Author Archives: THR.o Staff

Weekly suggested reading in Tobacco Harm Reduction – 25 May 2011

Must Reads

American Cancer Society concedes that smoking rates are not dropping, but what really bothers them is THR
In their major report about cancer prevention, they concede that there was no reduction in smoking 2003-2009, despite increasingly draconian anti-smoking measures. But even as they produce the best possible evidence in support of THR, in the same document they aggressively attack efforts to promote THR. They condemn low-risk nicotine products that do not cause any measurable risk of cancer because… well, it is not really clear. They explicitly lie and claim that smokeless tobacco products “increase the risk of oral, pancreatic, and esophageal cancer, as well as noncancerous oral conditions”, citing this to the notorious 2008 Boffetta et al. paper that has be debunked by numerous authors, including us, Peter Lee, and Boffetta himself. Our favorite bit was, “The products also may discourage use of evidence-based cessation therapies among those who want to quit”; it is difficult to find a “health” organization that has less of a clue about what constitutes evidence. Most organizations with titles that consist of “American”, “Society”, and another noun exist to promote that other noun, which sometimes really makes you wonder…
http://www.eurekalert.org/pub_releases/2011-05/acs-ros051911.php
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029459.pdf

Rodu reports on THR-promoting (risk-based) tobacco tax policy in Indiana and Kentucky
We reported a rumor of this last week but there was no confirmation available. Brad Rodu provides the missing details and describes his role in bringing it about. Not mentioned is that a similar situation also exists in Pennsylvania (no special excise tax on smokeless tobacco) thanks to similar efforts by Bill Godshall. http://rodutobaccotruth.blogspot.com/2011/05/tobacco-harm-reduction-as-basis-for-tax.html
We do have to take issue, however, with Rodu’s citing of a report by NCPA that we pointed out was total junk science. Credit should go where it is due (to Rodu and Godshall and others who made the case for these policies) and neither credit nor the validity of the points should be diluted by random lobbyists who throw together inaccurate reports.
https://smokles.wordpress.com/2011/01/20/independent-high-quality-science-in-tobacco-harm-reduction-%E2%80%93-should-we-be-thinking-about-calling-it-a-day/

Amusing Enough Not to Miss

Australian anti-tobacco activists jump the shark?
http://ep-ology.blogspot.com/2011/05/unhealthful-news-141-follow-up.html
http://velvetgloveironfist.blogspot.com/2011/05/glorious-idiocy-of-simon-chapman.html

Other THR

New convenience-sample survey of e-cigarette users
No surprises in the results. Supports what we and others have always been saying and showing.
http://www.ncbi.nlm.nih.gov/pubmed/21592253

Snus causes weight gain?
A new study from Karolinska Institute’s anti-snus shop claims that, but it actually appears that being in your late-20s and 30s causes it (and there are some other oddities about the study too).
http://ep-ology.blogspot.com/2011/05/unhealthful-news-143-men-gain-weight-as.html
http://ep-ology.blogspot.com/2011/05/unhealthful-news-144-new-karolinska.html

New South Carolina snus study designed to fail?
The study will give Camel Snus, accompanied by no education about THR, to smokers who are not interested in quitting. Presumably relatively few will switch, and this will be compared to the “success” rates for abstinence-promotion methods. NCI seems to have found a researcher (Matthew Carpenter) who is on board with their plan to spend millions pretending to study THR while not actually learning anything. Sadly, since pointless artificial studies seem to trump better sources of knowledge, the results will probably be taken seriously in Western public health policy. We can only hope that real people know better.
http://www2.journalnow.com/business/2011/may/22/wssunbiz01-snus-focus-of-yearlong-study-ar-1051708/

Is this resource helpful to you?
Hello, readers. We think we have created a very useful weekly resource for anyone who is interested in THR but does not have as much time as we do to track down what it takes to be well-read on the subject. But this is a lot of work for us. So we need to know if you find it useful. If the answer is yes for you, please give us a shout-out via whatever medium you find out about this (e.g., retweet or message on Twitter, like or (better still) comment on Facebook, comment on this blog, send an email. If we do not get enough such feedback in the next few weeks, we will probably stop doing this. Thanks!

What does addiction to cigarettes/tobacco/nicotine even mean?
This grossly neglected topic, which is critical to everything from how to promote THR to whether it is ethical to push for abstinence, gets some rare attention this week.
http://www.harmreductionjournal.com/content/8/1/12
http://ep-ology.blogspot.com/2011/05/unhealthful-news-140-cigarette.html

New York smoking ban motivates THR (via Camel Snus ads)
RJR takes advantage of New York smoking ban to point out Camel Snus can still be used in public outdoor spaces. Unfortunately, they still cannot report the comparative risk to encourage smokers to switch completely. And, of course, the people who claim the smoking ban was about ETS attack the move.
http://www.cnbc.com/id/43138405
http://www.mediapost.com/publications/?fa=Articles.showArticle&art_aid=150957

Members of Swedish Parliament call for end to EU ban on snus
Naturally they play up the unproven claims about Swedish moist snuff being lower risk than other smokeless tobacco, but they get a lot very right. Plus the computer translation from the Swedish is funny in places.
http://www.snuscentral.org/Snus-Nus-in-General/35420-Article-Time-to-regulate-the-global-snus-use.html

Anti-tobacco activists seem intent on improving cigarettes rather than replacing them
There is a confluence of recent events that is difficult to see as coincidence. The most cynical interpretation is that the activists know that they will be out of business if smokers switch to low-risk alternatives but their jobs are secure if they can promote slightly-lower-risk smoking. Slightly less cynical interpretations include our extremists hypothesis (that those who want only abstinence/prohibition know they cannot get it if there is a popular low-risk alternative), cigarette industry influence, or an inability to understand what the evidence really shows. We cannot actually think of an explanation that is more positive than those. Evidence includes the discussion at the recent IOM hearing (see last week’s reading list) focusing on reduced-risk cigarettes, a call by the University of Minnesota anti-tobacco shop for chemical changes in cigarettes, which Siegel spins as being interpretable as even worse than its face value.
http://www.ncbi.nlm.nih.gov/pubmed/21602537
http://tobaccoanalysis.blogspot.com/2011/05/anti-smoking-researchers-tell-public.html

Related Topics

HRI (IHRA) annual meeting, Australia 2012, cancelled
Harm Reduction International (a recently change from their long-time name International Harm Reduction Association) cancelled its 2012 annual meeting, citing difficulties with their conference planners. Given the full year available to regroup from a logistical setback, however, this seems like a case where they were looking for an excuse to cancel. Did the increasingly prohibitionist politics in Australia make it too difficult to have the conference there?

In other name-change news…
The American Cancer Society has changed its name to the American Society for Cancer. Just kidding. But it is tempting to start calling them that.

Turkmenistan joins the FCTC
We wonder if they read the fine print before signing.
http://www.turkmenistan.ru/en/articles/14904.html

Roswell Park researchers
In a paper published in American Journal of Preventive Medicine (broken into three articles to maximize padding of their CVs) they claimed to show evidence that supports plain packaging and graphic warnings. However, a consumer preference for non-ugly packaging, when given a choice, and knowledge of what package colors mean is not evidence that they will buy less when all packages are ugly or become total idiots who will not know what names correspond to the old colors. Harassing smokers and improving public health are not synonyms.
http://www.ajpmonline.org/current

Alberta reaps the harvest of not supporting harm reduction for STDs
Currently spending a lot to fight the increasing prevalence http://bit.ly/j7XKzH because they refused to address it http://bit.ly/ilpmRR three years ago.

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

Recent Readings in Tobacco Harm Reduction – week of 11 May 2011

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

U.S. National Cancer Institute to fund snus-for-cigarette substitution study
Via Brad Rodu, who notes that it is not clear that the study will use a good methodology, the limits of its implications (looking at a single substitute product, not smokeless tobacco more generally), and the oddity of pharma-style testing for a consumer product that is already widely marketed. The biggest problem is that the cessation clinic setting tells us nothing about THR that we do not already know, so the knowledge created by this study will almost certainly be worthless (newsflash! some but not all smokers who want to quit find low-risk alternative products to be a good substitute). But, as Rodu suggests, the fact of NCI funding is more interesting, perhaps suggesting that the anti-THR orthodoxy may be showing some cracks.
http://rodutobaccotruth.blogspot.com/2011/05/national-cancer-institute-funds-camel.html

Press picks up on New Zealand Ministry of Health opinion that e-cigarettes are far safer than smoking
As we reported two weeks ago, this appeared in a Ministry report. Now it has been issued in a statement to Parliament and is in the popular press so the position now is clear to politicians and casual observers. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10724283
It is not yet clear whether this will affect the country’s de facto ban on e-cigarettes. E-cigarette industry pundits are not optimistic.
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/05/smokers-e-cigs-are-safer-but-we-would-rather-you-die-than-switch.html

Argentina bans e-cigarettes
Bad news for Argentinian smokers.
AFP

Worth Your Time
(not so important, but amusing enough to be worth reading)

E-cigarette manufacturer to market fellow-vaper detector
New packs would detect when another such pack was in proximity. This probably will not work — too brand specific and limited to manufactured product — but someone will eventually succeed in this niche that emphasizes the gear-head and social side of vaping.
http://www.nytimes.com/2011/05/11/technology/11smoke.html

Other THR

Australia still trying to kill the e-cig
Queensland Health representative desperately wants people to not use e-cigs. However, the subtext in this news article is that people in Australia have chosen to ignore the anti-health ban on e-cigarettes and are still shipping them in. http://www.couriermail.com.au/lifestyle/health/queensland-health-issues-a-warning-that-e-cigarettes-can-kill-you/story-e6frer7f-1226051143585
Government seems to be pursuing a “reefer madness” scare-tactic approach. A good analysis (and great takedown) of their propaganda:
http://fightantismokertyranny.blogspot.com/2011/05/e-cigs-are-out-in-land-down-under.html

Vapers Coalition asks anti-tobacco harm reduction groups to end their crusade against the e-cigarette
“A Petition for [a dozen major “public health” groups] to change their policy and support the sale and use of electronic cigarettes as a reduced harm option for committed adult smokers.”
http://actsmoking.epetitions.net/

Even in Bhutan, people still use tobacco
Tobacco use is prohibited, but 2.8% of people still admit to smoking and 11.1% to use of other tobacco products. Most extreme possible combination of demonization, high tax, public use ban, advertising ban, etc. leaves well over 10% using (and the black market profiting). Best argument ever for THR? http://www.kuenselonline.com/2010/modules.php?name=News&file=article&sid=19325

Related Topics

India ban saga continues
It also continues to get almost no coverage in the West, but the ban on cheap packaging for dip products is perhaps the biggest and strangest restriction of a popular drug ever, and certainly since the US banned alcohol. The Supreme Court, which ordered the ban, does not have a big enough army to enforce this. The results are interesting.
http://www.dnaindia.com/india/report_supreme-court-issues-contempt-notice-to-makers-of-rajnigandha-pan-masala_1541968

Current draft of next DSM would define “tobacco use disorder” to basically mean “uses tobacco”
While improvements are likely in the current rather silly draft from the American manual that some consider to define mental illness, the clear signal is that any tobacco use will be considered a psychological disease.
http://ep-ology.blogspot.com/2011/05/unhealthful-news-127-what-passed-for.html

New research finds that reduction in exposure to advertising has no substantial effect on tobacco consumption
That is not how the authors spun it — they just observed that there was a substantial reduction in exposure in countries with no substantial reduction in use. Those whose paychecks depend on not noticing the implications of their research often fail to notice them.
http://www.ncbi.nlm.nih.gov/pubmed/21556189

Further evidence of the benefits of nicotine for ADD
Again, the reader needs to ignore the authors’ attempt to spin the result so it comes across as anti-tobacco.
http://www.ncbi.nlm.nih.gov/pubmed/20231857

Deloitte study concludes that all effects of cigarette package graphic regulations are the unintended
The BAT-sponsored report included an econometric analysis that found no evidence that mandated package alterations, such as graphic warning lablels, affect smoking rates. The report further argues (without empirical analysis) that plain packaging will facilitate counterfeiting and threaten competition. http://www.bat.com/group/sites/uk__3mnfen.nsf/vwPagesWebLive/DO8GHFEN?opendocument

TPSAC and Siegel opine about menthol report in NEJM, and Siegel about outdoor smoking bans in NYT
http://healthpolicyandreform.nejm.org/?p=14233
http://healthpolicyandreform.nejm.org/?p=14231
http://www.nytimes.com/2011/05/06/opinion/06siegel.html
These are the typical general-audience fly-over summaries for those who have not been following those discussions. More interesting to experts in the area are some of the commentaries about the commentaries, e.g.:
http://taking-liberties.squarespace.com/blog/2011/5/6/michael-siegel-friend-or-foe.html
http://reason.com/blog/2011/05/06/inside-outside-upside-down-smo

How close are US prohibitionist drug policies to turning Mexico into a failed state?
Profitable black markets cost the world a lot more than tax revenue.
http://www.mcclatchydc.com/2011/05/10/113999/mass-graves-in-durango-may-set.html

New York granted permission collect excise on cigarettes sold on Native American reservations
A court granted a mechanism but the state supreme court delays it with a TRO. What is most interesting, though, is whether the lost grey market turns white or black. Unfortunately, that information will probably not be possible to sort out from the noise and time trend.
http://www.publicbroadcasting.net/wned/news.newsmain/article/1/0/1800934/WNED-AM.970.NEWS/Judge.Bars.Tobacco.Tax.Collection

B.C. Nurses Argue to Keep Insite Open
Insite, the safe injection facility in Vancouver, B.C., is still fighting to stay open, and local nurses have made to effort to support it.
http://www.vancouversun.com/news/decision-canada/court+decision+looms+nurses+argue+Insite+stay+open/4753900/story.html

Recent Readings in Tobacco Harm Reduction – week of 4 May 2011

By THR.o Staff

Must Reads

Mapping graphics illustrate WHO’s FCTC priorities
The World Health’s Organization’s Framework Convention on Tobacco Control (FCTC) is the world’s first health treaty. Isn’t it odd that it imposes the priorities of rich countries (e.g., lung cancer) on low-income regions that should have other public health priorities (e..g malaria)? A new graphical analysis illustrates the point:
https://smokles.wordpress.com/2011/05/03/what-these-maps-imply-about-tobacco-control-in-the-developing-world/

Worth Your Time

Charlie Sheen hired to tout e-cigarettes
The product name, “Sheen Safe Smoke”, is likely to trigger FDA prohibitions about health claims. One implication of this is that Glantz’s short reign, following Banzhaf’s retirement, as the most narcissistic person in anti-smoking has come to an end. Also, Sheen apparently still has to take smoke breaks despite puffing away on the e-cigarettes, so it is not exactly the best endorsement in the world.
http://www.dailymail.co.uk/tvshowbiz/article-1382270/Charlie-Sheen-unveiled-face-new-electronic-cigarette.html

Yes, it’s The Onion and, no, it is not really about THR. And yet…
“Pfizer Breaks Psychological Need To Always Seek FDA’s Approval”
“Pfizer spokesman Vincent Martin announced that the company had achieved a major personal breakthrough Monday by finally summoning the courage and confidence to overcome its need to constantly seek the FDA’s approval. ‘We’ve spent so many years fretting and obsessing over what the FDA would think of our new drugs, when all that time, the only people we really should have been worried about pleasing was ourselves,’”
Full satire: http://www.theonion.com/articles/pfizer-breaks-psychological-need-to-always-seek-fd,20298/
It worked for Star Scientific and Njoy. (Cue Sinatra: “…I did it my way.”)

Other THR

Tobacco Control‘s anti-e-cigarette broadside
At what point can a special-interest advocacy periodical/website no longer maintain the pretense that it is a scientific journal? This is not really worth reading for content, which consists of the same old boring incorrect anti-e-cigarette claims, but it is worth noting what the people on the tobacco control gravy train are being told they are supposed to think.
http://blogs.bmj.com/tc/2011/04/28/e-cigarettes-aren%E2%80%99t-a-solution-%E2%80%94-they%E2%80%99re-part-of-the-problem/

Some American youth apparently engaging in THR via pharma products
The authors seem oblivious to the possibility that “NRT” can be used for anything other than R and T, but they accidentally provide evidence of low-risk nicotine use in adolescents.
http://www.ncbi.nlm.nih.gov/pubmed/19819640

Are anti-tobacco extremists creating a “gateway” from low-risk products to smoking?
The “gateway” claim has always been a refuge for dishonest activists seeking to rationalize attacks on low-risk behaviors. While the evidence does not show that low-risk nicotine products are a gateway to smoking, if they were it would be due to the “they are just as bad for you” message from extremists. Restrictions on e-cigarettes are creating a market for less- or un-regulated nicotine-free versions, leading to claims (as in this story from Hong Kong) that these might cause smoking. While this seems unlikely where users have access to nicotine e-cigarettes, it is imaginable that prohibitions could create a path to easily-available cigarettes.
South China Morning Post

Siegel opines that reducing toxins in cigarettes holds no promise for harm reduction
Claims the available research invalidates this whole part of the FDA approach (does not mention similar thinking at WHO and EU) and suggests that tobacco companies know this.
http://tobaccoanalysis.blogspot.com/2011/05/sad-day-tobacco-companies-telling-truth.html
Nevertheless, there is new published research in the area almost every week, e.g.:
http://www.ncbi.nlm.nih.gov/pubmed/21519612

“Health promotion” activism remains mired in 1990s
An article in American Journal of Health Promotion calls for just doing more of the same tobacco control strategies that have already been played out. The greatest threat to THR (which they do not even mention) remains that this field is dominated by people who mistake “I do not understand why this does not work” for “this works”.
http://www.ajhpcontents.org.pinnacle.allenpress.com/doi/pdf/10.4278/ajhp.25.5.c1

Smokeless tobacco is cheaper, if price is the problem
A California man was arrested for a string of nicotine gum thefts. Since the thefts started last year, this is apparently evidence of off-label use for THR.
http://www.ocregister.com/news/-298953–.html

Related Topics

Junk science claim that ETS increases boys’ blood pressure
It is difficult to imagine a better example of bad epidemiology. The data shows higher blood pressure among children with the lowest second-hand smoke exposure, but by looking at only one subgroup (and ignoring the bizarre dose-response relationship), the authors spin it as showing just the opposite.
http://ep-ology.blogspot.com/2011/05/unhealthful-news-122-more-examples-of.html

Further evidence of smoking’s value for relieving PTSD
Too bad the authors insisted on spinning it as being about what creates a risk of smoking and not nicotine’s benefits, and implied that the relief was just a “belief” of those deluded smoking soldiers.
http://www.ncbi.nlm.nih.gov/pubmed/21523829

Chinese indoor smoking ban takes effect, but widespread disregard is predicted
http://www.latimes.com/health/la-fg-china-smoke-20110430,0,1092056.story

Meanwhile Chinese firm announces method for reducing nicotine delivery while keeping most of the health risk
It is not clear if market for reduced-nicotine products in China is created by anti-nicotine disinformation, as elsewhere, or if desire to smoke for social reasons is broader than desire for nicotine.
http://www.businesswire.com/news/home/20110427006390/en/China-Kangtai-Cactus-Announces-Consumer-Launch-Nicotine

Nepal planning new anti-smoking measures
Good news: the pictoral warnings will be implemented several months after other provisions, making analysis of their specific effect possible (if anyone is honest enough to do it). Bad news: I would really hate to be a merchant trying to enforce the provision banning sales to pregnant women (“are you saying I look pregnant?!”). Also, most harms from chemical exposures are worst before the mother is showing (still not known for smoking), so it boggles the mind how they would enforce this when it matters.
http://www.thehimalayantimes.com/fullNews.php?headline=Pledge+to+implement+anti-tobacco+bill+&NewsID=285485

Great quote re Greek PM getting WHO anti-tobacco prize for unpopular and unenforced smoking ban
“I am not sure that ‘political courage’ are words that describe the actions of a leader who follows a global health agenda at the expense of his people’s livelihoods and against their wishes.”
http://f2cscotland.blogspot.com/2011/04/world-health-organisation-honours-greek.html

Recent Readings in Tobacco Harm Reduction – week of 25 April 2011

By THR.o Staff

Must Reads

FDA concedes it must regulate e-cigarettes as tobacco products
US FDA yielded to the federal court order that required it to regulate electronic cigarettes as tobacco products rather than banning them as unapproved medicines.
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm252360.htm

Some commentators reported this as a huge victory for e-cigarettes, though it really just confirmed the victory already won in court. Our analysis of the situation was not as optimistic as some, noting there was little information about intentions and regulators can still interfere with the e-cigarette market in various ways if they choose. Here is our take on it, which links to commentaries by Rodu, Godshall, and CASAA, which include some marked disagreements:
https://smokles.wordpress.com/2011/04/26/fda-concedes-it-will-regulate-e-cigarettes-as-tobacco-products-the-devil-awaits/

The press coverage offered almost no insights.
http://ep-ology.blogspot.com/2011/04/unhealthful-news-116-yesterdays-non.html

Other THR

New Zealand Ministry of Health report includes pro-THR language about e-cigarettes
Characterizes e-cigarettes as “far safer than smoking”. Commentary by advocacy group with link to PDF of ministry report:
http://www.endsmoking.org.nz/ecigarette.htm

Smokers still find ST a good way to quit
Key result of new Minnesota study agrees with existing knowledge: smokeless tobacco products appeal to some smokers who are interested in quitting, with heterogeneity of preferences about different products. But due to the “give a man a hammer” problem, researchers continue to emphasize the relative popularity of products which is pointless (and probably meaningless given sample size and the artificiality of the situation). Imposing the medical model on consumer goods choice, rather than recognizing that the market will find a way to meet preferences, continues to produce silly research priorities.
http://www.ncbi.nlm.nih.gov/pubmed/21515003

But poor-delivery pharma products are still measurably inferior
Brad Rodu argues that a (different) small intervention trial provides further evidence snus is more satisfying than nicotine gum.
http://rodutobaccotruth.blogspot.com/2011/04/nicotine-delivery-and-satisfaction-snus.html

Ballin calls for unified policy across nicotine products
This position statement does not contain too much new information (though it has an interesting take on neutrality in the current about who is manufacturing something); its significance is that it is from one of the leading experts in the field, Scott Ballin. No apparent link to the original, but it was posted on a message board here:
http://www.vapersforum.com/showthread.php?t=30058

Iowa county proposes ban on dissolvables
Weeks after a state-wide ban died for the year, local anti-THR rule is fast-tracked. Perhaps just as harmful to THR, though more subtle, is apparent prohibition against marketing methods for encouraging smokers to switch like offering free smokeless tobacco sample with purchase of cigarettes.
http://thegazette.com/2011/04/21/tobacco-restrictions-proposed-in-linn-county/

An update on Oregon bill HB 3588, a bill to ban smokeless nicotine products.
Thad Marney of CASAA provides an update on this bill and the testimony he provided to the committee. The results sound fairly positive and it looks as though the bill may be dead for now.
http://www.casaa.org/news/article.asp?articleID=152&l=a&p

Related Topics

Latest from India
The talk in India about banning the local dip products (which is related to THR, but not really about since these products are not primarilly tobacco and seldom used for THR) continue to create a fascinating case study in tobacco policy.
http://ep-ology.blogspot.com/2011/04/unhealthful-news-111-black-markets-are.html
http://www.dnaindia.com/mumbai/report_ban-smokeless-tobacco-products_1534707

California students becoming hookah fans
A study found high school students found some interest in hookahs, perhaps reflecting consequences of the anti-industry rather than anti-smoke emphasis of anti-tobacco efforts. Half of student believe hookahs are safer than cigarettes, much more likely to be correct than the WHO, which says hookahs are 100 times as dangerous.
http://www.ucsdguardian.org/news/teenage-use-of-hookah-on-the-rise-cigarette-use-declines/

Canadian c-stores suffering from black market
A trade association study blames closure of 350 story in 2010 partially on four factors, including contraband tobacco trade.
http://newswire.ca/en/releases/archive/April2011/26/c6679.html

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

By THR.o Staff

Welcome to the second week of our new recommended reading / clipping series. Our goal is to provide a concise and organized weekly list of important readings for those interested in THR. We aim to provide enough information that someone just reading our headlines and summaries will understand the significant points of the stories, and can efficiently decide whether to follow the links.

We review many source of information to prepare this, but if you think there is something we have missed in the past or might miss next week, please send a suggestion.

Must reads” is a short list of readings that anyone who is serious about understanding THR should know about, though the summary alone may contain the must-know information. (Note that this week none of the stories fall into that category.) Worth your time” (we are open to suggestions for what to call this category) are amusing or otherwise edifying readings that are not “must reads” but seem inherently interesting enough to be worth reading. “Other THR” includes entries that those reading THR news for an hour should consider, listed in roughly descending order of significance. “Related topics” includes a few important stories related to THR but not about THR per se, particularly tobacco policy or research and other areas of harm reduction.

Must Reads

Nothing this week.

Worth Your Time

Tongue-in-cheek survey of e-cig users provides useful data
Social science research on e-cigarette use is lacking and the quantitative surveys done to date are not very informative, and as co-authors of the first such survey, we admit that. Our coauthor on that survey has collected free-text responses that are not just amusing but actually as good as most data collected on the topic.
http://www.ecigarettedirect.co.uk/ashtray-blog/2011/04/ecigarette-users-you-are-smarter-or-at-least-you-think-you-are.html

Other THR

Including e-cigarettes in a workplace smoking ban
The debate over whether e-cigarettes should be subject to some place-specific bans, like smoking, is just beginning. American e-cigarette advocates call for action to prevent a ban in a recent case:
http://www.casaa.org/CTA/article.asp?articleID=147&l=a&p

Good news about increased ST advertising
The authors, from the anti-tobacco extremist Legacy Foundation, presumably wanted to imply this is a bad thing, but their review of magazine ads for smokeless tobacco revealed a trend toward trying to recruit non-ST-users, particularly smokers, as well as an overall increase in ads.
http://ntr.oxfordjournals.org/content/early/2011/03/24/ntr.ntr038.abstract

Physicians understand little about THR
This article, purportedly a summary of the science for physicians but actually full of the usual anti-tobacco extremist disinformation about e-cigarettes and “third-hand smoke”, nicely (albeit painfully) illustrates how vulnerable medics are to disinformation about THR, which they often repeat as if they have expertise.
http://www.ncbi.nlm.nih.gov/pubmed/21475626

PMI e-cigarettes?
We have heard that Philip Morris International filed for international patents for e-cigarette technology this week. Unfortunately we are unable to identify any related documentation or discussion.

Engineering safer cigarettes
This topic gets little coverage in either THR or anti-tobacco publications, but it might actually generate more honest and practical science than either smoke-free alternatives or prohibitionism. A recent article by BAT researchers is a typical example of attempts at incremental improvement:
http://www.ncbi.nlm.nih.gov/pubmed/21501648

U.S. e-cigarette legal battle update
Katherine Devlin comments on a senior U.S. FDA official’s statement (which she characterizes as perjury) that only e-cigarettes bearing therapeutic claims were liable to seizure or had ever been seized. She reports on a pattern of continuing seizures (which she characterizes as contempt of court).
UKVapers.com

Students fume over “smoking” ban
University of Massachusetts students object to “anti-smoking” rules (which are really also anti-THR). It is good that university students can see through absurd claims that concerns about second-hand smoke justify anti-tobacco extremist measures.
http://dailycollegian.com/2011/04/14/students-should-fume-over-smoking-ban/

Any e-cigarette publicity is good publicity, for now anyway
Charlie Sheen is boldly using e-cigarettes, which yields a lot of publicity. The entertainment press seems to overestimate the industry, however, referring implying greater organization and product maturity than currently exist.
http://www.contactmusic.com/news.nsf/story/e-cigarettes-bosses-thrilled-to-have-chain-smoking-charlie-sheen-onboard_1212866

Uninformative Japanese study of e-cigarettes
This poorly-designed study could only confirm the already-known lack of major adverse events, but we included it because of this: “Each participant was asked to consume one filter cartridge per day (more than 150 puffs per day) for 4 weeks.” Japan seems to have very reasonable human subjects rules (most committees in Anglophone and European countries would reject a protocol that asked participants to consume a minimum amount of a “dangerous” substance, even if it was a huge improvement over the cigarettes they would otherwise smoke) and so might be a good place for future THR research.
http://www.jstage.jst.go.jp/article/seikatsueisei/55/1/55_59/_article

Related Topics

Further evidence that claimed miracle effects of smoking bans are junk science
It has long been clear that advocates of smoking bans in pubs and other venues have cherry-picked the data to imply that bans have miraculous effects on population health, immediately reducing heart attacks and other diseases by huge amounts. A study from RAND confirms that when the data is considered in an unbiased way any benefits become undetectable, as any realistic assessment would predict.
http://www.ncbi.nlm.nih.gov/pubmed/21465828

Prohibitions and taxes make smuggling an increasingly tempting alternative to working in THR
Serious-sounding calls for banning dip products continue even as the ban on plastic sachet packaging has already created a flourishing black market.
http://ibnlive.in.com/news/ban-on-gutka-smokeless-tobacco-products-soon/149076-3.html
http://timesofindia.indiatimes.com/city/mumbai/Defying-SC-order-illegal-gutka-business-thrives/articleshow/7967290.cms
In the U.S., violent criminals are reported to be taking over the cigarette black market.
http://www.usatoday.com/news/nation/2011-05-02-atf-cigarette-smuggling.htm?csp=34news
East African cigarette smuggling shows the absurdity of FCTC supply interdiction requirements.
http://tobaccocontrol.bmj.com/content/20/3/226.abstract

Concern that FCTC interferes with African development goals
FCTC requirements are at odds with an American program to help develop trade that benefits some of Africa’s poorest countries (story from Zambia).
http://allafrica.com/stories/201104070071.html

More evidence of nicotine relieving psych problems
It is a bit buried in the details, but the bottom line from this new study is that nicotine, from pharma products, relieves symptoms of severe schizophrenia. Sadly, the subtext is still, “we obviously have to force psych patients to stop using consumer nicotine products, so should we maybe consider letting them have nicotine patches and gum?”
http://www.ncbi.nlm.nih.gov/pubmed/21245085

Safe injection site cuts drug overdose deaths
A study estimates that Insite, the safe injection house in Vancouver, has cut drug overdose deaths in the area by 35%.
http://www.reuters.com/article/2011/04/18/us-drug-facility-idUSTRE73H34V20110418

Recent Readings in Tobacco Harm Reduction – week of 13 April 2011

By THR.o Staff

Welcome to our new recommended reading / clipping series. Our goal is to provide a concise and organized weekly list of important readings for those interested in THR. We aim to provide enough information that someone just reading our headlines and summaries will understand the significant points of the stories, and can efficiently decide whether to follow the links.

Must reads” is a short list of readings that anyone who is serious about understanding THR should know about (though the summary alone may contain the must-know information). “Worth your time” (we are open to suggestions for what to call this category) are amusing or otherwise edifying readings (or in today’s case, a video) that are not “must reads” but seem worth the time. “Other THR” includes entries that those reading THR news for an hour should consider, listed in roughly descending order of significance. “Related topics” includes a few important stories related to THR but not about THR per se, particularly tobacco policy or research and other areas of harm reduction.

Must Reads

BAT launches Nicoventures
British American Tobacco has created a separately-managed, wholly-owned company called Nicoventures Ltd., with “the aim of providing adult smokers with a variety of non-tobacco based options which would offer the same experience as a cigarette without the real and serious health risks of smoking.”  No details about their product plans are yet available.
http://www.industryleadersmagazine.com/british-american-tobacco%E2%80%99s-new-tobacco-free-nicotine-nicoventures/

Rodu calls on American Cancer Society to be honest, release data
ACS has long had epidemiologic data about Americans that clearly shows how much lower risk smokeless tobacco is compared to smoking.  However, they have demonstrated consistent unethical behavior in the area, cooking their publications to hide the value of THR (though a careful reader can find the truth) and have refused to release the data to other researchers or perform the requested analyses that would demonstrate the truth.
http://rodutobaccotruth.blogspot.com/2011/04/american-cancer-society-withholds.html

Rodu debunks classic “gateway” paper
Both Rodu and we have written versions of this before but this is a particularly useful debunking of the Haddock (2001) study of Air Force recruits in which the author manipulated his data to support the claim that smokeless tobacco is a “gateway” to smoking.  One thing that was mentioned by Rodu in this is that the most useful scientifically-legitimate information from that study (which we often cite) is that ST use is associated with a constellation of risky behaviors which it obviously does not cause.
http://rodutobaccotruth.blogspot.com/2011/04/smoking-gun-manipulating-definitions.html

Tobacco has highest profile ever at International Harm Reduction Association (IHRA) conference
The Beirut conference saw three sessions dedicated to tobacco as well as a talk in the closing plenary session by Carl V. Phillips.  There was strong support (including from long-time harm reduction leader Ernie Drucker who spoke at two sessions) but also some fierce resistance to adopting this topic as part of the “traditional” harm reduction community.  It remains difficult to predict how that will play out.
(links in two entries below)

Worth Your Time

IHRA film festival includes short file about THR
This ESTOC-sponsored short film does a wonderful job of summarizing the case for snus-based THR.  Scientific facts and an interview with Prof. Michael Kunze are embedded in amusing graphics and great pacing.  (Question to our readers:  We believe we were the first ones to really start pushing seatbelts as the best metaphor for THR, as done in the film, rather than condoms or needle exchanges.  Drop us a note to us or THR historian Chris Snowdon if you can support or dispute that belief.)
http://www.youtube.com/watch?v=X5zCMKW3jOg

Other THR

World Medical Association vows to step up campaign against smoking by banning low-risk smokeless alternatives
We are not kidding.  That is really what they said – and it was well after April Fools Day.
http://www.voxy.co.nz/health/world-physicians-intensify-campaign-against-smoking/5/87524

Talk from India about banning dip products (tobacco and other substances)
This will probably just turn out to be cheap talk about an absurd proposal, but there is an engineered campaign going on this week with coordinated calls for a ban being made to look like coincidence.  While this seems mostly to be posturing to set up future action, it is possible action could be taken soon if the government and WHO talk themselves into a corner, so it is a good time to invest in organized crime in India.  Not surprisingly, there is apparently no discussion about trying to move Indian products toward being as low risk as Western smokeless tobacco.  (Then again there is also no discussion of the science and that, contrary to the definitive Accepted Official Propaganda, there is not really very solid epidemiology about Indian products being so much more unhealthy.)
http://www.hindu.com/2011/04/13/stories/2011041359752200.htm
http://ibnlive.in.com/news/ban-on-gutka-smokeless-tobacco-products-soon/149076-3.html

E-cigarette company scams customers
Though this says nothing more about the quality of the product category than any other retail scam, look for this to enter the boilerplate attacks on e-cigarettes by anti-harm-reduction activists and regulators.
http://www.10tv.com/live/content/consumer10/stories/2011/04/07/story-columbus-e-cigarettes-trial-offer.html?sid=102

More about IHRA

TobaccoHarmReduction.org demonstrated low-risk alternatives to smoking every day at the conference’s new “demonstration space” (photo).  Recordings of some of the major talks will become available online soon and we will post links.  In the meantime, two participants blogged about it:
http://velvetgloveironfist.blogspot.com/2011/04/give-psychotic-drug-to-mentally-ill.html
http://ep-ology.blogspot.com/ (see entries for Unhealthful News #93-98)

Survey shows role of smokeless tobacco in retailer revenue
The Swedish Match-sponsored study (released as a conference report only so far) found “Moist smokeless tobacco (MST) accounted for 6% of tobacco revenues in tobacco shops, and 9% in c-stores.”  (Context suggests this refers to American retailers, though this was not stated.)
Convenience Industry News

Vaporcast (podcast) interviews Jonathan Foulds, Carl Phillips and Bill Godshall from Philly Vapefest
These interviews were conducted at the gathering of e-cigarette enthusiasts sponsored by National Vapers Club (a biannual event), Philadelphia, March 25-26 (audio only – no transcripts).
http://vaporcast.com/audio_files_smbl/VaporCast%20-%20VapeFest%20Philly%20Volume%202%20-%20Health.mp3

Further evidence that smokers have been misled into thinking that nicotine is the problem
A study published in the journal Addiction was primarily a sketchy study of smokers’ perceptions of packaging colors, but it also reported this deadly (because it prevents THR) misperception.
https://smokles.wordpress.com/2011/04/12/new-study-shows-that-smokers-are-misled-by-erroneous-information/

Iowa legislature rejects severe restrictions on dissolvable low-risk tobacco products
http://www.dailyiowan.com/2011/04/01/Metro/22541.html

Related Topics

New tobacco myth gains traction: Hookah smoking is 100 (or 200) times more hazardous than cigarettes
However, amusingly, the same actors touting that claim also claim that hookah smoking might be a gateway to cigarettes. Wouldn’t that be a huge harm reduction, given their risk claim? It is showing up in the popular press (e.g., Long Island Press). It seems to trace to a WHO report (note: large pdf file). For comments and debunking of some such claims:
http://ep-ology.blogspot.com/2011/04/unhealthful-news-97-my-favorite-new.html
Science Topics
http://ije.oxfordjournals.org/content/39/3/834.abstract

Pharmacokinetic study shows snus delivers nicotine a bit better than gum
http://www.ncbi.nlm.nih.gov/pubmed/21454913

Placebo-controlled study of smoking measures benefits of nicotine
http://www.ncbi.nlm.nih.gov/pubmed/21463067

Siegel calls for removing Chantix from the market as too dangerous
http://tobaccoanalysis.blogspot.com/2011/04/rest-of-story-calls-for-removal-of.html

Study shows youth smokers prefer same brands as adults, contrary to “starter product” hypothesis
http://www.observertoday.com/page/content.detail/id/557706/Established-youth-smokers-choosing-same-brands-as-adult-smokers-report-concludes.html

County health board proposes regulations on smoking in movies
Not a very important story, but is there really anyone who does not think the pendulum has swung too far to one side when local public health authorities presume to constrain free expression in mass communication because they just do not like smoking?
http://www.thepeterboroughexaminer.com/ArticleDisplay.aspx?e=3074917

Comments to FDA re graphic cigarette labels by TobaccoHarmReduction.org

We recently submitted comments to the FDA regarding their proposed graphic “warning” labels on cigarettes.  Our comments can be downloaded here.  We have been doing research on graphical warnings, so think we have a few useful comments on the topic, particularly that the proposed graphics are not actually warnings.  As background, the FDA page about this is here and the most relevant bit (the actual proposed pictures, which we refer to in our comments) is here.

Tobacco Harm Reduction 2010: The Book

Our new book, Tobacco Harm Reduction 2010: a yearbook of recent research and analysis, is now available for public download; see its home page at our website for details ; please use this blog entry as a home for any comments you have about it.