Just Stop!

Cessation, there’s a loaded word, to stop, cease and desist. When it comes to smoking you would think it’s important, in tobacco control a fairly important tool in the box. But how important? I was listening to Prof Luke Clancy on the Ray Darcy show the other day and I stopped in my tracks when he said cessation is only 6th in importance for tobacco control. Yes, 6th!

Some context; Luke was discussing the Horizon episode on e-cigarettes, subtitled miracle or menace. Luke took the menace side and when asked if e-cigs help people quit were they not a good thing. This led to Luke explaining that quitting was not that important, it was only 6th after other measures such as taxation.  I was gobsmacked.

I did some digging and believe it or not, Luke is right. Once you think about it, it makes sense.  Just getting people to stop smoking is a game of whack a mole, it is not going to end anytime soon. Better if they don’t start to smoke in the first place. Currently, this aim is being pursued by adopting some strategies to target uptake of tobacco.

  • price increases through higher taxes on cigarettes and other tobacco products
  • bans/restrictions on smoking in public and workplaces
  • better consumer information, including public information campaigns, media coverage, and publicising research findings
  • comprehensive bans on the advertising and promotion of all tobacco products, logos, and brand names
  • large, direct health warning labels on cigarette boxes and other tobacco products
  • treatment to help dependent smokers stop, including increased access to medications.

There it is; help dependent smokers stop, down the bottom at number 6.

That got me thinking…..

stop.jpg

One of the main themes of the Horizon show was, do e-cigs help people quit, they do as it turned out, although a sample of 6 is hardly definitive evidence, compared to cold turkey they were a positive miracle, the NRT group did just as well and we know the real world success of that. 4 to 7% success rate.Not quite in the walking on water or raising the dead class of miracle. I started wondering if the question posed was misguided, what if instead of “Do e-cigs help people quit?” we instead asked, “Could e-cigarettes replace lit tobacco?”

Different ball game, especially for the people following the bullet points above. Now they have to ask if recreational nicotine use is acceptable if it doesn’t carry the health burden associated with smoking?

We know vaping (for the non e-cig user, that’s what smoking an e-cig is called) is orders of magnitude less harmful than smoking, we have no reason to suppose it will turn out to be as damaging as smoking and so far it has little attraction for nonsmokers. So why the resistance? Why is vaping seen as a threat to tobacco control?

I don’t get it, really, I don’t. Unless tobacco control is less about preventing disease and early death and more about a wash, rinse, repeat, cycle of tobacco control measures without reference to what any objective observer would consider the measure of success, reduced smoking prevalence, and the consequent harm.

Sweden would get the gold medal Top 5 Countries with the Lowest Percentage of Adult Smokers

However, in the tobacco control world view, Sweden is 11th. The U.K, Ireland, Iceland, Norway and Turkey get the top 5 placings. Ukraine went straight to the top 10, better than Sweden, – See more at: http://www.fctc.org/media-and-publications/reports/1153-uk-leads-tobacco-control-in-europe#sthash.8Pd7Tsrd.dpuf

I guess tobacco control has different priorities than reducing smoking and preventing disease.

And I guess Prof Luke Clancy has the same indifference to the health of the people who pay his bills.

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