Simon Chapman AO is Emeritus Professor in Public Health at the University of Sydney where he ran public health advocacy and tobacco control courses for many years. In 1997, he won the World Health Organization's World No Tobacco Day Medal, and in 2003 was awarded the American Cancer Society’s Luther Terry Award for outstanding individual leadership in global tobacco control. For 17 years, he was deputy editor and then editor of the specialist journal Tobacco Control. In 2008, he won NSW Premier’s Cancer Researcher of the Year award and in 2013 was made an Officer in the Order of Australia for his contributions to public health. His latest book Quit Smoking Weapons of Mass Destruction will be published on 1 July.
What gave you the inspiration to write this book?
The single greatest privilege of academic life for me has always been that you are encouraged to write and get a salary to allow you to do lots of it. Along with music and great conversation, writing has always been a huge passion of mine. If I’m not writing something each day, or researching in preparation for doing so, I feel a gnawing hunger to get behind a keyboard. So, the overarching inspiration for the book was my almost visceral need to write.
This book has been percolating for almost 40 years since I first wrote about how most smokers quit in a polemical piece in The Lancet. I have always been an instinctively sceptical person and was beyond delighted to be named Australian Skeptic of the Year in 2013. It was my scepticism that locked onto the bizarre neglect in the tobacco control field about the overwhelming way that most ex-smokers quit (by doing it cold turkey) and the ambition of many of my colleagues and the pharmaceutical industry to try and erode this by convincing as many smokers as possible to do anything but try to quit alone.
How would you describe your writing process?
The idea for a book foments in a cauldron of influences. For me, these have been research experiences I’ve had, where a strong sense emerges that I want to go far deeper into a topic than you can ever do within the limits of a few academic papers. I always write a detailed introductory chapter first. I set out why I’m writing the book, what fascinates me about its focus and a summary of what’s to come. I often manicure this as the rest of the book is written. The meat of the book is the assembled almost like the way a jigsaw in completed. There are many sections that can be quite quickly and early written around the bones of each chapter. Then there are sections which take much longer, detailed work. I’m a morning person and always throw myself at the writing early in the day. In the afternoons, I typically research arguments I’m making, find references and look at the quality of the evidence before weaving new material into the draft text in the following days. I polish and rearrange sections of chapters when they start reaching penultimate status.
What is the most valuable piece of advice you've been given about writing?
If you can’t easily describe why you have written a book, what it’s about and what the most important ‘take-homes’ of your argument are, you are nowhere near ready to write it. Journalists are often very useful in helping you focus your thoughts on these things, as are good friends with no specialised understanding of the issues.
What message do you want this book to convey and what do you hope readers will take away from it?
As an experiment, try asking people you meet if they ever smoked, and if so, how they quit. You will quickly discover that up to three quarters of all ex-smokers quit without assistance, and many found it surprisingly easy, despite the enduring narrative about it being very hard. This book dives deep into why this information has been long hidden in plain sight. I hope readers will finish it knowing they have read a huge myth-busting book.
What did you find surprising during your research, is there something that stands out?
In the year or so that I was writing the book, I found a staggering amount of evidence for the case I was making. Often this was tucked away in tables where researchers had tried to spin different emphases from their data. Most quit smoking aids have quite abysmal track records of helping smokers quit, while paradoxically there have never been more ex-smokers in the population than there are today. Reconciling these two takes you to the heresy that most ex-smokers finally succeed with no thanks to drugs, vaping or any sort of professional ‘laying on of hands’. My growing surprise was at the immense neglect of the implications of this and how we should approach the task of maximising smoking cessation in whole populations.
What did you edit out of this book?
I have a large collection of material I’ve filed over the years where those who will loathe this book have vented their spleens about my work on this topic. I took the decision to not mine my files for some of the often truly vicious abuse I have seen on social media, in emails forwarded to me by others, and leaked posts to closed discussion groups by those doing all they can to denigrate unassisted quitting.
What in your view are your career highlights?
It’s pretty hard to go past two things: the advocacy I did with others in the 1990s for tough gun control policy in Australia. This primed the great majority of politicians across most parties and over 90% of public opinion measured in polls, to support law reform. This happened swiftly after the 1996 Port Arthur massacre where 35 were murdered. There had been 13 mass shootings in Australia in the 18 years before the law reforms. We then went 22 years without a single massacre. We calculated the odds of that occurring by chance were about 200,000 to one. Gun control works.
I also played a prominent role in advocating for plain tobacco packaging, introduced in 2012. Australia was the first nation to do that and since then another 16 nations have implemented or legislated plain packs. Many more will follow. This is the first time the packaging for any commodity has been totally prescribed by legislation.
Despite all the research into its harmful effects, in your opinion, why do people continue to smoke?
The reasons people take up smoking and continue to smoke are quite different. You start smoking because when you are young and very impressionable, you quickly realise that the whole gesturing display and rituals that are intrinsic to smoking are thick with signification about how you want others to see you. Smoking is a way of presenting yourself to those whose approval you worry about. It’s very uncommon for people to take up smoking after 20, so young people who take up smoking (and these days also vaping) hope that others who see them blowing smoke will inhabit the same understandings as them: that it’s richly cool and edgy.
What is your response to those who argue that vaping is less harmful than smoking and can be used as an effective tool for quitting smoking?
When smoking first skyrocketed with the availability of cheap cigarettes from mechanised production from late in the nineteenth century, lung cancer was a rare disease for several decades afterwards. From the 1930s onward occasional cases of lung cancer rapidly accelerated to the point that lung cancer became the world’s most prevalent cause of cancer death. And that’s before we even add other cancers caused by smoking, respiratory, and cardiovascular diseases and fires.
Just ten to fifteen years after vaping entered the stage, people with little to no understanding of the slow burn way that chronic diseases like cancer develop are declaring vaping to be all but risk free. This is weapons-grade irresponsible stupidity. We made every conceivable mistake with the failure to regulate tobacco. We should not repeat that with vaping. We allow prescription access to life saving drugs and to powerfully addictive drugs like codeine and methadone. That’s the way we should travel with vaping rather than treat it like a grocery item. Quitting smoking by vaping of course occurs for some, but there is a strong case that it keeps more in smoking than it tips out of it.
Have you ever had concerns about speaking out against the tobacco industry?
In the very early days of my career in the 1970s and 80s, there was the occasional lame attempt to muzzle me. But for at least 30 years, the pro-smoking lobby has had almost zero credibility. Ninety percent of smokers regret they ever started and it’s a political death wish to be cosy with Big Tobacco. Tobacco control is the poster child of modern chronic disease control and those working in areas like obesity, injury prevention and alcohol abuse prevention dream of achieving all the policy gains we have made. Across 50 years, every policy battle the tobacco industry has fought they have lost. Most people who work in the tobacco industry realise they are working for a pariah industry.
Do you believe it is possible that smoking will be phased out completely in Australia?
'Phasing out' is an easy thing to roll off the tongue but there’s lots of devil in the detail when the policy intent rubber meets the road. The key to it will be to remind politicians and the community that there is no product on sale that kills two in three of its long-term users and that tobacco needs to be treated like the peerless killer that it is.
Quit Smoking Weapons of Mass Distraction is out 1 July 2022, order your copy here.