Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Unbelievable advocacy of a known carcinogen
- Trevor Watts (15 February 2008)
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NO to Smokeless, Spitless Tobacco - SNUS - It's the KIDS..
- Samuel Garten, Ralph Victor Falkner (19 February 2008)
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Re: NO to Smokeless, Spitless Tobacco - SNUS - It's the KIDS..
- GEORGE Y CALDWELL (20 February 2008)
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The need for tobacco product regulation
- Coral E Gartner (20 February 2008)
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Before surrender teach cessation
- John R. Polito (21 February 2008)
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Re: Re: NO to Smokeless, Spitless Tobacco - SNUS - It's the KIDS..
- Samuel Garten, Ralph Victor Falkner (26 February 2008)
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Trevor Watts, Senior Lecturer and Consultant in Periodontology Guy's Hospital, London SE1 9RT
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Obviously the tobacco manufacturers would love it if some of their products received medical approval. But cancer of the tongue and floor of the mouth has a 5-year survival rate of 50% or less and is perhaps far more disfiguring than lung tumours. There are other unpleasant oral conditions with which tobacco is linked, and of course, there is a huge synergistic effect of alcohol, which most smokers imbibe. Consider also the mixed messages which accompanied the re- classification of cannabis. There is only one sensible attitude towards tobacco, and that is to oppose it in all forms. Competing interests: None declared |
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Samuel Garten, scientist tobaccowatch.org, 27616, USA, Ralph Victor Falkner
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We are in agreement with Sir (Dr.) Alexander Macara in that doctors should not advocate the use of SNUS - NO.. "There is no evidence smokeless tobacco can help people quit smoking. There are no studies we would consider sufficient." Dr. Terry Pechacek, Associate Director of Science at the Centers for Disease Control Office on Smoking and Health. (SNUS the BUMP, Nordic Reach (The Scandinavian Lifestyle Quarterly}, No.17 Volume XIX, 2007, p53). Also, "There is no scientific evidence whatsoever that smokers are able to switch to smokeless tobacco and remain switched," Dr. Thomas Glynn, the Director of Cancer Science and Trends at the American Cancer Society (The Independent, October 9, 2007) The vast majority of inveterate (long established, deep- rooted, in-grained) tobacco smokers that refuse to quit will not learn the art of SNUSing, i.e., the placement of the pouch (tea-bag) in a particular location within the mouth and sucking on the bag for 30 minutes without any movement. Murray Kessler, Chief Executive Officer of UST, Inc - the world's leading producer of moist smokeless tobacco products - tells us that 9 of 10 smokers that try smokeless tobacco reject the product. (Reuters Consumer and Retail Summit in New York, June 20, 2006) Dr. Britton was soundly defeated in a debate on the topic of the use of SNUS by Dr. Lewis Keir at the first National Conference for the British Association for Stop Smoking Practitioners in Manchester on September 26, 2007. As pointed out by Dr. Britton himself, "It's their (tobacco companies) job to sell as much tobacco as possible, so they will be targeting non-smokers rather than current ones, that's the worry." (SmokeFree Birmingham) The initial test marketing of SNUS in the states by traditional cigarette companies has failed and these companies are either removing the product (e.g., Taboka Tobaccopaks - Philip Morris) or calling for more education and public awareness. Many more reasons to reject SNUS and uphold the EU ban can be found at http://news.snus.biz . The primary reason for upholding the ban is the same as it was back in 1992 when it was created - Our Children. ERROR: sentence can be found in the Macara paper - against SNUS. He (Macara) acknowledges that smokeless tobacco is less addictive than smoked tobacco - THIS IS NOT TRUE.. Smokeless tobacco is NOT less addictive than tobacco smoking, in fact nicotine blood levels last longer and may even be higher when using smokeless tobacco (the pH of the smokeless tobacco is usually adjusted upward to increase absorption of nicotine from the oral cavity). (Maximum levels of nicotine were similar but, because of prolonged absorption, overall nicotine exposure was twice as large after single exposures to smokeless tobacco compared with cigarette smoking (Benowitz et al., Clin Pharmacol Ther. Jul;44(1):23-8, 1988) Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL pPARK, #18-33, SINGAPORE 259858
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When it is the Nicotine which is harmful in causing that "pleasant lift" in Blood Pressure with each fresh drag on a cigarette, what is the point in supplying an alternative source of the stuff in any other form? You will get nowhere. Better to prescribe tobacco, e.g. Turkish and Egyptian, Cuban cigars, that has been "slowly and Nature-cured" and where there is very little Nicotine left in the tobacco. It is the quick-cured "kiln-dried" weed that retains so much Nicotine. REPEAT REPEAT: "Second hand smoke killed nobody." Quote: Sir Richard Doll. Competing interests: None declared |
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Coral E Gartner, Postdoctoral Research Fellow School of Population Health, University of Queensland, Australia (4006)
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The suggestion that medical practitioners should consider encouraging a smoking patient to switch to snus, and thereby promote use of a tobacco product, is controversial. However, Britton suggests that long-term use of NRT or snus should be recommended as a ‘last resort’ for smokers who have failed to quit smoking by other means. This sounds more reasonable and humane than denying this option to recalcitrant smokers. Those who remain determined to staunchly ‘oppose all forms of tobacco use’ might reflect on whether the complete elimination of tobacco use from the population is a realistic goal and how might this be achieved? Unfortunately, Macara’s response discusses the hazards of higher risk SLT products (from India, Africa and old style US products). This is confusing and misleading as Swedish snus (the product discussed by Britton) is far lower in tobacco specific nitrosamines (TSNAs), and therefore less harmful, than these other SLT products. It should also be noted that these higher risk SLT products (chewing tobacco) are freely available in the UK, whilst snus is not. Medical practitioners considering suggesting snus as a last resort to their recalcitrant smokers should ensure their patients understand which products are lowest in risk. Better yet, the UK government could regulate all tobacco products and set maximum permissible levels of TSNAs for all smokeless products ensuring the most hazardous products are removed from the marketplace. Competing interests: None declared |
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John R. Polito, Editor WhyQuit.com 1325 Pherigo Street, Mount Pleasant, SC, USA 29464
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Last week I concluded presenting 63 nicotine dependency recovery seminars in 28 prisons. During presentations I devoted about four minutes to exploring harm reduction, via NRT not oral tobacco. The remaining 116 minutes were spent showing why getting off of all nicotine is likely the most intelligent decision they'd ever make, and how to succeed in doing so. I did so without any youth in the room, in as balanced a manner as time and my abilities allowed, while holding no financial state in nicotine delivery. Britton advocates harm reduction while ignoring an exploding body of alarming nicotine toxicology science.(1) Macara contends NRT "does not induce dependence" when 37% of current nicotine gum users are hooked on the cure.(2) Britton offers another quick-fix when the prescription needed - nicotine dependency recovery understanding - would take physicians a bit effort to master and dispense than pharmacology, or dependency delivery device transfer commands. Profit driven pharmaceutical influence has taken junk science to new heights by pretending the fiction that true drug addicts cannot recognize arrival of full-blown withdrawal when randomized to placebo, or a diminished syndrome when given chemicals that enhance dopamine flow.(3) Its influence(4) has transformed government quitting guides into near worthless pharmaceutical product shopping guides. It has rewritten official government cessation policy so as to declare all attempts to quit without pharmacology as violating it ("Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking").(5) Imagine declaring educated and supported cold turkey quitting illegal. Although the ethics of the fox residing in the hen house has been questioned,(6) corporations are driven by profits not conscience. Quick-fix stand-alone arguments like Britton's, dispensable within 4 minutes, will appear inviting to time-strapped physicians, frustrated by years of broken promises. But with patients spending substantial time in waiting and exam rooms, with PowerPoint projectors dirt cheap, with existing office computers just one new wire away, with the man who may well be the planet's most knowledgeable cessation educator offering physicians his life's work for free,(7) there is no excuse for putting quick-fixes ahead of quality patient cessation education efforts. Instead of cessation, imagine teaching them the relative safety of the super toxin nicotine, a natural insecticide once sold as BlackLeaf 40, whose LD50 of 60mg is more potent than strychnine at 75mg, arsenic at 200mg or cyanide at 500mg. Give cessation a try. Start with where they now find themselves, that this isn't some "nasty little habit" but full-blown drug addiction. Getting an addict to fully accept dependency is a critical first step. Like alcoholism being permanent, with that first sip key to relapse, it makes quitting's rules simple. You cannot kill or cure dependency but only arrest it. There is no having your cake and eating it too, no in-between, the time for games is over. There's a bright line in the sand screaming that recovery truly is an all or nothing proposition. Just one rule determines the outcome for all, a rule that provides a 100% guarantee of success to all who follow it, no nicotine today. Explain how the brain rewards nicotine's presence while punishing its absence, how by chance the nicotine molecule so resembles acetylcholine that once inside the brain, within 8-10 seconds of a puff, it docks with nicotinic-type acetylcholine receptors generating a powerful dopamine "aaah" reward sensation. Explain normal dopamine pathway function, in being the mind's priorities teacher and educating us as to species survival events, such as providing dopamine "aaah" rewards when anticipating eating or consuming food.(8) Nicotine took their salient event, pay-attention pathways hostage,(9) quickly burying nearly all remaining memory of life without it. The brain's fooled priorities teacher did its job well. It left them totally yet falsely convinced that smoking nicotine defines who they are, gives them their edge, helps them cope and that life without it would be horrible. Teach how their enslaved mind reinforces captivity by punishing them with urges, craves and anxieties, likely via the insulas,(10) when they wait to long between feedings. Teach how via tolerance the brain tries fighting back, by up-regulating acetylcholine receptor counts, requiring patients to gradually smoke more or differently over time in order to achieve the same remembered effect. Share the "Law of Addiction," that administration of a drug to an addict will cause reestablishment of chemical dependence upon the addictive substance.(11) Teach that "88% (12) - 92.6% (314 of 339)(13) of quitters who taste tobacco relapse, that they are not battling an entire pack or even a whole cigarette, but that just that one puff of nicotine that could, within 8-10 seconds, result in 50% occupancy of their brain's a2b4 type acetylcholine receptors, generating a powerful dopamine explosion that would soon have their brain begging for more.(14) Getting patients to fully accept that they smoke because they must, because a rising tide of anxieties begin to hurt when they don't, destroys their need for their long laundry list of nicotine use rationalizations,(15) the lies invented to explain the rational thinking mind's endless surrenders to the captive limbic mind. Although I've barely scratched cessation's surface I'm now passed the word limit BMJ asked me to respect. But on behalf of all still in bondage I beg providers to let this be a beginning not an end. Also, order staff to remove all tobacco ads from all waiting room magazines as they totally undermine office cessation credibility. John R. Polito 1. Slotkin, TA et al, Separate or sequential exposure to nicotine prenatally and in adulthood: persistent effects on acetylcholine systems in rat brain regions, Brain Res Bull. 2007 Sep 14;74(1-3):91-103; also Slotkin, TA et al, Lasting effects of nicotine treatment and withdrawal on serotonergic systems and cell signaling in rat brain regions: separate or sequential exposure during fetal development and adulthood, Brain Res Bull. 2007 Jul 12;73(4-6):259-72; and see Ginzel KH et al, Critical review: nicotine for the fetus, the infant and the adolescent? J Health Psychol. 2007 Mar;12(2):215-24 2. Shiffman S et al, Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample, Tob Control. 2003 Sep;12(3):310-6. 3. Mooney M et al, The blind spot in the nicotine replacement therapy literature: assessment of the double-blind in clinical trials, Addict Behav. 2004 Jun;29(4):673-84 4. Appendix C: Financial Disclosures for Panel Members, Consultants, and Senior Project Staff, Clinical Practice Guideline, Treating Tobacco Use and Dependence, June 2000 5. Finding and Recommendation 7, Clinical Practice Guideline, Treating Tobacco Use and Dependence, June 2000, 6. Helliker K, Nicotine Fix - Behind Antismoking Policy, Influence of Drug Industry, Wall Street Journal - February 8, 2007, Page A1 7. Spitzer, J, Joel's Library, www.whyquit.com/joel 8. Wang GJ et al, Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review, J Addict Dis. 2004;23(3):39-53 9. Volkow ND et al, Dopamine in drug abuse and addiction: results of imaging studies and treatment implications, Arch Neurol. 2007 Nov;64(11):1575-9. 10. Naqvi NH et al, Damage to the insula disrupts addiction to cigarette smoking, Science. 2007 Jan 26;315(5811):531-4. 11. Spitzer J, The Law of Addiction, 1988, an article in "Never Take Another Puff" 12. Brandon TH et al, Postcessation cigarette use: the process of relapse, Addict Behav. 1990;15(2):105-14 13. Borland R, Slip-ups and relapse in attempts to quit smoking, Addict Behav. 1990;15(3):235-45 14. Brody AL et al, Cigarette smoking saturates brain alpha 4 beta 2 nicotinic acetylcholine receptors, Arch Gen Psychiatry. 2006 Aug;63(8):907-15 15. Polito JR, Tearing Down the Wall, WhyQuit.com, June 2004 Competing interests: Nicotine Cessation Educator |
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Samuel Garten, scientist tobaccowatch.org, 27616, USA, Ralph Victor Falkner
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Regarding George Caldwell's comment second hand smoke never killed anyone?? U.S. Surgeon General Richard H. Carmona (June 27, 2006) issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke. The report, The "Health Consequences of Involuntary Exposure to Tobacco Smoke," finds that even brief secondhand smoke exposure can cause immediate harm. A recent case report from http://news.snus.biz on February 12 describes an acute asthma death associated with work-related ETS. This may be the first death to be reported nationally from acute asthma associated with environmental tobacco smoke ETS, second hand smoke, passive smoking, involuntary smoking). The case report (Am J Ind Med 51:111-116,2008) states the woman arrived at the bar in Michigan and, according to co-workers, seemed happy and healthy. About 15 or 20 minutes later she collapsed and within a few minutes died. Competing interests: None declared |
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