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Mountain Vapor Blog

Welcome to the blog area of our site where we hope to keep you updated on the trends of the e-cigarette industry as well as product reviews.

FDA’s New Vision for Tobacco Harm Reduction


U.S. Food and Drug Administration Commissioner Scott Gottlieb on July 28 fully endorsed tobacco harm reduction. In a speech (here), he clearly defined the problem: “[I]t’s cigarettes that are the primary cause of tobacco-related disease and death.”  Dr. Gottlieb cited facts about nicotine, emphasizing its addictive qualities and the need to keep children away from all tobacco products. He also made one critical distinction: “[T]he nicotine in cigarettes is not directly responsible for the cancer, lung disease, and heart disease that kill hundreds of thousands of Americans each year.  Yes, it got them all addicted and kept them addicted for the long term.  And it got most of them addicted when they were still teenagers.  But it’s the other chemical compounds in tobacco, and in the smoke created by setting tobacco on fire, that directly and primarily cause the illness and death, not the nicotine.” This has been one of my principle themes for over two decades. Dr. Gottlieb called for reduction of nicotine in cigarettes to non-addictive levels, an idea that I criticized in my 1995 book, For Smokers Only (updated version here) and more recently in my blog (hereand here).  However, I was critical because advocates of nicotine fadeout were deluded in thinking it would work in the absence of viable tobacco substitutes.  Unlike them, Dr. Gottlieb embraces the harm reduction component: “…we need to envision a world where cigarettes lose their addictive potential through reduced nicotine levels.  And a world where less harmful alternative forms, efficiently delivering satisfying levels of nicotine, are available for those adults who need or want them…” The new commissioner underscored the value of less harmful products: “I also hope that we can all see the potential benefits to addicted cigarette smokers, in a properly regulated marketplace, of products capable of delivering nicotine without having to set tobacco on fire.  The prospective benefit may be even greater for the subset of current cigarette smokers who find themselves unable or unwilling to quit.” Note two key phrases above: (1) “less harmful forms [of tobacco], efficiently delivering satisfying levels of nicotine, are available for adults who need or want them;” and (2) “…current cigarette smokers who find themselves unable or unwilling to quit.” I used the latter words in 1994 to describe my vision for a new approach to smoking control: “In a review of the avoidable causes of cancer, Doll and Peto observed that ‘No single measure is known that would have as great an impact on the number of deaths attributable to cancer as a reduction in the use of tobacco or a change to the use of tobacco in a less dangerous way.’  Unfortunately, the second part of this observation has not received attention.  Because smokeless tobacco causes far fewer and considerably less serious health effects than does smoking, it should be promulgated as an alternative to cigarettes for smokers unable or unwilling to overcome their nicotine addiction.” (article here, emphasis added) Dr. Gottlieb’s use of “unable or unwilling” acknowledges the effectiveness of tobacco harm reduction, without judging smokers.  This theme is repeated in Dr. Gottlieb’s closing: “A renewed focus on nicotine can help us to achieve a world where cigarettes no longer addict future generations of our kids; and where adults who still need or want nicotine can get it from alternative and less harmful sources.  FDA stands ready to do its share.” Many of the commissioner’s talking points are virtually identical to the policies I have researched and advocated for two decades.  Dr. Gottlieb notes the rancor in this field, saying, “…there’s the ongoing divisive debate around the pros and cons of e-cigarettes.  Precious little progress has been made as competing camps dig in on the benefits and risks of a harm reductionist approach to this new technology.  Both sides are convinced that they’re right, but we’ve seen little progress, and virtually no common ground.”  He encouraged “…participants from all sectors in the ongoing harm reduction debate…to take a step back and work together to reach greater common ground.” I applaud Dr. Gottlieb’s leadership on this issue and offer my support in turning his vision into reality. Original author: Brad Rodu
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Huge FDA announcement on future tobacco and nicotine strategy


July 28th, 2017

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Government’s Abstinence from Smokeless Truth Detailed by Wall Street Journal


The Wall Street Journal on July 21 reported what readers of this blog already know: “Many scientists agree that…smokeless tobacco, including chewing and dipping tobacco, is significantly less harmful than cigarettes.  But rather than encouraging the country’s 37 million smokers to switch to less-risky products, U.S. health officials have so far stuck with an abstinence-only message to the public.” Journalist Jennifer Maloney underscored the government’s withholding of relative risk information about smokeless tobacco: “Online fact sheets published by the Centers for Disease Control, the Food and Drug Administration and the National Cancer Institute list multiple health risks associated with smokeless tobacco…but give no indication it is less harmful than cigarettes. ‘There is no safe form of tobacco,’ the cancer institute says on its website.” Scientific research says otherwise.  Although it is impossible to prove absolute safety, dozens of epidemiologic studies over three decades have documented that health risks among American chewers and dippers are not significantly elevated.  Last year, a government study failed to find any mouth cancer risk among men who chew or dip (here).  The CDC claims that it is unable to provide risk estimates for smokeless users (here, hereand here).  Yet researchers from Altria produced them from CDC data; these are seen in the chart above (source here).  Smokeless users’ risks were comparable to those of nonusers of tobacco, whereas smokers had twice the risk of dying. That Altria was able produce these dramatic results from CDC’s data underscores the government’s refusal to acknowledge the scientific truth about smokeless tobacco’s reduced harm profile. That is irresponsible and contrary to public health interests. Federal health officials told Maloney, “more research needs to be done on the potential population-level consequences of broadcasting the fact that some tobacco products are safer than cigarettes.”  Such facts should not be withheld from the American public.  Here is the consequence of public health officials’ persistent obfuscation and mendacity: There were 8.1 million smokeless users in 2014, according to the National Survey on Drug Use and Health (NSDUH) (here), and 41% of them were also smokers.  This means that 3.36 million Americans are equally comfortable and satisfied using nearly harmless chew or dip, and smoking, which is deadly.  Government data shows that smokers have no idea that they are needlessly putting their lives at risk (here).  Federal agency leaders are aware of the differential risks, but choose not to push that potentially life-saving information to the public.  The Wall Street Journal is to be applauded for helping to expose this transgression. Original author: Brad Rodu
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Challenging the prohibitionists – submissions to Australian parliamentary inquiry into e-cigarettes


July 21st, 2017

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United Kingdom Doubles Down on Support for Tobacco Harm Reduction


The United Kingdom Department of Health’s new position statement (here), “Towards a Smokefree Generation,” is, as Clive Bates wrote (here), “probably the first significant government policy paper anywhere that recognises and pursues the opportunities of tobacco harm reduction, rather than defining these technologies as a threat to be suppressed.  For that, the Department of Health and its allies deserve considerable credit.” Indeed. British health authorities have been telling smokers the truth about vaping since 2011 (as I have noted here, here, hereand here), and British smokers have listened – the UK’s vaping population has ballooned to 2.9 million (here), while smoking has significantly declined.  In fact, a Public Health England official recently reported (here) that the UK smoking rate is now the second lowest in the European Union, after SWEDEN! Meanwhile, the U.S. persists in advocating for a “tobacco-free society” and a “tobacco endgame,” demonizing smoke-free products with untruths and giving continuing life to urban anti-vaping myths.  The UK paper underscores this stark contrast. “Towards a Smokefree Generation” sets forth the facts about e-cigarettes’ relative safety: “… the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.” The UK Department of Health promises to help smokers make the switch: “The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products. Public Health England has produced guidance for employers and organisations looking to introduce policies around e-cigarettes and vaping in public and recommend such policies to be evidence-based.” The paper dismisses the unfounded claim that second-hand vapor is a health threat: “Public Health England recommends that e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy.” Additionally, the document invites the introduction of new tobacco harm reduction products, an apparent reference to products like Philip Morris International’s heat-not-burn iQOS: “… there has been the development and very recent introduction of novel tobacco products that claim to reduce the harm of smoking. We welcome innovation that will reduce the harms caused by smoking and will evaluate whether products such as novel tobacco products have a role to play in reducing the risk of harm to smokers.” Concluding, the UK pledges: “Public Health England will continue to provide smokers and the public with clear, evidence based and accurate information on the relative harm of nicotine, e-cigarettes, other nicotine delivery systems and smoked tobacco, to enable informed decision-making.” American health authorities, are you listening?Original author: Brad Rodu
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English tobacco control plan embraces tobacco harm reduction – world first


Positive…

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American experts call for risk-based reform of FDA regulation of tobacco and nicotine


July 14th, 2017

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The Illogic of Condoning Vaping & Condemning Smokeless – Both Are Safer for Smokers


While many American tobacco researchers and policy experts have, of late, moved to endorse reasonable regulation of e-cigarettes and vaping, most persist in condemning smokeless tobacco products, which have been proven to be nearly harmless.  It is irrational to support one and prohibit the other, when both are legitimate harm reduction options for smokers. The illogic of this dual position is displayed in the work of Dr. Dorothy Hatsukami, a prestigious tobacco researcher, author of 250 published articles (here) and recipient of tens of millions of dollars in NIH funding (available here,including $13 million to study reducing nicotine in cigarettes).  Dr. Hatsukami recently signed a letter to FDA Commissioner Scott Gottlieb (here) and published an article in Tobacco Control (here). In the letter to the commissioner, Dr. Hatsukami applauded his “openness to the concept of tobacco harm reduction…There is already a considerable body of science and experience suggesting that a harm reduction approach…could yield substantial and highly cost-effective public health benefits…at this time we do not believe that the current regulatory framework for the low-risk nicotine products such as e-cigarettes and smokeless tobacco is appropriate or will deliver the substantial public health benefits we hope and expect FDA’s oversight will bring.”  The letter encouraged the FDA to regulate tobacco products according to risk and to “support informed choice through truthful communication of risk.” However, in her Tobacco Control commentary, Dr. Hatsukami took a contrary view, fully endorsing the FDA’s proposed standard for NNN, which I have eviscerated hereand here.  She wrote, “If [FDA] puts the proposed rule into effect, it would be a significant and important step towards minimising the harms from smokeless tobacco use.”  Surprisingly, she asserted that “the risk for oral cancer is considerably higher for smokeless tobacco users,” and cited a federal study documenting that American men who dip or chew tobacco have no mouth cancer risk (here). Notably, other signatories to the Gottlieb letter are genuine tobacco harm reduction advocates who have endorsed the substitution of smoke-free tobacco by smokers.  They include Clive Bates of the UK and Canada’s David Sweanor, who filed a comment (here) labeling the NNN rule “reckless and pointless.”  American signatories who are on record about the relative safety of smokeless are Sally Satel (hereand here), Kenneth Warner (hereand here), David B. Abrams (here) and Raymond S. Niaura (here).  Original author: Brad Rodu
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Reckless and pointless at the same time – FDA proposes NNN standard for smokeless tobacco


Just looking for our submission? Here it is: Submission by Clive Bates & David Sweanor – PDF

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Drinking, Bingeing and Toking More Popular Than Smoking Among Teens in 2014


Teen smoking deservedly gets a great deal of attention from the media and public policymakers, but one government survey shows that teens consume alcohol and marijuana at far higher rates than cigarettes.The National Surveys on Drug Use and Health (NSDUH), which I discussed last week (here), provide intriguing insights into use of licit and illicit products.At left are 2014 NSDUH estimates of the numbers – and percentages by age – of Americans using cigarettes, smokeless tobacco, alcohol and marijuana in the past month. (Binge drinking is defined as consuming five or more drinks within two hours)  There were nearly 56 million smokers, 8.6 million smokeless tobacco users, 22.5 million marijuana users and a whopping 140 million drinkers.  There were actually more binge drinkers (61 million) than smokers.  The following table shows the number of teens (12-17 years) and young adults (18-20 years) who used these substances in 2014..nobr br { display: none } td { text-align: center} Numbers (millions) of Teens and Young Adults Who Were Past-Month Smokers, Smokeless Users, Drinkers, Binge Drinkers and Marijuana Users in 2014Teens (12-17 yrs)Young Adults (18-20 yrsTotalSmokers1.233.244.47Smokeless Users0.500.661.16Drinkers2.805.888.68Binge Drinkers1.533.745.27Marijuana Users1.852.774.62There were some 1.2 million past-month smokers under 18, and about half a million underage smokeless users.  These numbers pale in comparison to those for alcohol.  There were 2.8 million drinkers under 18, and another 5.9 million between 18 and 20.  There were more underage binge drinkers (1.5 million) and marijuana users (1.85 million) than smokers.  The totals for marijuana, drinking and binge drinking are all greater than smoking.Teenage smoking must be prevented, but teen abuse of alcohol and marijuana also requires attention.Original author: Brad Rodu
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U.S. Can’t Decide How Many Adults Use Smokeless – 8.1 Million or 5.1 Million?


Federal officials routinely obfuscate on the subject of smokeless tobacco, and particularly on the number of smokeless users in the U.S. The newest numbers are reported by Dr. Rachel Lipari and Mr. Struther Van Horn of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). They say, “In 2014, an estimated 8.7 million people aged 12 or older used smokeless tobacco in the past month.” (available here)  Their finding is based on data from the National Survey on Drug Use and Health (NSDUH). That number included teens (Age 12-17 years).  When including only adults (18 and older), the NSDUH estimate is 8.1 million in 2014, which contrasts with a 2015 CDC-supported National Health Interview Survey (NHIS) adults-only estimate of 5.1 million. The 59% higher NSDUH number probably results from the use of different definitions.  NSDUH collects information on past-30 day use, whereas current users in NHIS is every day or some days. The primary conclusion in the Lipari/Van Horn report is that “Smokeless tobacco is not a healthy alternative to cigarette smoking.”  This is a non sequitur, as the NSDUH survey includes no information on health.  The government inconsistency also extends to smoking numbers, as I discussed previously (here, hereand here).  The NSDUH estimate of adult U.S. smokers for 2014 was 55.8 million, about 40% higher than the NHIS estimate of 40 million for that year. It is time for federal officials to acknowledge the gross inconsistency of the government’s tobacco use estimates. In all likelihood, the higher NSDUH estimates, which reflect the fact that Americans use tobacco products more irregularly than every day or some days, are closer to reality than those based on the NHIS. Original author: Brad Rodu
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Time for the Government of Sweden to get behind snus and tobacco harm reduction

One of the more puzzling things about snus is the reluctance of Sweden’s government to claim credit for what is by any standards an extraordinary public health achievement. So here I write to the relevant ministers requesting that they acknowledge Sweden’s success, show some leadership and promote the concept of tobacco harm reduction.  The challenge to the EU prohibition of snus brought by Swedish Match and New Nicotine Alliance provides an opportunity for the Government of Sweden to change its approach.  I wrote the following heartfelt plea, attaching the letter that 18 comrades sent sent to the European Commission: Lifting the unjustified European Union ban on oral tobacco or “snus” in the light of ongoing legal action hoping it might encourage a more constructive pro-health, pro-trade, post-enlightenment approach. 

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Smoking May Harm Mental Health


Research has documented a strong link between smoking and various mental health disorders, including anxiety, depression, schizophrenia and bipolar disorder.  The CDC advises that about 20% of American adults had some form of mental illness in 2009-2011, and the smoking rate for that group was 36%, in contrast to 21% for all others (here). There is certainly an association, but there are four distinct possibilities with respect to causality: ·       Mental health problems cause people to smoke. ·       Smoking causes mental health problems. ·       Both pathways exist. ·       Neither pathway exists. My economist colleague Dr. Nantaporn Plurphanswat is the lead author of an innovative analysis that identifies a potential causal pathway for mental illness and smoking; the work appears in the American Journal of Health Behavior (abstract here).  Our co-author is University of Illinois professor Dr. Robert Kaestner.  We used data from people in almost all states participating in the federal Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2010.  BRFSS collected information on smoking and asked participants “…for how many days during the past 30 days was your mental health [which includes stress, depression, and problems with emotions] not good?” Recognizing that traditional approaches cannot identify a causal pathway between smoking and mental illness, Drs. Plurphanswat and Kaestner employed an instrumental variable approach, in which variation in smoking at the state level is strongly associated with cigarette excise taxes, but the excise taxes are completely unrelated to outcomes like mental health.  The IV analysis provides information on whether smoking leads to mental health problems, or vice versa. Our results indicate that smoking may harm mental health: it is significantly associated with 14 or more days of poor mental health.  Most of the effect due to smoking is from large increases in the number of mentally unhealthy days and not by small increases among many smokers.  The BRFSS data cannot tell us whether smoking is a form of self-medication practiced by those who suffer from specific mental health disorders.  However, our analysis confirms that smoking may contribute to anxiety, depression and emotional distress.  Thus, policies that reduce smoking may have a positive spill-over effect in improving mental health.   Original author: Brad Rodu
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A critical review of an Australian anti-vaping polemic


John Maynard Keynes: “when the facts change, I change my mind. What do you do sir?”

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Avoiding bureaucratic destruction of the US vaping market – proposals for a new approach by FDA


June 18th, 2017

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EU Snus Ban Costs More Lives


A new report from the Swedish Snus Commission underscores the accelerating human toll of the European Union’s unconscionable ban on smokeless tobacco: “…among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.”  Sweden is the only EU nation in which sales of snus are legal. In 2009, epidemiologist Phil Cole and I, analyzing data from the World Health Organization and the International Agency for Research on Cancer, reported in the Scandinavian Journal of Public Healththat 274,000 smoking-attributable deaths would be avoided if men throughout the EU had the smoking prevalence of men in Sweden (here).  Four years later, I updated that figure to 291,000 (here).        The Snus Commission report, available here, was produced by a distinguished group of Swedes.  The commission’s chairman is Anders Milton, a physician and former President and Chairman of the Swedish Medical Association, President of the Swedish Confederation of Professional Associations from 1993 to 2001, and President of the Swedish Red Cross from 2002 to 2005.  His collaborators are Christina Bellander, a journalist who previously headed business development at Swedish TV4 and was a Board Member of New Wave Group AB, Mittmedia AB and the Swedish Educational Broadcasting Company; Göran Johnsson, a former member of the Social Democratic Party’s Executive Committee, Board Member of Volvo AB and Chairman of Swedish national television broadcaster SVT from 2011 to 2014; and Karl Olov Fagerström, a WHO-recognized nicotine and tobacco researcher who has authored 150 articles in peer reviewed journals. The casualty list from the indefensible and immoral EU snus ban continues to grow. Original author: Brad Rodu
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Pariahs, predators or players? The tobacco industry and the end of smoking


June 12th, 2017

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The Swedish Miracle Continues


 A special report on tobacco and e-cigarettes published by Eurobarometer, the official polling organization of the 28-nation European Union (here), underscores the remarkable success of what researchers call “The Swedish Experience”. According to the report, the prevalence of smoking in Sweden is just 7%, with no other EU country even remotely close.  UK prevalence is 17%, while only Denmark, the Netherlands, Belgium and Ireland are below 20%.  The prevalence of daily smoking in Sweden is a bare 5%, as shown in the chart at left (credit to Lars Ramstrom from Sweden), and the prevalence of former smoking is 41%, the EU’s highest by far.  Eurobarometer provides an array of impressive statistics: “In all but one country, at least eight in ten (80%) of smokers consume tobacco products daily. The exception is Sweden, where only just over half (52%) give this response. In turn, over a fifth (21%) of smokers in Sweden are irregular smokers, consuming listed tobacco products less than monthly.  In all other countries, very few respondents give this answer.” There is only one explanation for Sweden’s remarkable number: the popularity of snus, the sales of which are prohibited in all other EU nations.  The new report reveals that 20% of Swedes use snus daily.  The only other countries with daily smokeless use are Denmark (1%), home of Oliver Twist chewing tobacco pellets, and Finland (2%). The Eurobarometer report should pressure the EU to end its snus ban.  Swedish Match has filed a complaint with the European Court of Justice to compel EU action.  For more on “the worst regulation in the EU,” see Clive Bates’ excellent commentaries, such as this (here). Original author: Brad Rodu
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Chewers and Dippers: Get the Facts on Smokeless from CASAA


Smokeless tobacco users in the U.S. are constantly under attack for their “bad habit”.  Public health officials and organizations deliberately misinform consumers about smokeless health risks, generating undue pressure to quit from friends and families. The truth about smokeless has been hard to come by. Chewers and dippers can watch my informative video interview with Mudjug’s Darcy Compton (here), or they can read or listen to my book, For Smokers Only, How Smokeless Tobacco Can Save Your Life.  Now, there’s another option: a downloadable pamphlet from Consumer Advocates for Smoke-free Alternatives Association (CASAA) titled, “Smokeless Tobacco: Separating Fact from Myth” (available here).  Save it as a pdf and print copies to share. CASAA is a non-profit organization “dedicated to ensuring the availability of reduced harm alternatives to smoking and to providing smokers and non-smokers alike with honest information about those alternatives so that they can make informed choices… We believe that consumers are best served by ensuring diversity in the marketplace and by being provided with truthful and accurate information so that they can make informed decisions regarding their health and lifestyle choices.” CASAA’s 200,000 members are active in tobacco legislation, litigation and regulation.  The group maintains an archive of thousands of testimonials from former smokers who found safer cigarette substitutes (here).  Everyone who cares about smokers, smokeless users and truthful information should become a member here. Original author: Brad Rodu
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Letter to European Commissioner for Better Regulation on the worst regulation in the EU – the snus ban

Eighteen of us have just written a detailed letter to Mr Frans Timmerman, the EU’s Commissioner for Better Regulation (amongst other things) drawing his attention to one of the worst regulations in the EU, the ban on oral tobacco, better known as snus. This ban is now facing challenge in the Court of Justice of the European Union (case C 151/17) by a producer, Swedish Match, and the consumer group, New Nicotine Alliance (see NNA background on the case).

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