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

Inhale Poison to Stop Smoking: Official

Since I’m on the mailing list, I’ve once again started receiving notices of the forthcoming 2017 version of the so-called Stoptober anti-smoking effort put out by Public Health England (part of the UK Department of Health).

It’s not my intention to mock this campaign. Smoking is a serious problem and anything that helps people to quit is to be welcomed. However, as in previous years, the approach used lays itself open to parody.

The first message encourages me to ‘keep motivated’ to stop smoking. (I am of course a non-smoker and have signed up purely for professional purposes.)

Let’s have a look at this phrase, because it contains within it one of the many paradoxes of the current official attempts to deal with the smoking problem.

Encouragement to keep motivated suggests that smokers are in a similar position to middle-aged couch potatoes who should get off their backsides. One certainly needs motivation to overcome one’s natural resistance to exercise and start on the road to fitness.

Smokers, however, are not in this situation at all. Is the reason they smoke because they lack the motivation to quit? Is it believed that if only smokers could increase their motivation to a certain degree, this would tip the balance so they would actually quit? Most smokers have plenty of motivation already – they don’t want to get lung cancer after all – but they seem to be unable to act on it. Why is this? Insufficiency of motivation is not the problem.

Stoptober seems to be trying to persuade smokers they ought to stop, as of course they should. But is this the best way to go about it?

The sub-text is that if only smokers realised the risks they run by continuing to smoke, and if only they could appreciate the benefits of quitting, then they might be sufficiently motivated to make a quit attempt. This approach is based on logic, common sense and the need to use willpower to refrain from the apparently irresistible urge that smokers have to keep smoking. Then, with the increased motivation to be provided by the twenty-eight daily inspirational  sound-bites (or whatever they will turn out to be) of this year’s Stoptober campaign, the participants – if they can only hold out for twenty-eight days – will find themselves in the fortunate position, like the chance to be entered into a lottery, of being five times more likely to quit! This curious statement is from the Stoptober 2016 version, of which my critique can be found at: http://nicotinemonkey.com/?p=842

The next message asks, ‘Have you got a Quit Buddy?’ This means ‘Someone you can call on when you need help’. There we go again: stopping smoking is too difficult to do on your own, so you need someone to call on when (not if) you need help. How encouraging! And what is that someone supposed to do? Say ‘There, there, don’t worry, the horrible cravings and urges will soon pass! Stay strong! You can do it! Remember, if you can survive for twenty-eight days, you’ll be five times more likely to quit for good!’

Today’s message is as follows:

Have you thought about using a stop smoking aid? There are lots of aids to help you quit, including prescription tables (sic), NRT (such as patches, gum, lozenges) and even e-cigarettes. Talk to your GP, pharmacist, local stop smoking service or vape shop to find out more.

Why should a smoker need an ‘aid’ to quit? Again, the implication is that it’s too difficult to do on your own. However, the suggested aids for 2017 are not just the same old nicotine products and prescription drugs, but now we even have e-cigarettes! One way to find out about these is to pop along to your local vape shop.

This is where I must part company with Stoptober. It speaks of the ineffectiveness of the previous Stoptober campaigns (they started in 2012) that they have to throw in a new way of keeping your nicotine addiction going. And vape shop owners must be rubbing their hands in anticipation of juicy profits at this now official endorsement of their products. I think it’s highly irresponsible.

As I have said before, proffering e-cigarettes as a stop-smoking aid is misleading. For many smokers who take up vaping, it merely amounts a new way of continuing their nicotine addiction, maybe indefinitely. Whether it’s really less harmful than smoking only time will tell.  See http://nicotinemonkey.com/?p=1406

Text © Gabriel Symonds

Yummier Than Fruit

There is no doubt that e-cigarettes are big business.

The flyer I received recently about the forthcoming Vapexpo conference in Paris lists around two hundred brands of e-cigarette liquid from sixteen countries.

Promoted on the misleading meme that e-cigarettes help smokers quit, if anyone has any doubts that vaping is drug addiction by other means, they only need to look at the two-minute promotional video for a variety of e-cigarette liquid, produced in Malaysia, with the apt name of  Nasty Juice.

It opens with disconcertingly close-up and slow-motion views of a young man biting into an apple, a strawberry and a mango, in that order, while his eyes roll back in ecstasy. Then the tempo changes as he appears to be in some distress with his hands on his head and the voice-over asks, ‘What if, what if we can make it yummier?’ The answer seems to descend from heaven as, with a look of bliss on his face, he reaches up to grasp – a can of Nasty Juice! This, the voice-over intones, has ‘more flavour, more sweetness and more juiciness, just for you’. And finally the punch-line: ‘Quitting smoking cigarettes is possible than ever (sic)’.

If you wish to enjoy eating apples, strawberries or mangos, you merely need to visit your local fruit shop and buy them, provided they are in season. I often do this myself. But you would have to be out of your mind to buy synthetic chemical essences of these flavours and inhale them into your lungs. Yet this is what e-cigarette users do, and not just occasionally, which would be bad enough, but many times every day for years on end. Nasty juice indeed.

Is vaping safe? The obvious answer is ‘No’. The function of our lungs is to absorb oxygen and to exhale carbon dioxide produced by the body’s metabolism. Therefore, normally only clean air should be inhaled. E-cigarette vapour typically contains nicotine, water, propylene glycol, glycerin, flavourings and traces of heavy metals and other nasty chemicals.

How can one prove that vaping is, or is not, safe? You can’t. There is no reliable way of speeding up the process of long-term exposure to e-cigarette vapour to produce in a few weeks or months what the effects of daily vaping would be in humans after, say, twenty years. This doesn’t prevent scientists from trying, though.

There was a report in the doughty Mail Online (12 September 2017) of a study carried out by intrepid researcher Dr Pawan Sharma from the University of Technology, Sydney. The headline breathlessly informed us: ‘Vaping in pregnancy increases a child’s risk of asthma even if the e-cigarettes are nicotine free.’ In mice, that is.

Isn’t it enough on common sense grounds that vaping is likely to be bad for your health and even more so for pregnant women and their babies? But suppose Dr Sharma’s study had found no harmful effects of vaping in mice, would that mean it’s safe for pregnant women to vape away as much as they like? Obviously not – mice are not the same as humans and it’s an absurd and groundless assumption to regard animals as valid ‘models’ for human illnesses.

Dr Sharma admitted as much because, when I wrote and asked him to please tell me what is the scientific basis for believing that the results are applicable to humans, he was honest enough to reply: ‘These results can’t be extrapolated to humans right away.’

Then why did he do the experiments in the first place? Nonetheless, does he think the results might be extrapolatable (able to predict what happens in humans) in the future, and if so, when, and why? Of course I heard nothing further from this seeker after the truth.

Researchers working for Big Tobacco, on the other hand, are striving to prove the opposite: that tobacco products such as heated (not burnt) tobacco ‘sticks’ (for example, iQOS and ‘glo’) are potentially less harmful than smoking in humans. See http://nicotinemonkey.com/?p=1642. At least Philip Morris, the subject of this post, are cautious enough in their lawyerly fashion only to refer to this new-fangled way of poisoning yourself with tobacco as a potentially reduced risk product.

You can ‘prove’ anything you want with animal experiments. They should be seen for what they are: crude, cruel and useless for understanding human diseases.

Vaping should also be seen for what it is: a way of continuing nicotine addiction that it is hoped will be safer than smoking.

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Quite right.

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

Text and photo © Gabriel Symonds

B*llsh*t from Philip Morris

It’s only a rat!

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

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

So why does PMI carry out animal research?

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

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

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

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

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

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

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

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

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

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

So that’s all right then.

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

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

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

This is a mouse

and this is a man (not to scale).

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

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

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

Text © Gabriel Symonds

Top photo © Doctors Against Animal Experiments

The Great E-cigarette Confusion

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

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

Deborah Arnott:

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

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

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

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

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

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

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

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

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

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

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

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

So there. Ms Arnott please note.

Text © Gabriel Symonds

Photo credit: Wikimedia

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

How to solve the problem of smoking in pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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 addicted are you?

A little-known advantage of not smoking

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

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

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

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

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

Suppose you truthfully answer the numbered questions thus:

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

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

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

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

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

How to do this is easier than one might think.

Text © Gabriel Symonds

How to be popular

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

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

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

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

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

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

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

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

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

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

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

Are we non-nicotine users missing something?

Text © Gabriel Symonds

Feebleness, duplicity and futility

Why should you need willpower to refrain from poisoning yourself?

We do not need to read very far into the current (July 2017) edition of Tobacco Control to have demonstrated to us yet again the feebleness of the current official approach to the tobacco problem, the duplicity of the tobacco industry and the futility of academic research into smoking.

Turning over the cover of the journal with its curiously ambiguous name we arrive on the first page at an editorial headed, ‘It’s the 21st century: isn’t it past time to ban menthol cigarette sales?’ The reason for posing this question is:

Because menthol appears to make smoking initiation easier…and may be associated with greater addiction or difficulty in quitting, scientific groups have urged that policy-makers ban menthol in tobacco products.    

What these scientific groups, whoever they are, apparently fail to realize, apart from the cockeyed idea that there are degrees of addiction, is that the reason smokers are addicted is nothing to do with the presence or otherwise of menthol in cigarettes, but because they are addicted to the nicotine. It’s true that menthol cigarettes may make smoking initiation easier because it to some extent disguises the horrid taste of cigarette smoke, but if menthol were banned tomorrow, what difference would it make? Can you imagine a callow youth, foolishly thinking that smoking will make him appear more grown up, approaching a purveyor of tobacco, surveying the various poisonous products on offer and then saying to himself, ‘Nah, no menthol? Forget it!’ He would obtain somehow or other, even if underage, a packet of non-mentholated cancer sticks, likely proceed to become addicted to them (whether ‘more’ or ‘less’ addicted is immaterial) and carry on smoking for years or decades.

On to the next page, under ‘Worldwide News and Comment’, we are reminded of an appalling situation:

With over a billion deaths forecast this century if current trends continue, reducing tobacco use remains an urgent priority…(emphasis added)

Why aim only to reduce tobacco use? How many tobacco-related deaths this century would be acceptable? Half a billion? One hundred million? Why is it not an urgent priority, or even an ordinary priority, to abolish tobacco?

Then Ms Ashima Sarin and Mr Rajiv Janardhana, the authors, go on as if they are hurt in their feelings :

Despite the harm of its products, the tobacco industry continues to obstruct, delay and attempt to dilute the introduction of…measures…against the tobacco epidemic.

Of course the tobacco industry obstructs, delays and dilutes. Do they think the tobacco industry will do the decent thing and close down their factories as soon as practicable?

A more hopeful stance, however, is revealed on the same page by the news that the Danish Institute for Human Rights has recommended that ‘Philip Morris International (PMI) should immediately get out of the tobacco business’, noting along the way that:

Tobacco is deeply harmful to human health, and there can be no doubt that the production and marketing of tobacco is irreconcilable with the human right to health.

And how does PMI respond to this charge? Like this:

Acknowledging and acting on the societal harm caused by our products is central to our human rights commitment and to our vision for a smoke-free future to replace cigarettes with smoke-free products.

So that’s all right then? Well, it isn’t all right. It’s downright dishonest. Note that their acknowledgement of harm is diluted by calling it ‘societal harm’. No mention of the billion deaths this century to which PMI’s poisonous products will contribute. They merely proffer their ‘smoke-free products’ as if they’re the answer to the harm caused their ordinary ‘products’ – by which they presumably mean cigarettes. And their ‘vision’ for a smoke-free future is not a future without tobacco, but one where, at some unspecified time hence, their cigarettes will be replaced with a ‘product’ where tobacco is merely heated instead of being burned. A safer cigarette! These are already available – PMI calls them iQOS or IQOS. So what are they waiting for? Why don’t they stop making ordinary cigarettes right now?

Let’s press on through Tobacco Control to a research paper from New Zealand: Achieving the tobacco endgame: evidence on the hardening hypothesis…

I won’t bore my readers by quoting the title in full, but the intriguing neologism ‘endgame’ – which I suppose in this context means the happy state where nobody smokes anymore – appears nowhere but in the title, and by ‘hardening hypothesis’ they are referring to so-called ‘hardcore’ smokers who are ‘more addicted and less able or less motivated to quit.’ All clear?

I have already commented on the illogicality of degrees of addiction, but what do they mean by ‘less able or less motivated to quit’? Degrees of quitting ability or of motivation to quit are, likewise, nonsensical. Nonetheless, motivation is assessed by the number ‘quit attempts’ a smoker may make in a year, an ‘attempt’ being arbitrarily defined as an occasion on which a smoker has refrained from smoking for at least twenty-four hours.

All this is of no practical use whatsoever. There are only two states one can be in with regard to smoking: either you smoke, or you don’t. It is not as if motivation to quit can be increased, as this paper suggests, by greater exposure to information about the harms of smoking. The implication is that if only smokers realised the damage they were doing to  their bodies and the money they were wasting by smoking, they would all have sufficient motivation and ability to quit and, therefore, presumably would just quit.

Not to worry, because this learned six-page, five-author paper comes to a reassuring conclusion: tobacco control strategies that result in reduced smoking prevalence are not accompanied by an increase in ‘hardcore’ or ‘hardened’ smokers. What a relief!

Text © Gabriel Symonds

Danger! Never Smoke While Using Oxygen!

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

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

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

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

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

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

What, then, should be done?

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

Why, then do they do it?

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

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

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

Text © Gabriel Symonds

How many smoking deaths in the US would be acceptable?

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

Let us dissect this statement. If he wants to ‘regulate’ cigarettes, rather than abolish them, this implies there are some circumstances where smoking is legitimate or acceptable. And what, may I ask, would 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.

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

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

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

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

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

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

Splendid clichés and buzzwords abound:

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

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

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

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

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

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

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

There’s more:

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

What to do about it? This is what:

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

Plus this pie-in-the sky:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Why nearly all stop smoking websites are unhelpful

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

Readers’ Digest

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

WebMD

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

wikiHow

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

helpguide.org

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

kidshealth.org

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

Mayo Clinic

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

Medical News Today

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

1. Fear

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

2. Reminding smokers of the benefits of quitting

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

3. Nicotine patches or gum

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

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

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

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

5. Combining nicotine patches or gum with stop smoking medicine

The same objections as above apply, only more so.

6. E-cigarettes

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

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

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

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

8. Humour

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

9. Vulgarity

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

10. Willpower

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

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

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

12. Cold turkey

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

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

And the one best way to stop smoking?

Just stop!

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

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

Text © Gabriel Symonds

Philip Morris tortures animals

Yesterday

Today

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

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

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

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

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

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

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

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

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

They present themselves as the good guys:

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Stopping Smoking through Vulgarity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

 

Why not just eat a banana?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

They – Will – Cause – Death!

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

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

This is part of what he said:

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

Death or pleasure – what a choice!

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

Cancer Research UK’s failure to call for banning cigarettes

 

Why is this allowed?

As an example of the continuing official confusion in about smoking/vaping, here is a statement (9 Dec 2016) by Cancer research UK:

Harm reduction is a type of public health policy that aims to reduce the harmful consequences of substances, or actions, without necessarily reducing or eliminating the use itself. For example, condoms don’t completely eliminate the risk of sexually transmitted infections, but they reduce the risk of contracting one by about 99%. Same goes for seat belts and airbags in car accidents.

This is a false analogy. What they say about condoms, seat belts and airbags is true, but whereas sex and car transportation are normal or essential human activities, smoking is not a normal or essential human activity; it is drug addiction. And why do they say, in relation to the harmful consequences of substances, which must include smoking, ‘without necessarily reducing or eliminating the use itself’. Surely this is the whole point. Even if we allow that including the word ‘reducing’ here was unintended, and we have, then, ‘without necessarily eliminating the use itself’, why is Cancer Research UK apparently not concerned about eliminating ‘the use’, that is, smoking itself?

Again, they patronisingly say, ‘E-cigarettes aren’t 100% safe. But very few of the things we do each day, or the products we buy, carry no risk at all.’ This is the same false analogy in different words. Using e-cigarettes – an unnecessary and pointless substance addiction – cannot be compared with ‘the things we do each day, or the products we buy [in the course of normal human activities]’.

The conclusion is: ‘The evidence is showing e-cigarettes can help beat the tobacco epidemic. And when they have the potential to save millions of lives, should we just sit back and wait?’

Of course we should not just sit back and wait. But if they are so confident that the evidence shows e-cigarettes can help to beat the tobacco epidemic and have the potential to save millions of lives, why has it apparently not occurred to them that tobacco should be banned at the same time?

Note the emotional appeal: ‘save millions of lives’. It is not as if we are talking about  normal unavoidable risks, such as riding in motor cars or using ladders to change light bulbs. Smoking is a voluntary activity and the millions of lives that are at risk from this cause could be saved by smokers merely ceasing to smoke. So if Cancer Research UK believes the way to do this is for smokers to change their way of obtaining nicotine to e-cigarettes, it implies that they think nicotine addiction in some form or other is part of normal human life.

Another view of the unnecessary and pointless difficulties that are unwittingly put in the way of people wishing to stop smoking, in spite of the best intentions of stop smoking counsellors, is shown in a film put out by Cancer research UK, called ‘Trying to stop smoking – Brian’s story’.

Here, in the first word of the very title of the film, ‘Trying’, we have a spotlight on the wrong-headed orthodox approach to smoking cessation. I have argued before there is no such thing as trying to stop smoking; there is only failing to stop. See, for example, these blogs:

http://nicotinemonkey.com/?p=1435 and  http://nicotinemonkey.com/?p=683.

Brian tells us he’s forty-nine years old and has been smoking for about thirty years. He wants to stop because he’s afraid of dying prematurely. What stronger reason to quit could one possibly have? He’s tried (that is, failed) to quit about four times, but he just gave in, he says. Now he’s decided to access his local stop smoking service. They provide support from a trained advisor. So far so good. But now ‘[the clients] get their choice of stop smoking medication.’ Already we have reinforcement of the difficulties of stopping: it’s so hard to quit you need a drug to help you, for goodness’ sake! He’s going to take a drug called Champix which ‘blocks the nicotine receptors in the brain’. So there should be no problem then? Brian says, ‘Tomorrow’s the quit date. I shall have my last cigarette. The Champix – I’ve been on it six or seven days now, you can really feel it working – I feel ill.’  This is actually what he says.

Then the following encouraging words appear on the film: ‘The stop smoking services give you the best chance of stopping smoking, but it’s still hard and only half of people succeed.’ Brian continues: ‘When I woke up this morning I really, really needed a cigarette, but after a while I just forgot about it.’ Yes, that’s the point: if you have the right attitude you can just forget about smoking – without the need to feel ill from Champix. Then he has the carbon monoxide level in his breath measured – and it had gone right down after one day of not smoking. Wonderful – if entirely predictable. Next, he tells us he’s feeling ‘Kind of rough. Absolutely dying for a (expletive deleted) cigarette…is it working? No…The last four weeks have been pretty stressful.’ Nonetheless, his final words are that the counselling and the drug have ‘given me an extra chance…I feel good…Yeah.’ Let’s wish him luck to resist any temptation to smoke again.

Now, consider Brian’s struggle to give up smoking and his taking of a drug that made him feel ill to achieve this aim, to say nothing of the possible harm he has already done to himself by smoking for thirty years: what more does Cancer Research UK need to call for an outright ban on tobacco?

Text © Gabriel Symonds

Exploding e-cigarettes

Why bother with all this?

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

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

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

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

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

Also, note this:

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

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

The unfortunate Ms Williams takes up the story:

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

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

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

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

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

Now note this:

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

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

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

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

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

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

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

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

Pt:  Yes, of course I would.

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

Pt: I’ll think about it.

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

Text © Gabriel Symonds

Ooh! Ain’t it Wonderful!

Is smoking harmful, or isn’t it? Or is it, perhaps, good for you? In particular, the weighty question needs to be considered: is there any connection between passive smoking (breathing cigarette smoke-polluted air produced by other smokers) and dementia?

A headline in an online publication called ‘Care Appointments’ says: ‘[The University of] Wolverhampton secure (sic) funding to assess impact of passive smoking on dementia.’

Specifically, £153,976 – a nice round figure – has been secured to study the ‘Impacts of Environmental Tobacco Smoke on Incidence and Outcomes of Dementia’. The study will be led by one Professor Ruoling Chen from the University’s Faculty of Education, Health and Wellbeing, no less.

The plan, it seems, is to study groups of old people with and without dementia to see whether passive smoking increases the risk of getting it, and, if someone is unfortunate enough to suffer from dementia, whether passive smoking makes the course of the disease better or worse. Of course it is possible, though I doubt it, they may find that passive smoking is protective against dementia or that dementia patients fare less badly as a result of cigarette smoke exposure.

I can tell you now that this study will be a complete and utter waste of time – to say nothing of a waste of £153,976. Here’s why:

Whatever Professor Chen and his colleagues discover, what are they going to do with the result? If passive smoking is bad for dementia we shall have yet another reason to add the already existing numerous compelling reasons for stopping smoking, and, indeed for banning tobacco. And in the extremely unlikely event that they find smoking is good for dementia, what then? Should  everybody consider taking up smoking to prevent dementia or reduce its severity?

The opportunities for research of this kind are endless but we already know more than enough about the harmful effects of smoking. The £153,976 would be better spent on lobbying for the cigarette factories to be closed down.

Text © Gabriel Symonds

How to smoke without smoking!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds