Smoke and mirrors: Filthy habit and grizzly killer

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A filthy habit and a grizzly killer that reflects our most unpleasant yearnings. 

Sir Walter Raleigh has got a lot to answer for. This lauded chap from the olden days brought us potatoes and tobacco – fags and chips. Two of Britain’s biggest health burdens. Thanks for that, Walt.

It is cigarettes that have wreaked most havoc, however, and they continue to reek to this day. Relationships, marriages, friendships have all gone up in smoke.

Meanwhile, smoking has been keeping the NHS and pharma busy for decades, as cancer, heart disease, strokes and emphysema have discarded millions of people into the ash tray of oblivion. Industry continues to plough billions into researching and delivering treatments for those with smoking-related diseases, while increasingly concentrating on areas of prevention – but shouldn’t pharma’s focus be on making life better for people who do have disease, but don’t smoke?

 

Heart of darkness

When I was growing up in the 1980s, iconic images, such as James Dean – squinting into an uncertain future, made smoking irresistibly exotic, while the striking packages were an early example of how mesmerising graphic design can be.

My generation, however, were the first to have some seriously disturbing information to contend with, as doubts crept in about how ‘cool’ smoking actually was. Public information films warned of the ‘natural born smoker,’ born with an addiction to nicotine. People also started to die from cancer, as a result of starting in the ‘30s and ‘40s. The impact was negligible, as children were seduced into a habit that was flaunted by their parents. Smoking was in offices, pubs, streets, in advertising and in our homes.

Smoking is also a notorious passion killer. I once told a former girlfriend that she had to choose between her & I, and Benson & Hedges. To this day, if I need to summon contempt for a smoker, I channel the feeling of being metaphorically stubbed out after issuing what was a very reasonable ultimatum.

The entitlement and the self-righteousness of the smoker is the real burden on the NHS and pharma’s priorities, because it guarantees a long succession of tumours. There is no such thing as a considerate smoker. Smoke, by its very nature, goes where it pleases, regardless of explicit signage. I do believe in the basic human right to indulge, as long as it doesn’t kill me. People can drink and abuse drugs at their own risk, because it’s not mine. But each and every time someone ignites a cigarette they are making a conscious decision to kill, not only themselves, but me – us – as well.

With this considered, it seems utterly preposterous that in 2016 smoking is still legal – we are still subjected to the grey-faced dystopian tribe of doorway chokers making an enemy of their own future, and many willing to do so in a phony war they can’t possibly win; their principles as thin as the paper around their tobacco.

The people who fail to see the misery that their habit is weaving, end up as the half-ghosts, outside hospitals, pulling along their drip trollies with one hand, and nursing a smouldering dog end with the other – the last days burning away in a grotesque plume. The final insult.

Our sympathy must cease – why should anyone in a modern, civilised world tolerate smoking?

I have seen the new plain cigarette packages and, yes, graphic illustrations of disfigurements and cancerous decay are hideous, but is it enough? If the government refuses to ban smoking then they must restrict it to nicotine prisons, into which smokers can climb, but out of which smoke cannot escape.

In the final analysis, you wouldn’t invite Jack the Ripper to a hen night and expect him to be back by seven, so why would you expect a smoker to act responsibly in the presence of passive bystanders. I can draw little distinction between a serial killer and someone who insists on smoking.

 

Quitters 

For smokers who have seen the utter futility of what they are doing, help is at hand. Healthcare professionals are only too willing to help them, when it seems the will to live isn’t strong enough. Here are the thoughts of key sympathisers.

“Smoking cessation medicines have been shown to be one of the most effective methods to stop smoking, when combined with support from a healthcare professional. As pharmacists, we are often the point of contact for smokers, many of whom get stuck in a cycle of trying to quit with no NHS support, and not succeeding on other therapies, like NRT. Pharmacists in the community or hospital are in ideal locations to offer evidence-based advice to help smokers make an informed decision.”

Darush Attar-Zadeh, Respiratory Lead Pharmacist Barnet CCG

 

“As nurses, we are often one of the first points of contact for people looking to quit smoking – whether in a GP surgery or at a smoking cessation clinic. The findings from the EAGLES study highlight the benefits of smoking cessation medication and provides us with key information to help us have informed conversations with our patients who are looking to stop smoking.”

Tracy Kirk, respiratory nurse consultant and primary health care educator.

 

EAGLES has landed

Pfizer has flown into the smoking den by releasing its EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) data. The study is the largest placebo-controlled trial to compare the neuropsychiatric safety and efficacy of ‘varenicline’ and ‘bupropion’ with placebo and nicotine patches.

The results demonstrated that the use of varenicline or buproprion in patients, with or without a history of psychiatric disorder, is not associated with an increased risk of serious neuropsychiatric adverse events. In addition, patients taking varenicline showed superior continuous abstinence rates at weeks 9–12, and 9–24, than patients treated with placebo, bupropion or nicotine patch. Furthermore, patients treated with each of the medications had higher abstinence rates than those treated with placebo.

Robert West, Professor of Health Psychology, University College London and co-author of the EAGLES study commented: “This study should reassure regulatory authorities, doctors and patients about the safety and effectiveness of medicines to help smokers stop. Every smoker should receive the offer of evidence-based support to stop at least once a year – currently most do not.”

EAGLES also included an efficacy objective to determine smoking abstinence rates in patients. The results showed that patients with and without a history of psychiatric disorders, taking varenicline, had significantly higher continuous abstinence rates than patients treated with bupropion or nicotine patch. Those treated with each of the medications had higher abstinence rates than those treated with placebo during both time periods.

Dr. Berkeley Phillips, UK Medical Director, Pfizer, commented, “EAGLES adds a significant, additional body of important safety and efficacy data for varenicline in a large population of smokers. At Pfizer, we remain committed to effectively supporting smokers throughout their journey to stop smoking.”

 

Murder most foul

When it comes to destroying lives and, ultimately, ending them – nothing gets close to smoking.

Global yearly death toll 6,000,000

10,000,000 yearly deaths across the world by 2030

One billion deaths by end of the century

In 2012-13 460,900 hospital admissions were attributed to smoking in the 35+ age group – accounting for 5% of all admissions.

Half of all long term smokers will tie prematurely, losing ten years, on average.

In 2013, 17 per cent (78,200) of all deaths in adults aged 35 and over, in England, attributable to smoking (around one in six).

Data provided by ash – action on smoking and health

 

Illlustration by Alex Buccheri