all such tests being unscientific because they are inherently incapable of producing meaningful results for humans (except by chance), one may ask what right has anyone to cause pain and suffering to even one laboratory rat? Especially for so trivial a reason as to develop new ways for humans to poison themselves with tobacco products.

I was indeed being unjust to PMI in the above-mentioned post – I was too kind.

Text © Gabriel Symonds

Top photo © Doctors Against Animal Experiments

How to be popular

I quote from British American Tobacco’s International Marketing Principles, 2015:

We will not portray smoking as an activity that makes people appear more popular,appealing or successful.

But they seem to have no qualms about portraying the use of their new product with the almost unpronounceable name of ‘glo’ as an activity that makes people appear more popular, appealing or successful.

This is from a twenty-four page booklet about ‘glo’ in Japan. I picked it up from promotional display in the street outside a corner shop selling cigarettes. A young person seeing this – and how can you prevent children and young people from seeing this and similar advertising? – might well want to try it just to appear popular and appealing like the models in the picture. While all of them except one are raising their glasses in a toast to something, three of the models are looking directly at the exception, the young man holding, not a glass of wine, but his ‘glo’ contraption. Also, note the bowl of fruit in the lower part of the picture – healthy food – being associated with the poison you can suck into your lungs with the ‘glo’ thingummy.  The advertising people must have worked really hard on this one!

 So I wrote to BAT through their website asking them the following question:

In your International Marketing Principles you say, ‘We will not portray smoking as an activity that makes people appear more popular,appealing or successful.’ But your promotional leaflet and the website for ‘glo’ in Japan does just this very thing. Do you have different ethical standards and marketing principles in different countries?

I received a polite reply from someone in their External Affairs department in Japan:

Although we don’t have specific International Marketing Principles in place for Tobacco Heating Products yet, please be assured we are applying the spirit of our existing principles to ‘glo’ as well as adhering to all regulations and voluntary codes.

I shall leave it to the reader to judge how far the spirit of BAT’s existing principles applies to to  their ‘glo’ product.

And how about this display in a Tokyo convenience store, conveniently placed at a child’s eye level:Big Tobacco, fearing that sales of cigarettes are going to decline more and more (at least in most developed countries), are rushing to bring out alternative tobacco products with the claim that these are less harmful. Apart from BAT’s ‘glo’, examples are Philip Morris’s IQOs (or iQOS) and Japan Tobacco International’s  ‘Ploom’ – at least you can pronounce the last-mentioned.

The fumes generated by these products still contain poisons, although maybe in smaller amounts compared with ordinary cancer sticks. The user is going to suck the fumes thereof into his or her lungs many times a day for years on end. And for what? To achieve a state of bliss? To see visions of heaven?

Are we non-nicotine users missing something?

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

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

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

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

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

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

Splendid clichés and buzzwords abound:

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

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

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

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

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

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

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

There’s more:

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

What to do about it? This is what:

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

Plus this pie-in-the sky:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

How to smoke without smoking!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Tobacco is the Root of all Evil

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

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

Here they are:

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

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

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

These three speak for themselves.

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

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

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

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

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

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

This is the cringe-making style of the writing:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Great Smoking Paradox

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

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

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

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

Eliminating the tobacco threat by implementing tobacco control measures…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Controlling Tobacco with Horrible Pictures

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

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

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

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

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

 The flim ends with the written statement:

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

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

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

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

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

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

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

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

It goes merrily on making and selling cigarettes.

Text © Gabriel Symonds