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Is smoking a disease or a habit?

David Atherton
25th April 2011

On the 7th April 2011 I was invited to speak at the British Medical Journal’s debate on whether smoking is a disease (addiction) or a habit. Sponsored by Pfizer the other speakers were Chritianne Vink a Biological Psychologist who supported me, Alison Britton a lecturer in law from Caledonian University and Antonella Cardone,  Public Health Director, Global Smokefree Partnership Rome who were for wanting smoking to be classified as a disease. Some of it is in bullet form and not fully articulated but I hope you get the idea.

Good morning ladies and gentlemen,

As a regular speaker I start every speech by confirming the papers on active smoking cigarette. Bradford-Hill later Sir Richard Peto (1) first published British GPs 10 years early mortality. Dutch health ministry (2) 7 years and  British Institute of Actuaries (3) 7 years too.  86% of lung cancer cases and 90% emphysema. Lifetime risk of LC is 8%

Extensive research even tell you why LC prevalent.  Burning of tobacco – benzo(a)pyrene a 5 ring benzene molecule and is a Class 1 carcinogen. This causes a guanine to thyamine transversion – helix of DNA structure -causes the P53 to be inert- allowing LC cells to grow. (4)

WHO/IARC ”In 1998, Pierre Hainaut and his collaborators at IARC analyzed the mutations in lung cancers that were at the time in the IARC p53 database. They found that the positions of damage by benzo(a)pyrene spotted by Pfeifer and his team were frequently the sites of mutations in lung cancers of smokers but rarely in lung cancers of non-smokers.”

Interestingly the G to T transversion is “rarely seen in none smokers.”

 24th September 2009 from Dr. Hellend a Norwegian geneticist.

“A number of molecular and clinical characteristics differ between lung cancer related to tobacco use and those not related to tobacco use. 62 % of lung cancers among never-smokers are adenocarcinomas and 18 % are squamous cell carcinomas, while corresponding numbers among patients who smoke are 19 % and 53 %. The K-Ras-gene is often mutated in tumours from smokers, but seldom in tumours from non-smokers; whereas the EGFR-gene is mutated in tumours from non-smokers, and not in smokers. Also, age and sex distribution, therapy response and prognosis are shown to differ between the groups.
INTERPRETATION: Lung cancer in never-smokers should probably be regarded as a different disease-entity than smoking-induced lung cancer. This could impact prognosis as well as treatment.”

Out of 82 studies into LC 87% (6)

On heart attacks and smoking bans, there is no decrease in heart attacks after bans.

 ”This study examined a total of 217,023 heart attack admissions and 2.0 million heart attack deaths in 468 counties in all 50 states over an eight-year period.” Conclusions were:

  1. “In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases.”
  2. “An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature.”

Also goes onto accuse others of publication bias.

We have been misled harm of SHS it seems we are about to enter the brave new world of anti  tobacco  now wanting more control over smokers. The debate is about whether smoking is an addiciton or habit

The philosophy

More state and medical control of patients and more laws to pass. Pathetic addicts who need guiding, training bullied cajoled and even MADE to behave in a prescribed way by the medical establishment and backed laws.

This is Hegel’s  Marxist Self Consciousness- explain – proletariat have false beliefs – Stalin justify suppression elections and subjugation of the population.  We have been misled by tobacco companies and are usless addicts who need to be shown the righteous path.


Smoke down pub, smokers who booked non smoking flights, cant look at a cigarette until lunch, smoking section of train smokers walked down same with flights.

In the new study published in theJournal of Abnormal Psychology, Dr. Reuven Dar of Tel Aviv University’s Department of Psychology found that the intensity of cravings for cigarettes had more to do with the psychosocial element of smoking than with the physiological effects of nicotine as an addictive chemical. ”These findings might not be popular with advocates of the nicotine addiction theory, because they undermine the physiological role of nicotine and emphasize mind over matter when it comes to smoking,” Dr. Dar says. He hopes this research will help clinicians and health authorities develop more successfulthose utilizing expensive nicotine  smoking cessation programs than patches and gum.

He and his colleagues monitored the smoking behavior and craving levels of in-flight attendants, both women and men, who worked at the Israeli airline El Al. Each participant was monitored during two flights — a long flight of 10 to 13 hours in duration, from Tel Aviv to New York, for example; and a two-hop shorter trip from Israel to Europe and back, each leg lasting three to five hours. Using a questionnaire, he sampled craving levels of the attendants throughout the duration of their flights.

Dr. Dar and his colleagues found that the duration of the flight had no significant impact on craving levels, which were similar for short and long flights. Moreover, craving levels at the end of each short flight were much higher those at the end of the long flight, demonstrating that cravings increased in anticipation of the flight landing, whatever the flight’s total duration. He concluded that the craving effect is produced by psychological cues rather than by the physiological effects of nicotine deprivation.

No smoking on the Sabbath

In an earlier 2005 study, Dr. Dar examined smokers who were religious Jews, forbidden by their religion to smoke on the Sabbath. He asked them about their smoking cravings on three separate days: the Sabbath, a regular weekday, and a weekday on which they’d been asked to abstain. Participants were interviewed at the end of each day about their craving levels during that day.

What Dr. Dar found is that cravings were very low on the morning of the Sabbath, when the smoker knew he would not be able to smoke for at least 10 hours. Craving levels gradually increased at the end of the Sabbath, when participants anticipated the first post-Sabbath cigarette. Craving levels on the weekday on which these people smoked as much as they wanted were just as high as on the day they abstained, showing that craving has little to do with nicotine deprivation.

Dr. Dar’s studies conclude that nicotine is not addictive as physiological addictions are usually defined. While nicotine does have a physiological role in increasing cognitive abilities such as attention and memory, it’s not an addictive substance like heroin, which creates true systemic and biologically-based withdrawal symptoms in the body of the user, he says.

Dr. Dar believes that people who smoke do so for short-term benefits like oral gratification, sensory pleasure and social camaraderie. Once the habit is established, people continue to smoke in response to cues and in situations that become associated with smoking. Dr. Dar believes that understanding smoking as a habit, not an addiction, will facilitate treatment. Smoking cessation techniques should emphasize the psychological and behavioral aspects of the habit and not the biological aspects.”

Persuaded by this paper Professor Martin Jarvis Trustee of ASH 2003

7766 adult cigarette smokers.

Main outcome measures Hardcore smoking defined by four criteria (less than a day without cigarettes in the past five years; no attempt to quit in the past year; no desire to quit; no intention to quit), all of which had to be satisfied.

Results Some 16% of all smokers were categorised as hardcore. Hardcore smoking was associated with nicotine dependence, socioeconomic deprivation, and age, rising from 5% in young adults aged 16-24 to 30% in those aged ≥ 65 years. Hardcore smokers displayed distinctive attitudes towards and beliefs about smoking. In particular they were likely to deny that smoking affected their health or would do so in the future. Prevalence of hardcore smoking was almost four times higher than in California.

Conclusion Hardcore smoking presents a serious challenge to public health efforts to reduce the prevalence of smoking, but the proportion of hardcore smokers does not necessarily increase as overall prevalence in a population declines. More hardcore smokers could be persuaded to quit, but this will require interventions that are targeted to the particular needs and perceptions of both socially disadvantaged and older smokers.

So 84% treat smoking on a take it or leave it basis.

I spoke to John on the NH S Narcotics Annoymous Help Line spoke to John who has dealt with thousands of addicts. Not one heroin, crack , cocaine addict gave up without intense expert help.

Lets look at some of the ways people give up.

Point out smoking it is not only the nicotine aspect. It is the socialability, having something tactile in your hand, and even the sucking reflex. Look at most of methods how smokers quit.

Today Action on Smoking and Health (ASH), the public health charity has apologised to Allen Carr’s Easyway Organisation for unfounded comments made by its Director in November 2006.

In November of last year, Deborah Arnott, Director of ASH claimed that specific success rates quoted by AllenCarr Easyway were “plucked out of the air” and “basically made up.” She made these comments whilst on the BBC Radio 4 “PM” programme during a piece concerning the death of Allen Carr, founder of Allen Carr’s Easyway organisation.

Deborah Arnott’s comments referred to two independent studies conducted by eminent experts in the field of smoking cessation which had already been published in peer reviewed journals indicating a 53% success rate for Allen Carr’s Easyway to Stop Smoking Clinics after 12 months.

Following a complaint by Allen Carr’s Easyway International, Deborah Arnott and ASH now acknowledge that it was wrong for Ms Arnott to have made the comments relating to the 53% success rate and have issued an unreserved apology.

ASH has agreed to pay the legal costs incurred by Allen Carr’s Easyway.

The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences Simon Chapman

Research shows that two-thirds to three-quarters of ex-smokers stop unaided,”

In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer have done so unaided.

“Research shows that two-thirds to three-quarters of ex-smokers stop unaided,” and that “53% of the ex-smokers said that it was “not at all difficult” to stop, 27% said it was “fairly difficult”, and the remainder found it very difficult.”

E cigs

“The researchers conducted an online survey of 222 first-time purchasers of electronic cigarettes, also known as e-cigarettes, from a leading electronic cigarette distributor. Of those who were not smoking at six months, 34.3 percent reported not using electronic cigarettes or any nicotine-containing products. Almost 67 percent of respondents reported having reduced the number of cigarettes they smoked after using electronic cigarettes.”

The research was executed in South Africa about 349 participants for two months. Out of the total participants 45% had been effective in quitting smoking cigarette following they adapted e cigarettes.

Medical doctors who had participated from the study discovered that electronic cigarettes are better alternate options towards the typical cigarettes. 6% of participating smokers were in a position to quit inside 14 days and after 8 weeks 45% have been in a position to stop the deadly routine.

Nicotine Replacement Terapy

A success rate as low as 1.6% as is written in a letter to the British Medical Journal (BMJ) by Professor Michael Siegel. (3) A more recent study piles on the agony at 0.8%, “The actual number of subjects who achieved one-year continuous abstinence with the nicotine patch was 5, or only 0.8% of the sample.” (4) This in the BMJ study stated “The long term (that is, greater than six months) quit rates for OTC NRT was 1% and 6% in two studies and 8–11% in five other studies. These results were not homogenous; however, when combined the estimated OR was 7% (95% CI 4% to 11%).  Conclusions: OTC NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice. ” (5)

Bill Godshall, executive director of Smokefree Pennsylvania, in a letter sent to the New Jersey senate: “Proponents of [the bill banning indoor use] have grossly and intentionally misrepresented the health risks of e-cigarettes in order to scare legislators into voting for this unwarranted legislation that threatens (instead of improves) public health. Smokers who have recently quit and/or are trying to quit need support, not harassment and ostracism.”

So in summary the empirical evidence suggests that the most successful ways of giving up are

1. Cold turkey 66%

2. Allen Carr 53%

3. E Cigarettes 34%

4. Nicotine Replacement Therapy after a year is 8%

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2085438/pdf/brmedj03396-0011.pdf

2. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029

3. http://www.actuaries.org.uk/sites/all/files/documents/pdf/0561-0571.pdf

4. http://www-p53.iarc.fr/download/tobacco.pdf

5. http://www.ncbi.nlm.nih.gov/pubmed/19844277

6. http://www.pnlee.co.uk/documents/refs/lee2010B.pdf

7. http://www.nber.org/papers/w14790.pdf

8. http://tobaccoanalysis.blogspot.com/2009/04/new-study-of-national-heart-attack.html








Marsh A, Matheson J (1983) Smoking behaviour and attitudes. London: Office of Population Censuses and Surveys. Social Survey Division.








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