Tag Archives: Tobacco Control

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

How Not to Stop Smoking – Part III

In the Tobacco Control Industry three unhelpful concepts regularly crop up in learned articles in scholarly journals. Or scholarly articles in learned journals.

Trying to give up

This is the idea which is derived from the common response people give if asked whether they smoke. If they do, they’re likely to say, ‘Yes – but I’m trying to give up.’

It’s the classic head-heart conflict. All smokers, if they’re honest with themselves, wish they didn’t smoke. This is the head or logical part. But for some reason they seem to have an almost irresistible desire to keep doing it – the heart or feeling part. They may try to justify it to themselves by saying they enjoy smoking, it helps them relax or that it relieves stress – the enjoyable or helpful cigarette. But if one looks into these proffered reasons, even a cursory enquiry will show they don’t make sense: they’re rationalisations or attempts at justification.

Incidentally, why should a smoker need justification or an excuse to smoke? And to whom is it directed? To the smokers themselves, their loved-ones or society in general? The fact that a smoker appears to need justification or an excuse for smoking merely points up the conflict.

If a smoker says, ‘I smoke – but I’m trying to give up’, what this really means is that the smoker is failing to give up, and this is demonstrated every time her or she lights another cigarette.

What does ‘trying to give up’ or ‘making a quit attempt’ mean anyway? These phrases are commonplace in the medical and specialist smoking cessation literature and what they seem to mean are merely the smoker saying that he or she is trying to give up or is making a quit attempt. One can even read about smokers who are ‘thinking about making a quit attempt’.

The whole idea of trying to quit or making a quit attempt should be seen for what it is: not as the expression of a desire to quit smoking, but as a statement of an intention to continue. Such expresions, therefore, are meaningless. You don’t need to try to quit smoking; you just need to quit! It’s the ‘trying’ that’s the problem. Those who stop, stop; those to try, smoke.

Worse, it plays along with the mind-set of many smokers who in their heart of hearts don’t really want to give up smoking. But if they can delude themselves that they’re ‘trying’ to quit, it lets them off the hook – they can carry on for a bit longer, or a lot longer. This is doubly unfortunate because it also reinforces the illusion which many smokers have that there’s something enjoyable or helpful about smoking, so they have a reason for putting off the evil day when they take the plunge and actually quit.

Not yet ready to quit

A related concept is the idea of being ready, or not, to quit smoking: ‘I smoke – but I’m not yet ready to quit.’ So that’s all right then!

In their heads, all smokers wish they didn’t have to go through life poisoning themselves with tobacco smoke, but in their hearts they find it more comfortable to carry on, at least for the time being. So they’re always looking for an excuse, even if they don’t admit it: ‘I want to give up – but not now, not yet, I’m not ready.’

The reality is that smokers in a sense will never be ready to quit – that’s why they’re smokers. Of course, many smokers do quit and one can then say that they were ready at this point, but it’s stating the obvious. It’s the ‘not yet’ part, like the ‘trying’ part of quitting, that’s the problem. Those who are ready, quit, and those who aren’t, smoke. For many smokers the idea of readiness really means the lack of it: an excuse to continue smoking.

Further, the idea of readiness is reflected in the common advice that one should ‘prepare’ to quit. Nearly all stop smoking methods will tell you to pick a date in the near future when you intend to quit. I have posted a blog previously on why this is a bad idea. http://nicotinemonkey.com/?p=377

Way, method, technique or process of quitting

Another unhelpful idea in smoking cessation is mention of a method or technique or way to do it. These usually involve nicotine products, prescription drugs or gimmicks such as hypnosis, acupuncture, magnets in your ears or even laser treatment. This is curious. Why should you need a technique to stop doing something?

Similarly, many smoking cessation so-called experts talk of quitting as a process or journey. It’s no such thing. You stub our your last cigarette – and you’re in a new state or situation: the happy one of being, and remaining, a non-smoker.

There are further problems with the view that you need a way or method or technique to quit smoking. As with notions of ‘trying’ (that is, failing) or of being ‘ready’ (or not) to quit, as well as reinforcing the fear that quitting is terribly hard, it provides a built-in excuse for failure. The smoker can say, it – the technique, method or whatever it was – didn’t work! Further, it ties in with the smoker’s mind-set, though this may not be consciously admitted, that they don’t really want to quit, so again they can blame the technique or method for their failure to quit, if they fail.

A better way

Smoking cessation research should look into the psychological aspects of successful quitting. How did smokers do it who stopped abruptly and didn’t start again? How is it a smoker can go on an intercontinental flight without difficulty yet on the ground has a strong desire to smoke every forty minutes?

What will be discovered is that those former smokers who put their mind to it, didn’t need will-power to refrain from what they no longer wanted to do and thus had no difficulty thenceforth in ceasing to poison themselves with tobacco.

Text © Gabriel Symonds