Centers for Disease Control: Release Smokeless Stats

The U.S. Centers for Disease Control and Prevention (CDC) has for decades published annual estimates of smoking-related deaths, which I have analyzed on occasion (here and here).

It is remarkable that what I refer to as the CDC’s “Big Kill” estimates are delivered with single-digit precision.  For example, the current estimate of smoking-attributable deaths is 480,317 (available here). 

In stark contrast, CDC spokespeople include plenty of dire warnings but no relative risk or other specific information when talking about smokeless tobacco.  For example, a recent agency report claimed that “Exclusive smokeless tobacco users have higher observed levels of exposure to nicotine and carcinogenic tobacco-specific nitrosamines… than exclusive cigarette smokers.” (abstract here).  Implied is the specious message that smokeless may be more dangerous than cigarettes. 

The CDC also asserts that smokeless use “causes cancer of the mouth, esophagus... and pancreas… and increases the risk for death from heart diseases and stroke” (here) – claims based upon cherry-picked or irrelevant studies, in the manner I discussed last week (here).

Despite the fact that the agency has the necessary data, CDC pronouncements about smokeless tobacco never cite numbers or estimates.  In contrast, British researchers last year reported that there were no cancer deaths due to smokeless tobacco in the U.S. and Canada (discussed here).  Clearly, the CDC can calculate deaths due to smokeless tobacco, but the agency chooses not to do so.    

The CDC’s stonewall on statistics has been observed by others.  An astute reader of my blog recently shared this fascinating story (available here):

“It's funny, after coming to this site I was curious so I went to the CDC website to see if they provided any estimates as to the number of deaths attributable to smokeless tobacco usage. I couldn't find anything on their website so I sent them an email. To their credit, they did respond, and said ‘...at this time, we do not provide estimates of deaths attributed to the use smokeless tobacco products.’ So I responded and asked them if they might be able to point me to some other source of data for these estimates. And again, to their credit, they did respond, but only to say ‘We are not aware of a source of this estimate.’  Hmmm...I would think if smokeless tobacco was indeed such a plague upon society, that they would at least be able to show some numbers.”

This reader is on target.  The CDC continues to scaremonger about smokeless tobacco while it withholds data that likely shows ST-related deaths at near zero.

Taxpayers can call (800-232-4636) or email (here) the CDC to demand details and sources on the precise dangers of smokeless tobacco use.  Please share any replies as a comment to this post.

Memo to the FDA: Release Survey Data

An update on the activities of the FDA Center for Tobacco Products was provided two weeks ago by Director Mitch Zeller at a meeting of the National Association of Tobacco Outlets (NATO).  Zeller repeatedly referred to the Population Assessment of Tobacco and Health (PATH) Study, “…a longitudinal cohort study on tobacco use behavior, attitudes and beliefs, and tobacco-related health outcomes among youth…and adults in the United States.” (description here).

Zeller said that agency staff presented information from the study at a scientific meeting earlier this year, and that additional reports would be forthcoming.  In fact, the FDA and a privileged group of investigators at Roswell Park Cancer Institute, the National Institute of Drug Abuse and Westat, a private consulting firm, are producing information based on a comprehensive dataset that is not available to anyone else.   

During the NATO public Q & A session, I asked Zeller if the FDA had set a date for public release of the PATH dataset.  He answered in the negative.

Here we go again.  For years, I have documented that the CDC routinely withholds the underlying data it uses to calculate the “Big Kill” estimates of smoking related deaths (here and here) which are used to drive tobacco regulations and federal policy.  Additionally, the CDC and American Cancer Society refuse to release data (here) on the minuscule risks of smokeless tobacco use -- data that could support product applications for reduced-risk status (I have described what the Society should do to remedy this here).  These organizations have treated smokeless tobacco users with contempt by refusing to release this information.

This institutional data embargo now affects e-cigarette users.  Every year, the CDC parlays its exclusive access to the National Youth Tobacco Survey to convince Americans that e-cigarettes will enslave and kill their children (here and here).  When the CDC releases the data months or years later, a completely different picture emerges (here).

As for the PATH study, the FDA timeline shows that it plans to “finalize restricted Use Data Set [public release] for baseline data” in the Fall, with simultaneous release of a “complete first manuscript of baseline results.”  In other words, the FDA will start spinning the results before it releases the data for independent analysis.  This is unacceptable; if the dataset is good enough for the FDA to produce a publication, then it is good enough for public perusal.   

For 20 years, biased analyses of restricted federal datasets have driven tobacco litigation, legislation and regulation.  The FDA should make the PATH survey publicly available at the earliest possible date.

Finally, U.S. Official Admits that Smoking Deaths are Declining

Dr. Phil Cole and I asserted in 2008 that smoking-related deaths in the U.S were on the decline. Finally, this month, an FDA official arrived at the same conclusion in a journal article.

In “Calculating the Big Kill,” which appeared in Regulation, the Cato Institute’s flagship publication (here), I made the case that “CDC [Centers for Disease Control and Prevention] estimates of smoking-related deaths do not add up.”  I noted that “U.S. smoking rates have been declining almost continuously since the mid-1960s, when 42 percent of American adults smoked.  The rate dropped to 28 percent in 1988 and has now declined to 21 percent.  Put simply, the proportion of Americans who smoke has been cut in half over the past 40 years.”

I asked, “Why have the CDC [big-kill] estimates not fallen?”

My question was based on a research study that Dr. Cole and I published a year earlier in Nicotine and Tobacco Research (abstract here), showing that “there were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002.”  We noted that despite the substantial decline in smoking prevalence, the estimate of smoking-attributable deaths from the Centers for Disease Control and Prevention had changed hardly at all. 

Five years later, my question is still relevant.  The answer is clear: The CDC chose not to acknowledge the fact that deaths had plummeted.

Brian Rostron, a scientist at the FDA, has now published a study, also in Nicotine and Tobacco Research (abstract here), demonstrating that smoking-attributable deaths declined from 398,000 in 2000 to 370,000 in 2007.

As I explained in my Cato article, most people mistakenly believe that CDC officials actually count the number of smokers who die each year.  The truth is that the CDC uses a model that estimates the number of current and former smokers based upon data in the National Health Interview Survey (NHIS); the CDC subjects those smoker estimates to relative risks developed by the American Cancer Society in the 1980s, and then produces an estimate of the number of deaths that would not have occurred if they had never smoked.  Like any model, the quality of the output is dependent on the quality of the input.

I had noted that the CDC was using 20-year-old data to produce its “big-kill” estimates; Dr. Rostron concurs, saying that “the CDC has not substantially revised the methodology or data that are used in this procedure since their introduction in the 1980s.” 

Rather than using decades-old risk estimates, Dr. Rostron updated the relative risks for smokers and former smokers by calculating them from NHIS subjects from 1997 to 2004 who were followed through 2006 with linkage to the National Death Index.  Unlike the outdated CDC estimates, he adjusted risks for age, race/ethnicity, education, alcohol consumption and body mass index, which are important confounding factors for some or all smoking-related diseases.

Here are Dr. Rostron’s big-kill estimates:

Smoking-Attributable Deaths Among Men and Women in the U.S., 2000, 2004 and 2007
Year	Men	Women	All
2000	211,000	187,000	398,000
2004	200,000	180,000	380,000
2007	195,000	175,000	370,000

Although declining, Dr. Rostron’s big-kill numbers may still be too high because of the way he estimated deaths among former smokers.  Using his model, former smokers accounted for about 177,000 out of the 370,000 deaths from smoking in 2007.  This seems to be excessively high, as the 2007 NHIS documents that 60% of the 39 million former smokers had quit over 15 years previously.  Any excess risk for a smoking-attributable death was minimal to nonexistent in this group. 

Dr. Rostron’s deaths among former smokers were likely concentrated in those who quit less than 5 years earlier, and who therefore have risks similar to those of current smokers.  But it is inconceivable that this group of 6.3 million former smokers produced almost as many deaths as the 27.5 million current smokers in 2007.  Dr. Rostron’s model should be revised to reflect the different risks among former smokers who have short or long quitting histories.

Regardless, the main message of this study is valid: Smoking-attributable deaths have been in decline for over a decade.  This is good news that the CDC and other federal agencies have ignored for far too many years.