Entries Tagged 'Tobacco Harm Reduction' ↓

Wouldn’t it be ironic if the Altria juggernaut, the one that worked with the Campaign for Tobacco Free Kids to create the FDA regulation and its ban on characterizing flavors, except menthol and something called “tobacco flavor,” ultimately ended up by creating an FDA regulatory scheme that defined “tobacco flavor” so narrowly as to eliminate the vanilla, cocoa, licorice and other flavors that go into burley “toasting” and that were recently banned in Canada?  Now that the World Health Organization’s TobReg group is meeting this weekend in Jordan to lock down definitions of things like “tobacco flavor” as part of their work on Articles 9 and 10 of the Framework Convention on Tobacco Control wouldn’t it  be ironic if they came out against the American Blend cigarette?  Could it be that the success of Marlboro Lights as the kids’ cigarette of choice is due to the smoothness of an American Blend product?  What if the tobacco control world only wants harsh products on the market as the next stage in reducing tobacco consumption? Talk about Altria having opened up a pandora’s box.  No wonder they want the regulators to focus on flavored little cigars which are rarely if ever smoked by kids.

Prof. Michael Siegel of Boston University School of Public Health welcomed Action on Smoking and Health UK’s statement (http://www.ash.org.uk/files/documents/ASH_715.pdf) supporting the use of e-cigarettes by smokers who are otherwise unable to quit smoking, as it represents one of the first major anti-smoking groups that is in favor of allowing the product on the market.  ASH UK’s statement says it supports a “harm reduction approach to tobacco,” and for those who do not wish to stop smoking or find it difficult to quit, products that deliver nicotine in a safe way should be made available. Since most of the smoking-related diseases are caused by inhaling smoke, the e-cigarettes, which deliver nicotine without the harmful toxins in cigarette smoke, are “likely to be a safer alternative to smoking,” ASH UK said. ASH’s US counterpart has called for a ban on e-cigarettes. Siegel said anti-smoking groups in the US support a policy of banning e-cigarettes, though such an approach would result in ex-smokers returning to cigarette smoking (tobaccoanalysis.blogspot.com 10/15).

Congress is working through the FDA bill which will ultimately regulate the Tobacco Industry. It’s likey to pass this year but even if it doesn’t most view it as only a matter of time – although we’ve been saying this for over ten years now.

What’s not encouraging is how little the bill has changed in this time. The bill has become a piece of history apparently frozen in time.

According to reports Congressamn Waxman had to ask what MSA stood for – which certainly conveys the impression he’s not entirely in the loop.

As written the bill favors the status quo. That’s great if you’re PM USA, but things change and there are other stake holders.

No word is included about tobacco harm reduction – in fact for cigarettes the bill almost precludes it by setting the bar so high as to be unattainable.

There’s no language differentiating or explaining relative risk for tobaco products. All will carry similar health warnings. The general public will not be informed and will not know that smokeless tobacco products can be greater than 90% less harmful than combustible products.

The bill needs serious amendment. Whether that will happen at this late stage is debatable.

Contact your congressman and ask him to amend the bill to include language on relative risk and at least the possibility to enable development of a lower risk cigarette at sometime in the future. Smokers deserve nothing less.

The e-cigarette was almost unknown a little over a year ago – not so today. It is the hottest and most controversial product to hit the tobacco industry in recent history – and it’s kicking up a storm!

It is a game changer on several front and sits squarely in the front line (read firing line) of tobacco harm reduction.

Congress wants to ban it. FDA may do so – on the basis it is a drug-delivery device (nicotine) not a tobacco product.

The traditional tobacco industry sees competition as does big pharma which sees it as a threat to its highly profitable  NRT (Nicotine Replacement Therapy) products – which are considerably more expensive.

Public Health officials cite untested and unproven technology and efficacy. True; in the strictest sense, while completely ignoring the greater issue of protecting public health in self-protecting its own fiefdom. Even the most preliminary research shows it is likely to be considerably safer than cigarette smoking.

Most importantly comsumers want it.

Now you can have your say. Use this forum to make your case.

Use the link to particapte in this survey. Help at least keep the arena competitive, lively and provide consumers with choice.

http://www.ecigarettedirect.co.uk/research/survey.html 

Good luck and have fun.

In a letter to ECigarette Direct, Brad Radu, a professor of medicine and holder of an endowed chair in tobacco harm reduction research at the University of Louisville, criticizes Tobacco Free Kids for opposing safe alternatives to smoking and for supporting the Kennedy tobacco bill due to enter the senate next week.

According to the Professor, the stance taken by the organization was not a rational position but a moralistic one:

“There is no public health justification for denying smokers information about and access to safer sources of tobacco and nicotine. But the war against tobacco, conducted by Tobacco Free Kids and their allies, is not about public health. It has become the latest in a long line of misguided American moral crusades.”

The letter was itself a comment upon an open letter to Tobacco Free Kids, which the Professor predicted there would be no reply to. He was also gloomy on the prospects of the Kennedy tobacco bill being defeated, remarking:

“The American legislative process is closed to all but a few powerful interests, who will soon be gloating over their “success” in passing FDA regulation of tobacco.”

Ultimately, the professor thought, the actions of groups like Tobacco Free Kids and similar groups would costs lives.

“I am convinced that these anti-tobacco extremists will eventually be held partially responsible for the deaths of millions of uninformed smokers.”

We forwarded both the open letter and Brad Radu’s reply to Tobacco Free Kids, but have yet to receive a comment.

What do you think? Is the position of the bodies like Tobacco Free Kids a blind crusade against tobacco, or a practical stance taken to protect the young against the dangers of nicotine addiction?

Sen.Ted Kennedy has introduced his FDA tobacco bill (S. 982) and scheduled a Senate HELP Committee mark-up session on the bill beginning Tuesday, May 12. It’s very interesting to me that the following article was written for publication this month for C-Store Decisions. I urge you if you believe that Harm Reduction should be advanced in this legislation that you call, fax or email the members of the committee and let them know that the Voice of Reason needs to be included. I’m sure you may sense a bit of sarcasm in this writing but I do believe that the Voice of Reason needs to be heard! What are your thoughts? Do you think the the Committee will make the changes? What are your concerns? Or will they just not listen?

Harm Reduction: The Voice of Reason

My passion for the reduction of harm of tobacco products over the past few years has greatly increased. I have met many folks that have the same passion to develop products that provide great promise to those who choose to use tobacco but with less harm than the traditional cigarette. Great strides have been made within the last year to introduce many new products that would, from my perspective, reduce harm. I must say though I would have never thought that the quest for harm reduction would be besieged with so much controversy and ignorance.

A year ago I wrote an article about the possibility of “tobacco actually being safer one day”. Isn’t it possible that things change or are many sticking to old, outdated paradigms when it comes to the mere reference of the word tobacco? In response to this referenced article, I have had the opportunity to experience many new exciting products. The first would be a smokeless cigarette called, “Aeros”. I must say that when I received this package from its inventor Richard Horian I was absolutely amazed at its ability to deliver satisfaction. In my mind, the absence of smoke and all of the “nasty’s” would seem to imply a reduction in harm.

In my quest over the last year to help retailers properly market to consumers that are looking for options when they either can’t light up or are looking for an alternative I also found a product called, Smoke Scents. I have had many late night conversations with a now good friend, Maurice Goulet, about the marvels of aroma therapy. Another new friend is Stuart Garrett who interestingly enough has reintroduced Nicotine Water (homeopathic). From all of my research smokers tell me it taste just like water and satisfies.

I’m sure you’ve all been called on by David Dean or one of his team from Star Tobacco regarding a new segment in the tobacco offering called dissolvable, featuring Arriva & Stonewall that make the evil nitrosamines disappear. And last year at the NACS conference Reynolds introduced the Camel dissolvable tobacco line. And in case you haven’t noticed the little pouch called Snus is quickly becoming a household name through the efforts of many but specifically Reynolds. I have even seen a Snus that is made out of apple rinds and I’m told it tastes good!

There are many like Brad Rodu, Carl Phillips & Bill Godshall that champion moist smokeless tobacco as a leading product in the relative harm reduction offer. There are those in the industry that advocate that moist smokeless tobacco is 99% safer than lighting up. But yet, we are lead to believe by the labeling on the can that there is no difference. Oh and by the way, there are those that say nicotine is just like caffeine, but we never hear that on the news. And now we have a senator from NJ that seemingly is more interested in protecting nicotine delivery through traditional cigarettes or through nicotine products made by his financially supporting pharmaceutical buddies.

From my perspective, the debate over electronic cigarettes is an interesting one. The debate centers on old school thinking versus new school thinking as the anti-tobacco folks just don’t have the ability to think rationally. If this product or any other product shows promise in the quest to reduce harm, would it not be in the best interest of those who use tobacco products to allow for advancement. Or must we live in a world where folks are not rational and act like the “kid who decides to go home with the football because things aren’t going his way?”

Unfortunately, the voice of reason is being muffled by folks who are being misled by a group with an agenda. Whether that agenda is driven by politics, Big Tobacco, Big Pharma or by irrational “zero tolerance” zealots, people deserve to know the truth. There are many entrepreneurs, small companies and large companies that are either developing or supporting these new innovations that are the voice of reason! Can you imagine, that “our elected officials” through their support of the Waxman FDA tobacco regulation have doomed smokers by not listening to those that are the voice of reason? Pretty disturbing wouldn’t you say?

I’d like to explore what some believe is the truth behind the “anti-smoking” movement. The following thoughts may be controversial to some. So let’s get right to the topic of discussion!

Some in the industry believe Big Pharma in it’s quest to gain control of the nicotine empire has been a great supporter of the anti-smoking movement. Many will tell you that the anti-smoking movement has just been a cover for the anti-tobacco movement. An anti-tobacco movement that bodes well for the pharmaceutical industry.

At stake is the control of the largest market known to humanity, with an estimated 1.2 billion customers on this planet. The projected financial returns to Big pharma from smoking “cessation” (which, in reality, is not cessation, but a different way to assume nicotine) are truly staggering, and beyond the imagination of many including those in the tobacco industry. The battle is well worth the multi-billion dollar investments by Big Pharma as it seeks to control international and national institutions, politicians, and the media.

I admit I have a bias. I have spent my entire life in the tobacco industry. Am I just blinded by my bias or am I on target? I have watched those on the anti side argue the “no smoke deal” only to win that battle but not be satisfied. They then take to what I believe was their true cause an “anti-tobacco” movement. The tobacco industry has been accused of misleading the public. But has Big Pharma taken over that role? Is the government their tool as it seems that harm reduction is a “no-no” unless governed by Big Pharma and in the very near future it’s partner, the FDA?

If you disagree with my thoughts, let me know why. If you agree I’d like to know why. What are your thoughts? What do you think about Big Pharma and Nicotine? Do you agree or disagree about their involvement in the anti-smoking movement? The anti-tobacco movement?

Have the tobacco police gone too far?

I’VE been called a traitor,” says Michael Siegel, a public-health doctor at Boston University in Massachusetts. “It’s been a character assassination.” This treatment seems surprising as, reading Siegel’s CV, you’d think he was a poster boy for the anti-smoking movement. He regularly publishes research on the harmful effects of passive smoking and has testified in support of indoor smoking bans in more than 50 US cities.

Despite these credentials, Siegel has come under fire from colleagues in the field of smoking research. His offence was to post messages on the widely read mailing list Tobacco Policy Talk, in which he questioned one of the medical claims about passive smoking, as well as the wisdom of extreme measures such as outdoor smoking bans.

In front of his peers, funders and potential future employers, other contributors posted messages accusing Siegel of taking money from the tobacco industry. When Siegel stood his ground, the administrators kicked him off the list, cutting off a key source of news in his field. “It felt like I was excommunicated, says Siegel. “I was shocked: I’ve been a leader in the movement for 21 years.”

Siegel’s case is perhaps the most clear-cut example of a disturbing trend in the anti-smoking movement. There are genuine scientific questions over some of the more extreme claims made about the dangers of passive smoking and the best strategies to reduce smoking rates, but a few researchers who have voiced them have seen their reputations smeared and the debate stifled.

Putting aside the question of whether such tactics are ethical, they could ultimately backfire. About half of US states and many parts of Europe do not yet ban smoking even indoors in public places like bars and restaurants, so the anti-smoking movement cannot afford to lose credibility.

On the other hand, in some parts of the US, particularly California, the anti-smoking movement has grown so strong that smoking bans outdoors and in private apartments are in force in a few places, and being considered in more. These measures are at least partly based on disputed medical claims, so it is vital their accuracy be determined. But questioning the orthodoxy seems to be frowned on. “It’s censorship,” says Siegel. “We’re heading towards scientific McCarthyism.”

This is censorship. We are heading towards scientific McCarthyism
The irony is that the tobacco industry is notorious for its history of unethical research conduct. As evidence emerged in the 1950s linking smoking to lung cancer, several firms paid scientists to produce contrary findings. They held scientific conferences, and published journals to promote their results.

By the mid-70s, the dangers of first-hand smoke were indisputable, so the industry switched to questioning emerging evidence of the dangers of second-hand smoke. In spite of their efforts, a convincing case has now been made that long-term exposure increases the risk of heart disease, cancer, respiratory illness and cot death.

By the 1990s, California had banned smoking in all indoor public places, and in 2004 Ireland became the first country with a nationwide ban. The UK, Australia, some other European countries and about half of US states have since followed (see map).

Researchers like Siegel, and others under fire from the anti-smoking lobby, do not question that people regularly exposed to second-hand smoke suffer harm. “It’s difficult to imagine that there’s an easier argument to make than ’smoke is bad for you’;,” says Carl Phillips, an epidemiologist from the University of Alberta in Edmonton, Canada, who has also been targeted.

But in the past few years some of the claims about passive smoking have gone further. Siegel first got into trouble when he questioned assertions that breathing in second-hand smoke for just 30 minutes raised people’s risk of a heart attack to that of an active smoker.

There is no doubt that passive smoke affects blood flow, even over the very short term. Research in the 1980s showed that 20 minutes’ exposure makes blood platelets slightly more sticky, which could theoretically raise the risk of blood clots and hence heart attacks and strokes. Realistically, though, this would only be a danger for those already at high risk.

In 2001, a study showed that 30 minutes of passive exposure to smoke reduces the blood vessels’ ability to dilate (Journal of the American Medical Association, vol 286, p 426). If this happened repeatedly over a long period, it could permanently harm blood vessels and harden arteries. In a few people who are on the verge of a heart attack, it is possible that 30 minutes’ exposure could tip them over the edge. But it would be no worse than eating a high-fat meal; most people would easily cope.

When anti-smoking lobby groups highlight this issue, however, they fail to mention that most people would be OK. Here is a typical claim, from the US group Action on Smoking and Health (ASH) in 2006: “Breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed sitting on a park bench) can raise a non-smoker’s risk of a fatal heart attack to that of a smoker.”

Siegel has counted at least 65 organisations making such claims, and they are not fringe groups but anti-smoking stalwarts. They include the American Cancer Society and the UK National Health Service (NHS). “These claims are ridiculous,” says Siegel. “Just telling the truth would be enough to show that second-hand smoke is toxic.”

Even Stanton Glantz, a cardiologist at the University of California, San Francisco, who did a more recent study confirming the blood-vessel effect, acknowledges some of the claims about it are overblown. “A healthy 25-year-old won’t drop dead from a heart attack by breathing second-hand smoke,” says Glantz, who is one of the linchpins of the anti-smoking establishment.

Another disputed claim is whether the introduction of smoking bans in indoor public places brings about an immediate drop in heart attacks. A few studies of individual US cities have suggested this effect. According to Siegel, however, they covered small populations and were too short to account for yearly fluctuations, or indeed the fact that many western countries have seen a gradual long-term decline in heart-disease deaths.

Then last year, a large study was published that seemed to shore up the argument that bans cause a fall. The study covered most of the biggest hospitals in Scotland and compared the two 10-month periods before and after the introduction of the smoking ban in indoor public spaces in March 2006 (The New England Journal of Medicine, vol 359, p 482). It found a 17 per cent drop in people admitted to hospitals with acute coronary syndrome (ACS), which comprises heart attacks and angina.

Confusingly, however, the results of the study seem to be contradicted by the publicly available statistics on emergency admissions to hospitals due to heart attacks, released by the Scottish NHS in November 2007. These admittedly show fewer heart attacks in the year after the ban, but the fall was smaller, at only 7 per cent, which does not stand out from the background decline. In 2000 there was an 11 per cent drop, and between 2004 to 2006 the rate fell by roughly 5 per cent a year.

Sheila Bird is a statistician from the MRC Biostatistics Unit in Cambridge, UK, who is independent of either side in this debate. She points out that it is hard to compare the two sets of Scottish data because they measure different things: ACS diagnoses are made using blood tests while heart attack admissions are based on ECG measurements.

Bird also points out that because the NEJM study compared 10-month periods before and after the ban – not 12-month periods – it could have been distorted by seasonal fluctuations in heart-attack rates. The period before the ban spanned more colder months, when people generally have more heart attacks.

The picture in Scotland remains unclear, but last month saw a body blow to the side who say bans cause a fall. The first set of NHS data was published for England since the smoking ban came into effect there in July 2007. Between April 2007 and March 2008 there was a 3.7 per cent drop in heart attacks. That’s exactly the same as the year before the ban. Although the “post-ban” year includes three months before the ban, a crude analysis suggests that should only reduce the size of any fall by about one-quarter.

Third-hand smoke
Another issue that is currently raising eyebrows is the concept of “third-hand” smoke. This refers to the particles of smoke that linger on smokers’ clothes, hair and the carpets and furniture of a room for days, “outgassing” toxic vapours. Young children may be at particular risk, since they could ingest the residue while crawling around or mouthing their toys.

The first signs that third-hand smoke may be a danger emerged in 2004. A study showed that even if parents only smoke outside the home, detectable levels of cotinine – a metabolite of nicotine – were present in their children’s urine (Tobacco Control, vol 13, p 29).

Levels were much lower if the parents only smoked outside the house: 2.32 nanograms per millilitre compared with 15.57 from second-hand smoke. Still, some researchers think even this low level could be enough to cause harm, particularly to a child’s developing brain. “My sense is that these levels are high enough to be concerning,” says Kimberly Yolton, a psychologist at Cincinnati Children’s Hospital Medical Center in Ohio, who has previously shown that exposure to nicotine from second-hand smoke seems to slightly depress a child’s school results.

As yet there is no consensus on whether the cotinine levels are high enough to have any meaningful effect. “We’ll need a lot more evidence before we act on this,” says Martin Dockrell of Action on Smoking and Health in London.

In January, the issue of third-hand smoke gained new prominence after a paper on the subject in Pediatrics (DOI: 10.1542/peds.2008-2184). Many news outlets and even the US Department of Health and Human Services covered the “new-found risk”. Author Jonathan Winickoff, a paediatrician at Massachusetts General Hospital in Boston, said people should “hammer home” the risks of third-hand smoke, and urged smokers to wash their hands – and possibly clothes – before interacting with children.

The paper, however, sheds no new light on the degree of risk. It was just a telephone poll showing that people were more likely to have smoking bans in their house if they believed that third-hand smoke was harmful.

Does it matter if the dangers are exaggerated? Yes, says Siegel, because it risks alienating parents who might otherwise have heeded advice to avoid exposing their children to second-hand smoke. It could also leave people distrustful of health advice in general.

Establishing the truth relies upon researchers engaging in open debate about what the evidence really shows. This is less likely if criticism entails the risk of excommunication, as Siegel experienced. “It’s like an unwritten rule in this movement that you don’t question these claims,” he says.

At the time of going to press, the administrator who removed Siegel from the tobacco mailing list had not responded to New Scientist’s requests for a comment. However, one of the list’s current administrators, Bill Godshall, who is an executive director of SmokeFree Pennsylvania in Pittsburgh, defends the decision, claiming that some of Siegel’s posts had been “uncivil”. Siegel “staunchly opposed the very purpose of the listserve: advocating reasonable and responsible policies to reduce the leading cause of disease and death”, says Godshall.

But Siegel has his defenders. “It is sobering and scandalous to think, if Mike is correct, that our field now is guilty of the same junk science long perpetrated by the tobacco industry,” says Alan Blum, director of the Center for the Study of Tobacco and Society at the University of Alabama in Tuscaloosa.

It is scandalous if our field is now guilty of the same junk science as the tobacco industry
Ensuring the science is rigorous becomes paramount at a time when the anti-smoking clampdown is reaching new levels. Siegel fears that the growing concerns around third-hand smoke will trigger more firms to bring in non-smoking hiring policies, already in place at several US companies and the World Health Organization. Several independent researchers have voiced concerns that such measures will further exacerbate social inequalities between smokers and non-smokers (New Scientist, 31 January, p 5).

And even the most fanatical enemies of smoking have reason to be wary of the anti-smoking movement’s current direction. Making exaggerated claims will only reduce the movement’s impact in regions where smoking bans in indoor public spaces have not yet been introduced, Siegel believes. “It’s like the boy who cried wolf – the public won’t know the difference when the claims are true,” he says.

Siegel says his experience has not damaged his career, and has since set up a blog about the anti-smoking movement’s extremes. But Carl Phillips almost lost his job after he questioned the orthodoxy. Phillips is one of a few researchers who favour “harm reduction” strategies in tobacco control (New Scientist, 10 November 2001, p 28). This means promoting smokeless tobacco products – such as chewing tobacco, a form of “sucking” tobacco known as snus, and electronic cigarettes – to allow nicotine addicts to get their fix without many of the risks of smoking. Many anti-smoking researchers are vehemently opposed to such strategies.

Unlike Siegel, Phillips has accepted research grants from the US Smokeless Tobacco Company – a fact he declares on his research papers, and which was approved by his university as they came with no strings attached. This has allowed anti-harm-reductionists to paint him as a tobacco-company stooge, and he has experienced vandalism to a poster paper at a medical conference. After his adversaries threatened to block the school’s academic accreditation and cancel funding for other projects, the School of Public Health tried to terminate his contract. Phillips appealed to the university’s central administration, however, who overturned the school’s decision, and he remains in his post.

For many researchers like Phillips it’s a catch-22 situation. If their research challenges the orthodoxy, anti-smoking groups refuse to fund it, so they turn to tobacco firms instead. This provides ammunition to question the results. “It drives researchers from doing anything innovative,” says Phillips.

Given the tobacco industry’s reputation, this deep suspicion may be understandable. “The industry has sown the seeds of so much distrust that scientific debate can be difficult,” says Kelley Lee from the London School of Hygiene and Tropical Medicine, who has uncovered some of the industry’s dirty tricks.

On the other hand, many anti-smoking researchers accept grants from the drug firms that make nicotine-replacement therapies. When it comes to research ethics, the pharmaceutical industry’s reputation is not exactly whiter-than-white either.

So where can the anti-smoking movement go from here? “They must be intellectually mature enough to recapture the process of producing sound science,” says Lee. “There is no room for mud-slinging.”

Editorial: The dangers of inhaling dubious facts

David Robson is a junior editor at New Scientist

01 April 2009 by David Robson
Magazine issue 2702. Subscribe and get 4 free issues.
For similar stories, visit the Drugs and Alcohol Topic Guide
Editorial: The dangers of inhaling dubious facts

I find this to be a very interesting article written by David Robson. What are your thoughts? How can we get the “truth”? Do you agree with those quoted in the article? Were you aware that there are those within the anti-smoking movement that want the “truth” to be told? “Truth” that is not exaggerated or manipulated! Or do you think the facts as presented are the truth? Tell us your thoughts and what you think should be done? Let it fly!