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Tuesday, 13 November 2012

Quotes From a Study on NRT and Harm Reduction

In the tobacco control industry, the bar for what constitutes research or a study appears to be set rather low. Take twenty stakeholders in tobacco control and Big Pharma, and ask them what they think about nicotine replacement therapy (NRT) and nicotine-containing products (NCPs), and voila, you have a "qualitative study."  That is not to say the study is not useful. Indeed, it's a wonderful insight into the perceptions of the key players in the tobacco control industry.  I think the authors may come to regret publishing it.

The study I have referred to above is titled:  Regulatory Issues Concerning the Development and Circulation of Nicotine- Containing Products: A Qualitative Study.  It was co-authored by Catriona Rooke, Ann McNeill, and Deborah Arnott, and published on-line by the Oxford Press at the Oxford Journals Nicotine & Tobacco Research web page on 5 November 2012.

Here is a capture of the abstract, and honestly, you will know all that you need to know just by reading only the abstract:
So I have read the entire paper, and I'm totally not surprised. It's a doozy. My take on the whole affair is that the tobacco control industry -- even after 50+ years of doggedly demonising people who smoke and trying to get them to quit -- still does not understand smokers and the reasons why people smoke. Certainly, some people smoke purely for the pleasures of nicotine in their bodies -- some of those people may have proper nicotine addictions. Yet this is only but one factor to consider when exploring the reasons why people smoke. They don't get it at all -- they see nicotine as the end-all experience of smoking, but they're just missing the point (albeit, they do mention in the study that there is more to consider, such as "is it inhaling the smoke?").

Before I delve into and write further about the study above, I'm going to do the tobacco control industry a huge favour. I'm going to help you morons understand why people smoke. An important caveat, however: this is not all-encompassing. Because the reasons why people smoke are far too numerous to list them all, and each person is a unique individual.  What follows are generalisations.

Smoking for many is a ritual. It's a habit. An extremely enjoyable habit with a host of factors at play. Each person's habit is uniquely their own. For instance, setting down knife and fork when finished with a meal and lighting up a cigarette or cigar immediately thereafter is one of the most pleasurable times to smoke.  But it goes deeper than even that.  It's the act of smoking, inhaling deeply or shallowly per one's preference, and in my case, exhaling the smoke is a huge part of the pleasure of smoking. I love the act of smoking. And I love to watch people smoke, because everybody does it a little differently. Absolutely fascinating to observe someone's smoking style, as it were.

Going even deeper, for those who smoke tailor-mades (machine-made cigarettes), the ritual could start with "packing" the packet -- tapping it several times on a table or your palm, then peeling off the cellophane strip, opening the flip-top box, carefully removing the foil, and for the true connoisseurs of packet opening, inhaling the gloriously tempting odours of your freshly-opened packet of cigarettes, all before finally teasing a cigarette from the packet and lighting it.  That first draw, the warmth of it, the slow exhalation... all of it, together, forms the ritual.

For those who roll their own cigarettes, the ritual is different but equally important.  The paper choice, the filter (if used), opening the tobacco pouch and inhaling the scent of your tobacco, pinching a portion of tobacco from the pouch, separating it and carefully distributing the tobacco evenly along the length of the paper, capturing any bits that may have escaped and returning it to the pouch, rolling the paper up, gently licking the the paper, sealing it with a slow and precise motion, tapping the freshly-rolled cigarette on a table or a the flat side of a lighter, removing any loose strands from the tip, and finally, satisfied with your rolling efforts, placing the cigarette into your mouth and lighting it.

It's the whole act -- the ritual that keeps people smoking, and if one element of the ritual is broken, the others suffice or a new element is added. Smokers adapt to their environments, and the elements of the ritual are not inextricably linked. We use different rituals for each environment, and if you take away one from us, we take our rituals to the next environment. You cannot stop that. You cannot change that. There is nothing you can do about it, no matter how hard you try.  You are running a fool's errand by attempting to legislate a person's lifestyle choice.

Let's take it one step further.  For some, it's not just the act of smoking, it is (certainly in these times with display bans and high taxes) the act of obtaining your cigarettes or tobacco.  Indeed, the one thing that the tobacco control industry has consistently failed to understand over all of these years is this one very important thing:

The more difficult something is to obtain, the greater the reward one receives for merely obtaining it.

That is a fact.

Make something harder to get, and the person who does get it feels a greater sense of satisfaction from his or her efforts.  Make it more expensive, and the person who buys it feels a greater sense of pleasure from obtaining it, like any luxury product.  It's like art.  Most paintings are beautiful eye-candy, but the one that cost you £25,000 -- that one is very special, far more special than the glossy print you bought for £10 from Asda.  But if tobacco becomes too expensive, some buyers will seek out alternative illegal sources, and a new pleasure mechanism takes root for purchasing illicit goods. Could there be any greater pleasure than giving the government and its minions in Public Health two fingers by depriving them of the duty they all so desperately need to fund their careers?  So all of the tobacco control industry's efforts at making cigarettes unobtainable are having an opposite effect on those who seek out tobacco products.

Think about it, you insipid, prohibitionist morons in tobacco control.  Think for just five seconds about the children who are unable to legally buy cigarettes.  What sort of reward might they feel when they are able to get a hold of a sneaky cigarette or a whole packet that had been legally denied to them?  Nobody is saying we should give cigarettes to kids. I'm simply asking you to think about the rewarding feeling one gets from obtaining the unobtainable.

It's bloody magic, is what that feeling is. When I was a kid... oh, yeah, just getting the cigarettes added to the delight and ritual of smoking.  Oh, those were days! I remember being disappointed when I was finally of legal age.  Same for alcohol, come to think of it.  The mystique, the wonder, the magical pleasures of merely obtaining my vices, had faded. But the other rituals, these remained.

But you don't get it, tobacco controllers. Because all you see is nicotine-induced misery in a cigarette. You see only a cancerous death as the end result of a person's decision to smoke. This pseudo-religious belief blinds you from the realities of why people do what they do. You are so hell-bent on saving everyone from themselves that you fail to see the obvious: everything you do and have done will save no one who does not wished to be saved.  Each person must save themselves, and it is their own choice to do so or not. You are fooling yourselves if you honestly believe in your cause.

So let's go back to the study.  Let's look into the minds of the tobacco control industry's key players and see what they really think about their place in the world.  Fair use prevents me from using very much of the study, so I'm going to use two select quotes only for the dual purpose of educating my readers and for criticism.

The first quote validates everything people have been saying about Big Pharma's influence in the anti-smoking movement:
This is really the heart of the matter, isn't it?  It's about competition, and the hoops one industry must jump through compared to another. It's like a school yard politics, or perhaps squabbling siblings.  "If Liam doesn't have to do it, why should I have to? It's so unfair, mum!"   But one key thing to note in that passage above is that it's about "control."  Big Pharma hates that e-cigarette companies are not under the same controls that pharma companies are.  So Big Pharma is aggressively lobbying everyone in governments all over the world to shut down the e-cig companies, or failing that, to put them on the same playing field as pharma companies.

This isn't about health. This has nothing to do with health. IT HAS NEVER BEEN ABOUT HEALTH! It's about money, and who is allowed to make money.  And if you cannot stop your competitors from making money by using politicians to pass laws to shut those companies down, then you can sure as hell make it as difficult as possible for your competitors to make money.  That's Big Pharma's role in the NCP market.  They know that their NRT products fail to satisfy the ritual of smoking.  A nicotine patch is no patch at all on the pleasures of smoking. The inhalers taste awful and are nothing at all like the deliciousness of a full-flavoured cigarette with a cup of coffee, or a pint of bitter.  Despite Big Pharma's best intentions, nobody gets addicted to NRT products, because they suck. And if nicotine were so addictive as the anti-smokers claim, then why aren't people addicted to NRT?  Because it's the ritual of smoking that forms the pleasurable habit. It's not just about nicotine.

And those simple facts makes Big Pharma extremely jealous of e-cigarette companies, who are several orders of magnitude closer to the ritual of smoking than any NRT product could ever achieve. It grates at Big Pharma, annoys them, like an unseen mosquito buzzing away in a dark bedroom on a warm late-summer evening. You know it's there, and you know it wants to bite you. It senses your breath and hones in on you, goes quiet and lands on you. You feel nothing until after it's already bitten you and ingested a quantity of your blood. It flies away, unscathed, pleased and thrilled from engorging itself. And you, Big Pharma, are left with an itchy, stinging sore that keeps you awake for hours, and scratching barely provides any relief.

For the final confirmation that Big Pharma is in the nicotine supply business and ultimately sees Big Tobacco as its direct competitor (along with anyone who supplies NCPs), here's one last quote from the study.
The jig is up. You tell me who is more honest about what they sell.  Big Pharma, or Big Tobacco?  One is trying to save you from yourself by selling you products that do not work as they claim.  The other is trying to sell you a product that you already want to buy, a product that you are already aware comes with health risks for using.

Do read the whole study. You may need to register to get access.  Come to your own conclusions about what you read.  And note, I have barely scratched the surface of what's in this paper. I could probably write 20 blog posts about it.  

But I've made my point. And I rest my case.