Thursday, March 29, 2007

Smoking

I have been working for the last couple of weeks on smoking. If you want to get a good feel about the dimensions of the global smoking epidemic I recommend this site.

If you wish to become very well informed about harm reduction approaches to dealing with the smoking catastrophe I recommend this site. It is an excellent source of information - 50 live links that will introduce you to a vast literature much of which is genuinely surprising.

14 comments:

Shawn said...

Hi Harry,

I'm curious to know what you think of prohibiting tobacco completely, especially since tobacco strength has increased recently (from your blog post). Specifically, I'm curious about your position on tobacco prohibition vs cannabis prohibition (it looks as though its potency has gone up too).

hc said...

Shawn, I think the long-term objective should be to eradicate smoking. By 2020 as WHO note it will be the biggest preventable cause of death in the world.

For those who are addicted to nicotine my suggestion is to use medical nicotine or smokeless tobacco. I will amplify the nature of this suggestion soon.

Prohibiting smoking won't work given availability of illegal supplies and the huge costs to those addicted.

lock said...

Being a former smoker (quit 47 days - cold turkey) this is something I have taken an interest in of late.
I do believe that any form NRT is better than smoking, however I have some skepticism when it comes to using NRT to aid smoking cessation. Mostly due to my belief that double-blind trials do not work - a nicotine addict can tell if something contains nicotine...
There is also evidence that some NRT's result in cross addiction, nicotine gum being the main culprit.
Do you see some parallels between the old tobacco companies, and the crop of large pharmaceutical companies offering so called smoking cessation aids? Shouldn't these products contain similar warnings to conventional nicotine delivery systems (cigarettes)? As they are definitely both addictive and dangerous.
Whatever happened to human will power... The underlying fact is that to quit smoking, you really have to want to quit smoking.

Thats my rant for today anyway. Thanks for the great blog Harry, always poses interesting reading. One of the deciding factors for quiting was so that it could commute the 26km to work by bike, to beat Melbourne's growing congestion issues. Now I just need to convince my girlfriend that high density housing is the future, and that we don't want to live nowhere, 10km from the nearest train station...

hc said...

Lock, Congrats on giving up. I think the issue is one of relapse. If you can do it giving uop completely that is best. After nearly 20 years smoking I did.

If you go to the second website you will find that NRT or snus does reduce smoking - but you can remain addicted to the nicotine.

I hadn't heard that report for nicotine gum - for other NRT products I think it is not correct.

If you go to the Phillip Morris websites you will find that they see their future in NRT. In fact this is not good corporate citizenship on their part - they don't have a future without NRT and even with it I think not much of a future.

No I don't think NRT products should not have the same warnings as tobacco products as they are much, much safer - by some estimates risks are reduced by 1/1000. Yep they are addictive but they are a clean way of getting an addictive drug into your system and the dirty ways are terribly risky.

The difficulty in trying to reduce cancer rates is to overcome community perceptions that damages are the same between tobacco or NRT. They definitely are not.

I'll respond further with a post later.

lock said...

Cant find the reference to that report detailing percentage of addicted nicotine gum users. Found plenty to the counter though. Put it down to me spending too much time on those pro cold-turkey/nicotine is evil websites. Trying to quit, irrespective of the method is the important issue. And yes, remaining nicotine dependent is better than continuing to smoke - however I would not like to see an industry building on this.

Would love to sit in on a Phillip Morris SWOT analysis session... Where do they go from here? NRT is not going to generate a significant number of new users. Current users are dying. Possibly an opportunity for export to china, but then again they seem apt at meeting their own demand.

Reminds me of a movie "Thank you for smoking" released in 2005, would highly recommend it to all, especially smokers/ex-smokers.

Shawn said...

Harry,

why do you advocate cannabis prohibition and not tobacco prohibition? Cannabis is widely available illegally as tobacco would be if it were prohibited. Is it just a matter of scale?

hc said...

Shawn, Tobacco will be the biggest preventable cause of death on the planet by 2020. It causes immense suffering. That's the reason.

I favour not legalising marijuana and subjecting its illegal use to modest penalties.

conrad said...

I'm sure what the reason cf. marijuana vs. tobacco is.

Marijuana maybe not used on the scale of tobacco, but it is still exceptionally common -- so common that moderate fines are not going to get rid of it (nor reduce suppy much -- Is there really such a difference between usage in, say, Melbourne and Adelaide due to decriminalization ?) . In addition, I don't see them as much different either, including most of the harmful side effects, like lung cancer.

Shawn said...

Harry,

I'm sorry if I seem to be hounding you, but I'm still confused. In other posts you suggest Cannabis should continue to be prohibited because of its potential harm (skunk induced teen psychosis). But now you're saying tobacco causes immense suffering so it should not be prohibited. If I understand correctly, are you saying the more addictive and harmful a drug is the more you think it should not be prohibited?

Or am I getting things mixed up and you believe cannabis to be more harmful than tobacco?

Conrad,

I understand the link between cannabis and lung cancer is not very clear. Wasn't there a big study a while back suggesting cannabis doesn't cause lung cancer?

Also, a nitpicky detail, cannabis can be eaten to bypass the lungs.

hc said...

Shawn I think smoking is terribly harmful but 50 million Americans smoke. The absolute number has not changed much since the early cancer scares.

About half these people will die of tobacco-related diseases. Many are diehard smokers who cannot give up. They are addicted to nicotine.

Do everyr=thing possible to stop new smokers and try to get existing smokers who cannot end their smoking to substitute medical nicotine.

I'll post on this issue soon.

Anonymous said...

Hello there,

I was sad to notice that there is little mention of damage done to OTHERS by smokers.

I have been smoking passively since the day I was born and my life, both socially and healthwise, has been ruined by smokers.

It makes me quite resentful that (ex)smokers still seem to have little idea of the harm they are doing or the responsibility they have towards other people.

The tone of most of the comments still seems to be one of self-centered concern.

For someone like myself, who has spent a lifetime having to avoid hotels, restaurants, cinemas, even sport arenas and social clubs, like bridge and chess, family gatherings, friends' parties and most social gatherings indoors or out, it is very difficult to raise sympathy for those that are now suffering the consequences of their own actions.

It also gives me little hope for the future: until smokers' basic outlook for the wellbeing of others changes, there is little chance that even a total ban would be adhered to.

Please feel free to erase this comment. I feel better for writing it down. :-)

ColdDeadHands said...

Alcohol leads to immense suffering, whether it's a simple hangover, or injury and death from drunk driving accidents. It's addictive, and addiction to alcohol (alcoholism) has been termed a disease.

Shouldn't we, by your reasoning, work to eradicate drinking? It causes far more suffering than marijuana, a substance that you support throwing people in prison for. Let me guess: you like your booze, so therefore shouldn't be illegal?


You must have your head in your ass if you think that prohibition of so-called dangerous substances reduces the danger associated with it. I'm certain that organized crime would love to see tobacco prohibition... they'd make a KILLING!

hc said...

I think the heath implications of smoking are worse - it causes more hospital admissions than does alcohol.

Your comment on my apparent hypocrisy is not correct. That I drink does not make it a sensible practise.

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