"Medicines do not help smokers to quit in the long run"

The WHO has failed miserably in its efforts to get smokers to stop smoking. The problem is an exaggerated belief in nicotine medicines. This is according to Riccardo Polosa, a doctor and smoking cessation specialist.

Medicated nicotine such as patches and chewing gum, anti-addiction medicines such as Champix and Zyban. These are the WHO recommendations for smokers trying to quit. These are also the drugs that top the list when doctors in Sweden and other countries help smoking patients. But according to the doctor Riccardo Polosawho has been running a stop-smoking clinic in Sicily for 20 years, it is no longer sustainable.

"The WHO has not understood how smokers work, on a psychological level. Smokers don't like to be seen as sick. And using drugs to get smokers to quit doesn't work in the long run." says Ricardo Polosa during a conversation about the future of the WHO Tobacco Convention.

Medicines only work temporarily

He is joined by Professor Jed Rose, the doctor who invented the nicotine patch at the end of the last century. The nicotine patch has long been promoted as an aid for smokers trying to quit. But according to research conducted by Jed Rose at his clinic at Duke University, various nicotine medications are a problematic approach.

"Patches, chewing gum and drugs like Zyban and Champix are effective in the short term. According to our studies, half of the patients are smoke-free after 12 weeks. The problem is what happens later, after 6 months to a year. Then we see many relapses to smoking. Only between 10 and 20 per cent are still smoke-free. We have a great need for innovation here," says Mr Perez. Jed Rose.

And that's where products such as e-cigarettes and other smokeless nicotine products come into play, according to Jed Rose

"These are smoke-free products suitable for long-term use. They have the potential to replace nicotine intake from cigarettes, but in a less harmful form." he says.

E-cigarettes more effective

Jed Rose's observations have been supported by several independent studies. According to the British Cancer Society (CRUK), e-cigarettes are the most popular way to quit smoking among smokers. In combination with professional support, e-cigarettes are also very effective, twice as much as traditional nicotine medicines. CRUK sees vejpning as an important weapon in the fight against cancer. Especially in the long term.

Smoking despite lung disease

The doctor Riccardo Polosa has been using electronic cigarettes for 10 years as part of his smoking cessation programme. He has also conducted research on the technology and its health effects for smokers with documented lung diseases. He argues that smokers, especially older people with medical conditions, do not want to stop using cigarettes. Despite life-threatening diseases and failing health

"Smokers are difficult to work with. Most smokers want to stop smoking, but they don't want to stop using cigarettes. They know the risks, but cigarettes are worth much more to them. Cigarettes are part of a social context, something to do, to enjoy with a cup of coffee, a way to socialise, meet friends and so on." says Riccardo Polosa.

Loss of motivation

Nicotine replacement has no chance of replacing this value, according to Riccardo Polosa. And that is why the preparations do not work in the long run.

"The motivation to quit eventually disappears. And at the same time, the value of all the 'benefits' of cigarettes remains. So they start smoking again," he says. 

Smokers keep the rituals

Not only do smokers not like to be medicated, but they are also not interested in paying high prices for their medication, according to the report. Riccardo Polosa. So when e-cigarettes emerged as an option 10 years ago, he was quick to test them in treatment at the clinic.

"Electronic cigarettes are a tool that allows smokers to maintain their rituals. This is a psychological aspect of smoking and smoking cessation that we doctors often miss when we talk about harm reduction and smoking cessation."

Support from authorities

Men The influence of the WHO is strong. Several countries have either banning e-cigarettes or regulated technology in the same way as traditional cigarettes. Some exceptions are the authorities in United Kingdom and New Zealand which instead actively encourages smokers to switch to e-cigarettes. According to the UK Department of Health e-cigarettes 95 less harmful than cigarettes and the agency regularly updates its analysis of the research. In these countries, both health professionals and doctors are trained based on the independent research available today, mainly from the UK and the US. The view is that the nicotine in question is not particularly harmful in itself. It is rather the smoke as a delivery method that causes the main harm.

"Staring blindly at addiction"

Riccardo Polosa now calls on the WHO to change its approach and encourage harm reduction products such as e-cigarettes, instead of focusing on the potential risks of nicotine addiction.

"The fact that we now have a much cleaner method of delivering nicotine is a huge advance. And innovations in e-cigarettes have given smokers really effective ways to keep the nicotine, which they find so hard to release, without smoking. Addiction is a price to pay, but it's the key to a successful smoking cessation strategy," said Mr Pearson. Riccardo Polosa.

Listen to the full discussion on the WHO Tobacco Convention (see links above the article for individual participants' contributions):
Tobacco Harm Reduction, Policy and Practise

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