Smoking in the movies – again?

My apologies but I find this an entertaining topic. And lately what I’ve been wondering is why hasn’t someone done a content analysis of smoking in the movies?

Glantz and his minions appear to believe that one cigarette or smoke is much like the other and all you need to do to judge the given perniciousness of a film is to tally up every occurrence of smoking on the screen. What I suspect though is that most appearances of cigarettes in film are accompanied with an anti-smoking message of some kind. But I don’t know for sure, so someone needs to do the research. (It’s not exactly harm reduction so it’s a little out of our area).

Recently I watched Skyline, an incredibly bad movie. It takes place in Los Angeles , aliens have landed, destroyed most of the world and the people, and our protagonists are stranded in a penthouse apartment, still game but also realizing their days (or more likely hours) are numbered. A woman lights up a cigarette and without any sense of the absurd the other woman informs her she has just found out she is pregnant and the group agrees that that cigarette should be put out. I am not sure it that was intentionally insane but given that the script was California born, it might just have been meant to be played straight.

I also watched Barney’s Version in which Paul Giamatti plays a man who to the end loves his cigars. I like this because whether you think smoking is good or bad, it should be clear why people do things. If the character is doing heroin, it should be obvious that they do it because they get something from it. Otherwise, it remains a big mystery. They killed that guy because otherwise he would have killed them, they stole that money because they had none, they ate that food because they were hungry and it tasted good, and they used heroin because its bad for them?

And, as we’ve said before, the harm reduction angle here is if you want to effectively move people to safer alternatives, you need to know why they like doing what they do in the first place.

But even though I have raised the verisimilitude issue, for much of film it is a joke. If we take film as an educational medium it teaches us that killing people is pretty common and not always a bad career move and that the only way to really express your feelings is to shout and break things. If you really want that girl or boy, you stalk them until they give in. You will always get richer even though money doesn’t matter, and the more destructive your dog is, the more you will love them.

On the other hand if you have a character who is in danger and most likely will not survive the film, or lives a lifestyle that if not in this short period but soon will lead to their demise, why not smoke? In the same way that tobacco control programs aimed at countries with life expectancies under 50 are ridiculous, it is sheer lunacy to be concerned about any character on borrowed time who grabs a calming smoke.

So anyway, I am waiting for that study. And then we’ll see if its just me who’s heard the phrase “these things are going to kill me” and “I gotta quit one of these days” just about every time a smoker lights up in an American movie.

-Paul L. Bergen

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)

End of the game? The last SuperBowl?

Spurred by the continuing injury rates in high school football and long term chronic health conditions associated with being professional players, Action on Sports or Health (ASH) is putting together a new task force.

The first two appointees come following a distinguished career in tobacco control. ASH Director Borzon said that though this may seem unusual, it was felt that not only was a new perspective needed but that the force had to be composed of people not afraid to make what might be unpopular choices.

People seem to be afraid to suggest an outright ban on the sport but we are going to keep that option on the table. The question we have to ask is: can this country afford to keep subsidizing a sport that adds disproportionately to the health burden?

Professional football players are much more likely to have dementia and Alzheimer’s and at a much earlier onset. Taxpayers are shouldering the heavy cost of long term care for not only these players but for the chronic ailments of many high school players, not to mention ten or so deaths every year, many of them still school age children. And these same taxpayers have to wait in longer lines in emergency rooms being flooded by football and other team sport injuries. We have the advantage of being able to discuss an actual ban since, unlike smoking, removing football revenues would not imperil state budgets.

There’s already been quite a bit of talk among the players and coaches already but we’re just not sure if those are the people who should be working on this. We’re taking a page from the tobacco control playbook and making sure that no one in this task force be compromised by association so no players, owners or holders of seasons tickets nor anyone associated with the sports media. Essentially, we want to block anyone with any knowledge of this sport so that we arrive at untainted solutions.

Borzon also indicated that there was some dissatisfaction with the whole helmet concept in this brutal sport. Though it appeared that there was some advantage to using helmets, it had never been proven through the accepted standard of evidence, randomized control trials.

As far as we’re concerned nothing reduces injuries like just not playing football. You can wear a helmet but its no substitute for just quitting.

Borzon said that while there was a process to satisfy to create a ban, in the meanwhile, they already had some of the funding to start the research. They already had a few good candidate locations – towns with a strong tradition of football and the it was just a matter of taking a few hundred kids, separating them into helmet and not helmet groups, and just following them for a few years

We’ll do the studies but were already pretty sure what we’ll find. This sport is a cost and not a benefit. It stresses the system and if it wasn’t for peer pressure, probably no one would bother. A couple of studies out of California have shown that almost half of high school footballers started after seeing Friday Night Lights or some movie that had football in it.

Years from now people are going to look back and be amazed that we let this go on so long.

-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

Smoking in the movies (again) and helping out the ailing pharmaceutical industry

In today’s Huffington Post, there was yet another, and not particularly good, article on that new research report (abstract here) that smoking in the movies causes ex-smokers to want to smoke again.

I guess it takes a brain scientist to definitively state that seeing something makes someone who likes or liked to do that same thing want to do it (though I am not sure how they can separate fond memory from actual desire to do it again, and how they deal with that very iffy connection between contemplating an action and actually carrying it out). At least the abstract did not conclude with any calls to action though you can be certain that just about everybody reporting on this saw it as more evidence to support banning smoking in the movies.

There is no question that we are in some way affected by what we see but the world is too large and image sources too varied to think that the best way to deal with a risky health behavior is to remove all images or references to it. (You can bet that if the Californians have their way and all smoking references are expunged from movies (because this one is not about the kids so all of cinema is in peril now) and that when they find that some people still weirdly persist in smoking, they will not for even a second think they had it wrong but that people must be being compelled by the rest of the media and what will need to be done is to move on next to expurgating the books and the art galleries.

But it is nice to see the French exhibiting some common sense (that is, preserving the cultural record) in restoring Sartre’s airbrushed cigarette and leaving Jacques Tati’s inimitable trademark pipe alone.

Look, leaving aside that we should really not be messing with widely accepted cultural modes of expression, whether smoking is up on the screen or not, people will continue to smoke. So instead of pursuing better health through (ineffective) Philistinism, and since it seems that already most movie dialogue that concerns smoking is quite negative, why not take a lesson from The Tourist in which Johnny Depp smokes e-cigarettes. If you think the monkey see – monkey do mechanism is so powerful, why not use it to get people to switch to safer nicotine use?

In another example of not seeing the obvious, this Canadian article (which details the many reasons people smoke except they seem to have forgotten that some people actually enjoy it), along with this other one from the Spec.com asks that taxpayers should foot the bill to subsidize the underperforming cessation drug industry.

After the usual bellyaching about the social costs of smoking, and what a good investment it would be to pay the drug companies so that smokers could afford their product, wouldn’t it be so much simpler to remove the ban on electronic cigarettes in this country and to let those who do not know that smokeless tobacco is a safer option (yet another good meta-review on that recently). Making e-cigarettes and smokeless tobacco available and competitively priced is the best way for cessation (or health) minded smokers to switch and it will not cost taxpayers a cent.

-Paul L. Bergen

International smoking news roundup

While we are putting the finishing touches on a discussion of the press release out of Star Scientific on their reduced nitrosamine smokeless product, here’s some of the more entertaining (and exasperating) developments in the world of smoking.

First of all, out of Spain, two stories.

The first out of Time Magazine reports on the resistance to the new smoking restrictions on bars with some owners posting “smoking allowed” signs, others working to form an organization to counter this threat to their livelihoods, and in one case, a restaurateur providing a free drink to anyone needing to go outside to grab a smoke.

The second story is a rant by a Brit who used to enjoy the previously less fettered society and now rues a country taken over not only by his fellow countrymen but more than suspects that the changes in the law were to cater to the same healthist Brits he went to Spain to avoid. It is titled appropriately Whatever happened to my Spain?

I obviously had not noticed the sign on the door so I extinguished my cigarette and asked her why. Her answer really angered me, first because it had always been one of my favourite restaurants, and second because I knew that both she and her late husband were also smokers. She told me that of late the restaurant had seen a large amount of trade from English customers and it was they, she insisted, who had pressurised her into going smoke-free. Needless to say, I have never been back to that restaurant, from that day to this.

What was happening to “my Spain” I asked myself? What will the English be insisting on next? No Spanish food because it contains too much garlic, maybe? Or how about no Spanish music? I mean, do we really want their mumbo-jumbo? Yes, we bloody well do. Well, I certainly do. I want Spanish music and Spanish food and the Spanish language, which I think more Brits should learn a little more of. And I want Spanish traditions such as spending hours chatting, drinking and smoking in little local bars and restaurants, long into the night.

And in Bhutan, supposedly ruled with an eye to the happiness quotient, dogs are being trained to smell out tobacco in people’s homes. This is part of the country taking steps to go entirely tobacco free. The Prime Minister’s justification for the move, which he says is not draconian, is that tobacco “is no different from psychotropic drugs, for which the penalty in certain countries is death”. Well, if they kill people for drug use in other countries, it can only mean that those drugs are really bad, and not much that wrong with killing people.

Though you can smoke in your home in the Netherlands, a peachy little informer culture is being fostered by local anti-smoking groups. I suspect that there are few in those groups who lived through the war years.

-Paul L. Bergen

Harm reduction needs to be easy: the case of RJR’s new switching campaign

As previously mentioned, we, like many others were quite pleased to see the R.J.Reynolds Tobacco Company Christmas season campaign suggesting that smokers switch to smokeless tobacco (report here). Since many people still think the turn of the year is a time for a turn of the leaf, the time is most appropriate to put forth a suggestion that just might make more of an impact than at other times of the year.

The ads make no health claims. The idea is simply to try the switch and see if you like it. The actual text for one of the ads reads:

If you’ve decided to quit tobacco use, we support you. But if you’re looking for smoke-free, spit-free, drama-free tobacco pleasure, Camel Snus is your answer. Logon to the Pleasure Switch Challenge and see how simple switching can be. Camel Snus _ it might just change the way you enjoy tobacco.

And despite this innocuous text, an FDA spokesman is reported to have said that they were “reviewing the claims”. Nice work if you can get it is all I can say. I just reviewed the claims (none) and it took about as long as it took to read the passage. I suspect the FDA charge will require a few professionals and a board meeting and a subsequent request for recompense from RJR.

Readers of this blog know that we wholeheartedly promote switching from smoking to smokeless forms of nicotine use and thus we experience a certain degree of frustration seeing that a company trying to do the right thing, that is the thing that advances public health, has to avoid mentioning any hint of this product being 99% safer than smoking. (Because even though it is true, it could run them afoul of some fairly strong regulations).

And not to mention (and what an odd phrase that is since it signals its exact opposite) that the only health references on these ads are huge banners implying severe danger. The ads mention a website where you can learn more (https://snus.tobaccopleasure.com/modules/security/Login.aspx) and there following content devoid of any positive health claims runs a huge banner saying Warning : This product can cause mouth cancer.

If I didn’t know any better, and time was I didn’t, that would have stopped me dead in my tracks. And if that is not enough there is a rather extensive sign in system (to make sure I am not a child I suppose), the which are known to severely reduce consumer participation. (A few of us have tried to get through this hurdle with little luck so we have not been able to evaluate what lies on the other side, whether truth does survive in the Matrix or not.)

This is a pretty important point. Though we do not know what lies in the promised land, there is some implication of valuable information (and information that is qualitatively different from what we already have been given). But getting there is not unlike the security requirements to board a plane (papers and pat down) except that when you are flying you know your destination and already have decided that the difficulties of negotiating security are worth the annoyance.

Given these requirements and the uncertainty of a payoff we would bet that almost no one has crossed over.

Several of us (and we are almost certainly more motivated than the average consumer or would be switcher) answered personal information questions for minutes, including asking for U.S. social security numbers (i.e., something Americans are constantly told not to share with anyone other than employers and banks for fear of identity theft; in Canada the government actually forbids the use of our version of that number for any non-tax purposes). But after going through all of that, it asked us to make a phone call and/or fax our identity papers to them. Riiiight. It is not like they are promising a coupon for anyone who gets in, or even a transaction — this is just to be able to read information. Those phone lines must be flooded with the, let’s guess, 1/1000th of interested consumers who are actually willing to go to all that trouble.

(Carl plans to post more on these ad later, so we will let you know what excitement lies beyond the barrier if one of us ever gets through.)

It would be easy to blame RJR for being too soft when they should be actively pushing the safer alternative but the fact is they have little choice. For simply revealing the same benefits known to anyone doing the research, they could be subject to substantial fines.

Kind of like trying to sell driving with seat belts not because it is safer but because it looks cooler or feels nice to have something around you while you drive.

The usual suspects have been quite vocal in criticizing the campaign, painting it as a competition for would be quitters. While it is true that some quitters might appreciate learning about this alternative, the tone of the ad clearly emphasizes those who have considered quitting but are not doing so. Moreover, since the health benefits of switching are effectively the same as those from quitting, the would-be-quitters lose little (and more than make up for it by getting to continue using a product they like) and their health costs (if there are any) are overwhelmed by the benefits seen by switchers who would not have quit.

That “more than make up for it” reflects the fact that if they freely chose switching when quitting was still an option, it must be because it makes their lives better, a point that Carl has analyzed at length. It brings to mind the sportsman’s assertion that “winners never quit”. I guess the paraphrase would be that those who choose not to quit must be winners. In any case, like winners, most smokers who want to quit do not do so either, at least not for a long while, though perhaps they would switch with these alternatives available.

– 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

Time to change the diapers on Pediatrics Journal

Pediatrics cries wolf so often that it would be difficult to identify any real threats to child health within those pages. Not only do they construct visions of disaster out of little more than phone polls (that third hand smoke lunacy), generalize from ambiguous results (as will be elaborated on here) or just plain mislead (as in child poisonings from new nicotine products), this journal, as we have opined before, gives The Onion a good run for the money. For instance, where else would anyone take seriously the idea that paternal smoking around pregnant women could lead to subsequent obesity in the to-be-born children?

Just paging through the last couple of issues I found this article on the effect of breastfeeding on later academic achievement with the conclusions in the abstract as:

Predominant breastfeeding for 6 months or longer was positively associated with academic achievement in children at 10 years of age. However, the effectiveness of breastfeeding differed according to gender; the benefits were only evident for boys.

Notice that the result is just as much one of “predominant breastfeeding is not positively associated with academic achievement in girls”. I do not have access to the whole article so for all I know it actually negatively impacts females however the point is that a specific conclusion is being generalized without reason. It might be an interesting question as to why boys and not girls and the conclusion should have mentioned that.

But to the matter at hand, the latest movies cause smoking “evidence”. And let’s just state those conclusions right up front:

These findings imply that, beyond direct influences, the relationship between adolescents’ sensation seeking and parental R-rated movie restrictions in explaining smoking onset is bidirectional in nature. Finally, these findings highlight the relevance of motivating and supporting parents in limiting access to R-rated movies.

Note the word “bidirectional”. The definition for that is “moving or operating in two usually opposite directions” Not really the sort of thing you would want to encourage when suggesting behaviors. So what the conclusion actually is saying is that “we don’t know what causes what, we think they might both cause each other, but we have no problem using this to give advice”. But let’s delve just a little deeper into this intriguing study. And I quote:

We found that adolescents with lower levels of sensation seeking and those who reported R-rated movie restrictions were at lower risk for trying smoking. The results also revealed negative associations between adolescents’ levels of sensation seeking and later R-rated movie restrictions, which indicates that sensation-seeking adolescents are at higher risk for starting to smoke not only directly but also indirectly through changes in parenting. Sensation-seeking adolescents seem to influence their parents to become more indulgent regarding their movie viewing, which subsequently is related to higher risks for smoking.

Now, forgive me if I am wrong but I do see this being reprinted in the Journal of Results So Obvious That Only a Fool Needing to Pad the CV Would Submit It. And the results are: kids who are curious about things are more likely to act on that curiosity than kids who are not, and they are also more likely to pester their parents, and those parents are more likely to give in than parents who had never been pestered. (If following form, the next Pediatrics article about smoking precursors should encourage parents to administer growth inhibitors since aging is probably the single greatest determiner for later smoking).

But now, and I do apologize for going on and on about this, Pediatrics has turned its attention to caffeine consumption in youth. (I know, yes, these articles do not share the same authors but they do all get printed at this journal so I think it is not unfair to suggest that the journal is to blame, hence the title about changing diapers; the authors may provide the food but it is the journal that puts out the crap).

In this case, the study is not quite as bad as the media reports that follow though the authors do flap their lips a little more loosely as well once in the spotlight. The study reported that the findings indicated either that caffeine consumption led to disrupted sleep patterns or that children consumed caffeine in response to not sleeping well the night before. They were not sure which way this went but it still led to concluding that caffeine should be restricted, not because it was harmful but on the basis that the beverages had “detectable pharmacologic effects”. It does not sound like a bad idea in general not to ply your kids with pots of coffee or coke but I really do not see the above as actually supporting that.

By the way, the other grand finding in the study was (and they took pride in that this had not been widely documented) that children’s sleep patterns on the weekends varied from that of the school week. (Maybe this is what they mean when they talk about the great work of science being built up one small brick at a time!)

But come the media and we have the headline Caffeine Can Harm Children. And the quote:

“Parents should be aware of the potentially negative influence of caffeine on a child’s sleep quality and daily functioning,” Dr. Warzak asserts.

And as we know, when you put in the word potentially anything after is quite true. We could potentially fall into the sun tomorrow. Absolutely true.

Or more to the point: Pediatrics Journal could potentially tighten up their editorial policies. The journal has been around long enough to move on to potty training.

– Paul L. Bergen

Spilling nicotine: safety concern or clumsy researchers?

It takes something quite spectacular to take my attention away from any of the research coming out of the Prue Talbot labs but I will have to save that for tomorrow or the next day (hint: it comes from an even more disreputable source -Pediatrics Journal- and it has to do with smoking and the movies). But today the Prue.

There is no need to do any deep analysis of this research since it has been covered quite well already by the Old Rambler at StandFast, by Michael Siegel, and James over at Ashtray Blog.

I just wish to add a few additional points.

1. As opposed to any good news about harm reduction, this half baked nonsense is being repeated from here to India by every news agency without any analysis of the content.

2. The researchers conclude on the basis of their concerns about the packaging and instructions that the product should be removed from the market. To go once again to our beloved seat belt analogy, if there was some substandard accompanying information packet with the seat belts or even the odd one that caused an allergic reaction let’s say, would it seem reasonable to take it off the market considering the alternative (driving without)?

Once a product is off the market the greatest impetus for improvement has been removed. There is no assurance it will ever be let back in whereas in market there are customers to satisfy, and in general, products in the marketplace are redesigned to be more effective and safer over time. (This is really the secondary reason: of course the first is quite simply that removing it will result in the premature deaths of many citizens).

3. For some reason, people are taking more seriously the conclusions about the everyday workings of a product from people who are seeing it for the first time rather than the experience of hundreds of thousands who have already been using it for years.

Anna Trtchounian and Prue Talbot seem to be spilling nicotine all over the place and extrapolate their own clumsiness to the world at large. Of course, if you already believe in third hand smoke, any leakage of nicotine, no matter how small, is a serious concern. However, if you are a normal human being, it really isn’t.

This apparently horribly unsafe product is being used quite safely by the hordes, and might I add, much more safely than they could ever could use cigarettes.

4. This kind of research by those who remain quite alien to both the concepts of harm reduction in general (Prue labs discovering harm reduction cigarettes) or the product they are testing (once has a vision of the apes in 2001 touching the monolith and running away chattering and frightened) seems to be gaining in popularity. Not long ago we had Thomas Eissenberg saying there was not enough nicotine in e-cigarettes for the product to actually be satisfying.

This is unfortunately quite consistent with tobacco and addiction research in general where anti-tobacco researchers and advocates have managed to convince the world that only addiction keeps people smoking (no one really enjoys it).

And even more unfortunately, these few befuddled researchers in their labs, who are able to discount the world outside quite effectively, are having a disproportionate influence on that same world they dismiss.

– Paul L. Bergen