My new book Quit Smoking Weapons of Mass Distraction (Sydney University Press 2022 359pp ISBN 9781743328538) was published as an e-book on June 26 and as a paperback on July 1, 2020
You can download a full pdf of the book FREE here OPEN ACCESS e-book or order the book at Amazon here ($AUD40.00 paperback)
Below are quotes from the book that I hope will stimulate your interest.
The core message of the book
“The core message throughout this book has been that the overwhelming dominance of assisted cessation in the way that quitting has been framed over the past three decades has done a huge disservice to public understanding of how most smokers quit. Around the world, many hundreds of millions of smokers have stopped without professional or pharmacological help.”
On the dominance of unassisted cessation in how most ex-smokers quit
“If we were able to estimate the total number of people who have ever smoked and the total number who later stopped smoking completely, the proportion who were assisted in quitting by the actions of any kind of therapist or interventionist, or by consuming a potion, a pill or nicotine replacement (pharmaceutical, or most recently, from e-cigarettes) would be a small minority.”
“the overwhelming majority of research on smoking cessation has always focused on the “tail” of assisted cessation, not on the “dog” of unassisted quitting.”
“The inverse impact law of smoking cessation states that the volume of research and effort devoted to professionally and pharmacologically mediated cessation is in inverse proportion to that examining how ex-smokers actually quit. Research on cessation is dominated by ever-finely tuned accounts of how smokers can be encouraged to do anything but go it alone when trying to quit – exactly opposite of how a very large majority of ex-smokers succeeded.”
On the medicalisation of quitting:
“Many concerns previously perceived as normal human differences or problems have now been defined as tractable illnesses that can benefit from diagnosis and often lifetime drug taking.”
“It appears that there is no smoker, regardless of how much or little they smoke, and regardless of whether they are not at the point of trying to quit, actively trying to do so or have long stopped smoking, for whom medication and especially NRT is not recommended. It is in the interests of that industry to persuade as many smokers as possible to use pharmaceutical aids for as long as possible.”
On the effectiveness of nicotine replacement therapy
“the best complexion we can put on the question of how good NRT is in keeping smokers abstinent into the longer term (here two years), is to say that NRT fares better than unassisted quitting while it is being used, but that both strongly fade as the months and years go by, to the point that there is no difference at two years. Smokers’ curiosity about whether they will fare better in the long-term with a course of NRT than with unassisted cessation therefore looks like a ‘no’.”
On why results from randomised controlled trials of quitting medications poorly reflect real world use results
[one review] “found two-thirds of participants with nicotine dependence would have been excluded from clinical trials by at least one criterion … Those in such trials are thus very unrepresentative of all smokers wanting to quit.”
“frequent contact with research staff who are doing their best to ensure low rates of trial dropout, can combine to create an influential backdrop to using a quit-smoking medication or approach which is very different to the way people will use the same drugs or approach in “real-world” conditions outside a trial.”
“Undoubtedly, much smoker resistance to using cessation medication is due to many smokers learning from other smokers that real-world experience of using these drugs does not produce outcomes that remotely compare with benchmarks for other drugs they use for other purposes. Few if any other drugs for any purpose with such abject track records would ever be prescribed.”
“after over four decades of the pharmaceutical industry’s turbo-charged, no-expense-spared efforts to increase physician engagement and erode population resistance to pharmaceutical-based cessation, how many more years can the narrative of getting even more smokers to medicate retain any realistic credibility?”
On the pleasure of smoking
“The argument that smoking and inhaling nicotine is “pleasurable” is a bit like saying that being beaten up several times every day when you haven’t been able to smoke is something you want to continue with, because it feels so good when the beating stops for a while.”
On remaining smokers being “unable” to quit without help
“Those arguing that today’s smokers are increasingly heavily addicted and unable to stop, and therefore need assistance to do so, have very poor evidence supporting their case. Globally, vast numbers of smokers continue to stop or reduce their smoking every year. These include very heavy smokers and … many who quite suddenly stop smoking without making much if any preparation to do so.”
On quitline impacts
“an estimated 0.87% of all US smokers [ever call a quitline], with the target being 6% or more. In not one year between 2009 and 2017 did the reach exceed 1.19% of smokers, falling some 500% below the minimum target reach set by the quitline consortium management.”
On the unpublicised news that many ex-smokers found quitting easier than expected
“in these striking data about many ex-smokers finding the quitting experience less traumatic than expected, we rarely (if ever) hear comments or see campaigns from those in tobacco control discussing or highlighting this. We very seldom hear any efforts to de-bunk or leaven the “it’s very, very hard to quit smoking” meme by pointing out that many ex-smokers were pleasantly surprised that quitting was not as tortuous as they expected.”
On vaping
“today the dominant narrative about smoking is being undermined by a shift from one about quitting smoking to one about switching to vaping, to the great delight of those in the industries whose very existence rests on the widespread continuation of nicotine dependency.”
“Vaping advocates are fond of arguing that because nicotine is freely available in tobacco products, it follows that nicotine for vaping should enjoy at least the same, if not more accessibility and be freely sold almost anywhere. This argument has all the integrity of a chocolate teapot.”
On vaping safety
“If any scientist had declared in 1920 that cigarette smoking was all but harmless, as vaping advocates insist today about e-cigarettes, history would have judged their call as heroically and dangerously incorrect. But this is the cavalier call that many vaping advocates routinely make, after just 10 years or so of widespread use in some nations.”
“High-quality clinical and epidemiological data on vaping’s health effects are relatively sparse. There are no data on long-term health effects, reflecting the relative novelty of vaping and the rapid evolution of vaping products. Determining even short-term health effects in adults is difficult because most adult vapers are former or current smokers”
“Inhaling vapour many times a day for decades is unlikely to come without some sort of adverse effect. And time will tell what that will be”
“if you both smoke and vape (dual use), you’ll have higher levels than those who only smoke. So if dual use is the Mount Everest of toxicant exposure, then smoking is the K2 exposure, vaping is the Matterhorn and never smoking or vaping is the toxicant exposure at sea level.”
“All tobacco companies now marketing e-cigarettes are delighted to [promote vaping as all but benign], while just down the corridor in their tobacco divisions they continue trying to maximise demand for the cigarettes that will cause the same billion deaths [this century] they claim vaping could prevent.”
“all vaping evangelists believe that no impediment should be placed in the way of their lifesaving work. But medicine of course has a very long history of claims being made by purveyors of a multitude of miracle cures who also believe their crusades are far too important to be regulated.”
On vaping flavours
“I recently asked my 11-year-old granddaughter about what she thought attracted some of her Year 6 classmates to vaping. Instantly she replied, “You can get lemonade flavour!”
“Why aren’t any asthma puffer drugs flavoured? Because the pharmaceutical industry knows it would struggle to demonstrate that inhaling flavours is acceptably safe”
“By 2016–17 [available e-cigarette flavours] had more than doubled to 15,586”
“E-cigarette manufacturers should not represent or suggest that the flavour ingredients used in their products are safe because they have FEMA GRAS status for use in food because such statements are false and misleading (Flavor and Extracts Manufacturing Association (FEMA) 2021).”
“Compare daily inhalation numbers: asthma puffers:4-6; daily smokers:104; daily vapers 500-600 … making a mockery of the bizarre denialism that vaped nicotine is not addictive.”
How good are vapes for quitting smoking?
“17 reviews of the evidence and position statements by professional health associations published since 2017 have concluded that the evidence for e-cigarettes being effective for smoking cessation is inconclusive, insufficient, weak or inadequate”
“But there can be few if any other drugs, used for any purpose, which have even come close to the dismal success rate of e-cigarettes or NRT in achieving their main outcome. If we went along to a doctor for a health problem and were told, “Here, take this. It has a 90% failure rate. But let’s both agree to call this successful,” we would understandably take the view that “success” when used in this context was not the way that it is used in any other treatment context”
On whether vaping reduces amount smoked per day
“Data from 2019 from the UK government’s annual Opinions and Lifestyle Survey also show that the average number of cigarettes smoked daily by smokers who vape (8 a day) is almost identical to that by smokers who have never vaped (8.1 a day)”
Read reviewers’ comments here
Simon Chapman AO 