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Twitter Caught Up In This Year’s Annual Through With Chew Misinformation Orgy



Smokeless tobacco users are in for harassment this week, the 30th iteration of the annual Through With Chew orgy of smokeless tobacco misinformation.  Dippers and chewers will be demonized and the real science about the relative safety of their favored products will be twisted into fear-inspiring untruths. Consider this Tweet, for example, from the U.S. Department of Defense @ucanquit2 account on February 11: “Smokeless tobacco users are 50x more likely to get cheek, gum & mouth cancer than nonusers.”  The DoD made the same bogus claim two years ago (here).  I responded to this blatant fabrication with a Tweet of my own on February 15: “Your 50 claim is a complete fabrication by a staffer @theNCI. Here is the explanation: https://tinyurl.com/yxjsnugd . Furthermore, a large federally-funded study documented that men who dip/chew had ZERO excess risk for mouth cancer. ZERO. http://tinyurl.com/hd8nd49” After my Tweet was liked by 24 people and retweeted by 13, a strange chain of events occurred.  The Twitter accounts of many of the above were suspended.  The affected individuals pleaded with @TwitterSupport to make amends.  On February 16, I also asked for a correction: “To @TwitterSupport, Pls restore me/others. I am a scientist, 25 years published in this field. My tweet was professional and credible. In 2010 @CarlBialik at @WSJ investigated ‘50’ number and reported it was a fabrication used by @AmericanCancer, others http://tinyurl.com/y6a7ox8a.” That’s right.  Carl Bialik, “The Numbers Guy”, published a weekly column in the Wall Street Journal.  When Carl exposed the “50” myth (here) the American Cancer Society promised to stop using it: “Dr. Thomas Glynn, director of cancer science and trends for the American Cancer Society, said this week that his organization will no longer use the statistic citing a 50-fold increase in risk.” Yet still today, the Cancer Society and other tobacco prohibitionists tout the 50 number.       This week’s Twitter account suspensions likely resulted from a complaint by an authoritative anti-tobacco figure or agency.  While I understand that Twitter aims to protect the integrity of the information on its platform, in this case they sanctioned the wrong party. Note: As I post this on February 19, the suspended accounts have not been restored.   February 22: Today Jacob Sullum authored an article on the Reason Hit and Run Blog, "Did Twitter Punish Criticism of Government Propaganda About Smokeless Tobacco. (here).  A few hours later affected users reported that their accounts were returned to normal functioning. Original author: Brad Rodu
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Landmark Study Fails to Find Any Evidence that Vaping is a Gateway to Smoking among Youth

A landmark study, published on January 25 in the Journal of the National Cancer Institute, found no evidence that vaping is a gateway to smoking among youth. The data come from the largest, longitudinal study of youth smoking initiation -- the PATH (Population Assessment of Tobacco and Health) study -- and include two waves of observations on nearly 12,000 U.S. youth.The surveys asked numerous questions about both vaping and smoking behavior, including the frequency of these behaviors. It also assessed numerous risk factors for smoking that can be controlled for in multivariate analyses of smoking initiation rate differences between various groups. The baseline survey was conducted in 2013/2014 and the one-year follow-up survey occurred in 2014/2015.  The main reported finding of the study was that ever use of e-cigarettes at baseline is a risk factor for ever use of cigarettes at follow-up. This is consistent with the findings of several other studies.The Rest of the StoryBuried deep within the article is the rather startling, but most critically relevant finding of the entire study: The investigators were unable to report a single youth out of the 12,000 in the sample who was a cigarette naive, regular vaper at baseline who progressed to become a smoker at follow-up. Why? Because the number of these youth was so small that it was impossible to accurately quantify this number.Based on my own calculations from the data presented, out of the 12,000 youth, there were only 21 who were even past 30-day e-cigarette users at baseline (cigarette naive) who progressed even to ever smoking at follow-up. These youth reported using e-cigarettes only 1-5 days in the past 30 days at baseline, so it is not even clear that they were regular vapers. They literally could have tried an e-cigarette once 30 days earlier.It is possible that vaping was not a gateway to smoking for any of these 21 youth, but even if it was, they represent just 0.2% of the youth population. In addition, the study found that although ever use of e-cigarettes increased the risk of smoking initiation, recent use of e-cigarettes (within the past 30 days) did not increase the risk of smoking initiation. This finding is consistent with the hypothesis that youth who try e-cigarettes and do not particularly enjoy them such that they become regular users are the ones who are more likely to try smoking, but that youth who actually become vapers are not any more likely to subsequently try a real cigarette.The bottom line is that despite the widespread claims that vaping is a gateway to smoking initiation among youth, the most definitive study to date of this issue fails to provide any evidence to support that contention. If anything, it provides evidence suggesting that vaping acts as a kind of diversion that can keep some youth away from cigarette smoking.We will certainly need to await the results from future waves of the PATH study to have a clearer idea of the trajectory of youth vaping and smoking, but at the present time, I do not believe there is any evidence that vaping serves as a gateway to smoking among youth. In contrast, the evidence to date suggests that a culture of vaping is replacing, not enhancing, a culture of smoking.Original author: Michael Siegel
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Don't 'Narrow The Off-Ramp' For Smokers Who Want to Quit



On February 13 the Washington Examiner ran my commentary on the FDA Commissioner Scott Gottlieb’s vow to “narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs,” which would be a deadly mistake for many smokers.  Read the article on the Examiner website (here) and below. Smokers need all the help they can get to quit cigarettes. New research reported in the prestigious New England Journal of Medicine (NEJM) confirms that e-cigarettes are significantly more effective than FDA-approved nicotine medicines in helping smokers end their deadly habit. This study is impressive proof of the scientific concept known as tobacco harm reduction, the substitution of vastly safer smoke-free tobacco products – e-cigarettes and smokeless tobacco – by smokers who are unable or unwilling to become nicotine and tobacco abstinent.  Decades of scientific studies document that dipping and chewing tobacco are 98 percent safer than inhaling smoke (here, here, here, here, here), and the prestigious British Royal College of Physicians observed that “vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.” (here).  The NEJM article describes a British clinical trial in which 886 smokers were given either a refillable e-cigarette and one bottle of liquid, or nicotine medicines (pill, gum or patch).  E-cigarette users were encouraged to experiment with liquids of different strengths and flavors.  Nicotine users selected their preferred products and they were allowed to use them in combination and to switch them up as desired.  After one year, 18 percent of those in the e-cigarette group were not smoking, compared with 9.9 percent in the nicotine medicine group.  That is, e-cigarette users were twice as likely to quit than nicotine medicine users.  Another 13 percent of e-cigarette users reduced their smoking by at least 50 percent, compared to only 7 percent of nicotine medicine users.  This study confirms the results of earlier, smaller clinical trials in Italy (hereand here), New Zealand (here) and Greece (here).  More importantly, it addresses the demand of tobacco control activists for blue ribbon scientific proof.  Among that group are regulators in the FDA.  That agency’s historic mission has been to judge the effectiveness of medicines before making them available to the public.  Their primary assessment tool is the clinical trial – a highly sophisticated and costly experiment, in which doctors control the source and dosing of the medicine and all aspects of patient care. Until now, doctors have considered smoking a disease, to be treated with nicotine medicines, anti-depressives, nicotine blocking agents (like varenicline), and behavioral counseling.  Clinical trials were used to validate such regimens, and success rates have been abysmally low.      Today, e-cigarettes are upsetting the clinical trial cart.  As consumer products, they are widely available to millions of smokers, making it extremely difficult, if not impossible, to conduct controlled clinical trials (here).  Consumers, not doctors, are making the decisions in this environment.  Instead of clinical trials, the best evidence for consumer e-cigarette behavior can be gleaned from surveys.   My university research group’s analysis of government survey data shows that e-cigarettes were among the most commonly used quit aids by American smokers in 2013-2014, and they were the only aid more likely to make one a successful quitter than quitting cold-turkey (here).  Other studies in the U.S. and the United Kingdom have reported similar results, and together provide population-level, real world proof that smokers are quitting with e-cigarettes (here).   In the UK, government officials and most medical societies encourage smokers to switch to vastly safer cigarette alternatives.  It’s time for their U.S. counterparts to provide American smokers with the same lifesaving options (here).  The new British study adds to the argument against FDA Commissioner Scott Gottlieb’s vow to “narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs.”  That would be a deadly mistake for many smokers.  Original author: Brad Rodu
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TPSAC: Copenhagen Has Lower Lung Cancer Risk



The FDA Tobacco Products Scientific Advisory Committee (TPSAC) met on February 6 and 7  to consider smokeless manufacturers’ advertising and marketing claims that their products are safer than cigarettes (making them modified risk tobacco products, or MRTPs). Altria, whose U.S. Smokeless Tobacco Company subsidiary sought MRTP status for its Copenhagen snuff product, was the clear winner, as the committee approved the statement, “Switching completely to this product from cigarettes reduces risk of lung cancer.” (here) Clearly, Altria seeks to underscore the message that their form of smokeless tobacco, which is placed in the mouth and not inhaled, eliminates the risk for lung cancer that is high with cigarette use.  This obvious but important distinction was endorsed 8-0 by the TPSAC panel, with one abstention. Swedish Match, the other company pursuing an MRTP application (that is now almost five years old), was not as fortunate.  The panel rejected their claim that “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”  As I commented two months ago, “The term ‘lower risk’ is an understatement, as the risk is almost zero” (here), but the diseases weren’t the problem.  Some TPSAC members thought that approval would send the message to kids that snus was “safe.”  Brian King, a deputy director at the CDC Office on Smoking and Health, expressed concern about future unknowns: “…just because [snus usage] is low now we have to completely dismiss what the relevance could be in the future.” he said. “My response to that is one word: Juul.” (here) King also said that Swedish Match’s “continued absence of any youth data is preposterous to me.”  He seemed to be faulting the company for not surveying teens about snus products, even though, as the company pointed out, such research could run afoul of a ban on teen marketing.  Panel member Ken Warner supported the Swedish Match application.  “I think the health (benefits) are really clear compared to smoking -- more so than for any other smokeless tobacco product.  My sense is that if this is not approved, it might be the death knell for the [MRTP] process because we would be basically saying you can't get anything through this process.” Original author: Brad Rodu
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Researchers Tell Public that Vaping Causes COPD as Scientific Rigor in Tobacco Control Drops to an All-Time Low

Based on the results of a cross-sectional study showing an association between using e-cigarettes and reporting that one has ever been told they have COPD (chronic obstructive lung disease), a number of researchers have essentially concluded that vaping causes COPD, and one researcher is telling the public that use of e-cigarettes increases one's risk of COPD just like cigarettes.The paper, published in Drug and Alcohol Dependence, reports the results of a cross-sectional study based on the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey in Hawaii. The outcome variable was reporting ever having been told that one has COPD. The main predictor variable was ever having used an e-cigarette. The key finding of the study was that: "there was a significant association of e-cigarette use with COPD among nonsmokers (AOR = 2.98, CI 1.51–5.88, p Original author: Michael Siegel
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The War Against Tobacco Flavors Will Fail



Tobacco prohibitionists have objected to tobacco flavors for years.  As I noted nine years ago, “Unflavored smokeless tobacco products are unappealing to many smokers, so the success of tobacco harm reduction is vitally dependent on the availability of substitutes that are satisfying and flavorful. Anti-tobacco extremists know very well that satisfying and flavorful products are now on the American market, so they are using ANY tactic, regardless of its practical or scientific validity, to promote prohibition.” (here) Lately, prohibitionists have turned their focus to vapor products, with FDA Commissioner Scott Gottlieb threatening to ban e-cigarette flavors and menthol (here), while states (here, here, here, here, and here), cities (here) and counties (here) pursue their own initiatives.  The flavor war could permanently affect the vapor market, but its unintended consequences could entirely undermine the bans, driving growth in aftermarket flavor production and sales. Menthol cigarettes.  Although there is little scientific support for flavor regulation (hereand here), Dr. Gottlieb believes menthol is “one of the most common and pernicious routes by which kids initiate on combustible cigarettes” (here).  An FDA menthol ban would generate a robust aftermarket to meet the demand of affected smokers (here).  Scientists at the CDC, Battelle Laboratory and the University of Maryland have published easy-to-follow mentholation instructions (full article pdf here): Crush about a pound of menthol crystals, place them in a stainless steel pan, then spread out 5 packs of cigarettes in a single layer on a 16 X 9 inch rack about 1.5 inches above the menthol.  Cover the apparatus in a large plastic bag and leave at room temperature for about three days. Moist snuff/dip products.  Darcy “Mudjug” Compton and “Outlaw Dipper” Jared offer YouTube videos on adding Mountain Dew to moist snuff (hereand here), and creating a Copenhagen “Hawaiian blend” (here).  Another dipper demonstrates how to add food-grade essential oils to moist snuff (here). E-cigarettes and vapor products.  A flavor ban would not affect vapers who make their own vaping liquids. This segment of the market is already large and will grow; a few examples can be found here, here and here.  A ban might cause the retail market to fracture into two parts: one selling unflavored nicotine liquids, and another selling flavors (google search here).  A high-tax jurisdiction like Chicago, where a prohibitively high per-milliliter tax is imposed on nicotine-containing liquids, provides a template for flavor bans.  Vape shops there sell 30 ml bottles of zero nicotine e-liquids (no tax) and small concentrated bottles of high-strength nicotine (5 ml or less) that are subject to the excise tax.  Flavor bans would simply encourage purchase of flavorless e-liquid and leave consumers to purchase flavors that are widely available in grocery stores and online, such as hereand here. It is worth noting that the only known death attributable to vapor products in the U.S. resulted from a young child ingesting pure nicotine (here), which is used by do-it-yourselfers to create e-liquids.  A flavor ban would likely increase the risk of such accidents.   In closing, imagine if during Prohibition alcohol opponents had banned flavors only; beer, wine and other flavored spirits would have been eliminated, leaving only pure alcohol on retail shelves.  That policy would have been an abject failure, as would any similar ban on tobacco. Note: I would like to thank Brian Fojtik, former Senior Fellow with the Reason Foundation and currently President of Brownstone Communications, LLC, for his help with this post. Original author: Brad Rodu
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Having Health Insurance Increases Your Risk of a Heart Attack, and Other Cross-Sectional Study Foibles

Later this week, a research study will be presented at the International Stroke Conference in Hawaii that purports to show that vaping increases the risk of heart attacks. In a recent post, I showed that this research is fatally flawed because it violates the basic principle in epidemiology that correlation does not equal causation. The study found a correlation between using e-cigarettes and ever having had a heart attack. The authors conclude that vaping must therefore increase heart attack risk. However, the more likely explanation is the opposite: smokers who experience a heart attack are more likely to try to quit smoking and therefore more likely to use e-cigarettes.As an exercise, I used the same data (the 2016 Behavioral Risk Factor Surveillance Survey) to show that by the same reasoning, making a quit attempt increases your risk of a heart attack.Here are some other factors that increase your risk for a heart attack, based on the 2016 BRFSS:Having health care insurance (67% increase in heart attack risk)Having a health care provider (174% increase)Going to the doctor annually for a routine physical exam (150% increase in risk)Having ever received the pneumonia vaccine (253% increase in risk)Ever having had a mammogram (52% increase in risk)So according to anti-vaping researcher logic, obtaining health care insurance, obtaining a health care provider, going to the doctor for routine exams, getting vaccinated for pneumonia, and having a mammogram all increase your risk of a heart attack.By the way, the same analysis reveals that compared to vaping only occasionally, you reduce your risk of a heart attack substantially if you vape every single day.In fact, daily vapers are at lower risk of having reported a heart attack than people who never vaped!Original author: Michael Siegel
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Junk Science Exposed: New Study Purports to Show that E-Cigarettes Increase Heart Attack Risk



According to the headline of a UPI news story from last week, vaping has been linked to an increased risk of having a heart attack. This research finding was reported worldwide, including a scary headline in London's Sunday Express reading: "New research claims vaping raises risk of deadly heart attacks and strokes."This finding is profoundly important because if e-cigarette use does indeed increase heart attack risk, then the role of vaping in harm reduction comes into serious question.The news headline stems from a paper that is being presented this week at the American Stroke Association’s International Stroke Conference in Hawaii.According to the news coverage, the researchers used cross-sectional data from the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) and found that ever use of e-cigarettes increased the risk of reporting ever having had a heart attack, while controlling for age, gender, body mass index, history of diabetes, and smoking status. The same was true for the risk of reporting ever had a stroke.While the abstract itself does not appear to be publicly available, the news articles report that the study found a 59% increase in heart attack risk associated with the use of e-cigarettes. According to one article: "The American Heart Association has subsequently cautioned the public against using e-cigarettes."The Rest of the StoryIt is irresponsible to use the results of this cross-sectional study to conclude (or even suggest) that e-cigarette use increases heart attack or stroke risk. Why? Because the study only assessed the relationship between "ever" having used e-cigarettes and "ever" having had a heart attack. The study has no information on which came first. In other words, it is entirely possible (and in fact quite likely) that the majority of respondents who reported having used e-cigarettes and having had a heart attack actually suffered the heart attack first and then subsequently started using electronic cigarettes because they were desperate to quit smoking after experiencing this life-threatening event.A similar study (this one using cross-sectional data from the National Health Interview Survey) was published in the American Journal of Preventive Medicine last year and is subject to the same fatal flaw: it is highly likely that people who experienced a heart attack began using e-cigarettes in an attempt to quit smoking.Trying to Quit Smoking Increases Your Risk of Having a Heart AttackUsing the same methodology as these studies, I examined the relationship between trying to quit smoking and heart attack risk. I used the 2016 BRFSS and modeled the risk of having had a heart attack as a function of having tried to quit smoking (and succeeding for at least one day). I controlled for age, gender, body mass index, diabetes, and smoking status.The results:Making a serious quit attempt is associated with a significant increase in heart attack risk. It actually increases your heart attack risk by 41%.Obviously, what is going on here is not that quitting smoking increases your risk of having a heart attack. Instead, what is happening is that smokers who experience a heart attack are more likely to try to quit smoking.But the same reasoning used by researchers to conclude that vaping increases heart attack risk supports the conclusion that trying to quit smoking increases heart attack risk.For that matter, one could show that use of asthma inhalers is associated with an increased risk of having asthma, that use of insulin is associated with an increased risk of diabetes, or that the consumption of gluten-free food increases your risk for Celiac disease (caused by gluten allergy).For those who are curious, trying to quit smoking is associated with a 38% increase in the risk of stroke.Clearly, physicians should warn their smoking patients not to try to quit, as quitting appears to be associated with an increased risk of heart disease and stroke.Sadly, we don't have to recommend that physicians counsel smokers not to try to quit -- the American Lung Association is already doing that.Original author: Michael Siegel
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Does the American Lung Association Really Hate Smokers So Much that They Discourage Quit Attempts Using E-Cigarettes Despite New Clinical Trial Evidence of their Superiority to NRT?

On Wednesday, the New England Journal of Medicine published a new study that reported the results of a one-year randomized, clinical trial in which e-cigarettes were compared to nicotine replacement therapy (NRT) to aid smoking cessation. The study was conducted in the UK, and both treatments were accompanied by behavioral counseling. The result: "The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58)."This is the most definitive study yet on the effectiveness of electronic cigarettes for smoking cessation. It found that one-year smoking cessation rates with e-cigarettes were nearly twice those obtained using NRT. Although one must exercise caution in generalizing the results to the U.S., this evidence pretty much blows out of the water the claim being made by some anti-nicotine advocates that vaping actually inhibits smoking cessation.A previous clinical trial conducted in New Zealand had found that e-cigarettes were as effective as NRT for smoking cessation, but that trial used first-generation e-cigarettes that are not thought to be as effective as products currently on the market.This is great news for smokers, as it suggests that switching to vaping is another smoking cessation option that can be added to those already available. Certainly, for smokers who try to quit but fail with other therapies--like NRT--trying e-cigarettes is a strong and viable option. It may also be appropriate at this point for physicians to encourage smokers who want to quit and are open to trying e-cigarettes to make an attempt to switch to vaping even if they have not failed with other cessation approaches.The Rest of the StorySo here is what the American Lung Association had to say in response to the study:"The US Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit. We only support methods that are FDA approved and regulated. Switching to e-cigarettes does not mean quitting. Quitting means truly ending the addiction to nicotine, which is very difficult."In other words, the American Lung Association is saying that despite this clinical trial demonstrating that e-cigarettes are probably much more effective than NRT for smoking cessation, they would rather smokers continue smoking than make a quit attempt using electronic cigarettes.The American Lung Association is stating that it does not "support" the use of e-cigarettes by smokers. This means that if a smoker is not willing to try NRT or a pill, then the American Lung Association would not recommend that they try quitting with e-cigarettes as an alternative.Not only that, but according to this statement, the American Lung Association will never support the use of e-cigarettes because it will only do so once the FDA approves vaping as a cessation method, which will not and cannot happen. The FDA cannot approve e-cigarettes for smoking cessation because they are recreational products and not drugs. No manufacturer has ever applied to the FDA for approval of a vaping product as a smoking cessation method, and it is unlikely that will happen any time soon.What could possibly explain why a public health organization that is supposed to be committed to improving lung health would actually discourage smokers from trying to quit using e-cigarettes, especially in the light of strong clinical trial evidence of their efficacy?The only way I can reconcile this is to question whether subconsciously, the American Lung Association has so much hatred for smoking and smokers that they would actually prefer that a smoker continue to smoke and get sick from that smoking if they are not willing to use an FDA-approved pharmaceutical product. This is, after all, exactly what the organization is expressing. And although the reasoning behind this position is clearly not conscious, the only reasoning that could possibly explain it is some sort of underlying hatred of smokers and a desire to punish them if they don't try to quit "the right way" -- the "right way", of course, being defined by the American Lung Association.It is important to note that the American Lung Association had a number of alternatives to its recommendation that smokers refrain from using e-cigarettes to quit. They could have recommended that NRT or pharmacotherapy remain a first-line approach, but that those smokers who fail to quit using NRT or pharmacotherapy may want to consider trying electronic cigarettes. They could have recommended that smokers switch to e-cigarettes and then try to wean themselves off the nicotine. Instead, the American Lung Association chose to make a blanket statement urging smokers not to try to quit using e-cigarettes.I had thought that the tobacco control movement had reached its lowest point, but I never could have imagined that it would come to this: a national tobacco control organization has told smokers that they are better off continuing to smoke than trying to quit using an electronic cigarette. I don't think we can get any lower than this.Original author: Michael Siegel
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Unacceptable Behavior by Tobacco Control Researchers



Dr. Donna Vallone of the tobacco-prohibitionist Truth Initiative was first author last October of a Tobacco Controlarticle on JUUL users (here).  When the publication was promoted on the Society for Nicotine and Tobacco Research (SRNT) listserv, I asked the authors to resolve some problems with their report.  When they failed to respond to my listserv post, I described the flaws in a blog a week later (here), on November 7. The day after my blog post, Dr. Vallone responded on the listserve to all of my concerns, except one: failure to disclose information about the most important correlate of JUUL use – other e-cigarette use.  On November 9 and again on the 30th, I asked on the listserve for Dr. Vallone to provide information about concurrent use of JUULs, other e-cigarettes and cigarettes.  I also sent her private email requests on December 28 and January 18, all to no avail. Dr. Vallone’s failure to provide critical data suggests that the omission in her research article was intentional, designed to support the case for a “JUUL epidemic.” Dr. Vallone’s ignoring of repeated data requests illustrates the insularity and arrogance of much of the tobacco research community.  Manuscripts often are not competently reviewed, results not seriously challenged, and over-the-top policy prescriptions not sufficiently justified.  These behaviors will eventually be deemed unacceptable by the general scientific community.  In the meantime, the Truth Initiative’s findings on JUUL use are incomplete and uninformative. Original author: Brad Rodu
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Think before you sign: a new letter attacking the Foundation for a Smokefree World



WHO Executive Board – will it see beyond the pestering of abstinence-only activists?

A draft activist letter to the WHO Executive Board is circulating widely on email networks – so widely that it has even been sent to me. It is a response to an open letter from the Foundation for a Smokefree World to the WHO Executive Board, which is having its annual meeting 24 January – 1 February, 2019.

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Actionable Health Videos for Smokers, Dippers and Chewers



I have been educating tobacco users for 25 years about the differential in risks associated with combustible and smoke-free tobacco products.  I have published dozens of studies in medical and scientific journals (here), authored newspaper op-eds, been quoted in many news stories, penned over 500 blog posts and provided countless radio interviews.  In the face of this fact-driven effort, tobacco prohibitionists in the medical establishment and government have mounted a campaign of exaggerated and even fabricated claims against effective harm reduction tools, including smokeless tobacco, e-cigarettes and heat-not-burn products.  Occasionally, they have subjected me to ad hominem attacks.  With these measures, prohibitionists have dissuaded massive numbers of smokers from acting to reduce their risk and lengthen their lives.  Over these 25 years, 10 million smokers have suffered premature, and for many, preventable early deaths.Of late, vapers have become organized and vocal in challenging these unscientific, unprofessional, and even unethical attacks on tobacco harm reduction, but traditional tobacco users, like smokers, dippers and chewers, have been slower to respond.  One notable exception has been the extremely impactful work of two internet stars.  Darcy Compton joined with two friends in 2005 “to create a product that would fill a need of every smokeless tobacco user in America.  From the humble beginnings of three guys assembling spittoons by hand out of a residential garage, to a full-fledged manufacturing plant based in Southern California, Mud Jug epitomizes the American dream of hard work, honesty, quality and value. Every Mud Jug [portable spittoon] has been, and will continue to be 100% made in the United States of America.” (here)  Darcy is more than a founder and president of Mudjug (here); he’s the star of the wildly popular Mudjug YouTube Series that boasts nearly 200,000 subscribers (here).  In 2012, Darcy published a video review of my book, For Smokers Only (here), which has since drawn over 300,000 views.   Upon learning of the video in 2014, I contacted Darcy and accepted his invitation to record an interview with him, which is available here.  That chat, which has 211,000 views, demonstrates the educational power of social media.     Darcy subsequently introduced me to Jared, aka “Outlaw Dipper,” who recently conducted his own interview with me (here).  Five weeks later, that video has 138,000 views and 1,000 comments.  The FDA insists that the central message of its smokeless tobacco education campaign is “smokeless doesn’t mean harmless,” (here), but the campaign itself is harmful to public health.  The agency claims to “educate rural, male teenagers about risks of dipping,” but it engages in exaggeration, distortion, and even fabrication of minimal or nonexistent risks.  It willfully misleads smokers and dippers, putting their lives in jeopardy.In contrast, the videos from Darcy and Jared are educating hundreds of thousands about the simple, scientific tobacco truth that smoke-free is vastly safer.  Thousands of posted comments prove what surveys have shown (here): that most Americans remain unaware of the differential risks of smoking and dipping.  Darcy’s and Jared’s viewers aren’t just being entertained; many have subsequently switched from cigarettes to smokeless.  Darcy and Jared will never get public health awards for their videos, but they have performed a public health service of incalculable value. Original author: Brad Rodu
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The great American youth vaping epidemic. Really?








But is it really?

Updated: 15 February 2019 to add section 17

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Lynne Dawkins: E-cigarettes – an evidence update

Dr Lynne Dawkins of London South Bank University gives her terrific myth-busting lecture on e-cigarettes – see the YouTube video above. Here are the slides (Slideshare) and here below is Lynne’s summary of the key points.

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It’s Time for Tobacco 21



A December 19 “teen vaping epidemic” presentation by U.S. Surgeon General Jerome Adams at the University of Texas MD Anderson Cancer Center was particularly noteworthy for one passage (here):  “We want the science to be an important part of that policy discussion.  I think the science is clear that raising the age of which youth can purchase these tobacco products to 21 has clear public health benefits.  There’s no doubt about that.  The science part of this policy equation is clear: Tobacco 21 works.” To my knowledge, this is the first time the Surgeon General has publicly supported Tobacco 21.  Perhaps his landmark endorsement will prompt Congress to legislate that the minimum age for tobacco purchase match that for alcohol. There are compelling reasons to make Tobacco 21 the law of the land.  First and foremost, it would delegitimize tobacco sales to 18-year-old high school students.  While they constitute 14% of all high school students, they account for one-quarter of high school smokers and smoker-vapers (here).  Legal buyers – not manufacturers and retailers – are the primary source for tobacco products used by underage high schoolers (here). Another argument for Tobacco 21 is the track record of Alcohol 21, which was adopted by all states by 1988 (here).  There is no doubt this law has played an important role in the decline of high school drinking and binge-drinking (trend here), even though current prevalence is far from optimal. I have to acknowledge my discomfort with treating 18-20-year-olds as children, but the Tobacco 21 website provides this persuasive information: “For 600 years of English common law and throughout most of U.S. legal history, the age of 21 was regarded as the age of full adult status.  Until 1971 the legal minimum voting age was 21 and many states maintained age 21 as their legal drinking age.  It was not until the Vietnam War with the unpopular, forcible draft of disenfranchised 18-year-olds, that the age to vote in the U.S. was shifted downward to 18 by the 26th Amendment to the U.S. Constitution.  During that period 25 states also moved to reduce the age to purchase and consume alcoholic beverages.  The result was a dramatic increase in highway crashes, injuries and deaths caused by intoxicated drivers in the 16-20 age group.” Data from the National Highway Traffic Safety Administration reveals that in 1988 there were 10,200 drivers age 16-20 years involved in a fatal accident, and 25% of them had a blood alcohol concentration (BAC) of 0.08% or higher (here).  By 2016 the number of drivers in that age group involved in fatal accidents was 4,400, and 15% had a BAC of 0.08% or higher.  Alcohol 21 is only one of many factors that contributed to that reduction, and those numbers are still unacceptably high, but the trend suggests that Tobacco 21 will result in a reduction in teen tobacco use. Tobacco 21 has been endorsed by most major medical organizations (here), and it has been adopted by six states: Hawaii (2015), California (2016), New Jersey (2017), Oregon (2017), Maine (2017) and Massachusetts (2018) (here).  While the remaining states could adopt Tobacco 21 at will, congressional action would have a more immediate, profound effect in limiting high school students’ access to tobacco products. Original author: Brad Rodu
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Intolerable False Statements by FDA’s Mitch Zeller


Mitch Zeller, director of the FDA Center for Tobacco Products, should stop making false statements about smokeless tobacco. The FDA earlier this week expanded its smokeless tobacco campaign, arranging a series of interviews for Zeller (example here), whose script included two provably false statements.    “Every year more then [sic] 2,000 new [mouth or throat] cancer [cases] are diagnosed in the United States solely caused by smokeless tobacco use.” This number is a pure fabrication.  No medical authority, including the FDA, has ever produced such a figure, which is more than 50% higher than the agency’s estimate of two years ago (here). Even that number was a gross exaggeration, due to a serious technical error confusing the historical risks of dip and chew (essentially zero) favored by American men with the higher risks of dry powdered snuff preferred by women (here). The Zeller number is further undercut by last year’s American Cancer Society report which omitted smokeless tobacco as a cause of cancer (here).    Zeller also produced this false statement in his latest publicity tour: 2.     …“a white spot inside your lip or gum that you know if you’re seventeen eighteen years old and you see that and you don't pay any attention to it, it can progress to things like cancer.” A white patch, as I have documented (here), is simply a reaction to the irritating effect of the tobacco, similar to the development of calluses on a worker’s hand.  The link between white patches and cancer is virtually zero for dippers and chewers. As director of an FDA center, Zeller has a profound responsibility to enhance public health and adhere to scientific truth.  He damages his own credibility and that of his agency by making false statements.  Original author: Brad Rodu
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The War Against Vaping: Déjà Vu All Over Again



A document in the University of California San Francisco tobacco industry archives describes the hostile reaction in 1995 to my smokeless tobacco harm reduction strategy for smokers (here).  Opponents used messaging they would later redeploy against e-cigarettes: (1) all tobacco is dangerous, (2) medicines work, so substitutes aren’t needed, and (3) the children. In a CNN “Your Health” segment on October 21, 1995, correspondent Loretta Lepore “met a doctor who actually prescribes tobacco pouches as a way to satisfy the craving for nicotine without lighting up.” Lepore: “One, two, the count climbs to forty-six million U.S. smokers.  Charles Mayfield, a genetic cancer researcher was one, until his toddler demonstrated the error of his way.” Mayfield: “He used to walk around with a piece of paper rolled up like a cigarette…And, I mean, that had a devastating effect on me and my conscience.” Lepore: “Mayfield quit smoking, but he hasn’t overcome his nicotine addiction.  Now he gets his fix from smokeless tobacco.” Dr. Brad Rodu: “It’s a discreet, paper pouch that fits invisibly between the cheek and gum.” Lepore: “Oral pathologist Brad Rodu recommends all smokers make the switch.  He says it’s the smoke that causes fatal lung and heart disease.” Mayfield: “I’m using smokeless tobacco right now, and no one can even tell.” Lepore: “While the use of smokeless tobacco socially acceptable to some, many view Rodu’s approach as medically unacceptable.” Dr. Scott Tomar (CDC): “To recommend to smokers that they switch to smokeless tobacco is simply maintaining their addiction.” Lepore: “Instead, Tomar recommends an already approved nicotine replacement therapy.” Tomar: “Nicotine patch and gum, both have been found to be effective in treating nicotine addiction.” Rodu: “Nicotine patch and gum don’t provide nearly the same level, or nearly the same spike that smokers crave, and so are not effective for many smokers [Note: “ineffective” is more accurate, hereand here] Lepore: “And there’s another concern.” Dr. Clark Heath (American Cancer Society): “Smokeless tobacco carries with it a sharply increased risk of cancer.” [Totally wrong with respect to dip and chew here] Lepore: “A four to five fold increase over non-smokers.  Aside from health concerns, Dr. Rodu’s critics are also raising ethical questions about his approach.  Mainly, should doctors be advising patients to choose another addiction?  And if a patient gets sick from smokeless tobacco, is the doctor legally responsible?” Rodu: “Since when is it unethical to reduce the smoker’s risk for all tobacco-related diseases, including oral cancer?” Lepore: “A 1981 study published in the New England Journal of Medicine says 26 out of 100,000 smokeless tobacco users contract oral cancer each year.  The five-year survival rate for oral cancer is 50 percent.  In part, because it’s easier to detect than lung and other forms of cancer.  So according to Dr. Rodu’s theory, if all smokers switch to smokeless tobacco, the United States would see 6,000 cancer deaths each year [Note: this was a gross overestimate, based on falsified research, hereand here], versus 420,000 smoking-related deaths reported annually.” Lepore: “Dr. Donald Miller, an oncologist and Rodu colleague at the University of Alabama at Birmingham.” Miller: “I have wondered many times why I didn’t think of this.  It is an outstanding idea that really has the opportunity to change the way society thinks about cancer risk.” Lepore: “Critics say there’s also the risk non-smokers, especially teenagers, will start using smokeless tobacco, perceiving it to be safe.  But Dr. Rodu stresses his approach is for smokers only.” This transcript was circulated by Vincent Gierer, Chairman of the Board and CEO of US Tobacco, to employees of the world’s largest smokeless tobacco company in 1995.  Gierer challenged the baseless claims that my research was an industry ploy: “Obviously, Dr. Rodu’s thesis may cause considerable controversy, since some people may view his advice as favorable to our Company and our products.  Whatever your personal opinion of his thesis may be, I want to make clear the Company’s position regarding Dr. Rodu’s [book] publication.  The Company’s longstanding policy is not to make health claims about its products, nor to comment on health claims regarding other tobacco products.”Original author: Brad Rodu
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Peer review of: Charlotta Pisinger et al. (U Copenhagen public health), A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes, Preventive Medicine 2018.

by Carl V Phillips

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Vaping Is Not the Real Health & Safety Threat in Kentucky High Schools



Foundation for a Healthy Kentucky (FHK) and Kentucky Youth Advocates (KYA) recently launched a campaign to discourage e-cigarette use by youth (here).  KYA executive director Dr. Terry Brooks predicted that “unless we as a commonwealth treat e-cigs as the health threat it is — in terms of now and in the future — then in 2038, Kentucky will still be the cancer capital of the nation.”  According to Ben Chandler, FHK chairman and CEO, “the fact that youth e-cig use is often a gateway to cigarette smoking makes immediate action imperative.” Does evidence support the claim that e-cigarettes are a gateway to cigarettes? No.  Since the campaign cites the biennial Kentucky Youth Risk Behavior Survey, I have used KYRBS data to illustrate smoking and vaping among high school students in the Commonwealth from 2005 to 2017. The chart at left shows that current (past-30-day) smoking declined from 26% in 2005, to 24% in 2011.  E-cigarettes were not widely available during that period.  In contrast, during the e-cigarette era (2011 to 2017), current smoking dropped from 24% to 14%.  The prevalence of current vaping, collected only in the latter two years, was 23% and 14% respectively.  With the data showing show an unprecedented decline in smoking rates, there is no e-cigarette crisis among Kentucky high schoolers.  KYA asserts that they “are laser-like in our efforts to…protect kids from abuse and neglect,…help kids grow up healthy and strong…” (here)  If that’s the case, they shouldn’t ignore behaviors that are far more dangerous than vaping.  For example, 27% of Kentucky high schoolers were current drinkers, 13% were current binge drinkers, and 16% were current marijuana users.  Additionally: .nobr br { display: none } td { text-align: center}Prevalence (%) of Risky Behaviors Among Kentucky High School Students (KYRBS, 2017)Past 30 DaysRarely/never wore a seatbelt (as an occupant)9%Rode with driver who had been drinking14%Drove after drinking4%Texted or emailed while driving35%Carried a weapon (e.g. gun, knife, club)21%Past 90 DaysHad sexual intercourse29%..…and used condom, 51% of previousPast YearInvolved in physical fight21%Physically bullied on school property21%Electronically bullied18%Felt sad or hopeless29%Considered suicide15%Made suicide plan13%Attempted suicide8% Kentucky health organizations should stop obsessing about a mythical high school vaping crisis and focus instead on stopping other behaviors and activities that State data define as immediate health and safety threats.   Original author: Brad Rodu
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"Truth" Campaign to Kids: Better to Smoke 19 Cigarettes than to Vape One Juul Pod

And this "Truth" Campaign "Fact" Isn't Even True One of the oft-repeated "facts" being disseminated by the "truth" campaign is that one Juul pod is equal to 20 cigarettes worth of nicotine.More specifically, the "truth" campaign claims, as its #1 most important fact about Juul that: "The amount of nicotine in one JUUL cartridge is roughly equal to the amount of nicotine in a pack of cigarettes."Joining the "truth" campaign in spreading this factual information is the Centers for Disease Control and Prevention (CDC), whose web site currently states that: "a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes." This "fact" has spread like wildfire. Just as one example, a parenting article in a news magazine writes: "Each JUUL pod contains the approximate equivalent to 1 pack of cigarettes, or 200 puffs. So, if a user goes through one JUUL pod a day, that is the nicotine equivalent of smoking a pack of cigarettes a day."Similarly, the appropriately named "Scary Mommy" web site warns that: "one Juul “pod” contains 20 cigarettes worth of nicotine (that’s a pack of regular cigarettes)."It's not just scary mommy blogs that are disseminating this "critical fact" about Juul. The high tech-site "Inc." has this to say about Juul: "The secret is its uniquely potent formula--a single pod contains roughly as much nicotine as a pack of smokes."I could go on and on with examples. The Chicago Daily Herald reports that: "Most of Juul's single pods contain the same amount of nicotine as a pack of cigarettes." Collegiate Times tells readers that "Engineered to be much more convenient than a cigarette, JUULs are arguably more addictive as one pod is the equivalent of 20 cigarettes (or a typical pack of smokes)...". Vogue magazine reported that even "Dan from Poison Control" apparently informed one concerned caller that the amount of nicotine in a Juul  pod is exactly the same as the total amount of nicotine in an entire pack of cigarettes: "Dan from Poison Control called me back to say that a fresh Juul pod has the same amount of nicotine as 20 cigarettes."One respiratory therapist warned that because a single Juul pod contains as much nicotine as a pack of cigarettes, a youth who vapes is in danger of dying from nicotine poisoning: "Juul, which is one of the most popular brands on the market, contains the equivalent of 20 cigarettes. Many times, a bottle of e-liquid can contain the same amount of nicotine as a pack of cigarettes. That means kids, who might like the flavor and puff, puff, puff and go through the entire container, are taking in 20 cigarettes worth of nicotine. This sudden increase in nicotine can lead to nicotine poisoning, a potentially fatal condition."The Rest of the StoryThere are two severe problems with this claim by the "truth" campaign.First, the message that it is sending to kids is that you are better off smoking 19 cigarettes than vaping one Juul pod. This comparison certainly makes it sound like Juuling is a lot worse than smoking. And if that's the case, then the clear message is that you are better off smoking than Juuling.That's clearly the message that the "truth" campaign and other anti-tobacco organizations and health agencies are sending to public health practitioners. For example, the National Center for Health Research informed its readers that vaping is no safer than smoking. A magazine devoted to asthma and allergies told its readers that e-cigarettes are no safer than cigarettes for kids with asthma.This message is a potentially damaging one from a public health perspective. It undermines the public's appreciation of the severe hazards of smoking and obviously, if any kids end up smoking instead of Juuling because of this information, it could have disastrous consequences.Apparently, I'm not the only one who sees the problem with this message. A number of young people took to Twitter with the same message:"This JUUL thing is so Dumb I wanna smoke 19 Cigarettes.""Hey guys.. time to smoke 19 cigarettes instead of a juul pod cause it’s better for you!!!!" "Okay I’ll just smoke 19 cigarettes instead of my Juul now, thank you for the advice!"  "yeah f__k the juul go smoke 19 cigarettes instead."But there's a second, possibly more subtle problem with the claim:It's not true.It doesn't take an advanced math degree to fact-check this claim. We just need two pieces of information:1. The most highly concentrated Juul pod (there are two concentrations) contains 40 mg of nicotine.2. An average cigarette contains about 12 mg of nicotine.Thus, a Juul pod contains the amount of nicotine equivalent to that in about 3 cigarettes (not 20 cigarettes).Moreover, there is nothing terribly unique about the Juul in terms of nicotine content. There are hundreds of varieties of e-liquids on the market that contain 24 mg of nicotine per cartridge, with a cartridge delivering about 200 puffs, similar to a Juul pod. So in reality, the Juul contains less than twice the amount of nicotine present in many other electronic cigarettes.Focusing on the nicotine content obscures a more important factor, one which does actually separate out Juul from most other vaping products. That factor is the rate of absorption of nicotine into the bloodstream. Because of the nicotine formulation used in Juul (i.e., a nicotine salt), it is absorbed rapidly into the bloodstream and the pattern of nicotine levels in the blood over time mimics that of cigarette smoking. This is unlike the pattern for almost every other type of electronic cigarette on the market, which uniformly deliver nicotine quite ineffectively and therefore have a low addiction potential. By focusing on the nicotine content, rather than the formulation, the "truth" campaign and CDC are obscuring the most important information that people need to understand.This commentary is not to minimize the addictive potential of Juul, the fact that there is a high level of nicotine absorption from Juul (much higher than from almost all other e-cigarettes), or that the pattern of nicotine in the bloodstream over time produced by the Juul does mimic that of cigarette smoking. It is just to highlight that there are a lot of exaggerated claims out there and in addition to just being incorrect, some of these claims could actually do public health harm.Note: This post is dedicated to Kimberly Manor, the owner of Moose Jooce vape shops in Michigan: "Kim Shilling Manor smoked 2 1/2 packs of Marlboro reds a day. She smoked even after her husband died of lung cancer and her mother developed lung cancer. Kim quit smoking the FIRST time she tried vaping! It was life changing for her and she opened Moose Jooce so people could see just how easy it was to live smoke free!" It is because of Kimberly, and the literally 2 million other former smokers out there with similar stories, that I continue to try to reveal the "rest of the story."Original author: Michael Siegel
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