Category Archives: Smoking

Big Tobacco bashing

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

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

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

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

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

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

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

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

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

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

Give him a big hand for pointing out the obvious.

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

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

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

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

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

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

Text © Gabriel Symonds

Cruel, unnecessary, shameful

Jane Goodall and friend

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

This is an extract:

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

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

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

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

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

Why are some individuals vulnerable to addiction and others not?

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

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

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

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

The scientists and leaders go on:

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

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

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

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

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

In reply to this charge they say:

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

So that’s all right then.

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

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

That word is: repulsive.

Text © Gabriel Symonds

Oyez! Oyez! Learn to love your lungs!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Further up the garden path

I wrote about the Population Assessment of Tobacco and Health (PATH) Study on 17 June 2017 (http://nicotinemonkey.com/?p=1605). Here is another paper about it in, where else, Tobacco Control (July 2017).

It’s written by a no less than forty-one American authors from thirteen different institutions. The conclusion of this astonishing collaborative effort confidently asserts that

…the PATH Study will contribute to…the evidence base to inform FDA’s regulatory mission…and efforts to reduce the Nation’s burden of tobacco-related death and disease.

This interesting idea set me musing why they seem only concerned to reduce tobacco-related death and disease rather than eliminate them.

The paper helpfully starts by putting the problem in perspective by commenting on the  Surgeon General’s Report on smoking and health from 1964.

It has been over 50 years since the Surgeon General of the USA first concluded that ‘cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action’.

Some kind of remedial action does seem to have happened because, we are informed, ‘Cigarette smoking prevalence has been halved since publication of 1964 Surgeon General’s Report’. This good news, however, is somewhat tempered by the shocking fact that ‘tobacco use…[still] cause[s] over 480,000 annual US deaths’. Further, we are reminded that ‘Scientific evidence [shows] that smoking causes at least 15 types of cancer, as well as numerous chronic diseases including heart disease, stroke, lung diseases and diabetes’.

In response to this dire situation the Surgeon General’s Report of 2014 merely ‘highlighted the need for continued implementation of comprehensive tobacco control programmes and policies’. Better than nothing I suppose. But fear not – we are also told that

The Food and Drugs Administration (FDA) now has regulatory authority over the manufacturing, marketing and distribution of tobacco products to protect the Nation’s health.

Considering the nearly half-million annual US tobacco related deaths, the Nation’s health is clearly in need of protection. To help it achieve this vital aim it’s a relief to know that the FDA now has within it a Center for Tobacco Products (CTP) that has been ‘charged with regulating tobacco products’. And the way it is supposed to do this is by ‘weighing potential benefits and harm to current, former and never users of tobacco products’. And what might these potential benefits be?

Now, where does the PATH Study come into all this?

The PATH Study’s research focus is most clearly illustrated in its eight overarching objectives

One of these, which are also referred to as ‘primary objectives’, is to

Characterise the natural history of tobacco dependence, cessation and relapse.

And when the characterisation is complete, then what?

We already have voluminous research on the effects of smoking. To what end is it hoped further research will lead? The paper makes repeated reference to ‘regulation’. What does this mean? That it is acceptable for some people under some circumstances to smoke? That in the unlikely events that people under the age of, say, 18 never start to smoke, that tobacco products including e-cigarettes are never sold near schools, that marketing is restricted to adults who wish to use tobacco products, that smoking and vaping in public indoor spaces nevermore occur, that cigarettes products are only sold in plain packs festooned with horrible pictures and dire health warnings, then our tobacco regulators can give themselves a pat on the back and go home?

If this imaginary scenario were by some miracle to become reality, there would still be millions of adult smokers in all countries of the world except Bhutan.

So that’s all right then.

Text © Gabriel Symonds

Blame the government if you can’t stop smoking!

In ASH Daily News of 20 October 2017 there appears a commentary on a report lamenting recent cuts to local authority stop smoking budgets. Ms Hazel Cheeseman, Director of Policy at ASH, has this to say:

Without high quality local services in place vulnerable groups of smokers, such as pregnant women or smokers needing surgery, risk being left to go it alone. The responsibility for this must be shared between local and national government.

Every word in this statement attests to a lamentable lack of understanding of the smoking problem and how to deal with it.

All smokers are vulnerable – to the harmful, often lethal, effects of smoking. I suppose Ms Cheeseman is especially concerned about these particular groups because the harmful effects of their smoking are likely to make themselves felt within weeks or months rather than after the years or decades it may take for ordinary smokers to become ill or die as a result of their cigarette addiction.

But with the current absurd situation where cigarettes are on open sale everywhere, it’s not enough, apparently, just to try and discourage people from buying them. There’s much wringing of hands by the likes of Ms Cheeseman that these particular vulnerable smokers are at risk of being ‘left to go it (quit) alone.’

So the responsibility of these smokers to quit lies not just with the individuals concerned but with local and national government.

And how is it that local and national government finds itself in the embarrassing position of being accused of not living up to its responsibilities? It’s because ‘an increasing number of authorities [are] making cuts to stop smoking budgets.’

If only there were enough money to go around so that local and national government could fund stop smoking budgets to its heart’s content! Could we anticipate, in such a case, that stop smoking services, staffed by highly skilled counsellors offering the latest in stop smoking aids including e-cigarettes, would be available around the clock on every high street in the cities and towns of Britain? And if this fantasy were to become true, would we see droves of smoking pregnant women and smokers needing surgery queuing up to be cured of their addiction or at any rate being offered a hoped-for less harmful way of continuing their addiction?

Pregnant or in need or an operation and think you can’t stop smoking? Don’t worry – it’s not your fault! It’s the fault of local and national government for not funding stop smoking services enough!

The fact is, whatever the availability of stop smoking services and no matter what stop smoking ‘aids’ may be offered, the individual smoker has to make the decision – and stick to it – not to smoke ever again, or at least not to smoke until the baby is born or the operation is over. And they have to do this on their own.

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

Stigmatization and the Corner Shop

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Steam and Smoke on Love Island

There was recently on the ITV network in Britain a so-called reality show, ‘Love Island’, although it seemed rather a far cry from everyday reality to me. It featured a number of attractive young men and women who appeared to be on holiday in a villa in Majorca. The object of the series was to see who had sex with whom and how soon. There were certain rules that needed to be followed and the winning couple got £50,000 – with a lot more to follow in endorsements, etc.

The participants all had enviable good looks and beach-ready bodies, with several of the men sporting tattoos and fancy haircuts. The dialogue, carried on in Estuary accents, was notable for its emptiness and repetitive use of a certain vulgar word. Naturally, it was wildly popular.

But what was truly shocking about this boring series was not the vulgarity or the sex, but  that some of the participants were seen – dare I say it? – sm*k*ng! What a let-down! What a turn-off!

Apparently a daily supply of cigarettes was dished out with the condoms, but of course this activity – the one with the cigarettes, that is – should not be shown on television in case it encourages others.

But the point I want to make is this. Ms Deborah Arnott, Chief Executive of Action on Smoking and Health (ASH), when asked to comment on this aspect of the series, said:

I consider it reasonable to require programme-makers to have very strong justifications for showing smoking in a programme likely to be seen by young people, particularly if it depicts smoking by glamorous and attractive characters or people. I have seen no such justification in this case.

It seems to Ms Arnott, then, that there are some circumstances where it could be justified for smoking to be shown in programmes, whether or not the characters are glamorous and attractive. Perhaps she would tell us what these are. I have to say that, however much I wrack my brains, I cannot think of any such circumstances. Therefore, surely Ms Arnott – and especially Ms Arnott whose day job is discouraging smoking as much as possible – should say unequivocally that she considers there are no justifications for showing smoking in current TV shows likely to be seen by young people, or by old people for that matter, whether the characters depicted are glamorous and attractive or even if they are dowdy and ugly.

And how did an ITV spokesman respond?

The islanders are only shown smoking if this happens at the same time as they are having conversations we believe to be editorially important to the narrative of the show.

This is even more idiotic than Ms Arnott’s qualified criticism. What difference does it make whether smoking is shown at the same time that the participants are having conversations that are deemed editorially important, or even just ordinarily important, or indeed if they are entirely unimportant to the narrative of the show?

The inane conversations, important or not as they may have been, are one thing. The connection, let alone justification, however, between smoking and the narrative is non-existent. I cannot think of a single good reason for smoking to be shown in a modern play, film or TV show.

It’s an entirely different matter in a period piece such as Edward Albee’s play, Who’s Afraid of Virginia Woolf? (1962), in which two hard-drinking couples set about having a furious row with each other. It was made into a film in 1966 starring Richard Burton and Elizabeth Taylor. In the film the protagonists are portrayed as smokers, but at that time smoking was regarded as normal and was an integral part of the characterization. Today, of course, knowledge about and societal attitudes towards smoking have been transformed.

Any depiction of smoking in a contemporary film, play or TV show should not be countenanced; it looks ridiculous and wrong.

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

Mrs May to the Rescue!

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

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

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

He proudly notes:

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

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

Set against this, however, are some dismal figures:

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

To deal with this dreadful situation, Stevie boldly declares:

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

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

I like a man with self-confidence:

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

Now let’s get to the contradictory bit:

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

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

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

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

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

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

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

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

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

They really are stuck in discouraging mode:

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

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

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

In spite of acknowledging that:

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

all that our Steve can offer is a platitude:

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

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

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

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

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

Text © Gabriel Symonds

How many smoking deaths in the US would be acceptable?

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

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

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

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

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

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

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

Instead, the envisioning goes on to:

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

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

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

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

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

Text © Gabriel Symonds

Out with ASH – in with CAT!

Gentle reader, please bear with me until l come to the bit where I disclose the amazing revelation that recently came upon me in a dream.

Now, the following is from the website of ASH (Action on Smoking and Health), quoting the UK National Institute for Health and Care Excellence (NICE):

While recognizing that quitting smoking is always the best option for smokers, the NICE guidance supports the use of licensed nicotine containing products…to help smokers not currently able to quit to cut down and as a substitute for smoking, where necessary indefinitely.

Unfortunately, this doubtless well-intentioned advice is based on a fundamental misunderstanding of smoking and thus does smokers a disservice.

Here’s why. The talk of ‘smokers not currently able to quit’ fails to recognise that all smokers are unable (or think they’re unable) to quit – that’s why they’re smokers. Further, the qualification ‘currently’ implies smokers may be able to quit at some point in the future, but until they reach that happy state they have tacit official approval to carry on smoking for the time being – which often means a long time.

Today a smoker is unable to quit, but sometime in the future he has a Road to Damascus moment, the scales fall from his eyes and the cigarette from his lips – and suddenly he’s able to quit! So he does. Or does he?

In any case, on what evidence does NICE talk of smokers being ‘unable to quit’? Are there any? It’s indulgent and even collusive with smokers to characterize them in this way. ‘There, there, don’t worry if you can’t quit at the moment – I’m sure you’ll be able to quit sometime in the future!’ This merely gives smokers an excuse and a reason to feel less bad about smoking while they carry on doing it.

Further, NICE really ought to know better than to imply that cutting down the number of cigarettes smoked daily will do any good for a smoker’s health. It won’t. It merely creates a false sense of security: ‘I’m cutting down – so that’s all right then.’

But now we come to the real bummer, if you’ll pardon the Americanism.

NICE seems to think it’s fine for smokers to use, not just any old nicotine products, but licensed nicotine containing products (gum, patches, suppositories, etc.) as a substitute for smoking, where necessary indefinitely’.

You don’t need a substitute for smoking! And, under what circumstances, would NICE be so good as to explain, is it necessary to use licensed nicotine containing products at all, let alone indefinitely.

This nihilistic thinking seems to be, among the NICE people and many involved in so-called tobacco control, that it will never be possible to get all smokers to stop and so the best compromise is that those who can’t or won’t stop should be encouraged to continue their nicotine addiction, where necessary indefinitely, in a possibly safer way than smoking.

ASH’s policy contributes to this weak approach. As mentioned, the acronym means Action on Smoking and Health, but the only action that needs to be taken to deal once and for all with the smoking epidemic, it to abolish tobacco. Unfortunately, ASH doesn’t agree with this.

Therefore, I propose that instead of more and more effort going into ‘tobacco control’, a new organisation – of which I would volunteer to be the honorary secretary and president – should be set up, dedicated to closing down the cigarette factories.

I would call it the Campaign for the Abolition of Tobacco (CAT).

Text © Gabriel Symonds

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

Philip Morris tortures animals

Yesterday

Today

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

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

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

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

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

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

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

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

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

They present themselves as the good guys:

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Stopping Smoking through Vulgarity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

Tobacco is the Root of all Evil

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

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

Here they are:

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

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

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

These three speak for themselves.

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

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

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

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

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

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

This is the cringe-making style of the writing:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

The Great Smoking Paradox

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

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

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

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

Eliminating the tobacco threat by implementing tobacco control measures…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

The article continues:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

More BAT Duplicity

Fumatul ucide is Spanish for smoking kills

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

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

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

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

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

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

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

Freedom through Responsibility 

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

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

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

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

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

Experts advise no smoking during pregnancy – and we agree.

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

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

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

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

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

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

Then we have:

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

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

Text © Gabriel Symonds

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

 

Nothing much changed in thousands of years

German industrial cigarette machine – makes 10,000 cigarettes a minute

There are some individuals and organisations who have found a way to deal with awkward questions: ignore them!

Recently I cast my critical eye at the website of the venerable cigarette manufacturing company, Japan Tobacco International (JTI). In their ‘About tobacco’ section we find the amazing fact that ‘Smoking has a tradition that dates back thousands of years.’ So that’s all right then. Slavery, genital mutilation of children and dog-fighting also date back thousands of years. And another thing they say in the same section is that ‘The way a cigarette is prepared has not changed much.’ I suppose it all depends on what they mean by ‘much’ and from when they are considering change. Up to the late 1800s cigarettes were hand rolled but modern machine rolling can produce up to 20,000 cigarettes a minute. Seems like a pretty big change to me – to say nothing of all the sophisticated additives that can be found in cigarettes these days. So I hope JTI will forgive me for imagining that their site may not be quite straightforward – it’s rather smoke and mirrors, particularly smoke.

Now let’s come to my main concern. If you read the JTI  website carefully you can see how they try to justify continuing to be in the tobacco business – although they make a point of adding, rather obviously, that ‘If you want to avoid the risks of smoking, you should not smoke.’ So that lets them off the hook.

What they don’t acknowledge is how cigarettes themselves have created the problem, that is, nicotine addiction, whereby smokers find it difficult to stop.

This is what JTI says about addiction:

Many smokers report difficulty quitting smoking. The reasons they offer vary. Some say they miss the pleasure they derive from smoking. Others complain of feeling irritable or anxious. Others speak simply of the difficulty of breaking a well-ingrained habit. Given the way in which many people – including smokers – use the term ‘addiction’, smoking is addictive.

It is interesting to see how these comments, while seeming responsible and sensible, could be taken as self-serving.

‘Many smokers report difficulty quitting smoking.’ This is not true. All smokers (whether they report it or not) have difficulty quitting smoking – that’s why they smoke! Or at least one can infer as much.

But do smokers spontaneously report that they have difficulty quitting or is this elicited by the questioner? And what are the circumstances under which this question was asked? What was the question anyway? Did they approach a random sample of smokers and say, ‘Excuse me, do you have difficulty quitting smoking?’ It’s a loaded, not to say insulting question. Or did they say to someone smoking a cigarette, ‘Excuse me, if you have difficulty quitting smoking would you please tell me why.’ Same situation. Or perhaps they asked a sample of smokers attending a smoking cessation clinic who had agreed to take part in such a survey. These smokers would obviously be a select group and therefore can’t be taken as representative of ‘many’ smokers.

So I used the contact section on the JTI website to ask them whence these comments come from. Are they from a scientific paper reporting the results of a survey or are they just made up by the JTI copywriter? I am still waiting for a reply.

Let’s give them the benefit of the doubt and assume many smokers had somehow reported that they have difficulty quitting, and that they were then asked to say why they thought they were in this unfortunate situation. Let’s take the quoted alleged reasons one by one.

‘Some say they miss the pleasure they derive from smoking’. But if they say they miss the pleasure of smoking this means they have already stopped, so the difficulty is retrospective and these former smokers cannot therefore be included in the ‘many’ who allegedly currently have difficulty stopping smoking.

As for a habit, whether well-ingrained or merely ingrained, that smokers apparently have difficulty breaking, this is not why smokers smoke or why they find it difficult to stop. Habits are easy enough to make or break but drug (nicotine) addiction is another matter entirely.

Those who ‘complain of feeling irritable or anxious’ as a reason for having difficulty in quitting are nearer the truth, but why do they feel this? Because the irritability or anxiety is caused by the cigarettes themselves or, more specifically, by the withdrawal symptoms of nicotine.

Then we have:

But no matter how smoking is described, people can stop smoking if they are determined to do so. No one should believe that they are so attached or ‘addicted’ to smoking that they cannot quit.

Note how ‘attached’ is written as part of the normal flow of the sentence but ‘addicted’ is in inverted commas. This implies that smokers are not really addicted to smoking, only attached to it, and that if they really wanted to stop they would. Thus JTI reveal themselves: Don’t blame us if you think you can’t quit – you could if you wanted to!

What JTI does not admit, of course, is that the difficulties smokers may experience in quitting are an inherent part of the poisonous product they have provided for their customers to get hooked on – and to remain hooked on – for years or decades.

Text © Gabriel Symonds

Are smokers getting a raw deal?

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

Sir Ronald Harwood
Playwright and screenwriter

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

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

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

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

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

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

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

 I’ll come back to this is a moment.

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

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

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

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

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

Both these assumptions are questionable.

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

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

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

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

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

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

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

Text © Gabriel Symonds

General Practitioners Can Foretell the Future!

Here’s an amazing news story. No, it’s not the Flat Earth News, but comes from the hallowed pages of The Scottish Sun. (Online edition, 25 January 2017.)

First, the surprising headline: GPs telling smokers how soon they will die ‘makes them three times more likely to quit’.

Now hang on a minute. How is it that GPs have suddenly gained the power to foretell the future? I wish I had that gift – it could be useful to know what next week’s stock market prices will be. Or, on the other hand, it might not be so nice if I could tell when I will depart this world myself. I plan to die my sleep when I’m 95¾ but as it’s not given to us to know the time or manner of our passing I’ll have to leave it to providence.

Let’s accept for a moment that GPs have indeed somehow acquired the miraculous gift of second sight, what then? The result, given in the body of the piece, is that ‘smokers are three times more likely to try and quit’. (Sigh.) So smokers, knowing when the sands of time will run out for them, are three times more likely to try and quit! Three times more likely than what? And what’s the good of ‘trying’ to quit? This means failing to quit – which they’ve been doing all along.

Another way of looking at it, we’re informed, is that ‘The numbers turning up for [stopping smoking] help sessions trebled when doctors detailed how long they had left [to live] if they kept on lighting up.’

Same thing. Put the fear of God into a smoker and he or she will be three times more likely to attend stop smoking help sessions and/or try (i.e., fail) to quit. Big deal.

All right, Dr Symonds, could you please stop being so cynical? But I’m not. This is actually the bankrupt state of the current orthodox approach to smoking cessation.

Unless a patient is terminally ill from, say, cancer or heart disease, it’s impossible to tell when someone will die. ‘The doctors gave me six months to live’ is a dramatic but merely fanciful idea from pulp fiction. Any prediction of this sort is no more than guesswork. Although it’s true, unfortunately for them, that smokers are considerably more likely to contract cancer or heart disease than non-smokers, they are very likely already aware of this. Even so, it does little to put them off smoking. Fear tactics don’t work very well. So let’s make it really scary and see what happens.

This is the wrong approach. How come the bottom didn’t drop out of the cigarette market when they started putting warning labels on cigarette packs saying ‘Smoking causes cancer’? The reason smokers smoke is not because of ignorance of the dangers of doing so. It’s a deplorable situation in which the following facts need to be recognised and acted upon:

  • Smoking should be seen for what it is – drug (nicotine) addiction.
  • Smoking is not a habit which some people find enjoyable even though it’s bad for them.
  • Smoking-related diseases kill around 100,000 people in Britain each year.
  • This is – or ought to be – unacceptable.

What follows from this is that the government should have as an explicit objective the banning of the manufacture and sale of tobacco products.

Text © Gabriel Symonds

A little-known risk of smoking

Here is a sad story which illustrates a little-known sad fact about smoking.

It was recently reported in the Southern Daily Echo online news that ‘a Mum tried to smuggle nearly 35,000 cigarettes through Southampton docks’. It is said that she ‘tried to avoid paying almost £11,500 in tax by storing the tobacco in her luggage following a 13-night luxury Caribbean cruise.’

This lady reportedly had been travelling with her ex-partner, a plumber, with whom she had enjoyed the cruise. At least we can assume they enjoyed it until they returned to port. Well, that is neither here nor there but this odd couple was convicted of attempting to defraud Her Majesty’s Revenue & Customs. Very wicked. And quite rightly they were punished – though somewhat leniently, almost kindly – for this offence.

He was ‘handed a 12-month community order and told to carry out 100 hours of unpaid work’ and she was ‘ordered to pay court costs of £45 and an £85 victim surcharge.’

But what is interesting are the further facts and statements that emerged from the court hearing and subsequent probation reports.

The lady said that although they were on their way home on the cruise ship they had ‘experienced doubts’ – whether moral or other we are not told – and considered throwing their loot into the sea. But on further reflection they decided to risk being apprehended so that – and mark this well – ‘so that her (the lady’s) ex-partner could carry on smoking and spend his pension on food instead of tobacco.’

Let us think about this. There was nothing to stop him spending his pension on food instead of tobacco if he was so minded, but because, it is implied, he had a greater need or felt it was his priority to spend his pension on cigarettes in preference to food, they were somehow driven to break the law. At least they didn’t harm the fish and sea birds who might have eaten the cigarettes if they had been thrown overboard. All that would have happened if they had got away with it is that the gentleman would have continued to poison himself by inhaling tobacco smoke and would have avoided starvation, at least till the cigs ran out, because apparently his priority is to smoke rather than eat. If he smoked twenty per day, 35,000 cigarettes would have lasted him nearly five years if he didn’t die of a smoking related disease in the meantime.

The chairman of the probation service who considered the case noted that ‘there was a huge demand for good plumbers and urged [the miscreant] to get back into work and feel “self-worthy” again.’ The report also said, of the lady, that she wanted ‘to help her ex-partner with his smoking habit.’ Some help. And I wonder whether this smoker, no matter how good a plumber he might be, as a smoker ever feels self-worthy. Or if any smoker (synonym: nicotine addict) really ever feels self-worthy.

So now we have another harmful effect of smoking: the temptation to break the law.

How much nicer a holiday would this couple have had, quite apart from the little unpleasantness when they returned to dry land, if the good plumber had decided while breathing all the fresh air on his cruise, thenceforth to stop poisoning himself by inhaling tobacco fumes and had never bought the huge stash of cigarettes in the first place. And he wouldn’t have been at risk of starving himself to death.

Text © Gabriel Symonds

Calling out Philip Morriss

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

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

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

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

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

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

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

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

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

Then we hear from Deborah Arnott of ASH:

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

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

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

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

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

Text © Gabriel Symonds

The Fear of Not Smoking

Recently I was waiting in a queue to change some money at Haneda Airport and I noticed a strong smell of tobacco. At first I thought it was coming from someone nearby, because the clothes of a heavy smoker can reek of tobacco, but then I realised I was standing outside the Smoking Room. Periodically the door would open and close as people went in and out, allowing the fumes from inside the room to pollute the air in the vicinity where I was standing. This set me pondering further on a matter to which I have already given much thought: why do smokers – at any rate those about to board an aeroplane – smoke?

Clearly it’s not because of enjoyment. Rather the opposite. Smoking being rightly forbidden in most of the terminal building, and of course on the aircraft itself, these unfortunate people who are addicted to the nicotine in cigarettes are topping up their nicotine levels in the hope it will last until they land at their destination, maybe many hours later. They may for this reason smoke two or three cigarettes one after the other and put up with the dizziness and nausea which this can cause. Some smokers use nicotine patches to help them survive the flight.

It’s similar to the situation of Japanese office workers on their way to the station in the mornings. They’re not allowed to smoke at home, nor on the train, so they top up their nicotine levels while they have the opportunity – even though it’s forbidden to smoke while walking along the street in many areas of Japanese cities. I have frequently observed such smokers. Do they look happy and content? No, they look harried. But why?

The answer to the above questions is the same for the person about to board an aircraft as for the salary man on his way to work: fear – of what may happen if they can’t smoke. Well, what does happen if a smoker can’t smoke when he or she wants to? I’ve asked hundreds of smokers this question and at first they usually say ‘nothing’ or ‘I don’t know’. Then, after some thought, many will admit to feeling mildly uncomfortable, that is, irritable and nervous. These feelings are due to nicotine withdrawal. If they’re not relieved by smoking another cigarette, what will happen? Will they become intolerable? The answers are ‘Nothing’ and ‘No’, respectively.

But it’s not so simple as that. Many – or I might say all smokers – even if they’re not really conscious of it, are afraid the discomfort will become intolerable: that’s why smokers smoke (if they’re allowed to) – whatever they’re doing or are about to do.

It gets worse. Unfortunately for them, smokers who desperately try to top up their nicotine levels before boarding an aircraft are ensuring that when they land they’re going to feel even more uncomfortable than they did before they got on the plane. This is from the larger dose of nicotine they took in than they normally would, and the enforced longer period before the withdrawal symptoms can be relieved by another dose.

Many smokers, however, if they put their mind to the reality of not being allowed to smoke on board an aircraft, accept it and forget about smoking for the duration of the flight – and they are perfectly all right.

The lessons from this, which contain the key to successful quitting, are as follows:

  • Smoking is not enjoyable or relaxing.
  • On the contrary, smoking causes anxiety, nervousness and irritability
  • These symptoms, nonetheless, are mild
  • The fear that they will become intolerable is real, if unconscious
  • If smokers do nothing these symptoms will go away

The only thing that smokers will lose by not smoking is their fear of not smoking.

Text © Gabriel Symonds

Nicotine Withdrawal Symptoms and Readiness to Quit

What are nicotine withdrawal symptoms? I have done a survey of the records of the last one hundred patients I treated for smoking cessation in face-to-face sessions. These records contain near-verbatim accounts of what patients say in reply to open-ended questions, since I have found this is the best way to gain an understanding of what is going on in smokers’ minds. It’s in complete contrast to the orthodox, tick-box approach: ‘The following is a list of nicotine withdrawal symptoms – tick all that apply to you: cravings, headaches, stomach pains, depression, nervousness, etc.’

What is remarkable about asking smokers the question ‘What do you actually feel when you feel you want a cigarette?’, is that they usually find it difficult, at first, to say anything at all. Or they might say ‘I don’t know’ or ‘Nothing’. Secondly, when given time for reflection and perhaps after some gentle prompting, their responses are remarkably similar. Thirdly, what is also notable about the replies is the mildness of the symptoms described: they are not that bad in the great majority of cases. Fourthly, they are nearly all mental symptoms.

In descending order of frequency, these are the symptoms mentioned – most patients had more than one:

Anxiety                                               72%
Irritability                                           46%
Distraction                                         20%
Feeling of something missing        16%
Frustration                                        12%
Thinking about smoking a lot          8%
Panic                                                    8%
Light headed                                      3%
Dry mouth/bad taste                        3%
Headache                                           2%
Neck tightness                                   2%
Depression                                         2%
Sleepiness                                          2%
Others                                                1%

Others: sweaty hands, weakness, chest tightness, feeling of lightness in the body, feeling mildly unwell, cough, loss of appetite.

I have paraphrased some symptoms to avoid undue complexity. For example, if patients said they felt short-tempered I have put this under Irritability; difficulty in concentrating and insecurity under Distraction; and nervousness, restlessness and stress under Anxiety.

Some symptoms deserve special mention. Headache occurs frequently in lists of nicotine withdrawal symptoms. As can be seen it was noted only twice among my one hundred subjects: in one case it referred to a feeling of tightness in the muscles at the back of the neck, so this could have been due to associated anxiety; in only one case was it mentioned as a specific symptom. No one mentioned stomach upsets or sleeping difficulties. No one said he or she had ‘cravings’ for a cigarette; all they said, on the relatively rare occasions when such a symptom was noted, was that they were thinking about smoking a lot.

Now let’s do an informal survey of nicotine withdrawal symptoms from the internet. Putting this phrase into Google produced 542,000 hits. Taking a few at random, these are the sorts of dire symptoms you’ll find:

Intense cravings for nicotine, tingling in the hands and feet, sweating, nausea and intestinal cramping, headaches, coughing, sore throat, insomnia, difficulty concentrating, anxiety, irritability

Cravings, restlessness, trouble sleeping, rough mornings, irritability, headaches, anxiety, heightened stress, depression, restlessness/boredom, nausea, heartburn, moodiness

Urges to smoke, depressed mood, difficulty sleeping or sleep disturbances, irritability, frustration or anger, anxiety, difficulty concentrating,  restlessness, decreased heart rate, increased appetite or weight gain

Dizziness, fatigue, insomnia, cough, constipation, hunger, sweet tooth, obsessive desire to smoke, irritability, headaches and pressure behind the eyes

Where do they get these from? Are they just copied from one internet site or textbook to another, endlessly replicated and taken as gospel truths with no one (apart from me) going back to the original sources?

Let me anticipate one objection here. In my own research I list only the immediate symptoms of nicotine withdrawal, maybe those felt one hour after the last cigarette. The other sources to which I refer sometimes list symptoms according to a timeline, perhaps from two hours to twelve weeks or more. Again, I would ask, what is the evidence that recent ex-smokers experience such prolonged misery? I always follow-up my patients and the common story is that most feel very few or no withdrawal symptoms in the longer term.

The myth of the suffering you will likely go through if you try to give up smoking on your own is part of a narrative that you will need help to do it. And the help that’s usually offered consists, bizarrely, of nicotine products or prescription drugs. At best, these are only about 20% effective, so out of one hundred smokers using such methods, eighty will fail and will still be smoking a year later.

Worse, this approach ties in with the mind-set of smokers: they don’t really want to quit. This is hard to admit to oneself, but they feel less foolish about smoking if they believe they’re ‘trying’ to quit. Thus, they unconsciously look for a quit method that will probably fail.

In their heads smokers wish they didn’t have to go through life poisoning themselves every day just to feel normal, but in their hearts, because smoking is drug (nicotine) addiction, they find it more comfortable to carry on, at least for the time being. So they’re always looking for an excuse for smoking, directed to themselves or their loved-ones, even if they don’t admit it: ‘I want to give up – but not now, not yet, it’s too difficult, I’ll be hell to live with if I try, I’m not ready.’

The reality is that smokers will never be ready to quit – that’s why they’re smokers. In any case, what does it mean, being ‘ready’ to quit? Suppose you reach the stage where you’re ready, what then? You find a method of quitting that will likely fail, so you can carry on smoking. Of course, many smokers do quit, but what has readiness got to do with it? How long does the state of readiness need to last to qualify as a valid concept? Presumably the shorter the better. If you were ready to quit smoking for a year but never managed to do it, you would look rather foolish. So those who are ready, quit, and those who aren’t, smoke! In the former case, you smoke your last cigarette, declare that you’re ready to quit and – that’s it  – you’re a non-smoker. The idea of readiness really means the lack of it; it’s not a prerequisite for quitting, but an excuse to continue smoking.

Text © Gabriel Symonds

Nicotine and Alcohol Addiction

These two problems are often linked in people’s minds and may be reflected in their responses to a suggestion that they should stop smoking:

‘I smoke, but I don’t drink.’ – so that’s all right then.

‘I only smoke with a drink.’ – the ionly smoker.

‘If I give up smoking I suppose you’ll want me to give up drinking as well.’

Although there are similarities with nicotine and alcohol addictions, there are important differences.

Most people can drink as and when they choose (circumstances permitting) and it will never become a problem. However, with smoking, for virtually everyone who does it at all, it’s a problem right from the beginning. This is because (barring the very small number of ‘occasional’ smokers), all smokers smoke because they’re addicted to the poison nicotine. Whereas with drinking, although the majority will never become addicted to alcohol, a sizeable minority do, with the potential for severe disruption of health, family relationships and working life.

The reason for this lies in the way alcohol is metabolized by the body, that is, the way it is broken down in the liver to simpler chemical compounds before being eliminated through the kidneys. I am one of those people who could never become an alcoholic, though I hasten to say I am in no way thereby superior to anyone else. If I drink too much, which I have to admit I have done on rare occasions in the past, one wakes up in the middle of the night with a pounding headache, nausea and feeling wretched. Depending on the degree of overindulgence these feelings can vary from being relatively mild to wishing one were dead! It’s completely stupid, of course, because it’s self-inflicted and wholly predictable. One is ‘having a good time’, feeling pleasantly intoxicated and there’s the wrong-headed idea that if a little alcohol is nice, more is nicer. The trouble is the dreaded delayed effect – and when you realize you’ve had too much it’s too late! Only time brings relief: a few hours, or after a bad binge, perhaps a whole day elapses before one feels human again. During this time of recovery from alcohol poisoning the last thing you want is another drink – the very thought is enough to make you throw up!

In contrast, the actual or potential alcoholic experiences drinking in a rather different way.  He or she has a high tolerance for alcohol – can ‘drink other people under the table’. He doesn’t get drunk as described above, but may become disinhibited and perhaps indulge in uncharacteristic behaviour. Apart from wanting to go on drinking there is not much change in how he feels. Eventually – after a couple of bottles of wine or half a bottle of whiskey (or more), he will fall asleep. On waking he may feel a bit morose, but not all that different from how he usually feels. However, what such drinkers want and are looking forward to, is ­another drink. If they’re feeling depressed and anxious, they know another dose of alcohol will make them feel better. In the early stages of alcoholism this can wait till evening, a ‘respectable’ drinking time. As they slip further down the slippery slope they need a drink earlier and earlier in the day in order to relieve the awful feelings of anxiety, shakiness and black mood. In advanced cases the sufferer starts drinking as soon as she awakes and will go on drinking throughout the day in order to try to stave off the depression, the anxiety, the shakes and hallucinations which are caused by alcohol withdrawal. Most people do not degenerate to this advanced stage and may remain somewhere in between heavy social drinking and mild alcoholism, while suffering cumulative damage to their bodies from excessive regular alcohol intake. The organs most affected by alcohol are the liver, heart and brain – three rather important bits of you!

The cure for smoking and alcoholism is the same: total, permanent abstinence. This is much easier for smokers because, if they can be helped to understand why they smoke in the first place, they’ll realize there’s nothing to give up – smoking is utterly pointless. The perceived pleasure that some smokers claim they experience is an illusion.

On the other hand, alcohol for an alcoholic does have some benefits – even if questionable and at a terrible cost: it can help the drinker to reach a state where he can for a few hours escape the miseries of life. There is, therefore, a sacrifice, but it’s a small one. There are advantages, too, in not drinking. Sometimes I have dinner with non-drinking friends. These occasions are no less enjoyable for the absence of alcohol. The pleasure of the event comes from the stimulus of the company one is with. So-called social drinking is as much a convention as anything else. And if you don’t drink alcohol with dinner at a restaurant, you can drive yourself home afterwards and the bill is much cheaper!

© Gabriel Symonds

E-cigarettes poised to take over the world!

mick-jagger Amazing discovery! Now you can enjoy poisoning yourself with nicotine without doing yourself any harm at all! Guaranteed 95% safe! You can get the same satisfaction as smoking cigarettes without the tar!

Really?

I can’t get-no satisfaction…a man comes on to tell me…but he can’t be a man ’cause he doesn’t smoke the same cigarettes as me…’cause you see I’m on a losing streak…

These lyrics by the Rolling Stones (1965) are not, perhaps, in the Nobel prize league, but they do make a point, although probably not the one they intended.

It’s hardly necessary to paraphrase the words, but I’m going to anyway as I warm to my theme:

You can’t be a man unless you smoke, and if you do you won’t get no satisfaction, and you’re on a losing streak.

My theme today is the news that British American Tobacco has offered $47 billion (sic) to take over another cigarette maker, Reynolds American, with the aim, apparently, of consolidating their hold on the emerging e-cigarette market which is reported to be worth $4.1 billion in the US alone in 2016. On top of that, of course, are much bigger profits to be made from the continuing sale of cigarettes.

With eye-watering figures like these, industry-watchers are all agog. And in the meantime the debate rages on, with some analysts noting a fall in sales of e-cigarettes because of consumers’ health concerns over vaping, resulting in them relapsing to using ordinary cigarettes, and so forth.

Let’s cut through all this and see what the issues really are:

Do e-cigarettes –

  1. Help smokers quit ordinary cigarettes?
  2. Result in the long-term use of cigarettes as well (dual use)?
  3. Encourage children or young people to start vaping or smoking who otherwise wouldn’t?

In addition, there are these two important questions:

  1. Are e-cigarettes safe for users and bystanders?
  2. Would the world come to an end if e-cigarettes and/or normal cigarettes were banned?

As far as I am aware, in spite of vociferous claims being made on both sides of the debate, the evidence so far is incomplete; so the short answer to questions 1, 2 and 3 is that we don’t know. To question 4 the answer is probably not – although in twenty years’ time it could turn out to be a disaster – and as for the last question I shall leave it to up to my readers.

Now let’s move on a bit further. Apart from the Rolling Stones’ lyrics, in regard to smoking and vaping the word ‘satisfaction’ occurs rather often. What does it mean?

If you’re hungry and eat a nice meal it’s perfectly understandable if you were to say you felt satisfied. But in relation to using nicotine in some form, what does it mean, if anything?

It means that before the smoker or vaper (vapeur if you’re French) smoked or vaped, respectively, he or she was feeling dissatisfied by the deficiency or inadequacy of something (as the OED puts it). The ‘something’, clearly, is nicotine. Miraculously this feeling is immediately relieved –  to some extent if not fully – by smoking or vaping, as the case may be, when the deficiency of nicotine is made up in the person’s bloodstream and brain.

Nicotine use, as I have previously mentioned, is a self-perpetuating activity: each dose results in mild withdrawal symptoms which are quickly but temporarily relieved by the next dose, and the cycle repeats indefinitely – unless you do something about it. And the something you can do about it – if you wish to be free of nicotine addiction – is to cease putting nicotine into your body by any means.

So what do people get out of using nicotine? I have asked hundreds of smokers (but not so far any vapers) this question, and these are my observations: it’s usually claimed that it’s enjoyable or helpful in some way, or both. (This is fully explained in my book, Stop Smoking: Real Help at Last, and the following is the bare outline.)

It’s often difficult for smokers to say exactly what they mean by saying they enjoy smoking. Is it the taste, the smell or the nicotine ‘hit’? What emerges is that the claimed enjoyment is illusory – it’s merely the relief of the dissatisfaction or discomfort of the withdrawal symptoms of the nicotine provided by the previous cigarette; this relief is perceived as enjoyable.

As for the helpful cigarette, this means that smokers find it appears to relieve stress or assist concentration. Again, when one looks into the matter in more detail, these are also illusory benefits; nicotine withdrawal symptoms are mildly stressful and distracting so it’s the cigarettes themselves which cause stress and thus difficulty in concentrating.

How nice it must be not to have the dissatisfaction in the first place!

Text © Gabriel Symonds