Monday, April 19, 2010

Poisoning Public Health Issues

Anti-tobacco extremists have a big problem with smokeless tobacco. There is virtually no scientific evidence that long-term smokeless tobacco use is associated with ANY disease. So extremists have engaged in a media campaign to vilify these products in exceptionally creative ways.

I previously discussed the specious claim that smokeless tobacco products contained dangerous levels of wintergreen flavor (available here). Now a diatribe from Gregory Connolly, a Harvard University tobacco prohibitionist, has created the illusion that smokeless tobacco products are a major cause of poisoning among American children. The study was published in the journal Pediatrics (see the abstract here). It was tailored to produce a media frenzy, and it did. Here is a typical headline from MSNBC: “Tobacco mints tied to kids’ poisoning: smokeless products 2nd most common source of accidents.”

Most Americans will think that children all over the U.S. are dropping dead from accidental exposure to smokeless products. Connolly and his colleagues at Harvard, the CDC and an Ohio poison control center collected information on 13,705 incidents from the National Poison Data System from three years (2006-2008). Out of context, that appears to be an alarmingly high number.

I can’t provide context on the three-year data they accessed, but I was able to review the 2008 annual report of the American Association of Poison Control Centers (read it here). I think you will find the report informative.

It turns out that tobacco products accounted for only about 1% of the over 684,000 cases of exposure to non-pharmaceutical agents of all kinds in children less than 6 years of age in 2008. That’s 7,310 cases. Here’s a table of the top 20 exposures:

Non-pharmaceutical Exposure Cases Among Children Under 6 Years of Age, 2008

Product Category
Number of Exposures
Cosmetics and personal care products 170,210
Household cleaners 120,295
Foreign bodies 94,792
Pesticides 42,260
Plants 41,842
Arts, crafts, office supplies 28,331
Alcohols 23,569
Deodorizers 20,487
Solvents, oils 14,565
Bites, venom 10,808
Chemicals 10,470
Paint, paint strippers 9,593
Adhesives, glues 7,725
Essential oils 7,334
Tobacco 7,310
Batteries 5,432
Polishes, waxes 4,700
Building, construction products 4,683
Fertilizers 4,579
Food poisoning 4,503
Everything else 51,084

All 684,572

The MSNBC subheadline (“smokeless products 2nd most common source of accidents”) reflects another omission in Connolly’s abstract. He listed smokeless as the second most common TOBACCO source in the abstract, without revealing that it was a distant second. Cigarettes were responsible for 77% of 2006-08 tobacco exposures. In comparison, smokeless tobacco was only responsible for 13% of tobacco exposures.

The 2008 report shows that smokeless tobacco products were responsible for 1,105 of the 7,310 tobacco exposures, or about 15%.

So let’s do the math: in 2008 smokeless tobacco exposures were 0.16% of the 684,000 total exposures among children less than 6 years of age.

There is one more flagrant omission in Connolly’s journal article: he didn’t report the number of exposures involving nicotine medicines. That information is available from poison control reports; in 2008, 589 children under 6 years were exposed to nicotine medicines, slightly more than half of those exposed to smokeless tobacco. It’s another example of Connolly’s extreme selectivity.

Connolly used the results of his study to comment that tobacco manufacturers were “recklessly playing with the health of children.” When put into proper perspective, (exposures like household cleaners, solvents and oils, paint and paint strippers, fertilizers), Connolly’s selective reporting of poison control information is recklessly playing with the tolerance of the American public for honest discussion of important public health issues.

[Originally created on April 19, this entry was updated on April 20.]


Anonymous said...

It's a deadly campaign they're waging Dr Brad, they must have hearts of stone.

I bet a lot more kids were exposed to pharmaceutical nicotine too but medical poisoning isn't a valid health risk to pharm reps I suppose.

It's time adults were given equality with kids, we like flavours too and our own recreational activities. People who think the rest of us deserve nothing other than misery and depression for the sake of their children are not fit to be parents.

It's no wonder recent research shows that depressed people are more likely to be smokers. It depresses me to hear the rubbish that's thrown at us from bimbo propagandists in the name of science. As if it's all for our own good ... they make people neurotic with the cognitive dissonance they create.

Vocal EK said...

And "Nicotine Pharmaceuticals" (those would be the yummy fruit, mint and cinnamon flavored Commit lozenges and Nicorette gum) were responsible for 1,174 poisonings. There is no category under "Tobacco Products" for dissolvables. The products might fit into "Other Types of Tobacco Products," which only accounted for 97 poisonings.