Recent Readings in Tobacco Harm Reduction – week of 18 May 2011

Wow, it was a very busy week indeed. Our goal with this is to provide a fairly quick efficient update on the topic, but it is going to take rather longer this week.

Must Reads
(anyone interested in THR should at least be familiar with the headline)

UK NICE collects comments on their “smoking harm reduction” draft scoping
Will it really promote THR, or is it another institutional fake THR effort designed to undermine the progress in THR? Our comments point out fatal flaws that suggest the first, and if they are ignored, we will know the answer:
https://smokles.wordpress.com/2011/05/14/tobaccoharmreduction-orgs-comments-on-uk-nices-thr-guidance-scoping-draft/
We also point out how some of the proposed questions embed misleading rhetoric (anti-harm-reduction rhetoric):
http://ep-ology.blogspot.com/2011/05/unhealthful-news-132-question-rhetoric.html

IOM presentations available online
The Institute of Medicine has been tasked with playing the declare Scientific-Truth-By-Committee for FDA, to decide “Scientific Standards for Studies on Modified Risk Tobacco Products”. They met May 9-10 and a few stakeholders and other interested parties made presentations, some (perhaps all) of which are online. Strangely, we have found no index, so we are creating one here. There is a lot of material here and we have not digested most of it, so we have to just links to them (all PDFs) without summary or analysis. Not all are “must read” quality in terms of information quality, but do stand as position statements.
RJ Reynolds (Michael W Ogden)
BAT (Chris Proctor)
Swedish Match (Lars E Rutqvist)
FDA Office of New Drugs (David Jacoson-Kram)
California EPA (Andrew G Salmon)
American Cancer Society (Thomas J Glynn)
Mitch Zeller (pharma industry consultant)
John A Baron (academic)
Peter Shields (academic)

Worth Your Time
(not necessarily important analysis or information, but amusing enough to be worth reading)

Column attributes US anti-THR efforts to President’s need to have a “War on…” in his resume
In Obama’s case, it is a “War on Fun”. (Though the War on Drugs is probably sufficient to explain it, and as we have noted in previous writings, most such Warfare comes from the “left”)
http://www.sfexaminer.com/opinion/op-eds/2011/05/youre-not-president-until-youve-waged-war-social-problem

Simon Chapman (et al.) self-parody re Australian plain packaging rule for cigarettes
A BAT report suggested that plain packaging will aid black market, and this would exert downward price pressure on the legal market. The press (probably not on their own) widely misconstrues this observation about market behavior as a threat to drop prices out of spite (“Tobacco giants threaten to slash cigarette price over Australia’s plain packaging plans”). Meanwhile Chapman manages, in a single essay, to demonstrate a failure to understand basic economics, a well-known Shakespeare quote, and that illicit drug markets exist even when governments do not want them to. It is great reading if you take it as comedy. Not so funny is that those in power clearly care primarily about hurting companies rather than helping people. Chapman’s view is that if BAT objects to a policy, then it is good, without regard to that objection being to losing business to smugglers.
http://blogs.crikey.com.au/croakey/2011/05/17/plain-packaging-has-tobacco-industry-spinning-in-desperation/
http://www.telegraph.co.uk/health/8518400/Tobacco-giants-threaten-to-slash-cigarette-price-over-Australias-plain-packaging-plans.html
Also, the official name of the olive green color of the new packages is now “drab green” due to objections by olive merchants. You just can’t make this stuff up.

Other THR

DuMaurier snus discontinued in Alberta
Bad news for Albertans: Imperial Tobacco Canada has discontinued duMaurier snus in Alberta. Anti-tobacco activists can claim victory over public health.
https://smokles.wordpress.com/2011/05/17/it%E2%80%99s-official-no-more-dumaurier-snus-in-alberta/

Harm Reduction Journal article on dissolvables test market
Authors conclude that in Indiana test market, “retail promotional strategies for Camel Sticks, Strips & Orbs appear to be targeting … primarily current smokers.” However, “consumer awareness, interest and trial were low.”
http://www.harmreductionjournal.com/content/8/1/10/abstract

Harm Reduction Journal article from Swedish Match
Overview of their GothiaTek standard and the history of Swedish snus, and some visions of the future. A useful statement-to-regulators style company position paper.
http://www.harmreductionjournal.com/content/8/1/11/abstract

Harvard Med School affiliate and Massachusetts dentists join those distributing some of the dumbest anti-THR claims
Reported by Brad Rodu, the lack of shame about dooming smokers is surpassed only by the lack of shame about being willing to spout pseudo-scientific nonsense.
http://rodutobaccotruth.blogspot.com/2011/05/misinformation-from-dana-farber-cancer.html

Deadly combination: Extremist political actors and little local governments in way over their heads
Fringe special interest groups love little governments like Bhutan and, in this case, a western Massachusetts town that is the latest to consider banning e-cigarettes. Look for the anti-nicotine extremists to keep up this tactic indefinitely — they have a lot of money to use (they are the Koch brothers the non-industrial sector) and there are tens of thousands of little governments to lobby. Most such governments (i.e., semi-volunteer positions held by whoever in town happens to want the job) are incapable of understanding the science, and so many can be tricked.
http://iberkshires.com/story/38485/Adams-Board-Of-Health-Eye-E-Cigarette-Ban.html

Rumor of Indiana enacting THR-based tobacco taxes
Bill Godshall reported the rumor of a lowering of smokeless tobacco taxes explicitly based on recognition of the comparative risk compared to smoking, but we have not been able to find any documentation of this.

Small qualitative study of vapers is an (tiny) ethical and epistemic triumph
The researchers seem genuinely interested in doing the right research despite the concessions to the usual bad standards of the field. They discover (in the sense of “Columbus discovered”) that vaping offered a huge benefit to quality of life and that dedicated vapers will not be dissuaded by supposed problems. The article suffers from irrelevant (to the point that it seems like it really may have been an intentional joke, or maybe demanded by the funder (ACS) or the anti-tobacco journal) statements of pseudo-scientific concerns, as well as the usual sloppy and random introduction we expect in public health articles (e.g., the “only” previously published study on the topic is one of the three that I am aware of and one of the two actually cited). But while the research (interviews of 15 people at a Vapefest) provides far less information than a week of internet reading would, this paper still could represent a slight trend toward recognizing that THR is a consumer choice, not a medicine, and that ethical and informative research about people requires treating them like people. Now if health researchers can only learn to write about people in ways that do not evoke images of a “discovered” “native” ROTFL while reading a 19th century Royal Society anthropology paper about his culture. http://ntr.oxfordjournals.org/content/early/2011/05/12/ntr.ntr088.abstract?keytype=ref&ijkey=095WzUwnLNO6Er9

US manufacturers increase price across smokeless tobacco products
CSP News

Fight over Washington State anti-e-cigarette proposal
E-cigarette proponents have a loud voice.
http://www.komonews.com/news/local/121963999.html

Unlike other areas of tobacco policy, e-cigarette supporters consistently present responses to junk claims
In this week’s example, CASAA spokesperson, Kristin Noll-Marsh responds to a clueless attack on e-cigarettes from University of Kentucky “public health” people.
http://www.kentucky.com/2011/05/16/1741853/non-profit-fights-to-reduce-harm.html

E-cigarette quality control to be done as science fair projects
Actually, this is about university student research, though the idea is the same — an excuse to learn how to use lab equipment on a simple project. But while it has been much ridiculed, it does remind us that there is a profound lack of such QC. However, someone perhaps needs to teach the kids to do a bit of background reading before talking to the press: The first “contaminant” that they got so excited about was known to be present in the flavoring agents.
http://timesfreepress.com/news/2011/may/17/smoke-and-mirrors-utc-student-finding-out-whats-e-/

Related Topics

Study provides reminder that we should differentiate preference for nicotine from pure habit or overcoming a behavioural change threshold
The study had all the problems of any smoking cessation study, but offered the insight that substituting for the habitual behavior (with a sham inhaler) can help some smokers quit. A humane research agenda would really focus on the difference between “want to quit but have an activation threshold problem” and “say they want to quit but do not really want to be abstinent” (and thus would benefit hugely from THR).
http://erj.ersjournals.com/content/early/2011/05/12/09031936.00109610.abstract

…and maybe (maybe!) deactivating nicotine would be appropriate for the former of those groups.
It looks like at least one of the many proposed drug therapies that keep people from getting the benefits of nicotine will soon be on the market (they typically called “vaccines”, but like the one in the news this week, most function some other way). Don’t expect the outcry from “medical ethicists”, who unlike ethicists seldom dare to take a controversial position, that we would expect for interventions designed to keep people from enjoying other disfavored pleasures. It might be appropriate for those who would be better off abstinent than using THR, but cannot get past the quitting threshold because of nicotine. But are there really any such people? (Would the drug be any better for pregnant women than the nicotine? We will never know unless it is really bad.)
http://thereader.es/en/spain-news-stories/6255-Anti-nicotine-injection-will-be-on-the-shelf-by-2012.html

Nothing much new from India this week, but will “tobacco” be the next “nicotine”
Efforts to equate nicotine with smoking have successfully confused many consumers, medics, and even scientists into believing that THR is not possible. Now ASH-UK and the BBC seem to want to confuse users of South Asian dip products into believing the tobacco is the harmful bit even though pure tobacco products clearly do not cause the risks attributed to SA-style products. Watch for “now tobacco free!” dip products that cause more risk than current products.
http://www.bbc.co.uk/news/health-13413053

Accidental epidemiologic science
Hong Kong researchers reported estimates of health risks from smoking that are much lower than the current Official Conventional Wisdom (while still calling for stronger regulation). Their specific numbers, in which they apparently found that only 1/3 of lifelong smokers will die from smoking, (as opposed to the current mantra, that it is 1/2 of everyone who ever smokes) are of little importance and might be quite wrong (we could not find the original research report). But it is nice to see an implicit reminder that someone still knows that epidemiologic effects vary by population (across space and time) and are not constants that are defined by a political process.
http://www.rthk.org.hk/rthk/news/elocal/news.htm?elocal&20110516&56&755681

FCTC now just trying to look silly?
It is reported that the FCTC is calling for Bhutan, where personal possession and use of tobacco results in prison, to better comply with their dictates by raising taxes on imports (the non-existent legal variety, of course), and criticizes the country for lack of a national strategy or action plan for tobacco, and other shortcomings. This might be a joke or a false report — it is kind of hard to tell, and it is just too funny to assume it is not.
http://www.kuenselonline.com/2010/modules.php?name=News&file=article&sid=19382