Tag Archives: ASH

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

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

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

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

Exploding e-cigarettes

Why bother with all this?

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

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

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

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

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

Also, note this:

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

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

The unfortunate Ms Williams takes up the story:

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

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

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

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

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

Now note this:

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

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

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

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

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

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

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

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

Pt:  Yes, of course I would.

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

Pt: I’ll think about it.

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

Text © Gabriel Symonds

Controlling Tobacco with Horrible Pictures

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

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

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

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

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

 The flim ends with the written statement:

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

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

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

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

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

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

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

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

It goes merrily on making and selling cigarettes.

Text © Gabriel Symonds

Calling out Philip Morriss

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

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

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

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

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

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

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

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

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

Then we hear from Deborah Arnott of ASH:

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

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

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

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

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

Text © Gabriel Symonds

Sitting on the ASH tree fence

‘Action on Smoking and Health’ (ASH) is a charity set up by the Royal College of Physicians of the UK. It’s supported by those worthy bodies, the British Heart Foundation and Cancer Research UK.

ASH’s website informs us that it’s ‘a campaigning public health charity that works to eliminate the harm caused by tobacco.’ So far so good. But then they say their approach is ‘To press for policy measures that will reduce the burden of addiction, disease and premature death attributable to tobacco.’ (Emphasis added.)

Well, which is it? Do they aspire to eliminate the harm caused by tobacco or only to reduce it? Even the first-stated aim is ambiguous. Do they seek just to eliminate the harm but leave the tobacco in place – implying the possibility that harmless types of tobacco or a safe way of using it could be developed – or get rid of the tobacco itself?

They are then quick to point out: ‘We do not attack smokers or condemn smoking.’ Why the defensive tone? Has anyone said they do attack smokers or condemn smoking?

This is sitting on the fence. You can’t have it both ways. They need to be a bit more – how shall I put it? – Trumpian.

I wouldn’t attack smokers either – it’s not their fault that they’re nicotine addicts; but I do condemn smoking. Or rather, I condemn the situation that’s resulted in there being a billion smokers in the world today, or if one takes a more parochial view, the unfortunate fact, according to ASH, that there are 9,600,000 adult smokers in Britain. In this sense I think the UK and other governments have a lot to answer for: knowingly allowing for about the last fifty years a useless and unnecessary addictive drug in the form of dangerous cigarettes to be freely available. And maybe the reason for this is that in 2014-15 the UK government received £9.5 billion in revenue from tobacco tax (excluding VAT) although it spent a trifling £87.7m on services to help people stop smoking and a further £58.1m on stop smoking medication in 2012-13, according to ASH.

Just to see this in context, again using ASH’s figures:

Every year, around 96,000 people in the UK die from diseases caused by smoking.

It hardly needs to be said, but I’ll say it anyway: this is a shocking, scandalous and unacceptable situation.

Apart from the lack of clarity noted above, what is ASH trying to do about helping smokers to quit? From their fact sheet of September 2014 it’s interesting that although the key to easy quitting is within their grasp, they don’t seize, preferring to follow the conventional approach:

Smoking feels pleasurable, but much of the pleasure of smoking is actually relief from nicotine withdrawal. Soon after smoking a cigarette the body starts to crave nicotine and many smokers will feel increasingly uncomfortable until they have the next cigarette. Smokers often report feeling distracted or unable to enjoy themselves when they are not able to smoke…some smokers find it challenging to give up nicotine because it is a powerful and addictive drug.

This is along the right lines, but it’s not quite there.

The reason smokers find it hard to quit is psychological: the withdrawal symptoms are not that bad, but smokers are afraid that the discomfort will become intolerable. In reality the opposite will happen: the discomfort of the withdrawal symptoms is temporary and it will go away.

What ASH recommends, in common with almost everybody else, to get over the ‘cravings’, is:

…nicotine containing products such as patches, lozenges, inhalers, and/or gum [and] there is also some evidence that electronic cigarettes are effective as quit aids. The idea is to wean yourself off nicotine by gradually reducing your intake until you don’t need it any more.

Worse, they then encourage smokers to:

Find a temporary substitute habit. Smoking a cigarette gives smokers something to do with their hands or mouth. The popularity of electronic cigarettes may, in part, be due to their satisfying this need. Alternatively, you could chew gum, drink more water, fruit juice or tea, or eat something.

This is absurd. You don’t need a substitute, temporary or otherwise, for smoking. The rest of this advice contradicts what they’ve already said: nicotine is a powerful addictive drug – it’s nothing at all to do with satisfying a need to do something with your hands or mouth.

The emphasis on finding a substitute for smoking and weaning yourself off nicotine gradually is counter-productive. All that the smoker who wants to quit needs to do is to cease putting nicotine in any form into his or her body. And the withdrawal symptoms – renewed each time by another dose of nicotine in any form – will go away for good.

Text © Gabriel Symonds