Dancing in the Dust (Poem_

And there we were

High in the house

Locked and shuttered in the disappointment room*

While from far below

The laughter and music drifted up

And we knew that crystal chandeliers hung

Casting light and warmth

Over our elders while they danced at the ball

And we could imagine the wine in sparkling glasses

And see the taste, and feel it spilling down our parched throats

So we held each other close

And danced in the dust.

*A  room, usually on the top floor of the house, where mentally disabled or mentally ill children were kept during the 1800-1900s to remain out of the public eye.

Two by Two (Poem)

Where the chameleon eats its own words
And slyly glances at the weasel and the mouse
Who look on with envy, but learn the lesson well
And an arc of lies is built, high on that hill
Then two by two it is filled.
See, here they come, weasels, mice, ferrets, lizards, moles and last of all,
Slowly, two snails sharing a single shell.

And when a scientist eats his own words
And looks towards the rest
Who see the table; filled with deceits
Who, after the feast
Can retreat to the safety of the arc of lies
They climb the hill
Two by two
See, here they come, weasels, mice, ferrets, lizards, moles and last of all,
Slowly, two snails sharing a single shell.

Light (Poem)

Matthew 5:15
Neither do people light a lamp and put it under a bowl. Instead they put it on its stand, and it gives light to everyone in the house

As night was falling the lamp was lit
While it shone
People welcomed it –
And the room laughed
But then they looked towards the wall
A shadow growing, grim and dark, a tall shadow
Who, reaching out its evil hand
Took the light, lifted it from off the stand
Lifted it from off its stand and swallowed it.

And so people now hide what light is left
They hide it under bowls
And if some brave soul
Knocks the bowl aside, reveals the light and rescues it
The room will briefly laugh again
But if you look towards the wall
You will see
A shadow growing, grim and dark, a tall shadow
Who, reaching out its evil hand
Will take the light; lift it from off the stand
Lift it from off its stand and swallow it.
And all will be, once again, dark.

A Dialogue with Pigs (Poem)

He talked to pigs
And hearing his words
Plunged their snouts back into the trough
But Merlin gained a gift through madness
And out of the wilderness he came, with power.

And though we too talk to pigs
Though they hear our words
They do not listen
And plunge their snouts deep into the trough
But we will gain a gift in madness
And out of the wilderness we will march,
with power.

I am Concerned

“I am concerned that e cigarettes will act as a gateway into smoking.” This is a lie, but how to prove it? Actually it is very easy. You see there is now such an abundance of evidence that this is not happening that, any ‘expert’ must be aware that there is no gateway effect. Add to this the twisting of statistics and other shoddy and desperate tactics, and it is easy to see that the advocates of this concern must be the ones most aware that they have no need to be concerned in the first instance.

Look at the statement, “I am concerned that…” This is often read to mean that there is some danger that ‘it’ might be happening, or might happen sometime in the future – but the evidence says otherwise.  

I could claim to be concerned that the moon might fall out of the sky, but my experience says otherwise, and no one would believe that this was a genuine concern.  I could express concern that the next car heading towards me will suffer catastrophic brake failure and run me down, but my experience says otherwise, and I would be mad to live my life thinking about this kind of possibility.

I could parade in the shopping centre with a placard saying, “The end of the world is nigh.” Let me rephrase that, “I am concerned that the end of the world is nigh.” And people would walk past and when past, smile a little. So when professors of Public Health state that they are, “concerned those e cigarettes might lead to cigarette smoking,” why does no one walk past smiling?  

Oh! The evidence……. Well, a taster….







“Regular use of electronic cigarettes amongst children and young people is rare and is confined almost entirely to those who currently or have previously smoked.”

So despite the evidence, despite the fact that it is not happening Public Health officials repeat the dire warning and express their concern.  Concern! Concerned about something that is not happening, has never happened and is not likely to happen – what next? The end of the world perhaps?

“Lovejoy’s Law”

Or, when used by health advocates against the use of e cigarettes, the twisted nature of the cry, “Think about the children.”

In 1996 Helen Lovejoy, a character in the TV programme, ‘The Simpsons,’ pleaded, “Won’t someone please think of the children!” This has become known as Lovejoy’s Law.  This is a plea which has been made repeatedly, not just in the TV programme, but by individuals and organisations opposed to the development and public use of e cigarettes.

There are two purposes for the use of the plea, ‘think about, or, what about the children.’ One is legitimate for use in reasoned debate – the other is not. It is legitimate to use the question to draw attention to the plight of children:  It is not legitimate to use it to detract from logical argument and where it becomes an appeal to emotion.  So when Anti-Smoking organisations and health bodies take up the cry, “Think about the children.” How exactly is it being used? Is it part of a reasoned debate on the topic of e cigarettes, or is it an appeal to emotion – a logical fallacy?

The history of the appeal goes back, back before the popularity of e cigarettes had been established, in fact, before the opponents of e cigarettes had even heard of them, and, ironically, to a time where they were wishing that they did exist. That is correct: The very same people who object to vaporisers now, when they were dreaming as if they were something out of science fiction, had once placed them at the top of their wish lists.[i]

In October 2008, Action on Smoking and Health, produced a document called, “BEYOND Smoking Kills.” It was funded by The British Heart Foundation and Cancer Research UK. It was endorsed by a mass of health organisations and charities, and by many local authorities.  It is, however, the sub-title I find interesting: “PROTECTING CHILDREN, REDUCING INEQUALITIES.”

This is where they, and we, I am afraid, get into a bit of a muddle. You see, based on conventional wisdom – based on what was truly believed to be the dangers of smoking cigarettes (and second hand smoke)[ii] by ‘those in the know,’ to demand that we, ‘think about the children,’ was legitimate, rational and logical. However the same document advocates… as a future means to protect the children… the e cigarette… but not in so many words.  So, if, now, the e cigarette is a threat and we must, ‘think about the children’ in the face of this threat, how can it be that the people advocating this were, at that time, praying for the very thing that has been developed to fit their criteria[iii],… the e cigarette… as a means of protecting the children?[iv]

So the e cigarette was a means of protecting children then, and is a threat to them now? Hardly!

In fact, what we have is the same argument being presented in favour of two very different scenarios. The problem is that it just does not seem like two different scenarios.

And this is the crux of the matter. This is why I have presented to you what is contained in the document, “Beyond Smoking Kills.”  The appeal, “think of the children,” was based on a genuine desire to save countless lives where young people were being attracted to a deadly habit. However, when applied to e cigarettes the same does not hold true.

Children are not being ‘attracted’ and the activity is not ‘deadly.’ There is no evidence to suggest that children, who are never-users of cigarettes, are taking up and using e cigarettes. We have to be careful with statements like this, for two reasons. There is an important difference between the terms, ‘using,’ and, ‘trying,’ and that never-users of tobacco cigarettes, may, in the future, begin to use e cigarettes.  I wish to deal with these separately.

That there is a difference between, ‘using,’ and ‘trying:’ to see the importance of making a definition between the two words, look at an early CDC report which confused the two. On the 5th of September 2013, the Centres for Disease Control & Prevention (CDC) issued a press release. The headline and sub-heading screamed, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012. More than 75 percent of youth users smoke conventional cigarettes too.”[v]  (You will note that I used the word, ‘screamed’ here. It is an emotive term, and, as previously stated, emotion is a powerful tool when trying to convince someone about something – the question you have to ask is, ‘is the use of the device justified?)

Well, in the case of this headline, I think I can justify the use of the word, ‘screamed.’ The first reason is that this press release was taken up world-wide by the press. The story was a dominant one. Newspapers, television and radio all over the world featured it. But it was the emotion which carried the story, not the substance. The report itself did nothing to support the headline. As Carl V. Phillips stated, “The biggest lie is that they report nothing about use.[vi]  All the reported statistics are about trying the products.” There is a great deal more wrong with the headline but the confusion between, ‘using,’ and, ‘trying,’ is my main concern here. Enough to say that e cigarette use had not doubled as the headlines claimed, but the news was out, and it was believed. The emotive message had carried the day.

That young people who have never smoked but who might, in the future, take up e cigarette use is not really a concern either. I would argue that it is to be expected. It is just common sense. It is common sense to expect that among the young people who might be attracted to smoking cigarettes, some will prefer the safer option – but this does not mean that they will go on to smoke tobacco. In fact, why would they? If they enjoy the experience of using e cigarettes, why move over to something which is less enjoyable, and a damn sight more dangerous, and, if they do not enjoy the experience, why try something worse? But the public, generally speaking, cannot see this – they are blinded by emotion: the e cigarette in many minds IS smoking; IS evil; IS dangerous. That e cigarettes might be replacing tobacco smoking actually does seem to be the present trend, though be careful, just because one set of figures is rising does not necessarily mean that this is the reason for the fall in the other – but it looks that way.

I think that one of the better arguments that I have come across is contained in Kristin Knoll-Marsh’s blog which compares the emotion surrounding young peoples’ use of e cigarettes to the furores over sex education and use of condoms. As she states, “They also wring their hands over youth use, worrying loudly that kids will try e-cigarettes and then move on to the more risky behaviour of smoking. (Like anti-safe sex folks argued kids learning about safe sex would lead to more un-safe sex, leaving many people scratching their heads with that logic.) However, after 10 years on the market and increased use by (mostly smoking) youth being widely reported, CDC statistics show that youth smoking continues to decline significantly: Worrying over increased youth use of e-cigarettes while smoking rates are declining is akin to worrying about more teens having sex using condoms while STD and unwanted pregnancy rates are declining.”[vii] (Highlight mine)

But, as it used to be the case with the issues surrounding young people with regard to sex, so it is the case now with the young and e cigarette use.

The users of the phrase, ‘think about the children,’ when applied to smoking, and then to vaping, have found themselves lost in an ethical maze. Happily some are beginning to find their way out. Some of the major anti-smoking organisations and charities are now speaking out against the imposition of banning use in public places[viii]

But we must, ‘think about the children.’ Well, when thinking about children, is it not an idea to see what they think, or do you see them as mindless, naïve and in need of guidance for every step they take? This image of children certainly does not show in a recent New Zealand study which looked at the perceptions of Maori junior school pupils with regard to e cigarettes.[ix] The result of this small but very important study, demonstrates that far from seeing e cigarettes as something that could act as a gateway to smoking, they were seen as the opposite. It was recognised by the little ones (and they were little and not older children)that e cigarettes were being used as an escape from smoking – where does this leave the argument that e cigarette users should be hidden from sight to protect the children?

It is always a temptation in the face of the, ‘think about the children,’ demand to respond by arguing that e cigarettes do not present the children with any threat, however, there is actually no need to do this. As stated at the beginning, there are only two reasons for using the phrase; one is a genuine desire to protect the children from a threat, and the other is to cover up the fact that a threat does not exist. I hope you can see the problem here – if a threat does not exist, how you establish something which is not there? This being the case, one is forced to discuss the alleged danger. All the opponents of e cigarettes have to do is exactly what we have witnessed them doing right from the start, produce a string of unfounded claims, irrespective of the fact that they are not evidenced and use the media to publicise it. A newspaper does not need evidence, just someone to say something… but the damage is done.

The tiny apology, months after the initial publication of the story, does not undo the damage. Here, the readers of the original article have not seen the apology and are convinced that e cigarettes do harm, and added to this they feel the heavy weight of responsibility to protect the vulnerable little ones in our society from this danger. There is no debate now. Any argument to say that e cigarettes do not present danger must not be tolerated, and the ‘evil’ advocates for e cigarette use must be silenced. We must, ‘think about the children.’

Whenever you hear or read, we must, ‘think about the children,’ ask yourself, why this demand is being made. Is it genuine, or is it an attempt to cover the fact that no real danger or threat exists and that the ‘children’ argument is being used as an emotive red herring?

[i] The harm of tobacco can be reduced by helping smokers to quit, reducing exposure to secondhand smoke

and preventing people from starting smoking in the first place. For heavily addicted smokers who are

currently unable or unwilling to quit, there is also the possibility of switching to pure nicotine products (which,

like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives).As smoking is responsible for half the difference in deaths across socio-economic groups, tobacco control also has a major role to play in reducing health and social inequalities. These aims are profoundly inter-linked. Children who live with parents who smoke will breathe cleaner air, and be less likely to become smokers themselves, if their parents quit or switch to pure nicotine products. Poor families will also benefit from the financial savings of quitting.


[ii] For those who do not agree with the argument that second hand smoke presents a danger, do you see how powerful the emotive argument becomes? The same will hold true for those who do believe in the danger from second hand smoke. My wording casts doubt on this and I would ask you to think about your response when you read it.

[iii] A commercial nicotine products designed for long-term use as a replacement for smoking. http://www.ash.org.uk/beyondsmokingkills Chapter 8.

[iv] Smoking prevalence is declining but not fast enough. Too few people successfully quit every year and too many people start smoking. New ways of driving down smoking prevalence are needed. Smokers are addicted to nicotine but are harmed by the tar and toxins in tobacco smoke. It is therefore possible for smokers who are currently unable or unwilling to quit to satisfy their nicotine craving at much lower risk by switching to pure nicotine products (which, like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives). Although these products are not 100% safe, they are many orders of magnitude safer than smoking. Given the higher levels of addiction among the most disadvantaged smokers, the promotion of wider access to pure nicotine products as an alternative to smoking is an important means of tackling health inequalities.

Currently pure nicotine products are not attractive to smokers as direct replacements for cigarettes as they do not mimic the speed and intensity of nicotine intake that a cigarette provides. Regulation difficulties inhibit the development of more efficient and effective pure nicotine products. As a result, the most toxic nicotine products – cigarettes – are barely regulated while the safest products – medicinal nicotine – are highly regulated.

If they are to compete with tobacco products, pure nicotine products must be sold on equal terms or better: pricing should favour pure nicotine products over tobacco. Public education is also needed as many smokers (and health professionals) have a poor understanding of the relative safety of pure nicotine products including nicotine replacement therapy.


➣ Develop a strategy and an appropriate regulatory structure to improve the acceptability, attractiveness and accessibility of pure nicotine products for use as an alternative to smoking for those who are currently unable or unwilling to quit.

➣ Encourage commercial development of pure nicotine products designed for long-term use as a replacement for smoking.

➣ Develop a communications strategy to counter public misunderstanding of the health impacts of nicotine. This should promote nicotine replacement therapy for quitting and encourage the longer-term use of pure nicotine products as alternatives to tobacco.

➣ Tax pure nicotine products at the lowest rate of VAT.

➣ Evaluate the cost-effectiveness of providing pure nicotine products free on prescription to smokers for as long as they are unable or unwilling to quit.

➣ Increase investment in research into the long-term impacts of nicotine.

http://www.ash.org.uk/beyondsmokingkills Chapter 8.

[v] http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html

[vi]The headline of the press release manages to fit in one lie and two misleading claims, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012″.  The biggest lie is that they report nothing about use.  All the reported statistics are about trying the products, perhaps only once, which is obviously not the same thing (and CDC knows this).  Some statistics reported are for “ever having tried” and the others are “tried at least once in the last 30 days”.  They misidentify anyone who has tried in the last month as a current user, which is a rather blatant lie.  (Of course, some of those who tried recently may well actually be users, but there is nothing in the report that lets us conclude that even one single student is actually an e-cigarette user.)

The second sneaky lie was listing “middle school” ahead of “high school” even though the results for the former are trivial.  But it is scarier to imply that this is mostly about 12-year-olds and not 18-year-old high school students, isn’t it? http://antithrlies.com/2013/09/07/cdc-lies-about-kids-using-e-cigarettes/

[vii] http://wivapers.blogspot.co.uk/2014/12/are-e-cigarettes-are-new-condom.html

[viii] ASH recognises that whilst efforts to help people stop smoking should remain a priority, many smokers either do not wish to stop quit or find it very hard to do so because of their addiction to nicotine. For this group, nicotine containing products which have been properly regulated to ensure product safety, quality and efficacy should be available as an alternative to tobacco.

Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe. Electronic cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are a safer alternative to smoking.

In addition, electronic cigarettes reduce secondhand smoke exposure in places where smoking is allowed since they do not produce smoke. Nonetheless, nicotine is an addictive substance, electronic cigarettes currently available are highly variable in terms of delivery of nicotine and product quality, and smokers are uncertain about the effectiveness of the product. There are concerns, as yet unsupported by evidence, that these products may provide a gateway into smoking for children and young people. The regulation of these products, in particular with respect to their advertising, promotion and sponsorship needs to be undertaken with these factors in mind.

In the UK smokefree legislation exists to protect the public from the demonstrable harms of secondhand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation, but that it should be for organisations to determine on a voluntary basis how these products should be used on their premises



Two structured focus groups and twelve individual interviews were conducted with twenty Māori and Pacific children (6–10 years old) in low socioeconomic areas in Auckland, New Zealand. Children viewed short video clips on an iPad that demonstrated an actor smoking a tobacco cigarette, sucking a lollipop or using an electronic cigarette or a nicotine inhaler.


Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the ‘smoking’ behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker’s inability to quit.


In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.


Hate Thy Neighbour.

“Psychological manipulation is a type of social influence that aims to change the perception or behaviour of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at another’s expense, such methods could be considered exploitative, abusive, devious, and deceptive. Social influence is not necessarily negative. For example, doctors can try to persuade patients to change unhealthy habits. Social influence is generally perceived to be harmless when it respects the right of the influenced to accept or reject and is not unduly coercive. Depending on the context and motivations, social influence may constitute underhanded manipulation.[i]


I find this definition of psychological manipulation from Wikipedia very interesting, not least the comment following on from, “exploitative, abusive, devious, and deceptive,” being the addition that, “Social influence is not necessarily negative.”  The example given to justify this is, doctors, using psychological manipulation ‘to change unhealthy habits.’ However the circle completes with, “Depending on the context and motivations, social influence may constitute underhanded manipulation.”


This raises a number of questions, particularly when applied to the issues which surround the use of alternative, smokeless, recreational products. (E.g. E cigarettes, snus etc.)  What if some of our doctors are also victims of [negative] psychological manipulation and are being used as a conduit because of this?  What if doctors have failed to be impressed by attempted psychological manipulation but remain the unwilling channel for the dissemination of misinformation?  And if doctors are being used to disseminate: exploitative, abusive, devious, and deceptive messages with regard to smokeless tobacco, recreational products and harm reduction in general, what is the source of this information – what motivates the source, and, what are its social implications?


So, are doctors the target of psychological manipulators? To answer this I think I should try to establish the nature of the manipulation and who stands behind it.


This is a story which goes back a long way, in fact for my purpose, back to 1914 and the UK Government’s Select Committee investigation into the dealings of the pharmaceutical industry.[ii]  The 2014, Select Committee Fourth Report makes reference to the 1914 Committee findings

“After careful consideration of the evidence laid before them your Committee find:

(1) That there is a large and increasing sale in this country of patent and proprietary remedies and appliances and of medicated wines.(2) That these remedies are of a widely differing characters, comprising (a) genuine scientific preparations; (b) unobjectionable remedies for simple ailments; and (c) many secret remedies making grossly exaggerated claims of efficacy…(3) That this last-mentioned class (c) of remedies contains none which spring from therapeutical or medical knowledge, but that they are put upon the market by ignorant persons, and in many cases by cunning swindlers who exploit for their own profit the apparently invincible credulity of the public. (4) That this constitutes a grave and widespread public evil…”


I would like you to focus on, “…cunning swindlers who exploit for their own profit the apparently invincible credulity of the public. (4) That this constitutes a grave and widespread public evil…”

This was 1914, and cannot possibly refer to the huge, modern pharmaceutical corporations who, ‘use’ science as a base for all they do – can it?

Well, why is it included in the Forth report? Simply this, just as ‘swindlers’ gave out false hopes, the present gigantic pharmaceutical industries play on people’s fears and anxieties.

“People have been taking ineffective and harmful medicines for centuries. However, there is reason to fear that the industry has positively nurtured anxieties about ill-health. The fundamental problem, it is alleged, is that the industry is increasingly dominated by pressure from its investors and the influence of its marketing force and advertising agencies rather than its scientists. The industry is hugely influential, affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it. Its influence in Parliament is extensive… It is claimed that pharmaceutical companies encourage us to see ourselves as ‘abnormal’ and thereby requiring (drug) treatment. They have a powerful incentive to do so; the more people who see themselves as suffering from a medical condition, the larger the market and the greater the profits.”

Pharma exerts massive influence, “affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it.” And these are the utterances of the UK Government Select Committee, not mine. So where does this fit into the definition of psychological manipulation? As a reminder, “Psychological manipulation is a type of social influence that aims to change the perception or behaviour of others through underhanded, deceptive, or even abusive tactics. By advancing the interests of the manipulator, often at another’s expense, such methods could be considered exploitative, abusive, devious, and deceptive.”

Are the tactics employed by the pharmaceutical industry, underhand? Well, yes. Take for example, ghost writing. Ghost writing has a number of definitions, but the one I am interested in has to do with medical research papers which are written by someone not acknowledged in the article and who are engaged by pharmaceutical companies who have a vested interest in the content. It is difficult to estimate just how far this practice exists, but exist, it does. “…the practice of misleading readers about potential competing interests and hiding contributions to a published work, no matter whether these contributions should be most appropriately disclosed in the author by-line or acknowledgements section, is unethical and totally unacceptable.[iii]

It has now got to the level where ghost writing is being openly ridiculed. In, HARLOT plc: an amalgamation of the world’s two oldest professions[iv], we find…

“Once your data are sufficiently cooked, it is time for us to help you write them up. Our “Ghost Writers in the Sky” have perfected the “Johnny Mercer strategy” for reporting indeterminate trials:

We “accentuate the positive” by reporting only favourable subgroup analyses. Moreover, you don’t have to settle for just one paper in just one journal. For no extra charge, we will randomise the sentences in the original article and submit the suitably camouflaged duplicate publication to a second, unsuspecting journal. Additional publications (our current record is 42) are available for correspondingly higher fees, but we warn you at the outset that these fees will be multiplied by a DVF (déjà vu factor).

We “eliminate the negative” by omitting or burying all unfavourable results where nobody can ever find and report them. After all, what they (patients, clinicians, regulators, and the public) don’t know can’t hurt you. We have a contact in the Wieliczka salt mine who can guarantee burial of negative results 200 metres underground.

And we definitely “don’t mess with Mr In-Between.” We stay out of the DMZ (disappointing, minimally important zone) by suppressing equivocal results and bothersome confidence intervals. We report only relative risk reductions when absolute risk reductions and numbers needed to treat (NNTs) reveal that your drug really isn’t worth a bean.”

Humour aside, ghost writing is underhand, and is encouraged by the pharmaceutical industry. Where ghost writing occurs in medical journals, it is aimed at deceiving medical practitioners and scientists and the regulatory bodies, as well as providing ammunition for the multitude of health organisations and medical charities. It is designed to change the perception of these audiences in order to further the ends of the pharmaceutical industry, and in the case of alternative, smokeless, recreational products, is very much to the detriment of those who would have switched away from tobacco cigarette smoking, but were put off due to the publicity generated by articles written by agents of the pharmaceutical industry. This fits neatly the definition of psychological manipulation. 

Closely aligned to ghost writing, and with similar aims, are the activities of Key Opinion Leaders. (KOL’s)  Indeed, one of the tasks of some KOL’s is to actively participate in ghost writing activities. But first, what are KOL’s and what is their purpose? How are they recruited and how are they managed?  Oh! And how are they rewarded?

KOL’s are not a homogeneous group. They can be sub-divided (for my purposes) into two different categories. The first group, the ones at the bottom of the pecking order, are general practitioners, though some others may well be specialists.  Above them, at the top of the tree, we have the researcher KOL’s. Amongst this second group the pharmaceutical companies, or their agencies, work very hard to train them, where they are developed into ‘product champions.’

The general practitioner KOL’s serve to speak to other medical practitioners at dinners, lunch time talks or other medical events – which are mainly organised by pharmaceutical company representatives. Let us face it; the word of another doctor is going to carry more weight that the sales pitch of a company rep. One US newspaper, in Tampa Bay, reported on the activities in that area, and it makes for very interesting reading. It demonstrates just how important these KOL’s are to the pharmaceutical industry. http://www.tampabay.com/news/health/medicine/drugmakers-willing-to-pay-to-get-doctors-approval/1031817  and there is a great deal more. “Filed reports from only seven companies, made public as a result of legal actions, have revealed that hundreds of U.S. physicians are paid more than $100,000 each year and that many more are paid more than $10,000.  such amounts could hardly be justified by the value of the recipients’ own prescriptions.”[v]

Another indicator of the importance of KOL’s is the length that the pharmaceutical companies will go to in order to identify and then groom potential candidates, after which, the degree to which they are trained, and finally, the way in which they are controlled. For a description of this – and more, go to and read, Key Opinion Leaders and the Corruption of Medical Knowledge. It can be found here, http://onlinelibrary.wiley.com/doi/10.1111/jlme.12073/pdf

(The important word in the above title is ‘corruption.’)

This corruption has been facilitated through an industry’s cynical infiltration of a whole profession where it can manipulate the thinking and actions of that profession. It does so through lies and misrepresentations at all levels within the medical world. We have corruption through ghost writing, leading to the seduction and manipulation of, medical practitioners, and further up the scale, of researchers, academics and other ‘product champions,’ influencing, not just medical practitioners, but the media and politicians, and worst of all, the general public who are the object of this hidden, but frenetic activity. The ones who suffer as a result of false science and the false hopes raised in them through this false science and it all boils down to the application of very sophisticated psychological manipulation: So sophisticated in fact, that many of the manipulators, indeed, appear to believe their own lies.

Once again may I remind you of the important adjectives in the definition of psychological manipulation? They are: ‘exploitative, abusive, devious, and deceptive.’ It would appear that the machinations of the pharmaceutical industry well and truly fit the bill, in fact, the more I see of Pharma, the more I wonder if the definition of, psychological manipulation, was created just for them. May I emphasise what the definition also says. “Social influence is generally perceived to be harmless when it respects the right of the influenced to accept or reject and is not unduly coercive.”  I will now attempt to analyse this comment, particularly in the light of the development of alternative, smokeless, recreational products, and with particular emphasis on, ‘unduly coercive.’

The first aspect of the definition which pains my eyes is the switch from the use of, ‘psychological manipulation’ to, ‘social influence,’ when about to discuss the role of doctors and their attempts to persuade people to avoid ‘unhealthy’ habits. From this comment, I perceive that the psychological manipulations by the pharmaceutical industry have even found their way into the creation of caveats in the definitions of the term in mainstream dictionaries.  How can the views of doctors be merely considered ‘social influence’ when the driving forces behind them are out and out attempts at psychological manipulation? And worse, what if the advice being given is not good for the recipient of that information? How can this be harmless?

And this brings us to the example of alternative, smokeless, recreational products, and in particular, e cigarettes.  I will concentrate on this phenomenon, but It has to be added here that snus is also shining example of the good which Harm Reduction products can create: In fact one of the ‘manipulations’ of Pharma is that there is no real evidence of the effects of harm reduction – we need long term studies. Well, in snus there are, ‘long term studies,’ and they are very impressive indeed[vi]. (A couple of links discussing snus and its effects are provided in the end notes) But most people may not have heard about snus, though they have heard about e cigarettes, and because of the furore they have generated in the media, the public have at least a basic (often misguided) understanding of what they are – if not what they do.

Make no mistake, the pharmaceutical industry are terrified of e cigarettes and the level of threat they present to their profits. It is so bad; they have even joined forces with the major tobacco companies in order to ward this threat off; not that this prevents each from following its own agenda when the situation proves beneficial to one or the other. So now we have tobacco companies producing smoking cessation products, and the pharmaceutical industry, through its psychologically manipulated satellites, simply pretending to hate Big Tobacco, but making sure that the actions it takes generate maximum publicity while achieving virtually nothing.  https://brainyfurball.wordpress.com/2014/06/21/tobacco-control-a-wolf-in-sheeps-clothing/  it is a symbiotic arrangement which is designed to guarantee the continuance of tobacco smoking, and in particular, its attraction to a considerable number of young people. As long as the public, in general, do not see this…

Well, they will not, that is what psychological manipulation is all about, and both Tobacco and Pharma are world leaders in the field.

The main attack on e cigarettes by Pharma has come via organisations like the British Medical Association and its endorsed journal, the BMJ. Indeed, this is the official journal of the BMA. Equally, e cigarettes have been attacked by a myriad of medical charities and organisations. The pressure has been relentless.  I single out the BMJ in particular because of its relationship to the BMA and the pharmaceutical industry. Neutral, it is not.

The BMJ is connected to a consultancy company, the CCM Group.  The CCM boasts, and I reproduce it here,[vii] (Just scan read the next few paragraphs)


“CCM is pleased to be the publisher of The BMJ exclusively in Greece, Turkey and the Middle East: The official journal of the British Medical Association (BMA); Serving the medical profession since 184; Reaching key opinion-leaders worldwide; (KOL’s again)  Quality, Prestige and Influence; Reaching 22,000 physicians in the Middle East; Reaching 15,000 physicians in Turkey; Reaching 15,000 physicians in Greece; Providing maximum visibility & impact for your advertising; A Portfolio of Marketing Opportunities; Full Colour Ads; B/W Ads; Product & Company News; Inserts & Reprints; Advertorials; Wrappers; Symposia; Communicate with key influence groups through the ideal advertising vehicle… with excellent value for your money; Stay ahead of the competition; Increase market share; Reinforce brand image; Control expenses; BMJ Specialist Titles (Specialist Titles are international peer-reviewed journals published by BMJ. Specialist Titles publish clinical and experimental articles pertaining to each particular disease and are committed to promoting the highest standards of scientific exchange and education. Most of these are authoritative journals in their respective fields and are the official Journals of their respective societies):

Archives of Disease in Childhood: The official journal of the Royal College of Paediatrics and Child Health is devoted to child health and disease, with emphasis on clinical paediatrics: Published monthly.

British Journal of Ophthalmology: Published monthly, the journal covers all clinical and pathological aspects in the field of Ophthalmology.

Evidence-Based Medicine: Launched in 1995 and published bi-monthly, this journal helps clinicians to base their clinical decisions on the best current scientific evidence.

Evidence-Based Mental Health: This journal is essential reading for mental-health practitioners, managers and policy makers. It uses scientific criteria to select and abstract the most reliable and important clinically relevant papers from an expanded range of journals: Published quarterly.

Evidence-Based Nursing: Designed to help nurses base their clinical decisions on the best current clinical evidence. This journal is jointly published by the Royal College of Nursing Publishing Group and BMJ Publishing Group: Published quarterly.

Gut: The official journal of the British Society of Gastroenterology. Gut is a leading international journal in gastroenterology and has an established reputation for publishing first class clinical research of the alimentary tract, the liver, biliary tree and pancreas: Published monthly.

Heart: The official journal of the British Cardiac Society covers the latest advances in the diagnosis and treatment of cardiovascular disease: Published monthly.

Journal of Neurology, Neurosurgery and Psychiatry: The Journal of Neurology, Neurosurgery, and Psychiatry publishes original articles, short reports, editorials, commentaries and more; covering the whole field of clinical neurological practice, neurosurgery & neuropsychiatry. Emphasis is given to common disorders. Focusing on clinical neurology, neurosurgery and neuropsychiatry: Published monthly.

Sexually Transmitted Infections: A long-established journal dealing with issues of sexual health, sexually transmitted diseases, HIV and AIDS. Published bi-monthly, the journal attracts original articles on the clinical, microbiological, behavioural, epidemiological, social and historical aspects of sexually transmitted diseases.

Sports Medicine: The journal covers the latest advances in clinical practice and research on all aspects of sports medicine: Published monthly.

Thorax: Thorax is one of the world’s leading respiratory medicine journals publishing clinical and experimental research articles on respiratory medicine, paediatrics, immunology, pharmacology, pathology, and surgery. Thorax is one of the highest ISI ranked journals covering all aspects of pulmonary medicine: Published monthly.

Tobacco Control: A scientific journal which considers all aspects of tobacco prevention and control: Published bi-monthly.

Evidence-Based Learning Resources: Are you looking for up to date and evidence based learning resources? Then BMJ learning is for you. It provides learning for professionals in primary care and hospital medicine and offers a range of services to support your everyday learning needs. You can:


 This is a very long arm, but what of the body? CCM boasts of its clients, and in particular, pharmaceutical companies…[viii]

3M Egypt Otsuka Pharmaceutical Co. Merz & Go GMBH
Abbott Laboratories Egyptian Promoters Centers Mid Pharma
Abdi Ibrahim Eli Lilly and Company Minapharm
Actavis E-Merck Mission Pharma A/S
African Export-Import Bank Essex Chemie A.G. Mustafa Nevzat
Afric-Phar Fako Nerhadou International
Aghios Savvas Hospital Farbo Group Nestle Nutrition
AkzoNobel Ferring Pharmaceuticals Nile Pharmaceutical Co.
Al Razi Pharmaceutical Co. Gen Nobel
Alcon Pharmaceuticals Ltd. Genzyme Near East Novartis
Alconcusi GlaxoSmithKline Novo Nordisk
Algorithm SAL Global Napi Pharmaceuticals Numil
Al Haya Medical Company Global Pharma Nutricia
Ali Raif Graphic International Centre Nutridar
AlKamal Import Office Co. Grunenthal GMBH Nycomed
Alkan Establishment Gulf Pharmaceutical Industries Julphar Onko-Kocsel
  1. Lundbeck A/S
Organon Scientific Office
Alpha Chem Advanced Pharmaceutical Industries H.E. Ministry of Health Pfizer
Alpharma H2O Concepts Pharco Pharmaceuticals
Altana Pharma Habib Scientific Office Pharma International Company
American Hospital Health Technologies Limited Pharma Vision
Amoun Pharmaceuticals Co. Hikma Pharmaceuticals Pharmaserve
AMP Hoffmann La Roche PharoPharma
APM IASO Hospital Pierre Fabre Medicament
Arabian Ethicals ICN Pharmaecuticals Polypeptide Laboratories
Armenia Surgical Center IDS Promax
Arrow Food Distribution IE Ulagay-Menarini Publicis Graphics
ASDA’A Public Relations Impact BBDO Rafarm
Asmedical Scientific Office IMS Health Ramco
Astellas Innotech Rameda Scientific Office
AstraZeneca Inter Pharma Roche
Aventis Intermark Rostom
Ayoub Pharma International Nutrition Co. Sadco
Bayer Healthcare ISO Medica Sandoz
Beaufour Ipsen International IVAX Pharmaceuticals Sanofi Aventis
Becton Dickinson Diagnostics Jamjoom Pharmaceuticals Sanofi Pasteur
Benta Trading Janssen-Cilag Sanovel
Bilim Jeddah BioCity Schering AG Pharmaceuticals
Biochemie Johnson & Johnson Shering-Plough
Biofarma Jordan Pharmaceutical Manufacturing Co. Scope
Biogene Julphar Gulf Pharmaceutical Industries Sct. Hans Hospital
Boehringer Ingelheim Juva Sante Sedico Scientific Office
Boston Scientific KAT Hospital Servier
Bristol Myers Squibb Kocak Sky High Advertising
Cana Leo Pharmaceuticals Solvay Pharmaceuticals
Carat Leo Scientific Office Spimaco
Central Laitiere Lifescan, Inc. Stiefel
Chemipharm Limited Liptis Pharmaceuticals Tabuk Pharmaceutical Manufacturing Co.
Chiesi Madaus AG Takeda
Ciba Vision Magrabi Eye and Ear Center Tamer & Co.
Cooper Maroc Magrabi Hospitals & Centers Tenzing Business Services
Copad Egypt Scientific Office Marny’s C/O The Arab Pharmaceutical Manufacturing Co.
Danon France Masafat Travel & Tourism UCB Pharmaceuticals
Danone May & Baker Unipharm
Dar Al Dawa Mectapharm United Pharmaceuticals
Dar Al Hikma Media Insight Dubai University of Ottowa
Delta Pharm Medical Union Pharmaceuticals Vichy Laboratories
Dem Ilac Medtronic Wyeth Pharmaceuticals
Deva Memphis Pharma Yamanouchi
Dhahran Health Center MENA Marketing Novalac Zimmo Trading Est.
DKT Mepha  
Dumex Merck  
Eczacibasi Merck Scientific Office  
EGD Merck Sharp & Dhome  

And just in case my US friends are feeling a bit left out, CCM Medical Publishing & Education mention: American Academy of Orthopaedic Surgeons; American College of Cardiology; American College of Chest Physicians; American College of Physicians; American Psychiatric Association; American Society of Clinical Oncology

But of course there is no pharmaceutical influence in public Health. Of course our doctors are independent of the pharmaceutical industry…  And this just illustrates the reach of ONE consultancy. Have a look for yourself… https://www.groupccm.com/static/publishing

With a complex, massive international network of companies to back it up, the monstrous media machine swings into action. It has had no bigger target, ever, than the e cigarette. Misinformation is disseminated through the journals to the press and television media. It is littered with sound bites and, very rarely, if ever, is there an attempt to back up the claims being made. One KOL after another is wheeled out to give ‘substance’ to, sometimes absolute nonsense. For example: ‘Smoking’ e cigarettes might lead to cocaine addiction.


 Ok, so it does not say ‘will,’ but the idea is firmly rooted in the minds of the readers. And there are many, many other examples where stupid claims are made with regard to some supposed threat presented by e cigarettes.

One is “An unexpected consequence of electronic cigarette use,[ix]” where it was claimed that e cigarette use led to a case of lipoid pneumonia. It was a ridiculous attempt at scaremongering, aided and abetted by the bias of the authors. It was subsequently ridiculed by other doctors and scientists[x] who pointed out that the authors had made elementary mistakes through gaps in their knowledge of basic school chemistry. But the damage had been done and the story, but not the rebuttals, appeared in media outlets all over the world.


Other claims are made: E cigarettes might act a gateway to young people into smoking; nicotine is dangerous; and…. Well…. E cigarettes might act a gateway to young people into smoking; nicotine is dangerous, and of course we should keep in mind that, E cigarettes might act a gateway to young people into smoking; nicotine is dangerous. This is what the opponents of e cigarettes have been reduced to, repetition after repetition of the same old rubbish: Demands that the unprovable be proven – over and over again. This is the strategy of the manipulator, say something often enough and loud enough and it will be accepted.


There is one other claim, one that leads to my reason for the title and one which provides more evidence of psychological manipulation, and that is that e cigarette vapour endangers the health of others. At this point I will remind you of the caveat to the definition of positive psychological manipulation, is that it should not be, “unduly coercive.” I am afraid to say that in the area of second and third hand nicotine exposure… it is.

Nothing upsets and angers the general public more than the thought that they are being poisoned by these ‘dirty smokers.’ E cigarette users are being classed as ‘dirty smokers’ as well due to the manipulations of Pharma and its powerhouses. I need present no evidence for this as it is self-evident in the attitude of the public towards second hand vapour and smoke. It is self-evident in the arguments of those proscribing bans in public places. It litters academic literature. The demand is ever present for smokers and vapers to be ostracised and hidden away from the rest of society. The demand is always there for one man to hate his neighbour and this is created, aided and abetted right from the top down straight into your doctor’s surgery, and, via the newspaper, it lies in wait, on the floor, under the letter box of the house next door, just needing to be picked up and read.

[i] http://en.wikipedia.org/wiki/Psychological_manipulation

[ii] http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/4204.htm

[iii] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120312/

[iv] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300797/

[v] http://onlinelibrary.wiley.com/doi/10.1111/jlme.12073/pdf







[vii] https://www.groupccm.com/static/british-medical-journals

[viii] https://www.groupccm.com/static/client-list

[ix] http://journal.publications.chestnet.org/article.aspx?articleid=1206478

[x] http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/2014/157-glycerol

Day 157: Bubblegum and other irrelevancies.


The BMA today proved themselves more idiotic than I thought possible. Apparently the fact that bubblegum flavours exists in vaping products is evidence that ordinary vapers – like me – “want a new generation addicted to nicotine.” Because of course nicotine, separate from tobacco smoke, is so highly addictive that it has never been proven to cause addiction when used to treat disease. I must have taken a wrong turn in that statement somewhere. Perhaps the BMA have new evidence on the addictiveness of nicotine when removed from tobacco smoke, because they would need it in order to back up their statement that “Nicotine is very addictive” without qualifiers. This is the same nicotine that N.I.C.E have approved for long term use in NRT, and that is being prescribed for that purpose by GPs in the UK. It isn’t magically clean of taint when in NRT, and dirty…

View original post 316 more words

Tobacco Control: A Wolf in Sheep’s Clothing

On February 12, 2014, in my blog, An Outlandish Thought[1], I put forward the view that Tobacco Control were trying not to stop, but to encourage people to take up smoking – it would seem that the idea was not as ‘outlandish’ as I first surmised.

 It would seem that there is a large body of academic thought which supports the view that horrific images might actually encourage some smokers to keep smoking, and, some non-smokers to take up the habit, and failing that, the images might be ignored altogether.

 As far back as 1953, psychologists were looking at the effect of fear in advertising[2]. The results of their investigations were not as you or I would expect.  The model which was being presented at that time is known as “The Drive Model.” Part of this model argues that,”… when individuals are presented with threatening information they will be motivated to search for responses that reduce the threat. When a response reduces fear, it is reinforced and becomes part of one’s permanent response repertory. The drive model therefore suggests that higher fear should result in more persuasion, but only if the recommended action is perceived as effective in averting danger.” (Janis, I. L., & Feshbach, S)

 Take a close look at the end of the quote, “…but only if the recommended action is perceived as averting danger.” This is a theme which has been continued as the decades roll by.   Following the Drive Model was the Parallel Response model (1970) which suggests that fear appeals produce two separate and potentially interdependent processes: danger control processes (efforts to control the threat/danger) and fear control processes (efforts to control one’s fear about the threat/danger)[3] And once again we find that with the horrific message, the way which one turns is decided by the efficiency of the recommendations for avoiding the danger.

  As the years passed, the idea was further and further refined; the SEU models, including, Rogers’s Protection Motivation Theory (PMT)[4]. This attempted to explain the effect of fear and when it works, however the PMT model fails to explain why it does not work. PMT and SEU[5] models deal, in the main, with high threat coupled to high efficacy of the recommendations to avert the danger – but what happens if the perceived threat is low?  What happens if the perceived efficiency of suggested measures to avoid the threat is low?

 But first, a word about the difference between threat and fear, it is assumed that when faced with a threat, fear will follow. This, it is assumed, will result in an action to avoid the threat. And this is the logic SEEMINGLY being followed by advocates of warnings and graphic images on cigarette packs. They say that the fear induced by the images and warnings will encourage people to stop or never start smoking.  However, this is not the way it works. It is true that action will follow on from a threat which induces fear, but what will be the nature of the action?

 Take the graphic warnings being issued on cigarette packs. In this instance there are two distinct groups who react to these images and warnings. Young people, both smokers and never-smokers and, older established smokers.

 What happens when a young smoker, or would be smoker, sees a horrific image on a cigarette pack? The answer, as far as avoiding cigarettes, is nothing very much at all. Why? The image does not induce fear. Why?  The threat event is too far away. It is, to the mind of a young person, very remote – it can be ignored. Perhaps this explains why horrific images are being found to be so ineffective. Perhaps this is why the uptake of cigarette smoking among the young remains so high. A month is a lifetime to many youngsters, so how long is ten or twenty, how long is thirty or forty years away? How far away is, ‘if at all?’

And with established smokers the effect is different but with a similar result Take note that “…the more one is defensively resisting a recommendation the less one is making appropriate changes in line with the message’s recommendations[6].” And, “…that messages that fail to make people believe the recommended response is effective and/or that they are able to perform the recommended response produce stronger fear control/defensive response[7].” I hear an echo reaching me from 1953… listen carefully, does it say, wait for it “…but only if the recommended action is perceived as effective in averting danger.”

 The Meta analysis of Fear Appeals: Implications for Effective Public Health Campaigns, (Kim Witte, PhD Mike Allen, PhD) sums things up rather nicely:” In sum, fear appeals appear to be effective when they depict a significant and relevant threat and when they outline effective responses that appear easy to accomplish. Low threat appeals appear to produce very little, if any, persuasive effects. Thus, regardless of which theoretical model is advocated, the advice to message designers is the same: a persuader should promote high levels of threat and a high level of efficacy to promote attitude, intention and behaviour changes.”

 So look at the gruesome image on the packet. Read the warning, “Smoking Kills.” And now look at the recommended action… Sorry, I will reword that statement, look FOR the recommended action – No, I do not see one. Ok, so it is implied, ‘stop smoking.’  Will that be perceived as ‘effective’ advice?  Well, maybe effective if it was within some range of possibility, but is it? Even the best reported results for quit attempts is hardly 10% – so the messages (implied) recommended action, in practical terms is, 90% fail. Not good. Not effective, so other defence mechanisms kick in.

 What are they?

 They might, scrutinize the message to find ways to criticize and downplay the information in order to reduce the threat. They might, engage in a biased search for inconsistencies, and evaluate the evidence with a bias in the direction of their preferred conclusion.  And always, the spectre of another failed attempt to follow the recommended action: ‘stop smoking.’

 So the young see the threat as being something in the distance, something that can be dealt with later – the threat level is low. Adult smokers despair at the recommended action, and although the messages and images may create fear, the recommendations are not realistic, the efficacy is low, and so denial takes place.

 Messages and images have only a very limited impact in smoking cessation.

 The same holds true for plain packaging and for hiding cigarette products out of sight. In fact, these actions can be seen to be an attraction for young people – a reason to start smoking, not resist.

 There is a mass of information on the psychology of the attraction of the unknown. Couple this phenomenon to the advertised (low) threat value of cigarette smoking  to locking cigarettes out of sight, and a large percentage of young people will find the allure that has been created, irresistible.

 But what is worse – I believe that Tobacco Control is aware of all of the above.

 How would they know?

 The answer is a very simple one. A very large proportion of the psychology of fear appeals, and communications, and attitude change are written for the advertising industry.  This includes the health advocates who use this particular advertising to create the effect they desire. Now, we encounter a slight problem. What exactly is the effect they desire? If they are not aware of the effects of presenting warnings without effective avoidance strategies, they are negligent. If they are aware that warnings and gruesome images, that hiding cigarettes out of sight will have no effect, and indeed be an attraction – they are culpable.

 I choose to think it is deliberate. Tobacco Control is expert at marketing. It, I believe, knows the psychology involved inside and out. Whole university departments give ‘expert’ advice on a continuous level. Why, even one prominent Tobacco Control advocate has a PhD in the subject.[8] I wonder how many millions have been spent by the various Tobacco Control groups looking into this very topic.

 But the main reason I see Tobacco Control as a wolf in sheep’s clothing has nothing to do with the above. It is simply this…

 They have fought tooth and nail against the development of e cigarettes and personal vaporizers. They have consistently argued for the over-regulation of harm reduction products. Why would any group which purports to be acting in the interest of people’s health which to stymy, to destroy a product which will save many millions of lives? And to me, again, the answer is simple. It is against their interests to see this happen. For whatever reason, I think, it is important for them to keep their respective positions, be it an organisation or individual within an organisation. It is power, it is money, it is prestige and position, and all of these are up for the taking – as long as a percentage of people continue smoking: As long as it never become known how duplicitous their activities really are.  


[1] https://brainyfurball.wordpress.com/2014/02/12/an-outlandish-thought-2/

[2] Janis, I. L., & Feshbach, S. (1953): Effects of Fear-Arousing Communications. Journal of Abnormal and Social Psychology, 48, 78–92

[3] Leventhal H: Findings and theory in the study of fear communications, in Berkowitz L (ed.): Advances in Experimental Social Psychology (Vol. 5): New York, Academic Press, 1970, pp.119-186

[4] Rogers RW: A protection motivation theory of fear appeals and attitude change. J Psych 91:93-114, 1975.

Rogers RW: Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation, in Cacioppo J, Petty R (eds.): Social Psychophysiology: New York, Guilford Press, 1983, pp. 153-176

[5] Sutton SR: Fear-arousing communications: A critical examination of theory and research, in Eiser JR (ed.): Social Psychology and Behavioural Medicine. London: Wiley, 1982, pp.303-337.

[6] http://www.mnt.ee/public/Fear.pdf

[7] http://www.mnt.ee/public/Fear.pdf

[8] Simon Chapman His PhD looked into the relationship between cigarette smoke and advertising. http://boltonsmokersclub.wordpress.com/author/junican/