Not-So Fine Whine, From the Society for Research on Nicotine and Tobacco

 

The Society for Research on Nicotine and Tobacco (SRNT) bills itself as “the only professional association dedicated exclusively to the support of researchers, academics, treatment professionals, government employees, and the many others working across disciplines in the field of nicotine and tobacco research.” 

The organization claims that it advances the field of nicotine and tobacco research by working with groups including the FDA’s Center for Tobacco Control and Center for Drug Evaluation and Research, the National Cancer Institute (NCI), and the National Institute on Drug Abuse.  While those relationships are appropriate, SRNT’s bragging about its “close relationships” with the Truth Initiative, the Campaign for Tobacco Free Kids (CTFK), the Association for the Treatment of Tobacco Use Dependence, and the American Cancer Society is unseemly, given those groups’ open hostility to any research or data supportive of nicotine, tobacco or tobacco harm reduction.

Responding to the CDC losing $310 million for its Office on Smoking and Health (OSH), SRNT published a “Nicotine & Tobacco Research Community Call to Action.”

The call to action links to a CTFK letter, dated April 30, that argues for continued CDC OSH funding: “The elimination of CDC’s Office on Smoking and Health would have a profoundly negative impact on our nation’s efforts to reduce the death and disease caused by tobacco…OSH has provided grants to all 50 states and territories to support tobacco prevention and cessation programs. Comprehensive state and local tobacco control programs…OSH has provided funding to state quitlines…With $310 million, CDC will be able to address the challenges posed by e-cigarettes…”

Stated more accurately, if the CDC loses this funding, it will no longer be able to pursue its stated goal of achieving nationwide tobacco prohibition.

SRNT emphasizes the prime reason they support continued funding for their CDC piggybank: “More than ever, we need to explain how tobacco impairs health, why people continue to use tobacco, and what can be done to reduce tobacco-related deaths.”  

In reality

 The only tobacco use that impairs health is smoking;

2.  People use tobacco because it is pleasant and satisfying; and,

3   We can reduce tobacco-related deaths by reducing smoking. 

This bit of federal spending reduction may actually promote public health, “more than ever.”

 

American Cancer Society, Which De-Listed Smokeless Tobacco as a Cancer Risk, Now Targets Nicotine Pouches

 

The journal JAMA Network Open last month published a short report by American Cancer Society and University of Georgia researchers who used Nielsen retail scanner point-of-purchase sales data to estimate U.S. sales of four nicotine pouch brands: Zyn, Rogue, On! and Velo.  While the authors acknowledged that their “data did not represent all nicotine pouch products and online sales,” they still reported a whopping increase in consumption: “Overall sales [of nicotine pouches] increased from 126.06 million units from August to December 2019 to 808.14 million units from January to March 2022.”

This raised a red flag at the American Cancer Society, which issued a press release subtitled, “Researchers at the American Cancer Society stress health interventions to continue reducing nicotine pouch use.”  What health concerns did they cite?  The press release mentions “flavorings, sweeteners”, “colorful packaging that looks like mint containers,” and the usual culprit, “addictive chemical nicotine, which can negatively impact your learning, attention span, and proneness to addiction.”

The closing line of the report reflects the real intent of the authors and the Society: “Health campaigns warning of potential adverse health outcomes of nicotine pouches are needed.”

The question remains: What are those “adverse health outcomes”?  Four years ago, the Society issued a policy paper identifying the top 17 causes of cancer (here).  Smokeless tobacco products were not on the list, as the Society promised to “focus on the primary goal of ending deadly combustible tobacco use.”

Today, the Society has apparently shifted its focus to nicotine pouches.

The American Cancer Society has for decades opposed all nicotine/tobacco products.  Since smokeless products are vastly safer quit-smoking options, the organization has betrayed its “vision to end cancer as we know it for everyone.”  Rather than ensuring “that everyone has an opportunity to prevent…cancer,” the Society ensures that smokers and their families continue to suffer. 

Seven years ago I wrote, “It is time for tobacco users, their families and friends to send a message to the American Cancer Society: ‘Say goodbye to our donations.’  Tell ACS volunteers in your community that the society must acknowledge scientific facts and abandon its tobacco prohibition stance.  Until the ACS tells the truth about tobacco harm reduction, charitable contributions should be directed elsewhere.”

Finally, A Direct Comparison of Smoking and Smokeless Tobacco Use

I have documented how American health authorities refuse to directly compare the health effects of smoking and smokeless tobacco (ST) use.  The results of such an exercise would require them to acknowledge the products’ vast risk differentials.  For years, the American Cancer Society has possessed data that would allow this comparison (here, here, and here), but they refused to run the analysis or provide me with the data (here). I recently explained how FDA officials hid the comparison in a New England Journal of Medicine article (here).

I have spent much of the past 25 years trying to correct this information deficit.  Lacking access to the necessary data, the only comparison I could make was indirect (here), which was less than ideal.

Now, at last, the data are in full view.  Altria scientists in April published the first-ever follow-up mortality study of cigarette smokers and ST users, using national surveys and the National Death Index, all of which are produced by the U.S. Government and publicly available.  The first author of the impressive study, published in Harm Reduction Journal, is Michael T. Fisher. 

The figure at left illustrates the results for all causes of death, all cancers and heart diseases; smokeless tobacco is referenced as SLT.  In each section, hazard ratios – the likelihood of dying compared with never tobacco users – are illustrated for smokers by the first set of black dots/squares in the red circles; former smokers are in the next set; and ST users are in the third set, circled in blue.

Smokers are at more than twice the risk of dying from all causes than never tobacco users.  Former smokers’ odds are about 30% to 50% higher than those of never tobacco users (HR = 1.3 – 1.5).  Current ST users who never smoked died at the same rate as never tobacco users.

Compared with never users, smokers had even higher odds for dying from cancer, from 2.9 to about 4.2.  Former smokers also had higher odds, varying from 1.6 to 2.4.  Once again, ST users died at the same rate as never tobacco users.

Smoking isn’t as big a risk factor for diseases of the heart; other factors, like obesity, diet, physical fitness and diabetes, are also important.  Smokers in this study had odds ranging from 1.2 to 2.2, and not all of these were significant.  ST users had no excess risk.

In summary, this analysis of government data confirms that ST use is vastly safer than smoking.  The FDA and CDC not only had this data, but used it in other mortality studies of smokers and cigar users.  By not publishing the results on ST users, federal officials maintained the illusion that ST “is not a safe alternative to cigarettes.”  It is ironic that cigarette industry researchers produced this pivotal analysis.  Stay tuned to this blog for more results.