Wednesday, October 29, 2014

Gateway Claims Aimed at E-Cigarettes: Counterfeit, Déjà Vu

In their war against e-cigarettes, government officials often claim that the devices are a gateway to smoking.  CDC director Dr. Tom Frieden asserted (here) that “…many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.”  The National Cancer Institute last March promoted (here) Dr. Stanton Glantz’s tortured analysis of youth e-cigarette use (discussed here and here).  While his data failed to support a gateway effect, his employer, the University of California San Francisco, made the claim anyway (here).     

Politicians also have a penchant for yelling “fire” about smoke-free devices.  U.S. Senator Richard Durbin and Democratic colleagues in the House and Senate issued a report in April titled “Gateway to Addiction” (here).  The term “gateway”, obviously used as an attention-grabber on the cover, appeared only once in the text -- as a nonspecific example of how e-cigarettes “could also increase public health risks” for non-smokers.

The marijuana gateway claim didn’t gain currency until the 1950s.  Back in the 1930s, Harry Anslinger, the first commissioner of the Federal Bureau of Narcotics (here) and the driving force behind the prohibitive Marijuana Tax Act of 1937, denied a gateway claim during Congressional hearings.  According to the excellent history of marijuana prohibition by Richard Bonnie and Charles Whitebread (here), Representative John Dingell asked Anslinger “whether the marihuana addict graduates into a heroin, an opium or cocaine user.”  The Commissioner replied unequivocally, “No sir; I have not heard of a case of that kind. I think it is an entirely different class. The marihuana addict does not go in that direction.”

By 1951, Anslinger changed course while testifying in favor of the Boggs Act, which increased federal penalties for narcotics and marijuana.  Endorsing marijuana’s new reputation as a treacherous gateway drug, he said: “The danger is this: Over 50 percent of those young addicts started on marijuana smoking. They started there and graduated to heroin; they took the needle when the thrill of marijuana was gone.”

So began marijuana gateway scaremongering, which Dr. James Anthony, professor of epidemiology and biostatistics at Michigan State, labels as “…‘vapors’ that emerged from a political cauldron during the middle of the 20th century when it was very difficult to find definitive and convincing evidence of harmful effects of cannabis use – over and above (1) the sometimes extremely severe consequences of criminal penalties for simple cannabis possession and use, and (2) adverse effects on mouth, nose, throat, and lung.” (abstract here)   

This should sound strikingly familiar to vapers (e-cigarette users) and tobacco harm reduction advocates.  As they did with marijuana, prohibitionists make the gateway claim against e-cigarettes in the near-total absence of “definitive and convincing evidence” of harm.

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.