Wednesday, May 22, 2024

Timeless Knowledge from an Insightful Mathematician


I recently read on X (Twitter) a tribute to the book, “A Mathematician Reads the Newspaper,” by John Allen Paulos. 

The author is a professor of mathematics at Temple University, and his bio, here, is impressive.  The book, still in print and available on Kindle, was originally published in 1995.  More importantly, it remains relevant today, especially, as the reviewer put it, if you want to “become smarter and a better consumer of information who will not fall into [the] many traps of the media.”

I don’t recall having contact with Paulos, but his tome includes these two insightful paragraphs:

“More than 400,000 Americans die annually from the effects of smoking, but there is some intriguing evidence that the number could be drastically reduced by the widespread use of smokeless chewing tobacco.  Professors Brad Radu [sic] and Philip Cole recently published a note in Nature in which they claimed that the average life expectancy for a thirty-five-year-old smokeless tobacco user would be fifteen days shorter than that for a thirty-five-year-old smoker.  This is in contrast to 7.8 years lost by smokers.  The authors estimate that a wholesale switch to smokeless tobacco would result in a 98 percent reduction in tobacco-related deaths.

“Since a small amount of tobacco lasts all day, tobacco companies would likely oppose smokeless chewing tobacco.  There has already been strong opposition to it from some antismoking groups because of an increase in the risk of oral cancer (which is much rarer than lung cancer, emphysema, and heart disease).  I suspect that another reason is a certain misguided sense of moral purity – not unlike opposing the use of condoms because, unlike abstinence, they’re not 100 percent effective.  If the numbers presented here are confirmed, however, recommending a switch to smokeless tobacco for those smokers (and only those) who can’t quit would seem like sound public policy.”

Paulos has a knack for interpreting numbers, and he understands the “misguided sense of moral purity” that has dominated tobacco policy – and killed millions of smokers – for nearly 30 years.



*Nota bene: Phil Cole and I never claimed that a “wholesale switch” to smokeless would result in a 98 percent reduction in smoking-related deaths, as that would not have accounted for residual deaths from former smoking among those switchers.  Rather, we based the 98 percent reduction on the following premise: “If, instead of smoking, smokers had used smokeless tobacco.”  It is a subtle but crucial distinction, but it does not detract from the huge risk reduction available to individual smokers who switch.


Tuesday, May 14, 2024

Video on the Bad Science That Keeps Smokers Smoking, and Dying


I recently participated in a panel discussion about tobacco harm reduction (THR) at the Tobacco Merchants Association meeting.  While assembling my powerpoint presentation, I recalled that I presented to this group 18 years ago, in 2006, what was likely their first introduction to THR. 

To view my 10-minute primer on bad science – then and now – watch this video, starting at the 26-minute mark.  I discuss the genesis of the myth that smokeless dip and chew products present a high risk for mouth cancer (discussed extensively in this blog by searching for “Winn”), and my THR team’s attempts to correct fatally flawed vaping research articles.    

I’m happy to provide the slides upon request.    

Tuesday, May 7, 2024

What Medscape Subscribers Really Thought About Its Tobacco Harm Reduction Programs


Earlier this year, Medscape, which describes itself as “the leading online global destination for physicians and healthcare professionals worldwide,” invited me to participate in a series of short continuing medical education (CME) programs on tobacco harm reduction (THR).  Medscape clearly disclosed that the series was sponsored by Philip Morris International, but the programs were firewalled; faculty were not in contact with or influenced by the sponsor.

Topics included, among others, an examination of nicotine, and the differential risks of combusted versus smoke-free tobacco/nicotine products.

I recorded two programs.  The first, “Nicotine Misperceptions: What Does the Evidence Say,” was published online by Medscape around March 1.  The second, in collaboration with Dr. Sally Satel, “Harm Reduction From Tobacco: An Evidence-Based Discussion,” was published April 1.  Dr. Satel also recorded a third program.

Following publication, a few anti-tobacco crusaders objected, threatening “a rapid global boycott by healthcare professionals disgusted by [Medscape’s] behaviour” in two British Medical Journal articles and one in The Examination.  I will not provide links to these, as they include ad hominem attacks on me.  Dr. Satel recounts the sorry tale in this article (here).    

As Dr. Satel notes, Medscape buckled, whining that “use of this funder was a misjudgment that was out of character for Medscape Education and that doing so may have disappointed our members.”

But were Medscape members truly offended by the PM sponsorship?  Evidence from an email I received from a Medscape manager says “NO.”  Shortly after my nicotine program aired, I received an unsolicited email from the manager titled, “One of the best CME programs I have seen in a long time…” Following is the text of that email, with some passages highlighted by me.

“We have the preliminary results from your program that was posted less than a month ago, and I am personally flabbergasted by the participation - over 6000 learners and over 2200 test takers!

“The comments from participants have been incredible as well:

  • I can better educate and motivate pts on how to cut down their use of nicotine products. I am also more cognizant now that those who use cigarettes may have a more difficult time quitting. Will refer these pts to our clinical pharmacist who can also help advise and prescribe the appropriate tobacco cessation products.
  • This was fantastic! This down to earth harm reduction approach is absolutely key to help meet people where they are, as nicotine addiction is so strong! Much better outcomes can be achieved as these presenters described, using less harmful forms of nicotine. As the doctors stated, there is a great need to educate providers, and clarify misconceptions about nicotine vs various methods of ingesting nicotine. I hope this presentation reaches a wide audience! One of the best continuing eds I have done in a while.
  • Dispelled many myths I previously held about nicotine that I will no longer propagate.
  • Thank you for bringing up such an important topic that can bring down the costs of healthcare and truly improve the public health. I am a psychiatric provider and have had a large number of patients successfully quit smoking with harm reduction measures!

It is tragic that Medscape capitulated to rabid tobacco prohibitionists and stopped providing vital, life-saving information to health professionals.