The Truth Initiative Belies Its Name in New Smokeless Tobacco Screed

The Truth Initiative is a billion-dollar foundation devoted to tobacco prohibition.  Launched as the American Legacy Foundation with cash from the 1998 Master Settlement Agreement (here), the group changed its name in 2015.  The Initiative recently issued a “fact sheet” on smokeless tobacco that is grossly inaccurate and misleading.

On one hand, it suggests that smokeless is safer: “Switching completely from smoking cigarettes to using the least harmful forms of smokeless tobacco (e.g., Swedish snus) may result in lower health risks to individuals,”…cancer risks are “lower for smokeless tobacco users than for smokers,” and “…smokeless tobacco use, while harmful, is less harmful than cigarette smoking.  The least harmful smokeless tobacco products are low-nitrosamine Swedish snus…”

The last statement is blantantly wrong.  As I explained in a recent post (here), it is impossible to differentiate risks among Swedish and American smokeless products.  There is no basis for the claim that “Harms from smokeless tobacco products vary by product type.”  

The Initiative departs from mainstream science with an additional assertion: “Smokeless tobacco use causes precancerous oral lesions, oral, esophageal, and pancreatic cancer.”  Their source for that hyperbolic statement is the same as a recent FDA campaign: embarrassingly weak and misleading information from Paolo Boffetta and colleagues at the International Agency for Research on Cancer, debunked here.  While actual risk estimates for these diseases would leave the media and consumers totally unimpressed, the Initiative omits them all, much as other anti-tobacco agencies routinely do.

Imprecision, hyperbole and cherrypicked data are the hallmarks of the well-funded and often taxpayer-supported tobacco prohibition movement.  In the absence of truth and transparency, public health only suffers.

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. 

UCSF Study Falsely Links E-Cigarettes to Smoking

Academics at the University of California San Francisco have used the 2011 and 2012 National Youth Tobacco Survey to fabricate a claim that “e-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco.”  Lead author Lauren Dutra provided that quote to the media in a UCSF press release touting the study (here).  Dr. Stanton Glantz was a coauthor.  The study appears in the Journal of the American Medical Association Pediatrics.

The UCSF press release also contains a demonstrably false leading statement: “The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.”

These percentages DO NOT refer to current e-cigarette use, but to ever e-cigarette use, “even just one time.”  I have analyzed this data before (here and here).  E-cigarette use among middle and high school students did double between 2011 and 2012, from 1.0 to 2.0 percent.  The chart on the left provides a truthful picture of e-cigarette use.

 

The Dutra-Glantz study consisted of a dizzying array of statistical analyses that could not possibly support their claim that e-cigarettes are a gateway to cigarettes.  Unfortunately, the media is headlining this false claim around the globe. 

The only positive note in this otherwise dark story is that, for the first time, Dr. Glantz’s fabrication was called out by the American Cancer Society and the American Legacy Foundation.  The ACS’s Dr. Thomas Glynn said in the New York Times, “The data in this study do not allow many of the broad conclusions that it draws.” (here). 

Dr. David Abrams of the American Legacy Foundation confirmed that the data do not support the authors’ conclusion.  “I am quite certain that a survey would find that people who have used nicotine gum are much more likely to be smokers and to have trouble quitting, but that does not mean that gum is a gateway to smoking or makes it harder to quit,”

There is more.  My chart shows that although e-cigarette use increased, exclusive cigarette smoking plummeted, from 4% to 2.8% among middle school students, and from 14.6% to 11.8% among high school students.  This dramatic decline further undermines Dutra-Glantz’s claims.

Anti-tobacco extremists have won this media skirmish against e-cigarettes, but at a price – their integrity.

Legacy Tells the Truth – Tobacco Harm Reduction Revolution Gains Momentum

After 20 years of staunch opposition to and misinformation about tobacco harm reduction from anti-tobacco forces, one prominent figure has broken ranks, offering the truth and a cautious endorsement of safer tobacco products. 

David B. Abrams, PhD, Executive Director at American Legacy Foundation’s Schroeder Institute for Tobacco Research and Policy Studies (here), recently acknowledged in a college newspaper (here) that smoke-free tobacco products are vastly safer than smoking.  Here is the key passage from that article:

“Though he said that there is not much research on e-cigarettes, Abrams said the studies he has seen ‘put e-cigarettes in the category of somewhere between nicotine replacement therapy, which is pharmacy-grade nicotine from a pharmacy, and smokeless tobacco products, which are not harmless but are also much less harmful than cigarettes.’  He said that in terms of risk, he would slot e-cigarettes between snus — a type of powdered tobacco — and dissolvable nicotine products.”

Coming from an executive at one of the most anti-harm-reduction organizations, this is a revolutionary statement.  As readers of this blog know, numerous published epidemiologic studies document that American and Swedish smokeless tobacco products have disease risks so low that they cannot be measured with any precision.  Dr. Abrams’ risk assessment for e-cigarettes is therefore accurate.

This was the second time in two weeks that Dr. Abrams acknowledged the substantial risk differential between combusted and smoke-free tobacco.  On November 25, he commented at a Wells Fargo e-cigarette forum in New York:

“[E-cigarettes are] dramatically less and probably in the order of 10 to 100 times less dangerous than combusted cigarettes.  And certainly even less harmful than the data I've seen for

smokeless tobacco, although they're also dramatically less harmful than cigarettes.  So I'd say they're somewhere in between the ‘safest nicotine replacement pharmaceuticals’ and smokeless. And I would regard smokeless as a decent harm reduction strategy along with e-cigarettes in the map of harm reduction versus quit or die total abstinence.” 

Thus far, the campaign to inform smokers about safer products has been led by a handful of tobacco research and policy experts (here).  Dr. Abrams’ statements should pressure harm reduction deniers to abandon their failed quit-or-die mantra and start telling smokers the truth about safer cigarette substitutes.  This underscores my view that the tobacco harm reduction revolution is unstoppable.