The Problem with Quit Smoking Campaigns
A great irony permeates the relationship between the Australian Federal Government; Nicotine Replacement Therapy (NRT) based advertising and the Australian smoker. The prevalent position required by Government (to their non-smoking voters) strives to convince smokers to end their habit, however the Government is now as dependant on the taxes from smoking and excise-like products; some $10.2 billion in 2012 (Van Onselen 2012), as smokers are dependent on cigarettes. In this essay I will address the manner in which the visual media within Australian Government anti-smoking campaigns bring suggestions to the subconscious directly opposing the desire to quit smoking.
Whereas Government has, via their association with non-pharmaceutical sponsored advertising e.g. The Cancer Council, produced visual media representations which actually serve to psychologically discourage the habit, such as the latest advertisement questioning “Is this how your friends see you?”, those advertisements linked with pharmaceutical companies utilise an aspect of Australian essentialness and the subtlety of Neuro-Linguistic Programming (NLP) to ensure repeated attempts to quit using their highly profitable nicotine based products, when nicotine is not the basis of the addiction. (Jain and Mukherjee 2003 281). Pierce and Gilpin (2002 1260) state “Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation”. Findings by Alpert, Biener and Connolly (2011 1) from Harvard School of Public Health and The University of Massachusetts Boston found “Nicotine Replacement Therapies (NRT’s) designed to help people stop smoking, specifically patches and gum, do not appear to be effective in helping Smokers quit long-term, even when combined with smoking cessation counseling”.
Through Visual Media representation biased toward Pharmaceutical company involvement, the Australian public has come to see smoking as a disease. To treat a disease you need pharmaceuticals, be they real or placebo. (Chapman and MacKenzie 2010).
“In the 1930s, when Bill Wilson and his associates put together the basic ideas of Alcoholics Anonymous, they decided that alcoholism (and later, drug addiction more generally) should be treated as a disease of the spirit. They held that alcoholism, while rooted in moral failings and character defects, had its final manifestation as disease.
Although the disease concept was originally designed as a metaphor with the intent of saving addicts from humiliation, in 1956 the American Medical Association (The AMA) accorded alcoholism the medical status of disease. From then on the idea of addiction-as-disease gained momentum and was finally concretized through the growth of the huge business concerns that developed around it. The medicalization of addiction came to full fruition in the Minnesota Model which immortalized the definition of addiction as a chronic, progressive disease that ultimately ends in death. There are multiple reasons for arguing against the idea that addictions are diseases…… the disease concept implies a level of brokenness and biological stasis that limits creative thinking about the problem.” (Gray 2012).
Pharmaceutical companies sell pharmaceuticals. Not lifestyle choices, not avoidance of rejection by society. They sell pharmaceuticals. When they advertise an end to the smoking habit, they are advertising their pharmaceuticals. Research indicates that the increasing medicalization of smoking cessation implies cessation need be pharmacologically or professionally mediated (Chapman and MacKenzie 2010). The average Australian smoker reads “You cannot do it by yourself. You need either professional help or our prescribed NRT.” We have a situation where advertising leads consumers to seek medications they do not need, or to forgo less expensive and safer treatment options (Dukes 2001). Further research as far back as 1964 specifically cited that the tobacco habit should be characterised as a habituation, rather than an addiction (The Surgeon General 1964). Even today, the one warning the Government cannot place on a packet of cigarettes is “Nicotine is addictive”. (The Surgeon General 2010). To do so would be libellous. They print “Smoking is addictive” and yet the advertisements used by Pharmaceutical companies present a necessitous substitution of one source of nicotine (cigarettes) to the slow weaning process of another source (NRT) as the only way to quit because of the alleged addictive properties of nicotine, be it through patch, lozenge, gum, inhaler or spray. To the Australian smoker, subtly influenced by the NLP of the advertisement; Nicorette, Nicotinell, Nicabate, Nicoderm. The first syllable says it all, when the evidence is far from conclusive (Frenk and Dar 2011 1).
An impasse has been reached. The Government, reliant on their taxes, the pharmaceutical companies reliant on their profits and the smoker reliant on well-meaning yet misguided advice from their GP or the subtle NLP cues in advertising for “expert” direction to quit the habit. The advertisement declares “For most smokers, it takes multiple attempts to successfully quit.” (Figure 1.) Whereas this may be true, what has that suggested to the subconscious mind of the struggling smoker? It’s OK to fail. Most smokers do anyway.
The text positions the portrayal of the smoker as likely to fail. Pharmaceutical companies do not want quitting smokers. They want repeat customers. 100,000 scripts filled for NRT in the first month after the drug was placed on the Pharmaceutical Benefits scheme in 2011 (Department of Health and Ageing 2011). Everybody wins, apart from the smoker who, frustrated and confused, tries another round of NRT (paying full-price this time) or prescribed anti-depressants such as Zyban or Champix (again, produced by the pharmaceutical companies) in order to try and break the habit. As stated by Christopher La Barbera (2001 14) “manipulative marketing techniques enhance demand for medicines beyond necessity and pose hazards to consumers.”
Does nicotine it have an effect on the human body? Absolutely. (Domino 2013). Nicotine however, also stimulates the production of two chemicals produced naturally by the body. Dopamine and Epinephrine (Jain and Mukherjee 2003 281). Dopamine is a chemical produced by the brain. A “mood elevator” if you will. Epinephrine is a form of adrenaline produced by the adrenal glands. It all depends on how the smoker is feeling when they smoke, as to whether the brain allows receptors to receive the Dopamine or the Epinephrine. Smoking when relaxing triggers the receipt of Dopamine. Smoking when stressed triggers the receipt of Epinephrine. Instant gratification. The essentialness of the Australian.
When the body becomes used to a certain level of Dopamine or Epinephrine, it requires that level to feel “normal”. When those levels are not met, the brain signals it’s need by what we are told by pharmaceutical advertisements are “cravings” or “withdrawals”, NLP terms used in hard drug use (Gray 2012 1).
Most of the nicotine is normally out of the body between 2-4 days, dependent on how many cigarettes the smoker smokes in a day. What does the Visual Media used in pharmaceutical adverts tell us? A 10 week “Step Down Programme”, not including an extra two weeks on the “Pre-Quit Patch”.
“Medical Institutions, both Government Licensing Authorities and Voluntary Societies have powers and responsibilities to monitor professional advertisements to defend the public interest against deception” (Serour and Dickens 2004 195) and yet we now have a defined grey area of addiction versus habituation which has allowed a loophole for Pharmaceutical companies to turn a human essentialness into a profit.
What the smoker is dealing with is a memory. Not a craving; a memory linked with pleasure and instant gratification. Unfortunately, (as far as a pharmaceutical company is concerned), there is no money to be made from a memory, so they call it a nicotine addiction.
The Pharmaceutical industry continue to experiment into various methodologies to deliver the NRT, (Patch, Gum, Lozenge, Inhaler, Spray) much in the same way toothbrush companies must come up with a new handle or bristle configuration every few months and razor manufacturers must add yet another blade to the shaving head, but once again confirming the hidden agenda of the Pharmaceutical companies, many (NRT) assisted cessation studies but few (non-NRT) unassisted cessation studies are funded by Pharmaceutical companies manufacturing cessation products (Chapman and MacKenzie 2010). Why would they fund (non-NRT) assisted studies? It is not in their best interests to have smokers become free of their habit unless it is via their product.
The visual representation used in media, specifically advertisements regarding smoking cessation will, unfortunately, continue to mislead and misdirect the consumer by bringing suggestions to the subconscious directly opposing cessation as long as there are linguistic loopholes to be exploited, profits to be made and non-smoking voters to be placated.
- Alpert, Hillel R., Lois Biener, Gregory N. Connolly. “A Prospective Cohort Study Challenging the Effectiveness of Population-based Medical Intervention for Smoking Cessation,” Tobacco Control, doi:10.1136/tobaccocontrol-2011-050129.
- Chapman, S., R. MacKenzie 2010 “The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences.” PLos Medical Journal 7 (2): e1000216 doi:10.1371/journal.pmed.1000216
- Department of Health and Ageing 2011 “The Extension Of The Listing Of Nicotine Patches On The Pharmaceutical Benefits Scheme From 1 February 2011” http://www.health.gov.au/internet/ministers/publishing.nsf
- Domino, E.F. University of Michigan 2013 “Nicotine And Tobacco Research 2013” 15 (1): 11-21.
- Dukes, David E. 2001. “What You Should Know About Direct-to-consumer Advertising of Prescription Drugs.” Defence Counsel Journal Jan 2001. 68. (1). 14, 36. http://web.ebscohost.com.dbgw.lis.curtin.edu.au/ehost
- Fig.1. 2012 “Open The Door To Quitting” Advert. New Idea Magazine. Feb 2012.
- Frenk, H and Reuven Dar 2011 “If The Data Contradict The Theory, Throw Out The Data: Nicotine Addiction In The 2010 Report Of The Surgeon General.” Harm Reduction Journal (8): 12. http://www.harmreductionjournal.com/content/8/1/12
- Gray, Richard 2012 “Thinking About Drugs And Addiction” http://www.nlpco.com/library/therapy/addictions/#axzz2kqq80t6g
- Jain, R., K. Mukherjee 2003. Indian Journal of Pharmacology 2003 (35): 281-289
- La Barbera, Christopher. 2012. Irresponsible Reminders. Ethical Aspects of Direct-to-consumer Drug Advertising”. Ethics and Medicine: An International Journal of Bioethics. (Fall 2012) 95. http://search.proquest.com.dbgw.lis.curtin.edu.au/docview/1170931344?accountid=10382
- Pierce, J.P., E.A. Gilpin 2002. Impact of Over-the-counter Sales on Effectiveness of Pharmaceutical Aids for Smoking Cessation. Journal of the American Medical Association 2002 Sep 11; 288(10):1260-4.
- Serour, G.I., B.M. Dickens 2004 International Journal of Gynaecology and Obstetrics 85 (2): 195-200
- The Surgeon General 1964 “The 1964 Report on Smoking and Health.” Profiles in Science 1964: 1 http://www/profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60
- Van Onselen, Peter. 2012. “Smoke Screen in Plain Packs”. The Sunday Times, July 15.
The whole session appeared to be a waste of time.... nothing appeared to be working properly. I didn't lose consciousness. I didn't go into a trance, or at least I didn't think I did, and yet after that session, not only did I stop smoking but I actually enjoyed the process. Allen Carr (an extract from Easy Way to Stop Smoking).