Wednesday, October 22, 2014

Snus Users’ Hearts Keep on Ticking, Not Fluttering

Swedish researchers from several institutions document that snus use is not associated with atrial fibrillation (commonly known as AFib), the most common heart arrhythmia (irregular timing of the heart beat) and a risk factor for stroke (abstract here). The same group previously reported that snus use conferred no significant risk for heart attack (discussed here) and stroke (here).

Led by Maria-Pia Hergens, researchers analyzed data on Swedish men who were subjects in several studies.  While snus users had no risks for Afib, smokers had a small but significantly elevated risk (Hazard ratio = 1.16, 95% confidence interval = 1.01-1.33)
Although smokeless tobacco cannot be proven to be absolutely safe, this study adds important evidence that any cardiovascular effect is very minor.

Given the number of institutions represented by its authors, the report is an important development for tobacco harm reduction.  In contrast are the biased 1990s and 2000s studies from the Karolinska Institute.  There, a small group of KI researchers had access to the construction workers’ cohort and refused to share the data.  Instead, they manipulated the information to fabricate some health risks and amplify others in snus users, a fact which I documented in numerous blog posts (examples here, here, and here) and in letters to journal editors. 

Thursday, October 16, 2014

Federal Survey Data on Tobacco: It’s Not About The Children

I have documented for several years a nonstop decline in smoking rates among American teens (here, here, here, and here  )

Rates of smoking and use of other tobacco products among teens are so low that they no longer provide a valid basis for the draconian anti-tobacco policy prescriptions favored by the FDA and CDC. 

A fresh National Survey on Drug Use and Health summary (here) confirms low tobacco use by teens.  The chart at left shows that the smoking rate continued its free-fall through 2013.  Cigar use also declined over the past decade to 2.3% in 2013, while smokeless tobacco use was flat at about 2% over the entire period.

These figures aren’t underestimates.  As I discussed previously (here), NSDUH estimates tend to be robust because they include any product use over the prior 30 days. 


Other NSDUH data (in the second chart) point to the population that should be targeted by the FDA and CDC – those aged 18-34.  The sharp jump in smoking prevalence from 11% at ages 16-17, to 27% at ages 18-20, underscores that the latter group is where the real problem starts. 

Anti-tobacco forces know that problematic behaviors in adults don’t stimulate support for prohibitionist policies, so they continue to inaccurately suggest the existence of a youth-tobacco crisis.  

Wednesday, October 8, 2014

More Third-Hand Nicotine Nonsense: From Vapor?

Nicotine can be detected in a chamber after releasing vapor directly from an e-cigarette, according to a report in Nicotine and Tobacco Research (abstract here) by Roswell Park Cancer Institute investigators.  A Carl Phillips parody of the abstract (here) convinced me to review the journal article.  Clive Bates also published a scathing critique (here).

Dr. Maciej Goniewicz and collaborator Lily Lee released e-cig vapor from 100 4-5 second puffs into a 12 x 10 x 9 foot room.  Meticulous collection of samples revealed that about 205 micrograms of nicotine were spread out over 81 square feet of tile floor.  This is unsurprising, as most of the nicotine in vapor is expected to eventually fall to earth.  Far less nicotine was recovered from vertical surfaces like walls and windows. 

As Phillips noted, a huge amount of vapor was involved in this test, and it was injected directly into the room without passing through a user.  Even so, Phillips notes in his parody, “this means someone would have to lick clean the entire surface of a sliding glass door in order to get a dose of nicotine similar to smoking half a low-nicotine cigarette.”  Or, Phillips might have said, one would have to lick about two thirds of the 120 square foot floor. (Recovery from a vertical surface is about one fourth that of the floor.)

Four years ago, I reported that third-hand smoke is an almost imaginary vector by which smokers expose everything and everyone to dangerous toxins (here).  Today, smokeless tobacco users are also the scare campaign’s targets.  According to a 2013 study in Nicotine and Tobacco Research, “children living with smokeless tobacco users may be exposed to nicotine and other constituents of tobacco via contact with contaminated dust and household surfaces.”  (abstract here).  In this scenario, a child could consume 20 micrograms of nicotine, about one tenth the amount of the vapor floor-licker, by eating about one ounce of dust.

For Goniewicz and Lee, the exposure to nicotine from e-cigarettes is important because of “potential risks of thirdhand exposure to carcinogens formed from nicotine released from e-cigarettes.” This is reminiscent of reports that U.S. paper currency is contaminated with cocaine (here) or heroin, morphine, methamphetamine and PCP (here).  That issue was put into perspective by Adam Negrusz of the University of Illinois at Chicago (here): “I never think about this as a source of danger. We have more things which can be potentially harmful.”

Third-hand nicotine harmful?  Don’t even think about it.

Tuesday, September 30, 2014

CDC Sees E-Cigarette Use at Marked Increase and Leveling Off – Tortured Logic

The CDC has released another “more of the same” report on e-cigarette awareness and use.  The lead author is Dr. Brian King; the report appears in Nicotine & Tobacco Research (abstract here). 

While the manuscript refers at least 15 times to an “increase” in U.S. e-cigarette use from 2010 to 2013, Dr. King informed the media that e-cigarette use is leveling off (example here).  Ironically, Dr. King characterized the plateau in use of a vastly safer cigarette substitute as “a positive note.”  

On what did Dr. King base his “leveling” remark?  His conclusion was cherry-picked from two out of about a hundred percentage figures in Table 2 (in yellow in the screenshot on the left; you'll need some magnification).  Those percentages were not even mentioned in the results, but Dr. King considered them important enough to highlight for the media. 

This is a perfect example of the CDC producing data claiming one thing – a “considerable,” “marked,” “rapid,” “doubling” increase in e-cigarette use – then pitching it to the media as something else – a “leveling,” which is “positive.”  The agency’s purpose is to disparage a vastly safer cigarette alternative.  

The report contains other examples of distorted logic.  A reasonable observation – “The marked increase [in use] among former smokers could be attributable to the use of e-cigarettes for cessation.” – is supported by the fact that ever e-cig use among former smokers increased to 10% in 2013.  But King and his coauthors perversely observe that “…the increase could be attributable to new initiation of e-cigarettes among individuals who had successfully quit without previous use of the product, highlighting concerns over the potential for these products to promote relapse to combustible tobacco use.”

In other words, the CDC thinks that e-cigs are a gateway to smoking because they might be corrupting former smokers who had previously been abstinent.  As Lewis Carroll wrote, “It sounds uncommon nonsense.”