Wednesday, August 10, 2016

A Smokeless History Lesson For Vaping Advocates

E-cigarettes are under siege by federal health authorities and NGOs, aided and abetted by countless university researchers funded generously by the National Institutes of Health (here).  Many of their tactics were introduced 35 years ago.  Here, in brief, is the story of smokeless. 

The American anti-smokeless campaign started on March 26, 1981, when Deborah Winn, Ph.D., reported in the New England Journal of Medicine that the relative risk for oral cancer among powdered dry snuff users was 4, a risk she described as "exceptionally high".  In reality, that risk translated to a mere 12 deaths per year among 100,000 long-term users (For perspective, compare this with the contemporary annual U.S. death rate of 10 per 100,000 users of automobiles, here).  Winn studied only the use of powdered dry snuff, not the moist snuff and chewing tobacco that the vast majority of American smokeless tobacco consumers prefer.  She later acknowledged in two obscure scientific publications – a 1983 IARC report (here) and the 1986 Banbury Report 23 from Cold Spring Harbor Laboratory – that her study involved only dry powdered snuff, but her omission of that critical detail in the initial article set the stage for condemnation of all smokeless products as health hazards (discussed in detail here). 

Winn also falsely inflated the moderate relative risk of 4 to a startling and unsubstantiated 50 (explained in detail here).  The fifty fabrication was adopted by public health agencies and associations worldwide, and continues to pollute the web sites of the American Cancer Society (here) and the State of Kentucky (here), among many others.

The office of the Surgeon General of the United States has been tarnished by the campaign to demonize smokeless products.  Surgeon General Richard Carmona grossly distorted the facts when he testified before Congress in 2003, saying “there is no significant evidence that suggests smokeless tobacco is a safer alternative to cigarettes.”  I also testified at that hearing (here) and published in the Washington Times the following week an op-ed dismantling Dr. Carmona’s testimony (here).  It was another Surgeon General, Antonia Novello, whose 1994 false claim, “The majority of our experts predict an oral cancer epidemic if the current trends in spit tobacco use continue,” (here) prompted me to enter the field of tobacco harm reduction. There was never any basis for that prediction, and it was never realized. 

Major medical institutions have damaged their credibility by spreading misinformation about smokeless tobacco.  These include the Mayo Clinic, the Legacy Foundation, the National Cancer Institute (here) and others.  Other examples of this scientific travesty were described in a comprehensive review of tobacco harm reduction penned by William Godshall and me in 2006 (here).

Today, e-cigarettes are attracting growing support from public health proponents who recognize their value as safer alternatives for cigarette smokers.  It is consternating, however, that some of these experts persist in demonizing smokeless tobacco products whose relative safety is supported by dozens of irrefutable epidemiologic research studies. 


Chris Price said...

It would probably help this argument if a list of some of the studies that support it can be provided, along with a brief commentary on why these studies are likely to be accurate; accompanied by another list of studies that present the opposite conclusion, and why they are less likely to be accurate.

Whenever this message is presented to the public, the inevitable response is, "What are the studies that support this position?", "Why should I believe this study and not [this example] by [opposing professional]?", and "Your position is opposed by [X person] and/or [X organisation] and they appear to have more stature in this field than you/your source".

In the end this argument is one between professionals (or those who appear to be expert in the field, at least to outsiders) and a really strong argument is often needed. This would comprise national health statistics (facts) and evidence (studies) that are hard to refute. For example, if Sweden is to be used as an example of the facts and evidence, and that could also be used for other regions with harder to find resources (such as the USA), then a single work is needed that:
- Tells us how many smokers and ST users there are now in Sweden, and in the past;
- What the national health stats are, present and past, and why these stats might be different/better than those for other countries;
- A list of studies that reinforce the argument that the stats are better in Sweden because Snus consumption does not result in measurable levels of mortality/morbidity.

An article or short series on these topics might help those of us who have to provide a long list of studies to refute the usual 'oral tobacco is highly dangerous' and still end up losing the debate because we don't have the best citations, or are not able to explain why study X is better than study Y by Prof Z, and cannot provide any graphical evidence to support the contention that low tobacco-related disease rates in Sweden are the result of more Snus usage, and not the 'highly efficient tobacco control policies of Sweden' argument that is commonly used.

Those of us who know the players know who to trust on this; those who don't will believe the big names, unless presented with an extremely convincing argument.

The problem with this topic area is that the evidence is just too difficult to find and evaluate for the average person, or even for those who wish to present a brief but strong argument. It really needs a definitive guide to why modern ST is a far better choice than cigarettes, and above all such a guide needs to explain why the usual suspects are wrong.

As a THR advocate of the anything but cigarettes class, I have a great deal of trouble convincing people who have been strongly influenced by the propaganda. Until a comprehensive guide to the subject is available, that includes an explanation of why opposing arguments are wrong and gives specific examples, my job is almost impossible. The average person needs to be convinced with facts and hard-to-refute argument, because the propaganda cost a huge amount of money and is very good at its job.

I don't need convincing, but many of the people I interact with do, and since (1) I'm unpaid, and (2) I don't have any letters after my name, it is not unreasonable for me to ask others with better resources to provide a more coherent argument. A 'coherent' argument, here, is one that is hard to refute. That means it needs facts, evidence, and *good reasons why the opposition's argument is wrong*. In one place, ideally.

This debate needs winning, and the current resources do not, in my opinion, achieve that goal. Most of us write for other cognoscenti and that is the wrong approach. What is needed is a strong, coherent, comprehensive argument that is very hard for others to refute.

cigarbabe said...

They should be jailed or fined. How many people may die from their lies?