Sitting on the ASH Tree Fence
‘Action on Smoking and Health’ (ASH) is a charity set up by the Royal College of Physicians of the UK. It’s supported by those worthy bodies, the British Heart Foundation and Cancer Research UK.
ASH’s website informs us that it’s ‘a campaigning public health charity that works to eliminate the harm caused by tobacco.’ So far so good. But then they say their approach is ‘To press for policy measures that will reduce the burden of addiction, disease and premature death attributable to tobacco.’ (Emphasis added.)
Well, which is it? Do they aspire to eliminate the harm caused by tobacco or only to reduce it? Even the first-stated aim is ambiguous. Do they seek just to eliminate the harm but leave the tobacco in place – implying the possibility that harmless types of tobacco or a safe way of using it could be developed – or get rid of the tobacco itself?
They are then quick to point out: ‘We do not attack smokers or condemn smoking.’ Why the defensive tone? Has anyone said they do attack smokers or condemn smoking?
This is sitting on the fence. You can’t have it both ways. They need to be a bit more – how shall I put it? – Trumpian.
I wouldn’t attack smokers either – it’s not their fault that they’re nicotine addicts; but I do condemn smoking. Or rather, I condemn the situation that’s resulted in there being a billion smokers in the world today, or if one takes a more parochial view, the unfortunate fact, according to ASH, that there are 9,600,000 adult smokers in Britain. In this sense I think the UK and other governments have a lot to answer for: knowingly allowing for about the last fifty years a useless and unnecessary addictive drug in the form of dangerous cigarettes to be freely available. And maybe the reason for this is that in 2014-15 the UK government received £9.5 billion in revenue from tobacco tax (excluding VAT) although it spent a trifling £87.7m on services to help people stop smoking and a further £58.1m on stop smoking medication in 2012-13, according to ASH.
Just to see this in context, again using ASH’s figures:
Every year, around 96,000 people in the UK die from diseases caused by smoking.
It hardly needs to be said, but I’ll say it anyway: this is a shocking, scandalous and unacceptable situation.
Apart from the lack of clarity noted above, what is ASH trying to do about helping smokers to quit? From their fact sheet of September 2014 it’s interesting that although the key to easy quitting is within their grasp, they don’t seize, preferring to follow the conventional approach:
Smoking feels pleasurable, but much of the pleasure of smoking is actually relief from nicotine withdrawal. Soon after smoking a cigarette the body starts to crave nicotine and many smokers will feel increasingly uncomfortable until they have the next cigarette. Smokers often report feeling distracted or unable to enjoy themselves when they are not able to smoke…some smokers find it challenging to give up nicotine because it is a powerful and addictive drug.
This is along the right lines, but it’s not quite there.
The reason smokers find it hard to quit is psychological: the withdrawal symptoms are not that bad, but smokers are afraid that the discomfort will become intolerable. In reality the opposite will happen: the discomfort of the withdrawal symptoms is temporary and it will go away.
What ASH recommends, in common with almost everybody else, to get over the ‘cravings’, is:
…nicotine containing products such as patches, lozenges, inhalers, and/or gum [and] there is also some evidence that electronic cigarettes are effective as quit aids. The idea is to wean yourself off nicotine by gradually reducing your intake until you don’t need it any more.
Worse, they then encourage smokers to:
Find a temporary substitute habit. Smoking a cigarette gives smokers something to do with their hands or mouth. The popularity of electronic cigarettes may, in part, be due to their satisfying this need. Alternatively, you could chew gum, drink more water, fruit juice or tea, or eat something.
This is absurd. You don’t need a substitute, temporary or otherwise, for smoking. The rest of this advice contradicts what they’ve already said: nicotine is a powerful addictive drug – it’s nothing at all to do with satisfying a need to do something with your hands or mouth.
The emphasis on finding a substitute for smoking and weaning yourself off nicotine gradually is counter-productive. All that the smoker who wants to quit needs to do is to cease putting nicotine in any form into his or her body. And the withdrawal symptoms – renewed each time by another dose of nicotine in any form – will go away for good.
Text © Gabriel Symonds