Effects of alcohol on smoking cessation – 2

As discussed in my previous post, alcohol and smoking very often go together and having a drink of alcohol in the early stages of trying to quit will increase your risks of relapsing to smoking. But does either a current or past history of alcohol problems affect someone’s chances of successfully quitting?

First of all we should define what we mean by “problem drinking”.
Men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week are considered to have a high probability of having alcohol problems or being a problem drinker. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).
The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

1. Have you felt that you should cut down on your drinking?
2. Do you ever drive when you have been drinking?
3. Is someone in your family concerned about your drinking?
4. Have you ever had any blackouts after drinking?
5. Have you ever been absent from work or lost a job because of drinking?
6. Do you have to drink more than before to achieve intoxication or the desired effect?

If your answer is “yes” to even one of these questions, this is a sign that you likely have an alcohol problem. Another online test for alcohol problems can be taken at: http://www.alcoholscreening.org/

Professor John Hughes (University of Vermont) reviewed the evidence on whether having a history of alcohol problems (but not current problems) reduces the chances of successfully quitting smoking. He found that smokers with past alcohol problems tend to be heavier smokers than those without alcohol problems, but that they can quit smoking about the same rate as those without past alcohol problems. He hypothesized that this may be because such smokers learned skills required to beat an addiction when they resolved their alcohol problems, and this helps them neutralized their increased nicotine dependence.

Not surprisingly, however, people with current alcohol problems tend to have poorer outcomes when it comes to quitting smoking. There is a fairly close association between smoking and problem drinking. For example, in a study published in 2000 based on a survey of almost 43,000 adults, Dr Deborah Dawson (National Institutes of Health) reported that the proportion of past-year smokers rose from 23.8% of those who never drank 5+ drinks on any drinking day to 61.8% of those who drank 5+ drinks weekly or more often. She also found that but drinking 5+ drinks at least once a month reduced the odds of smoking cessation by 42%.

A recent study by Leeman and colleagues from Yale University noted that many (46%) trials of medicines for smoking cessation exclude people with a current or post alcohol problem. It was also noticeable in their study that trials of new medicines were more likely to do so. Thus 45/125 (36%) trials of nicotine replacement therapies (gum, patch etc), 15/22 (68%) bupropion SR trials and 3/3 varenicline (Chantix) trials excluded participants with either current or recent alcohol problems. This is part of the reason that clinicians often want to wait for more studies when a new “wonder drug” comes out that appears to get better outcomes than previous medicines. Typically the first few studies of a new drug (usually sponsored by the company making the drug) include only “ideal” candidates for the drug, rather than typical patients who might use it in the real world.

So what does all this mean?

Firstly, if you think you may have a current alcohol problem you should get help with that immediately. If you scored in the “problem drinking” range on any of the questions mentioned above but still don’t think you have a problem, then here’s one more test. Starting tomorrow, go 30 consecutive days without drinking any alcohol. If you can do it, then fine, maybe your alcohol consumption isn’t currently a problem. If as soon as you think of it you perceive it to be too much trouble, or if you try it and can’t do it, take that as confirmation that you can’t control your alcohol consumption. You should then discuss this with your family doctor and attend a local AA meeting.

Secondly, whether or not you think you have a current alcohol problem, you should make plans to quit smoking. If you feel you would rather get the drinking under control first, that’s fine, but make a concrete plan to tackle the smoking very soon and mention this to your doctor and AA sponsor right from the start. More people with alcohol problems are killed by their smoking than their drinking, so this is not something to put on the back burner for long. Once you have 30 days without drinking under your belt then its time to talk to your doctor/sponsor again about quitting smoking and to set a quit date.

Finally, just because people with a history of alcohol problems were excluded from some trials of smoking cessation medicines doesn’t mean you shouldn’t use an FDA-approved smoking cessation medication. This should be discussed with your doctor but if anything, the evidence suggests that the more nicotine dependent you are the more helpful an approved medicine (nicotine replacement therapy, Zyban or Chantix) will be. But as always, your chances of successfully quitting smoking will also be improved if you get counseling from a trained provider.

Labels: smoking cessation alcohol problem relapse

Permalink | 0 Comments| Email Post

Post your comment

Effects of alcohol on smoking cessation - 1

The question of the effects of alcohol use on smoking cessation is best separated into 2 different but related questions.

1. Does drinking alcohol increase someone’s chances of relapsing to smoking during the early stages (e.g. first 6 months after quitting smoking)? And

2. Does either a current or past history of alcohol problems affect someone’s chances of successfully quitting?

Lets tackle question one first.

Dr John Cunningham and colleagues from University of Toronto recently conducted a survey of smokers interested in quitting. They found that most (82%) daily smokers who were current drinkers reported they frequently or always experienced a strong urge, desire or thoughts about smoking when they drank alcohol. In fact the research literature is very clear that consuming alcohol increases craving for a cigarette and makes it more likely that an individual will smoke.

In a series of laboratory studies by Dr Sheree McKee and colleagues at Yale University, smokers were given monetary rewards for not smoking, and then allowed to drink either alcohol or a taste-matched placebo drink (with no alcohol). After consuming the alcohol beverage, participants were less able to resist the first cigarette and initiated their smoking sessions sooner, and smoked more cigarettes compared to the placebo beverage.

So what does this mean for the drinker who wants to quit smoking? Lets first of all assume you are not a “problem drinker” (see next post for definition). My usual advice is that you abstain completely from alcohol during the first 30 days of an attempt to stop smoking. After that, you should think carefully about when you choose to drink alcohol and carefully consider whether it may make you more likely to smoke. If it’s a situation in which other people will be smoking or cigarettes will be available that’s another big trigger at the same time. In the second month after quitting I’d advise against drinking in a situation when others are smoking. Having a glass of wine at dinner with people who are not smoking may be a safe way to test the waters. On subsequent occasions, when you are considering whether to go to an event or whether to drink at it, ask yourself whether drinking will make you more likely to smoke. If the answer is “yes” then either don’t go or don’t drink when you go. If you decide to go and drink (which I don’t recommend if others are smoking there), make sure you are very clear in your mind that no-matter whatever else happens, you are going to leave that event without drinking excessively and without smoking. That means making sure you have your smoking cessation medicines (and use them), and that you know what you will say if offered a smoke. Ideally, try to arrange to meet someone else there who knows you have quit smoking and is supportive.

Here’s another thing to consider. If you’ve managed to not smoke for 30 days, that’s a tremendous achievement that likely took a lot of effort. If you continue to succeed it will likely add around 10 healthy years to your life (and possibly as many as 30). To risk throwing all that away in order to have a drink of alcohol doesn’t make much sense. Also be very wary of the addiction trying to put you into a situation where it will be easy to relapse. Other smokers, a party atmosphere, and then a few drinks on top. Sounds like a good excuse for a smoke? So make sure you don’t let it be.

Finally, if you are someone with a current or past history of alcohol problems then the decision is even clearer. Lets tackle that one in my next post.

Labels: smoking cessation alcohol relapse

Permalink | 3 Comments| Email Post

Post your comment

The Nicotine Reduction Strategy

In my last post I mentioned a “regulated nicotine reduction strategy” that has been proposed numerous times over the past 10 years or so, but most consistently by Professor Neal Benowitz of the University of California at San Francisco. I mentioned some potential pros and cons to the strategy, and also mentioned an alternative strategy that could be called a “regulated toxin reduction strategy”, whereby cigarette manufacturers are required to reduce the permissible toxin deliveries from cigarettes (i.e. carbon-monoxide, NNK, lead etc) while potentially leaving the nicotine delivery stable. The logical end-point of this strategy is a product that does not require burning of tobacco or inhalation of smoke, but is capable of delivering sufficient nicotine to feed the smoker’s addiction.

It is fairly easy to present these two strategies as competing with each other, as they may be considered as mirror images of each other. One aims to take the addictive agent out of cigarettes, and the other aims to take out the toxins while leaving nicotine intact. Some may accuse these strategies of being “prohibition” in disguise. In determining whether either really involves prohibition it’s worth comparing them to the prohibition of alcohol that was attempted in the United States 1920s. That law prohibited the manufacture, sale and transportation of alcohol (not its consumption). Note it was the drug – alcohol – that was banned, not beer or whiskey per se. So the analogous prohibition relating to tobacco would involve a ban on the manufacture, sale or transportation of products containing nicotine. In fact no one has proposed such a law (that I’m aware of). The Benowitz proposal involves reductions to extremely low levels of the nicotine allowed in cigarettes, but may allow nicotine to be available in other forms (e.g. pharmaceutical nicotine gum). This is therefore not prohibition of nicotine.

The other point I want to make is that the 2 strategies could end up in a very similar situation if they focus on reducing permissible nicotine levels in smoked products but allow nicotine to remain in smokeless products (whether they be nicotine gum or snuff). With each strategy a point will come when cigarettes and other forms of smoked tobacco can no longer sustain their place in the market, and people who want to continue to take nicotine will have to do so in a smokeless form (and therefore avoid the very high risks of lung cancer and emphysema caused by inhaling smoke into the lungs).

At this moment this is something of an academic debate, because tobacco remains relatively unregulated in the US, and even if an agency like FDA were given the power to regulate tobacco one cannot be sure how or even if they would exercise that power. For the foreseeable future, smokers should focus their attention on trying to quit smoking completely. Hopefully some of the tips in my previous posts will help increase the chances of success.

Labels: nicotine regulation reduction smoking smokeless

Permalink | 2 Comments| Email Post

Post your comment

Institute of Medicine Report: Ending the Tobacco Problem (2)

The main problem with a 400-page report is that few have the time or inclination to read it all. So let me summarize what I thought were some of the interesting points relevant to smoking cessation.

The main section on smoking cessation in chapter 2 provided some interesting facts. Of the 45 million smokers in the US in 2004, 41% (15 million) tried to quit in the previous 12 months. Of smokers trying to quit on their own, between two-thirds and three quarters relapse within 2 weeks. Of all those trying to quit, only around 2% remain quit long term after each quit attempt. One of the studies mentioned in the report asked smokers in four countries if they agreed with the statement, “If you had to do it over again, you would not start smoking”. 90% of smokers agreed, indicating near unanimous regret among smokers for having ever started. Recent data from the United States suggests that teen smokers already regret having started. 61% say they want to quit and 59% made a quit attempt in the past 12 months.

It is this kind of evidence on tobacco addiction, together with the fact that 90% of smokers initiate smoking as children (i.e. before age 18), that helped the Committee on Reducing Tobacco Use conclude that an assertive and perhaps even paternalistic approach to tobacco control is appropriate. One alternative perspective, often proposed by the tobacco industry, is that it’s a legal product and adults have the right to chose whether or not to use it, based on awareness of the risks. The committee took the view that as most smokers became addicted as children, as the risks are so extremely large and as they are frequently not well understood by consumers, it is appropriate to implement a wide range of policies that would lead to a large reduction in tobacco consumption.

One of the more radical strategies discussed in the report was a mandated gradual reduction in the amount of nicotine in and delivered by, all cigarettes. This would require a reduction from around 10-15mg of nicotine IN each cigarette to around 0.5mg IN each cigarette. This roughly corresponds to a reduction from around 1 – 1.5 mg nicotine absorbed per cigarette now, to around 0.05 mg nicotine absorbed per cigarette (i.e. less than a twentieth of the current amount). It was suggested that this may occur over a period of 10-15 years so as to allow smokers the opportunity to get used to the changes. I think it is entirely plausible that cigarettes containing only 0.5mg nicotine and delivering only 0.05mg would no longer be addictive. However, I am concerned that the proponents of this strategy may have underestimated the consumers’ response to these changes.

We would all hope that if this strategy were implemented, smokers would gradually feel they are getting less satisfaction from their cigarettes, and would choose to quit completely. Similarly we would hope that young people who try those minimal nicotine delivery cigarettes would get so little nicotine from them that they would not become addicted. The report acknowledges some of the potential unintended effects but may have missed some. It is widely accepted that during the early part of a nicotine reduction strategy, existing smokers would likely inhale more smoke per cigarette in order to try to get more nicotine. If the nicotine reduction strategy took 15 years, the idea of smokers inhaling MORE smoke throughout that time is a serious problem. There must also be a concern that organized crime would see this as a perfect opportunity to continue to make money by selling off imported (smuggled) high nicotine cigarettes. Then there’s the difficulty of enforcing this type of regulation. How would a policeman, seeing someone smoke a cigarette, determine if it was a new ultra-low nicotine cigarette or an illegally imported normal medium nicotine cigarette? It is also unclear whether this reduced nicotine strategy would apply to tobacco products other than cigarettes, such as cigars, pipe tobacco, roll-your-own loose tobacco, bidis, kreteks or smokeless tobacco? If not, then what’s to stop the nicotine addict from switching from cigarettes to another nicotine delivery product, some of which (all the smoked varieties) would likely be at least as harmful as cigarettes?

So I think the report was correct to suggest that this strategy needs careful consideration, but it could have suggested some other potential strategies (e.g. gradually reducing the toxicity of the smoke delivered by cigarettes, over 10 years, down to the point where cigarettes and other burned forms of tobacco are no longer permissible).

The full report, and various summaries are available online for free at:http://books.nap.edu/catalog.php?record_id=11795

Permalink | 2 Comments| Email Post

Post your comment

Institute of Medicine Report: Ending the Tobacco Problem (1)

Last week the Institute of Medicine issued a 400-page report produced by its 14-member Committee on Reducing Tobacco Use, which presents a blueprint for reducing smoking so substantially over the next 20 years that it is no longer a significant public health problem in the United States.

The report first highlights the progress that has been made. Between 1965 and 2005, the percentage of adults who once smoked and who had quit more than doubled from 24.3 to 50.8 percent. Furthermore, the percentage of adults who have never smoked more than 100 lifetime cigarettes increased from 44% in 1965 to 54% in 2005. It predicts that if things continue as they have over recent times, smoking prevalence will decline from 21% in 2005 to 16 % in 2025. However, the report identifies tobacco as the only lawful consumer product for which national policy is to eliminate consumption (reflecting its status as the only one that kills 50% of its consumers when used as intended). It suggests that there is now a need for more aggressive tobacco control strategies designed to reduce consumption more quickly than current trends.

The first major recommendation was for a strengthening of traditional tobacco control measures, including increasing excise taxes on cigarettes by at least $1, comprehensive legislation banning smoking in public places, increasing access to smoking cessation interventions (partly by requiring these to be fully covered by insurance policies), and school and media based prevention interventions. The committee projected that these strategies could reduce smoking rates to 10% by 2025.

The second major recommendation was for a transformation of the legal structure regulating the manufacture, marketing and use of tobacco products. This would include empowering the Food and Drug Administration to regulate tobacco, allowing states to implement their own more stringent regulations, requiring larger more graphic warnings on packs, requiring retailers to be licensed, restricting internet sales, and banning marketing to young people. One particular regulatory strategy that was discussed (but not specifically recommended) was requiring a gradual reduction in the permissible nicotine delivery of cigarettes, so that before 2025 they cannot deliver sufficient nicotine to maintain or initiate addiction.

The committee did not project the full impact of both the traditional tobacco control strategies plus the full legal and regulatory changes. However, if fully implemented now, these could conceivably reduce regular cigarette use to lower than 5% of adults by 2025.

My initial reaction is that this is a very bold but sensible report. State and national legislators should read it and follow its recommendations. I have no doubt that if this were to happen, it would have a dramatic effect in reducing tobacco smoking and improving health in this country.

The full report, and various summaries are available online for free at:
http://books.nap.edu/catalog.php?record_id=11795
In my next posting I’ll give you my slightly more detailed opinion of the report.

Labels: smoking tobacco policy

Permalink | 0 Comments| Email Post

Post your comment

Is There Such a Thing As a Safer Cigarette?

In previous postings I’ve discussed the fact that so-called “light” or “low-tar” cigarettes are no less harmful than “regular” cigarettes. However, in recent years we have seen the launch and marketing of a number of cigarette brands that either directly claim or imply that they may be less harmful than regular cigarettes.

For example, the manufacturers of “Omni” cigarettes have claimed that they produce lower levels of many carcinogens and others toxins to which smokers are exposed. However, this research measures only a few of the more than 4,000 chemicals in cigarette smoke that are harmful to humans and it is based on how Omni cigarettes are smoked by machines, not human beings. One of the main lessons from studying “Light” cigarettes is that smokers don’t smoke them like machines, and so what typically happens is that as emissions of a few chemicals goes down, so emissions of other chemicals increase. For example, a study by Professor John Hughes (University of Vermont) found that people who switch to Omni inhaled around 20% more carbon-monoxide.

Another cigarette that has claimed to deliver fewer carcinogens is “Eclipse”, manufactured by RJ Reynolds in the USA. This cigarette is different in that it is designed to primarily heat the tobacco and nicotine rather than burn it. Again, however, studies have found that this cigarette, while likely delivering lower levels than some toxins (including nicotine) than a regular cigarette, tends to give the smoker higher levels of carbon-monoxide. A more detailed report on the eclipse cigarette is available at: http://tobaccofreekids.org/reports/eclipse/

Similar results have been found with “Quest” cigarettes, which are available in three varieties with lower and lower nicotine levels. As smokers switch to the lower nicotine containing variety so they take larger puff volumes and absorb higher levels of carbon-monoxide per cigarette in order to try to obtain their usual dose of nicotine. The simple lesson from decades of research trying to develop a safer cigarette is that if you light anything with a match and then inhale the smoke resulting from burning of the product, then it will deliver an unavoidably toxic cocktail of thousands of chemicals to your lungs and the rest of your body. The same is true for some of the more recent brands that have been launched (e.g. Marlboro Smooth). The only safe cigarette is an unlit one, and the best thing a smoker can do to improve their health is to quit smoking completely.

Permalink | 0 Comments| Email Post

Post your comment

How addicted are you? (2)

In my last comment, I mentioned 3 key questions that can be used to assess how addicted you are, even if you never tried to quit. Of course most smokers have tried to quit more than once, and in New Jersey, more than half of smokers in high school tried to quit in the past year!

In fact it was research on the development of addiction to nicotine in adolescents (by Professor Joe DiFranza at University of Massachusetts Medical School) that led to the development of a useful questionnaire measure of nicotine dependence called “The Hooked On Nicotine Checklist (HONC)”. His research group found that even young people not yet smoking every day already showed symptoms of nicotine addiction, and that answering yes to just one of the questions meant that the person was over 20 times more likely to be smoking regularly years later. The questionnaire consists of 10 simple questions (below) and your score is the number of questions you answer “yes” to.

1. Have you ever tried to quit but couldn't?
2. Do you smoke now because it is really hard to quit?
3. Have you ever felt like you were addicted to tobacco?
4. Do you ever have strong cravings to smoke?
5. Have you ever felt like you really needed a cigarette?
6. Is it hard to keep from smoking in places where you are not supposed to, like school?

In answering the last four questions, when you tried to stopsmoking, or when you have not used tobacco for a while ...

7. Did you find it hard to concentrate?
8. Did you feel more irritable?
9. Did you feel a strong need or urge to smoke?
10. Did you feel nervous, restless or anxious because you couldn't smoke?

If you score zero that means you are probably not addicted to nicotine at all, and giving up smoking should be just a matter of making a decision to quit and getting on with it. Any score above zero indicates some degree of addiction, and a score of 7 or higher is indicative of being highly addicted. The average smoker scores around 7.

The higher your score, the more likely you are to benefit from getting some assistance with your attempt to quit smoking, via a counselor, and including an FDA-approved smoking cessation medicine. Again, getting a core of 10 doesn’t mean its impossible for you to quit. It just needs you’ll need to prepare and to take your quit attempt seriously to have a good chance of success.

Permalink | 0 Comments| Email Post

Post your comment

How addicted are you to cigarettes (1)?

The central defining characteristic of addiction to a substance is a strong compulsion to use the substance when the person tries to abstain. Many of us like to do things like play golf, eat potato chips, or drink fruit juice. But if for some reason we couldn’t do those things for a couple of weeks, we might think it was a bit of a pity but we wouldn’t have much difficulty in not doing/consuming those things. Tell an alcoholic they can’t drink alcohol for two weeks or a heavy smoker they can’t smoke for two weeks and it's quite a different matter. The smoker will be thrown into a panic at just the thought of not smoking for such a long time, and during that time will find him/herself having frequent thoughts about smoking and urges to smoke. In addition, they will experience mood disturbances, poor concentration, insomnia and increased appetite caused by nicotine withdrawal. Less than half of smokers who decide to quit last for the first week after an unaided quit attempt, and less than 5% last for a year.

So if any of this sounds familiar to you, then you are at least somewhat addicted to tobacco. Of course some smokers have never had a proper quit attempt or had to abstain for a long period of time. So how would they know if they were addicted? The answers to a few key questions have been shown to provide a fairly accurate measure of tobacco addiction, even without knowing the person’s quit history. The first question is the most obvious one:

How many cigarettes do you smoke per day?

It is clear that smokers who smoke less than 5 cigarettes per day have less difficulty quitting than those smoking 15 per day, who find it easier to quit than those who smoke 25 or more per day. Nowadays, with cigarettes being so expensive and there being so many places one can’t smoke, I’d say that anyone smoking over a pack a day is likely to be extremely addicted, and anyone smoking 10 or more per day is likely to be moderately addicted.

The next key question is slightly less obvious.

When you wake in the morning, how long is it before you light up your first cigarette?

People who light up within 5 minutes are extremely addicted, 5-30 minutes are highly addicted, and 31-119 minutes moderately addicted. People who regularly don’t smoke within the first two hours of waking in the morning are only mildly addicted, if at all. Very recently it has become clear that waking at night to smoke is also a marker of being highly addicted.

Do you sometimes awaken at night to smoke?

If you answer “yes” to this question this is also a sign of being highly addicted. Being addicted does not mean you can’t quit. It just means that it won’t be as easy as stopping eating potato chips might be. It also means that to have a good chance of success, a quit attempt will need to be taken seriously and should include an FDA-approved cessation medication.

Permalink | 0 Comments| Email Post

Post your comment

Facing The Tobacco Industry – 2

As mentioned in my previous comment, I recently gave a presentation at a tobacco industry conference on the future of tobacco harm reduction. My main message for the industry was that tinkering around with cigarettes will not make them meaningfully less harmful. Even if they manage to entirely eliminate a couple of the toxins in tobacco smoke, that still leaves thousands of others to do damage. So I see the attempt to produce and market a less harmful cigarette as being likely to mislead the public and do more harm than good. Our lungs simply are not built to absorb smoke and there’s no way round that fact. However, there are ways to make smokeless tobacco products that are much less (about 90%) less harmful than cigarettes, and there is evidence from Sweden and a few other countries that smokers can switch to these smokeless products. So my recommendation to the tobacco industry was to collectively withdraw from the manufacture and sale of smoked products (within 10 years) and to focus on making and selling low-toxin smokeless tobacco products that deliver nicotine. As you might imagine, not everyone in the audience was thrilled about being told that their industry has caused the premature death of over 13 million people in the US over the past 40 years, and that they should now withdraw their main money-making product.

Of course, many people on the public health side are not thrilled at the idea of more widespread smokeless tobacco use either (and I’m guessing that your immediate reaction to the idea is probably not warm and fuzzy). But I’d encourage you to really look into the evidence on this if you are interested (or even if you just think I’m crazy). You can see my slides and listen to audio recordings of 2 of my presentations at the UK Smoking Cessation Conference online at:

Foulds J. “Tobacco Harm Reduction.” Invited plenary presentation at the First UK National Conference on Smoking Cessation, London, UK. July 9& 10, 2005. The slides and full audio recording of this presentation are available online at:
http://www.uknscc.org/2005_UKNSCC/speakers/jonathan_foulds.html

Foulds J. “Smokeless tobacco: Problems and Opportunities” Invited plenary presentation at the second UK National Conference on Smoking Cessation, Gateshead, UK. June 26, 2006. Audio and slides available online at:
http://www.uknscc.org/2006_UKNSCC/speakers/jonathan_foulds.html

You can access my slides and presentation notes for the TMA meeting this month at..
http://www.tobaccoprogram.org/fouldstma.htm
(This is a large powerpoint file that may take a few minutes to download and is best viewed in “normal view” format to access the accompanying comments).

If you want to learn more about the form of smokeless tobacco called “Swedish snus” you can download pdfs of a couple of articles I’ve written on it from this website:
http://www.tobaccoprogram.org/staffarticles.htm(I’d recommend the ones by Foulds, Ramstrom etc in 2003, and Ramstrom & Foulds 2006).

Just to be absolutely clear, smokeless tobacco is very far from harmless. I would not recommend anyone to use it. If you are thinking of quitting smoking or quitting smokeless tobacco then that is absolutely the best thing you can do for your health. If you are looking for something to help you quit then one of the safe and effective FDA-approved smoking cessation medicines, plus some counseling from a trained professional is the way to go. But if the tobacco industry are to stay in business selling tobacco (and there's every reason to think that will continue, whether we like it or not), I'd rather it was by selling a product that can feed nicotine addiction without causing lung cancer or emphysema.

Permalink | 0 Comments| Email Post

Post your comment

Facing The Tobacco Industry

I had an unusual experience last week. I was invited to speak on “The Future of Tobacco Harm Reduction” at the 92nd Tobacco Merchants Association (TMA) Annual Meeting, in Williamsburg Virginia, (May 7-8). I’ve been invited to participate in industry events before, but always declined – partly because by participating one runs the risk of being used by the industry PR machine to imply that they are working with public health professionals to solve the remaining issues with tobacco and health (not true). Another practical issue with participation is that I don’t accept any funding from the tobacco industry but also don’t feel inclined to spend my own money traveling to their events. However, on this occasion I’d also been invited to speak on tobacco at Virginia Commonwealth University, near where the TMA meeting was taking place, so that wasn’t an issue. I was also advised by a colleague that if you have a message you want to get across to the tobacco industry then this meeting is one of the best venues to do so. I have a pretty clear message for the tobacco industry. I believe that if some of them pay attention to it, (and I am aware thats a big "if") millions of people could avoid smoking-caused diseases and premature death. But I think its worth a try. So off I went at the beginning of last week to give a presentation to over 200 representatives of all the major tobacco manufacturers, on the future of tobacco harm reduction.

One of the points I wanted to get across, was that public health workers have every good reason to be wary of entering into any dialogue with the tobacco industry, as they have a long and clear history of abuse of science, and neglect of health, in order to make more profit. I will put my whole presentation up on a link early next week, but just to give you a flavor, I presented data showing that the biggest US tobacco manufacturers had sold over 21 trillion cigarettes, for around $600 billion, and caused the premature deaths of over 13 million Americans since the 1964 US Surgeon General’s Report concluded that smoking causes lung cancer. I then asked for a minute’s silence to remember the 13.4 million people whose premature deaths had been caused by the tobacco industry during those years. I presented a series of quotes by industry executives that we can now clearly see to be lies. Just in case anyone wanted to argue that all that stuff is in the past, I ended that section by presenting the conclusions of Judge Kessler in her ruling on the Department of Justice law suit against the tobacco industry (in the past year):

“They mounted a coordinated, well financed, sophisticated public relations campaign to attack and distort the scientific evidence demonstrating the relationship between smoking and disease…..
…
The evidence …proves that defendants have engaged in a massive 50-year scheme to defraud the American public.”

U.S. District Judge Gladys Kessler, August 17th, 2006, in finding the major US Tobacco companies guilty of racketeering.

There were certainly moments during my presentation in which the audience looked a bit stunned (rabbits in the headlights sprang to mind), but I think it is important to remind the tobacco industry as frequently as possible of the health effects of their work, and the reality of their business. Frankly the only reason they have gotten away with it for so long is because they make so much money they can afford to have lots of politicians in their pocket. I gained the impression that the industry hardly gives a thought to the health effects of its products. It proceeds as if it is selling widgets, thinking only of the next marketing gimmick and how to make more profit. Early next week I’ll tell you what I suggested that they do next, and provide you with a link to the whole presentation.

Permalink | 1 Comments| Email Post

Post your comment