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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.

In cheap publicity stunt Royal Society of Public Health sounds a fake alarm about a non-problem

Today the Royal Society of Public Health is pitching its ‘undercover investigation’ into vape shops selling stuff to adults who don’t smoke. Naturally, the primary purpose of this exercise has little to do with public health but is a publicity stunt for an ailing organisation in a declining field that offers ever less to the public or to health.

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The Human Toll of Anti-Tobacco Extremism


This is a tale of two tobacco users and the very different medical advice they received. In 2005, two physicians and a dentist published a report in the American Journal of Psychiatry(reference here): “Ms. A, a 52-year-old woman with schizoaffective disorder, bipolar type, started smoking shortly after her first psychotic episode at age 19 and, on average, smoked about 1½ packs per day for 33 years. She had attempted to quit using pharmacotherapy, nicotine gum, or patches in combination with cessation classes. Both gum and patch treatments were ineffective since they did not control her craving for cigarettes. “Her motivation to quit was strong because of the sequelae of smoking: bronchitis, isolation from others, and destabilization of her psychiatric illness from frequently awakening to smoke. Her brother with a bipolar disorder had experienced severe burns over most of his body and died secondary to a fire caused by his smoking. For her, smoking had become a constant reminder of his suffering, which led to nightmares and further isolation. She was afraid to jeopardize the health and safety of others. “One year ago, she was cross-titrated over a 1-week period to oral pouches. Since that time, she has not resumed smoking, and her psychiatric and medical symptoms have stabilized. Before her cessation of smoking, she lived an isolated existence. Now she resides with and cares for her parents. For Ms. A, ceasing to smoke was a life-changing event.”  A disabled veteran with post-traumatic stress disorder sent me this email: “My doctor has been pounding me regarding mouth cancer and me dipping. I have good oral hygiene, but she insists I will get cancer. I now find myself worrying sick every time I have a wrinkled gum, or cut from a chip....etc. “Please give me advice. “Should I be concerned and quit dipping and switch to a vape or gum??  It is about to drive my wife nuts, it seems I’m always looking at my mouth now, and the doctor has her convinced too that I’m at a 4 times more likely [to get mouth cancer] than a non dipper.  Your input to ease my mind please.  I do not have a laptop, but saw your book.  Can’t read it on the phone.  So thought I’d ask.  My grandfather, right here in Kentucky smoked Pall Mall nonfilter cigs for 65 years...he died from a bleeding stomach ulcer caused by aspirin... I NEED TRUTH AND PEACE OF MIND. So I don’t become ocd more than I am since she gave my wife all these statistics.  I’d rather hear the blunt truth. “Should I be worried? “I’m 41, dip a can in a day and half, have dipped for 17 years since I went in the Army. I have high BP...(according to them) 140/84.. “Appreciate it very much if you would kindly respond.” I asked the writer to put me in contact with his physician, so that I could provide her with factual information and resources for the benefit of all her patients. These stories are polar opposites, but equally poignant.  Doctors in 2005 successfully switched a patient with severe mental problems from cigarettes to smokeless tobacco, citing two of my studies (here and here) as the scientific basis for their humane and “life-changing” guidance.  In 2017, a misinformed physician tormented a disabled veteran about smokeless tobacco’s negligible mouth cancer risk (here).      Too many doctors cause unnecessary suffering among tobacco users and their families.  Their actions are influenced by the misguided crusade against smokeless tobacco conducted by many government agencies and prohibitionist organizations.  This harmful disinformation effort must end. Original author: Brad Rodu
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Problems Multiply for Proposed FDA Smokeless Tobacco Rule


The FDA on January 23 published a proposed smokeless tobacco (ST) regulation that would require a radical reduction in levels of N-nitrosonornicotine (NNN), a tobacco-specific nitrosamine.  I documented (here) that the rule is based on erroneous calculations of ST risks; others have since raised additional concerns. Scott Ballin, Health Policy Advisor to the University of Virginia’s Morven Dialogues, observes that the FDA ignored its statutory requirement, when setting product standards, to “invite appropriate participation though joint conferences, workshops, or other means, by informed persons representative of scientific, professional, industry, agricultural or consumer organizations who in the Secretary's judgment can make a significant contribution.” Brian Fojtik, Senior Fellow at the Reason Foundation, notes (here) that the FDA invited participation from selected stakeholders: “Within hours of publication in the [Federal] Register, a comment was filed by a coalition of interest groups collaboratively (American Academy of Pediatrics, Cancer Action Network, American Heart Association, American Lung Association, Campaign for Tobacco Free Kids and Truth Initiative) . . . a reasonable person is left wondering how six large organizations could possibly have each reviewed a highly technical, 50-page rule, reached conclusions on the rule’s specific merits and crafted a collaborative response that all agreed to sign within hours of the rule’s publication in the Register.  Even in the most forgiving of lights, the appearance is unseemly and should necessitate the withdrawal of the proposed rule.” Another major error in the FDA’s proposed rule-making process was identified by Altria in a March 3 comment submission.  The agency filed a regulatory impact analysis (here) for the rule, estimating that 30% of moist snuff products currently meet the 1 ppm dry-weight limit (Table 3, panel A).  However, FDA miscalculated the wet-weight to dry-weight conversion, invalidating the estimate.  Moist snuff is about 50% water; when it is dried, the level of any agent in the remaining tobacco will double.  The FDA did the reverse, calculating that a product with 2 ppm NNN wet-weight would have 1 ppm dry weight.  The correct conversion is 0.5 ppm wet-weight to 1.0 ppm dry weight.  Almost no moist snuff products on the U.S. market are at 0.5 ppm wet weight. Altria urged the FDA to withdraw the proposed rule because it “would fail to provide a scientifically valid formula for manufacturers to measure and maintain records of NNN levels on a dry weight basis in order to demonstrate compliance with the product standard.” Original author: Brad Rodu
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Educating Air Force Generals About Tobacco Use & Risks


The Military Health System and the Defense Health Agency last November published a grossly misleading article on their website titled, “Quit the spit: Smokeless tobacco no better than lit” (archived article here).  After I educated Air Force officials, the article was removed.  Here is the story.  The piece wrongly asserted that smokeless tobacco (ST) use is equally harmful as smoking: “…putting in a dip or a chew can cause as much harm as lighting up cigarettes... ‘A lot of the effects smoking has on the body – causing blood vessels to narrow raising blood pressure and causing several cancers – are the same for smokeless tobacco,’ said Air Force Col. Thomas Moore, a preventive medicine doctor and in charge of health promotions for the Air Force Medical Support Agency... ‘You’re really not gaining anything by giving up cigarettes just to put in a load of chew,’ said Moore.” (emphasis added) In a November 18 email I advised Colonel Moore of the article’s numerous errors: “These passages send the clear, unmistakable and completely false message to military personnel that smokeless tobacco use is just as dangerous as smoking.  Numerous scientific studies published over the past twenty years provide indisputable evidence that smokeless tobacco use is vastly safer than smoking.  For example, a 2002 report by the British Royal College of Physicians (here), one of the world’s oldest and most prestigious medical societies, stated ‘As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking, depending on the product.’ “Your just-as-dangerous message may be considered a breach of medical ethics.  A 2004 study (here) authored by a panel of international tobacco research and policy experts concluded: ‘…[smokeless] products pose a substantially lower risk to the user than do conventional cigarettes.  This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking.’ “Members of our armed forces put their lives on the line every day.  The Military Health System and the Defense Health Agency should show them respect by giving them truthful information about tobacco use.  There is a lot at stake.  In another 2007 report (here) the Royal College concluded ‘...that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.’ “I urge you to promptly retract the article or issue a substantial revision to reflect the indisputable evidence that smokeless tobacco use is vastly safer than smoking.  Please let me know if I can provide any additional information to facilitate this action.  I appreciate your prompt response to my request.” In the absence of a response, I sent a similar email to U.S. Air Force Surgeon General Mark Ediger.  This generated a reply from Major General Roosevelt Allen, Jr., Director of Medical Operations & Research in the Office of the Surgeon General.  He wrote that I was “correct in stating that current scientific evidence clearly delineates different levels of health risk associated with the various forms of tobacco use,” and he promised “to see if it is possible to post a clarification of the article on the Health.mil site.” At General Allen’s request, I supplied a portfolio of published medical articles on ST and tobacco harm reduction.  Sometime in February, the offending article was removed from the military website.  It is evident that senior Air Force health officials recognized that the Defense Health Agency’s article was indefensible, given the vast difference in risks involved in smoking and ST use.  I am hopeful that this awareness will translate into a rational tobacco policy at the Department of Defense and beyond. Original author: Brad Rodu
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Department of Defense Anti-Smokeless Campaign Is “50” Shades Darker


February is a popular month for tobacco prohibitionists to attack smokeless tobacco (ST).  A year ago, this blog refuted seven false claims (here) from county health departments.  This year, the U.S. Department of Defense (DOD) escalated the attack. Thanks to David Sweanor of the University of Ottawa Centre for Health Law, Policy & Ethics, we became aware of an outrageous DOD website called UCanQuit.  Sweanor, who has a long history of fighting cigarette company malfeasance, coauthored a commentary last month labeling an FDA ST misinformation campaign unethical (here).  The DOD site prompts users to engage in chat sessions to obtain quitting advice.  The apparently scripted responses from human agents are filled with false information, such as these from Sweanor’s session:“Chewers are 50 times more likely than nonusers to get cancer of the cheek, gums, and inner surface of the lips… long-term users have a 50% greater risk of developing oral cancers than non-users.”A “50 times” risk is a boldface lie (here), as the proven risk is nearly nil (here).  While the American Cancer Society in 2010 told the Wall Street Journal that it would no longer use the 50 number (here), DOD perpetuates that falsehood, even as it makes a contradictory misstatement about a 50% increased risk. DOD chats are numbingly focused on ST nicotine levels.  In Sweanor’s 12-minute session, the subject came up 16 times: “[ST users] are hooked on nicotine, a highly addictive drug…[ST] products deliver substantial doses of nicotine along with powerful cancer-causing chemicals… nicotine from [ST] is absorbed through the mouth…nicotine obtained from smokeless tobacco is comparable to that of cigarettes… One can of snuff gives you as much nicotine as 60 cigarettes. Nicotine gives you the ‘buzz’ but is highly addictive… [ST] contains MORE nicotine than cigarettes! Using snuff or chewing tobacco may give you three to four times as much nicotine as from smoking a cigarette. And the nicotine stays in the bloodstream longer. Use two cans a week and you'll get the same amount of nicotine as smoking a pack and a half a day…” When Sweanor inquired, “any difference in relative risks? Is using snus safer than smoking cigarettes for someone addicted to nicotine?”, the response was only more of the same: “one can of snuff gives you as much nicotine as 60 cigarettes…Smokeless tobacco contains MORE nicotine than cigarettes! Using snuff or chewing tobacco may give you three to four times as much nicotine as from smoking a cigarette. And the nicotine stays in the bloodstream longer. Use two cans a week and you'll get the same amount of nicotine as smoking a pack and a half a day.” Other experts subsequently visited the DOD site to engage in chats, with similar results.  My 12-minute session yielded 14 nicotine mentions, plus one particularly bizarre exchange. This list appeared suddenly and without context: “1. Cadmium: used in car batteries 2. Formaldehyde: embalming fluid 3. Lead: a poison 4. Nicotine: an addictive drug 5. N-Nitrosamines: cancer-causing chemical 6. Polonium 210: nuclear waste 7. Acetaldehyde: irritant 8. Hydrazine: toxic chemical 9. Benzopyrene: cancer-causing chemical 10. Uranium 235: used in nuclear weapons 11. Sodium: salt, can cause high blood pressure 12. Sugar: can cause cavities 13. Fiberglass and Sand: abrasive” The implication was that these are deadly constituents of ST.  I have previously noted that such lists are meaningless, as everything we consume contains trace amounts of contaminants (here).  Chew and dip are no exceptions, but the contaminants at trace levels pose zero risks (here). Because tobacco prohibitionists often imply that such trace contaminants are added to ST, I asked my chat correspondent: “I don't understand the answer starting with cadmium. Do you mean that those things are added to dip and chew?”Chat operator:  “Yes they are.”I asked: “How do dip and chew makers get access to uranium?” Chat operator: “I have no idea.”Finally, an honest answer.  DOD has gone to the dark side with their taxpayer-funded, unfactual, anti-smokeless website. It should be taken down. Original author: Brad Rodu
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E-Cigarette Toxic Chemical Exposure Is Same as for Nonsmokers


The new finding from British and U.S. e-cigarette researchers understated the good news for vapers. “Long-term NRT-only and e-cigarette-only use…is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes,” reported scientists at the University College London; King's College, London; the Roswell Park Cancer Institute in Buffalo, New York; and the U.S. Centers for Disease Control and Prevention (CDC). Their work, with Lion Shahab as lead author, appeared in the Annals of Internal Medicine last month (abstract here).  “The observed carcinogens and toxins” were a group of volatile organic compounds (VOCs), including acrolein, acrylamide, acrylonitrile, butadiene and a combination of ethylene oxide, acrylonitrile and vinyl chloride.  The researchers actually measured metabolites – products formed when the body breaks down the VOCs – in the urine.The finding is good news for vapers, who avoid the thousands of toxins in smoke.  But the study and associated media coverage gave the impression that e-cigarette use also resulted in excess exposure to the VOCs.  That may not be true.People are exposed every day to these VOCs, in the air and in our food and drinks.  Research published by K. Udeni Alwis et al. in 2012 (abstract here) showed that nonsmokers have measurable levels of these chemicals.    Here are compared results from the Shahab and Alwis studies.  The former did not report absolute levels of the VOC metabolites; rather, it designated smokers as the referent group, and reported levels in vapers as a percentage of levels in smokers.  The Alwis study reported actual levels in smokers and nonsmokers, allowing me to calculate the percentages.       .nobr br { display: none } td { text-align: center} Percentage Exposures to VOCs in Vapers (Shahab) and NonSmokers (Alwis), Compared to SmokersVOCPercentage in VapersPercentage in NonSmokersAcrolein33%26%Acrylamide43%42%Acrylonitrile2.9%2.5%Butadiene11%18%Combination*44%35%*ethylene oxide, acrylonitrile and vinyl chlorideThe table shows that VOC exposures in vapers were similar to exposures in nonsmokers.  For example, in the Shahab study, vapers’ exposure to acrylamide was 43% of the exposure among smokers, whereas nonsmokers’ exposure was 42% of smokers in the Alwis study.The authors of the Shahab report, particularly Dr. Alwis (who is at the CDC), should have made the connection between the results of the two studies.  The fact that vapers’ VOC exposures are similar to those of nonsmokers is headline-worthy.Original author: Brad Rodu
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Challenging the proposed e-cigarette prohibition in Taiwan

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March 4th, 2017

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Heavy Snus Use: Possible Link to Type 2 Diabetes


A Swedish research study finds that heavy consumption of snus is associated with type 2 diabetes (abstract here).  Analyzing data from six groups of Swedish men, researchers found no risk of type 2 diabetes in all snus users combined, but they reported a modest elevated risk with higher levels of consumption, at 5-6 cans per week (Relative risk, RR = 1.42, 95% Confidence Interval, CI = 1.07 – 1.87) or 7+ cans per week (RR = 1.68, CI = 1.17 – 2.41).In a Karolinska Institute press release (here), lead research author Sofia Carlsson said, “We can confirm earlier suspicions that snus-users have a higher risk of type 2 diabetes.”  In fact, the new study confirmed only one “earlier suspicion”, as Carlsson’s is only the second study to show an association at higher consumption levels.  Here are the results from the four studies that have been published to date: .nobr br { display: none } td { text-align: center}Studies of Snus Use and Type 2 Diabetes in SwedenAuthor, Year, Snus UsersRelative Risk (95% CI)Eliasson et al., 2004Current snus users (prevalent diabetes)1.06 (0.43 – 2.64)Current snus users (follow-up diabetes)No casesӦstenson et al., 2012Current snus users1.1 (0.6 – 2.0)1-5 cans per week0.6 (0.2 – 1.4)6+ cans per week3.3 (1.4 – 8.1)Rasouli et al., 2017A. Current snus users0.96 (0.67 – 1.37)A. Ever snus usersLess than 5 boxes per week0.78 (0.56 – 1.09)5+ boxes per week0.95 (0.57 – 1.58)B. Ever snus users0.91 (0.75 – 1.10)Less than 3 boxes per week0.88 (0.72 – 1.08)3 + boxes per week0.92 (0.46 – 1.83)Carlsson et al., 2017Current snus users1.15 (1.00 – 1.32)1-2 boxes per week1.14 (0.86 – 1.50)3-4 boxes per week1.03 (0.82 – 1.29)5-6 boxes per week1.42 (1.07 – 1.87)7+ boxes per week1.68 (1.17 – 2.41)A.    Swedish snus usersB.    Norwegian snus users    Significantly elevated RRsWhile those two studies suggest that high snus consumption is associated with type 2 diabetes, more research is needed to confirm a link. Many other factors are known to contribute to this type of diabetes (here), including age, overweight or obesity, inactive lifestyle, smoking (here), family history, high blood pressure and high blood cholesterol levels.  Research and analysis must fully account for these factors in order to confirm or refute a snus link.Original author: Brad Rodu
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Are e-liquid flavours really ‘hooking another generation of kids’?

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Attraction to vaping? Or attraction from smoking? Or just a consumer preference?

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Nicotine, Smokeless Tobacco & Tourette Syndrome


A man with Tourette Syndrome, a nerve disorder developing in childhood and involving muscle tics (repetitive involuntary movement) and voice problems (here), recently posted online his experience with smokeless tobacco.  Diagnosed at age six, he was treated unsuccessfully with numerous drugs.  At ten, he experimented with dipping and discovered that it controlled his symptoms.  His doctor “was not happy that i was dipping but he under stood [sic] and told me the reason for that [alleviation of symptoms] was the nicotine…”  The doctor prescribed nicotine lozenges, which worked.  Later, the man resumed dipping. Youth initiation of tobacco use is wrong, but this individual’s experience is worth noting.  Tourette is a challenging and frustrating disorder for which medicines are not always effective. A search of the medical and scientific literature reveals that nicotine has been used with mixed results to treat the symptoms of Tourette, mainly as a supplement to other medicines (here, here, here, here, here, and here ).  Researchers have primarily tested nicotine gum and patches, which deliver very low, non-addictive doses.  These medicines have been shown to be less than ideal quit-smoking aids (here); perhaps their low nicotine levels limited their effectiveness with Tourette as well.  Moist snuff, in contrast, delivers a higher dose of nicotine for several hours, which may account for the symptom relief in the case described above.    There is growing evidence that tobacco and nicotine may play a role in preventing and/or managing nerve disorders such as Parkinson’s disease, multiple sclerosis and Alzheimer’s disease (here).  Unfortunately, nicotine and smoke-free tobacco have been so demonized by prohibitionists that researchers are reluctant to fully investigate the benefits of these products.Original author: Brad Rodu
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Hold the Mayo

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Once again the Mayo Clinic indulges in unethical and misleading risk communications in the form of a new article on e-cigarettes,  promoting fear and confusion and dissuading smokers from trying them.

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Australian medicines regulator intends to continue to protect the cigarette trade – we challenge its bizarre reasoning

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Solid as a rock?  The TGA justification for banning e-liquids certainly isn’t

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Complicated Models Can’t Alter the Data - Part 2: Youth Smoking Is Way Down


As reported here last week, University of California San Francisco researchers Lauren Dutra and Stanton Glantz tortured data from the National Youth Tobacco Survey (NYTS) to support a purported “lack of a demonstrable acceleration in the long-term rate of decline” in youth smoking after 2009.  This was despite the fact the survey data showed that smoking among high school students declined from almost 16% in 2011 to 9% in 2014 – a reduction of 43% in just three years (here).  The “untortured” NYTS findings can be confirmed by charting data from another federal survey: the National Survey on Drug Use and Health (NSDUH), which I have used for smoking research for many years (discussed here). Once again, I used 2010 as the anchor year for equal intervals before widespread e-cigarette use (2006-2010) and after (2010-2014, the latest year for public access of NSDUH data).  I tallied smoking rates among boys and girls age 14-18 years, which is comparable to high school students in the NYTS.  The definition of a current smoker is also the same in the two surveys: anyone who smoked on at least one day in the past 30. The accompanying chart clearly illustrates that smoking declined among boys (-13%) and girls (-20%) from 2006 to 2010.  However, during the next four years, the rate of decline doubled – to   -31% for boys and -41% for girls. Findings from both federal surveys are consistent: The decline in smoking among high school students accelerated as demonstrably safer (here) e-cigarette use increases.  Original author: Brad Rodu
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Complicated Models Can’t Alter the Data: Smoking Among Youth and Young Adults Is Way Down


Smoking among high school students declined from almost 16% in 2011 to 9% in 2014 – a reduction of 43% in just three years.  That is according to data from the National Youth Tobacco Survey (NYTS) that I recently published (here).  Now two researchers at the University of California San Francisco, Lauren Dutra and Stanton Glantz, torture the NYTS data to support a perceived “lack of a demonstrable acceleration in the long-term rate of decline” in youth smoking after 2009.  Dutra and Glantz analyzed smoking among children from 2004 to 2014.  They used a complicated model to determine the rate of decline from 2004 to 2009, then compared that to the 2011-2014 rate, when e-cigarette use was increasing among youths.  The UCSF publicity statement on their work (here) states: “E-cigarettes …are actually attracting a new population of adolescents who might not otherwise have smoked tobacco products…”  Professor Glantz is quoted: “E-cigarettes are encouraging, not discouraging, youth to smoke and to consume nicotine, and are expanding the tobacco market.”  This resulted in headlines such as “Vaping encouraging youth to smoke” (here) and “E-cigarettes are creating a brand new generation of cigarette smokers” (here). If Dutra-Glantz’s claims are true, we should see evidence of the “new generation” in the young adult population, particularly in current smoking rates among 18- to19-year-olds.  I used the CDC’s annual National Health Interview Survey to analyze two five-year periods: first, when e-cig use was minimal to nonexistent (2005-10), and then when e-cigs were in wide and growing use (2010-15).  I used the standard definition of current smokers: those who had smoked at least 100 cigarettes in their lifetime and smoke every day or some days. The accompanying chart clearly illustrates that smoking declined among 18- to 19-year-olds during the first five years.  However, from 2010 to 2015 the rate dropped by over half among 18-19 year-old males, and by nearly two-thirds among females. One fact is crystal clear: The decline of smoking in young adults is accelerating. Original author: Brad Rodu
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Vaping and tobacco harm reduction in Ireland – consultation response in five quotes

The report is out for public consultation until the 3rd February 2017.  The consultation page allows for a free-form response.  You can put in whatever information you think will assist the review team.   Here is my response, framed around five quotes from the Royal College of Physicians:

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Experts to FDA: End the Smokeless Tobacco Misinformation Campaign


Two internationally renowned tobacco policy experts are urging “the FDA and like campaigns and health information websites” to “follow established ethical principles and accepted communication methods to inform the public of less-harmful tobacco/nicotine products as well as the greater harms of smoking.” Lynn Kozlowski, professor at the University of Buffalo School of Public Health and Health Professions, and David Sweanor, adjunct professor of law at the University of Ottawa, published their commentary online in Addictive Behaviors (open access, here).  Their focus is a $36 million FDA campaign against smokeless tobacco “that fails to directly warn about the much greater harms from smoked tobacco (predominantly cigarettes).”  Shortly after the campaign’s launch in April 2016, I produced a detailed analysis showing that it was based “on population cancer estimates derived from unreliable and inappropriate relative risks” (here).  I insisted that “the FDA should publish an honest estimate of the risks and consequences of smoking and smokeless use, and issue public messages that inform rather than mislead.  The current campaign wastes taxpayer resources, obfuscates the truth about smokeless tobacco and, ultimately, denies smokers information that could save their lives.” Kozlowski and Sweanor echo my criticism of the FDA’s war on smokeless, noting that “consumers and potential consumers have a fundamental right (based on the principles of autonomy, health communication, and health literacy) to be well aware of the dramatic differential harms from the various products they are already or might consider using (reference here).”  Consumers don’t have that information, and the authors blame “…health authorities [that] have failed to provide accurate differential risk information on tobacco products” for decades.  They highlight misinformation from the Mayo Clinic, which I have criticized for 12 years (here), and former U.S. Surgeon General Richard Carmona’s congressional testimony of  2003, which, as I noted at the time (here), ignored decades of published research and the findings of Britain’s esteemed Royal College of Physicians. Kozlowski and Sweanor offer clear policy prescriptions: “The public and especially users of multiple tobacco/nicotine products need to be provided accurate and actionable information on major differential tobacco/nicotine product risk. “This recommendation applies equally to youth who are using prohibited products and adults who are using legal products. “Deception or evasion about major differences in product risks is not supported by public health ethics, health communication or consumer practices. “Public health agencies have an obligation to correct the current dramatic level of consumer misinformation on relative risks that they have fostered.” The Kozlowski/Sweanor commentary mirrors my 23-year science-based argument that government and other health authorities must stop lying about vastly safer tobacco products.  “Health-focused agencies,” they write, “need to regain some credibility in communicating about tobacco/nicotine product risks and work to place it responsibly in the context of comprehensive public health activities.” Original author: Brad Rodu
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Reshaping American tobacco policy: eight proposals for the Trump administration

Welcome to a new report written by me, Clive Bates, with David Sweanor of Ottawa University, and Eli Lehrer, President of the R Street Institute. The fully designed report is available at R Street with press notice.

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Federal Studies: ZERO Mouth Cancer Deaths Among Men Who Dip or Chew Tobacco


The U.S. Food & Drug Administration (FDA) on January 23, 2017 published a proposed smokeless tobacco (ST) regulation (here) that is based on erroneous calculations of ST risks. The agency would require a radical reduction in N-nitrosonornicotine (NNN), a tobacco-specific nitrosamine, in smokeless tobacco (ST) products.  Most American ST products today have very low NNN levels: about 2-10 millionths of a gram per gram of product – that is, 2-10 parts per million (ppm), while a limited number of products contain 10-15 ppm (here).  The FDA proposes to limit the NNN level in ST products to one ppm or lower.  As is typical with FDA action on ST (here and here), this proposal is based on obscure calculations and flawed assumptions and interpretation.  Here is a summary of the FDA logic: Compared with never users, ST users have an excess risk of mouth and throat cancer (Relative risk, RR = 2.16). ST use causes 276 deaths from mouth and throat cancer in the U.S. each year (this number was rounded to 300 in the proposed rule) – 268 men and 8 women. ST products contain NNN, a human carcinogen that causes mouth and throat cancer. Reducing NNN levels to no more than 1 ppm will reduce the number of deaths by about 115 per year.While the latter two statements are by no means scientific certainties, in this post I will focus on the demonstrably inaccurate first assertion, which is the flawed basis for the FDA’s calculation of “300” deaths due to ST use. The FDA’s use of an RR of 2.16 is in error. The figure, based on a 2008 report (abstract here), combines radically different RRs for men and women.  In 2002, I documented (here) that men, who generally use moist snuff (also called dip) or chew, do not have significantly elevated risk for mouth and throat cancer (RR ~ 1).  In contrast, women, who primarily use powdered dry snuff, have significantly elevated risk (RR ~ 4-6).  My research is in general agreement with risk estimates published last year by the National Institute of Environmental Health Sciences’ Annah Wyss and colleagues at the National Cancer Institute and over a dozen universities and health centers in the U.S. and beyond (abstract here).  They determined odds ratios (ORs, interpreted the same as RRs) among snuff and chew users for head and neck cancer – which includes voicebox cancer in addition to mouth and throat, but the risk estimates are applicable.  The combined OR among snuff users, men and women combined, was 3.0, which is similar to the FDA estimate.  However, the OR among men was 0.86, while the OR among women was 8.89.  The ORs for chewing tobacco were not significantly elevated for men or women.  I will use the Wyss ORs to show how the application of risks specific to men and women change the FDA estimates.  First, the following table (adapted from Table 5 in the FDA’s proposed rule) summarizes the data the FDA used (ST prevalence, RRs and total numbers of deaths from mouth-throat cancer in the U.S.) and the agency’s estimates for deaths attributable to ST (last column).  The FDA erred in applying a single RR (2.16) for men and women when, in fact the RR is 0.86 for men and 8.89 for women. .nobr br { display: none } td { text-align: center} Table 1. FDA Estimate of Annual Deaths from Mouth and Throat Cancer Attributable to Smokeless Tobacco (ST), Men and Women in the U.S.Prevalence of ST Use (%)Relative RiskAll Mouth/Throat Cancer DeathsPercentage Attributable to STNumber Attributable to STMenAge 35-64 years4.62.162,7705.1140Age 65+ years3.92.162,9974.3128WomenAge 35-64 years0.22.168320.32Age 65+ years0.32.161,6990.36All8,298276 In the next table I illustrate how the death estimates change if the specific ORs for men (0.86) and women (8.89) from the Wyss study are used.  .nobr br { display: none } td { text-align: center} Table 2. Revised Estimate of Annual Deaths from Mouth and Throat Cancer Attributable to Snuff Use, Men and Women in the U.S.Prevalence of ST Use (%)Relative RiskAll Mouth/Throat Cancer DeathsPercentage Attributable to STNumber Attributable to STMenAge 35-64 years4.60.862,77000Age 65+ years3.90.862,99700WomenAge 35-64 years0.28.898321.5613Age 65+ years0.38.891,6992.3139All8,29852As noted earlier, my revised estimates are specific to snuff use – powdered dry snuff for women and moist snuff for men.  However, the risks for chewing tobacco in the Wyss study are not significantly elevated for men or women, so that product would add zero deaths.  In summary, the FDA failed to use RRs specific to men and women, resulting in overestimation of cancer deaths in the former and underestimation in the latter.  Using the same FDA formula and assigning the proper risks, I estimate that 52 women using powdered dry snuff die each year from mouth-throat cancer, but the number of deaths among men who use dip or chew is zero.  The proposed regulation is therefore unjustified for dip and chew products. Original author: Brad Rodu
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New WHO/NCI Report Falsely Conflates Smoking & Tobacco


The World Health Organization and the U.S. National Cancer Institute recently published a 700-page report on the economic consequences of smoking, tobacco use, or both (here).  The dozens of tobacco experts who contributed failed to distinguish between tobacco and smoke.  This is especially disappointing, since one of the two editors, University of Illinois at Chicago professor Frank Chaloupka, previously acknowledged the difference (here). The report’s summary conclusions, which are mainly about smoking and not tobacco, follow, with smoke highlighted in red and tobacco highlighted in green.1.  There are about 1.1 billion smokers in the world, and about 4 in 5 smokers live in low- and middle-income countries. Nearly two-thirds of the world’s smokerslive in 13 countries.2.  Substantial progress has been made in reducing tobacco smoking in most regions, especially in high-income countries. Overall smoking prevalence is decreasing at the global level, but the total number of smokersworldwide is still not declining, largely due to population growth. Unless stronger action is taken, it is unlikely the world will reach the WHO Member States’ 30% global reduction target by 2025.3.  Globally, more than 80% of the world’s smokers are men.  Differences in prevalence between male and female smokers are particularly high in the South-East Asia and Western Pacific Regions and in low- and middle-income countries.4.  Globalization and population migration are contributing to a changing tobacco landscape, and non-traditional products are beginning to emerge within regions and populations where their use had not previously been a concern.5.  An estimated 25 million youth currently smoke cigarettes.  Although cigarette smoking rates are higher among boys than girls, the difference in smoking rates between boys and girls is narrower than that between men and women. Smoking rates among girls approach or even surpass rates among women in all world regions.6.  Worldwide, an estimated 13 million youth and 346 million adults use smokeless tobacco products.  The large majority of smokeless tobacco users live in the WHO South-East Asia Region.  Smokeless tobacco use may be undercounted globally due to scarcity of data.7.  Secondhand smoke exposure remains a major problem. In most countries, an estimated 15%–50% of the population is exposed to secondhand smoke; in some countries secondhand smokeexposure affects as much as 70% of the population.8.  Annually, around 6 million people die from diseases caused by tobacco use, including about 600,000 from secondhand smokeexposure. The burden of disease from tobacco is increasingly concentrated in low- and middle-income countries.In the last item, the substitution of tobacco for smoke is obvious.  In fact, most of the report is distorted by this bogus substitution.   The sham synonym tactic reflects the anti-tobacco posture of the report’s sponsors, NCI and WHO.  Officials at those organizations supplied two prefaces, totaling 2,700 words. “Tobacco” appears 128 times, while “smoke” is used only 14 times.Decades of scientific studies document that tobacco is not synonymous with smoke (here and here).  The deliberate conflation of terms by anti-tobacco forces would not be tolerated in any other serious scientific or medical debate.  Original author: Brad Rodu
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CDC Omitted Important Findings in Report on 2015 National Youth Tobacco Survey


The U.S. Centers for Disease Control and Prevention released selected information from the 2015 National Youth Tobacco Survey in April 2016 (here).  The agency cherry-picked numbers from previous surveys to portray e-cigarettes as a threat to teens, while ignoring sharp declines in teen smoking (here, here and here).Last month, the CDC released the underlying 2015 NYTS data, ending an eight-month embargo that prevented analysis by independent investigators.  The agency traditionally reports current smoking and vaping numbers separately, ignoring dual use and wrongly suggesting that the numbers are independent.  In contrast, here I report exclusive users of these products as well as dual users.  I also add important findings that the CDC omitted.The chart shows current use (that is, on one or more days in the past 30) of cigarettes and e-cigarettes among middle and high school students over the four-year period.  The CDC emphasized the large increase in e-cig use from 2011 to 2015.  As I noted earlier (here), the large spike from 2013 to 2014 was likely due to a change in the NYTS questions.  It is clear that the increase slowed during the last year, but prevalence of exclusive e-cig use among high schoolers still  increased from 8.2 to 10.6%; dual use declined marginally from 5.2 to 5.0%.  The prevalence of exclusive smoking among high school students was flat at 4.0%.  Given that the CDC has relentlessly asserted that e-cigarettes are a gateway to smoking, it is unsurprising that the agency did not publicize responses to two questions in the 2015 survey that focused on which products students used first.  I report here for the first time how high school students answered these questions, comparing two groups of current smokers: those who only smoked cigarettes and dual users of cigarettes and e-cigs.The question, “Which of the following tobacco products did you try first?” produced these results:.nobr br { display: none } td { text-align: center} Table 1. Percentage of High School Current Exclusive Smokers and Dual Users Who Tried Various Tobacco Products First, NYTS 2015ProductExclusive SmokersDual UsersCigarettes60.2%66.8%Cigars11.36.0E-cigarettes6.58.7Smokeless tobacco9.17.6Hookah4.56.7Other products1.12.6Not sure2.91.3Never tried any product4.40.3All100%100%Percentages in bold: Exclusive smokers significantly different than dual users. The table shows that there were no significant differences between exclusive smokers and dual users in the product first used.  Most had tried cigarettes first (60% and 67% respectively); the rest had chosen cigars, smokeless, e-cigs and other products.  There is little evidence here for the CDC’s claim that e-cigarettes are a gateway to smoking.A question about initiation further exposed the relationship between cigarette and e-cigarette use.  Here is how current exclusive smokers and current dual users responded:.nobr br { display: none } td { text-align: center} Table 2. Relationship of Cigarette and E-Cigarette Use Among High School Current Exclusive Smokers and Dual Users, NYTS 2015ResponseExclusive SmokersDual UsersNever tried cigs or e-cigs16.4%1.8%Only tried cigs19.82.7Only tried e-cigs0.51.9Tried cigs before ever tried e-cigs48.777.2Tried e-cigs before ever tried cigs 14.616.4All100%100%Percentages in bold: Exclusive smokers significantly different than dual users. This table shows that large majorities of high school current exclusive smokers and dual users started with cigarettes.  Only 15-16% of these students are even eligible to be considered gateway cases, in which users moved from vaping to smoking.There are troubling inconsistencies in these tables.  For example, 16% of current exclusive smokers – who only used cigarettes in the past 30 days – responded that they never tried cigarettes (Table 2).  Four percent of exclusive smokers responded that they had never used any tobacco product (Table 1). The “Y” in NYTS stands for youth, and responses from these surveys are known to be inconsistent.  In working with the data, if one eliminates participants who gave inconsistent responses, there would be considerably fewer valid participants.  I discussed this problem in 2015 (here), when I called on the CDC to “issue a comprehensive report on the internal consistency and relative validity of the NYTS data.” The agency appears to have ignored that issue.Original author: Brad Rodu
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