The perfect ‘product’ for nicotine addiction

The US Food and Drug Administration (FDA) recently announced it has awakened to the interesting idea that the way to help people quit smoking is for them to have a wider range of ‘products’ available in addition to so-called nicotine replacement therapy (NRT).

The FDA recognises that NRT (nicotine-containing gum, patches and lozenges) is of limited effectiveness and so it now wants the smoking public to have access to more options, in particular, e-cigarettes. Further, it wants to have NRT and e-cigarettes approved as medical products and possibly even have them covered by health insurance.

Let’s pause for a moment to consider this curious situation. In the US cigarettes are freely and legally available for sale to anyone over 18 (21 in some states). As a result many people become addicted to smoking and because of this there are about 480,000 deaths from smoking-related diseases in the US every year. And the way the government is trying to deal with this is that when people are already addicted to the nicotine in cigarettes and find it difficult to stop smoking, they should be offered nicotine in some other form as a ‘therapy’ to help them. But because NRT doesn’t work very well they need to have other products or options available as quit smoking aids.

Isn’t there something a bit odd about this? Either nicotine-containing consumer products (especially cigarettes) should cease to be available, in which case the problem wouldn’t arise for those who don’t yet smoke, or we need a radical new approach to treating nicotine addiction for those already in this unfortunate position.

It gets worse. The FDA is contemplating new measures that would enable cigarette companies to get non-cigarette nicotine-containing products approved as medicines to treat the nicotine addiction that their primary product, cigarettes, caused in the first place.

Big Tobacco must love this. They can present themselves as part of the solution to the smoking problem – a win-win situation for them because they can anticipate their income will be protected as sales of cigarettes fall while sales of alternative nicotine products rise. This might just about be acceptable if they were to announce, for example, that at the stroke of midnight on 31st December 2020 all cigarette production in the US will cease. Of course they won’t commit themselves – any suggestion of phasing out combustible tobacco products is projected to some vague time in the fairly distant future.

Tobacco companies should be seen for what they are: the whole of the problem. And the only role they can have solving it – and it would be a very big role which would virtually eliminate the problem – would be to stop making cigarettes.

Instead of pushing for this obvious measure, or even mentioning it, the FDA Commissioner, Dr Scott Gottlieb, verbosely talks about ‘what we can do to create additional pathways to bring additional nicotine replacement therapies to the market’.

By the time smokers are addicted to nicotine it’s too late. Dr Gottlieb is pursuing a non-existent goal. You have to remove the cause of nicotine addiction, not treat it when it’s happened. Why aren’t smokers clamouring for relief, for a ‘product’ or even for a range of options to help them escape their thraldom to nicotine?

Because the tragedy of nicotine addiction is that many sufferers don’t want to escape.

Text © Gabriel Symonds

How to quit smoking the hard way

I have written before about the American Cancer Society’s efforts to scare people into quitting smoking (29 April 2016 http://nicotinemonkey.com/?p=293). This august organisation appears again in connection with the so-called Great American Smokeout, an annual event in November. It’s worth looking at the current offering in a little more detail.

There’s a film titled: ‘Smoking Cessation – 3 Steps to Quitting’. (The word ‘Cessation’ would be better omitted.)

The object seems to be to get smokers to quit through fear: the word ‘cancer’ occurs in spoken or written form in this short film (it’s just over three minutes) no less than nine times.

Everything about this film is a demonstration of how to quit smoking the hard way. It starts by mentioning what smokers already know: that if they quit they’ll feel and look better and their risk of cancer will be less.

Here’s a brief excerpt of the script with my comments:

It’s hard to quit smoking

It isn’t, if you go about it in the right way

It can take several tries to stay quit

The concept of trying to quit is meaningless – you either smoke or you don’t.

What is important is that you learn from each attempt so that you can plan better for the next.

Even if we accept the idea of a ‘quit attempt’, what is there to learn? All this means is you have merely failed to quit, so now what do you do?

There’s no one right way to quit.

But there is. You just stop!

There are three steps that lead to quitting for good. First, make the decision to quit and set a quit date.

This is counter-productive and I explained why in my post of 10 May 2016 (http://nicotinemonkey.com/?p=377). In any case, there’s only one step that leads to quitting for good. You make the decision to quit and – that’s it! You never smoke again. If you make a decision to quit but put it off for, say, the next three weeks, you haven’t ‘made a decision to quit’ – you’ve decided to carry on  smoking. And what’s going to be different in three weeks’ time?

Second, make a plan to manage your day without smoking. Smoking is likely a big part of your daily life and activities, so your next step should include a plan for how to manage your day without smoking.

Why do you need such a plan? If you stop smoking you just carry on with all your normal activities without smoking.

Think of the different things you can do instead of smoking that can help you manage cravings.

Here we go again: you’ll have ‘cravings’ that will need to be ‘managed’. As already mentioned, you don’t need to do different thing instead of smoking: you just carry on with your normal activities.

Some of these might include exercising, getting out the house for a walk or visiting a local park, chewing gum or hard candy, relaxing with deep breathing or meditation…

It would be rather uncomfortable chewing on hard candy. And do you really have to go the trouble of learning meditation in order to stop smoking?

Finally, talk to your doctor or pharmacist about your decision to quit. They can provide counselling and discuss other options like medications to help you quit. Studies show that you have a much greater chance of quitting when you get support.

Now we come to the point. Why would you talk to your doctor or pharmacist unless you were seeking a prescription drug or an over-the-counter medicine, respectively? You don’t need medications to help you quit – you just need to quit!

You may also want to talk to your doctor about a screening test that can detect lung cancer early – a low-dose CT scan. It is a fast and painless test that can find early stage lung cancer when it is more easily treated.

Apart from being scary, this is controversial: there’s no proof that such screening saves lives even in heavy smokers. One of the problems is that if the screening shows the all-clear, the next day a cancer might start to develop.

Curious that in all this there’s nary a word about why people smoke: nicotine addiction.

Text © Gabriel Symonds

The painting is ‘Morning Coffee’ is by Atanas Matsoureff

Big Tobacco bashing

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

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

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

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

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

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

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

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

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

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

Give him a big hand for pointing out the obvious.

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

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

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

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

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

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

Text © Gabriel Symonds

Cruel, unnecessary, shameful

Jane Goodall and friend

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

This is an extract:

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

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

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

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

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

Why are some individuals vulnerable to addiction and others not?

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

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

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

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

The scientists and leaders go on:

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

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

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

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

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

In reply to this charge they say:

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

So that’s all right then.

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

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

That word is: repulsive.

Text © Gabriel Symonds

Oyez! Oyez! Learn to love your lungs!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Four Professors and a Counterfactual

All the fun of the fumes

The long-windedly titled The National Centre for Smoking Cessation and Training (NCSCT) recently produced a video called E-cigarettes safety: The facts explained.

The trouble is that there are precious few facts available at the moment; but there are plenty of opinions.

The film features four Professors who are well known e-cigarette enthusiasts and a layman, Clive Bates, Director of Counterfactual Consulting, whatever that is.

The OED, interestingly, defines counterfactual as ‘Pertaining to or expressing what has not happened or is not the case’ which perhaps explains Mr Bates’s view as stated in the film.

First let’s hear from Professor Linda Bauld, a behavioural scientist, no less:

We know from studies that nicotine is relatively safe.

What studies? What does she mean ‘relatively safe’?

Next we have Professor Robert West, a psychiatrist:

They (e-cigarettes) don’t use tobacco at all.

This is almost true, except that the nicotine in e-cigarettes is derived from tobacco.

Then Ann McNeill, Professor of Tobacco Addiction, explains:

Most things we do in life carry a risk. So, for example driving cars. Cars cause lots of road accidents, lots of people killed on the roads. But we don’t stop people driving. We try to make them (cars) less harmful.

This is a false analogy. Driving is a normal and essential human activity whereas smoking and vaping are not normal activities; they are undertaken only by drug (nicotine) addicts.

Finally we have Professor John Britton, an epidemiologist:

If we try to put a figure on the relative risk of e-cigarettes compared to smoking, my view is that it’s going to be well under 5 per cent of the risk…so we can be confident that electronic cigarettes are much less hazardous than tobacco cigarettes.

His view? How can we be confident? Just because he says so?

Then he makes a curious statement:

Where their safety lies relative to not using anything is much harder to place.

This is nonsense. Obviously there is no risk at all in not using anything, compared to using  cigarettes or e-cigarettes.

He does at least say something sensible – up to a point anyway:

Inhaling a vapour many times a day for decades is unlikely to come without some sort of adverse effect…It would be better avoided, but from the smoker’s perspective it is a far better bet than carrying on smoking tobacco.

A bet? So it’s all a matter of chance? He doesn’t seem to know what his point of view is.

Back to Professor West:

E-cigarettes are substantially less harmful than cigarettes and the reason that we can reasonably infer this is because of the concentration of chemicals that are in e-cigarette vapour compared with the chemicals that are in cigarette smoke.

So he goes from asserting that e-cigarettes are substantially less harmful than ordinary cigarettes to saying that it’s something we can only reasonably infer.

Professor McNeill again:

Flavourings are necessary for electronic cigarettes because people wouldn’t use them if they didn’t have some sort of flavours added. We need to entice smokers to use electronic cigarettes.

Does she realise what she is saying? How about enticing smokers to stop smoking and stop using nicotine in any form?

Professor West:

Some concerns have been raised about…the risks [of] flavourings in e-cigarette vapour…these are flavourings that have been tested and the concentrations are sufficiently low that we wouldn’t expect them to pose a significant health risk.

More opinion, supposition and guesswork. What if his expectations are wrong?

Professor Britton:

The propylene glycol…in electronic cigarette fluid…is used to make theatre fog, it is mildly irritant to the airways but is doesn’t seem to have any lasting long-term effects.

More guesswork. For how long and how often are people exposed to theatre fog? When did you last attend a theatre when there was fog?

He adds:

Glycerol [also present in e-cigarette vapour], likewise, is widely used in food. And again there’s no evidence or reason to expect it will have a significant long term effect on the airway.

Yes, it’s eaten in foods, but this is a different matter entirely from it being inhaled into the lungs!

And continues:

There is evidence that if you [are in a] room with somebody using one of these products (e-cigarettes) that there is nicotine and perhaps other chemicals in the atmosphere around you but at tiny levels. Levels not to be concerned by at all.

How does he know? What is the evidence? I would be concerned about unnecessary eposure to any levels of poisons.

Then he says:

I think if you’re in an enclosed space and somebody’s breathing out clouds of vapour that’s just unpleasant and it’s intrusive and it’s discourteous.

Quite.

Professor McNeill has an extensive list of publications to her name but has she actually treated any smokers? One wonders, when she makes statements like this:

The most effective way of quitting is to use a medication such as nicotine replacement therapy or it could be electronic cigarettes combined with behavioural support.

What does she mean ‘the most effective way of quitting’. Smokers who quit without medication or e-cigarettes combined with behavioural support haven’t done it effectively?

Professor West again:

E-cigarettes [are] there for people who…just want to go out to a shop and buy a product which they can use to stop smoking without seeing a health professional.

Why do you need a ‘product’ to stop smoking? Why not just stop?

And what does our counterfactual consultant have to say?

E-cigarettes [are] an alternative to smoking.

You don’t need an alternative to smoking!

Professor Britton:

E-cigarettes…normalise electronic cigarette use.

That’s the trouble!

And if we could normalise electronic cigarette use for the nearly nine million people in the United Kingdom who are still addicted to tobacco that could only be good thing.

A good thing for whom?

This is a product that can transform health…health-wise [smokers] achieve pretty much what they’d achieve if they quit smoking completely.

A huge assumption.

Do we really want to have millions of people sucking on e-cigarette drug delivery devices many times every day for years on end to gratify their nicotine addiction?

Text © Gabriel Symonds

A relaxed smoke in comfortable, modern facilities

For smokers who have occasion to visit Frankfurt Airport there is good news – and for non-smokers too – we are told by the online The Phoenix Newspaper, 7 November 2017:

Good news for smokers and nonsmokers (sic) alike: two more smoking lounges have just been added…at Frankfurt Airport. These comfortable, modern facilities are ideal for getting away from the hustle and bustle and enjoying a relaxed smoke…Nonsmokers benefit too, because the lounges are equipped with powerful ventilation systems that prevent any smoke from escaping into the rest of the terminal building, including the directly adjacent areas.

How are non-smokers supposed to benefit from this development? At Frankfurt Airport smoking is already forbidden except in designated areas. So only smokers will benefit, if you can call it that, by having more places in which they are allowed to inhale tobacco fumes and thereby top up their nicotine levels.

It reminds me of days gone by when aircraft had smoking and non-smoking seats. I used to travel between Japan and England regularly and would remind my travel agent that I required a seat in the non-smoking section. Then I would add a further request: ‘And please put me as far away as possible from the smoking seats!’

This hardly made any difference though, because on aeroplanes the air is recirculated and on a smoking flight one would be forced to breathe dilute second-hand tobacco smoke. Thus I would arrive at my destination suffering from mild bronchitis and conjunctivitis. Once I wrote to the head of British Airways asking him to consider make their flights entirely non-smoking. I received the lame reply that their policy was to follow public trends, not set them.

Now, in Germany it seems smoking is regarded in some quarters as a normal human activity. But these new smoking lounges at Frankfurt Airport are good news neither for smokers nor non-smokers.

No matter how powerful the ventilation system in smoking lounges may be, it cannot prevent the stink of stale tobacco smoke being noticeable and unpleasant near the entrances. (See my earlier post on this matter: http://nicotinemonkey.com/?p=1124.)

And what about the poor cleaners who have to go into these places to remove cigarette  litter and be exposed to second- and third-hand smoke? (Third-hand smoke means the poisons emitted from burning cigarettes which adhere to the surfaces of the seats, tables and walls.)

It’s not even good news for smokers because it merely assists them to continue to be in thrall of their addiction. And it’s nonsense to talk of ‘These comfortable modern facilities are ideal for getting away from the hustle and bustle and enjoying a relaxed smoke.’

The Phoenix Newspaper has got it wrong: smokers don’t enjoy smoking, though they may think they do, and smokers are never relaxed – particularly before boarding a flight.

Smoking should be forbidden everywhere inside airport terminal buildings. At Heathrow, for example, smoking is only permitted in designated areas outside the terminal building; they don’t look very comfortable – and, I might add – nor should they be.

It’s not as if smokers are discriminated against, although they may feel they are, by having to go outside to smoke. They discriminate against themselves – by their compulsion to keep inhaling poisonous tobacco smoke. Should airports facilitate this behaviour?

Those who run airports may say it’s not their place to try and reform smokers, but why do they have to provide modern comfortable facilities for them?

Let’s suppose the powerful new ventilation system in Frankfurt Airport’s comfortable modern smoking lounges is completely successful in preventing the slightest whiff of tobacco fumes seeping into the surrounding areas and further, that these powerful new ventilation systems prevent any third-hand smoke poisons from adhering to the surfaces within the lounges. In such an imaginary scenario, are people who are not nicotine addicts, that is, normal people or non-smokers, supposed to feel grateful for the wonders of modern ventilation technology?

The implication of Frankfurt Airport seems to be that the default position is that non-smokers (and if we were talking about cocaine addicts, are people who are not addicted to cocaine referred to as non-cocaine users?) should have to accommodate or put up with the needs of nicotine addicts and if they can’t avoid cigarette fumes in public places should just shrug their shoulders and hold their noses.

This is indeed what normal people are expected to do in all the German cities I have visited, where smokers regularly congregate outside buildings. It’s not just the stink, but it’s actually dangerous because exhaled tobacco smoke contains many poisonous chemicals.

And what comeback do normal people have against nicotine addicts? If annoyed by someone smoking are they supposed to approach the perpetrator and say, ‘Excuse me, does my non-smoking bother you?’

To change the widely held perception of the normality of smoking, I propose that the term ‘non-smoker’ be abandoned. Henceforth there should be an explicit distinction between those who ‘use’ nicotine and those who don’t. The former should be known for what they are – nicotine addicts – and referred to as such, whereas those who are not in this predicament should be called normal people.

Text © Gabriel Symonds

The attempt and not the deed, Confounds us

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

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

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

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

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

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

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

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

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

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

They claim that

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

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

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

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

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

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

Text © Gabriel Symonds

(The title is from Macbeth.)

Further up the garden path

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And when the characterisation is complete, then what?

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

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

So that’s all right then.

Text © Gabriel Symonds

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Blame the government if you can’t stop smoking!

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

Pondering the Wafting of the Fumes

 

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

How not to solve the smoking problem

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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 consider just the title: why is it merely Smoking Cessation in Pregnancy and not Smoking Prohibition in Pregnancy?

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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, I wonder, might those be? Then he wants the regulation, such as it may turn out, to encourage the development of new tobacco products that may (or, presumably, may not) be less dangerous than ordinary cancer sticks.

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

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

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

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

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

Instead, the envisioning goes on to:

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

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

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

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

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

Text © Gabriel Symonds

Out with ASH – in with CAT!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds

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

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

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

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

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

Splendid clichés and buzzwords abound:

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

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

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

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

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

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

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

There’s more:

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

What to do about it? This is what:

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

Plus this pie-in-the sky:

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

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

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

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

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

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

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

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

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

Text © Gabriel Symonds