Archive for April, 2010

In my last post I gave a brief introduction to the wonderful world of e-smoking, the claytons cigarette of the smoking world. “The cigarette you smoke when not having a smoke”. Whatever did happen to Claytons anyway? I remember the ads on TV and in magazines along with of all things, Horlicks – a malted drink and nothing to do with fake alcoholic beverages (note: I saw Horlicks in the supermarket recently. It’s somehow comforting to know that it is sill available, although I’m not exactly sure why). Not that electronic cigarettes have the same message as Claytons because electronic cigarettes are predominately used to provide the substance that smokers crave – nicotine, where as Claytons did not contain any of  that other societal evil; alcohol. Why Claytons and Horlicks have an association in my mind, as if they belong together is a mystery. Another mystery is why I have these memories at all and why they’re firmly implanted in my brain. It sure goes to show how heavily imprinted we become by media campaigns.

And so it is with tobacco, that evilest of all weeds. Millions of dollars has been invested to train us with the belief that everything associated with tobacco is extremely bad and something to avoid at all costs. We’re also told with authority that if you happen to be addicted to the stuff and smoke, then it is in your best interest to quit – “Every cigarette is doing you damage” as the commercial drums into our skulls with a repetitive snaring of our subconscious rhythm and every cigarette is doing us damage. It may even possibly kill us. Statistics demand that we heed the message, because 50 percent of smokers will die from the damage of cigarette smoke. Of course along with the quit message we are re-assured that there is help. Big Pharma have just the product up there sleeves – we can quit with the aid of NRT (Nicotine Replacement Therapy)  or we’re encouraged to visit our GP who can then prescribe the correct medication if need be, which presumably equates to finding ourselves at the corner Chemist filling out a script for Champix/Chantix. But what the QUIT campaigns neglect to inform us of is that NRT is not a therapy at all but just a substitute addiction, a grab for cash from addicted smokers. Have you ever noticed that NRT is at price point similar to that of tobacco? Why is that? If Big Pharma and Government were so interested in our health then it stands to reason that nicotine replacement therapy ought to be significantly cheaper than cigarettes but they are not. It’s akin to pricing Methadone at price point just a little less than that of Heroin – it sounds ridiculous but that is what smokers are asked to participate in .

What Big Pharma also neglects to mention is the fact that for the most part, NRT is an ineffective treatment for addiction. At best it is the equivalent of a methadone program for nicotine addicts and at worst, it is taking smokers for ride while they entertain the notion of quitting. Quitting any addiction is about abstaining from the substance one is addicted to and not replacing the witch for the bitch. If you are serious about quitting as espoused by the QUIT campaign, it is purely a matter of stopping and then sticking to that decision no matter what. I’m not trying to trivialise the struggle by saying that it is simply a fly-by process that is easily attained, because it is not an easy decision to make and stick to. But if the goal is to quit smoking and nicotine, the most effective way is to just to stop and white knuckle it through the turmoil which may be for an extended period or may be short lived. For some it is easy but for others it’ll be a daily struggle for an X amount of time. I myself have never ever gone past the contemplative stage and is easy for me to lambast NRT and Big Pharma over quitting with a piece of Snus (rhymes with goose) stuffed in my upper lip but the truth is, NRT or other so called smoking addiction treatments are a sham.

It is somewhat ambiguous and disingenuous when our minds are infected with the notion that addiction is a medical problem which ought to be treated with medicine and in the case of nicotine addiction, the medicine to treat the addiction is very same substance of addiction -  nicotine. It’s a strange irony that nicotine products manufactured by Big Pharma are deemed tolerable and acceptable, however any nicotine product from Big Tobacco is automatically considered evil when the truth is that Big Tobacco is in a better position to actually develop a product that smokers would want to use and if they were smart they could develop a safer alternative. In fact the product is already available but it wasn’t developed by the Philip Morris’s or British American Tobacco’s of the world but by a company called Ruyan and if it could be evolved to it’s full potential, it will certainly provide a product that could easily be adopted by even the most hardcore or diehard smoker . The opposition inherent to the Tobacco industry makes any technological advancement in nicotine delivery prohibitive when the idea that nicotine addiction is in itself evil. Big Tobacco would most certainly have their bottom lines first and foremost in their minds so any product they’d wish to market would be highly addictive and thus something outrageous to the Anti lobby. But lets not hastily throw the baby out with the bath water when it is worth considering that the leading cause of preventable disease and death is caused by smoking and not nicotine itself. With the abysmal failure of NRT as a successful treatment of nicotine addiction, looking further afield from the offerings of Big Pharma begins to look attractive.

If there are doubts about the ineffectiveness of people quitting smoking using NRT, one need look no further than the self evident. If NRT were an effective treatment would we still see people smoking? If they were an effective replacement then it is a reasonable supposition to see far greater numbers of smokers jumping ship and using patches, gum or lozenges rather than sucking on cigarettes – because they’d be a far better nicotine delivery system than cigarette smoke . But that is not what we see and apart from those who are thinking about quitting who then use these products to reduce withdrawal symptoms while they ponder the cost benefit analysis of quitting or those that use NRT when it is prohibitive to smoke, they fail to deliver. They ought to be marketed as a harm minimisation tool rather than a quitting aid because lets face it, they don’t work! They may reduce the amount of cigarettes one smokes but as a replacement they fall way short in doing what the label proclaims it to be and as for a therapy we can most assuredly dismiss such outrageous propaganda as merely a softening ploy to ease the ridiculous cost we’re dishing out to Big Pharma to use the drug we’re addicted to.

Besides we are assuming that nicotine is the only thing that the cigarette smoker is addicted to, when there are thousands of other chemicals in cigarette smoke that could be equally addicting or a multitude of chemicals acting together that has the right combination to satisfy. If it were just nicotine then we’d expect to see a lot of smokers who use NRT to least switch addictions to just nicotine after adjusting to the slower delivery but either the NRT products themselves are too stingy with nicotine or cigarette smoke has other compounds that make it a far superior product to satisfy the craving the smoker seeks. The problem is that nicotine itself has been demonised when it is safer in magnitudes of order to cigarette smoke, which makes it difficult to introduce a product with at least a comparable nicotine delivery system to cigarettes to adequately gauge if a faster and higher nicotine product would be effective in reducing cigarette smoking. Possibly clinical trials have occurred where this indeed the case although I know of none, it has been the demonization of nicotine that has thwarted any advancement in harm reduction as a viable alternative when the philosophy from the Anti-Tobacco lobby is Quit or Die. I really don’t understand this message at all when cigarettes are still sold, why is too much to allow a product that is safer although just as addicting when the real killer is still on retailers shelves? It makes absolutely no sense.

It’ll be a far better use of resources to hammer us with the message that quitting is easy and you can do it cold turkey than it is offering some panacea to tobacco addiction through NRT when clearly it is not or by extolling the Quit or Die message as the be all and end all of harm reduction and well being. Smokers want a way to stop smoking in the most painless way possible and if quitting is entirely the goal in mind then it should be encouraged but if there is resistance to quitting then at present we are left with the message of Quit or Die! So if we fail to quit we are resigned to die with our cigarettes in hand. It’s a strategy that is far from effective because it is a dichotomy that is counter to what quitting is about – the health and well being of the individual smoker. It seems that whole basis of this message is to drum it into the psyche of smokers in the hope that eventually it’ll sway the judgement of the smoker in favour of quitting. If addiction were such a simple process as bashing people like the god-botherers neighbourhood door knocking campaigns then we’d see far less smokers and we’d also see churches filled to the brim, but we see neither. The QUIT of Die message is perhaps more effective in brainwashing people from actually picking up cigarette smoking than it is in persuading smokers to quit. Fear campaigns aren’t really going to be an effective intervention in reforming existing smokers. Although media campaigns and mind manipulation are standard fare in every day life, when it comes to persuading addiction to leave its host it is perhaps not as easy a task as normal mind control because addiction works on far baser level than that of the higher cognition centres of emotion that seem to be the play ground of advertisers. Quit or Die! If you can’t or won’t quit then you die. How marvellous, but is it the truth, the whole truth and nothing but the truth?

Are there really only two options smokers have – Quit or Die? Therein lies the problem with the Quit or Die message – there is no middle ground when the option of harm minimisation is effectively taken away from the discussion, it has conveniently placed aside in favour of politicking. What of those smokers who realise that smoking is harmful but have no motivation to quit or who have tried but remain unsuccessful? What if those smokers would happily switch from smoking if a satisfying replacement, which was less harmful than cigarette smoking was available? Perhaps these people are a minority but shouldn’t they at least be offered a substitute with minimal intervention from the Anti camp?

With the introduction of electronic cigarettes into the market we have at least one other option to curtail the inhalation of cigarette smoke even though quitting nicotine is perhaps not on the agenda. Certainly “no nic” juice is readily available for those that wish to be free from addiction, but  electronic cigarettes can also be used as a replacement to smoking tobacco by inhaling nicotine in a glycerine vapour. A health risk is still present, however the risks remain unknown but it is reasonable to assume from preliminary studies that electronic cigarettes are safer than cigarette smoking by orders of magnitude. Shouldn’t this product then be embraced rather than shunned?

Not according to The Therapeutic Goods Administration – they in their infinite wisdom have deemed the electronic cigarette as a therapeutic good. According to this bureaucracy, e-cigs are not dissimilar to NRT – a medical device no less. Absolute baloney! The whole argument rests upon some website that dared suggest that one could stop smoking using electronic cigarettes. Notwithstanding anecdotal evidence that people have quit smoking and then progressed to zero nicotine vapour using electronic cigarettes, it is still a device that is used by many if not the majority as an alternative to smoking – more akin to smoking a cigarette than it is a patch. It looks like a cigarette and produces vapour like a cigarette and feels like a cigarette when inhaling but it is not a cigarette. How can it be even entertained as a therapeutic good? It delivers a recreational drug and not medicine for crying out loud! Big Pharma believes nicotine is a medicinal drug to treat nicotine addiction and if that were really the case then cigarettes themselves are medicine. Preposterous!

Given that the efficacy and safety of electronic cigarettes is yet to be fully determined with scientific testing, they do seem to at least be seen favourably by a few researchers and academics, while others in academia suggest electronic cigarettes are little more than placebos. However, studies have been conducted on the safety and efficacy of another smoking alternative, although little is known about this product outside of Scandinavia – that product is Snus.

Swedish Snus has been used for 2 or 3 centuries in Sweden and to a lesser extent in Norway. What is Snus? Snus is a moist oral tobacco that has been milled into a fine powder and then pasteurised by either a fermentation or steaming process to eliminate micro organisms. Salt and flavours are added, traditionally with bergamot which gives a citrus taste and newer flavours such as mint, berry, cinnamon and many others to inspire the taste buds of tobacco lovers of all persuasions. Some Swedish recipes are as old as snus has been consumed. Ettan being a registered trademark since 1822 and probably the oldest commercially available snus brand today.

The process of steam pasteurisation is considered to produce a product that is between 90 to 99% safer than cigarette smoking, primarily due to the fact that nothing is inhaled, thus having no impact on the respiratory system and also because of the low count of tobacco specific nitrosamines (TSNA) present, which are the main carcinogenic compounds found in tobacco. The fermentation process does not produce the same low TSNA count due to micro organisms not entirely killed in the process, which then begin producing nitrosamines as a by product as the tobacco ages. The shelf life is considerably less because of this, although it is most certainly a better proposition to that of smoking tobacco, which has the highest TSNA count by far. Swedish Snus is the product to purchase if one’s goal is harm minimisation while enjoying tobacco relatively guilt free. It is not without risk but is substantially less harmful than smoking. Snus does elevate the risk of pancreatic cancer, it doubles the risk from of those that do not use snus but it is half the risk of those that smoke. Nicotine is a drug and as such it poses health risks but if one is already addicted to tobacco smoking and who is unwilling to quit, then snus may offer a safer and satisfying way to deliver nicotine and tobacco alkaloids without the dangers of inhaling tobacco particulates.

Snus can either be purchased as loose or in portions. Portions are packaged in tea bag type pouches which are placed between the lip and gum, usually under the upper lip. Loose is not pre packaged in pouches and is moulded into a cylinder with either a pris tool or by hand, also placed in the same area of the mouth. Both are a spit less moist oral tobacco, although if using loose there is the possibility that it may become dislodged and make a mess in your mouth, so is probably not the type a novice should choose to use. Unlike chewing tobacco, which does require constant spitting, Snus produces little saliva because of its placement in the upper lip, near the front of the mouth making tobacco juices less likely to run, which may be a little nasty tasting. Because the upper front has less saliva ducts it generally eliminates the need to spit out the tobacco juice which is an irritant to the stomach and digestive system if swallowed.

Because smokeless tobacco was harshly treated in the 1990s, it was taken off the Australian and European markets. Quite wrongly, it was considered a health risk and carcinogenic due to studies done on Indian oral tobacco products, which do cause cancer and are entirely a different kettle of fish than that of Swedish Snus.

Unfortunately we in Australia are at the mercy of the federal government who in their infinite wisdom have laid a taxation regime on par with regular tobacco which wouldn’t be so bad if snus wasn’t 50% water. Because it is a moist tobacco we are being taxed $160 AU for water. Our taxation system is disproportionate to the harmfulness scale and for that reason alone, snus which is considerably less harmful than tobacco cigarettes, ought to be taxed at a far less rate than cigarette tobacco. Our taxes make it a prohibitive product to most smokers in Australia and it is an outrage and shame given that the leading cause of preventable death is tobacco smoke. However there is a fair chance that if one orders small amounts, in the range of 5 cans or less then they can get through customs without having to pay duties which offers a very cheap alternative to smoking with the health benefits to boot.