Wednesday, June 20, 2018

American Cancer Society’s Combustible Tobacco Statement Contains Falsehood

The American Cancer Society’s new position statement offering a “bold new framework” for eliminating combustible tobacco use in the U.S. (here) contains a demonstrably invalid statement: “Cigarette smoking is the leading cause of cancer mortality in the United States (1), accounting for as much as 98% of all tobacco-related deaths (2) [emphasis added].

The problem with the highlighted phrase is that no estimate of “all tobacco-related deaths” in the U.S. has ever been produced by the government, academia or health organizations.  The percentage of deaths attributable to smoking, while undoubtedly large, is simply not known.

In reference 2 above, ACS attributes the false assertion to a New England Journal of Medicine article by tobacco researchers Michael Fiore, Steven Schroeder and Timothy Baker (here).  That article made virtually the same statement and cited a citizen petition submitted to the FDA in 2010 by Dr. Joel Nitzkin on behalf of the Tobacco Control Task Force of the American Association of Public Health Physicians (here).  Careful review of the Nitzkin filing reveals nothing to support the ACS or NEJM claim.

This falsehood can be corrected.  With some effort, the very small number of deaths from smokeless use and cigar/pipe smoking can be estimated from large federal datasets.  Government researchers and the ACS have the resources and should make this a priority, in order to provide a scientific foundation for FDA tobacco regulation.

Fabrication, or repetition of false statements, particularly by trusted authorities, organizations, and public figures, can result in widespread acceptance of myth as truth. Such cavalier inattention to fact is not acceptable in scientific discourse or public health policymaking, where actual lives are at stake (here).

Thursday, June 14, 2018

American Cancer Society Sees Zero Cancer Risk for Smokeless Tobacco

A June 11th American Cancer Society policy paper (here) states that the Society will “focus on the primary goal of ending deadly combustible tobacco use… Given this imperative, ACS will provide smokers and the public with clear and accurate information available on the absolute and relative health impact of combustible tobacco products, nicotine-based medications, [electronic nicotine delivery systems] and other novel tobacco products…ACS will increase its efforts to guide smokers toward evidence-based cessation options that enable them to quit as quickly as possible and eliminate their exposure to combustible tobacco smoke.”

ACS researchers have estimated the number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States (available here).  They identified 17 risk factors causing 660,000 cases of cancer.  Cigarette smoking was the primary cause (responsible for nearly 300,000 cases), while herpes virus type 8 produced the fewest cases (1,040). 

Smokeless tobacco was not among the 17 risk factors – a tacit acknowledgment that the risk of cancer from smokeless tobacco is de minimis.  Taking this position, ACS seems to be abandoning its 30-year crusade against tobacco harm reduction.

Over the years, I have noted in this blog how ACS failed to provide smokers and the public with clear and accurate information about smokeless tobacco.  Rather, it exaggerated risks (here, here and here); withheld risk information (here, here, here and here ); and criticized the British Royal College of Physicians’ harm reduction report (here). 

ACS describes its new stance on eliminating combustible tobacco use as a “bold new framework for action.”  The policy paper indicates a shift to cautious support of e-cigarettes, conceding that “although the long-term effects of [e-cigarettes] are not known, current-generation [e-cigarettes] are markedly less harmful than combustible tobacco products.”

In fact, the long-term effects of smokeless tobacco use are known to be next to nil.  I hope ACS follows with bold new action explicitly acknowledging that dip and chew products are vastly safer than cigarettes.