Category Archives: nicotine addiction

Cruel, unnecessary, shameful

Jane Goodall and friend

The words in the title were used by Dr Jane Goodall, the distinguished primatologist and animal welfare campaigner, in a letter to the FDA Commissioner, Dr Scott Gottlieb, protesting about nicotine addiction experiments on monkeys.

This is an extract:

I was disturbed–and quite honestly shocked– to learn that in 2017 the U.S. FDA is still, in 2017, performing cruel and unnecessary nicotine addiction experiments on monkeys…

I have been told that FDA researchers implant squirrel monkeys as young as one-year-old with devices to deliver nicotine directly into their bloodstreams. The young primates are then placed in restraint devices and trained to press levers to receive doses of nicotine. This apparently enables them to determine at what point they become addicted…

To continue performing nicotine experiments on monkeys when the results of smoking are well-known in humans—whose smoking habits can still be studied directly—is shameful.

As a result of Jane Goodall’s letter the research has been suspended.

However, ‘scientists and leaders in the addiction community’ responded to the suspension with an open letter in which they attempted to justify animal experiments in addiction research. Among other claims, they say we need answers to the following questions that only animals testing can provide:

Why are some individuals vulnerable to addiction and others not?

Why does relapse after any kind of treatment occur at such phenomenally high rates?

Why do drug abusers persist in seeking and taking substances that so clearly will lead to incarceration, poverty, even death?

Let us suppose that we had a complete answer to all these questions; that we knew everything that could possibly be known about the underlying behavioural, physiological, neurochemical and molecular changes, etc., that occur in addiction – what then? What would, or could, the scientists and leaders in the addiction research community do with this knowledge?

These questions are of purely academic interest; they are not of the slightest use in a practical sense for helping people with substance addictions.

The scientists and leaders go on:

With more than 440,000 people in the United States dying from tobacco use each year, clearly nicotine addiction remains a significant public health problem and it is quite evident that we do not understand this disorder well enough to eradicate it.

Really? What more understanding are they seeking that could possibly help them to eradicate the shocking death toll from tobacco use?

I trust these ivory tower dwellers, in the same way that I suggested to Dr Gottlieb in a previous post (http://nicotinemonkey.com/?p=1708), will allow me to lead them back down to earth.

There exists a mountain of research on smoking and addiction. Those who call for yet more research do not appear to understand that we have already an overabundance of information to take the one necessary step that would virtually eradicate the death toll from tobacco use: abolish tobacco.

Further, the scientists and leaders cannot resist making ad hominem attacks on Dr Goodall, referring to her pejoratively as a ‘celebrity’ and even questioning her scientific credentials when she points out the self-evident truth that it is ‘extremely cruel to restrain the monkeys’.

In reply to this charge they say:

Despite her scientific background—which should result in knowing that evidence and citations matter—Goodall cites no evidence for her claim that restraint is ‘extremely cruel’…In reality, empirical evidence—that is data – show that restraint devices used in such studies do not cause severe stress to the animals, because they are slowly trained to be familiar with and calmly enter and remain in the restraint devices.

So that’s all right then.

Restraint devices don’t cause severe distress, they say, but this is an admission that they do cause distress. Monkeys, being intelligent animals, no doubt realise that resistance is futile and they have no choice but to submit to their cruel fate.

There is another word one could add to Jane Goodall’s apt description of these experiments as cruel, unnecessary and shameful.

That word is: repulsive.

Text © Gabriel Symonds

Oyez! Oyez! Learn to love your lungs!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Pondering the Wafting of the Fumes

 

The more I read about the smoking problem the more it becomes clear there is an almost complete lack of understanding among so-called experts about why smokers smoke.

For example, even Dr Robert Proctor, who knows a thing or two about smoking and the tricks of the tobacco trade – he wrote a book running to 737 pages on the subject (Golden Holocaust, 2011) – doesn’t appear to know much about smokers. I have a great respect for him but he is an historian, not a smoking cessation counsellor. This no doubt explains him writing stuff such as

…the other reasons [apart from addiction] people smoke – to ponder the wafting of the fumes, for example, or to obtain some form of oral gratification. Or to emulate [the actor] Johnny Depp or [the actress] Keira Knightley. (Tobacco Control, September 2017)

Do smokers say, as reasons for smoking, that they love to ponder the wafting of the fumes, they obtain oral gratification and they can imagine they are like their favourite film stars, as being so important they would risk disease and death rather than give these up?

Then we have two medical academics, Lynne Dawkins and Hayden McRobbie, who say in a report for The British Psychological Society (August 2017) that

Cigarette smoking delivers a high level of nicotine to the brain very quickly…which immediately activates the brain chemical, dopamine. Because other stimuli (e.g. the handling of the cigarette, the ‘catch’ of smoke in the throat) are associated with this effect of nicotine, they too can become pleasurable in their own right, contributing to smoking addiction.

I do not know if Drs Dawkins and McRobbie have personally treated any smokers, but is it really true that smokers say, when asked why they smoke, that the handling of cigarettes and the ‘catch’ of the smoke in the throat are so pleasurable that they would rather risk death and disease than give these up?

And as for the speed of delivery of nicotine to the brain allegedly activating dopamine as a reason for addiction, this implies smokers smoke because they are addicted to the pleasure they experience from smoking that is mediated by dopamine.

Do smokers smoke, then, to achieve a state of bliss, some wonderful orgasmic sensation or pleasure of any sort? If you talk to smokers they don’t say this. What they do say is that they feel better immediately after smoking than they did before. In other words, what they are seeking is the speedy – almost immediate – relief of the discomfort they were in as a result of nicotine withdrawal.

This is the reason – and for the practical purpose of helping smokers to quit – the only reason smokers smoke.

It is, therefore, pointless and counterproductive for academic researchers to become exercised over pondering the wafting of the fumes, oral gratification or experiencing that horrid ‘catch’ in the throat. These are incidental to the means smokers use in order to obtain rapid relief of the discomfort of nicotine withdrawal – they are not reasons of themselves for smoking.

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

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

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

The Great E-cigarette Confusion

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

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

Deborah Arnott:

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

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

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

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

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

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

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

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

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

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

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

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

So there. Ms Arnott please note.

Text © Gabriel Symonds

Photo credit: Wikimedia

How to solve the problem of smoking in pregnancy

In October 2015 in the UK a report was published called Smoking Cessation in Pregnancy: A Review of the Challenge. This endeavour was endorsed by no less than twenty-one worthy organisations such as Action on Smoking and Health, Bliss (‘for babies born too soon, too small, too sick’), the Community Practitioners’ and Health Visitors’ Association, and the like.

The report considers how to deal with the serious problem of pregnant women who smoke – an activity, as is well known, that is harmful to the unborn babies as well as to the mothers.

The unnamed authors start by congratulating themselves on their achievements against the Challenge Group’s 2013 recommendations, using a traffic-light rating system. There’s rather a lot of red and amber so there’s more work to be done, and they acknowledge the magnitude of the task: ‘In the region of 70,000 infants every year are born to mothers who smoke [in England].’

Rather than critiquing the whole paper, for this post I shall consider just the title: why is it merely Smoking Cessation in Pregnancy and not Smoking Prohibition in Pregnancy?

In the UK anyone aged over eighteen, pregnant or not, may go into any shop or supermarket where cigarettes are sold and buy – no questions asked – a packet containing twenty of these dangerous, addictive products.

Now let us suppose – just suppose – that smoking was banned for pregnant women. They would not be allowed to buy cigarettes in the shops or through the internet and other people would be forbidden on pain of instant excommunication knowingly to give cigarettes to a pregnant woman, and let us further suppose that this scheme worked perfectly so that there was no way a woman, once her pregnancy was confirmed, could legally smoke cigarettes or use any nicotine product. What would happen? Would there be an outcry? Would there be  marches in the streets with demonstrators carrying placards saying ‘We demand the right of pregnant women to smoke!’?

I suspect many women would be quite relieved that the dilemma of smoking in pregnancy had been taken away from them. They may well say to themselves, ‘Of course I know it’s bad for me and the baby, but now that I’m not allowed to smoke, well, I’ll just have to accept it.’

This is a fantasy, but at present, pregnant women as long as they are over eighteen, in spite of being strongly discouraged from doing so, may, if they wish, quite legally buy and smoke as many cigarettes as they choose.

Smoking in front of children is rightly discouraged and there are penalties for smoking in cars when children are present. But what about the developing baby in the womb of a smoker?

This absurd and unacceptable situation exists because in a democracy like Britain adults have the right to damage their health by smoking cigarettes. But should they have the right to damage other people’s health – including that of unborn babies – by smoking?

Before my critics start accusing me of being an agent of the Nanny State, let me make something quite clear. There is a big difference between smoking in pregnancy and other harmful behaviours and of course I am not proposing that laws  be enacted to try to save unborn babies from all possible dangers.

Heavy drinking in pregnancy is harmful to the baby: it can produce a serious condition called the foetal-alcohol syndrome. But the occasional glass of wine or beer is probably all right. Nonetheless, where to draw the line is unclear, and I would not advise drinking any alcohol in pregnancy.

But whereas the occasional alcoholic drink in pregnancy is probably safe, pregnant women who smoke do not do it occasionally; they do it every day, repeatedly. There is no question whatsoever that smoking can directly damage the developing baby and that is why is it strongly discouraged and help is offered to pregnant smokers to quit.

The reason that some women smoke when pregnant is the same reason they smoke when they’re not pregnant: nicotine addiction. They may claim they do it for pleasure or relaxation or to relieve stress but such claims are illusory – as any smoker can easily demonstrate to himself or herself.

The question, then, comes down to this: because of the high risk of serious harm to the unborn child, should smoking in pregnancy be banned?

Text © Gabriel Symonds

How addicted are you?

A little-known advantage of not smoking

In the NHS ‘Smokefree’ website there’s a section headed ‘Addiction test’. The purpose of this is to find out how dependent you are on nicotine.

The underlying concept, however, is wrong. If you’re addicted to nicotine that sufficiently defines your problem. The implication that there are degrees of addiction is unfounded and pointless. Another problem with this concept is that it’s discouraging and therefore counterproductive: an allegedly lightly addicted smoker may think there’s no need to quit (yet); and if someone is deemed heavily addicted this is likely to make her think it’s going to be too difficult to quit, so why go through the aggravation of trying?

How to decide your degree of addiction? The website uses the Fagerström Tolerance Questionnaire, developed by Karl-Olov Fagerström in 1991. Here are the questions with suggested answers from which you’re supposed to pick the ones that nearest apply to you:

  1. When you wake up in the morning, how soon do you smoke your first cigarette?
    Within 5 minutes
    6 to 30 minutes
    31 to 60 minutes
    After 60 minutes
  2. Do you find it difficult not to smoke in places like cinemas, buses or restaurants?
    Yes
    No
  3. Which cigarette would you hate to give up most?
    First in the morning
    Any other
  4. How many cigarettes do you smoke per day?
    10 or less (sic)
    11 – 20
    21 – 30
    31 or more
  5. Do you smoke more in the morning than during the rest of the day?
    No
    Yes
  6. If you are ill in bed, would you still smoke?
    No
    Yes

The problem with this questionnaire – apart from the illiteracy and wrong-headed underlying assumption that degrees of nicotine addiction exist – is that the criteria on which it is based are arbitrary.  Scoring is problematic too. On the NHS website the result is presented only as low, moderate or high addiction. The scoring system is 0 or 1 for yes/no questions, and 0 to 3 for multiple choice questions, but on what basis the score is converted to the descriptive result is not stated. More arbitrariness.

Suppose you truthfully answer the numbered questions thus:

      1. 1. After 60 minutes
      1. 2. No
      1. 3. I would hate to give up any except the first of the day
      1. 4. Ten cigarettes a day
      1. 5. No
      1. 6. No

So if you smoke your first cigarette sixty-one minutes or later after waking, you don’t find it difficult to refrain from smoking where it is forbidden (and how is ‘difficult’ defined?), and even if you smoke ten cigarettes per day, etc., then you would be regarded by the result of this questionnaire as being only lightly addicted. But whatever the supposed degree of addiction, a ten cigarette a day smoker still has a ten cigarette a day problem.

The simplistic thinking behind this approach is that someone who is ‘lightly addicted’ may be able to ditch tobacco just with the support of a counsellor, whereas for a ‘heavily addicted’ smoker, ‘cravings can hamper your quit attempts so you should use stop smoking medication to increase your chances of success.’ Note they say such a smoker should use stop smoking medication although this will only ‘increase [your] chances of success.’ It seems to be rather a chancy business.

On the contrary, in my experience heavy smokers may be easier to assist than light smokers. One middle-aged man getting through three packs a day, when asked why he smoked, put it like this: ‘I don’t enjoy it. It’s because I’m addicted.’ With my help he readily understood the mechanism of nicotine addiction and stopped there and then without cravings. On the other hand, those I sometimes find hard to help are young people smoking about five a day. They may have been pressed into coming by their parents, don’t really want to stop and believe their current relatively light smoking won’t harm them.

The concept of degrees of addiction should be abandoned. All smokers have the same problem: nicotine addiction, pure and simple. And the solution is the same for all of them: stop smoking.

How to do this is easier than one might think.

Text © Gabriel Symonds

Danger! Never Smoke While Using Oxygen!

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

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

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

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

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

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

What, then, should be done?

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

Why, then do they do it?

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

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

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

Text © Gabriel Symonds

How many smoking deaths in the US would be acceptable?

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

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

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

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

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

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

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

Instead, the envisioning goes on to:

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

Splendid clichés and buzzwords abound:

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

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

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

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

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

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

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

There’s more:

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

What to do about it? This is what:

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

Plus this pie-in-the sky:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Why nearly all stop smoking websites are unhelpful

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

Readers’ Digest

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

WebMD

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

wikiHow

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

helpguide.org

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

kidshealth.org

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

Mayo Clinic

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

Medical News Today

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

1. Fear

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

2. Reminding smokers of the benefits of quitting

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

3. Nicotine patches or gum

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

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

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

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

5. Combining nicotine patches or gum with stop smoking medicine

The same objections as above apply, only more so.

6. E-cigarettes

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

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

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

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

8. Humour

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

9. Vulgarity

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

10. Willpower

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

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

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

12. Cold turkey

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

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

And the one best way to stop smoking?

Just stop!

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

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

Text © Gabriel Symonds

Philip Morris tortures animals

Yesterday

Today

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

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

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

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

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

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

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

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

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

They present themselves as the good guys:

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Stopping Smoking through Vulgarity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

 

Why not just eat a banana?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

They – Will – Cause – Death!

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

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

This is part of what he said:

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

Death or pleasure – what a choice!

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

Vaping Forever!

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Controlling Tobacco with Horrible Pictures

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

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

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

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

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

 The flim ends with the written statement:

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

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

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

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

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

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

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

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

It goes merrily on making and selling cigarettes.

Text © Gabriel Symonds

What the ’Eck! Journalism or Medical Advice?

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

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

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

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

 Back to the smoking piece. He says nicotine affects

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No wonder stopping smoking seems to be so hard!

Text © Gabriel Symonds

How to stop smoking (?)

Is this a statement or a question?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Rubbish Way to Stop Smoking

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

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

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

This paper is contentious from the first sentence:

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

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

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

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

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

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

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

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

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

They continue:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

The article continues:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

More BAT Duplicity

Fumatul ucide is Spanish for smoking kills

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

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

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

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

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

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

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

Freedom through Responsibility 

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

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

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

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

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

Experts advise no smoking during pregnancy – and we agree.

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

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

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

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

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

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

Then we have:

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

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

Text © Gabriel Symonds