Dear Bellingen Shire
3 November 2020
This week is brought to you by the stalwarts of commerce -British American Tobacco, Burns Philp, and Philip Morris.
It’s amazing how so much can change as our society seeks solace in unlikely places. When I was in medical school the bookish profession of Epidemiologist was one of those in the end of the corridor, who lectured in the Friday afternoon death slot, and was decidedly unsexy. A bit like the librarians of medicine. That person with vested authority, who is always going to be right, who you really need, but keeps tapping you for not following the rules and catching out any slackers. And now suddenly epidemiologists are the most exciting people on the news. They’re up there sometimes in front of pollies. Celebrities in their own planetary vision right, and hey, some like Professor Raina Mcintyre are even starting to look like celebrities – with smooth style, commanding presentations.
I would never diminish Librarians, dedicated souls who have also had to twist with great agility in their custodial roles in the storage and presentation of knowledge, while our epidemic of digitalisation has seen their love and treasured charges being pulped en masse. In fact did you know there is even an action figure librarian doll, named Nancy Pearl after a real life American Librarian?
Now this is a twisted segue to introduce another Doll whose relevance will become a little more acute in a minute.
Sir Richard Doll is a famous British epidemiologist – back when that role was probably even less sexy. He was in a team who initially set out to find the assumed link between lung cancer and petrol fumes, or tar – in London Bus conductors. However, 70 years ago this year he published findings that were not what he expected. Funny how life does that so often. It is good to start with expectations, (called a Hypothesis in science) but even better to recognise the reality you didn’t know or want to find! (called the new Theory)
Actually, in 1950 he discovered and published that, far from tar or petrol, it was smoking that increased lung cancer by up to 50 times that of non-smokers. He stopped smoking himself and then went on to set up, with a dedicated team, a brilliant 50-year study of British doctors. Why doctors? – because they could be very easily traced and tracked, and they would get accurate reliable diagnostics. That team demonstrated beyond doubt that about ½ of all smokers would die from their addiction. In 1976 they also published the powerful evidence that smoking caused a whole array of diseases – heart, blood vessels , stomach cancer , gangrene. And not only did they see more disease in smokers, but there is also a linear relationship – ie the more you smoke, the bigger the dose, the greater number of diseases.
I am haunted by a clear vision of a patient I was sent to look after in my first ward in Princess Alexander Hospital , Brisbane as a trainee nurse in 1978. He was a professional man aged 42 with black glasses, very eloquent. He sobbed all night -“ I thought I had paid the price for my smoking when they cut off my leg. I can’t run with my kids; I can’t go back to work. But the phantom pains – there is never any rest!” I then struggled to reconcile that with the fact that the operating theatre staff lunchroom had a ceiling stained deep brown from cigarette smoke. Such is the power of addiction.
So, we had powerful evidence in 1950 of the poison and spectacular cost of nicotine addiction. We had incontrovertible evidence in the 1970s of the breadth of the impact, yet it took 68 years to finally push down the almost unstoppable, dishonest, corrupt, toxic lobbying might of the tobacco industry. In fact, Australia is still seen as a poster child, -leading the world in this campaign. The first time tobacco parasites have really been defeated in international courts, as they fought our “plain packaging laws”, tobacco tax, advertising bans, etc. Indeed, other country’s public health authorities are watching to see if we can hold firm. They all know the cost on their own populations, but also fear the fight.
The arguments against tobacco regulation were always like: the evidence is not in; there is doubt; not all science agrees; Advertising a legitimate product is ok; Business must be allowed to get on with creating jobs; this is a free country – not a nanny state; the taxes on tobacco are just a revenue raiser, this is legitimate consumer product, there is intellectual property rights invested in the decoration and packaging, we need ‘balance’ in the argument, we respect the right of our customers to make adult choices…” and it went on and on. All rubbish.
In the meantime they researched for themselves the science of addiction. The cigarette itself is physically designed on early Freudian psychological research into how to make it more alluring. They employed the biggest spinners and ad contracts. Those of us born before 1980 will remember the Marlboro Man! The quintessential tough’ cool’ masculine stereotype as he reared up on his appaloosa stallion on a ridge top with the caption – “come to where the flavour is – Marlboro Country!” Or the beautiful white charger ridden bareback by a lovely lady through the ocean breakers , mane flying and the jingle – “fresh is the flavour of Alpine”.
Well, they added menthol to alpine. It is a local anaesthetic so that you could not taste that you were burning a chemical laden weed – just the cool anaesthesia – and called that fresh. In the early 1990s the brand Marlboro was the biggest single identifiable root cause of death in the US! One brand! In 1993, while on exchange to Wyoming to learn from a US country doctor, I met a guy who worked with the Marlboro man – after he had become an anti-tobacco campaigner, while he was dying of lung cancer. His classic story was from when he was the hottest thing in advertising in the US of A, he went to a conference in Aspen, Colorado. He admitted to having a little trouble with the elevation and breathing. He went out for a smoke, offering one to a bunch of tobacco executives. When they declined and he wondered why they didn’t use their own product – the reply was: “Of course not! That’s a right we defend for the poor, the black, the young, and the stupid!”
In Australia now we’re down to about 11% of the population still smoking, and dropping, down from 40-50%. So, what the hell has this got to do with a Covid19 letter? Apart from the fact that smoking is a risk factor that elevates the likelihood of dying of Covid from ~1% to ~ 9%.
A few months back I was alarmed that the Covid Crisis started to be seen by some in governments, “development” or other areas, as a great crisis not to waste. A great time to make unpopular or sneaky moves while the population is compliant and concentrating elsewhere. Last month while scanning through the medical headlines, I saw that the TGA had reluctantly approved vaping liquid as a therapeutic item for restricted sale – on prescriptions from a doctor, as an aid in the cessation of smoking. It was previously not legitimate to sell nicotine vaping liquid in Australia – most people get it on the black market or mail order.
The argument from tobacco/nicotine company lobbyists is that they are part of the solution now (despite still selling billions worth of tobacco into unregulated and third world markets), that they are legitimate businesses, that vaping is less harmful than tobacco as it does not contain the 2000 smoke related chemicals. Even Dr Wodak, the long serving Sydney specialist in addiction for whom I have enormous respect, thinks there is a medical and harm reduction role for this.
Now statement of allegiances: I am not taking a moral position on people who have addiction issues. No, I have never experienced first hand an addiction, though I have spent a lot of decades helping people who have. I do not have an objection to free commerce, private business and providing jobs – indeed my wife and I run a private small business with 10 employees!
But I really object to lying, obfuscation, suppression of evidence, and the parasitic behaviour of people who peddle poison in the guise of business. Now, an effective parasite does not want to kill its hosts too quickly or it too will extinguish. So it needs to string out the death slowly so that the host doesn’t know it, and then target a whole new cohort of young hosts. This is precisely the strategy now from the purveyors of vaping.
In my medical news feeds are reports that vaping has become an absolute buzz in teens in the US – they are the rapidly growing market. The nicotine levels are significant in the liquid. Let’s be clear – this is a very poisonous substance. It is not jelly babies, and yet is being flavoured to mimic them. The kids are precisely the new target, just in the same way that “Alcopops” were targeted at kids.
As I trawled thought the arguments for and against the legalisation of vaping nicotine the ultimate goal of the lobbyists is clear. Despite all the hand wringing and wanting to be “part of the health solutions” they actually want vaping NOT to be registered as a therapeutic agent, but to be a consumer product. With this they would have far less oversight as to marketing, quality, effects, dangers yet to emerge. And once in, then we’re back to the 70-year battle of debated truths. These are the same people who stand to profit from the cost and misery of a drug of addiction. So, if it is only nicotine is it safer? – well, we’re yet to see. One of the reports from the US points out that kids vaping do so far more frequently than they would have smoked – which requires a bit more effort. Also, most studies show that people starting vaping then actually Vape, and still smoke! What is really being offered is a big jump in dose of what is really a deadly, neurologically active, poison. Targeted at kids, by clever , financed and experienced marketers, it’s like saying let’s make little sweetenned cyanide pills legal because you get a buzz if you taste a little bit of it.
Despite the above accolade to Richard Doll, the first paper to link smoking with disease came out in the 20s in Germany but was ignored. That was only a decade or 2 after smoking really became widespread. So how will our youth look in 10 -20 years?
In the summation of the various opinions and reports it seems that Australia is a big target for this industry as they are smarting from their defeat in the plain packaging ruling. They have a lot to gain from claiming our scalp with this new product. I hope it is never allowed as consumer product and I am not convinced of the value in prescribing it. Let’s keep alert to things sneaking in.
On the topic of drugs -While in the Covid19 era we’re seeing some interesting data now being sourced from sewerage works. The health departments are testing for Covid19 traces in Wastewater in 55 sewerage plants around the country, but also for drugs. They expected to see a big kick up in alcohol consumptions (and its’s obvious end product!), but in fact this has not really happened – it seems drinking is still seen as something more done in company. However, each state has its own favoured poison – In Sydney there has been a big kick in cocaine use while for rural NSW it has been methamphetamine and heroin.
Nevertheless alcohol and tobacco still account for the largest amount of drug related harm.
I don’t know what our local works see. It would be wonderful if they just found increased by- products of exercise!
The NSW Health Critical Intelligence Unit (they could have at least called it the “Critical Intelligence Annex”?!) carried a report reviewing 26 countries, and the biggest determinants of breakout of Covid 19 deaths and disasters have been: softening of border controls; early easing of lockdowns; poor supervision of quarantine facilities – but you knew this already. So far the 2nd , or third wave, has been a different strain of the virus, more amongst younger people, and thus far a little lower in fatality rates – though that may change as the numbers out of Britain and Europe are stacking up. Remember the sad mortality rate in Britain – 2-300 per day – reflect what happened a month ago. That was when doctors were screaming (such as Brits do) to reintroduce lockdowns. So, if it comes to us, we need to be agile and responsive early.
Once again, Our local covid19 clinic is opening 0900-0930 (or later if there is a big line up) at Watson St in Bellingen and will of course respond if there is an upsurge in concern (i.e. outbreak nearby). Still seeing only viruses that cause the common cold. We’ll see what happens when borders open.
Please remember this is just one perspective and check any detail with your GP – and let’s keep having polite conversations about how we want our society to look after this historic change in the world.
Dr Trevor Cheney