Thursday, September 15, 2011

'Nudge unit' urges use of smokeless cigarettes

By Victoria King
Man smokingTobacco smoke contains harmful toxins and carcinogens

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Encouraging smokers to switch to smokeless "fake" cigarettes could save tens of thousands of lives, according to a government-backed report.
The idea comes from the Cabinet Office Behavioural Insights Team - or "nudge unit" as it has been called.
It also says making people write "This is an honest account of the truth" on insurance claims forms could cut fraud.
But critics of the unit's activities have suggested there is little evidence that such "nudges" actually work.
The Behavioural Insights Team (BIT) was set up in July 2010, based around the ideas of two academics, Richard Thaler and Cass Sunstein, who believe that bad choices and laziness are a large part of what makes people human.
Therefore, they argue that instead of appealing to voters' self-interest, by for example urging people to eat more healthily, politicians must help to make the "right" choices "easier to make.
Drinking and debt
In its first annual report, the BIT said the government should promote the use of "safe" alternatives to cigarettes - products which deliver nicotine in a fine, pure vapour, instead of in harmful smoke which also contains toxins and carcinogens.
However, versions of smoke-free cigarettes are currently illegal in a number of countries, including Canada and Brazil, because their potential side-effects have not been fully investigated.
In the UK, medicines regulators have actively discouraged the development, marketing and promotion of cigarette substitutes containing nicotine because it is addictive, but they are now looking into approving such devices for use.
The BIT report also listed a number of other proposals in a range of policy areas - some of which are already being trialled - including:
  • making drinkers more aware of how much alcohol others consume - on the basis that most people overestimate how much others drink
  • removing alcohol from prominent positions at the front of supermarkets - Asda, Morrisons and Waitrose have already done so
  • redesigning hospital prescription charts to cut down on errors due to incorrect completion and bad handwriting
  • providing upfront rewards like shopping vouchers or council tax holidays to encourage household energy efficiency improvements - rafter than stressing the longer-term gains to be made
  • altering letters to tax debtors to inform them that the majority of people in their area have already paid up and reminding them of the link between tax and local services - trials showed a 15% improvement in response rates
  • placing declarations of honesty at the start of forms, not the end, to "prime" respondents to tell the truth, or requiring them to write out, by hand, an "honesty sentence"
Some MPs and peers have criticised the cost of the BIT - which is more than £500,000 a year - and its potential effectiveness.
Its head, Cabinet Office minister Oliver Letwin, told the Lords science committee earlier this year that its ideas were not guaranteed to work, but said it was worth trying as the moves suggested were "pretty cost-free".
His comments came after a critical National Audit Office report in February which said the BIT had failed to convince a single government department to use its ideas.
The government said it agreed there were "few circumstances in which nudging alone is likely to be sufficient", but in addition to rules and regulations, "we have rightly been thinking about how we can encourage people to lead healthier lives through the application of behavioural insights and other non-regulatory instruments".
The annual report suggests that hundreds of millions of pounds could be saved if all its suggested measures are adopted.
In the case of unpaid tax, it estimates that sending amended letters to all self-assessment customers would free collectors up to chase an extra £30m in unpaid Exchequer revenue each year.

Monday, August 15, 2011

Can scary labels, scary taxes end smoking?


Can scary labels, scary taxes end smoking?

By Bob Greene, CNN Contributor
August 14, 2011 9:32 a.m. EDT
The U.S. Food and Drug Administration has mandated use of nine new warning labels on cigarette packs.
The U.S. Food and Drug Administration has mandated use of nine new warning labels on cigarette packs.
STORY HIGHLIGHTS
  • Cigarette prices have shot up due to taxes designed to discourage smoking
  • Bob Greene says more than 40 million Americans still smoke
  • He says gruesome warning labels to be used next year are unlikely to wipe out smoking
Editor's note: CNN Contributor Bob Greene is a best-selling author whose books include "Late Edition: A Love Story" and "When We Get to Surf City: A Journey Through America in Pursuit of Rock and Roll, Friendship, and Dreams."
(CNN) -- On a trip to New York this summer, I was in the newsstand/gift shop of a hotel, and a man in front of me in line was purchasing something. I heard the clerk say to him: "That will be $18.30."
He handed her his money, and she handed him a pack of cigarettes. He thanked her and left.
"A pack of cigarettes costs $18.30?" I said to the clerk.
"That's our most inexpensive price," she said. "Some of them are over $20."
"And people pay that for them?" I asked.
"All day long," she said.
New York is the extreme -- it has the highest cigarette prices in the nation, because of steep taxes on each pack. I knew that hotel gift shops routinely charge a premium for convenience, so the $18.30 price had to be on the lofty side; I walked down the street to check cigarette prices at a Duane Reade drugstore, and was told that even there they ranged from $10.88 to $13.80. A pack-a-day smoker in New York City pays well over $3,000 a year for cigarettes.
The government does not want people to smoke, because smoking, beyond any question, can lead to serious illness and death. One of the ways federal, state and local governments try to dissuade smokers is to hit packages of cigarettes with taxes intended to make potential purchasers think twice because of the elevated prices.
The Centers for Disease Control and Prevention is quite blunt about this: "Raising the price of tobacco has proven to be one of the most effective strategies for preventing and controlling tobacco use." The CDC says there is a dollars-and-cents formula; it says that each 10% increase in the price of cigarettes is estimated to reduce consumption by nearly 4% among adults.
According to the organization Campaign for Tobacco-Free Kids, nationally the average per-pack state excise tax on cigarettes is $1.46 (this is in addition to a federal tax of $1.01 per pack), and the average pack of cigarettes is sold for $5.58.
Yet here is a surprising statistic: According to the CDC, there are approximately 46.6 million adult cigarette smokers in the United States. After all these years of government warnings about how sick cigarettes can make you, and all the tax increases: 46.6 million.
The CDC says that the percentage of adults who smoke has gone down dramatically: 42.4% were smokers in 1965, and 20.6% were smokers in 2009, the most recent year tabulated. But the population of the country has grown, so the raw number of smokers today is almost as large as it was in 1965, when, according to the CDC, there were 50.1 million adult smokers.
It makes you wonder whether those startling, explicit illustrated warning labels that will be printed on packs of cigarettes starting next year are, despite all good intentions, destined to fall short of full success.
You've probably read about the labels. They will cover half the surface of each pack of cigarettes sold in the U.S. Health-advocacy groups and government officials say the labels are designed to discourage cigarette consumers at the point of purchase. There are nine illustrations that will be used. They include a photograph of a diseased lung, a picture of a tracheotomy hole in a man's throat, a picture of a man with his bare chest surgically stitched up. . .they are genuinely revolting, and no one will be able to buy a pack of cigarettes without seeing the pictures. The R.J. Reynolds Co., manufacturer of Camel, Kool, Winston and Salem cigarettes, has said that the government-mandated images it will have to feature on its packages are "intended to elicit loathing, disgust and repulsion."
But if 45 years of increasingly alarming warning labels hasn't wiped out cigarette smoking, there seems to be a question about whether anything, including higher taxes, will.
How many of today's 46.6 million smokers do you suppose will see the new warning illustrations and think: "I didn't know that -- cigarettes can harm your health? Cigarettes can kill you? I had no idea." Is there anyone in the United States, smoker or nonsmoker, who isn't aware of that?
If cigarettes were a brand-new product, being introduced for the first time right now, there is no way they would be allowed on the market. But they have been around for so long that, gruesome warning labels aside, there is no chance that they will be outlawed.
Just from a political standpoint, few in the Congress, let alone the White House, would want to have to stand for re-election in some future November after having angered 46.6 million adults -- even those who fervently wish they could stop smoking -- by taking their cigarettes away. If you thought Prohibition was a mess. ...
Cigarettes, in the years before the first warning labels went on in 1966, were an impulse purchase: 35 cents, 40 cents, 50 cents a pack. But of course, cigarettes also used to be presented as a happy and carefree part of Americana; during the 1940s and 1950s, when the holiday season came around each year the cigarette companies would sell specially designed cartons, covered with pictures of wreaths and berries and of Santa Claus. Children gave them as gifts to their schoolteachers, families handed them to their milkmen and postal carriers. In retrospect, the message might as well have been: "Merry Christmas -- hope you die!" But few people thought of cigarettes as being potentially fatal in those years.
You would think, with the rising price of cigarettes, some people might just decide to listen for fire-engine sirens, follow them to the site of the blaze, then run into the burning building behind the firefighters and inhale a lungful of smoke. It would be more economical. There are 20 cigarettes in a pack; the people buying the higher priced ones in that hotel gift shop are, in essence, rolling up a dollar bill and setting it on fire each time they smoke.
And after all the decades of warnings, the CDC reports, there is this statistic:
Every day of the year approximately 2,200 adults -- who presumably have heard about the health hazards their entire lives -- begin, for the first time, to smoke cigarettes on a daily basis.
The opinions expressed in this commentary are solely those of Bob Greene.

Monday, August 1, 2011

Kicking the Habit with Electronic Cigarettes


Kicking the Habit with Electronic Cigarettes

Unwanted Robots @2011 Karla Fetrow
By: Sergio Impleton
Kicking the Habit with Electronic Cigarettes
Promoting an active anti-smoking campaign at a time when economics are so anxiety ridden, a shot of heroin wouldn’t prevent night tremors from turning into nightly mental volcanic explosions seems wicked in the extreme, but the academics of negative health effects have been on such a roll, to fly in the face of smoking opposition now would be tantamount to gaining a reputation as a serial killer.  Not only do we have to consider the disgusting residues of tar and chemicals rattling around in our lungs and coursing merrily through our bloodstream, we are guilty of the malignancies caused by second hand smoke.  Nobody wants to be accused of poisoning their children, even if said children live in an area with enough industrial pollution to choke out the life of King Kong.  The pressure was on.  Either quit smoking or for the rest of my natural or unnatural life, I would be branded a criminal.
I’ve been a smoker for over twenty years, which is to say, suddenly tossing the cigarettes out the window is easier said than done.  A smoker going through withdrawal pains is not a very pleasant person to be around.  When those nerve endings get hit with those problematic dilemmas that require keeping your cool and sorting out priorities, a long draw on a nicotine loaded cancer stick has a way of simmering down the explosive potential.  For example, little Jimmy thinks he needs an i-phone because all his best friends have one, and he’ll be the odd man out, with all fingers pointing at his parents’ neglect of generosity and limited income if he doesn’t have one.  First rule of academic association; never appear as though the family income has a bottom line.
As a smoker, little Jimmy could explain the situation, and I would listen, calmly shaking a cigarette from the pack and inhaling deeply, contemplating the issue.  “Well, Jimmy, no.  I can’t afford an i-phone for you right now because I can’t even keep up on the cable bill.  I’ll tell you what.  If you can get the family to agree to cut the air-conditioning down, I’ll buy you an i-phone and won’t tell anyone that the acceptable temperature in the house has been set at eighty degrees.”  Without a cigarette, the somewhat more explosive answer is this; “No, Jimmy, you can’t have an i-phone because I said so.  Now, go console yourself with down-loading all the Netflix movies you can before they raise their prices.”
Actually, budget was a big motivation for my half-hearted decision to quit.  I had already dwindled my pack a day habit to a pack every two days, but in the face of rising costs, it still wasn’t enough.  My wife kept reminding me that eliminating this luxury habit from my life would enable us to once again afford weekend barbeques of steak and hamburgers instead of just hamburgers and hot dogs.  I considered the patch.  A friend of mine had used it.  There was one hitch.  His medically approved patch came accompanied with a support group of prescription regulated nicotine anonymous ex-offenders.  Apparently, the patch would not work as effectively without the voice of social conscience strong-arming its way into the door.  Every morning he would receive a phone call asking how he was doing and assuring him that he can last one more day without the demon smoke warping his sound mind and sound judgment.  I had two problems with that.  First of all, I wanted to monitor my own nicotine flow.  If I wanted to bombard my bloodstream one day, and dwindle it down to the equivalent of five cigarettes the next, I wanted to be able to do this without my patch making the judgment call.  Secondly, the last thing I wanted was someone who carried the nasal tone of false exuberance my wife used whenever she decided I needed to be included in her diet/exercise program.  One more word of encouragement and I would jump out the window of a seven story building.
There was one ray of hope; the electronic cigarette.  It’s the ideal companion for the modern, plugged in, cyber interface junkie.  The kit that I bought; electronic cigarettes come as a kit; has a battery charger that snuggled into a computer slot as comfortably as the upload cord for a digital camera.  It has ten individual filters, each one equaling a pack of cigarettes.  You exhale a smoke that is nothing more than water vapor.
That was the sales pitch that sold me.  A potential new world opened up. Not only would I be able to smoke in the house without worry that the wife or kids would dial up EPA with a complaint, I could go out in public.  I could walk a free man, puffing my electronic cigarette at street corners, in restaurants, at the movies, and nobody would do a thing about it.
“That’s delivering the wrong message,” said the wife.  “The idea is that you can socialize with others without demonstrating to them that you have an oral fixation. You are thumb sucking in public.”
“We all have oral fixations,” I argued.  “Thumb sucking begins in the womb.  It’s instinctual.  Chewing gum?  An oral fixation.  That extra helping at the dinner table that you don’t need?  Oral fixation.  And what about the bottles everyone carries around with them these days?  It used to be that the only bottles you saw clutched were wrapped in a paper bag and in violation of open container laws.  Now, you don’t see anyone without a bottle; bottled soda, bottled juices, bottled water.  People don’t even need to eat anymore.  They carry all their vitamin and mineral needs in a bottle they suck on throughout the day.”
The wife guiltily put down the bottle of vitamin enhanced water she was drinking.  “At least I’m not sucking on a drug.”
Before we could get into a debate over the questionable use of drugs, she acceded and I bought my first electronic cigarette kit.  At first, it was like playing with a new toy.  I examined this marvel of engineering and could barely wait until I had to try out my first charge-up or filter change.  I gulped down those sweet little doses of nicotine as fast as I could, but something was missing.  Before the day was out, my lungs were climbing up into my throat, screaming for a little tar and chemical laced smoke.
As I inhaled my first real cigarette of the day, I realized smoking is more than the act of inhaling nicotine; it’s a ritual.  The act of lighting it with your very own, personally attached lighter, watching the end flame up, the ash accumulate, the cigarette dwindle were all a mental process of smoker satisfaction.  I felt bad because it became obvious my new electronic state of the art smoking wasn’t really going to let me go cold turkey on old fashioned, messy, wickedly intoxicating tobacco.
I redoubled my efforts, willing myself to believe my electronic device was the same as a real cigarette.  I think I tried a little too hard.  I lost my first electronic cigarette by unthinkingly tossing it out the car window .  With five filters left and no igniter to activate them, I was forced to buy another kit.  By this time I was getting the hang of it.  Cautious not to smoke and drive again, I still lost myself in the feeling of its reality.  If I was holding it while shrugging into my coat, I automatically protected the end from breaking.  If I was waving it around, I brushed my clothing for loose ash.  I constantly found myself tapping it on the ash tray, while the red glow button on the end winked on and off in alarm.  I killed my second electronic cigarette, when, completely absent of mind and unsound of body, I lit the end of it.
I was in a quandary.  If I bought another electronic kit, I would be kicking in seventy-five dollars for nicotine in two weeks time; double the average amount I was paying for cigarettes.  Still, I had more than a dozen drug packed filters left and it seemed a pity to waste such marvels in modern engineering.  I bought one more, determined the third time was be the charm.
I have, so far, managed to preserve this delicate instrument of refined smoking pleasure.  There are times when forgetting my cigarette is artificial instead of natural, are luxurious moments instead of disastrous ones, such as the time I dozed off watching television, my electronic tube in hand, then shook myself severely awake, reminding myself I was holding a cigarette in my hand.  But it was just a tube, laying peacefully across my chest.  I took one half-conscious drag.  “Not bad,” I thought and the pleasurable thoughts of being able to electronically smoke in grocery stores, restaurants and theaters danced once more in my head.
The time finally came when I was able to leave the sanctuary of my house and go out into public again without craving for release by hiding in an alley way with other drug addicts furtively sucking away at their coffin nails.  My wife actually consented, or more accurately, dragged me along to a Saturday outing at the library.  In essence, these excursions were to give the kids a heightened sense of culture, and hopefully to read a few books, but predictably they stuck pretty much to their own cultural understanding; the library computers.
Adjacent to the computer mode was a glassed in coffee shop, where satisfied mamas and papas drifted over to relax while their kids tore apart the reading room.  It was the ultimate luxury in parental responsibility.  They could actually observe and compare the behavior traits of their half-civilized prospective academicians.  Not to be outdone by the young students buying their cappuccinos and mocha; by the sports moms in their sweat bands ordering squeezed juices and bran muffins, we joined the line in attendance and asked for two American coffees, black.
As I sat there, enjoying the first real euphoria of the day, all centered around this marvelous beverage while a drizzling rain outside accentuated the comfort of its warmth, the wife fooled around with her cup and eyed a particularly blond, tan young athlete sipping her strawberry smoothie.  “You know,” she said, “I wonder if we should give up coffee.  It is a drug after all.”
I looked down at the recycled paper heat band wrapped around the cup.  Printed across it was the legend, “coffee.  The last legal drug.”  I thought about my struggles to overcome my smoking habit; the hours of pacing when all I really wanted was a ten minute break; a smoking ritual.  It had been marvelous, perfectly timed, this corner of stepping out of the clatter of modern drudgery and watching the minutes tick away with the shrinking of the cigarette.  Ten minutes of perfect calm.  I thought about how many times I had been distracted from writing because I wanted that calm flow of nicotine to induce my fingers to keep typing, my brain to keep flowing in relaxed harmony with the words I pegged down.
Sure, there are a number of benefits dwindling down my smoking habit has brought me.  I can actually jog along with the wife for a short distance without sounding like a freight train with a missing piston.  I can smell again, although this sometimes is a drawback.  I notice the cigarette smoke on other people’s clothing and sniff it a little just as a remembrance, which doesn’t endear them at all to someone who already has a reputation as peculiar.  I kept closing my son’s door until the wife came in and removed a dozen bottles of slightly unfinished gatorade floating with growths of what can only be assumed to be a new species of life.
Still, my active thoughts rebelled.  Humankind had survived for centuries on drugs.  Shamans, witches, soothsayers, temple priests and priestesses all were the results of mind altering drugs.  Artists thrived on their drug taking routines and more than one writer has scratched his deepest internal quests, objectives and truths while floating in a euphoric blue haze of drug induced inspiration.  I could lay a wager that the covered wagons didn’t cross America with the pioneers swigging away at water bottles every five hundred yards, but they did save some of that water for coffee in the morning, along with a precious, hand rolled cigarette.  For all we knew, the next genius would pop out of a cup of java.  It had taken me months to rein in a habit that had caused momentary lapses into sanity in an otherwise painfully chaotic world.  Did I really want to give up this single pleasure that had been a part of my morning routine for over two-thirds of my life and battle with the consequences of withdrawals, and who knew; possibly an end to all inspiration, intellectual responsibility and rational behavior?  Hell no.

Tuesday, July 26, 2011

Smokers Not Very Receptive To Shocking Images


Main Category: Smoking / Quit Smoking
Article Date: 13 Jul 2011 - 0:00 PDT


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A team of researchers led by the University of Bonn found clear changes in how emotions are processed in smokers. After an abstinence period of 12 hours, the brain's fear center was mostly out of commission in addicts. The researchers assume that a campaign using images of smokers' lungs as deterrents on cigarette packs as both the US and EU are currently planning will hardly have an effect on this group.

The study, which was supported by the German Research Foundation, brought together scientists from the Universities of Bonn and Köln, as well as from the Charité in Berlin. 28 younger persons who had been smoking for quite a number of years and an equal number of non-smokers participated in this study. Each of the subjects was shown photos of happy, fearful and neutral faces while their brain activity was recorded. The researchers were particularly interested in the amygdala a structure the shape and size of an almond. "It is the brain's fear center," said Privatdozent Dr. Dr. med. René Hurlemann, Oberarzt at the Klinik und Poliklinik für Psychiatrie und Psychotherapie of the Universitätsklinikum Bonn.

The amygdala was always active when the participants were shown fearful faces. "Initially, there were no differences visible between smokers and non-smokers," reported Dr. Ozgür Onur, the study's principal author and neurologist who used to work at the Universitätsklinikum Bonn and is now employed by the Universitätsklinikum Köln. "So, the processing of emotions in the brain worked in a similar manner in both groups." This was always the case when the addicted participants were allowed to smoke sufficiently. The study's subjects, who ranged in age up to their late twenties, consumed an average of 17 cigarettes a day, and had been doing so for nine years.

Lower amygdala activity after abstinence

However, when the smokers came off a 12-hour abstinence period, the picture changed. "After only a few hours of abstinence, the activity of the fear center was far lower, as compared to the earlier state," said Onur. "They simply were indifferent to images of fearful people."

This lack of fear is problematic. "The amygdala is prevented from performing its natural function," explained Hurlemann. "Fear is an archaic instinct that protects us from doing things that are dangerous." Smokers who have recently been abstinent do not show this natural response pattern they are not afraid of the consequences of smoking. "It seems that they are mentally caught up in their addiction, resulting in a lowered receptivity for fear-inducing stimuli," said Onur. "It seems that smokers need nicotine in order to maintain the normal function of their amygdala."

Hurlemann doubts that the shocking images of smokers' lungs and tumors on cigarette packs, which are in the works in the US and also under consideration in the EU, will have much effect on the majority of addicts. "In those who stop smoking, the activity of the fear center has been lowered so much that they are not very receptive to the scary photos," said Hurlemann.

Half of all smokers die early

"There are 1.2 billion smokers worldwide," said Hurlemann. "Statistically it can be assumed that about half of them will die early from consequences related to smoking." That is why it was important to ask how these people could be helped, he added. "Maybe we should invest more in therapy measures for smokers and into research to find the optimum smoking cessation methods for different types of patients?"

In non-smokers, however, the amygdala is active, which is why in his opinion, shocking images will be effective for them. "Those who do not smoke yet can probably be kept from smoking by such scare tactics," Dr. Ozgür Onur concurred.