Tobacco Control and Harm Reduction Fallacies

The way to solve the smoking problem is obvious

I have asked this question before, but no one seems prepared to answer it. If tobacco is merely to be controlled rather than abolished, this implies there are some circumstances where tobacco use is legitimate or acceptable. And what, pray, are these? Furthermore, to talk of tobacco harm reduction is an admission that tobacco use, to some extent at least, is harmful.

Why do people use tobacco in the first place? The answer to this question underlies the whole problem. For the vast majority of people who smoke at all, it’s not an occasional activity. It’s abnormal behaviour that smokers engage in repeatedly every day. For pack-a-day smokers this means sucking toxic tobacco fumes into their lungs around 200 times, and pro rata for those smoking more or fewer cigarettes daily.

If we ask smokers why they smoke, the usual immediate response is that they don’t know. But after a little thought, common answers emerge that it’s enjoyable or relaxing, or both. These reasons make no sense. What other normal human activity is so enjoyable that it needs to be indulged in repeatedly to such an extent every day? And, if smoking is relaxing, what state were smokers in just before they smoked? Clearly, not relaxed. And why is that? Because smoking, quite apart from relieving stress, causes stress through the mechanism of nicotine withdrawal.

Quitting smoking means returning to the happy state, other things being equal, that smokers were in before they started smoking. This should be a matter for rejoicing. Smokers need to understand that never again having to poison themselves with tobacco fumes is marvellous! It’s essential to view quitting smoking in this light. If one approaches it with hesitation, doubt, or even foreboding you’re setting yourself up for failure. Also, contrary to what orthodox quit smoking clinics will tell you, quitting smoking is not a process or a journey: it’s a state. Either you smoke or you don’t. Furthermore, as a smoker you have an urgent need to quit right now – not next week or next month or at some vague time in the future.

Why it’s a bad idea to set a smoking quit date
Nearly all stop smoking methods will tell you to pick a date in the near future when you intend to quit. This is a bad idea. Here’s why:

First, it reinforces the widely held but mistaken notion that stopping smoking is terribly difficult. You have to prepare yourself for it, as if you’re going to take an exam or the driving test, and work up your willpower for the big day.

Second, it plays along with smokers’ often unrecognised attitude that they don’t really want to quit. If smokers are advised to set a quit date, it means they can carry on smoking, at least for a while: a week, ten days, a month – or longer. And what then? They may well find that it’s not the right time or they’re not yet ready to quit, so they put off the fateful day. The fact is that most smokers will never be ready to quit – that’s why they smoke.

Setting a quit date also encourages the idea that smoking has some redeeming features such as that it’s enjoyable or relieves stress. Thus, smokers can continue for a little longer to enjoy these imagined benefits, thereby reinforcing their inherent reluctance to quit and implying they will suffer a sense of loss when at last they ‘give up’ smoking, if they do. And what’s going to be different ten days or a month hence? Suppose you put off quitting for two weeks. If you succeed then, if you’re a pack-a-day smoker, you’ll have poisoned yourself by smoking an additional 280 cigarettes. This won’t do your health any good.

With this approach to quitting, you’ll likely be fretting over the looming quit day, regretting the sacrifice you’re reluctantly planning to make, and then be struggling with the hindrance of nicotine gum or patches or prescription drugs to deal with the anticipated awful withdrawal symptoms. As a smoker, you have an urgent need to quit right now.

The tobacco harm reduction fallacy
Now let’s return to the curious idea of tobacco harm reduction. This implies either that quitting tobacco is too difficult, so if smokers can’t or won’t quit, then at least let them continue in thrall to their nicotine addiction – for such it is – in a way that is (probably) less harmful than smoking. This is a counsel of despair and almost an insult. It arises in the minds of orthodox smoking cessation counsellors because of their failure to appreciate that the only reason smokers smoke is nicotine addiction. Counter-intuitively perhaps, once this fact is grasped, quitting smoking can be easy.

Denormalising smoking
In tobacco control circles one may hear talk of ‘denormalising’ smoking. What a wonderful idea! But how is it going to come about and what is it hoped will happen if it could be achieved? The answer seems to be that by continuing with tobacco control policies, that is, by increasing tobacco taxes each year, putting ever more horrible pictures on cigarette packs, devising ‘hard-hitting anti-smoking campaigns’ which means trying to get smokers to quit through fear, raising the age at which people are legally allowed to buy cigarettes, increasing non-smoking public areas, and by generally casting disapproval on the activity of smoking, eventually it will no longer be regarded as normal to smoke. And then what?

Here are two definitions, taken at random from the internet, of denormalisation of smoking:

Denormalisation is an array of actions (such as what?) implemented to induce and reinforce the public perception of a health-compromising behaviour as socially unacceptable.

Deploying a combination of communication tools traditionally used by the tobacco industry (public relations, influence marketing and advocacy actions) and through the renewal of the storytelling around tobacco consumption and its industry, tobacco control organizations can change the social perception of tobacco products and the industry, in society….at a European and international level…contributing to this objective of denormalisation. (Yawn.)

The above quotes are babble. Nonetheless, there is a simple way to denormalise smoking.

At the local supermarket in Tokyo where I often do grocery shopping, at the checkout they sell…cigarettes! Admittedly, these are locked in a glass cabinet, but the staff will open it on request and as many packs as you want will be added to your bill, that is, as long as you’re over the legal age in Japan to buy cancer sticks, which is 20 years. But why are these useless, dangerous products on sale at all?

Once cigarettes are no longer on sale in the shops, no one will be able legally to buy them, smoking will largely disappear from public view, and thereby will become denormalised. But for those who can’t wait, they can easily quit smoking and all nicotine use with the Symonds Method. See the Books Page.

Text © Gabriel Symonds.

Picture credit: Sutirta Budiman on Unsplash