Dr.s Simon Chapman and Ross MacKenzie’s 2010 paper, The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, and more recently Chapman’s op ed on the marketing and promotion of NRT and pharmacopeia for tobacco cessation may well be the key to the next paradigm for effective tobacco control.
Recently there has been much attention given the ostensible “inveterate smoker”, the smoker who does not quit. It has been felt that after we raise the cost of tobacco, create tobacco free space, and eliminate tobacco marketing there still are going to be people who will not or cannot quit. This alleged population has been much of the motivation for those referring to themselves as harm reduction advocates, encouraging the promotion of forms of nicotine delivery allegedly less harmful than smoking. Chapman and Mackenzie’s work here calls into question whether that population exists at all and the validity of research funded by those marketing NRT or pharmacopeia.
He make 3 structural points: Most research is done by those interested in interventions and because of that primarily are testing their own means. In a capitalist society there is the tendency for medical means to become commodities. And lastly that these interventions are based on the erroneous assumption that there are some individuals who have an impenetrable addiction that warrants the interventions.
Yet 3/4 of all ex-smokers quit with no assistance at all. Cold turkey quitters outnumber all cessation methods combined. Studies have shown that most successful nicotine addiction was overcome with no preparation at all, that certain environmental cues prompted cessation and abstinence.
Recent genetic discoveries have suggested that there are predispositions to nicotine addiction and has been a facet of the thesis of the inveterate addict. This should not be underestimated in evaluating the risks of ever starting to use nicotine. But Chapman and Mackenzie’s research sheds light on the need to shift our perspectives toward modifying the environment beyond increased pricing, tobacco free spaces, and marketing reform. What we have been calling cessation support perhaps should not take as strong an active, or pharmaceutically interventionist, role as it does a further reformation of the environment.
The theory that some people cannot quit without intervention becomes a self fulfilling prophecy when seen with the enormous amounts spent by pharmaceutical companies, and others, advertising cessation assistance and funding research to test their products. We know that youth are more likely to start smoking if they believe quitting will be easy. Are we not re-enforcing the myth that quitting is difficult with our capitalist emphasis on marketing cessation support?
The under publicized figures surrounding cold turkey cessation point to rogue capitalism as a major factor in challenging tobacco perhaps no less than that of the tobacco industry. Somewhere in the evolution of dealing with nicotine addiction the emphasis on changing people’s perspectives on tobacco use from a social issue to a medically treatable problem a step was missed. There is little doubt that if there weren’t a dollar to be made it would not have happened.
Dr. Chapman points out that for the developing world, the growth market for tobacco companies, NRT and pharmacopeia is not a viable economic or realistic option. His paper suggests that we are far from optimizing the environmental and behavioral cues that enhance cessation and should not be dissuaded by the drive to profit in our capitalist society.
This also helps clarify where the harm reductive E cigarette clamor is coming from. Right now E cigarettes can’t decide whether they are cessation devices or that fairy tale of a safe tobacco habit. Emphasizing the fact that most people overcome nicotine without NRT shows how unwarranted another nicotine delivery device is.
400 years ago European colonial efforts to export tobacco co-opted an entheogenic plant from aboriginal Americans. In short order the plantation economy spawned the genocide of native peoples and the importation of an enslaved African population. As the leading cause of death and disease today is the capitalism surrounding tobacco today significantly different? The profit certainly isn’t.
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