Nicotine replacement has no proven benefit in quitting, say all the papers

Here is an example. And another, from north of the border.

Stories like this used to be commonplace. Sometimes, like this one, they were brought out to herald national no-smoking day. As ever their aim was to convince people that the best way to stop smoking was to rely on a nicotine crutch and under no circumstances to depend on your own will power.

Freedom 2 Choose (the UK group) has long campaigned for recognition that the claim 'four times more likely to quit with the NHS' was based on as much hot air as the claim that the Scottish smoking ban resulted in a 17 per cent drop in heart attacks (press release from 2009 can be read here). The Scottish group, Freedom to Choose group (Scotland) held its own demonstration at the 2010 (Glasgow) conference of the United Kingdom National Smoking Cessation Conference: the annual trade fair of smoking cessation professionals (the 2012 conference has yet to be announced).

The announcement that smoking cessation medications don't work any better than will power has had a muted reception from anti-smoking professionals. John Britton, of the UK Centre for Tobacco Control Studies, says it is 'not a surprising revelation' (is he about to resign, then?) He seems to feel that the availability of NRT gives people the necessary inspiration to quit, even though it doesn't actually make them any better at doing it. Deborah Arnott of Action on Smoking and Health seems to have her head in the sand:

Deborah Arnott, chief executive of the Action on Smoking and Health (Ash) charity said there was good evidence that the provision of medication and counselling to help smokers quit, as provided by the Stop Smoking Services in the UK, was effective and cost-effective. "Ash agrees, however, that it is essential that such support is provided as part of a comprehensive tobacco control strategy, which includes mass media campaigns to encourage smokers to quit."

Arguing along the same lines, research leader Gregory Connolly (Center for Global Tobacco Control, Harvard School of Public Health) adds:

"We have to think about, when we go into the real world, what are the other factors out there that are contributing to the relapse that the drug is not [addressing]," he said. "Clearly we know that social interventions such as price, clean indoor air policies and very strong public education campaigns do have a long-term effect and we can show that through population research." [emphasis added]

What do we know about clean air policies and strong public education campaigns? That they have led directly to stagnation in the long-term decline in smoking. The driver to smoking cessation is volition. Wanting to give up is key. Mass media campaigns don't help when their intent is to frighten people into quitting or otherwise ostracise or demoralise them.

The only effective starting point is wanting to quit. And being aware that some of the people and institutions who tell you how difficult it is want to make money, or prove their worth to society, by helping you.

Who's in charge over there?

What do Scottish Parliamentarians do if they want to smoke at work?

It's all written down here, in a policy statement from the Scottish Parliamentary Corporate Body, the organisation that runs the Parliament building and its affairs. It tells you where and when you can smoke and what you must not wear while doing so. It tells you what will happen if you flout the policy. The sugar on the pill is an offer to cover half the costs of treatment to any employee who wants to give up smoking (what's in it for them – being known as Investors in People, perhaps?). (This looks as if it could add up considerably, but it is limited to £292 per person per year. We might never know why they don't just round it up to £300.)

I don't know what the Macedonian equivalent to the SPCB is but wouldn't it be fun if this situation kicked off here?

Learning about the Framework Convention on Tobacco Control

Frank Davis has covered this important international treaty this morning here, including a startling map showing countries that have so far ratified the Framework Convention on Tobacco Control (even though much land is covered that has very low population levels). As usual, his readers follow up with further enlightening links.

Frank rightly points out that this treaty binds its members to certain courses of action regarding tobacco, which is one reason that it will be difficult to make governments backtrack on the smoking ban or other related legislation.  They consider their FCTC treaty obligations bind them more than loyalty to their electorates.

He is also correct to point out section 5.3 (links and quotes provided), which seeks to stop tobacco industry interference (for 'tobacco industry', read 'anyone that disagrees with it'). Such clauses explain, for example, why tobacco growers were excluded from the recent COP-4 tobacco talks in Uruguay – they were a dangerous distraction from the issues being discussed.

It can't be emphasised too much how important such international agreements are in making it an uphill struggle even to talk properly about the smoking ban (never mind fight it). They do actually undermine governments' relationships with their people, by destroying the normal course of political accountability.

Reconciling different interests in society is essentially a perennial problem. Not being a student of international relations, I don't know how much international agreements help to keep the peace internationally. But this one seems to be bad news all round. In spite of all its claims to be about health, representatives from a very poor sector in society, tobacco farmers, were excluded from a major global conference that threatened their livelihoods, while those from the richer sections of society dominate the scene, claiming to represent the interests of such poorer people. It still astonishes me that the first multilateral treaty created by the World Health Organisation is about smoking, rather than communicable diseases suffered by the poorest in global society. Can it be because the poor struggle to afford drugs, while rich countries can be duped into spending billions of dollars on anti-smoking treatments?

Royal Oldham row about shelters

The Royal Oldham hospital is reluctantly conceding that it has a problem with smoking on site since its 2006 ban, but some trust bosses would rather spend £80k on smoking cessation treatments than allow a shelter to be built that might cater for smokers and give them an alternative to doorway smoking.

If it comes to wasting money I agree that these trust bosses have a point about the shelters. It would be far more effective to set aside ventilated indoor areas for smoking in, than build a shelter that is out of sight of the main building and inconvenient for people to use. Provide somewhere sheltered, comfortable and pleasant (with an option of coffee facilities) and people will use it without the need for persuasion.

The drawback: the nation's so-called tobacco addicts would thereby get confused and think they are being given a green light to smoke. That would be terrible: one couldn't run the risk of (possibly bereaved) smokers thinking they had any right to experience true hospitality in a public place. It would send out entirely the wrong message.

The best we can hope for in the current hostile climate is that the trust will permit a shelter to be built. A poster summarises the situation well in the Kent Medway hospital story:

The sound of grief and sobbing from an old person, or parents who have lost a child, is still hard to take. Would you make them walk half a mile so you couldn't get a whiff of their smoke? After all, this second hand smoke doesn't actually harm you, y'know.