Category Archives: nicotine replacement

Elementary my dear Watson

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

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

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

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

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

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

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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.

Obama criticized for use of unapproved anti-smoking therapy

Reported recently at FoxNews:

US President Barack Obama has a secret weapon in his battle against his smoking habit — celery, he revealed in an interview gaining traction Thursday.

First Lady Michelle Obama said earlier this month that her husband had not smoked a cigarette for almost a year.

In an interview posted late Wednesday, Obama confirmed to 4029tv.com that he had given up smoking for good — however the stresses of being commander-in-chief have seen him adopt a healthier addiction.

“There’s certainly days where I’ve got to grab a lot of celery sticks to make up for that bad habit that I gave up,” Obama said.

The POTUS has joined the legions of ex-smokers who have switched to using celery but officials at the FDA and some of the leading voices in public health warn that celery is not a proven anti-smoking therapy and is not a safe alternative to smoking.

Researcher Thomas Eissenburg who has investigated celery as a cessation aid described the results of that work as being inconclusive and not that promising. “We found smokers who had never used celery before and had them try it but found that most of them found it difficult to get a substantial amount of smoke while drawing on the stalk and subsequent cotinine testing found that not enough nicotine was being gleaned for this to really function as a satisfactory substitute for smoking.

Noted urinanalysis specialist Stefan Hesht warned that it has long been know that celery contains harmful chemicals.

Celery has always been known as a salty plant, containing a high level of what is knows as celery-specific salt, or CSNa. Consumption of CSNa has declared by major health organizations, like the Office of the Mayor of New York, to be a deadly hazard. To put the risk in perspective, if you consumed your entire calorie intake for the day in the form of celery you would eat well over 10 grams of CSNa, more than five times the recommended safe level.

When asked to comment on this, Leif Stock, a spokesman for the celery industry, responded that celery was historically considered salty tasting, but modern research has shown that it is actually contains more potassium, known as the “good salt”. He added that no epidemiology had ever shown a danger from celery and that the only tests of CSNa that had ever suggested any risk were animal tests, such as pouring large quantities of isolated CSNa on a garden slug. He added “when eaten in its natural form, the celery stalk poses no measurable risk, even to slugs.”

When asked to respond to this, Hesht replied:

Look, the fact is that when I test the urine of celery eaters, I find high levels of CSNa! It varies a little depending on where your celery comes from, Swedish celery for instance is quite a bit lower in CSNas but I can still measure it and if I can measure it, that means it cannot be healthy.

Among others commenting on this latest action by the President was Johnathan Winickoff, well known for his tireless advocacy in regards to public safety:

Of course being such an influential figure Obama places us in a difficult spot but the bottom line is that celery has not been submitted to the FDA for testing as a cessation aid. We really have no idea of what the long term effects of daily celery consumption are. Is it safer than smoking? Maybe. Do we know for sure? No, Nobody has done the tests that need to be done. I guess one thing I do know as a pediatrician is that celery seems tailor made for kids.

Roni Rabid, previously at the NYT and now at Legacy said that:

this sets a bad example for the kids. Our research has determined that if children see anything stick-like and particularly anything tubular being put in and out of the mouth, those kids are much more likely to end up smoking. This is why often as not you will see me sitting in the dark with Slanton Glance watching those scenes in those movies so we can better save the kids.

However, Jack Amis of the National Grocers Association said that while celery had no official clearance as a cessation aid, he himself was a previous smoker and was now entering his third year as a smoke-free but daily celery user. He said many celery buyers were former smokers or smokers who were curious about whether this would work for them. “We don’t really see kids buying these things” he added.

The FDA’s Larry Ditton said:

We realize that because Obama is Commander in Chief and thus technically part of the armed forces he is not allowed to use Champix or others of the class that could lead to a psychotic breakdown but it really is just a question of semantics. Champix is a proven cessation aid that has worked for a few people and celery is just a vegetable.

We cannot really promote celery in this regard and anyone who does is contravening WHO guidelines. And given the listeria outbreak of last year, our concern for public health means that we will keep fighting to take celery off the shelves until more testing has been done.

Could arguably the most powerful person in the world do a lot of damage due to an adverse reaction to this drug? Of course, and we or our good friends at Phizer would not feel any responsibility for any such actions but, we still believe that this sets the wrong example when instead of a vegetable he could be using one of the many fine drugs available to help him in these difficult times.

But it is not only presidents looking to this alternative. For those on the street, there are many who have found this to be the answer, at least for the time being. One long time celery user who preferred to remain anonymous said:

Other celery users I know feel a bit of pressure to then give up the celery as well but I don’t plan to. If its not hurting me and I enjoy it, why stop? I think what and the shape of what I put in and out of my mouth is my business and nobody else’s. And you know, I could never go back to smoking. Its just not as fresh and after you’ve used celery for a while you get to liking that crunch. I would miss the crunch.

But if they took it off the shelf. I don’t know. There’s a lot of us now and you take it off the shelves and you’ll just have some shady types setting up a green market, and then all these government types will have managed to do is make criminals out of many of us and back to smoking for the rest.

Nobody wants a President enslaved to Big Tobacco but is the tradeoff thousands of kids taking up the evil weed because they saw the big man on the stalk? Given his prominence this might be one case where a private hidden vice is more in the national interest than publicly flaunting an unproven substitute.

-Paul L. Bergen (with input from Carl V. Phillips)

One ban deserves another….

When the FDA banned flavored cigarettes in 2009, an action that resulted in quite a bit of press and plaudits but affected a negligible portion of the tobacco market, one wonders given the lack of any real evidence supporting that action, if it was simply to leverage more substantial actions.

Now we see the threat of a ban on menthol which since it actually affects many smokers is generating some resistance. Unlike ‘fruity” cigarettes which even most smokers did not know existed, menthol is huge. (I am sure the shadowy types invested in the black market are crossing their fingers hoping to see the ban happen.)

But even if the flavored cigarette ban seemed like a lot of ado about nothing, anything the FDA publishes is interpreted as grounds for like and extended actions (such as when their laughable e-cig assay was used to support a potential e-cig ban in the Middle East).

In the first iteration, in New York City, the ban was supersized to include all flavored tobacco products. The same is currently being considered in Washington state but Utah is where the real action is.

In Utah, the ban is being considered for not only smokeless tobacco products but also e-cigarette liquid. And addition to this, only e-cigarettes that have an on/off switch will remain legal.

Apart from our obvious concerns about smokers losing access to good and safer alternatives, these red herring child scare statements, and the nonsense that adults don’t appreciate flavor (because if you argue that flavor is targeted at children you are kind of implying that), this removal of flavor (and that e-cig switch) which are presented as “reasonable” conditions are anything but. They function as de facto prohibitions. (So far the only real complaints have been that pipe tobacco is at risk; Representative Ray suggested they buy it when they are travelling in other states but wasn’t concerned “flavored tobacco is flavored tobacco”.

Vapers and snus users are much more attuned to flavor than smokers. If you look at the user boards and blogs you have a plethora of talk about flavor and experimentation. In contrast, most smoker discussions (other than cigar and pipe) center on rights more than anything. It does not really matter whether this flavor orientation is a function of the products themselves or of how users are contextualizing them but that they appear to be intrinsic to the use. Remove the flavor and you are removing what appears to be quite important to just about everybody using them.

You know they also tried this in Wisconsin but when it was suggested that state money be used to persuade local governments to support a ban, ran up against a spoilsport Representative with with common sense, who said “the state shouldn’t be paying groups to influence local governments or public opinion”.

Now I am not one for conspiracy theories but if I were I just might tie together the facts that:
1. the board of the FDA Center for Tobacco was dominated by individuals with one foot in pharmaceutical products and the other in general anti-harm reduction and
2. Utah is specifically exempting flavored nicotine replacement products from the ban (because there is no way that kids would find candy flavored nicorette appealing) and
3. there seems to be a rising demand across the country that public funds subsidize these nicotine replacement products at the same time that
4. these safer alternatives that seem to actually help people quit smoking are being systematically attacked.

No. That just can’t be right because all those good people really care about you and me and they are working day and night to make sure we don’t make the awful mistake of quitting smoking the wrong way.

-Paul L, Bergen

When quitting is an option and not a necessity

Though it seems to be so much more common and easier to divide behaviors into good and bad, the problem with drug use is that it is so much more complicated than that. Drug users are as varied as anyone, and since almost everyone is a drug user of some kind, its pretty specious to draw such presumptuous demarcations. Once you replace morality with health (health, in my opinion, actually being the more “moral” approach) more natural and pragmatically useful categories come into play.

Rather opposing abstention and use, why not envision an opposition of bad enough to worry about and not bad enough to worry about. Forgive the vernacular but to me it seems to make more sense than terms like safe or dangerous.

With the dominant mindset we have all nicotine users (whether snus-ers, smokers or vapers) lumped together and on the other side the abstainers. The inappropriateness of this grouping (in the context of public health) is also evident when nicotine users are contrasted with prescription drug users, alcohol consumers or any other drug users. Its just not helpful when someone on anti-depressants or beta blockers criticizes someone for boosting their neural process or relaxing via a dose of nicotine.

But the main point is that the practical division is along the lines of how risky a behavior is. Once health is the measure then we will find that the constructive nicotine use breakdown is smokers on one side and everyone else on the other. (This is not meant in any way as castigating individuals who choose to smoke but is simply a breakdown of what health risks the behaviors are associated with. Its no different that separating high from low risk sports activities. Higher risk activities are not morally suspect; they are just higher risk.)

Once the powers that be stop blocking basic information about the comparative risks of various nicotine deliveries and once people understand that in the long run switching to snus or e-cigarettes is roughly equivalent to quitting then we should see a dramatic increase in switching and we might also see attitudes toward quitting change.

As mentioned in the last post, even if the health risks of using nicotine are perceived as negligible some people will still want to quit -and all the power to them. The point is that people should have the information and they should have the right to do what they will with that information.

What intrigues me is what might happen to the multi-billion dollar cessation industry should the THR message be widely acknowledged. Obviously some of the current cessation products will be reconfigured or remarketed as “dual use”, that is, as either cessation or switching products. (I’m pretty sure this is already taking place to a degree.) This industry, which maintains such mutually beneficial bonds with tobacco control, just might need to disengage in the interest of developing and then promoting products for tobacco harm reduction.

If Big Pharma holds its present course, and tobacco/nicotine use policy moves to being health-based, then the whole cessation industry will become even more like the diet or exercise fad industries – useful for a very small part of the population but a waste of time, money and effort for most. Those industries serve to delay too many people from pursuing the real solutions to their problems.

Most smokers have been browbeaten into believing that they have to try and quit on a regular basis, and many do the quit and relapse dance to exhaustion. (I wonder how much smoking takes place to take the edge of having to contain that identity clash of simultaneously being a smoker and being a quitter.) They have also been misled to believe that pharmaceutical aids to quitting are pretty well mandatory. (See here for Chapman’s critique of the lack of official support for cold turkey; if you are in the market for quitting nicotine, it seems to be the way that has worked for most).

The “official” explanation of the failure rate is that it takes many attempts to successfully quit. I can just imagine the meeting on that one.

“Bob here says the figures show that almost all our customers are failing up to ten times. They do eventually quit but hey, there must be something wrong with our product. And thanks for that Bob but you are looking at it the wrong way. Its not a product problem; its a user profile. The product is perfect. Smokers are just so addicted that it takes that many time to break through their addiction.”

“Maybe they’re just quitting after trying that long and it has nothing to do with our product?”

“Don’t be an idiot.”

Regardless of the THR message being widely accepted or not, these companies will still push their products as being healthier and safer than e-cigarettes and smokeless tobacco. In the meanwhile, most everyone will come to understand that there are few real differences among all these low risk nicotine delivery methods (especially once the smoke clears on the crucial combustion/noncombustion divide). People will also realize they have the power to choose between continued use or quitting with negligible differences in health consequences.

When we reach that point, those who have been actively opposing and obscuring the truth about these products will be revealed for what they really are: not public health advocates, not beneficient guardians of the public trust, but as sadly impoverished abstinence-only advocates. And not only just abstinence-only advocates, but abstinence-only advocates of a relatively benign (and in fact very useful) drug. Here’s hoping that day comes soon.

-Paul L. Bergen

Removing the addiction myth is a good first step

I just read two very different articles, one on the pitfalls of the addiction myth from a smoker’s perspective and the other about prison libraries as a valuable resource. What they share is a perspective on how healthy options can proceed best from non stigmatized arenas.

In the first, from Underdogs Bite Upwards:

If the NHS really wanted to help people stop, they would play down the addiction story. They would tell you that stopping is just a matter of not doing it any more. Instead they hype it up until you believe you will pass through the very fires of Hell after stubbing out your last one. That approach almost guarantees the smoker will fail. Those feelings of nervousness and twitchiness and irritability are not caused by lack of nicotine. They are your mind’s response to being convinced that you are about to suffer terribly from something you can’t quite identify. The whole smoking-cessation industry is designed to fail. It is designed to keep its staff employed and to do that it needs smokers to keep smoking.

and

I’ve read Allen Carr’s ‘Easyway’ book….you’ll find in there a passage where he tried to start smoking again to see if his method would work on a relapsed smoker. He couldn’t start again. He didn’t enjoy it.

Well, we’re not supposed to be enjoying it. We’re supposed to be slavishly addicted to it. One cigarette causes addiction, isn’t that the mantra? So how come Carr couldn’t restart on the grounds of not enjoying it?

Carr’s success rate was down to his method being voluntary. People went to him because they wanted to stop. The NHS success rate is paltry because they push people into stopping. They are forcing people to stop doing something they don’t want to stop doing.

The belief in being addicted not only locks the user into continuing even if they no longer feel like it but probably makes it less likely for them to consider safer nicotine alternatives. Underdogs stresses the point that keeping the addiction perspective strong bolsters the pharmaceutical industry, and while I agree with that, I think just as much that, unless you can free yourself of that belief like Carr did, it is just as likely to keep you smoking, and keep you coming back to smoking.

If after weighing the pros and cons of the behavior, you can smoke or not, based more on whether you enjoy it or not and not because you think you have little choice in the matter, you are free to make the better decision. You will also be more open to those safer alternatives rather than painting nicotine use as a prison you need to escape from.

Which brings us to the Boston.com article on prison libraries. In general, the point is that prisoners use the library for many purposes other than sourcing educational materials; some watch movies or read glossy magazines, and some use it as a place to leave letters for other inmates. But many coming to the library for other reasons end up being exposed to and then attracted to the more traditional uses of the library. They come to see it as a nonjudgmental space in which they can begin to move beyond their circumstances.

Libraries, like the idea of a world beyond addiction, are new ideas to many people, many of whom are best situated to profit from those ideas. Both libraries and stigma free nicotine use open up the arena for people to take charge of their own behavior, to determine their own best futures, and to break free of the stultifying patterns that have kept them enchained.

– Paul L. Bergen

Still no big picture vision at the CMAJ when it comes to tobacco

The Canadian Medical Association Journal has popped up in the news again and this time criticizing the government for delaying instituting new warning labels on cigarette packages. (Globe and Mail coverage here and original CMAJ editorial here).

Essentially the story is that new labels have been developed but have not been rolled out which will threaten our leadership position in tobacco control as well as raising concerns that the same old warning labels no longer influence smokers as much as they should.

In terms of continuing smokers, this might be a reasonable argument but one would think that the other prime target (potential smokers) would not need new labels since they have yet to see the old ones. Some continuing smokers who then quit do cite the labels as factors in quitting. This posting is not to question the effectiveness of the labels but to question why an institution that supposedly cares about smokers will be so strong on this and yet utterly ignore tobacco harm reduction which if properly promoted would do much more good than warning labels.

(But of course I cannot help but opine slightly on the label question. As far as those new smokers who tend to be young -they also tend to be attracted to smoking precisely because it is risky and therefore the labels might in fact attract them. Overall, I suspect the effects of the labels are not unitary and vary from one individual to another. The funniest thing about this all is that these labels are deemed so important and then once in place the packages themselves are put into the dark market so that the only way you get to see the label is by deciding to purchase the product. The joke then is that the message not to buy the product is only available to you if you buy the product. Or perhaps this is the ultimate government revenue joke in managing to discourage the use of the product that you purchase which keeps the taxes coming in even if you throw away the pack.)

But to return to the point at hand which is that this health oriented organization moaning about how concerned they are about tobacco associated outcomes and then deciding only to endorse solutions that are politically correct and not include those that could save many lives. It seems that only smokers who quit are worthy of consideration. (For more on CMAJ see here and here).

If I were to apply the same argument they do to explain the government inaction on new labels (possible tobacco industry influence) I would accuse them of possibly being in the pocket of pharmaceutical interests who have so much invested in their revolving door quitting smoker customers returning over and over again after failing at using their cessation products.

-Paul L. Bergen

Potpourri: Nicotine related news and articles

Rather than post a full article today. it seemed appropriate to promote a couple of articles elsewhere worth reading and some short comments on a couple of recent news items.

First the articles.

1. I was going to critique another of the Tobacco Control envisioning “new ways” articles, the Hatsukami et al which suggested various avenues of research to determine whether (and they really had already concluded that the whether was only a polite way of saying when) nicotine reduction could be applied to tobacco products in order to wean off the population however Brad Rodu said as much as needed to be said on that, and said it very well. See Imagining Tobacco Without Nicotine at TobaccoTruth; from October 6th.

2. Over at VelvetGloveIronFist, Chris Snowdon has a close look at the contradictions embodied in the work of Stanton Glantz (from his earlier writings critiquing methodological errors endemic in the health literature to his later publications transgressing his own guidelines for evidential significance. See Stanton Glantz: Then and now from October 14.

Now the news items:

3. Is Iceland going Swedish?. Cigarette sales are down 13% and snus/smokeless sales are up 9% (see here at Iceland Review Online). Its a straight forward report with no editorializing which contrasts strongly with a similar smoking down/smokeless up story out of Washington back in August (see here for my comments on that story).

4. More support out of Maryland for nicotine being protective or ameliorative for Alzheimer’s Disease (AD). This is not really surprising since nicotine is strongly anti-inflammatory. It is a very good option since most of the drugs used to counter the effects of AD have fairly common and fairly aggravating side effects. The article is unusually calm in its discussion with only a passing mention of manipulating the drug in order to reduce the addictiveness.

What is beautiful about nicotine for this application is that given the typical AD sufferer being 65 or over, addiction is irrelevant (and in any case would be preferable to cognitive decline) and even if the most dangerous form of obtaining nicotine (smoking) were the administration, with the effects tending to lag far after the start of chronic use, the usual health concerns are almost negligible.

-Paul L. Bergen

They just can’t let a good thing be a good thing

Of course Katherine Heigl’s success in switching from cigarettes to e-cigarettes couldn’t go without some negative spin.  In this exceedingly skeptical commentary on her public praise of the e-cigarette, we find that ubiquitous red herring: addiction.

The fact that e-cigarettes still contain nicotine and are therefore addictive is heralded as the e-cig’s main failing in this article, along with the other usual suspects (like the claim that it has not been proven in smoking cessation, and that it contains dangerous chemicals).  Addiction is that convenient go-to argument for when you really want to denigrate something, but there’s not much there to argue against; a necessary item in anyone’s backpocket arsenal of pejorative terms.  Unfortunately, its normative nature makes it difficult to argue against its invocation (unlike the others, which are empirical claims), and questioning it leads us into a circular argument.  Why is nicotine bad?  Because it’s addictive.  What is addiction?  It’s something bad.

Particularly embarrassing is the article’s quotes from three pulmonary experts, giving shameful advice to smokers to avoid these because they still contain nicotine.  These experts absolutely should be cheering the advent of the e-cigarette, but of course, they can’t just let a good thing be a good thing.

(Note that after I wrote this I noticed Michael Siegel’s post on it from yesterday, and he goes into some of the other statements made in this article.)

And to top it all off, we have Dr. Len Horovitz, a pulmonary specialist, claiming that nicotine replacement aids are the best way to quit smoking – patently false, since quitting cold turkey is by far the most successful way smokers quit, long-term.  That put aside, the fact that the article negatively spotlights the addictiveness of nicotine, and then recommends a nicotine source as the way to quit smoking, is just another example of brow-furrowing, baffling statements made by the anti-tobacco faction.

(Horovitz, by the way, is not new to the “We Hate E-Cigs” fan club… check out this link for some previously-made comments of his.  And it turns out he is a member of HD Reps, a talent agency for broadcasters.  Basically, he’s a convenient source for members of the media who need an opinion on something.  Interesting that he’s getting his 15 minutes from making anti-e-cig claims.)

 

-CMNissen

GlaxoSmithKline and the FDA entreaty

GlaxosmithKline, the maker of Nicorette and Nicoderm, have petitioned the FDA to remove dissolvable tobacco products on the grounds that a better action would be to enhance their own product and make it more widely accessible. They argue as well that there is a lack of efficacy of smokeless products in regards to smoking cessation and that they are marketed in such a way as to initiate and perpetuate smoking. (Article link here.)

(Let’s just remove that last phrase first since it has been discussed here before: tobacco companies are not allowed to market these products as cessation aids or to accurately describe them as safer; such claims might encourage switching. They are restricted to marketing their much safer than smoking products only as “for when you cannot smoke”. So it is disingenuous to criticize a company for using the only marketing hook left if they are not allowed to promote the rational use of these products.)

This message from this successful company (45 billion in revenue in 2009) has been widely criticized as trying to obtain competitive advantage at a time when smokeless products are at their most vulnerable. Not only is the FDA focusing on these products but the advisory panel is stacked with members who have financial interests in pharmaceutical products. As a business strategy, this makes sense.

What is less obvious is how amoral and possibly evil this action is. Though I hesitate to apply “evil” to these machinations, what else can you call an action that could result in many dying as a result not of their principles but of your own, and principles solely in the interest of profit?

We know that people smoke or do not smoke for many reasons. We know that they vary quite a bit in how difficult it is for those who wish to quit to do so, and that for different people, different methods are successful. It is all about individual differences. This means that some people will not be able to quit using pharmaceutical products which in itself means that if those are the only option, the people that could have succeeded by other means are needlessly doomed by removing those alternatives.

I understand the concerns of makers of these pharmaceutical nicotine products. With the new smokeless tobacco products, the distinctions between the two categories are becoming quite subtle. And if anybody has long term evidence of relative safety on their side, it is the tobacco products. We have decades of good data on populations using these products day in and day out for years and we do not have that for pharmaceutical products. They are likely to be as safe as smokeless tobacco if so used but we don’t have the proof of that because people have not been using them that way.

What we do have is evidence in support of is that smokeless tobacco products outperform pharmaceutical nicotine in helping people quit smoking (see Rodu and Phillips).

And this same press release has the temerity to use the old “Tobacco use, including smokeless tobacco, is the largest cause of preventable death and disease in the world. More than 400,000 Americans die every year from tobacco-related disease.” For one thing, the stale move of collapsing “including smokeless tobacco” into this figure is misleading (one could have included “eating apples and oranges” and the statement does not become false). But the key word as always is preventable. Is not this impeding one of the more successful means of avoiding disease while using nicotine not preventable?

Finally, our modern anti-tobacco culture has allowed this story to be construed only as a slightly sleazy business move but imagine if RJ Reynolds or some tobacco company had issued the same release regarding pharmaceutical products. They would actually have had the stronger case (not that any alternative should be removed) but imagine the op eds on that, the outcry from the American Heart Association and so many others.

-Paul L. Bergen