Say Goodbye to the American Lung Association

 

While the American Lung Association bills itself as “the leading organization working to save lives by improving lung health and preventing lung disease,” the group’s recent formal comment on the FDA Center for Tobacco Products’ Strategic Plan essentially endorses the greatest threat to lung health: cigarette manufacturers. Here is an excerpt from the group’s filing:

“Strategic Goal #4 - Improve Public Health by Enhancing Knowledge and Understanding of CTP Tobacco Product Regulation and the Risks Associated with Tobacco Product Use 

“Remove language from the description for this goal that references informing adults about the relative risk of tobacco products” (emphasis in original)

“As mentioned in our comments above, the description for this goal included language ‘and to inform adults who smoke about the relative risks of tobacco products.’ The Lung Association strongly recommends this language be removed from the description.”

The ALA asks the FDA to remove any reference to the scientific fact that smoke-free tobacco products are vastly safer than cigarettes.  They are effectively urging the agency to withhold lifesaving information about safer products from smokers and their loved ones.

The nonprofit world’s poor record on cigarettes led me eight years ago to advise the public to say goodbye to the American Cancer Society.  Still, the American Lung Association in 2020 reported revenue of $106 million, with some 60% attributable to fundraising events, gifts and other contributions. 

It’s time for tobacco users and their families and friends to defund the cigarette-manufacturer-supporting American Lung Association.  Send your charitable contributions elsewhere. 

 

 

  

 

2020 National Youth Tobacco Survey Introduced U.S. Youth to Heat-Not-Burn Tobacco Brands

 

Anti-tobacco crusaders continue to promote e-cigarettes and vape products to the nation’s youth.

ABC News has published a screed by University of Chicago pediatric resident physician Chidimma Acholonu in which she claims that “now a new smoke-free alternative called heated tobacco  is slowly gaining a foothold in the U.S. market…While heated tobacco products [known as heat-not-burn, HNB] only became legal in the United States in 2019, the device have [sic] already started to catch the attention of high school students.”

Dr. Acholonu credits unnamed “experts” for news that “Tobacco companies are attempting to glamorize these products.” How? Erika Sward, assistant vice president for advocacy at the American Lung Association, says, “[Tobacco companies are] attempting to make the packaging and the marketing look white and clear and clean and very modern.”

Huh? A teen HNB epidemic is going to be driven by white, clear, clean and modern packaging?

Dr. Acholonu is wrong when she says that HNBs “only became legal in the United States in 2019.” Reynolds’ Eclipse has been on and off the U.S. market for about 20 years, although it has never proven to be a viable substitute for combusted cigarettes.

Dr. Acholonu was probably referring to IQOS. The FDA authorized IQOS sales in 2019, and the agency approved a reduced exposure claim in 2020, saying its decision “is expected to benefit the health of the population as a whole.” IQOS has driven an unprecedented decline in cigarette consumption in Japan, and it is now available in more than 60 countries.

To analyze Dr. Acholonu’s claim that HNBs are catching the attention of high schoolers, let’s take a close look at the 2020 National Youth Tobacco Survey, which described HNB products this way:

“Some people refer to these products as ‘heat-not-burn’ tobacco products. Heated tobacco products heat tobacco sticks or capsules to produce a vapor. They are different from e-cigarettes, which heat a liquid to produce a vapor. Some brands of heated tobacco products include iQOS, glo, and Eclipse.”

Only 202 of the 14,531 students surveyed had used HNBs during the past 30 days, which represents about 1.4% of all U.S. middle and high school students. But there’s more.

The NYTS survey asked participants “Before today, have you heard of heated tobacco products?”  The survey provided a handy description, saying that HNBs “are different from e-cigarettes, which heat a liquid to produce a vapor.”  Just in case the kids were still unsure, the survey taught them some brands to look for: “Some brands of heated tobacco products include iQOS, glo, and Eclipse.” 

Over 11,600 (80%) of middle and high school students had not heard of HNBs. For these youths, the NYTS was their first introduction to iQOS, glo and Eclipse.

Let’s get back to the 202 HNB current users: 61 of them had never heard of HNBs “before today.” If they never heard of them, they didn’t use them, so they shouldn’t be counted. 

Now we have 141 HNB users, 67 of whom said they had used one or more of the following HNB flavors: clove, spice, chocolate, wine, cognac, cocktail flavors, candy, dessert, or sweets.  This is impossible, as IQOS and Eclipse are not sold in any of these flavors. Those 67 should not be counted.

Now we have 74 kids who said they are HNB users, which works out to be 0.4% of middle school students and 0.7% of high schoolers. With only limited availability of HNB products, it is likely that many of those respondents were mistaken, answering “yes” to the HNB question when they meant e-cigarettes or vapor products. In fact, among current HNB users, 60% were current e-cigarette users; only 14% were not using any other tobacco product.

In summary, the 2020 NYTS introduced large numbers of middle and high school students to HNB products for the first time. No amount of misinformation, like the ABC News story, can alter the facts about the phony “next teen tobacco epidemic.”

 

Exploiting the 50th Anniversary of the Surgeon General’s Report on Smoking

Fifty years ago, U.S. Surgeon General Luther Terry issued a landmark report describing the health risks of cigarette smoking.  Tobacco prohibitionists are using the anniversary to promote onerous measures aimed at the tobacco industry and consumers (here).

American Heart Association president Dr. Mariell Jessup claims that “taxes, strong smoke-free laws and fully funding state tobacco prevention programs… can reduce the number of adult smokers to less than 10 percent of the population in 10 years.”

Similarly unfounded assertions have been made for decades. In 1984, Surgeon General C. Everett Koop declared that the U.S. could be smoke-free by the year 2000 (here).

NBC reported that “raising the legal age to buy tobacco products to 21 would go a long way to stopping kids from ever getting addicted in the first place,” and it cites the American Heart Association, American Lung Association, American Cancer Society and the Campaign for Tobacco-Free Kids for support.  Unable to obtain an outright tobacco ban, these groups hope to impose rules similar to those for alcohol.  

Dr. Michael Fiore of the University of Wisconsin’s Center for Tobacco Research and Intervention, says tougher tobacco age restrictions make sense: “We do it with booze yet we don’t do it with cigarettes, when cigarettes kill about 10 times more people than alcohol does.”  That argument disguises the fact that alcohol has proven far more deadly for teenagers.

The current age requirement for cigarette purchase is 18 years, and the smoking prevalence for high school seniors is 16%.  In contrast, the requirement for alcohol purchase is 21 years; 39% of high school seniors currently drink and 26% have been drunk recently (here).

Dr. Fiore bemoans the lack of physician engagement with smokers; he thinks they should be nagged: “I would never dream of letting a patient with high blood pressure leave my office without treating it.  But every day in America, millions of Americans go in and out of a physician’s office and their smoking is not treated.”

The past 50 years have witnessed an increasingly aggressive tobacco control movement, with declining returns.  Tobacco control may have contributed, as the media suggests, to the saving of eight million smokers lives (abstract here), but tobacco prohibitionists also share responsibility for the 17.7 million smokers who died prematurely because they were denied factual information about safer smoke-free tobacco products.  

Instead of exploiting the 50^th anniversary, all public health groups should endorse rational, science-based tobacco harm reduction.  America’s 45 million smokers deserve nothing less.