My testimony at today’s FDA tobacco center meeting

Today I departed from my usual practice of fiercely avoiding any “science by committee” setting or engaging with government overlord-types, and gave some testimony at the Center for Tobacco Products TPSAC meeting. Greg Conley and Bill Godshall talked me into make the trip as an advisor to the tobacco harm reduction advocacy group CASAA. It was worth it — there were several great presentations by harm reduction advocates in the “citizen comments” that our public mastersservants grudgingly allow because they have to. Greg recruited several people who had quit smoking by switching to low-risk products, and there were great THR presentations also by Greg, Bill, Elaine Keller, Jeff Stier, Gil Ross, and others. I was pretty pleased with mine too, given that I wrote it while sitting through the talks earlier in the day (something to do during the tedious and pointless presentations by the well-paid consultants and others who were invited to speak by the hosts).

To appreciate my talk, I need to offer some background (which kind of spoils the freshness, I know, so if you are familiar with all this, you might want to skip right to the text of my talk).

Background for those who know nothing about CTP etc.: The US FDA was fairly recently given authority over tobacco products. The unit that formed is dominated by dedicated anti-tobacco extremists who are opposed to harm reduction, and its external scientific advisory group (TPSAC) is stacked with extremists and junk scientists, and contains no harm reduction experts even though most of their role is to evaluate harm reduction products. There is a serious threat that FDA will substantially restrict, one way or another, low-risk alternatives to cigarettes. They are particularly notorious for playing the chemophobia game, obsessing (or pretending to obsess) about detectable chemicals in products, implying that these have health effects even though the evidence about actually effects suggests otherwise. No doubt they are annoyed about having to deal with public comments, because (in a complete perversion of the term) they consider the stakeholders to be the busybody activist groups and not include the actual primary stakeholders, the product users. Public comments also are a challenge to their preferred way of dealing with information they do not like, which is to declare it to not exist and claim we do not really have any information (they still do that, of course, but they probably momentarily feel worried that someone is going to realize they are bullshitting). Indeed, the defining characteristic of this whole process seems to be to pretend that evidence about THR does not exist, because it is not exactly the “right” form of evidence, or is not collected by the “right” people, or whatever. That is the same old game used by the anti-harm-reduction extremists for a decade, but now it is official government policy.

Bits of background on this meeting: Today’s meeting was dedicated to dissolvable tobacco products, smokeless tobacco mixed with confectionary which dissolve in the mouth. These face particularly great existential threat from the regulators, probably because they compete with the almost identical products from the pharma companies who many of the extremists carry water for. The citizen comments period allowed for only 16 of us, and only for 3 minutes each — “government for/by the people” in action! It was quite clear from various comments and questions from the floor that many members of the committee did not understand key points about THR, despite supposed expertise and a year on the committee, and even more clear that they had never talked to any actual product users. (They appeared genuinely astonished to hear one of the presenters say that he has kept using an e-cigarette, even though he is sure he could quit, because he likes it.)

In yesterday’s session, the committee had been offered a lesson in the Swedish experience, about how smokeless tobacco use had caused the world’s best reduction in smoking and had been shown to have trivial health risks. They then tried to make up every possible reason about why that is not a good reason to encourage (i.e., allow) the marketing of new smokeless products in the US — because that is just not the same thing, so we really have no idea whether something similar could happen. Oh, and there was a trumped-up obsession with how children might get poisoned by these products (never mind that it had never happened, or the question of why they should be worse than existing pharma products that are almost exactly the same but much easier to unpackage, or other medicines) and resulting tangents about safe packaging.

Anyway, since (a) I figured several of the other presenters were already covering any basic information that I could communicate in 3 minutes, (b) Bill submitted 200 pages of written testimony (which they clearly did not read), and (c) the members of the Center and committee have had months to learn things, and if they did not already know them it was not because they had not heard them. In short, they either already knew what I could tell them as a THR expert, or the reason they did not know is that they were intentionally ignoring the information. So, I decided to go a different direction with my testimony. Here it is (in full — 3 minutes is a very short time):
I speak today as an educator with an interest in the nature of science and its role in the functioning of our society, and from that perspective would like to say, “won’t someone please think of the children?”
If an impressionable young mind stumbled across how science is often portrayed in this corner of our nation’s government, he would be at risk of never becoming scientifically literate, let alone to wanting to be a scientist.
First, science is supposed to be an honest truth-seeking process that attempts to figure out the best possible answer to a question, often via methods that require innovative thinking. Our impressionable young mind, however, might come away:
-believing that science consists of just a few narrowly-defined recipes, rather than taking in all the information we have in myriad forms, available from many forums, and thoughtfully making the best use of it;
-believing that health science focuses on looking only under streetlamps and obsessing about easy but not directly informative work like chemistry, rather than trying to do the more difficult work to translate this and other information into what we really want to know about health effects;
-from today’s session, he might believe that science involves such methods as manipulating children into giving the answers you want, speculation-laden anecdotes, limiting reviews of the evidence to exclude any evidence that you wish did not exist, and counting unsupported assertions by authors as evidence;
-and he would be taught that science it is not about identifying how we maximize our knowledge, but that it is involves declaring that we just do not know anything, when in fact we know quite a lot.
Our impressionable young mind is not going to think very highly of science, and he might reasonably conclude that the best way to get involved America’s version of science is to go to law school. And, yes, that means that misguided ways of looking at science may be a gateway to more dangerous behaviors.
Second, this poor child would get the impression that a hypothetical cardiovascular condition or cancer 40 years from now will be just as harmful as a near-term case in a current smoker, a case that was caused because smokers are discouraged from switching to low-risk alternatives. Do we really want to tell that child that we expect so little of him, that his generation’s health science will be so lousy that the 40-year-out cancer will be no more treatable that it would be today?
Finally, at the very least, I would urge this committee and Center to make sure that any such anti-scientific writing is kept in child-proof packaging, rather that being left laying around on the internet where anyone could stumble across it and damage their developing minds.
In case you are wondering, still more background re that third bullett (explaining the joke does not make it funny, but it can clarify): The “manipulating children” refers to the the Indiana Health Department who presented there and are the darling of the anti-tobacco extremist nutcase faction; their infamous “study” consisted of assembling some children, mixing dissolvable tobacco products (which the children had never seen or heard of before) in with some candies, and asking the children what they thought they were looking at. Obviously, they “discovered” that the kids thought the dissolvables were candies like the other items they were presented with. This is what passes for evidence for these people. I suspect it would be possible to convince the kids that the dissolvables were cats if you worked at it.

The “anecdotes” point refers to someone who presented statistics about thousands of tobacco poisonings which were meant to imply that dissolvable products were dangerous, but in fact showed the poisonings were from other products. Perhaps realizing how worthless her data was, she threw in a single story about a mild poisoning that might have possibly maybe been the result of dissolvables that someone had unpackaged and left around, maybe. The “unsupported assertions” referred to a really stupid report presented by someone from RTI (for which they probably got paid a fortune of our government’s money) reviewing some of the studies on the topic; the report highlighted whatever random conclusions the authors asserted, regardless of the fact that most were unrelated to the evidence reported in the study. In other words, they did work at the level of a bad MPH student (which I suspect is exactly what most of the researchers were). The “limiting reviews” referred to that RTI report, in which they every-so-conveniently had reasons to not include all papers not written by opponents of harm reduction, as well as similar behavior in all the other reviews of the day.

Unlike some of the other presenters, I did not get any questions from the committee. What could they say? The one question/comment I thought might come was something like “do you think this committee is some kind of joke”. I was prepared with an answer — “well, if you really cannot understand the seriousness of what I was communicating, then, I guess the answer is yes”. Alas, no one asked the question.

But I still wonder how many of them even began to understand what I was saying. I know that many of my THR-expert colleagues got it, but I kind of doubt a sufficient level of intellect is common among the officials and committee members. Long-standing science committees are generally populated by political hacks and former scientists who cannot or do not want to think hard any more. I was told that the top FDA guys looked like they were amused at least part of it (but whether that is a good sign or just a smug “yes, you caught us, but who cares — we are still the ones in power” is not clear). I noticed that at least one committee member, Jonathan Samet, perhaps was also getting it, but he knows my style from crossing paths over the years and, though I am pretty sure he does not like me, he gets it. He a clever guy, albeit someone who has risen to seemingly dominate institutionalized American epidemiology, due to position and connections, not scientific skill, and then perverted it with politics, further damaging and already shaky field. (No mystery why he might not like me, huh?)

Anyway, I am pretty sure they missed my final bit of satire. Before the citizen comments, the chair read this ridiculously long statement about how we are encouraged to start by disclosing our conflicts of interest, who paid for us to be there, etc. This is in keeping with the “look for any excuse to dismiss what someone has to say” mentality. It is ironic, since that committee is notorious for being stacked with people with enormous conflicts of interest. Anyway, I was not about to waste time from three minutes with that, but since I spoke a bit faster than I expected, I had 15 seconds left at the end. So I added,
Oh, and no one has ever paid me for my work doing history and philosophy of science like this.
And CASAA paid the two-figure cost of me coming here.
I am guessing that they had no idea that I was ridiculing their conflict of interest obsession.

The meeting was painful, but it is good to be reminded sometimes: I generally know with how little wisdom the world is governed, but sometimes it is useful to remind myself of some of the details. It was just so absurd. The committee would ask presenters questions the presenter could not answer but which (a) everyone on the committee should have already known and (b) someone in the audience was clearly the top expert on. But we peons in the audience were not asked to solve the conundrum, because science-by-committee does not allow for stepping outside the box (or in this case, beyond the plastic chain with “no one past this point” signs that separated the audience — I am not kidding). Several of the answers were in Bill’s submission, but they could not be bothered with looking at that. My favorite was when the committee was asking about some details of what one company had reported and the speaker was not sure; representatives of that company who undoubtedly knew the answer were sitting in the room, and no doubt some or all of the committee knew that, but the people up front went around and around without being able to figure out the answer rather than actually doing the research (asking) needed.

This kind of consultation among the privileged ignorant, which never actually seeks data, passed for scientific inquiry in the Dark Ages. But dark ages never really die. They just take refuge in government and religious institutions. So try not to think too much about the children — it is just too damn depressing.

Two items this week once again make me think twice about self-identifying as Canadian. I suppose I can take solace in the fact that one’s country and one’s identity is something quite different from what occurs in the corridors of power, or whenever prohibitionism rears its mishapen head.

The first item, brought to my attention via Velvet Glove, and reported in the Huffington Post, is about a spate of tainted ecstacy related deaths in Western Canada. What is crucial in the report is that the coroner, Lisa Lapointe, had pinpointed the unique look of the bad batch but did not make this information available to potential victims because “We don’t want to give the impression that these are the tablets that are risky, and other tablets are safe”.

While we might not be certain that the other ones are safe, we do know that the ones she found were poisonous, and in the interests of a political and not a health-related aim, she left the public at the same level of risk as before. Her job, as I understand it, is to find out what is causing harm and then taking the steps to reduce the likelihood of it recurring.

What is also remarkable about this is that the most prominent Canadian reports on this ceased to mention that the unique design had been uncovered and that that information was being deliberately withheld from the public.

How provincial are we getting when we need another country’s news agency to report on the most information in a domestic story, and the locally relevant life and death ramifications.

As far as I know, this dereliction of duty has not imperiled Lapointe’s appointment; how do you suppose we would treat a transport commissioner who did not label dangerous roads because that might give the false impression that all the other roads were safe?

The second story did get good local coverage but reported verbatim misinformation (lies to be perfectly accurate about it) from physicians who claimed to be concerned about public health. The story was a bit of a press release/ activism trying to raise support for the banning of shisha (flavoured tobacco used in hookahs).

The “good” doctors don’t seem to have much of a problem with unflavoured tobaccos but just tart up the product a bit and suddenly it is more dangerous.

They start with the old loophole complaint in that tobacco companies responded to the banning of flavoured small cigars by making them bigger and thus not subject to the regulation. What they seem to ignore is the ban was motivated by the belief that kids liked small cigars (which is why they did not target regular cigars in the first place). So if the company, which is well aware that there were plenty of adults who liked small flavoured cigars, sought to deliver a second-best choice to their stranded adult customers, how is that a loophole?
But I digress.

The passage I found such exception to was

Physicians for a Smoke-Free Canada wants all flavoured tobacco products banned, including shisha, because of their appeal to young people. Shisha, flavoured chewing tobacco and other flavoured products are sold with no warning labels, or with small ones, leading the public to believe they are not as dangerous as cigarettes, the group said.

“If Health Canada required these products to carry large health warnings like those on cigarettes, kids would be more likely to understand how harmful these products are,” Kapur said.

I find it quite strange when most of us regular folks are quite concerned about tossing around anything that could be construed as lies or ignorance, that this Dr. Atul Kapur, the leader of a national organization, has no problem parading, in full view, what is certainly one or the other. Insanity or arrogance, take your pick.

As in the case with the ecstacy, health officials are deliberately withholding information from the public which could affect their future prospects. Here they wish the authoritative line to be that cigarettes are no more dangerous than smokeless tobacco.

Of course what we really should all be clamouring for are large product descriptions saying just how much safer these products are than smoking.

[Request to one of my readers from SM:  Could you put me in touch with your local (Philadelphia area) rep to discuss this a bit more.]

The product has been re-engineered for taste to better appeal to the American palate than do existing General products.  It seems like a very appealing product, a huge improvement (at least for this American palate) compared to the existing General mint-ish product, which just tastes like vile medicine to most of us.  There is also a version of the new product without characteristic flavoring, which is presumably a bit Americanized from the unflavored US version of General, which is perfectly good but still a bit un-American in its flavoring.  (For those interested in more and better product assessments, members of the “snus press” were invited to try these in June to generate some buzz, and several reviews appeared.)

More important, though, is the plan to broaden distribution.  Currently I know only a couple of local specialty shops that sell General, while Camel Snus and others are available at every gas station and most every cigarette store.  Many of these others are perfectly good products (we, of course, do not endorse any particular Western smokeless tobacco product over any other – they are all equally good for THR).  But I have heard many people derisively say, “that’s not real snus!” about the RJR product and others, so the new widely-available General, which seems to deliver more nicotine, faster, and from a smaller pouch than Camel, characteristics which likely appeal to many consumers.

The Swedes and Swedophiles have been saying for a year or two, “that should be our market!”, and this will be a good test of whether that works out.  But whether the new product eats Camel’s lunch or RJR stays as strong as ever, the result will be better for consumers, and thus for public health.  Never doubt that a single thoughtful company, trying to better serve its customers, can improve the world.  Indeed, it is the one thing that most often does.

I was part of a congress (scientific meeting) that existed alongside a giant trade show that had >100 booths, mostly with merchants trying to sell their contributions production and distribution process for, in almost all cases, cigarettes.  Like most any trade show that includes lots of tangible visible products, it was interesting and fun, if you either liked the underlying business or just temporarily ignored your feelings about it.  The congress, by contrast, had no exciting displays or free beer.  It included most of a day about harm reduction (what I was participating in, of course), along with related sessions on various aspects of regulation, and black markets, and unrelated sessions on various technical topics.

The one thing that was striking about the trade show was the presence of about a half dozen e-cigarette merchants.  That is the good news.  The bad news is that they (all representing Chinese manufacturers, and there to try to recruit new distributors/retailers to buy and brand their OEM products) struck me as about as socially responsible as, well, the average merchant who was there.  That is not to suggest there was anything terrible about them, or about the average merchant there, but to express disappointment:  Not one of them I talked to had any idea there was a tobacco harm reduction movement in West, or had heard of CASAA or other organizations/projects.  I felt like THR was a fairly minor issue in their minds, and was nothing more than one of many selling points for the product, alongside “this one looks like a cigar!” or “we can provide the highest quality packaging!”.

In fact, the only merchant that seemed to be really pushing the health side was selling a substitute product, rather than a THR product: a green tea vaporizer e-cigarette with no tobacco or nicotine.  They were claiming that this product reverses the lung damage done by smoking (or, presumably, breathing the air in China), and have a brochure with pictures of a lung going through stages of becoming less blackened.  Well, obviously they were fake pictures, because even if the health claims were true, lungs are notoriously difficult to photograph while inside the body (wet, dark) and once they are outside the body, they tend to stop getting healthier.  Things like that almost make you sympathize with the FDA regulators.

Still, having e-cigarette hawkers occupy any of the floor space strikes me as a gain compared to the last one of these I was at, two years ago, where I do not think there was any presence.  Maybe it will work as a wake-up call to the other merchants where nothing else will.

[That reminds me of the previous one of these I attended, in Bangkok a couple of years ago.  I forget if I ever blogged about the wild events that week:  The government caved to pressure at the last minute to try to shut it down.  The venue was moved way across town and the merchants were forbidden from showing any consumer products, including images of them, and possibly tobacco leaf itself.  Needless to say, complying with this (on the grounds of a law that is supposed to protect children from seeing evil images -- never mind that this was a closed conference that no one could enter without volition and paying a fee, and obviously everyone was adults) was difficult.  Indeed, it apparently failed because near the end of the conference, some local government and QUANGO ANTZ marched in with the local cops they bribed and tried to arrest the conference organizers for violating the rule.

The best part of that story was that the local ANTZ took several hundred school children out of school, paying them some pocket change for their time, and bussed them to the venue to protest along a roadway -- it was great to see them what "think of the children" really means to these people.  Some speakers from the congress went out and invited the protesters (the leaders, obviously, not the hireling children) to come in and participate in the harm reduction sessions at the congress -- they refused, of course.  The most amusing part of the fiasco that due to the forced withdrawal of the Thai Tobacco Monopoly (which is to say, the government's large tobacco company -- yes, the same government that was trying to shut it down), their huge booth space was filled by the Thai government’s tourism operation, which brought in very young women who stood around in very little clothing and gave out drinks to the attendees, mostly men in suits -- yes, this is what the Thai government does to try discourage the reputation that there is anything seedy about Thailand, like the government selling cigarettes.]

Anyway, this week I participated in a panel discussion on THR.  It was kind of odd to not be giving a talk, but just because I am used to headlining does not mean I am not happy to not have to prepare anything!  I decided I would follow my usual self-defeating Cassandra role of being too far ahead of the room to be appreciated, with a single populist message:  The industry is made of up institution-oriented people who are part of the 1% (actually probably mostly in the next two or three percent below that, but you would not know what I meant if I said “the 3%”) and used to dealing with master-of-the-universe types in Geneva, Brussels, Washington, etc., and so is comfortable trying to negotiate with regulators to try to achieve a government-endorsed harm reduction miracle.  And they are optimistic about it working out that way, at least as concerns the US FDA.  But, I argued, the anti-tobacco extremists have enough power over the regulators, despite claims about “science based policy”, that there is little reason for optimism.  I could be wrong, of course, but I cannot summon up much optimism.

I argued that the second-best thing that could realistically happen would be for the industries to fight the regulators to a standstill, so that they cannot take any more anti-THR steps (like the FDA’s attempt to ban e-cigarettes), allowing consumers to continue to learn about THR and switch to low risk products, as is the trend.  The best realistic scenario would be for the elements of the industry that support THR to start working with consumers, treating them like the primary stakeholder they are, to encourage THR.  (Again, it is possible that governments and super-governments could change their tunes and start supporting THR, which would be better still, but I just do not see it happening until consumer THR awareness and action makes it too embarrassing for them to continue their present policies.)

I pointed out that it was indeed Wrong to act, when supposedly acting from the “corporate responsibility” perspective, as if the stakeholders that the industry needs to deal with are the regulators and anti-tobacco busy-bodies.  These are not stakeholders, and calling them that is a perversion of the term by the 1%-types to try to deny that the interests of millions of considers are most important, and they are the really primary stakeholder (with the industries secondary and the others relevant only insofar as they are helping out the primary).

Before I went into that, I led off with an observation asking the audience to consider an open minded person who is concerned with public health, and who was open to attempts by me, other panelists, and others to persuade them that parts of the industry are anxious to be part of the solution to the effects of smoking.  I suggested that we would immediately lose that person if he were to see one particular image from the congress and hear one soundbite spoken at the expo’s main dinner event.  And there were several other candidates for damning observations if those were not available.  I am not talking about things that would just cause ANTZ to go crazy (“Lord have mercy! look at those evil people who are trying to sell improved logistics control processes! and they are smoking indoors!!!!”), but rather things that would trouble an honest observer.  These do not, of course, change the fact that there are positive efforts from within the industry (I was there for a day of talks about harm reduction, after all), but optics matter.

[Oh, and sorry:  I am not going to report exactly what I am referring to.  While I doubt that anyone from ANTZland reads this blog regularly (since they are usually deathly afraid of being exposed to any ideas that might threaten their cherished faith), I suspect that it is periodically mined by those who consider "research" to be a word for "hunt up anything we can find that, when cited out of context, will support our cause".  It was fairly interesting, though, so anyone who talks to me personally might want to ask me about it and apologies to the rest of you.]

The low point of the meeting was listening to one of the presenters, who tried to summarize THR, getting wrong about 15% of what he said, and implying that the rest of it was somehow new and original innovation even though it was nothing more than what many of us have been saying for most of a decade.  I am not going to identify him because I am not trying to embarrass him.  (However, I have to say I will not show such restraint if he really has a publication coming out, as he hinted, that claims that his own exciting new research has discovered… well, facts and insights that appeared in the 2006 TobaccoHarmReduction.org FAQ and continue to appear and be updated in our summary report on THR (e.g., Chapter 2 of the 2010 Yearbook, and our forthcoming chapter in the Alan Marlatt tribute book, Harm Reduction 2nd Edition.)

My reason for mentioning this is to express further dismay about the stalled state of THR among the elite or chattering classes.  There has been great innovation in products and progress in uptake of THR, of course, which is much more important.  But the discussion has been pretty much stalled, perhaps waiting for governments to act.  So apparently the only way to liven things is to bring in someone with nothing new to say who just repeats (in a mangled fashion) exactly what many of us have been saying for most of a decade.  Of course, that statement is part self reflection — apparently I do not have enough that is interesting to say that I did not say in 2009 (which may indeed be the last time I introduced a genuinely new important idea).  What more can we say to help move things forward?  Or are we researchers and chatterers basically done, and the world will evolve based on what we have put on the record, with it not much mattering what more we do now?

I actually think that the populist thinking, as an alternative to supplicating to regulators and ANTZ, is important — both as a social science point and a practical suggestion.  But, as I said, that may be a bit too far ahead of the room.  Or I might be wrong.  But my experience says that two or three years from now, someone will be reciting a mangled version of the same points — without citing precedent and thereby claiming it is some purely personal discovery — and the room will be impressed by their insight.

Bergen comments on how e-cig researchers ignore what is already known
(see also the link in the comments to Kristin Noll Marsh’s similar post from earlier this year)
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/11/ecig-research-floundering-to-understand-what-vapers-already-know.html

RJR petitions US FDA to eliminate misinformation in mandatory ST warning labels
Read Brad Rodu’s excellent summary and analysis. No summary we could write would do it justice.
http://rodutobaccotruth.blogspot.com/2011/11/fda-petition-end-smokeless-tobacco.html

Other THR

NYT’s Tierney tells some truth about e-cigs
The New York Times’ technology pundit provocateur, John Tierney, devoted his periodic column to e-cigarettes and how it is odd that there is such opposition to them. It is a very good article, though it contains nothing that those familiar with the issues have not known for years (indeed, Tierney is guilty of writing as if he were producing insights when he is just reciting observations that could be found in, say, this blog). What is most interesting about it, though, is what it shows about the way that even sympathetic members of “the 1%”, as it were, tend to think about this issue: as being about the authorities, not the people. Though there is much talk about the choice to consume nicotine, consumers feel absent from the piece. Their preferences are represented by observations by Rodu and Godshall, who are good choices, and the little study by Polosa that we discussed last time (and re that, see the preceding entry above). But in addition, he cites groups that have good messages but are really only just a couple of people (American Association of Public Health Physicians, American Council on Science and Health) while completely ignoring the user community and its much larger organizations. Finally, he treats the fight as being a Democrat-Republican thing, which is typical corporate media simplification, and treats anti-THR activists in the “public health” community as a curiosity, rather than an existential threat, and does not seriously examine their ethics or motives (the motives of users are subtly suspect, but powerful organizations always get a pass in the NYT). Some have said “wow, great, who ever expected this in the NYT” and they have a point; but we say “it is too bad that this is better than the best we can ever expect in the NYT”.
http://www.nytimes.com/2011/11/08/science/e-cigarettes-help-smokers-quit-but-they-have-some-unlikely-critics.html

“Prohibitionists still kill”
Dick Puddlecote rails against anti-THR, writes an awesome penultimate paragraph,

The centuries old quest for prohibition isn’t about health, nor has it ever been. It’s still just a bunch of mentally unbalanced psychos adhering to unthinking, and largely unattainable, dogma without care for the deeply anti-social – and regularly lethal – consequences of their actions.

and also offers a somewhat different take on the previous article. It would have probably made our “too amusing to miss” section, but while the post is great reading, the topic is just to sad to be funny.
http://dickpuddlecote.blogspot.com/2011/11/prohibitionists-still-kill.html

Rodu’s town-based switching experiment makes the national news
Stories appeared in WaPo and USA Today, as well as numerous local papers. Sadly, the article (there appears to be just one, running in multiple papers), is not great. It leads with the reason this project is a good idea. Unfortunately, anyone who keeps reading will see an emphasis on the controversy rather than the science, and will likely not understand that switching is extremely beneficial.
Google News (note: WaPo no longer hosts copy)
http://yourlife.usatoday.com
And there is much worse out there, with some articles that still seems to include a THR message containing colossally-stupid comments from the anti-THR activists. When Matthew Myers says “more research is needed before anyone should suggest that the nation’s 46 million smokers would be better off using smokeless tobacco”, you have to wonder if he is afraid to travel because more research is needed about that whole “you can’t fall off the edge of the Earth” thing.
http://medicalxpress.com/news/2011-10-urges-smokers-smokeless-tobacco.html?mid=51534

New York Magazine explains the tech, appeal, and benefits of e-cigarettes
The content is simplistic, naive, and dated, as we expect from unhealthful news reporting, but it is mostly right and appropriately positive. This one gets a B+, putting it at the top of the curve for recent old media articles about THR.
http://nymag.com/news/intelligencer/topic/e-cigarettes-2011-10/

RJR reports ST replacing smoking, though not Altria
RJR sales were down about 7% for cigarettes but snus (dominated by Camel Snus) was up about the same percentage. Altria reported cigarettes down but its established (US Smokeless) and unsatisfying (Marlboro Snus) ST brands did not see the rise that Camel did.
http://files.shareholder.com (pdf)
http://www.altria.com

Even as snus is making remarkable progress in Norway, many medics there are clueless
A study found that only 36% of Norwegian GPs know that snus was much less harmful than cigarettes. More than 15% believed that snus was equally or more harmful than cigarettes.
http://ntr.oxfordjournals.org/content/early/2011/10/20/ntr.ntr159.abstract

Godshall writes about Vapercon
His combination personal narrative and press release about vaping is reprinted here.
http://www.e-cigarette-forum.com/forum/media-general-news/233541-live-vapercon-3.html#post4443115

E-cig merchant launches TV advertising via infomercials
Will it be possible for market incentive to educate about THR where volunteer work simply cannot? V2 Cigs says its 30 minute informercials will inform and educate in a fun way.
http://www.prnewswire.com/news-releases/v2-cigs-debuts-national-tv-advertising-campaign-133430118.html

Survey finds fairly decent awareness about e-cigarettes
The American Legacy Foundation was undoubtedly distressed to find that over half of American adults surveyed have heard of e-cigarettes, and 5% had tried them. Of those who had heard of them, two thirds knew they were less harmful than smoking. (h/t to Godshall for finding this SRNT poster)
http://www.legacyforhealth.org/Ecigs.pdf

Another ANTZy e-cig study
This is not a terrible study if you just look at the results and not the rhetoric; it is yet another confirmation that e-cigarette use is increasing nicely. Sadly, the authors make every effort to spin this as a bad thing and suggest — in spite of the fact that their results confirm what we know, that e-cigarettes are used by smokers to quit — that youth initiation is a cause for concern. Aside: It is a pretty good clue that if someone uses the term “ENDS” instead of “e-cigarette”, they are either ANTZ or trying to impress ANTZ. Avoiding the established natural term for a product is a thinly veiled way of saying “we are going to show our superiority to those degenerates who use this product by refusing to use their terminology.” Of course it is a pretty good clue when the report is from an anti-tobacco extremist organization (US CDC) and published in an anti-tobacco quasi-journal.
(thanks to Kate at vapersnetwork.org)
http://tobaccocontrol.bmj.com/content/early/2011/10/27/tobaccocontrol-2011-050044.abstract

Anti-smoking pseudo-scientist expands into anti-THR
To quote Godshall,

Stan Glantz claims tobacco morbidity/mortality doesn’t decline (and may increase) when smokers switch to smokeless tobacco or when smokers are informed that smokeless is far less hazardous, grossly misrepresents scientific and empirical evidence, criticizes recent USA Today and NY times articles, defames Brad Rodu, attacks privately funded research, and misrepresents FDA’s false and misleading claims about e-cigarettes and its failed attempt to ban products.

http://tobacco.ucsf.edu/two-high-profile-uncritical-media-stories-industry-supported-harm-reduction

Victory against Seattle proposal to ban e-cig use in public housing
This thread starts out with the problem, one of junk science and class warfare, but by the end of it, a solution has been reached. It is a nice good-news story.
http://www.e-cigarette-forum.com/forum/legislation-news/235432-seattle-housing-authority-proposes-banning-e-cigarettes-low-income-public-housing.html
CASAA also won a victory in removing e-cigarettes from a proposed apartment building smoking banAlameda California. But the fight to be able to engage in a low-risk activity with no impact on the neighbors, in one’s own home, continues elsewhere.
http://www.wavenewspapers.com/news/local/west-edition/Compton-approves-strict-ban-on-smoking-133127938.html

Dunworth reports on results of small survey of why e-cig users switched
Like most such surveys, it tells us little quantitatively, but offers interesting qualitative research (i.e., free text answers as case-studies).
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/11/why-we-switched-to-electronic-cigarettes-1-what-you-said.html

Related Topics

US court blocks emotional violence graphic labels on cigarettes
The labels, erroneously called warning labels, were judged to be emotional manipulation that probably would not withstand a constitutional free-speech challenge. Phillips’ analysis, with links to the judge’s full opinion and NYT reporting of the ruling:
http://ep-ology.blogspot.com/2011/11/unhealthful-news-187-cigarette-graphic.html
And another take on it:
http://www.newsworks.org/index.php/blogs/item/29771

Biotech company attempts to eliminate the benefits of smoking while keeping the costs
The company, 22nd Century Group, has engineered tobacco plants to be almost nicotine free, and are touting these as harm reduction (though you will notice that we did not put this entry in the THR section — quite intentionally). Normally we ignore that company, which giving the Zeller/Hatsukami crowd a run for their money in trying to co-opt and abuse the term “THR”, and even have “exclude if it contains…” parameters for them in our THR web search bots because they seem to send out a press release that includes the phrase “tobacco harm reduction” any time they do anything more interesting than change the toner in their office printer. But they managed to make the NYT. Not surprisingly, that article quotes several anti-THR activists but no one who actually supports THR, and implies that removing the nicotine from tobacco is a good thing. This fits the prohibitionist agenda (no doubt everyone quoted in the story is quietly lobbying for, and drooling about, FDA regulations that would mandate unacceptably low nicotine levels in products) as well as playing on the naivety/propaganda that classifies nicotine as a bad thing.
http://www.nytimes.com/2011/10/29/health/research/cigarettes-are-being-used-in-studies-to-help-smokers-quit.html

Researchers look for grand unifying theory of prohibition
First they torture mice to support a claim that nicotine exposure might prime the brain to appreciate cocaine. Then they report that one particular 2003 dataset (of course there is no cherrypicking there) shows that cocaine dependence was higher (whatever that means) when the user smoked before first using cocaine rather than the opposite order, which supposedly supports the claim (because …um… this effect of nicotine magically disappears if it is not used first??). Finally, “Now that we have a mouse model of the actions of nicotine as a gateway drug this will allow us to explore the molecular mechanisms by which alcohol and marijuana might act as gateway drugs,” said Eric Kandel, M.D., of Columbia University Medical Center and a senior author of the study. We would add a joke, but irony is kind of dead here.
http://www.nida.nih.gov/newsroom/11/NR11-02.html

Siegel offers clever analysis of how pro-pharma researchers bias smoking cessation study results
By chopping the “cold turkey” category into lots of subsets (“watched a video”, “called a hotline”, etc.) and then including a “none” category that includes only those odd individuals who did not so much as looked at a website, the junk researchers can make the “none” category look bad and suggest that pharma product use is common compared to other options. Michael Siegel, true to form, attributes this bias to pharma industry funding, and in this particular case that is a fairly compelling story. Naturally, there is no mention of THR in the government/pharma methodology, or in Siegel’s critique of it.
http://tobaccoanalysis.blogspot.com/2011/11/bias-against-cold.html

Report slams FDA over Chantix
The paper combs FDA’s adverse event reports and concludes that FDA’s method covered up serious problems and that the drug should not be considered an acceptable for “first-line” use, and only should be used after other quit smoking drugs fail. It appeared in a journal that is politically anti-tobacco, and of course there was no mention that none of the pharma products work very well, let alone of the THR option.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0027016
http://www.medpagetoday.com/PrimaryCare/Smoking/29437

Major brewery uses unusual staple food in providing alcohol harm reduction
They are in it to sell a new beer in Africa, obviously, but the cassava brew is expected to displace homebrews which are often dangerous.
http://www.guardian.co.uk/world/2011/nov/01/cassava-beer-commercial-brew-africa?cat=world&type=article

Healthy People 2020 = HP2010 with a little white-out
The Healthy People 2020 goals for tobacco use are out. What a surprise, they’ve decided to retain their goal for 2010, hoping that only 12% of people will be smoking in 2020, while neglecting to include the one thing that might actually help them achieve this: tobacco harm reduction. Indeed, they repeatedly try to imply that smokeless tobacco use has a major impact on health.
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41

Naive “smokers all want to quit” message continues to damage public health
An MMWR report making this claim got a lot of press. The problem is that all such survey questions conflate “I want to stop using this drug” with “I wish I could be as happy/productive/focused/etc. as I am while on this drug, but to do so without the drug”, and so lead to the erroneous conclusion that tools to just quit (but not replace the benefit of the drug) are all we need. By their standards, most everyone wants to quit sleeping too, so we should be happy that they do not push psychosis-inducing drugs in support of that too.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6044a2.htm

Phillips examines why claims of miraculous effects of restaurant/pub smoking bans are absurd
The first of a multi-part series that includes links to others’ recent analyses.
http://ep-ology.blogspot.com/2011/11/unhealthful-news-189-absurd-claims.html

Not content to denegrate science in the name of anti-tobacco, they are now playing with the cornerstone of Abramic religion
An ANTZ group calling itself Physicians and Nurses Against Tobacco introduces a campaign to declare the eleventh Commandment to be “Don’t smoke”, after another fringe group declared cigarettes to be non-kosher. Yes, really. Still looking for a limit to how far these people will go.
http://www.prweb.com/releases/2011/11/prweb8941006.htm

Compared to trying to rewrite Exodus, everything else looks pretty good…
…still, this is too dumb to not mention: The state of Missouri gave approval to a group led by the American Cancer Society to create a ballot referendum for a tax increase on cigarettes and a huge increase on smokeless tobacco. Combining the wisdom of the general population in setting tax policy with the ANTZealotry of ACS — what could go wrong?
http://www.sos.mo.gov/news.asp?id=1022

Why is Godshall recommending a clip from The Daily Show that is unrelated to tobacco?
He did not explain, but the answer is that the same organizations (ACS, AHA, etc.) who lobby against THR also defeated a pro-exercise bill, apparently because it would make people healthier without their involvement.
http://www.thedailyshow.com/watch/mon-october-31-2011/how-a-bill-doesn-t-become-a-law

Australia plain packaging fight goes on
There is a lot of noise, but we will not bother you with details or links. When something actually happens, we will cover it.

Smoking now code for America’s traditional valuing of freedom?
The Herman Cain campaign ad with its not-so-subtle smoking has gotten a lot of press. There is no agreement on what it means, but it might be that “denormalization” of smoking has finally turned it into a symbol of oppression, and that use of smoking imagery is not just teenage rebellion, but a revolutionary symbol about “reclaiming the real America” or some such. It is just so sad that in American politics, concern about liberty is so often bundled with… well, people like Herman Cain.
http://www.youtube.com/watch?feature=player_embedded&v=qhm-22Q0PuM

**Note to readers: If you have written something you wish to see included in the weekly readings, or produce a relevant news feed that we might be missing, please call it to our attention. If you think we missed a specific THR story of note in the previous week, let us know and we can include it the following week. Finally, if you figure you are someone whose feed we are using to help us collect stories — you can probably guess who you are — and would like to be sure to get an occasional hat-tip, let us know and we would be glad to do it (and please do the same for us if we are helping you).

Though the show has been on for some time, I just saw this a couple of days ago and it fit neatly in with what had been tumbling about in my head in regards to nicotine and the times we live in.

Nicotine has been seen as a good fit for the industrial age in that it was one of the few drugs that not only provided a respite from stress, but did not interfere with productivity. If anything, it enhanced it.

Though many of our everyday chores have been either eliminated or become much less onerous, life is not experienced as being any less stressful. It could well be that some of these chores, even if not exactly pleasurable, functioned also as islands of calm – stabilizers of everyday existence. With the emphasis on information, speed, and connectivity, it is not surprising to see reports on rising attention deficit disorders, and in general the drop of the average person’s ability to read to the end of a sentence or even complete the simplest

Nicotine focuses attention and relaxes. If ever there was a drug for our age, nicotine is it.

And with the rise of safe enough sources such as smokeless tobacco and electronic cigarettes, for many it might just be the answer to dealing with the modern, fast-paced, and cluttered cognitive environment.

Just to be clear, this is not a nicotine-for-all argument but a recognition that for some it is a pragmatic solution to the fragmentation of modern life. Even though I never get headaches, and thus don’t need aspirin, doesn’t mean that I don’t recognize that it might be essential for others.

Triangulating on anti-tobacco extremism
Why is an article about cigarette litter a must read? Well, we often argue that anti-THR is primarily motivated by anti-tobacco extremist who recognize that if low-risk tobacco products become popular, then there is no way their extreme goal — eliminating all tobacco use — will ever happen. Thus, they have the incentive to keep tobacco use a deadly as possible (discouraging harm reduction), which also introduces the other side of extremism: Being unconcerned with the damage caused by pursuit of the goal. Chris Snowdon writes about a similar phenomenon, the extremists fighting efforts to reduce the litter caused by smoking. The parallel is quite remarkable: an attempt to increase the damage done, and a willingness to damage valued social institutions (anti-litter or beautification groups) to do it. Not as bad as damaging public health, of course, but perhaps it even better supports our extremist hypothesis that some people still insist is just too cynical to be true.
http://velvetgloveironfist.blogspot.com/2011/10/cigarette-butts-some-loony-proposals.html

Amusing Enough Not to Miss

Anti-tobacco researchers are just funny
This week’s amusing publications in anti-tobacco blogs (they call them scientific journals, but we think our characterization is more accurate) include the Minnesota ANTZ farm writing a letter claiming that US tobacco companies could have lowered carcinogen levels in smokeless tobacco products, but did not. So, let’s see: The level of these particular chemicals that are believed to be carcinogenic (though the evidence is hardly conclusive) has come down dramatically, but in any case ST products with higher old levels of the chemicals have not been observed to cause cancer based on extensive epidemiology. So any benefit from this change is speculative and would have to be too small to measure. So what part of this do they not understand? Oh, right, the science part.
http://tobaccocontrol.bmj.com/content/20/6/443.short?rss=1

From Australia (of course), a screed about how terrible illicit trade in tobacco is, and how health agencies should just do something about smuggling and black markets even though they have absolutely no capacity to do so (for a hint on how well this will work, you might want to read any recent news report from Mexico). But they better not dare cooperate with the companies, who actually have some tools for combating smuggling, because that would mean tobacco control would have to act like grownups and recognize that generally one shares a lot of common ground with one’s opponents, and that they are not actually Voldemort or smallpox. (Note also the parallels between this and the “must read” story above.)
http://tobaccocontrol.bmj.com/content/20/6/436.short?rss=1

And Prue Talbot “discovered” that off-the-shelf e-cigarettes perform differently from each other, in terms of puffing force and time that is needed and such, and sometimes there is variation within a brand. We are shocked! to learn that e-cigarette users need to exert control over what they do and sometimes vary it in order to make the products work for them; could you imagine if that were the case for, say, food or cars… oh, wait. The concluding call for better quality control would seem much more honest if the ANTZ had not intentionally abdicated regulating e-cigarette quality by trying to ban them instead of helping make them better.
http://ntr.oxfordjournals.org/content/early/2011/10/11/ntr.ntr164.abstract

We realize that reporting anti-tobacco researchers’ poor understanding of how science and the world work may be on par with flatulence jokes, in terms of how creative the humor is. We will try to restrain ourselves for a few posts before doing it again. Oh, and we would like to note that we did not mention Stanton Glantz at all, so we did show some restraint.

Other THR

Rodu rips New England Journal of Medicine’s extremist commentary
Rodu points out (not in so many words) that commentary reads like it was written in the dark ages, with an unattenuated “quit or die” message, along with praise for the mythical promise of anti-smoking drugs. We suppose this is not too surprising since most institutions’ (e.g., medics’) understanding of smoking and the future of tobacco use is indeed trapped in a dark age.
http://rodutobaccotruth.blogspot.com/2011/10/new-england-journal-of-medicine.html

US considering ban on e-cigarettes on airplanes
The debate rages about this. There is a good case to be made for banning lots of things in an extremely confined and technologically dangerous situation. We could certainly get behind airplane bans on peanuts (a dangerous allergen that aerosolizes), perfume at a “characterizing” level of concentration, applying nail polish (actually already banned because of flammability, but not well enforced), and not showering. And maybe loudly talking to a stranger about inanities rather than, heaven forbid, actually reading a book. Vapor from an e-cig seems to fit that theme, with possibly unwanted smells and ever-so-slightly dangerous technology. The question is, would the ban be made for the right reason, or is it just a backdoor way to try to prevent people from using low-risk products, like the ban on smokeless tobacco that some airlines were talked into (and that, fortunately, is quite trivial to ignore).
http://www.huffingtonpost.com/kate-hanni/dot-proposes-ecigarette-b_b_1018004.html

Banning of smokeless tobacco in baseball in the news again
This total non-issue continues to obsess a certain ilk of ANTZ, and they go berserk about it every year at the time of the championship series. This time there is a orchastrated astroturf campaign of hundreds of commentaries and letters, and the campaigners have picked up some prominent politicians. The funny thing is that putting an end to the constant spitting in well-watched close-up television images would probably be a boon to THR, exactly what the ANTZ want to avoid. A few young baseball players might quit using chewing tobacco (which would be fine, so long as they did not smoke instead) but a lot more people would overcome their irrational opposition to snus-like products based on the spitting which they do not require. So all-in-all, if this is how the anti-ST people want to spend their time and political capital, bless ‘em.
http://espn.go.com/mlb/playoffs/2011/story/_/id/7118541/2011-world-series-senators-urge-baseball-ban-tobacco

Bergen commentary on the pleasures of vaping
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/10/vaping-pleasure.html?mid=50

Related Topics

We are all smokers now
Snowdon reports on the increasing expansion of anti-tobacco extremism into puritanical anti-free choice extremism about food, alcohol, and other of life’s pleasures.
http://velvetgloveironfist.blogspot.com/2011/10/fat-man-explains-slippery-slope.html
And he also reports on how anti-alcohol zealots are push-polling children to get their policy “suggestions”. (So we at THRo are declared to be not a stakeholder for UK policy science about tobacco and so they will not even read our advice, but children who cannot buy alcohol are just fine to query. NICE.) In any case, Chris Snowdon is on a tear right now, working a lot from the content of his recent book — buy a copy of that if you are at all interested in these topics.
http://velvetgloveironfist.blogspot.com/2011/10/alcohol-concerns-sleight-of-hand.html

Alberta government sells its lucrative tobacco stocks in anticipation of even more lucrative lawsuit
Leave it to the Canadian province of Alberta to find a new height in government hypocrisy about tobacco. The government had no problem taking advantage of the market, even beyond their taxes, which at least are defended by the (inaccurate, dishonest) excuse that they pay for the extra cost of smokers. But since the investment might interfere with simply confiscating the industry’s assets (or following the US lead and imposing hidden taxes on smokers and pretending it is a confiscation), it is time to bury it in a memory hole.
http://www.ctv.ca/CTVNews/Canada/20111020/alberta-tobacco-investments-111020/

**Note to readers: If you have written something you wish to see included in the weekly readings, or produce a relevant news feed that we might be missing, please call it to our attention. If you think we missed a specific THR story of note in the previous week, let us know and we can include it the following week. Finally, if you figure you are someone whose feed we are using to help us collect stories — you can probably guess who you are — and would like to be sure to get an occasional hat-tip, let us know and we would be glad to do it (and please do the same for us if we are helping you).

Kevin Libin sums up hypocrisy of medics who are pro-HR for heroin, but anti-THR
The National Post’s Libin is probably the strongest voice for THR at a major newspaper. (It includes comments from an interview with Phillips, though he apparently declined to include the observation from that interview: That it is a limousine-liberal class issue: junkies are the highly downtrodden that good “liberals” are supposed to look out for; smokers are the proletariat who should just do what their “betters” tell them to do.)
http://fullcomment.nationalpost.com/2011/10/14/kevin-libin-doctors-favour-junkies-over-smokers/?mid=5027

New Polosa et al. study shows the THR effectiveness of promoting e-cigarettes to smokers
The study was more informative than the “smoking cessation trial”-style trials with THR products (the fatal flaws in which we have discussed before) because subjects were smokers without an active interest in quitting and were offered e-cigarettes in what sounds like a fairly real-life manner. A remarkable number of them switched — hooray!
http://www.biomedcentral.com/1471-2458/11/786
See also Bergen’s interview with Polosa.
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/10/electronic-cigarette-interview-professor-riccardo-polosa.html

Other THR

Petition at US government site in support of e-cigarettes
American? Sign it, please!
http://casaamedia.blogspot.com/2011/10/point-click-activism.html

Godshall rips US FDA for focus on lists of chemicals
He recognizes that the inventorying of chemicals in tobacco products is required by law, but urges FDA to downplay the results, since claims that fiddling with chemistry reduce harm for cigarettes (or matter at all for low-risk alternatives) are contrary to FDA’s promised science-based approach. This very short, cogent comment would affect the behavior of anyone with shame about making silly scientific claims. In other words, it will be ignored.
http://www.e-cigarette-forum.com/forum/legislation-news/230631

British Columbia offering free pharma nicotine
It is kind of an interesting experiment, given that smokeless tobacco is hugely over-taxed and e-cigarettes have to be smuggled in: How much do you have to lower the price of pharma products to make them more attractive for THR. Apparently “free” is sufficient, since there was huge interest on the first day. It will be interesting to see what they do when they figure out that most people taking the offer are not trying to become abstinent.
http://www.ctvbc.ctv.ca/servlet/an/local/CTVNews/20111001

Pilot studies of what happens when you kinda sorta recommend a THR product
We are not quite sure what to make of this article, in which combined two small studies in which smokers in two countries were offered a small quantity of free smokeless oral tobacco products under very different protocols, without education or recommendation, to see what they would do. We suggest giving the authors credit for getting a summary of data from the pilots out into the world, but seriously question their choice to draw conclusions based on it. (Iin case you were wondering, this was the last THR article accepted by Harm Reduction Journal before Phillips took over as editor for tobacco articles.)
http://www.harmreductionjournal.com/content/8/1/27/abstract

UK grant that claims to be for THR
The National Institute of Health and Clinical Excellence awards a grant for “guidance development services”, whatever that means. But regular readers will recall that NICE is basically just trying to co-opt the term THR for business-as-usual extremist approaches (and you will recall that they allowed us to be a “registered stakeholder” for these efforts — until they got our comments, at which time they booted us). So it seems safe to decide that the best we can hope for is that nothing comes of this.
http://ted.europa.eu/udl?uri=TED:NOTICE:317616-2011:TEXT:EN:HTML

US Congressman explicitly compares his attacks on food marketing to his championing of anti-THR
Fortunately for us, even Waxman cannot manage to kill countless people by restricting food marketing, as he has done with anti-THR. Perhaps not so fortunate for food companies, though.
http://thehill.com/blogs/healthwatch/nutrition/187045-waxman-compares-republican-defenders-of-food-marketers-to-tobacco-champions

Siegel cleverly challenges disingenuous concern about propylene glycol
In response to trumped up worries about PG exposure from e-cigarettes from several of what he calls “anti-smoking and health groups” (he cannot bring himself to identify the as anti-tobacco extremists), Michael Siegel wonders why they are not calling for a removal of PG in cigarettes. This, of course, is also disingenuous, since the quantity of PG taking in from smoking is much smaller, but that is what makes it such a great “nyah nyah”: force the people who are making anti-scientific claims to try to figure out how to argue the science.
http://tobaccoanalysis.blogspot.com/2011/10/if-anti-smoking-groups-want-electronic.html

Related Topics

Quebec primed for safe injection sites
Landmark Supreme Court ruling over Vancouver site clears the way for Quebec. Can we expect e-cigarette promotion to follow? Not a chance (see the first article above).
http://www.cbc.ca/news/health/story/2011/10/11/quebec-safe-injection-clinics.html?cmp=rss

Australian plain package saga drags on
The new cause of drag is the Conservative opposition in the Senate questioning the wisdom of the policy, and so delaying a vote. Supporters of the proposal immediately leaped into full paranoia/denial/Orwell mode, suggesting that any opposition to them must be about tobacco company interests. Meanwhile, the UN is shocked! shocked! that cigarette companies whose core assets (brand identity) would effectively be confiscated by this policy are taking legal action, and this action might discourage other countries from pursuing the same treaty-violating policies. The bastards.
http://f2cscotland.blogspot.com/2011/10/bad-news-day-for-australian-government.html
http://www.healblog.net/health-news/who-official-accused-tobacco-industry-for-dirty-tricks/

Commentary on how Australia’s costly plain packaging fight is rather silly in light of failure to try THR
David Sweanor does not use most of those words in this brief commentary, but that is the basic message. It contains nothing that our regular readers do not already know, but it is a nice mash-up of the two themes, silly extremist behavior and the basic case for THR.
http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2011.00370.x/full

American Legacy Foundation now funding daydreaming
Arguably even sillier than opposing THR while coming up with controversial policy interventions that have measurable effects only in someone’s dreams, Legacy has skipped the policy and skipped right to the dreaming with their book and associated only discussion, “After Tobacco: What Would Happen If Americans Stopped Smoking?” …. Sorry, zoned out there for a minute, thinking about how nice it would be to get paid big bucks to daydream about what will happen when the extremists stop working to prevent THR.
http://www.prnewswire.com/news-releases/after-tobacco-what-would-happen-if-americans-stopped-smoking-131586963.html

Mexico’s black market in cigarettes up 400% in one year due to tax increase
In fairness, it only increased from 2% of the market to 10%, so it is still way short of Canada’s and many other black markets. We were just following the lead of the ANTZ, who would use the huge-sounding relative figure if it was a statistic they wanted to create alarm about.
http://www.menafn.com/qn_news_story.asp?storyid={41869f1b-3316-4052-b006-5c8968fea7d3}

Heartbreaking story of the lengths that anti-tobacco-extremists have gone to
http://cagecanada.blogspot.com/2011/10/principles-are-never-good-enough-excuse.html

This must mean that Big Pharma is marketing to kids, right?
In a study to be presented at this year’s American Academy of Pediatrics National Conference and Exhibition, it was found that kids and teachers could not tell the difference between medicine and candy 20% of the time. The study was conducted by two seventh-grade students (not yet inculcated in ANTZ thinking patterns) who came to the common sense conclusion that safe storage was the key rather than removing the medicines from the market.
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=28265

**Note to readers: If you have written something you wish to see included in the weekly readings, or produce a relevant news feed that we might be missing, please call it to our attention. If you think we missed a specific THR story of note in the previous week, let us know and we can include it the following week. Finally, if you figure you are someone whose feed we are using to help us collect stories — you can probably guess who you are — and would like to be sure to get an occasional hat-tip, let us know and we would be glad to do it (and please do the same for us if we are helping you).

Forgive the proliferation of other life forms in this title (and post) but it seems that whenever nicotine or tobacco are discussed, we end up wading knee deep through a bog of misinformation and ANTZ (thank you again Kristin Noll-Marsh for this most appropriate acronym for anti-nicotine and tobacco zealots). So we end up talking of caffeine and automobiles and unlike most other health related topics having to dress the discussion in children’s clothing so as not to enrage or offend.

Some time ago, Elaine Keller wrote in these pages about the nicotine as self medication elephant. But it is just one out of this herd thundering about and for the most part ignored by diligent and blinkered prohibitionists. One of the other pachyderms is that nicotine use is just another human behavior and a particularly popular one if history is a guide (and shouldn’t history constitute better evidence than utopian (or is it dystopian) fantasies?). But the tusker today is one that even many pro-THR activists and vaping communities are not talking about.

This elephant is the likely increase in the numbers of never before nicotine users trying snus or vaping.

From the ANTZ side this seems worse than smoking. After all, the promise of low risk nicotine use can only result in more people trying it and more people staying with it. Once health risks are no longer a sticking point, it won’t matter if the nicotine using proportion of the population goes up or down (as Carl Phillips has pointed out time and again, the economics of the case are that when you lower the cost of something, in this case the health risks, consumption will increase).

From their point of view nicotine use is intrinsically bad and any associated health risks are a side issue. We know this because if they did care about health risks they would be agitating for THR on every street corner.

But to the point at hand.

The central hope of THR is that low risk nicotine use supplants smoking. Currently more smokers than ever are switching and this is good. Every survey of vapers seems to come back with a result that implies that almost every vaper is an ex-smoker or a smoker trying to quit. Snus users (outside of Sweden) seem to be more of a mixed bag but the proportion of switchers seems to be getting larger there as well.

And if there is one thing both camps agree on, nicotine is not for kids.

But here’s the thing. The presaging of victory will be when we see more would be nicotine users starting with these products. ANTZ will be up in arms but if we accept that nicotine use is with us for the foreseeable future then only once initiation is typically with low risk products will that future be a better one.

Right now, vaping is almost considered as a post-smoking activity. While it is great that smokers have switched, isn’t it a little odd that smoking be thought of as a precondition for vaping? Should you be allowed only to vape or snus if you have first exposed yourself to a high risk nicotine delivery system? Should we only let you use seatbelts after driving for a while without?

No.

When you think that very little smoking will expose you to the same total risk as a lifetime of low risk nicotine use, you should be glad to see an uptick in new users. It is the only way that the transition to low risk nicotine use being dominant will occur.

And that is why, and we have already discussed this point often enough, low risk alternatives need to be at least as accessible as cigarettes. If someone (old or young) is about to try nicotine for the first time, that choice should not be weighted, as it now is, toward the one choice that might have serious consequences. As we have already seen in Sweden, once safer alternatives are both accessible and socially acceptable, cigarettes can become the less favoured option. The would be smoker turning instead to snus or e-cigarettes is not only virtually eliminating any health risks but is also making it more likely others will do the same.

We need to reach that tipping point.

(Just a note for the ANTZ: you can only ignore elephants for so long. Once you factor in the size difference, safety in numbers no longer applies.)

(see also: http://www.theonion.com/articles/last-american-who-knew-what-the-fuck-he-was-doing,26268/ — not so relevant to our project here, but too good not to cite, and arguably it relates to the FDA cite and a few others below)

Must Reads

New Book by Chris Snowdon
The Art of Suppression: Pleasure, Panic and Prohibition since 1800 covers the history of prohibition, similar ground to his Velvet Glove, Iron First.
http://velvetgloveironfist.blogspot.com/2011/09/art-of-suppression.html
We will admit that we have not had a chance to read it yet, but anything on this topic by Snowdon is a must read, regardless of the details. Absent out review, here is someone else’s:
http://dickpuddlecote.blogspot.com/2011/09/prohibition-is-unnatural-review-of-art.html

Amusing Enough Not to Miss

Their motto: “That didn’t work, let’s do it again.”
Snowdon makes this amusing observation about the prohibitionist factions (the post is related to THR in spirit only, being primarily about anti-alcohol laws in Scotland), but he points out that the observation about the motto certainly applies to anti-tobacco. Hmm, if only there was something that was proven to work — oh, wait, the motto probably extends to “that works, so we had better shut it down”.
http://velvetgloveironfist.blogspot.com/2011/09/scotland-prepares-for-failure.html

FDA “infographic” on their anti-tobacco effort so far
This is not intended to be funny, of course, but you cannot help but laugh at their “historic advances” that represent nothing but sound and fury, including “reducing youth access” (because until FDA showed up, no one thought to make rules that prohibited kids from buying cigarettes, right?). The best is their closer: “Unprecedented knowledge about tobacco products. FDA knows that more than 4,500 tobacco products exist, where they are made, and, for the first time, the ingredients have been revealed to the FDA.” Yeah, that’ll result in beneficial outcomes any day now. Note to Congress: If you put the FTC in charge of tobacco, they will look at advertising; if you put Homeland Security in charge, they will look at smuggling; if you put FDA in charge, they will look at manufacturing. (Also note the last clever caveat in that quote: it is not that the ingredients were not previously revealed, just not to them.) As for THR, there is, of course, no mention. What would they say, after all — “Our efforts to prevent harm reduction have been successful.”?
http://www.fda.gov/TobaccoProducts/NewsEvents/ucm273582.htm

Other THR

From the “we already knew that, but perhaps others will catch on” department: HPV, rather than, say, smokeless tobacco, has been the trending cause of oral cancer for decades
A recent study provides further evidence to support what the attentive have known for almost a decade, showing the extent to which HPV seems to be causing oral cancer.
http://news.yahoo.com/research-reveals-oral-sex-may-leading-cause-mouth-195800608.html

Stier-Conley commentary, The War on E-Cigarettes
Emphasizes the malfeasance by US governments in their advocacy efforts (there is no other word for it).
http://www.nationalreview.com/articles/277484/war-e-cigarettes-jeff-stier

RJR subsidiary working on anti-depressant that uses nicotinic receptors
“Most new depression drugs today work by increasing the chemicals serotonin, or serotonin and norepinephrine, in the brain. TC-5214 targets a different set of receptors, known as neuronal nicotinic receptors.” “It seems clear that nicotine, which activates the same receptors, can have antidepressant effects and boost cognition, Heinemann said. It is thought that many smokers and schizophrenics use cigarettes to ‘self-medicate.’” The relevance to THR speaks for itself, we think. (Thanks to Bill Godshall for finding this.)
http://www.reuters.com/article/2011/10/03/us-targacept-idUSTRE79268Z20111003

Swedish Match study published
We commented on this before, but it is now in final form. The study looks at a snus-based smoking cessation intervention and finds it effective. Unfortunately, this approach is a perfect example of “lamp-post” research, precisely measuring something we do not really want to know (what happens when you try to get a naive population to try snus in very artificial situations) rather than a decent measure of what we do want to know (will people adopt THR when they learn about it in realistic circumstances). But we understand why companies are motivated to pursue such studies, to respond to the anti-tobacco extremists who pretend to believe (or maybe they are really that stupid) that randomized trials are more informative about THR than the overwhelming more relevant observational evidence we have.
http://www.harmreductionjournal.com/content/pdf/1477-7517-8-25.pdf

Interview with Phillips re e-cigarettes
http://www.nicomate.com/articles/carl-phillips-electronic-cigarettes

Interview with Rodu re e-cigarettes (audio)
http://heartland.org/podcasts/2011/09/28/dr-brad-rodu-e-cigarettes

Ron Borland commentary supporting e-cigarettes
Abstract is at: http://www.bmj.com/content/343/bmj.d6269.extract
The full text is behind a paywall (great way to get the word out, isn’t it), except that information wants to be free:
http://vapersnetwork.org/documents/Borland%202011%20Electronic%20cigarettes%20as%20a%20method%20of%20tobacco%20control%20-.pdf

CASAA call to action against Boston’s proposed restrictions on e-cigarettes
http://www.casaa.org/CTA/article.asp?articleID=201&l=a&p

University of East London running online survey on e-cigarettes.
We do not know about the methodology, politics, etc., but here is a link for taking the survey:
http://www.uelpsychology.org/ecig/

Related Topics

FDA-NIH research collaboration announced
It will be a huge longitudinal study of tobacco users to assess effects of new regulations. Since the effects of new regulations — unless there is a miraculous promotion of THR — will inevitably be trivial, watch for hyping of trivial results and aggressive data-dredging and biased reporting to try to hide that fact.
http://www.news-medical.net/news/20111007/NIHFDA-study-to-monitor-and-assess-impacts-of-new-government-tobacco-regulations.aspx

Canada also spending a fortune on evaluating tobacco control policies
Unlike the US case, this might actually find something, since the predominant effective intervention (basic education) is not in place everywhere, and there might be a few places that could see a tax increase without tipping into the black market. Still, I would bet that for less than 1/100th the $7.4 million budget, we could create a fake research report now that would be difficult to distinguish from the one that will eventually come form this (“…proven effective regulations were implemented in many countries…” [with no actual proof they are effective included, of course] “…much more needs to be done…blah, blah, blah…”).
http://www.therecord.com/news/local/article/604836–uw-researcher-gets-big-grant-to-continue-global-tobacco-control-project

Australia seeks other goverments’ backing for plain packaging WTO fight
This is a great illustration of the monomania of the anti-tobacco extremists. The WTO has serious flaws that hurt poor people, but some parts of it work as well as we might legitimately hope for, like the parts that push back against pick-and-choose protectionism. But the ANTZ are willing to impose radical and thoughtless change on it to salvage one policy that any sensible analyst realize will accomplish approximately nothing.
http://www.reuters.com/article/2011/10/06/us-australia-tobacco-idUSTRE7953S820111006

Health economist proposes pay-to-quit approach for poor smokers
In an op-ed, Jody Sindelar proposes that smokers who receive Medicaid (the US medical fund for poor people) be paid to quit. What is interesting about this is that it clearly recognizes smoking as a consumption choice and thus changing the cost-benefit calculus can affect it. Also very positive is her proposal that proof be in the form of CO monitoring, and thus adopting THR would count as quitting, as it should. It would be a very interesting experiment to learn how many of these smokers will quit for what price, and thus how great the net benefits of smoking are for them. Not addressed is the problem one of us (CVP) wrote about in his dissertation (and that later became called the “anti-commons” in economics, for those interested): Paying people to give up something they have a right to do, but usually do not choose to do, creates the incentive to “discover” that you want to exercise that right in order to be paid to stop. How long does a non-smoker have to smoke before she is eligible for the quit smoking payments?
http://www.cnn.com/2011/10/05/opinion/sindelar-smoking-medicaid/?hpt=he_c2

Siegel argument supports claim that anti-tobacco organizations will just say anything, but they are just not so smart about what they choose to say
In two recent posts, Michael Siegel predicts that the current lawsuit against proposed US cigarette labels hinges on the whether they constitute forced anti-tobacco advertising and not just fair warning, and that the brief filed by ANTZ groups in support of the government benefits the plaintiffs by arguing just that.
http://tobaccoanalysis.blogspot.com/2011/09/amicus-brief-submitted-by-anti-smoking.html
http://tobaccoanalysis.blogspot.com/2011/09/hearing-on-cigarette-warnings-reveals.html

An interesting take on the corner anti-tobacco has put itself in
We missed this interesting column about the rise of activist smokers from Frank Davis during our thin coverage in September. The post (and its interesting comments) picks up on the paranoia of anti-tobacco researchers who justify their suspicious (to be charitable) research practices based on claims of threats. Davis argues that grassroots smoker activism is growing, which might contrast with our observations that the much smaller number of e-cigarettes users have created a more effective sense of identity and social movement.
http://cfrankdavis.wordpress.com/2011/09/03/letter-to-linda/

New American Legacy Foundation report calls for torturing mental health sufferers
The report is about how “tobacco use”, their misleading way of saying “smoking”, is common among those with diagnosable mental illness, which is common knowledge among experts on either tobacco or mental illness. They cleverly avoid pointing out that the reason for this is that nicotine is such a great drug for treating many psychological conditions and demand efforts to make them stop (without, of course, substituting low-risk nicotine). It would certainly be worth looking for cases where use may do more harm than good in this population, but we are never going to get an honest analysis of that from those with a huge obvious conflict of interest (i.e., they are dedicated to the elimination of tobacco). Speaking of COI, it is really interesting in their press release about this, Legacy aggressively acts to hide their huge COI, describing themselves as “dedicated to helping Americans live longer, healthier lives” without saying their real mission is to eliminate tobacco use.
http://www.legacyforhealth.org/4736.aspx

Glantz engages in passive aggressive threats to movie industry
Our catching up on the great writing of Chris Snowdon continues with:
http://velvetgloveironfist.blogspot.com/2011/10/stanton-glantz-clueless-clown.html
This follows Snowdon putting him in historical perspective in a post that ends, “How strange it is that we have 20/20 vision when it comes to identifying cranks and puritans in earlier times but are so blind to them in the present day.”
http://velvetgloveironfist.blogspot.com/2011/09/puritans-then-and-now.html

New marketing survey about tobacco use, including “dual use”
Some interesting information for those who follow the market — likely better than the “public health” surveys. We notice with amusement that multiple product use is strongly correlated with watching football and NASCAR. Someone needs to tell Glantz — we would just love to see him sending letters to the NFL and NASCAR threatening them.
http://www.cspnet.com/news/tobacco/articles/make-most-multis-0

Louisiana hospital bans “thirdhand smoke”
Perhaps not as destructive as trying to set the precedent for ignoring the WTO, but more troublesome about what it says about the ivory tower of allopathic medicine, a move is afoot to engage in employment discrimination against anyone who has been near smoking. How long until smokers are no longer allowed to visit dying relatives or attend the birth of their baby (we hope that at least the latter prohibition will apply only to the fathers).
http://www.foxnews.com/us/2011/10/03/louisiana-hospital-to-ban-odor-smoke-on-workers-clothes/?test=latestnews

**Note to readers: If you have written something you wish to see included in the weekly readings, or produce a relevant news feed that we might be missing, please call it to our attention. If you think we missed a specific THR story of note in the previous week, let us know and we can include it the following week. Finally, if you figure you are someone whose feed we are using to help us collect stories — you can probably guess who you are — and would like to be sure to get an occasional hat-tip, let us know and we would be glad to do it (and please do the same for us if we are helping you).