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. 

Thursday, June 7, 2018

FDA Aims at Wrong Target in Effort to Protect Teens


FDA Commissioner Scott Gottlieb has again mistakenly blamed e-cigarette companies for teen vaping.  Addressing the American Society of Clinical Oncology, Dr. Gottlieb issued a direct threat: “They better step up and step up soon – to address these trends along with us.  So far, I must say, I’ve mostly been disappointed by the tepid response from companies that know that a meaningful portion of their sales are being derived from kids.  The e-cig companies have a chance to do something about it.  The window is open. But it won’t be open for very long.” (here)  The commissioner also tweeted about “additional regulatory policy measures and new enforcement actions as part of our ongoing campaign.” (here) 

FDA survey data show that Dr. Gottlieb’s concern is misplaced. 

The charge that “a meaningful portion” of e-cigarette sales are made to children is undermined by a 2014 FDA survey: of 12.9 million adult (here) and 770,000 teen current e-cig users (here), only 9.9% of teens had bought their own e-cigs.  The 76,000 teens who purchased products from retailers accounted for only 0.5% of all users and an even smaller fraction of all sales. 

The fact that over 90% of teens obtained e-cigarettes from social sources, such as friends or family, makes “policy measures and new enforcement actions” against retailers entirely misguided.  It is illogical for the FDA to hold retailers responsible for teen e-cigarette use. 

The federal government has pursued the elimination of tobacco sales to children for decades.  Beginning in 1997, Washington required states to report underage sales via the Synar Program (here).  The latest Synar data shows that 9.6% of retailers were noncompliant in 2013.  The FDA also conducts compliance checks of tobacco retailers.  In 2016, the FDA reported a noncompliance rate of 11% (here).  The FDA should focus on this far more dangerous illegal cigarette sales issue, rather than obsessing over e-cigarettes. 

Bad actors – that small percentage of retailers who sell e-cigarettes to children – should be punished, but their infractions should not cause the entire vaping industry to suffer undue, overly broad sanctions.

Were government officials to truly prioritize teen safety issues, alcohol would be their number one target.  One-third of high school seniors drank in the past 30 days last year, and nearly 1 out of 5 were drunk (here), even though the legal age for alcohol purchase is 21.  

Demonizing e-cigarettes and their marketers and retailers may generate easy headlines, but real public health gains require data-based prioritization of threats, and for teens, those are alcohol and cigarettes.