Tuesday, August 25, 2015

British Government Backs E-Cigarettes for Smokers

Public Health England last week became the first national government agency to endorse e-cigarettes as safer options for current smokers.  Its report also dispelled several bogus anti-tobacco claims.

PHE encourages smokers to switch to e-cigarettes in order to stop smoking and to reduce smoking-related diseases and deaths.  The agency strongly rejects the claim that vaping is a pathway to smoking: “There is no evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it.”

Additionally, PHE refutes scaremongering about nicotine poisoning (a subject I previously discussed here): “When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in ‘childproof’ packaging. The accuracy of nicotine content labelling currently raises no major concerns.”

I have noted that some researchers have fabricated claims that vapor contains dangerous levels of formaldehyde (here and here).  PHE rejects the assertion: “Two recent worldwide media headlines asserted that e-cigarette use is dangerous. These were based on misinterpreted research findings. A high level of formaldehyde was found when e-liquid was over-heated to levels unpalatable to e-cigarette users, but there is no indication that…users are exposed to dangerous levels of aldehydes.”

Unfortunately, the PHE report overreaches in one respect.  It says that “best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes,” and this became the dominant media headline upon the report’s release.  To be accurate, PHE should have reported that e-cigarettes are far less harmful than combustible cigarettes, without specifying a percentage; there is no hard data to support a number.

The 95% is derived from the reported opinions of a group of international experts in a publication last year.  The opinions were merely “guestimates”.  In truth, the health risks of long-term vaping are not known, and they are at this time unknowable.  While there is universal agreement among tobacco research and policy experts that inhaling a vapor of propylene glycol, nicotine and flavoring agents is vastly safer than inhaling smoke containing thousands of toxins, the precise risk differential is unknown.

I routinely criticize e-cigarette opponents for violating scientific principles when they make outrageous claims against the products.  Recognizing that the PHE report is a welcome endorsement of tobacco harm reduction and e-cigarettes, I am disappointed that its value is at all compromised by a comparison that cannot be scientifically validated.

Wednesday, August 19, 2015

Base Tobacco Taxes on Tobacco Risks – A Valid Strategy Is Revived

On August 13 the New England Journal of Medicine published a commentary (here) by three prominent tobacco research and policy experts challenging “national, state, and local policymakers” to “expedite the move away from cigarette smoking” by basing tobacco taxes on health risks.  They recommend high taxes on high-risk combustible products, and lower taxes on low-risk smoke-free products like e-cigarettes and smokeless tobacco. 

Economist Frank J. Chaloupka of the University of Illinois Chicago, attorney David Sweanor of the University of Ottawa and economist Kenneth E. Warner of the University of Michigan acknowledge that “the science supporting a difference in risk between combustible and noncombustible tobacco products is well established,” and they conclude that “Sizable public health benefits could derive from current cigarette smokers’ switching to [e-cigarettes] and other noncombustible products.”

I made the same argument in a Tampa Tribune op-ed on August 16.  12 years ago.

In 2003, many states were under pressure to raise tax revenues.  I submitted op-ed columns to newspapers in 16 states, noting: “Excise taxes on tobacco products may be inevitable, but they don’t have to be illogical.  A common sense approach is to tax tobacco products according to risk.  Cigarettes, widely acknowledged as the most dangerous products, are already taxed at high levels by most states, ostensibly to discourage consumption.  But the health impact of smokeless tobacco use is much lower; scientific and medical research has confirmed that smokeless tobacco use carries only about 2% of the risk of smoking.  A rational tobacco tax policy would set taxes on smokeless products at 2% those of cigarettes.” 

The Tampa Tribune published my proposal (click on the image to read it), which included this:

“Taxing tobacco products according to well-established risks will serve the public health goal of reducing the death toll from cigarette smoking.  Economic research shows that a large price differential encourages cigarette smokers to switch to smokeless tobacco.  A growing number of public health experts, including the prestigious Royal College of Physicians in Britain, recognize that smokeless tobacco may be an acceptable substitute for smokers who have been unable or unwilling to quit.  They point to evidence from Sweden where, over the past century, men have smoked less and used more smokeless tobacco than in any other Western country.  The result: Swedish men have the lowest rates of lung cancer -- indeed, of all smoking-related deaths -- in the developed world.

“How have the Swedes achieved this record-setting reduction in smoking?  First, placing tobacco discreetly inside the mouth is far safer than setting it on fire and inhaling the smoke, and the Swedes know it…Second, smokeless tobacco satisfies, because it delivers nicotine almost as efficiently as a cigarette.  Nicotine is addictive, but it causes none of the diseases associated with smoking.  Third, the “spitting image” of smokeless tobacco is history, because modern products, available in Sweden and the US, can be used invisibly and as easily as breath mints.  Finally, in Sweden the price of smokeless tobacco products is less than half that of cigarettes, the difference largely reflecting levels of taxation.”

Twelve years later, it is comforting to see this taxation strategy gaining wider currency.

Wednesday, August 5, 2015

Say Goodbye to the American Cancer Society

You’re probably not familiar with Jordan, Minnesota, a town of 5,500 southwest of the Twin Cities.  The Jordan city council voted a few weeks ago to ban e-cigarette use indoors and at public gatherings.  Local governments throughout the U.S. are taking similar action, most of which is influenced by a sophisticated misinformation campaign.  A July 11 letter in the Jordan Independent (here) perfectly illustrates the role of the American Cancer Society as a principal driver of the effort to deny smokers information about and access to safer cigarette substitutes.

The letter, from an ACS volunteer, thanks the council for the ban and parrots standard exaggerations and falsehoods: e-cigs deliver toxic formaldehyde in higher amounts than smoke, threaten children’s health and don’t help smokers quit.

I have written extensively about the 30-year ACS smokeless tobacco misinformation campaign (here, here, here, here, here).  Now that organization is using the same tactics against e-cigarettes.  ACS volunteers nationwide follow a script that demonizes all forms of tobacco, the companies that market them and the people who consume them.

In Jordan, the local vaping community responded quickly to the ACS misinformation, with one commenting online: “Read some current studies, I cannot believe you are wasting money on nonsense. Say goodbye to our donations.

According to Charity Navigator, the American Cancer Society in 2013 received $878 million in contributions – nearly a billion dollars for their perceived fight against cancer.  In reality, a good portion of that largess was squandered on their dishonest and harmful tobacco prohibition crusade.

Last month, the Washington Times reported that the National Institutes of Health “spent $2  million [in research over three years] to have wives nag men about chewing tobacco. I was quoted in the story, saying that’s a case of “big government intervention for a small-risk lifestyle choice.”  I have documented that the NIH is spending hundreds of millions of dollars on “research” to counter tobacco harm reduction (here).  While there is little that can be done to stop this misuse of taxpayer dollars, pressure can be brought against the American Cancer Society.
It is time for tobacco users, their families and friends to send a message to the American Cancer Society: Say goodbye to our donations.  Tell ACS volunteers in your community that the society must acknowledge scientific facts and abandon its tobacco prohibition stance.  Until the ACS tells the truth about tobacco harm reduction, charitable contributions should be directed elsewhere. 

Wednesday, July 29, 2015

Cigarette-Nicotine Fadeout Fails; NIH-Funded Researchers Back “Easy Alternative Sources of Nicotine”

Drs. Neal Benowitz and Jack Henningfield were respected tobacco researchers in 1994 when they introduced a flawed smoking cessation prescription: force smokers to quit by reducing the nicotine content of cigarettes (here).  I criticized the idea in my 1995 book, For Smokers Only (now available as an e-book with a bonus chapter on e-cigarettes).

In the 20 years since, the nicotine fadeout strategy has failed to gain traction, while the alternate concept of tobacco harm reduction has attracted substantial support.  When Drs. Benowitz, Henningfield and their anti-tobacco allies attempted five years ago to resurrect nicotine fadeout as an FDA regulatory strategy, I labeled it “the most idiotic idea ever proposed by tobacco control advocates” (here) and described “the disaster that would result from radical reduction (prohibition) of nicotine in cigarettes” (here).

Today we have a fresh clinical trial (abstract here) from Dr. Benowitz that may mark the last gasp for this scheme.

Dr. Benowitz and coworkers enrolled 135 smokers who were “interested in a reduced nicotine cigarette study, and not interested in quitting smoking in the next 6 months.”  Eighty participants “smoked five levels of progressively lower nicotine content cigarettes, the first four levels being smoked for 4 weeks each.  The lowest nicotine content cigarette was smoked for 7 months.  [I call this the fade-out group.]  The control group smoked their usual brand of cigarettes for 12 months.”  Everyone got a year’s worth of free cigarettes, and information was collected for one additional year.

The results were dismal, starting with completion rates.  Smokers were paid to participate, which may have prompted 87% of the control group to complete the first year and 69% to make it through the second; the rates in the fade-out group were 46% and 38%.

The authors reported that “Quit rates were low in both [fade-out] and control groups, and not significantly different between groups at any time.”  That is an understatement.  The quit rate, validated by lab studies, was 2% among controls at one year and at two years.  Among the fade-out group, the rates were 3.8% at one year and 7.5% at two years.

There’s more bad news.  At one year, 43% of fade-out smokers admitted they had violated the study protocol by smoking regular cigarettes.

Dr. Benowitz likely intended the study to provide cover for the FDA to gradually reduce cigarette nicotine levels to near zero.  Instead, as he acknowledged, the fadeout theory was disproven: “Simply reducing the nicotine content of cigarettes alone may be insufficient to extinguish smoking behavior.”

Importantly, Dr. Benowitz concedes that “…easy access to alternative sources of nicotine (such as nicotine medications or electronic cigarettes) may be needed to achieve cessation of
cigarette smoking.”

Dr. Benowitz, welcome to Tobacco Harm Reduction.

A final note: I recently discussed how the National Institutes of Health have influenced the debate about tobacco harm reduction by doling out massive grants to university researchers nationwide (here).  The Benowitz study was supported by four grants from the National Cancer Institute and the National Institute on Drug Abuse; the total taxpayer tab was $29.2 million.

Thursday, July 23, 2015

British Media Watchdog Faults The Telegraph for Demonizing E-Cigarettes

Today The Daily Telegraph published a correction of false information in an article demonizing e-cigarettes, following review by Britain's Independent Press Standards Organisation (here).  The correction was published on page 4 of the newspaper (left) and online.

The original story, “Four in 10 teenage e-cigarette users would not have smoked, warn health experts,” was authored by science editor Sarah Knapton on March 31 (here).  The article’s subtitle and the lead sentence repeated the theme that “teenagers who would never have smoked are now using e-cigarettes” (my emphasis).

The study, published in BMC Public Health (here), made no such claim.  In an online comment I noted, “First, the survey did not ask teenagers if they are ‘now using’ e-cigarettes; it asked them ‘have you *ever* tried or purchased e-cigarettes.’  Second, the survey did not identify ‘teenagers who would never have started smoking.’  Rather, it identified teenagers who had not smoked at the time of the survey and those who had smoked but not liked it.” 

I filed a formal complaint with the IPSO.  On April 2, the agency replied that my complaint “falls within our remit and discloses a possible breach of the Editors’ Code of Practice” and that it was being sent to The Telegraph in order to “to provide it with the opportunity swiftly to resolve the matter to your satisfaction, directly, if possible.” 

The paper’s Head of Editorial Compliance, Jess McAree, emailed me on April 13, saying, “…there is nothing inaccurate or misleading about the article that requires amendment.”

I advised the IPSO that my complaint was not resolved:

“The article’s author, editor Sarah Knapton, could have described the study findings accurately. In her article teens who had ever tried or purchased e-cigarettes in the past were inappropriately
transformed into using e-cigarettes NOW…In addition, Knapton falsely converted teenagers who had never smoked in the past or who had tried it but didn’t like it into teens who would have NEVER started to smoke.

“These items are not just marginally inaccurate summaries, and they do not involve methodological complexities; they represent misuse of simple English words to conflate ever e-cig triers to current users and to redefine teens who hadn’t started to smoke as those who would never smoke. The article remains inaccurate and misleading, and it still requires amendment.

“I request that IPSO proceed with further consideration of my complaint.”

By May 11, my complaint was scheduled for a full committee hearing.  In desperation, The Telegraph’s McAree sent the IPSO a description of the study’s technical findings, which I pointed out was “completely irrelevant to my complaint.” 

Telegraph editors made a last-ditch, insufficient change on May 19, removing the phrase “would not have smoked” from the headline, but they made no substantial changes in the subhead or article (second photo). 

Finally, on June 25, the IPSO notified me of their finding that The Telegraph article was misleading in redefining teens who hadn’t started to smoke as those who would never smoke.  IPSO required the paper to take remedial action: “The article was on page 12 of the newspaper, and correction should be published on this page, or further forward in the newspaper.  The correction on the online article should make clear that the article had since been amended, and should be published at the foot of the online article.”  The IPSO published my complaint and its decision here. 

The IPSO should have acknowledged that The Telegraph mislabeled teens who had ever tried or purchased e-cigarettes in the past as users of e-cigarettes NOW.  However, this part of my petition was not upheld.  I am disappointed that the IPSO allowed the newspaper to transform ever use of e-cigarettes into current use.  Additionally, the IPSO inaccurately reported my complaint by not including the word “now,” which The Telegraph used in describing e-cig use in its subhead, first paragraph and fourth paragraph.         

The IPSO exists “to promote and uphold the highest professional standards of journalism in the UK, and to support members of the public in seeking redress where they believe that the Editors' Code of Practice has been breached.”  The organization maintains high standards of journalism, and it has a high bar for complaints.  Of the 188 complaints reviewed by the committee since its establishment in 2014, only 41 (22%) have been confirmed.  Fourteen complaints against The Telegraph have been reviewed; mine is the third to be upheld. 

The IPSO decision sends a message to the British news media: Get your facts straight when reporting about e-cigarettes.  It’s a shame that there is no equivalent media watchdog in the U.S.