More Chicken Little from Alberta Action on Smoking and Health

Today in the Edmonton Journal (Flavoured products a blatant ploy to target youth, Alberta anti-tobacco group declares) Keith Gerein wrote

New survey results indicating large numbers of Alberta teenagers are hooked on flavoured tobacco products is evidence enough that the province should immediately ban the items, medical professionals and advocates said Tuesday.

The supposed source for this statement was Health Canada’s 2010-2011 Youth Smoking Survey. To wit

Among youth who had ever tried smoking a cigarette, 30% (about 218,000) had used at least one flavoured tobacco product in the last 30 days, compared to only 1% (about 29,000 ) of youth who had never tried smoking a cigarette.

In my lexicon hooked is not quite the same as having tried something once in the last 30 days. Nor does this seem to be much of a problem if only 1% of non smokers try them (again maybe no more than once in the last 30 days).

Since smokeless tobacco, which as most who read this blog know, is about 99% safer than smoking, you can argue that 1. anytime those people who would have smoked used smokeless instead it was a good thing and 2. there is a chance that someone who might otherwise have become a smoker gravitated towards smokeless instead and ended up with the much less harmful habit. Of course no one wants the kids do be doing any of this – these are toys for adults.

One real problem with this survey is that the flavoured tobacco category conflated smokeless tobacco with menthol cigarettes and flavoured cigars. Considering the vast harm differences between inhaling and not inhaling smoke it would be no different than having a category consisting of e-cigarettes and menthol cigarettes together.

I suspect that Gerein did not read the survey which would have lead to quite a different sort of headline since the findings are that smoking (and marijuana and other drug use, and alcohol use) declined for all the groups. Isn’t that headline worthy? We can’t tell about smokeless tobacco since this was the first time that use was polled.

The language throughout the article suggests it was cobbled together from a press release from Les Hagen given the antiquated but incendiary cliches the anti-nicotine groups like to use. “Fruity spit tobacco” leads off the old argument that tobacco companies are targetting youth through the use of flavours. I have always found the implication that adults don’t like flavours odd. Humans like flavoured products. In fact, one of the things a lot of adult smokers found quite attractive about e-cigarettes, and sealed the switch, was the variety of flavours.

According to the article the most commonly used flavoured tobacco product by Alberta youth were cigarrillos. This seems to occasion a ban on flavoured tobacco products in general (again lumping them with the vastly different smokeless products). The real worry then from a harm reduction perspective is that flavoured smokeless tobacco has been gaining popularity as an alternative for smokers, and as a cessation aid. As the case is with e-cigarettes, once you introduce an effective and satisfying alternative to smoking, if you then remove it, you are then encouraging people back into a riskier lifestyle choice.

If we are going to ban something, why not ban groups from using public money (money from you and me) to agitate for removing healthier alternatives from the market?

Finally, the Health Canada report found that almost all youth obtained their products through social sources. In other words these products are not being sold to minors. I worry that if kids start liking Pernod even if they all get it from their parents that high minders will argue that it should be removed from liquor stores.

On a lighter note, the SAIT student paper had a nice little article by Sarah Pynoo – Health Canada’s E-Cig restrictions deserve to go up in smoke.

As for the criticism that cigarettes could lead towards children and young adults getting hooked on actual cigarettes, it seems a bit silly. For one thing, while both regular cigarettes and e-cigarettes have a variety of flavours, both are only available with ID to those over 18. Also, it’s pretty hard to imagine a kid getting hooked on candy-flavoured, nicotine-free vapour, and switching over to the harsh, lung-burning alternative of an actual cigarette.

Even professional harm reduction workers have issues with tobacco harm reduction

Ask any doctor what they would recommend if a patient of theirs who felt compelled to use a drug with proven health risks asked whether it would be better to take another drug which made them feel exactly the same but was a lot safer. Odds are the doctor would suggest switching.

Now ask them about smoking and e-cigarettes and the answer might change.

Though many doctors are coming around the health community as a whole is still experiencing a bizarre disconnect when it comes to nicotine. You can’t even call it cognitive dissonance because they don’t seem to experience any anxiety from endorsing harm reduction in general while rejecting it when it applies to smokers.

A few years ago at a small meeting held at one of the conferences of what used to be called the International Harm Reduction Association I witnessed a similar occurrence which given the context was even more disturbing. The meeting had arisen due to certain influential elements within the organization who wanted to eliminate tobacco harm reduction from their community.

It was very strange to see individuals who had supported safer sex, safer drug injection practices, and safe injection sites, practically foaming at the mouth at the thought of promoting tobacco harm reduction. One of the central objections was that one avenue of harm reduction, smokeless tobacco, was produced by tobacco companies, and these same people who would, if it improved the likelihood of safer practices, collaborate with drug producers and dealers, with difficult anti-democratic bureaucracies, and with pimps, would rather cut off their own hands than join with tobacco companies to find a solution.

When the people who are on the front lines of the battle reject what should be contiguous with their own goals (reducing the harm in risky practices) you have to be concerned about the average public health official.

I don’t want to be entirely negative here. I believe the tide is turning and to a great degree because e-cigarettes arose independently of the tobacco companies. However the companies are buying into the e-cigarette market and you can expect the objections to increase in number.

Most of these objections will be of the “just a way of maintaining nicotine addiction” nature. But guess what – along with the independent e-cigarette companies these “evil” folks are taking pretty well all the harm out of using nicotine. The addiction was never really the issue.

The anti-nicotine forces like to promote the idea that there is something special about smoking, nicotine and tobacco companies.

Not so.

Smoking is just another popular behavior with some safer satisfying alternatives available. Nicotine is just another drug like caffeine that feels good enough to make a difference but not so good that it disrupts the rest of your life. And tobacco companies are no different from any other large corporations that will do anything to keep customers.

Two ways in which vaping will clear more than just the air

(I would like to thank Char from VapeMate for bringing the podcast to my attention.)

I’ve just finished listening to a CBC podcast: The rise of E-cigarettes: Helping to quit or encouraging to smoke? It was oh so fairly moderated and presented opinions from various Edmontonians, a smoker turned vaper, an owner of a non-nicotine e-cigarette company and a London Drugs pharmacist, as well as an non-smokers rights activist from Ottawa. The interview with the pharmacist from the local stringer was the only place where the media side seemed to be a wee bit rabid about the affair.

Other than the ex-smoker there seemed to be a strong agreement that nicotine is the devil’s tool, that we need big randomized control studies before we let people near the nicotine e-cigs, and that the only goal worth pursuing was ridding the world of nicotine with only the faintest nod in the direction of improving public health. In fact one of the greatest howlers was when Melodie Tillson of the Non-smokers’ Rights Association described herself as part of the health community. This from someone who is fighting tooth and nail to keep e-cigarettes out of the hands of smokers. (By the way, superlative examples of those big trials exist showing how ineffective nicotine replacement therapies are, not to mention how dangerous Champix is, and given the ringing endorsement of these as “proven cessation therapies” I hate to think what kind of evidence would be needed to get e-cigarettes approved.)

But I diverge.

This reminded me of something I have been thinking about for some time and that is once you remove any substantial health risk from using nicotine (as in vaping or using smokeless tobacco) it will cease to matter whether or not you use nicotine. It would be like the old days where whether someone was a smoker or not did not imply anything about their character and it certainly was not a sufficient reason for barring them from employment.

And once whether you use nicotine or not ceases to matter, then quitting becomes moot.

So back to that article subheading: helping to quit or encouraging to smoke? It doesn’t matter. (Of course if they mean many vapers for reasons that only make sense to tobacco control advocates would drop their relatively safe habit for one with proven health risks, which stunk up their clothing and breath, caused them to hack, and which would make them (at least in Canada) stand outside alone in the cold just to get their nicotine. Isn’t that a little like discouraging people from using seatbelts because using them would make it more likely that they would want to drive without them?

But before I use up the typical online reading patience let me present point two.

Once we have finally driven home the point that nicotine and the health effects associated with inhaling burnt matter are two different things then research on nicotine itself can move forward.

Its no secret that whenever a substance or a plant has negative connotations it is difficult to get funding unless you are exploring the negative potentials. We can then do the same studies we do with caffeine or alcohol. We’ve already gotten hints that nicotine might be useful in the treatment of Alzheimer’s, Parkinson’s and ulcerative colitis. For all we know nicotine users might be better off in the long run than abstainers.

Once we finally get it that nicotine is a safe enough drug which a lot of people seem to get a lot of benefit from and that burning tobacco is one of the worst ways to go about getting it and once public health gets it as well, that the focus should be on health and not about whether someone is holding a tube to their mouth inhaling and then blowing something out, once we all get that then we can dismiss it as yet another interesting thing that a lot of people like to do and then we can move on to more important issues.

There’s more elephants in the room or on contemplating the new user red herring.

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.)

World No Tobacco Day 2011

World No Tobacco Day is soon upon us and I thought it might be useful to translate the original press release to reflect the real world implications of the FCTC treaty.

Some of us will be following this up with a blog post or two on how this treaty helps to maintain high levels of smoking-related disease. We do have a bit of a soft spot for this particular date since we launched our website, TobaccoHarmReduction.org on this day five years ago specifically to respond to WHO’s statement/position that all tobacco was equally harmful. In fact, locally we got more press on that day than WHO did for that year’s No Tobacco Day. (Assuming that they ever learned to swim in the first place, could they already have been jumping the shark?)

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The WHO Framework Convention on Tobacco Control (WHO FCTC) is the world’s foremost tobacco control instrument (hammer). The first treaty ever negotiated under the auspices of WHO, it represents signal achievements in the suppression of harm reduction and also in the oppression of all nicotine users regardless of whether or not such use has health consequences. In force since 2005, it is already one of the most rapidly and widely embraced treaties in the history of the United Nations, with more than 170 Parties. An evidence-unencumbered treaty, it reaffirms the right to restrict all nicotine users to only the most dangerous form of delivery and provides new legal tools to strengthen abstinence-only policies and wage a war on tobacco.

World No Tobacco Day 2011 will be designed to highlight the treaty’s overall self-importance, to stress signatories’ obligations under the treaty and to promote the essential role of the FCTC and WHO in demanding that countries meet those obligations.

Countries will be expected to obey the WHO FCTC as much as, if not more, than it did in 1996 when a resolution calling for this treaty was first adopted. Preventing tobacco use is the priority of this treaty. This year, thanks in part to FCTC efforts in obstructing access to safer alternatives, more than 5 million people will die from a smoking-related heart attack, stroke, cancer, lung ailment or other disease. That does not include the more than 600,000 people – more than a quarter of them children – who we will claim will die from exposure to second-hand smoke (according to the studies we prefer to accept).

As with any other treaty, the WHO FCTC confers legal obligations on its Parties – that is, on the countries (and the European Union) that have formally acceded to it.

Among these obligations are those to:
• Prevent public health policies from embracing harm reduction options.
• Adopt price and tax measures to strengthen the black market.
• Foster intolerance to even negligible exposure to tobacco smoke.
• Prevent safer (smokeless) tobacco products from being promoted as any more appealing than cigarettes.
• Work to eliminate any additives or processes that make any form of tobacco use pleasurable.
• Prevent any packaging information describing one tobacco product as safer than another.
• Nag people about the dangers of tobacco use.
• Promote and subsidize pharmaceutical products to smokers.
• Complain about the illicit trade in tobacco products created by our other actions.
• Ban sales (that are already banned) to and by minors.
• Pretend to support economically viable alternatives to tobacco
• Ignore that for in some economies tobacco is the most viable crop.

The treaty also recognizes the importance of international coercion in forcing low- and middle-income countries to meet their treaty obligations. The campaign will focus on the following key message: that countries must fully implement the treaty even if most of the early mortality in those countries has other causes and even if implementing this treaty will deplete funding initiatives addressing those concerns.

Other key messages will include:
• The treaty embodies the desire and commitment of many anti-tobacco organizations and thousands of activists to have a tobacco- and tolerance-free world.
• Individuals should encourage and help their governments in their own oppression.
• The treaty should be duly appreciated by institutions and individuals alike as a landmark in the history of demonizing a plant and drug rather than addressing the variable health consequences of the delivery methods.
• WHO and the FCTC stand ready to browbeat countries into meeting their obligations under the treaty and its related guidelines.

The treaty has already proved its efficacy in political posturing and selling the concept of prohibition to the general public. In itself a success, this treaty has already formed a template and inspiration to globally address other public health issues such as alcohol consumption and inexpensive convenience foods. Nevertheless, more must be done for the treaty to reach its full potential. At their recent meeting in Uruguay, the Conference of the Parties urged all countries to progress beyond outmoded conceptualizations of public health and individual welfare and to adopt its guidelines instead. Furthermore, they reaffirmed their commitment to prioritize the implementation of intolerance designed to control and demonize non-pharmaceutical nicotine consumption.

On World No Tobacco Day 2011, and throughout the following year, WHO will urge countries to put the treaty at the heart of their efforts to control the global spread of effective harm reduction and the threat of low risk nicotine consumption.

By bowing to WHO’s call, countries will enhance their ability to significantly reduce any harm reduction efforts, maintain the high burden of smoking-related diseases and deaths to keep the FCTC viable, and to remove the possibility of safe nicotine consumption.

It’s Official: No More DuMaurier Snus in Alberta

There have been more than a few moments in the last little while where I’ve been nearly inconsolable in my disappointment in the actions of my Canadian government.  One of those moments was when Health Canada peremptorily banned the e-cigarette.  Another was when my friend told me that he had tried to buy duMaurier snus (the only Canadian brand of pouched moist snuff available in my hometown of Edmonton, Alberta) at a major convenience store and was told they were no longer stocking it (Carl wrote about this here).  And yesterday, I learned from two different major convenience store chains in Alberta that not only were they not stocking it anymore, but duMaurier snus had been discontinued.  I could find no official announcement by the manufacturer, and I frankly found it surprising that they decided to discontinue it altogether; could the product really be losing that much money on an ongoing basis (beyond the initial costs, which I realize were great, but they are sunk now) that it was worth completely abandoning?  Especially in light of how Camel snus is taking off in the States, it was a surprise to me.

But then again, maybe it shouldn’t be that surprising.  As Carl has already written about in the above linked posting, a big part of the reason for why duMaurier snus was doomed inAlbertais because of the local anti-THR forces who ramped up their anti-smokeless campaign (which occurred after Carl set up shop at the University of Alberta where he and Paul started TobaccoHarmReduction.org).  Carl has described how the local government and NGO anti-tobacco people basically redirected all of their efforts from being anti-smoking to being anti-smokeless-tobacco after he started educating people there about THR.  The first of two fatal blows to duMaurier snus was the ban on all point-of-sale information (so smokers had no way of learning there was something else they might buy).  The second was an increase in taxes on smokeless tobacco that made duMaurier snus – formerly a relative bargain that might encourage smokers to switch – basically as unaffordable as cigarettes (at about $11 per pack). Restrictions on marketing (which were essentially anti-free speech laws) came into play, and it became impossible for Imperial TobaccoCanada (who introduced the snus) to communicate with their customers anything about the relative risks of their new tobacco product.

It is worth reiterating here Carl’s point about why the anti-tobacco activists were motivated to do these things: because if people found out about the low-risk THR products, they would quite logically start to use them more, and this would undermine the activists’ goal of universal abstinence from all nicotine (regardless of how low its health costs might be). Low-risk nicotine use would undermine the justification for their enormous salaries. In other words, the existence of duMaurier snus (and our group) in Edmonton threatened the existence of the anti-tobacco activists.

Unfortunately, those activists had about 100 times the resources we did, and with Imperial Tobacco basically muzzled, there was very little we could do to counteract the mass media campaign they waged against our group and duMaurier snus.  So it is not very surprising to find that it has, now, officially been killed in Alberta.  I guess congratulations are in order to the Alberta government and anti-tobacco activists, in their victory over public health, and in protecting the cigarette market from competition.

My disappointment yesterday was pretty great.  I generally buy snus online (since the taxes on the local snus successfully drove me away from that product – again, congratulations Alberta government), but occasionally I do use the local product when I run out of my shipped-in snus.  I have convinced many of my friends and family who smoke to use that snus, and I suddenly felt like because some rich activists in an ivory tower somewhere, with goals of purifying people’s behavior rather than improving their lives or health, decided to thwart our desire for better public health, we now have to accommodate them.  Our real life choices have changed for the worst because of them.

Now, there was briefly an unchecked thought that popped up from my subconscious that considered buying a pack of cigarettes instead, but it was vetoed before it took much form, because – as I’ve previously written – I simply don’t enjoy smoking.  However, the story is quite different for at least one of my friends – a former smoker – who has already switched back to smoking whenever he can’t find snus.  I wonder how many others this will have affected in that way as well.

[A note to readers: There are still many smokeless tobacco products available behind the counter at convenience stores, but these products tend to not have the mass appeal that Swedish-style snus seems to have.  They have not been marketed as THR products in Canada, nor do they seem to have made any inroads in that area.  It is important to note, however, that – being smokeless – it is still almost as good as quitting smoking entirely to switch to these products.]

-Catherine M. Nissen

What these maps imply about tobacco control in the developing world

I ran across a fascinating resource (Worldmapper.org) which maps various health outcomes onto regions of the world and thus produces a global picture which when compared against the typical map indicates imbalances or concentrations depending on your outlook.

This first map is one of prostate cancer deaths; that is, a cancer unrelated to smoking history. What you notice is that Africa roughly approximates its shape on a typical map.

Now take a look at lung cancer deaths ( see map below).

What you see in an Africa attenuated to the point of almost disappearing. Not of course if you look at something like malaria (again see map below).

This of course is quite a simplistic observation to make with just a few specifically chosen maps but I think the point is valid. When the FCTC targets regions like Africa and asks (demands) that health resources be used for tobacco control operations, the money that would make a difference if applied toward malaria (or countless other endemic diseases …see more maps on the site), that would save many lives, is funnelled off into satisfying political aims with little effect on mortality.

Australia – taking the team gold in the tobacco control olympics

Thinking back on grade school, I remember being quite miffed that Canada was the world’s 2nd largest land mass (2nd?? that damned Russia!!). But for this country, 2nd in anything was pretty unusual. And there are things you really don’t want to lead in. There is no pleasure in being the world leader in oppression of any kind though some of my fellow citizens seem to think it a good thing to be first in tobacco control. But even if we actually once were the world leader in that, we would have to cede that coveted spot by a large margin to Australia.

Canada might have been early in banning electronic cigarettes but Australia was first. And to add insult to injury, Australia has also banned that evil smokeless tobacco which is still quite available in our fair country. Not to mention that what used to be considered a free and wild country is also pushing forward on plain packaging.

It is quite fitting that Australia was the setting for this year’s World Medical Association conference and that one of the keynotes was a call to extend bans on smokeless tobacco products (led by Ardis Hoven, chair of the American Medical Association). It is not fitting that a medical group advocated removing the available safer alternatives to a common risky practice when in every other field they would vehemently argue the need for harm reduction. You can bet that almost every member of that organization would support methadone treatment.

So it will be another confusion of concerns when the newly named Harm Reduction International meets in Adelaide in 2012. While it is not certain whether we will attend or not, if we do, we will be presenting about products that are banned in that country. We will not be able to do the same demonstrations of those products which ended up being one of the highlights of the Beirut conference. And Aussies seemed to form a high proportion of the most intrigued participants in our sessions; they were intrigued at learning about some practical solutions to smoking related harm and then depressed since their government had made a point of banning those solutions.

You’d think that as a former penal colony, the Land Down Under would be a little more sensitive to encroachments on personal freedoms but perhaps its a case of former prisoners missing being ordered about. Whatever the reasons, Australia is determined to be world leader in tobacco control and I suspect that Britain should be concerned lest the colony turns its gaze onto the next logical target and threatens Britain’s lead in demonizing and criminalizing alcohol consumption.

In some ways, attending Adelaide would bring our group closer to approximating the experience of the many individuals who work with illicit drugs with the difference that typically the risky behavior is illegal but the safer alternatives are not only legal but available, actively promoted and often subsidized.

-Paul L. Bergen

Iowa more worried about candy than cigarettes

While not the full out bans being pursued in Utah and Washington, Democrats in Iowa are working hard to have retail restrictions to be placed on dissolvable tobacco products.

This is still a flavor motivated action as indicated on the Iowa Senate Democrats page. This is really quite the “wonderful” article; more misinformation per sentence than can usually be found, and worth addressing paragraph by paragraph.

However to fully make sense of some of this document it might be useful to present some of the expert input they relied on to get the real background on the issue.

Senator Mary Jo Wilhlem meets with Asa Shorkey and Claire Meyer, two children concerned about candy lookalikes that are loaded with nicotine.

I don’t see any of that tasty fruity, mint or cinnamon Nicorette on the table nor do I see flavored Viagra (orange, pineapple, banana, orange, or strawberry) but they could be behind the tic tacs. Also notice that these children are concerned about products they have no legal access to. Perhaps the good senator did not explain to the children that thanks to existing laws they would never come face to face with these products unless they circumvented those laws. Which raised the question of whether we may in fact have evidence of a crime in progress: flouting the laws she herself has sworn to uphold, the senator is exposing minors to products they otherwise not gain access to.

But on to the article:

Did you know that there are new nicotine products being sold here in Iowa that look like candy, smell like candy and taste like candy?

Given the demographics of our expert panel, pre-pubertal youths and politicians, of course they would pick what they are most familiar with as a reference point – candy. Anyone else might express this same exact sentiment as ” Did you know that there are new nicotine products being sold here in Iowa that look appealing, smell good and taste good?”

This is more of that usual nonsense implying that us adults do not want things we put into our mouths to taste good. I, for one, prefer a richly flavored and natty looking dissolvable tobacco lozenge to a bland gray pill, and tobacco companies know this. They need to attract adults to their product if they hope to make a go at it. But these Democrats must be visitors from another planet where children and adults are members of separate species with differing ideas of what tastes good.

But the anti-candy flavor argument which have no truck with anyone who possesses taste buds somehow tends to carry the day.

These nicotine-spiked products come in strawberry, banana and grape flavors to appeal to kids. Eating multiple tablets could cause vomiting, seizures or death.

Nicotine-spiked are they? This implies that these were originally candy products that were then “poisoned” rather than nicotine products that were then flavored. So with flavor now established as sufficiently evil, let’s turn it up a notch and throw in the risk, nay the certainty, of poisoning. Kids will be attracted to these and they will die. This particular unfounded panic, like the unfounded 3rd hand smoke panic, can be traced back to Pediatrics Journal (like Cassandra a doom sayer, but unlike Cassandra, believed more often than not).

I have no doubt that it is possible that eating too many nicotine tablets could lead to many adverse affects (but if we judged products by how they were abused whether by people taking too many or worse, very few products would remain available; Nicorette certainly would not.)

Even before these new products came on the market, tobacco poisoning was a problem. Between 2006 and 2008, the nation’s poison control centers received more than 13,000 reports about the ingestion of tobacco products by children under 6, according to a study that appeared in the journal Pediatrics in 2010.

Nicotine products are associated with some fatalities, but it might interest you to know that since 2004 there has not been a single death associated with nicotine or tobacco, and in 2003 the one related death was from ingesting a pharmaceutical nicotine product (see the AAPCC reports here).

In fact, the focus on smokeless products is rather odd considering how rare it is that children will ingest them. The just over 300 events a year are about half the number of people that are struck by lightning each year. Of course the lightning has more severe consequences with about a 10% fatality rate.

In general children prefer plain old cigarettes, eating them at about ten times the rate they do smokeless products. (The cigarettes are not flavoured so one could argue that the flavourings of smokeless products might actually make them less appealing to children given the distribution of events). To be fair, cigarettes are far more common than smokeless products and thus more likely to be found around the house. (Kids end up poisoning themselves more with quite a wide range of non-candy flavored products).

(As an aside: this whole report implies that this is a new threat. Though a wider range of products have recently hit the shelves, flavored smokeless products are not new. They have been for a long time and if they truly were so threatening we would already have a good history of child poisonings. We don’t.)

With tobacco companies finding new ways to target our kids, Senate File 154 would limit the sale of dissolvable tobacco to tobacco stores where children are not permitted.

On first consideration, the action itself does not sound unreasonable. What could be bad about limiting the sale of these tobacco products to tobacco retail outlets? Nothing at all. Except, as far as I can tell, this rule does not apply to cigarettes or any other tobacco products. So what you have is a regulation that will limit the purchase of safer alternatives to just a few locations which you can interpret either as an impediment to people trying to use safer forms of nicotine or as protecting cigarette sales. It certainly has no effect on children’s access since they are not allowed to purchase them anywhere.

The aggressive marketing we’re seeing from big tobacco companies underscores the need to protect Iowa’s successful tobacco-prevention and cessation efforts, including JEL (Just Eliminate Lies) and Quitline Iowa.

It seems a real concern is that the possible success of these alternative products could put the tobacco control programs at risk. And they could. In contrast to the expensive and ineffective tobacco control programs all they have to do is leave this on the market, make sure it is at least as available as cigarettes, and tell people the truth rather than continue with the lying that not only ignores the science but eats up tax dollars.

But it does not need to be seen as competition. Though JEL doesn’t add much to the debate other than more misinformation mixed with the news everyone already is quite aware of, for some smokers who are trying to quit, quitlines can be of use, just like the option of switching to safer smokeless nicotine products. If the cause is to get people off smoking, to reduce smoking related disease, then quit lines and dissolvable tobacco products both work toward that end. A false dichotomy is being promoted.

In summary, what is happening in Iowa appears to be part of a concerted effort to remove new low risk alternatives from the marketplace, resulting in fewer options for health minded smokers. Whether this is a clever means to protect the lucrative pharmaceutical market or just sheer anti-tobacco ignorance, it is an insult to everyone concerned to use the bodies (and opinions) of children to infantilize the debate.

The kids are already well protected but it seems smokers are unworthy of any consideration at all.

BMJ Tobacco Control plays the victim

The current issue of Tobacco Control has editor Ruth Malone penning Hate mail, tobacco control and social change:

As a result of the USA’s latest mass shooting, there are calls for more civil and civilised discourse. 1 The propagation of ‘hate speech’ towards political opponents, some say, led to this tragedy by fomenting and encouraging always unstable individuals to act on their most violent impulses. While the similarly inflammatory rhetoric of tobacco industry-supported ‘smokers’ rights’ groups 2 is familiar to most tobacco control advocates and many researchers, I can’t help but wonder at some of the exceptionally vitriolic correspondence recently received at the journal, particularly since we instituted the Tobacco Control blog (see http://blogs.bmj.com/tc/ ).

The blogosphere, unfortunately, has emerged as a place for all manner of anonymous adolescent angst and anger to be indiscriminately disgorged and widely disseminated. I am not sure why we thought perhaps the TC blog might be different, but it most assuredly receives its full share—most of which we do not publish because it simply upchucks an undigested stew of incoherent fury and makes no real contribution to the purpose of the blog. For example, among the recent unpublished tirades was one from ‘social leper’, also known as SickofitAll on another blog, who wrote: “I fucking hate you and your profession. I’ve paid for my iron lung—and her brat’s incubator, and that fat bastard’s reinforced bed…You should all be lined up against a wall and shot in your motherfucking faces”. The rant goes on to issue threats of violent rape in graphic detail and ends by …

As much as I disagree with most of what comes out of this journal, I don’t think it is all that productive to hurl outrageous invective however, I do sympathize with the frustration behind the cursing.

First of all, this excerpt is the only bit we have access to since like most of their compadres BMJ-TC meets behind closed doors. While on one hand trying to convince us that smoking related disease is the largest health issue of our time, on the other hand, it seems not quite important enough to let everyone participate in the problem solving (least of all the people who are most affected). I do hope that at some time they will gather enough courage to emerge from the shadows because until they do, we can only think that they do not quite trust their own words.

But based on what they deem fit for public consumption, we see that they feel they are being unfairly castigated by trolls.

What I suspect is more the case is that these enraged citizens are at the ends of their rope dealing with a group that does so much more than just fling words. This journal is part of the grand anti-tobacco movement that deliberately undermines effective tobacco harm reduction solutions. It is no exaggeration to say that they have caused the death of many a smoker (by both their misinformation and their working towards regulating away the safer alternatives) and maybe one of these hurlers of invective is a relative of someone who, as a result, died before their time.

It is amusing to see that Malone compared smokers’ rights advocates to budding assassins. The parallel I see is with the Palestinian boys who throw stones at Uzi toting soldiers. “Speaking truth to power” might seem ridiculous and self defeating but it is the only avenue of expression left.

-Paul L. Bergen