Category Archives: stop smoking

The attempt and not the deed, Confounds us

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

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

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

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

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

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

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

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

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

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

They claim that

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

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

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

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

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

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

Text © Gabriel Symonds

(The title is from Macbeth.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

How not to solve the smoking problem

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

How to smoke without smoking – Part II

‘There’s such a craving for cessation!’

This cynical comment was made to me by Christopher Proctor, chief scientist of British American Tobacco, the company whose poisonous products, legally on sale everywhere, are responsible for about 9,600 deaths every year in the UK. (They have 10% of the cigarette market and 96,000 people die annually from smoking-related diseases in the UK – latest figures from ASH.)

There’s gold in them thar smoking cessation! Now every man and his dog are jumping onto the bandwagon.

Let me explain. The latest trick, would you believe it, is called Harmless Cigarette™. Just what we’ve been waiting for! It’s promoted as ‘A natural way to quit smoking’. (What’s an unnatural way then?)

The idea seems to be that whenever you have an urge to smoke you suck on one of these thingummies – they look like cigarettes – which are described as a ‘therapeutic quit smoking aid’ (the word ‘therapeutic’ is redundant) and that this helps ‘satisfy smoking behaviors and hand to mouth gestures associated with smoking.’ The key to how they allegedly work is given in the description of one variety, thus:

Harmless Cigarette™ Oxygen variant is both odorless and tasteless and does not contain any ingredients.

It does not contain any ingredients! And it’s only $19.95 a pack!

Though there may be a ‘hand to mouth’ muscle memory component of nicotine addiction, and it is possible these gadgets may satisfy that aspect, nonetheless mention of ‘smoking behaviours’ implies that smoking is a psychological problem. Indeed it is. I wrote a book with this title in 2016 – see under the ‘Buy now’ tab.

The psychological nature of smoking was recognised as long ago as 1964. The following is  from the US Surgeon General’s Report, Smoking and Health, published in that year.

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

The psychological aspect of smoking is the key to successful quitting. This means that if smokers can be helped to understand why they smoke in spite of knowing the dangers, and why it seems so hard to stop – they can then stop smoking straightaway and with very little difficulty.

Text © Gabriel Symonds

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

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

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

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

Smoking cessation and humour

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

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

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

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

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

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

Yes, a cup of coffee without a cigarette.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Same as No 8.

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

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

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

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

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

Text © Gabriel Symonds

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

Controlling Tobacco with Horrible Pictures

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

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

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

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

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

 The flim ends with the written statement:

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

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

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

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

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

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

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

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

It goes merrily on making and selling cigarettes.

Text © Gabriel Symonds

What the ’Eck! Journalism or Medical Advice?

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

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

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

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

 Back to the smoking piece. He says nicotine affects

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No wonder stopping smoking seems to be so hard!

Text © Gabriel Symonds

How to stop smoking (?)

Is this a statement or a question?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Over 600 Flavours!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Rubbish Way to Stop Smoking

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

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

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

This paper is contentious from the first sentence:

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

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

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

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

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

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

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

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

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

They continue:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

The article continues:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Lies, Damned Lies and Big Tobacco

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

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

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

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

Let me quote from BAT’s website:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

 

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

The title is a quotation from Groucho Marx.

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Vaping for Fun

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Best Way to Quit Smoking

Now here’s something for smokers to ponder. The popular online medical information website, healthline.com, has a feature on ‘The best quit smoking apps’ for 2016.

Before we come to the list of the twelve winners we are reminded, in the usual encouraging way, that ‘Quitting smoking can be incredibly difficult, but it is ultimately worth the struggle.’ Never mind. Let’s check out a selection of their ‘picks for the best quit smoking apps of the year.’ They don’t seem to be arranged in any particular order.

Butt Out – Quit Smoking Forever in which you can ‘Track your cravings and how many times you end up smoking, then watch your progress over time.’

Craving to Quit which contains ‘Videos help to guide you through each step of the process.’

Get Rich or Die Smoking. This one ‘shows you what you can now buy with that money instead [of spending it on cigarettes]’.

There’s the cutesy spelling of Kwit which is for smokers who like games, it seems.

Smoke Free which enables you to ‘Log your habits and cravings, track how many cigarettes you’ve successfully not smoked’.

This is getting boring so I’ll pick just one more: Quit Smoking with Andrew Johnson. The reviewer seems to have forgotten that clichés should be avoided like the plague:

Like most bad habits, smoking can become a deeply rooted part of your routine…Sometimes it takes thinking outside the box to break through…uses deep relaxation to help send messages to your subconscious to help you kick the habit.

Apart from apps they list ‘The Top 8 Products to Help You Quit Smoking’. More  encouragement, put somewhat repetitively:

…quitting ain’t easy. More Americans are addicted to nicotine — the drug in cigarettes — than any other drug. And because nicotine is so addictive, it isn’t a drug you can just put down. Quitting can take several attempts…Quitting smoking is hard work.

The products, predictably, are nicotine gum, lozenges and prescription drugs. And one more I hadn’t come across before, The Quitter’s Circle. It’s another app:  ‘The revamped version includes many new features designed to guide Quitters through their Quit Plan.’

Techniques, methods, ways, tools, programmes, plans etc., to stop doing something, and now we have apps. This review of the winners for 2016 rubs it in that quitting (or kwitting) smoking is not just difficult but incredibly difficult and will be a struggle, not forgetting that quitting ain’t easy and is hard work. Gee, thanks.

There’s something wrong here. When I was doing my medical training it was pointed out to us that if many different treatments were recommended for a particular disease, it probably meant that none of them was much good. Another thing we learnt was that in order to treat a disease effectively you need to understand the cause, if possible.

This is the problem with the current orthodox approach to smoking. All the apps mentioned above are merely gimmicks of one sort or another.

Not one helps you understand why you smoke in the first place or why quitting seems so hard.

Text © Gabriel Symonds

Ditch Tobacco Completely!

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

E-cigarettes are 95% safer than smoking! Or are they?

Is this what we want to see?

Among those involved in public health who see it as their task to ‘control’ tobacco by supporting measures to ‘drive down smoking rates’, as they put it, a new refrain has arisen that has almost become a mantra: E-cigarettes are 95% less harmful than smoking tobacco!

Some tobacco controllers get a bit carried away by this figure. We have the self-styled world expert on smoking and addiction, Professor Robert West, a psychiatrist, who is on record as saying: ‘If we fail to take this opportunity that electronic cigarettes are potentially providing then we’re really condemning [smokers] to death.’

Condemning smokers to death? Do we line them up against a wall or string them up from lamp-posts? What I guess he means is that if we (whoever ‘we’ are) fail to take this opportunity, etc., then you, the smoker, are going to die because e-cigarettes are not available because of unprogressive legislation or because it was believed they were dangerous when they weren’t.

What an strange idea. Because we don’t all rush to embrace e-cigarettes, many unfortunates who are suffering from the incurable disease of smoking will die. But all they have to do, to avoid an untimely death from this cause, is to stop smoking (unless they’ve left it too late of course).

Then there is Dr Colin Mendelsohn (http://nicotinemonkey.com/?tag=dr-colin-mendelsohn) who, likewise, believes in treating smokers with nicotine. He recently said in an Australian podcast: ‘[E-cigarettes are] a life-saving technology which allow people who can’t quit smoking to switch to a much safer alternative. We know that they’re at least 95% safer than smoking.’

Where does this nice round figure of 95% come from?

It first appeared in 2015 in a report issued by Public Health England called E-cigarettes: an evidence update, in which these drug delivery devices are promoted as a ‘tool’ for smoking cessation. The lead author is one Ann McNeill who, in these days of super-specialization, is a Professor of Tobacco Addiction in the National Addiction Centre. We’ll come back to her in a moment.

Another author is the clinical psychologist Professor Peter ‘nicotine-itself-is-harmless’ Hajek who, though he denies links with any e-cigarette manufacturer, has received research funding from and provided consultancy to manufacturers of so-called stop-smoking medications.

The Public Health England report was strongly criticized in an editorial in the prestigious medical journal The Lancet, which pointed out that the report’s conclusions were based on a study of ‘the opinions of a small group of individuals with no pre-specified expertise in tobacco control’. Oh dear.

Now it turns out that this study was led by none other than the well-named and eccentric psychiatrist Professor David Nutt, who in 2009 was dismissed as chair of the UK government’s Advisory Council on the Misuse of Drugs after saying that ecstasy, cannabis and LSD are less dangerous than alcohol and tobacco. He also believes that the psychedelic drug, psilocybin, can be useful in treating depression (http://nicotinemonkey.com/?p=739). Furthermore, two of the portly Professor Nutt’s colleagues are mentioned in The Lancet editorial as having potential conflicts of interest due to their associations with an e-cigarette distributor and manufacturers of smoking cessation products, respectively. Oh dear again.

The original ‘95%’ article (Nutt, D.J., et al., Estimating the harms of nicotine-containing products using the MCDA approach. European addiction research, 2014. 20(5): p. 218-225) is an account of an interesting theoretical exercise at a two day workshop in London in 2013. The participants used a complicated statistical formula and arbitrary criteria whereby, somehow, if ordinary cigarettes are regarded as 100% harmful, e-cigarettes are only about 5% as harmful. They did at least admit that ‘Our understanding of the potential hazards associated with using electronic nicotine delivery systems is at a very early stage.’ Quite.

The British Medical Journal also waded in with an aptly titled article, Evidence about electronic cigarettes: a foundation built on rock or sand? The authors point out a number of potential serious problems with e-cigarettes, among which are (paraphrased):

  • Children and adolescents may take up e-cigarettes and progress to smoking
  • The long-term effects of e-cigarettes are unknown
  • E-cigarette liquids contain formaldehyde as well as flavourings and other substances which may be harmful to health
  • If e-cigarettes are used to reduce smoking, as opposed to quitting, there may be no overall benefit for health
  • There is no evidence that e-cigarettes are effective as aids for quitting smoking
  • There may be a risk to bystanders from second-hand vaping in enclosed public places

Of course Professor Ann McNeill was not going to take this lying down. She became very cross at all this criticism of her ‘e-cigarettes are at least 95% less harmful than tobacco’ claim, especially at The British Medical Journal article which she called offensive.

The same confused attitude of the medical establishment to so-called recreational drugs is reflected in a cringe-worthy sentence in an article in The British Medical Journal (28 January 2017, p156) on ‘Novel psychoactive substances (NPS)’, or ‘legal highs’ as they are inaccurately known. In Britain it is illegal to distribute or sell them but possession is not a criminal offence. This being the case, the authors apparently think use of these substances is part of normal life, for there is a box headed ‘Information for patients who ask about NPS’.

This scenario is extraordinary. Can you imagine a patient making an appointment to see his or her GP and then saying something like: ‘Doctor, I’m think of using a “legal high” at a party this weekend. Could you please advise me how to do it.’

In spite of the fact that a large part of the article is taken up with a discussion of the risks and dangerous side-effects of these substances, this is the advice: ‘If using a novel substance, as with any drug, start with a very small dose and increase to obtain the desired effects.’

There is only word a doctor should say to anyone planning to use such drugs: Don’t.

But it seems with the addictive drug nicotine, because distribution, selling and use are at present legal, according to the Public Health England report, ‘it would be preferable for a young person to use an e-cigarette instead of smoking.’

How about not using nicotine at all, in any form?

Text © Gabriel Symonds

Photo by Philafrenzy, https://commons.wikimedia.org/w/index.php?curid=45613779

Australia Leads the Way: Vaping is Verboten!

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Reluctant Quitter

Gentle reader, forgive my cynicism, but here we have another example of what might be called ‘The Hard Way to Quit Smoking’, this time from the website of New York City government.

As usual I’ll put selected quotes in italics and add comments, this time those an imaginary smoker might make as he or she reads through the site.

The title is How to Quit Smoking. Odd that you should need instruction in how to stop doing something. Why can’t you just stop?

Deciding to quit smoking is a step in the right direction. So you have to make the decision first and then you’ll have made a step in the direction of actually doing it. Only a step? How many steps are there?

It can be hard… Really? Oh, in that case I won’t bother. Why do they have to tell me it may be hard? Was I wrong to think it would be easy?

By preparing yourself, you will be more likely to quit for good. I see, so it really will be hard, but I can make myself more likely to quit. How much more likely? And more likely than what?

The following eight steps can help make quitting easier. So now they tell me – there are as many as eight steps! And even if I follow them all it seems it can only help to make it easier, not easy.

Step 1: Decide why you want to quit. Well, it’s obvious, innit? Would I want to quit if I didn’t have a reason?

Review your reasons to stay motivated. Quitting is hard… They’ve already said it’s hard – why do they have to keep rubbing it in?

Step 2: Get support and encouragement. Tell your family, friends and coworkers that you are quitting. Ask for their support. It really must be hard if I need support from my family, friends and coworkers. And if I ask for their support, what are they supposed to do, exactly?

Here are some resources to help you quit: Think about using quit-smoking medications, like the nicotine patch or gum. They can reduce your cravings and double your chance of quitting successfully. Oh dear, I need ‘resources’ to help me quit – like the nicotine patch or gum. That doesn’t make sense – I’m trying to get off nicotine! Do I really have to go through all that? And it seems I’m going to have cravings!

Step 4: Pick a quit date. Choose a quit date carefully. Select a day when your routine will be as close to normal as possible (i.e., no vacations, major work deadlines or major life events such as weddings, moving, etc.) All this business about pick, choose and select means it’s no good trying to quit when I’ve a major life event such as a wedding? But this is the main reason I want to quit – I’m getting married! And then I have another major event – we’re moving house! And I was thinking this was the best time to quit! I guess I’ll have to put off quitting smoking, but in that case my intended may not want to marry me!

Step 5: Identify and learn how to deal with smoking triggers. I’ve heard of smoking guns, but smoking triggers? Oh, I see, triggers (or cues) to smoke. What are these? Well, let me go the helpfully appended PDF on coping with triggers. Let’s see, the first one is Being around other people who smoke. And what do they recommend for that? Go to places where smoking isn’t allowed. Tell friends that you’re trying to quit. Brilliant, I’d never have thought of that. By the way, since I’m only trying to quit, I suppose it’s okay if I fail – tee-hee! Let’s look at another one: Taking a break at work: Try stretching or talk to a co-worker instead. I’m stretched enough as it is with all this trying to quit, and all my coworkers are smokers!

Step 6: Be ready to cope with cravings. This is getting worse and worse. Why do they have to repeat that I’m going to have cravings? And I need somehow to be able to cope with them!

I’ve have enough of all these steps. What else do they suggest? Ah, another PDF. This one’s called Don’t give up. But that’s just what I’m trying to do! Oh I see, they mean don’t give up trying to give up. Sense at last. And here are Other useful information and tips. What might these be?

Drink a glass of water
Pray or meditate
Distract yourself
Listen to music

Now I’ve got it! The way to increase my chance of quitting is to distract myself by drinking a glass of water while meditating standing on my head with music playing in the background. Impossible to smoke while I’m doing that!

Text © Gabriel Symonds

Cigarette harm reduction? What about harm abolition?

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

 

Mrs May – Save Us!

From the pages of that trusty source of the latest developments in medical politics, The British Medical Journal (7 January 2017), comes an arresting news item:

More than 1000 doctors and other healthcare workers…have written an open letter to the prime minister, Theresa May, and England’s health secretary, Jeremy Hunt, urging them to publish a new Tobacco Control Plan ‘without further delay’ to address inequalities in health.

The letter was organized by Dr Nicholas S Hopkinson, who does seem rather prone to writing open letters to the government. In fact he wrote one in 2014 but then only managed to garner 590 signatures. This was on the subject of plain packaging of cigarettes. (See Chapter 20 of my Smoking is a Psychological Problem.) At least he’s trying to do his bit.

In the current letter signed by a battalion of health-care professionals it’s quite right that they should speak up to address inequalities in health. Let me explain what I think this means.

In her inaugural speech from Downing Street in July 2016, the Prime Minister, anticipating Donald Trump, used the splendid phrase ‘one-nation government’ saying that it was in this spirit that she planned to lead the nation.

This was followed by a kind of creed:

…we believe in the Union: the precious, precious (sic) bond…we believe in a union…between all of our citizens, every one of us, whoever we are and wherever we’re from.

The next sentence was a ringing declaration:

That means fighting against the burning injustice that, if you’re born poor, you will die on average nine years earlier than others.

Apart from the poor, she went on to rail against various injustices she believes certain other people may be more likely to suffer, that is, people who are black, white working-class, women and the young. Is there anyone she’s left out?

I’ll not attempt to solve all the world’s problems in this blog, so let’s just stick with the poor, those unfortunate people who are more prone to suffer inequalities in health and have a shorter life-span. According to the letter:

Half this difference in life expectancy is because of higher rates of smoking among the least affluent, so major improvements can be achieved by driving down smoking rates among the most disadvantaged.

This is true, but how to do the driving down? It seems the 1000 signatories haven’t much idea and are imploring Mrs May to show them the way.

What they expect to hear, no doubt, is more of the same. We can assume this includes plain packaging, tax increases on cigarettes, further restriction of smoking in public places, gruesome pictures of diseased body parts on cigarette packs and scary health warnings. In addition, the letter ponderously tells the PM that the new Tobacco Control Policy requires:

…comprehensive and sustained government strategy…to ensure adequate funding for the recurring costs of measures that are known to be effective – mass media campaigns, smoking cessation services and tackling tobacco smuggling, etc.

As I have said many times, this is all well and good but it doesn’t get to the heart of the problem.

Why are cigarettes regarded as part of the landscape? How can the government justify allowing the continued open sale of cigarettes? At the current rate of decline it will take decades for smoking prevalence to reach zero, if it ever does. And how many people will die from smoking-related diseases in the meantime?

Why don’t they ask Mrs May to ban tobacco?

Text © Gabriel Symonds