Third Hand Smoke, Again!?

I see that Chris Snowdon has a great post on the absurdity and a bit of history on the third hand smoke meme that refuses to die. It seems that while good ideas are often unnoticed or ignored that the really bad ones, and this one is bad in so many ways, tend to get a lot of press. I suppose that they do serve a purpose in uncovering which journalists uncritically repeat items without examining the source materials (for instance, this article from Roni Rabin at the NYT).

The third hand smoke nonsense is particularly dear to us here as we responded (quite some time prior to this blog’s existence) to the Journal of Pediatrics article when it came out. At the time, we had noticed how fast and furiously this story spread throughout the news media and the blogs. It was as though so many had been waiting for this, just like someone suddenly getting some small evidence of what previously rated as little more than a conspiracy theory. You could hear the “I knew it” s resounding throughout the land. Perhaps the most risible of the follow up stories was of Apple techs refusing to touch smokers’ computers.

One small excerpt from our letter:

The authors, in the article, press release and subsequent interviews, argue the danger of third hand smoke, such that smokers are encouraged to change clothing and bathe before holding their children. And yet, the authors still encourage the smoker to breastfeed the innocent child, rather than substitute a tobacco-free bottle of milk or formula (6). This can only mean that, despite repeating the nonsensical mantra of there is no safe level of exposure, whatever this non-safe level of exposure is, it must be much lower than the toxicity of bottle-feeding. The authors also suggest, not in the article but in related interviews, that the nose is an accurate determiner of toxicity, an interesting but outdated pre-scientific method that cynically takes advantage of the lay population (8, 19, 24, 26).

Many educated readers already have a jaundiced view of what passes for epidemiological research, and this article not only justifies their attitude but serves as the epitome of sloppy science, of politics and opinion and desire masquerading as science. We predict that a decade from now, if books and blogs continue to claim that epidemiology is junk science, they will still be citing this article as a perfect example.

-PLB

New Look

Welcome to the new look of the THR blog. I hope that no one was too attached to the old look and cannot promise that this will not change every now and then.

What drove this particular change is that the old format with the narrow column not only made short posts seem long but that there seems to be some difficulty matching the comments to the posts. There seem to have been a number of comments that refer to the post before rather than the one they are attached to..which can make them rather difficult to respond to.

-PLB

If car driving had been treated like smoking

Imagine for a moment if concern over traffic death and injury had been treated the same way that smoking related death and disease has been.

1. The main cause of traffic deaths is driving. The optimal means to eliminate this danger is to stop driving. However, though there are alternatives, driving is so basic to most cultures that few governments can seriously consider making private vehicle ownership, or driving, illegal.

2. Enter the inventions of seat belts and airbags. These are not perfect solutions; in fact, though over the population these would radically reduce the toll from driving, some injury and death would arise from using these devices (see here, and here). Given that these alternatives are not perfectly safe, we cannot in good conscience allow them onto the market.

3. Automobile manufacturers are allowed to make their cars safer but must refrain from introducing these devices as they might not only cause some injuries but that they may encourage people who otherwise might not drive to then do so. (If these manufacturers are able to improve the safety of their cars they cannot in any way promote their cars as being safer than any other).

4. Anti-driving groups push for auto prohibitiion and regulation on the grounds that not only does driving hurt drivers but that vehicles imperil innocent pedestrians and children. These same groups also argue against seat belts and airbags because not only are they particularly dangerous to children but that even if they are safer overall, they are much more dangerous than just not driving.

5. These same groups then move to add r ratings to movies in which automobile driving is seen as normal. If there is someone driving in a movie they should either be a villain or they should end up in an accident before the movie is over.

-PLB

Is Britain about to ban e-cigarettes?

Disturbing news out of Britiain via James at Ashtray Blog. It seems that the British version of the FDA, the MHRA or Medicines and Heathcare products Regulatory Agency has opened a consultation on e-cigarettes which most likely is a preamble to regulation which could be interpreted in such a manner as to effectively result in an outright ban of product. (See the consultation form and accompanying documents here.)

On the surface of it, it seems a reasonable response to a new growing unregulated product. No one would argue against some form of quality control. However, one worries about the following:

1. Strictly limiting who sells this product could make it less available than cigarettes which is enough under many circumstances to make cigarettes the rational choice when deciding between the two. In other words, limiting the availability nudges the population toward the more harmful choice, the same choice that the same government keeps trying to discourage by other means.

2. Demanding manufacturing guidelines when none of the manufacturers are domestic can only lead to, at the best, significant lapses in supply, and more likely, the abandoning of the market for less regulated regions. This is not to argue against product regulation in general but simply to point out one negative that could threaten the whole category.

3. So far, there appears to be not much of a black market in these devices but increased regulation could create one, and ironically, it would be driven by health concerns.

In the document, three options for post consultative action are laid out, with the MHRA indicating their preferred choice which would result in all devices being removed from the market within 21 days and then requiring some sort of certification to be made available. This would result in some individuals returning to the more harmful smoking, and as bad, many smokers not ever trying this much safer source of nicotine.

One hopes in the end that reasonable voices will prevail but the document contains a passage that indicates this is unlikely. The wholly discredited FDA assay of ecigarettes is referred to as evidence of the potential harm of ecigarettes and as good cause for this sort of action.

I hope that I am wrong and there are at least a few smokers (or vapers) on the MHRA committee who will help steer them to some common sense. In the meanwhile, I encourage all to enter their suggestions into the consultation process (link here)

-PLB

No more brands: good idea?

Death cigarettes 1991-1995

One idea that pops up in Britain every now and then, and is now once again gaining ground, is the notion that another good way to reduce smoking in the population would be to force tobacco to be sold in generic packaging; no more branding. This idea is common not only to the anti-smoking crowd there but has some strength in the tobacco harm reduction community as well.

To my knowledge this has never been seriously considered in America where to the jaundiced eye it would seem that a few civilian deaths would never be considered that good a reason to interfere with potential profits or even commercial speech. But in Britain, there appears to be a much stronger anti-corporate trend in general, and when mixed with the every increasing nannyism of the state make ideas like removing branding quite acceptable.

The idea is of course that commercial packaging increases the attractiveness of the product and may entice new users. Though the general consensus seems to be that branding operates chiefly to keep customers it is probably also true that it might influence a first purchase of tobacco. I would suspect however that the packaging is more likely associated with a prior context like the community; people tend to smoke what their friends do, and thus strengthen existing bonds.

But there is every possibility that debranding might erode any residual coolness of the category and thus lose a few users.

However, I do see a number of drawbacks.

1. Branding can be used as a powerful bridge to move people to less harmful forms of nicotine use. New categories like smokeless tobacco can be intimidating but not so much when it comes from the same company.

2. Losing branding is quite likely to increase black market tobacco purchases. Not only might the black market enhance their product with branding but anyone who is deprived of a distinguishing style will be more likely to take advantage of much cheaper sources. And of course, any increase in the black market means loss of tax revenue, loss of information about tobacco use in the population, and the loss of the existing quality control which might result in greater harm.

But overall, those who really think that debranding will drop smoking rates should consider how much debranding has hurt marijuana usage.

-PLB

The battle is not between public health experts and tobacco companies..

In the Business section in the NYT this weekend, Duff Wilson and Julie Creswell put together a more balanced article than ever would have been accepted in the same paper’s Health section. (You might recall that this was perhaps the most prominent newspaper uncritically repeating the most inane tobacco nonsense of the last year if not the century, the laughable concept of and pseudo-study on third hand smoke. (See article here.)

That being said, the article contains within it a few of those amusing contradictions so typical of the anti-tobacco crowd, amusing until you realize that there are real world consequences to these folks treating health issues as political games.

The article reports critics saying that allowing tobacco companies to market their reduced risk products as reduced risk products is simply a strategy to “dodge indoor smoking laws” and “to encourage smokers to use oral tobacco products as supplements”. They go on to cite Stanton Glantz criticizing the dual use marketing that companies engage in.

In any other field, mandating that a company not describe its product accurately would be considered absurd, and furthermore having self described health proponents demanding that a company limit itself to promoting a potentially life saving alternative purely as an option to maintain the opposite is just short of criminal. To add insult to injury, these same experts then blame the companies for complying with the very regulations they, the experts, drafted.

Now, as well, the critics are saying this attempt at informing the public about the greater safety of smokeless tobacco is simply a diversion from dealing with the more harmful cigarettes. Again, one marvels at the cognitive convolutions taking place since one of the most effective way of dealing with the harm associated with smoking is to promote safer alternatives.

(The persistent spotlight on smokeless products can be found via anti-tobacco activists more than with tobacco companies. It is not uncommon to find on many dental or ENT websites volumes about the dangers of smokeless tobacco and not a mention of cigarettes.)

Ultimately, and there are so many other things to comment on here (the nonsense about flavoured tobacco products, characterizing political figures as health experts, etc..perhaps a part 2 post will come), we once again are given the notion of an upcoming battle between tobacco companies and public health experts. This dichotomy only makes sense politically and has no place is discussions of health. With the article quoting Nitzkin, we see at least some division in public health, and that is where the battle will really be on, between persons in public health who are subverting the common good for their own ends and for those who truly are trying to improve that good.

-PLB

It’s not the tobacco, it’s not the additives; it’s the smoke!

Mike Siegel recently posted a blistering argument against trying to improve the health effects of cigarettes by removing the various non-tobacco ingredients. We agree with his main thesis in this, but would like to take the point one step further (and, in so doing, disagree with one of Siegel’s secondary points): Removing the tobacco from cigarettes would also do little to make them less unhealthy.

If people continued to smoke rolls of, say, ground cooking herbs or sawdust, ten to twenty times a day, day after day, the health effects would be similar to what we now see. (They would undoubtedly be somewhat higher or lower, but probably similar and it is difficult to predict what direction they would move in.) Put another way, freuquently smoking shredded plants is quite unhealthy, whereas the tobacco per se has relatively little to do with this. It is not the tobacco, it is the smoke.

Of course, if cigarettes contained only sawdust, consumption would drop to about zero, nearly eliminating the risk. But intentionally making something maximally unappealing by creating pure deadweight losses is unethical public policy — if a ban is sufficiently supported and legal, it can be enacted. If there is not support for a ban then a crypto-ban via ruining the quality of a product (e.g., by taking the flavoring out of smokeless tobacco or taking the tobacco out of cigarettes) violates core ethics of making public policy in a free pluralistic society.

Carl V. Phillips

Is it safe?

Sometimes I feel like Dustin Hoffman in Marathon Man where Laurence Olivier who plays the demented Nazi dentist keeps asking him “is it safe?”

Tobacco harm reduction, and harm reduction in general operates on the principle of whether an action or substance is safer than another, not so much their absolute safety. One of the most prominent anti-tobacco harm reduction strategies is to ask the question of “is it safe” in order to avoid the comparison (For example.). Other factors being equal, once you accept that nothing is absolutely safe but that some things are safer than others, only a moron would not see the advantage in going with the safer activity.

Today, Michael Siegel had a good post on the FDA forging forward under their new tobacco mandate and pledging time and money to determine the toxic elements in tobacco smoke. As he points out, we have plenty of evidence about it being pretty harmful and a better use of these resources, if health is the issue, would be to concentrate not on further determining how dangerous smoking is, but to finding and promoting safer alternatives.

On the other hand, we have anti-e-cigarette articles coming out daily on how e-smoking is or might not be absolutely safe. (See this BBC article.)

You could easily have made the same arguments against airbags and seatbelts. Those items, which have saved the lives of thousands to date, have on occasion caused death when otherwise it might not have happened. They are not absolutely safe. But they are safer, and that is why they are now standard equipment in automobiles.

-PLB

Finland to ban smoking: 2

Still, the Finland move has engendered little response. You would have thought that anti-smoking groups would have been falling over themselves to endorse this move. You would have expected another crazy John Banzhaf press release by now. (For the BBC article see here.)

I am interested in seeing the results of trying something like this. I also suspect that though the numbers of smokers will appear to drop, the main result will most likely be a strong black market and a new criminal class. For a great insight on this from someone who has seen how effective prohibition has been in an even less popular substance, watch this from Ethan Nadelmann.

I don’t really need to add much more to that but there are other issues as well.

The fact is that these days no country can really close its borders, and tobacco use tends to drift from legal regions into those that aren’t, as witness the bleeding of snus use from Sweden into surrounding snus banning areas. And part of that snus drift is due to people realizing it is a much safer way of using nicotine. Of note in this article is the following regarding lower risk products:

“One of the discussion points raised by the Finnish government is also to ban any new tobacco products from entering the market in the future,” she says.
“Say one day you have a product that is less harmful – that product would then not be made available to adult consumers in Finland.”

This shows that the move is not health based but morally driven. Not only will they ban tobacco products simply on the basis of being tobacco but they are either ignorant of the fact or willfully denying that those products already exist. If they did care about the health, they would open the market to safer forms of nicotine. As you can see in this video below which accompanied the BBC report, even the journalist frames this as a war between the country and the corporations; even he does not see that the forgotten part of this equation is the user.

-PLB

Finland to ban smoking

In Canada and the United States, most drug related stories have been buried by the excitement regarding the recent rulings in favour of keeping Insite open, and having the FDA butt out of regulating the importation of electronic cigarettes.

That being said, one very important global news story almost slipped past our radar: Finland is trying to eliminate smoking within the next 30 years (full article here).

While most comments on this news story indicate that people are frustrated by these paternalistic laws, and quite frankly are sick of living in a “nanny state”, the government expects the legislation to pass without much objection. Conversely, I am, with regards to this proposal, of two minds.

On the one hand, the Finnish government is equivocating on the risks associated with different methods of tobacco delivery, thereby limiting smokers’ options to choose lower risk alternatives. They intend to do this by putting tobacco products behind the counter. We’ve indicated here and elsewhere the dangers of conflating a spectrum of risk to two categories: “risky” and “not risky” – so I won’t go into much detail aside from pointing out that this is bad. Very bad.

On the other hand, there are people who will quit using tobacco in Finland just because it is illegal. This is good. These people would probably be able to have quit, anyway, but this legislation may represent a good catalyst. Smoking is bad, and quitting is best, so that’s one potentially positive outcome. Moreover, while vilifying, and embarrassing smokers by forcing them to become outlaws should they continue smoking is inherently bad, smokers may, in the end, benefit.

In Canada, contraband cigarettes make up between 20 and 50% of all tobacco sales. The government indicates this creates “unfair competition for an honest business”. Certainly this is true, but when tobacco use becomes completely illegal, a black market will be the only source for people who believe they are truly addicted to find cigarettes. With enough competition, cigarettes will be more affordable in these markets.

Further to this, the government will be at a loss when it comes to leveraging astronomical sin taxes against smokers, many of whom are already economically disadvantaged. That can be the continuing smokers’ final F-U; a satisfying feeling of smoking cheaper cigarettes with no proceeds going toward the entity which seemed bent on incrementally depriving them of their small pleasure.

In Canada the government is losing almost 1 billion dollars annually on contraband cigarettes, while collecting approximately 1.8 billion on legal sales. Finland is closing the doors on millions and millions of tax dollars, while enacting an inherently bad law that is impossible to enforce behind closed doors. So, good luck to Finland and best of luck to those who will use this legislation as the impetus to quit. Finally, further luck still to those who will continue to smoke and refused to feel shamed by this paternalistic legislation.

-CEH