Wordplay: Alternative Substitutes

Wordplay: Alternative Substitutes

There are times every once in a while where I do truly become completely speechless. Lunchtime today was one of those times. For those of you that aren’t aware, my access to social media is restricted during the working day - as it should be, I have work to focus on.

So imagine my surprise when I come across this post from one Dave Dorn and this tweet from Dick Puddlecote:

Wondering what all this was about, I delved into the link that Mr Puddlecote kindly tweeted. I wished I hadn’t.

A “service specification” from the Proprietary Association of Great Britain (PAGB). Guess what, they are a trade association representing the interests of manufacturers of branded over-the-counter medicines, self-care medical devices and food supplements.

Over-the-counter meds. Pharma. One of the Unholy Trinity arrayed against the humble consumer driven e-cigarette.

Nicotine and tobacco use continue to be major public health challenges. There are still around 8 million smokers in England and smoking causes almost 80,000 deaths per year.

Since when did nicotine become a “major public health challenge”?

It is also a significant factor in health inequalities and ill-health. Moreover, smoking places a significant burden on the health service, costing the NHS approximately £2 billion each year.

Wonder why it is such a factor in inequalities eh ASH?

In the last 2011 Tobacco Control Plan (TCP), the Government set a national target of reducing smoking prevalence to below 18.5%.

Looking at the figures, since e-cigs became the method of choice for many to either stop completely or just simply switch, the rate of decline in smoking prevalence accelerated. Coincidence? Maybe. It isn’t the definitive cause of the decline, but it is one hell of a factor. A consumer driven product, enjoyed by millions worldwide, and approximately 3 Million in the UK alone has done something the cretins in tobacco control have utterly failed to do. Drive down smoking rates. All those policies, bans, tax rises and “denormalisation” campaigns so loved by ASH et al did the grand total of diddly-fucking-squat. No wonder tobacco taxation is so high.

There is an opportunity to reduce these inequalities and smoking prevalence across England through ensuring that stop smoking services are tailored to the needs of population groups which are most likely to require them.

I truly am no real fan of stop smoking services. They are there for a reason, granted. Doesn’t mean I like them. There are those that use them and there are those that flat refuse to. Guess which type I am. For those SSS like Leicester, Bristol or Harrow that openly embrace e-cigs as an option either for cessation - should the individual so choose - or as an alternative are there because those services are doing exactly what is being suggested - tailoring their services.

There never has been, nor will there ever be a “one-size-fits-all” solution for those that want to give up smoking. Some can stop at the drop of a hat, some take a little longer, some want Champix (and the potential side-effects that go with it), and some want to use new nicotine delivery devices - e-cigs, heat-not-burn. Some even go down the route of switching to Snus or other smokeless tobacco.

Fundamentally, those services that aren’t e-cig friendly are struggling to get people through the door because there is a key element these people will just never get. They don’t understand the smoker. Never have, never will.

The Stop Smoking Service outlined in this specification is designed to reduce smoking rates and the associated illnesses and mortality. The Service is designed to promote licensed interventions as a step towards nicotine abstention.

I wondered if “nicotine abstention” would come up in this document. I wasn’t particularly surprised to see it. After all, that is the goal of many in public health/tobacco control. Complete and total abstinence from nicotine.

Dave Dorn explains why this is impossible.

Oddly enough, both ASH & Cancer Research UK both wanted a separate nicotine regulatory authority back in 2005, thereby removing NRT (and all other “alternatives”) from medical regulation. The consensus behind this approach was to acknowledge that “safer forms” of nicotine usage were available and should be regulated independently to provide smokers with safer sources of nicotine that are acceptable and effective cigarette substitutes, and to encourage development of innovative, effective and user friendly products.

Well guess what? There is a set of innovative, effective (for many, not all) and user friendly products. The very same products that PAGB now want SSS to stop supporting.

With the exception of ‘reducing smoking rates in pregnant women at the time of delivery’, ‘smoking prevalence’ is defined as being reliant on either tobacco products or nicotine substitutes (as opposed to licensed nicotine replacement therapies (NRTs)).

Here’s a newsflash for you cretins.

The definition of substitute is as follows:

a person or thing acting or serving in place of another.

Alternative words - synonyms - include replacement and alternative.

Now look at NRT. Nicotine Replacement Therapy. By that definition, smoking prevalence won’t change if someone uses NRT or an e-cig. Muppets. The whole idea behind NRT is that the user follows a definitive course designed to “step-down” nicotine intake, mimicking (to an extent) a reduction in smoking. No wonder it has such a dismal failure and relapse rate.

It’s medical. It’s dull. It’s boring for heaven sake.

Good alternatives aren’t boring, medical or dull. That’s why vaping, Snus, heat-not-burn and other “new nicotine” products - the “unlicensed” for you Pharma shills out there - are more popular as a method for either stopping or switching.

Reducing smoking prevalence – defined as being smoke-free, without the assistance of nicotine substitutes at 52 weeks after the first quit attempt – through use of licensed stop smoking aids where appropriate and the use of unlicensed stop smoking aids only where necessary.

Just enough wiggle room for some to say “we’re not going to support e-cigs (or other new nicotine products)” and you can bet there’s going to be a lot of those - this is exactly what the pharmaceuticals want. They want a product that they had no interest in - ‘cos they can’t make money off it - to be driven into their domain, where they can then leverage cash off it.

So you see, the pharmaceutical companies are worried. The tobacco companies only want their products out there, and elements of public health & tobacco control want the entire lot binned.

This document, produced by the trade association for the pharmaceutical companies, goes against existing NCSCT, NICE, and PHE guidance. Not to mention the RCP’s wish to see e-cigs “promoted as widely as possible”.

Shenanigans abounds.

(Image credit Diego Schtutman/shutterstock)