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A subtle tobacco control self-contradiction lie, re FDA pumping cigarette stock prices

by Carl V Phillips

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All people like better products. Teenagers are people. Therefore….

by Carl V Phillips

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Vaping Plays a Role in Young Adults’ Low Smoking Rate


The anti-tobacco Truth Initiative tweeted that the smoking rate among young adults (18-24 year old) in the U.S. is “just 10.4%,” based on the 2017 National Health Interview Survey (NHIS) (here).  But the Initiative didn’t tell the whole tobacco “truth.”  Using the same NHIS data, I prepared the chart at left which confirms that smoking is way down among young adults, continuing a decline I reported previously (here).  Nearly 85% of young adults have never smoked, including 2.7% who currently vape, 13% who tried e-cigarettes and 69% who never used either product.  Among the 5% who are former smokers in this age group, over half were current vapers or had tried vaping products.  Even more impressive, 7 out of 10 current smokers were either current vapers or had tried e-cigarettes, meaning they could eventually make the switch to smoke-free. Advocates of greater tobacco control make a specious boast when they celebrate lower smoking rates while ignoring the positive impact of vaping.  Original author: Brad Rodu
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Letter to WHO’s DG against prohibition and for risk-proportionate regulation

Dr Tedros Adhanom GhebreyesusDirector GeneralWorld Health OrganisationAvenue Appia 201202 Geneva

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Innovation for Consumers: E-cigarettes and novel tobacco products – Part of the problem or part of the solution?

September 5th, 2018

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Let’s try to get our criticisms right, shall we? (More on the recent “vaping causes heart attack” study)

by Carl V Phillips

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Slight Teen Vaping Increase and A Continued Smoking Decline in 2017


Despite the rhetoric, there is no “Juul epidemic” among high school students.   The purported epidemic has been widely cited in the media.  Just last week, an article in the New England Journal of Medicine (here) asserted that “use of these products is rampant among young people.”  The authors based their claim on “Media stories about Juul … [that] highlight anecdotal reports from students, parents, teachers, and school superintendents.”  This falls far short of normal journal standards.  (The NEJM commentary also included the confounding contentions that “Pod mods are easy to conceal from authority figures” and “Juul vaporizers measure 93.98 cm,” or an astounding 37 inches.) Campaign for Tobacco-Free Kids president Matt Myers has been a cheerleader for the mythical epidemic: “Everyone was asleep at the switch.  And by the time we woke up, we had an epidemic on our hands.  I've never seen a tobacco-related product spread across this country as fast among young people as this product.” (here)     In fact, no one else has seen it.  Claims of a Juul epidemic are baseless.  Government data show that while e-cigarette experimentation increased among American high school students from 2011 to 2015, the year Juul was introduced, vaping stabilized in 2015 and smoking rates continued to drop.  In 2017, 1.15 million (7.7%) American high school students were current (past 30 days) e-cigarette users, 556,000 (3.7%) smoked, and 632,000 (4.2%) used both products, according to the Centers for Disease Control and Prevention’s 2017 National Youth Tobacco Survey (NYTS). Comparing those numbers to 2016 (here), smoking and dual use declined marginally, by about 0.2 percentage point, while vaping increased by 0.5 point.  While Juul sales may have surged, neither they nor any other e-cigarette brand produced a youth vaping epidemic. *The apparent spike in e-cigarette use increased among high school students from 2013 to 2014 was partially due to what researchers term an artifact, related to a change in the survey design.  Questions about e-cigarette use were bundled with those for “other” tobacco products until 2014, when they appeared in a separate section, after cigarettes, cigars and smokeless tobacco. Original author: Brad Rodu
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Dual use and the arithmetic of combining relative risks

by Carl V Phillips

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FDA Tobacco Center Exaggerates Number of Youth Tobacco Users




The FDA Center for Tobacco Products published an inaccurate graphic in June (the “Most Used Tobacco Products in 2017” Venn diagram here) and tweeted it on August 8 (here), asserting that 2.1 million U.S. middle and high school students in 2017 were current (past 30-days) users of e-cigarettes, 1.4 million were current cigarette smokers, and 1.3 million were current cigar smokers. The graphic, which mischaracterized data from the 2017 National Youth Tobacco Survey, would lead most to believe that nearly 5 million youth used the three products. That conclusion would be grossly off the mark. In fact, NYTS data indicate there were only about 3.3 million current users of these three products, with a 40% overlap. (This is not surprising, as research shows that use of one tobacco product is associated with use of others here, hereand here.) The next chart breaks out exclusive and multiple users of e-cigarettes, cigarettes and cigars, based on my analysis of the 2017 NYTS data.  Over 50% (1,125,000) of the 2.1 million e-cigarette users didn’t smoke at all, 22% smoked both cigarettes and cigars (red font), 15% smoked cigarettes, and 12% smoked cigars (yellow font).  These distinctions are important, as they are associated with different levels of e-cigarette use, shown in the following chart.  A large majority (74%) of exclusive vapers used e-cigarettes infrequently (1-5 days in the past month); only 12% reported frequent use (20-30 days).  Vapers who smoked cigarettes or cigars were much more likely to be frequent e-cigarette users (20-21%); frequent use was 38% for users of all three products.   Using a misleading graphic, the FDA exaggerates the number of teens who use tobacco.  Original author: Brad Rodu
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A balanced view of ad hominem judgments

by Carl V Phillips

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UK Favors E-Cigarettes, Scores Major Smoking Reduction; Anti-Vaping Ireland Sees Smoking Rates Unchanged


There is, as I have noted (here), a stark contrast between British government and medical authorities’ support for e-cigarettes and vaping, and the demonization of same by most of the American public health community.  A similar clash of positions exists between the United Kingdom and Republic of Ireland. The British blogger Dick Puddlecote observes (here) that the UK and Ireland are “nearest cultural neighbours, so closely aligned [that] we that we don't even enforce passport requirements between the two countries.  The British and the Irish are about as good a comparison for ecological purposes as there can possibly be.  And, as [British Member of Parliament Sir Kevin] Barron said, the only difference between UK policy and Irish policy is that over here our government cautiously welcomes new nicotine products whereas in Ireland they don't.” Puddlecote underscores: “In the UK smoking rates have nosedived, while in Ireland they have barely shifted.” I have verified that statement by reviewing government data.  The UK’s Office for National Statistics reported that smoking prevalence was 20% in 2012, after stalling during the six previous years (here).  However, between 2012 and 2017, the rate fell to 15% (here).  Ireland started out in 2012 at nearly the same prevalence, 22% (here).  But five years later it was unchanged (here), according to the Ireland Department of Health. The difference in smoking reduction in these neighboring countries is extraordinary.  As Puddlecote observes, “this deserves more attention…You just have to wonder why the tobacco control industry and other politicians, both sides of the Irish Sea, have been so silent about it.” Indeed.   Original author: Brad Rodu
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South Africa draft tobacco Bill – protects cigarette trade and denies smokers options to quit


August 8th, 2018

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More Vaping Facts, Not All Good, from 2017 CDC Data


CDC and other U.S. government agencies rarely publish straightforward numbers and conclusions about adult e-cigarette use; their focus is usually on underage use.  Last month, by re-analyzing the federal data, I demonstrated that the number of American vapers declined in 2017 (here); following are additional insights. As seen in the table below, the number of every-day e-cigarette users increased between 2014 and 2016.  However, in 2017 the number dropped by almost a quarter-million.  The proportions of current, former and never smokers in 2014 were 50%, 46% and 4%.  By 2016 the proportions were 32%, 58% and 10%, indicating that more every-day e-cigarette users were former smokers.  In 2017, the proportion of former smokers inched up again: 32%, 60% and 8%..nobr br { display: none } td { text-align: center}Number (in millions) and Prevalence (%) of Every-Day and Some-Day E-Cigarette Use in the U.S., 2014 to 2017Every-DaySome-DayAll20142.71 (1.1%)6.20 (2.6%)8.91 (3.7%)20152.94 (1.2%)5.40 (2.2%)8.34 (3.4%)20163.03 (1.2%)4.77 (2.0%)7.80 (3.2%)20172.79 (1.1%)4.09 (1.7%)6.88 (2.8%)  The number of some-day e-cigarette users declined in 2017 for the third consecutive year, to 4.09 million – over 2 million fewer than in 2014.  Most were current smokers in all years, but the proportions shifted:  In 2014, they were 80%, 12% and 8% for current, former and never smokers.  By 2016, the proportions were 68%, 18% and 14%; and in 2017, they were 62%, 15% and 23%. In 2017, there were 1.17 million never smokers who were current vapers, and 80% of this group (933,000) were using e-cigarettes some days.   The vast majority of some-day users were either 18-24 years of age (68%), or 25-34 (23%), suggesting that vaping is displacing smoking in these younger groups. It is unfortunate that the number of daily and some-day U.S. vapers is declining, as the facts demonstrate that tobacco harm reduction can only be successful if smoke-free tobacco consumption increases among inveterate smokers. Note: Thanks to Bill Godshall for requesting these additional insights. Original author: Brad Rodu
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More Proof from FDA Population Data Showing E-Cigarettes As Popular Quit-Smoking Aids


While the number of American vapers declined over the last three years (as I reported here), e-cigarettes were still far more popular quit-smoking aids than medicinal nicotine or other drugs, according to researchers at the University of California San Diego (here). Tarik Benmarhnia and colleagues used information from Waves 1 and 2 of the FDA-funded Population Assessment of Tobacco and Health (PATH) Study to evaluate “the influence of [e-cigarettes] and pharmaceutical cessation aids [varenicline, bupropion and nicotine medicines, NRT] on persistent abstinence (≥30 days) from cigarettes, and reduced cigarette consumption” during the period 2013 to 2015.  They concluded: “Our results indicate that [e-cigarettes] are a more popular choice than approved pharmaceutical products as a smoking cessation aid among US quit attempters, over three quarters of whom were daily smokers.  In the future, as [vapor] products continue to evolve to make nicotine delivery more similar to that obtained from a cigarette, it is possible that they may play a bigger role in assisting smokers to quit combustible tobacco.” This study confirms my research group’s earlier analysis of Wave 1 PATH data: E-cigarettes are among the most commonly used quit aids for American smokers, and they are the only aid more likely to make one a former smoker (i.e., a successful quitter) than trying to quit cold-turkey (here). Original author: Brad Rodu
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CDC Data Shows That E-Cigarette Use Declined Again in 2017


About 6.9 million Americans were current users of e-cigarettes in 2017, according to data in the 2017 National Health Interview Survey, the source for CDC national smoking estimates.  That’s a million fewer vapers than the prior year, and over two million fewer than in 2014, the first year NHIS surveyed for vaping.     The number of current vapers who were former smokers had increased through 2016, but dropped in 2017, from 2.62 to 2.3 million.  This is not good news for tobacco harm reduction. Another fascinating detail from 2017 is that 1.17 million never smokers currently used e-cigs, and over two-thirds of those were 18-24 years old.  This may be an extension of the recent increase in high school vaping (here), but it’s important to note that smoking in this age group is way down (here).  Vaping has been portrayed as a menacing new epidemic by tobacco and nicotine prohibitionists in government and elsewhere.  It now appears that the misinformation in their anti-vaping messages has been effective (here).  The number of vapers has tragically declined.  Original author: Brad Rodu
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FDA: You Can Run Models, But You Can’t Hide Facts About Smokeless Tobacco


In a recent New England Journal of Medicinearticle, FDA researchers went to great lengths to conceal the fact that smokeless tobacco (ST) use has an entirely negligible impact on life expectancy. The article, “Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States,” (here) by Benjamin Apelberg and colleagues, was the centerpiece of FDA Commissioner Scott Gottlieb’s March 15 announcement of a radical nicotine reduction rule for cigarettes.  Drawing from the research, an FDA press announcement (here) declared that if cigarettes were minimally- or non-addictive by 2020, approximately 5 million additional adult smokers would quit smoking within just one year; only about 1.4 percent of the U.S. adult population would smoke cigarettes by 2100, in part, because more than 33 million people would avoid becoming regular smokers; more than 134 million years of life [would be] gained among the U.S. population. While it is entirely unclear how nicotine reduction would produce the first two results, there is a fundamental flaw in Apelberg’s model that mainly affects the third, years-of-life, claim.  Correcting for that error, the model would likely confirm that ST products are nearly risk-free. Apelberg estimates excess deaths among smokers by linking participants from National Health Interview Surveys (NHIS, 1997-2004) to the National Death Index (NDI) through 2006.  He also estimates deaths among users of ST, but uses an entirely different dataset – smokeless users who were enrolled in 1982 in the American Cancer Society Cancer Prevention Study II. Apelberg’s use of two data sets -- NHIS for smokers and CPS-II for ST users – violates a basic rule of modeling: all inputs should be from the same or similar sources.  NHIS should have been used for analysis of both groups.  That was the procedure, for example, when Michael Fisher and colleagues used NHIS and NDI to produce a stable estimate for all-cause mortality among smokers and ST users (here).  Apelberg may have used CPS-II because it shows that ST users’ mortality rate was 18% higher than that of never tobacco users.  Had he used NHIS, he would have had to acknowledge that smokeless users had no significant risks, as Fisher documented only a 5% excess that was not significant (HR= 1.05, CI = 0.90 – 1.23) (here). The FDA analysis was biased through the use of exaggerated risks from an American Cancer Society study that has never been evaluated by independent researchers (here, hereand here).  In this way, the FDA hid the negligible health impact of ST use. A letter I submitted to the New England Journal of Medicine describing the flaw was not accepted. Original author: Brad Rodu
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Weight Wisdom: Avoid Extremes, But Being “Over” May Have Benefits


A new CDC-released study by National Center for Health Statistics’ Dr. Katherine Flegal and colleagues (here) confirms results from her groundbreaking 2005 report (here): compared with people of normal weight (BMI = 18.5 to less than 25), those who are overweight (BMI greater than 25 but less than 30) have a lower mortality rate.  Higher mortality rates are seen with obesity (BMI greater than 30) and underweight (BMI under 18.5).     Applying weight-based mortality rates to the U.S. population, Flegal estimated in 2005 that overweight resulted in 82,094 fewer deaths, and a significant number of excess deaths were associated with obesity, a (n = 111,909) and underweight, (n = 33,746).  As I noted in this blog five years ago (here), Flegal’s conclusions are consistent with those of many other scientific studies.  I have long had a professional interest in population research on weight and health. In 2004, I published the first study to show that Swedish men who quit smoking by switching to snus avoided the weight gain usually seen with smoking cessation (abstract here).  In 2015, my research group analyzed data from the National Health and Nutrition Examination Surveys to demonstrate that changes in population smoking do not contribute significantly to changes in population overweight and obesity.  (BMC Obesity article available here). The impact of weight on life expectancy is clear: Those who are underweight or severely obese are at risk of dying prematurely, while mere overweight is associated with a lower mortality rate.Original author: Brad Rodu
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Vapers: Tell the FDA You’re Not Merely An Anecdote!


A year and a half ago, I blogged about government agencies ignoring federal survey data showing that 2.5 million former smokers were current vapers (here).  When FDA tobacco center director Mitch Zeller dismissed this evidence as mere “anecdotal reports,”  I argued that such data constitutes legitimate population-level evidence. Aiming to build a fresh dataset on smokers’ success in using vapor as a quitting aid, the Vapor Technology Association (VTA) and Consumer Advocates for Smoke-Free Alternatives (CASAA) just launched a national campaign called “I Am Not An Anecdote” (here). The groups are asking vapers to submit to the FDA detailed, sworn statements to “encourage Congress and federal regulators to reject any proposal that would ban OR limit flavored e-liquid products.” The groups note that “FDA Commissioner Scott Gottlieb has said that your ‘personal stories are important to me.’  But, he also refers to your stories of quitting cigarettes with vapor products as ‘anecdotes.’” While individual cases are, in scientific terminology, anecdotal, their cumulative value is considerable.  Vapor is replacing combustion at dramatic rates worldwide.  My research team used 2013 FDA-funded survey data to produce a peer-reviewed report on U.S. e-cigarette use (hereand here).  Our analysis showed that e-cigarettes are the most popular quit-smoking aid among American smokers and that they are the only aid more likely to make them former smokers (i.e., successful quitters) than are cold-turkey attempts (here). FDA should give weight to published studies, even when they do not conform to visions of a tobacco-free society.  The agency should also recognize the scientific value of mass declarations of smoking cessation accomplished through vaping substitution. Original author: Brad Rodu
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American Cancer Society’s Combustible Tobacco Statement Contains Falsehood


The American Cancer Society’s new position statement offering a “bold new framework” for eliminating combustible tobacco use in the U.S. (here) contains a demonstrably invalid statement: “Cigarette smoking is the leading cause of cancer mortality in the United States (1), accounting for as much as 98% of all tobacco-related deaths (2) [emphasis added]. The problem with the highlighted phrase is that no estimate of “all tobacco-related deaths” in the U.S. has ever been produced by the government, academia or health organizations.  The percentage of deaths attributable to smoking, while undoubtedly large, is simply not known. In reference 2 above, ACS attributes the false assertion to a New England Journal of Medicine article by tobacco researchers Michael Fiore, Steven Schroeder and Timothy Baker (here).  That article made virtually the same statement and cited a citizen petition submitted to the FDA in 2010 by Dr. Joel Nitzkin on behalf of the Tobacco Control Task Force of the American Association of Public Health Physicians (here).  Careful review of the Nitzkin filing reveals nothing to support the ACS or NEJM claim. This falsehood can be corrected.  With some effort, the very small number of deaths from smokeless use and cigar/pipe smoking can be estimated from large federal datasets.  Government researchers and the ACS have the resources and should make this a priority, in order to provide a scientific foundation for FDA tobacco regulation. Fabrication, or repetition of false statements, particularly by trusted authorities, organizations, and public figures, can result in widespread acceptance of myth as truth. Such cavalier inattention to fact is not acceptable in scientific discourse or public health policymaking, where actual lives are at stake (here). Original author: Brad Rodu
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USC Ended Partnership with Anheuser-Busch InBev in April; Ohio State and San Diego State Should Follow Suit

I have been informed by the USC Suzanne Dworak-Peck School of Social Work that the School and its research team that had been involved in the Smart Drinking Goals project terminated its involvement with the project in April 2018 and that they are no longer associated in any way with the project.The USC team had prepared toolkits summarizing the best current scientific thinking regarding environmental strategies for alcohol prevention. Although the team's involvement was apparently slated to last at least through 2018, they terminated their involvement in April and have completely disassociated themselves from the Smart Drinking Goals project.I applaud USC and this research team for dissociating from the project.The Rest of the StoryTo the best of my knowledge, the Ohio State University is still involved with the Smart Drinking Goals program, and in addition, since yesterday I have learned that San Diego State University also seems to be involved with the program. Both of these institutions should immediately follow the lead and example set by USC and terminate their involvement with this project and their partnership with Anheuser-Busch InBev.While public-private partnerships are sometimes tenable, in this case, you cannot have a credible partnership when the private corporation is bullying and disrespecting the autonomy of governments to implement their own public health measures to prevent excessive alcohol use and its associated harms. I cannot fathom an academic institution partnering with a company that went so far as to threaten a lawsuit against the city of Rostov in order to force it to allow the sale of beer at the World Cup soccer matches in Rostov Arena. Obviously, this completely undermines the supposed "smart drinking goals" initiative and exposes it for what it really is: a public relations hoax.I have since learned that San Diego State University has apparently also partnered with Anheuser-Busch InBev to aid this public relations initiative. According to the university, it accepted a $200,000 grant from the alcohol corporation to be a part of the "implementation planning" for the Smart Drinking Goals project.This grant completely exposes the hypocrisy of the alcohol company and demonstrates why this whole project is a hoax. Ironically, part of the San Diego State University project is to develop programs to reduce excessive alcohol consumption in sports arenas! Now you can see why this is a complete joke. At the same time that the company is, out of one side of its mouth, proclaiming that it cares about reducing alcohol consumption at sports arenas, from the other side of its mouth it is threatening to sue cities in order to force them to sell alcohol and facilitate excessive alcohol consumption in their sports arenas!This hypocrisy boggles the mind, and it demonstrates that the Smart Drinking Goals program is not a sincere effort to address public health concerns but instead, a public relations hoax.Hopefully, Ohio State and San Diego State will follow the example set by USC and immediately terminate their partnerships with Anheuser-Busch InBev.Original author: Michael Siegel
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