Tobacco Leaves on a Dollar

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.

E cigarettes, NRT, and Distraction

The Wall Street Journal reports that tobacco giant Reynolds American International is involved in talks to purchase Niconovum the Swedish manufacturer of Nicotine Replacement Therapy products. NRT is of course a popular method for tobacco cessation. At first blush this seems a truly strange union. Is RJR trying to sabotage tobacco cessation efforts? Or is this simply revealing what we have known all along about tobacco marketing? It is nicotine dependent.

"We are, then in the business of selling nicotine, an addictive drug effective in the relief of stress mechanisms." RJR July 17, 1963. Bates 1802.05

And if we suspect Niconovum’s/RJR’s nicotine products why then should we not be suspicious of others that profit from the sale of nicotine like Pfizer et al. Is it because we question RJR’s intent and not the drug companies that have made a huge business out of cessation products?

E cigarettes are being promoted as smoking cessation devices by everyone except the E cigarette companies. That classification would give the FDA more authority to regulate the devices, the nicotine. More than anecdotal evidence is required to show that nicotine delivery in this fashion is harmless or effective.

The best evidence that E cigarettes pose no competitive threat is demonstrated by a lack of opposition from the tobacco cartel. If tobacco companies thought nicotine vapor threatened their profit, we’d know because they would swoop down and buy the tiny businesses that are producing these vaporizers. And they may yet just as RJR is eyeballing NRT manufacturer Niconovum. In the meanwhile big tobacco is content to let E cigarettes play the spoiler for the myth of a safe cigarette. The poor will never get their fix as cheaply as the traditional cigarette and the few who can afford to switch to taking their nicotine in a vapor will reaffirm nicotine addiction as a normal part of the day. But at the end of the day as long as it contains nicotine big tobacco has nothing to lose.