World Expert on Smoking and Addiction Nicotine Monkey

With such a billing, who might this be?

It’s Professor Robert West, a psychologist and self-styled world expert on smoking and addiction who thinks unless e-cigarettes are made available we’re condemning smokers to death (BBC interview, April 2014).

He published a book in 2013 with the intriguing title The SmokeFree Formula, A Revolutionary Way to Stop Smoking Now. Always keen to learn more about helping people to stop smoking, I bought a copy. But there’s nothing revolutionary about his approach – it’s entirely conventional.

It rambles on for 246 pages and is full of unnecessary words, tautologies, and repetition.

Acknowledgements are made in a chapter headed ‘Thanks Go To…’ Why not ‘Thanks To…’ or simply ‘Acknowledgements’? Now he really gets into his hyperbolic stride: ‘I am deeply grateful to…’ (I am grateful to…); ‘Grateful thanks to…’ which occurs twice. (Thanks to…) Significantly, he expresses his grateful thanks to ‘several pharmaceutical companies that develop and manufacture smoking cessation treatments for their financial support.’ At least we know his potential conflicts of interest.

Let’s move on to the Introduction. There’s a subheading: ‘Read This First’. Introductions, if they’re read at all, are generally read first. That’s why they’re called Introductions.

Unfortunately, this introduction, which you’re urged to read first, is discouraging to would-be quitters because it emphasises the difficulties they’ll face:

Being bad-tempered is a classic symptom of nicotine withdrawal…There are so many things that could go wrong…incessant cravings…When the going gets tough…

Unnecessary words: ‘By opening this book you have taken a huge stride to giving up smoking forever.’ (…you have taken a stride to giving up smoking.); ‘I’ll then show you how you blend these ingredients together into your own personal formula to be free of smoking forever.’ It sounds like a cookery lesson, but presumably he means to say: I’ll then show you how to create a personal formula to be free of smoking. Still with the cookery theme, lack of editorial vigilance is evident: ‘What ingredients you choose to use is [sic] entirely up to you.’ (The ingredients you choose are up to you.)

Professor West even bizarrely advises:

You can think of stopping smoking as like [sic] looking for love

How can you compare a desire to stop poisoning yourself with tobacco fumes with looking for love? He uses this inappropriate analogy to mean that you should keep trying till you succeed, but why rub it in that it’s likely to be so difficult?

At one point he even starts to sound like Jesus:

I want this book to be the best investment you ever make. I want you to be healthier, happier and have more money…I want to join you in your journey to a better life and be there to help you along the way…I will be with you for as long as it takes.

One might find something like this in Pseuds Corner in Private Eye (the British satirical magazine).

Reading the first chapter, called ‘Understanding Why you Smoke and Find it Hard to Stop,’ Professor West’s approach emerges. He’s done research using questionnaires in which smokers are asked why they smoke and whether they often smoke in certain situations. Also, his team devised the ‘Mood and physical symptoms scale questionnaire’. In this, his subjects are asked, while smoking and when they’ve stopped, to rate their feelings over the previous twenty-four hours in terms of depression, anxiety, irritability, restlessness, hunger, poor concentration, poor sleep at night, sores in the mouth, constipation, and cough/sore throat. With such leading questions the idea is reinforced that these are symptoms smokers trying to quit might indeed experience.

He does say one sensible thing: ‘Your brain has got used to nicotine and is now experiencing withdrawal symptoms because your nicotine level is falling.’ However, curiously, this idea is developed into the theory that ‘nicotine has trained that part of your brain that gets you to do things to light up a cigarette whenever you find yourself in a situation where you would normally smoke.’ And the reason this happens, he says, is that nicotine indirectly causes dopamine to be released in your brain ‘which acts as a kind of reward’ and ‘It is this dopamine release that attaches the impulse to smoke to whatever situation you happen to be in when you normally do it.’ All clear?

One wonders what sort of reader is being addressed by a style of writing like the following:

These nerve cells need to talk to each other…Nicotine is like a cuckoo in the nest…your brain is being taught to sit up and beg for nicotine…smoking a cigarette is a bit like eating food when you are hungry, drinking when you are thirsty, telling a funny joke (Would you tell an unfunny joke?)…This chemical is called acetylcholine. (Don’t worry, I’m not going to test you on these names later!)…the bit of your brain that is giving you the urges to smoke is not the clever part. It’s the stupid part.

The discouragement continues:

Nicotine…has changed your brain chemistry to create powerful urges to smoke…you will have to show self-control…exert self-control and fight off the urge to smoke…you still need willpower…you start to feel a whole load of unpleasant symptoms when you can’t smoke…nicotine withdrawal symptoms come on very quickly and they are not pleasant.

And so on, and on.

Two chapters are dumbed-down lessons in the psychology of smoking and addiction, respectively. Among other gems, the author discretely mentions, ‘Since you are so engrossed in my lesson in psychology…When I was first at university it took me a year to discover I didn’t really like staying up all night and partying.’ Well, fancy that! A hint of doubt on this confession does seem to creep in since he asks the reader, and presumably himself, ‘What am I saying here?’ Indeed. The introspective vein continues in the next chapter, ‘Why do you Want to Stop Smoking?’, opening with: ‘I’ve talked a lot about how nicotine keeps you smoking.’ Yes, he has.

Let’s move on to Part Two, subtitled with our now familiar cookery theme, ‘The Ingredients’.

The reader is told to ‘Think of this section as a storehouse full of useful ingredients sitting on shelves waiting for you to use them.’ (The last word is redundant.) Then he goes into the different types of evidence of effectiveness in helping people to stop smoking including the hallowed Randomised Controlled Trial.

Professor West describes his ‘Nicotine withdrawal: The train study’, which he conducted with Professor Peter Hajek, modestly introduced as the ‘founder of the model of group support given to smokers right across the globe,’ whose other claim to fame is his assertion that vaping is no more harmful than drinking coffee (BBC op cit). No citation is mentioned, but apparently they took a group of thirty smokers and put them on a non-smoking train from London to Glasgow.

We then measured how they felt every 30 minutes during the four-hour journey. This was the first study anyone had ever done (these last four words are redundant) to see how quickly nicotine-withdrawal symptoms and urges to smoke emerged in a natural setting.

It’s hardly a natural setting. Thirty smokers, making an otherwise pointless train journey used a tick-box method to try to answer the above-mentioned question. Not surprisingly

We found that the mood of our volunteers started to deteriorate quite quickly, and…continued to get progressively worse…When the train reached Glasgow our volunteers couldn’t wait to get off the train and light up.

And the conclusion of this trial?

Nicotine-withdrawal symptoms come on very quickly and they are not pleasant.

This depressing result was entirely predictable. But I suppose the mention of this and similar experiments is only to be expected in a book written by a professor of psychology who does research rather than who actually treats smokers. (I did ask Professor West if he had treated any smokers himself. He said he had, but declined to say how many or to enter into a discussion.)

This kind of research is very different from the approach where individual smokers are asked open-ended questions about what they feel when they haven’t smoked for a while or have tried to stop. In my experience it’s striking that most people find it difficult to say anything at all, other than that they feel they want a cigarette.

It seems curious to try to investigate smoking cessation by the same methods that are used in the scientific study of the treatment of disease. For example, if you suffer from a stomach ulcer and it can be treated with drug A or drug B, a randomised controlled trial could be done to see which, if either, is better. But smoking is a voluntary activity. All the smoker has to do, if he or she wants to stop, is merely to stop smoking.

Chapter 7, ‘Your Approach,’ we’re told, ‘is all about you.’ This nice warm feeling, however, is quickly dispelled by yet another exposition of all the problems you are likely to encounter when you stop smoking:

The first four weeks are definitely the hardest from the point of view of cravings and withdrawal symptoms. There may well be times when you are hanging on by the skin of your teeth. You will need to do everything you can to keep from having that fateful puff on a cigarette…The next four weeks are easier…but if you are still finding it hard and your morale is sagging, things can be very difficult…After that…You may well miss your cigarettes…It’s just sooo (sic) easy to pick up a cigarette and smoke it. (Emphasis in original.)

Gee, thanks Professor.

Professor West is also at pains to stress that if you don’t stop smoking, ‘you have not failed – there is no such thing as failure when it comes to trying to stop smoking.’

Well, that’s a funny way of looking at it. The definition of a smoker could be someone who has failed to stop, and this is demonstrated every time he or she lights another cigarette.

A more accurate title for this book would be: Conventional Ways to Stop Smoking: 80 per cent Failure Rate.