The Pharmaceutical Journal
Vol 277 No 7409 p84
15 July 2006

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Smoking cessation and its problems more
The nonsensical rulings of our nanny state are beyond all credulity more
Finding of engraved tablets in Iraq illustrates archaeologists' rivalries more

Smoking cessation and its problems

An article by three medical experts from Aberdeen and Nottingham in the 3 June issue of the BMJ has drawn a useful summary of the problems inherent in smoking cessation. It points out that cigarette smoking delivers the powerfully addictive drug nicotine rapidly and in high doses directly to the brain. Nicotine itself does not cause major health problems in most users — most harm comes from the accompanying tar.

Smoking causes a range of chronic diseases including chronic obstructive pulmonary disease and cancers affecting almost every body system, and resulting in more than 100,000 deaths each year in the UK. So long as cigarette smoking remains an acceptable behaviour in adults, it will be difficult to dissuade children and adolescents from experimenting.

Primary prevention will depend upon the setting of good example, comprehensive bans on advertising and sustained increases in the price of the materials. Smoke-free policies in workplaces and public areas need to be enforced. Meanwhile, all health workers should encourage smokers to quit, offering non-judgemental advice, discovering reasons for not doing so, and emphasising behavioural support and pharmacotherapeutic aids.

Many forms of nicotine replacement device are available, ranging from sprays to patches. There is no evidence that any one formulation is better than another, so that an individual’s preference may be taken into account. For the heavy smoker, the combination of a sustained release product with a rapid-acting one may be effective when the craving becomes powerful. Nicotine replacement therapy is recommended for up to three months, followed by gradual withdrawal.

Bupropion has similar efficacy to nicotine replacement and may help to avert weight gain. However, it has been associated with convulsions and is therefore contraindicated in patients with a history of epilepsy or seizures. Treatment with it should be started one or two weeks before the date of tobacco quitting, initially with 150mg daily for six doses, doubled thereafter, and stopped if the patient has not quit smoking within eight weeks. Nortriptyline is similarly useful. There is no evidence that complementary therapies such as hypnosis or acupuncture have any effect.

A real intention to give up tobacco lies at the root of successful antismoking treatments. Without a serious intention to give up any effort to help may prove disappointing.

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The nonsensical rulings of our nanny state are beyond all credulity

We live in a strange world where lawyers rule the roost. Every day they tell us that we should keep them constantly on our payroll so that they can argue our cause when someone else tells us that when we say yes we mean no, and that the only solution is to be dragged through a court of law to test our bona fides.

Perhaps this situation is inevitable when we have to deal with crafty governments largely composed of failed, or occasionally successful, lawyers. These ensure that we cannot avoid the sensation of having a disapproving nanny always peering over our shoulder.

A remarkable instance has come to light in my local newspaper of 9 June. This reports that the planning department of the council of Torbay has declared that the celebrated palm trees that grace that pleasant resort present a hazard to humans and should no longer be planted in public spaces in case people sustain injury from their pointed leaves. Critics have pointed out that the principle involved is capable of infinite expansion and would lead to the logical conclusion that virtually any decorative plant raised to decorate a public garden could be banned as a danger to health. Rose bushes have nasty thorns, horse chestnuts have already shed their conkers upon unsuspecting skulls, Christmas trees are capable of casting their needles into the innocent eye.

It is difficult to discover exactly what prompts such criticisms of plants we have lived with for generations, unless it be the fear of people manning local authorities that some busybody will bring an action for damages against them.

Yet Torbay has, so far as we know, never been inundated with complaints and demands for compensation brought about by holidaymakers. Alas, we live in a litigious-minded society, and it is difficult to devise a remedy so long as there is money to be made from minor accidents of daily existence.

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Finding of engraved tablets in Iraq illustrates archaeologists' rivalries

A comment in the 14 April issue of Science draws attention to the rivalries that can develop in the world of archaeology.

Italian archaeologists working at Eridu, a desert site in southern Iraq, have reported finding some 500 engraved tablets just below the surface. According to an Assyriologist from the University of Rome, the tablets in question date from 2600 to 2100BC. Since they hold data of literary, lexicological and historical nature, he concludes that they may have formed part of a library.

Publicity given to the discovery is said to have puzzled some archaeologists and outraged others. It is argued that Eridu was largely abandoned during the period quoted, and a New York anthropologist claims that most libraries were established considerably later than the dates suggested by the Italian investigators. A US team that inspected the site shortly after the outbreak of the Iraq war has commented that, although they did come across ancient bricks stamped with the names of kings, such bricks are of little historical interest. A group from the Iraqi State Board of Antiquities and Heritage, which recently went to Eridu to investigate the rumours, found no evidence of inscribed tablets.

The Italian team has been criticised for undertaking unauthorised investigations at nearby Ur, another city of ancient Sumer, where foundation stones and door sockets were removed to a local museum. Since their permit was for photographs only, they committed a breach of the local antiquities law. The bricks and tablets from Eridu, however, were not removed.

This seems to be yet another of the fierce controversies related to the activities of rival investigating teams. It is a pity that scientists cannot be more objective in their reporting of finds and sites of serious cultural interest.

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