Wednesday, 7 October 2015

On Vapers Helping Smokers Quit

Writing for Forbes, Sally Satel has highlighted an interesting new approach to encouraging smokers to quit.
Why not assemble a loose network of potential vaping sponsors? True, some vapers communicate informally with smokers already, but if we can build a vaper-smoker buddy system into the public health landscape, we can further arm the fight against smoking. 
The local health department or area hospitals could run public service ads on TV or radio and post billboards advertising the availability of vaping buddies (or sponsors, navigators, etc). A website would contain the name of local vapers who volunteer to serve as sponsors or direct smokers to local vape shops where those names would be listed, too. 
Civic-minded vapers could sign up to be sponsors through the local vape shop or health department. 
It need not be a long-term relationship, but it would be a great way to introduce a patient to vaping if his or her physician determines that the patient intends to keep smoking for the foreseeable future or has had little to no success in quitting with the help of conventional anti-smoking aids.
Former smokers talking to current smokers and giving them the benefit of their advice. An informal way of quitting smoking for those who choose to, and without it costing the taxpayer more than a few pennies in leaflets. What is there not to like if you're a professional committed to reducing smoking prevalence, eh?

Well, maybe this bit.
Unlike many abusers of intoxicants, nicotine-dependent people don’t need to learn to live without a drug, they need to learn to use it in a safer form. They need practical advice (best local vape shop, how to maintain equipment, how to find high quality e-liquid); they need to know what they can expect (e.g. that dual use – vaping while continuing to smoke, at the beginning is very common) and which puff techniques lead to maximal satisfaction. They need a fair assessment of the known and unknown risks associated with alternatives to cigarettes and some need general motivational support if they are ambivalent about relinquishing cigarettes.
This all relies on the 'public health' cabal ditching the idea that nicotine is some evil that must be eradicated at all costs. Do you see that happening anytime soon? No, neither do I.

There is also the fundamental problem that tobacco control is called tobacco control for a reason. Control is the part which pays the wages, which funds careers and shonky science. Without the control element, there is no tobacco control.

This initiative may very well - in fact I'd say it definitely would - deliver a dramatic increase in smokers switching to vaping. The reason being that most smokers do not want to sit across a desk with some stop smoking adviser in a clinical setting and receive schmalzy, twee advice on how to stick a patch on their arm so the local NHS trust receives its financial kickback from Pfizer or whoever.

It's the same concept as people generally hating hospitals. They know a hospital is a good thing and would scream if theirs were shut down, but it's not an environment anyone enjoys staying in for very long. A stop smoking "clinic" - for most smokers who have thought about quitting - is about as enticing a prospect as an evening in the company of E. L. Wisty.

It is precisely why quitting cold turkey is still, and always will be in the current state of play, the overwhelmingly most popular choice for smokers.

Then, of course, Satel points out another big drawback with the concept.
Take public vaping. Vaping has already been banned from offices, public parks, restaurants and airports. But at the very least, it should be allowed in non-smoking adult establishments with well-marked vaping areas. While not emission-free, any “second-hand” vapor that wafts several feet, unlike smoke from a cigarette, will be virtually undetectable as the subtly “flavored” odors dissipate rapidly. Studies show that emissions, such as propylene glycol, formaldehyde, and acrolein, are at negligible levels, thus below clinically meaningful thresholds for otherwise healthy bystanders. 
The idea is for people who smoke to be exposed to vapers as often and as visibly as possible. The infiltration of vapers into non-smoking environments where there are temporarily abstaining smokers (that is, smokers who are, at the moment, banned from lighting up) is a great way to spur curiosity and conversation about vaping.
I can almost hear you giggling from here.

We have Welsh 'public health' currently spreading all kinds of evidence-free shit at assembly level in pursuit of a ban on vaping in public places and - to my knowledge - there has yet to be a single tobacco control industry worker come out and aggressively condemn a vaping ban anywhere in the country.

Not. Even. One.

E-cigs are banned on trains, for no reason; on station platforms, for no reason; in pubs, bars, cafes, for no reason; in Premiership football and rugby grounds, for no reason; at the recent Ashes cricket series at the behest of the ECB, for no reason; and e-cigs are being included in outdoor smoking bans too, for no reason (to compound there being no reason for banning smoking outdoors either).

Where is the outrage from people who are supposed to be a friend of the vaper? Where is the commitment to reducing smoking prevalence where e-cigs are concerned? Where is the vehement objection to stupid bans from people who have been accustomed to bullying businesses for the past decade over smoking bans?

All we hear, instead, is mild platitudes about how it is up to businesses to decide their own policies.

The idea of vapers helping smokers to quit is an extremely good one, and it will work, but unfortunately it rests solely on stubborn, self-interested, trouser-stuffing tobacco control freakery to evaporate first. And that ain't gonna happen anytime soon.

It's a simple fact that smokers will be more likely to quit by chatting to a knowledgeable vaping friend in a pub than they would in a clean sterile office opposite some patronising detached stop smoking adviser, with a target to meet, who hasn't got the first clue how e-cigs work.

However, I'll tell you how it's going to go. Public Health England will like the idea, they will get round a table with ASH and all the other tobacco control tax-spongers  and spout about how game-changing this great initiative could be. But in the back of their mind they will be thinking about how such an approach will make many of their kind redundant so will insist on it being delivered by stop smoking services in a clinical environment, thereby killing the thing stone dead.

Just watch it happen.

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