Stigmatising smokers different from stigmatising tobacco companies?

Professor Hilary Graham this week criticised the use of stigma against smokers. It's kind of her but I am not sure how much it advances any argument. It was covered by a few publications: this one reports:

She has now called for a rethink on how smoking is portrayed and for the focus to be on education rather than vilification.

So what exactly does this change? The health establishment sees too many smokers among the population and especially among its disadvantaged. Beginning with the smoking ban, it has created an excessive fear of secondary smoke. It has sought to portray smokers as vulnerable and mainly poor. It has always been part of their mission to reduce what they call 'health inequalities', which (unbelievably) it actually believes smoking causes. The general public has taken its cue and come to the conclusion that smokers are smelly and pathetic as well as being murderers. At least, a vocal minority has taken this line.

The glitterati of the tobacco control movement don't have to enforce ridiculous laws like the smoking ban. (They can leave that to juniors in the environmental health departments.) They feel responsible for social inequalities – how can they fail to feel responsible, having trumped scholars through the ages by discovering what causes disparities in health in the community?

They have successfully split the left wing, which used to be friendly to working-class and community solidarity, by invoking the demon 'tobacco company' as a typical 'big business'. Tobacco funding has become dirty and is not even allowed to sponsor football matches, while, in the course of business, corporations can buy votes and ensure the success of their projects.

Professor Graham's idea of education rather than vilification doesn't fundamentally challenge anything, as the language of anti-tobacco has always been paternalistic rather than adversarial. Highly educated tobacco control professionals are taking it on themselves to explain the problems of the poor through a tobacco-soaked lens, and trying to persuade them of the errors of their ways. They encourage the community to see them as helpless addicts and have even campaigned successfully for legislation that will take them out of social circulation, to prevent them being role models for the rest of us. Hysteria about tobacco has encouraged people to think that those who have lost loved ones to heart, lung, or other 'smoking-related' complaints can justly blame tobacco, because nothing else makes people ill, right?

We are in other words in a situation where the powerful class has managed to influence social relations profoundly, and where the less powerful are told by the powerful how to behave in polite society. They are denied public space and the powerful are seeking ways to invade their private space. (They have already substantially invaded it by defining pubs, which are business enterprises as 'public places'.) There is no way that smokers can easily engage in any form of social protest, without accepting their subordination as a group. Those that cannot adapt to this requirement will see social protest as not concerning them – they will be marginalised.

And they will be the most marginalised, and perhaps in the most need of direct political action, of coming together to discuss, make plans, support each other.

No Professor Graham – you may be well intentioned, but you don't really understand that it is the purpose of tobacco control to disenfranchise and marginalise smokers, and the hateful expression of the most virulent anti-smokers is inevitable collateral damage.

Scotland bribes smokers to quit: the efficacy of medication

NHS Tayside is extending its programme that offers money to people who use NHS services in order to attempt to stop smoking, on a postcode lottery basis. It targets its efforts towards those in deprived areas whose postcode indicates that they are probably heavy smokers, in order to try and close the 'health inequality' gap. 


The Courier explains. The scheme (which pays £12.50 a week in supermarket vouchers) has allegedly reached a quit rate of 50 per cent after four weeks. (Only five readers have left comments on this story, and they don't seem very happy about the outlay on the scheme.) This stupendously high quit rate (compared with what is normally achieved – see Michael Siegel's review of a recent study) apparently justifies the roll-out of the scheme, known as quit4u, from Dundee into neighbouring towns. 


Interesting that arch anti-smoker (and plain packaging advocate) Simon Chapman doesn't buy the line that NRT works, or that expenditure on it is justified.

The pharmaceutical industry has a clear commercial interest in eroding public and professional confidence in unassisted smoking cessation, yet easily implemented ideas, such as graphic health warnings, are more effective than nicotine replacement therapy. 

Is Chapman biting the hand that feeds him? It is not hard to find pharmaceutical links with the anti-smoking industry. Indeed health professionals were cautioned about this close relationship only a few weeks ago, by the World Health Organisation. Some of Chapman's anti-smoking colleagues are puzzled by his line of argument. Many have taken issue with him.  Not only does he not believe in smoking cessation treatments, he believes that pharmaceutical interests exaggerate the difficulties of smoking cessation, and that anti-smoking campaigning should not attempt to make out that people can't quit without help. Two years ago he published a major study that made the following points:

• - Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
• - Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
• - Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
• - Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.

The message still hasn't got through to Tayside. 


I would love to know how Chapman expects the anti-smoking bandwagon to get pharmaceutical industry support if he goes about dissing the effects of nicotine replacement therapy. Does he expect to extort the money from the tobacco industry? Only time will tell.