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San Francisco is the stupidest place in the world to think of the children

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by Carl V Phillips

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Response to Press Release Announcing Proposed Ban on Electronic Cigarettes in San Francisco

Here is my point-by-point response to several of the statements made in the press release issued by City Attorney Herrera announcing the introduction of legislation to ban the sale of all electronic cigarettes in the city of San Francisco: "City Attorney Dennis Herrera and Supervisor Shamann Walton today announced joint steps to curb the epidemic of youth e-cigarette use, which has erased more than a decade’s worth of progress in reducing youth tobacco consumption."The “epidemic” of youth e-cigarette use has not “erased” progress in reducing youth tobacco consumption. The gains in reducing youth smoking prevalence are very real and will translate into millions of lives saved down the road. The problem of vaping has nothing to do with tobacco use because e-liquids do not contain any tobacco. Youth who vape are not tobacco users. They are vapers. So youth e-cigarette use has not undermined gains in reducing smoking. It is a separate problem that, while serious, is far less of a hazard to the public’s health than the epidemic of youth smoking."San Francisco has never been afraid to lead,” Herrera said, “and we’re certainly not afraid to do so when the health and lives of our children are at stake."San Francisco is apparently afraid to lead because they are willing to take the politically expedient step of requiring safety testing for e-cigarettes, but they are not willing to place the same requirement on real cigarettes. In fact, tobacco cigarettes have already had their safety testing and they failed miserably. If San Francisco wants to lead, then why isn’t it taking cigarettes off the shelves?"Banning vaping products that target young people and push them towards addiction to nicotine and tobacco is the only way to ensure the safety of our youth."  Let’s stipulate that. But if that’s true, then certainly banning tobacco products (i.e., cigarettes and smokeless tobacco) that target young people and push them towards addiction to nicotine and tobacco is also the “only” way to ensure the safety of our youth."San Francisco, along with the City of Chicago and the City of New York, sent a letter to the FDA this morning demanding that the FDA do its job and immediately conduct the required public health review of e-cigarettes that, by law, was supposed to happen before these products were on the market." The law does not require the FDA to conduct a public health review of e-cigarettes. What it requires is that manufacturers who want their products to remain on the market must submit a pre-market tobacco application to the agency for approval. This review was not supposed to happen before the products were on the market. They were already on the market in 2014 when the FDA issued its regulations. The FDA delayed the deadline for these applications because not doing so would have resulted in the elimination of vaping products, forcing millions of ex-smokers back to smoking and removing a huge competitor to cigarettes. It would have been a huge gift for cigarette companies. So it’s a good thing that the FDA did not enforce its original August 2016 deadline."In coordination with the City Attorney’s Office, Supervisor Walton is introducing groundbreaking legislation at the Board of Supervisors today that would prohibit the sale in San Francisco of any e-cigarette that has not undergone FDA review." This is not ground-breaking. What would have been ground-breaking is if the city introduced legislation to ban all tobacco products that have not been reviewed by the FDA and found to be reasonably safe. Surely, cigarettes would have been on this list."This is not an outright ban on e-cigarettes. It’s a prohibition against any e-cigarettes that haven’t been reviewed by the FDA to confirm that they are appropriate for the protection of public health."It is essentially an outright ban on e-cigarettes because the city knows full well that there isn’t a single e-cigarette that has gone through the pre-market approval process (since that deadline was extended until 2021). But the more important question is why the Board of Supervisors believe that e-cigarettes should only be sold if they are shown to be appropriate for the public health, while they are allowing cigarettes to be sold even though we know for certain that they are not “appropriate for the public’s health.”"The FDA has simply failed to do its job in unprecedented fashion,” Herrera said. “These are prudent steps to ensure that we know the health and safety implications of products being sold here. If the FDA hasn’t reviewed it, it shouldn’t be on store shelves in San Francisco." If they really mean what they say, then certainly, cigarettes should be on store shelves in San Francisco. You can’t take as a serious public health effort a proposal that e-cigarettes should be taken off of store shelves in San Francisco because we’re not certain of their health implications, yet it’s perfectly fine to let cigarettes remain on store shelves in San Francisco despite the fact that they have dismally failed their “safety review.” There is simply no public health justification for banning e-cigarettes but not real cigarettes."Tobacco use is the leading cause of preventable disease and death in the United States. Tobacco kills more than 480,000 people a year in this country. That’s more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined." Exactly! Yet vaping products are not responsible for a single one of those 480,000 deaths. And so the city of San Francisco’s response to 480,000 deaths from cigarettes is: Let’s ban the fake cigarettes and let the real ones, which are causing 480,000 deaths a year, to stay on the shelves."These companies may hide behind the veneer of harm reduction, but let’s be clear: their product is addiction." Veneer of harm reduction? There is overwhelming evidence that vaping is much safer than smoking. It is convenient to ignore this scientific evidence because it doesn’t make for as good of a story. But public health needs to be guided by science and evidence, not by political expediency.Original author: Michael Siegel
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San Francisco Considering Banning Electronic Cigarettes, But Letting Deadly Real Cigarettes Stay on the Shelves

Yesterday, San Francisco City Attorney Dennis Herrera and Supervisor Shamann Walton announced that they are introducing an ordinance to the Board of Supervisors that would ban all electronic cigarettes until they are officially reviewed and approved by the Food and Drug Administration (FDA). Since there is not a single e-cigarette on the market that has undergone such an approval process, the ordinance does indeed ban the sale of all electronic cigarettes in the city of San Francisco.The reasoning behind the proposal is as follows: "Today we are taking action to protect our kids. By law, before a new tobacco product goes to market, the Food and Drug Administration is supposed to conduct a review to evaluate its impact on public health. Inexplicably, the FDA has failed to do its job when it comes to e-cigarettes. Until the FDA does so, San Francisco has to step up. These products should not be on our shelves until the FDA has reviewed the threat they pose to public health."The Rest of the StoryThis has to be one of the most insane public health proposals I have ever seen. This legislation basically says: "We care so much about the health of our kids that we can't allow e-cigarettes to remain on the market until they have a complete safety review. However, we are perfectly happy allowing cigarettes--which have had extensive safety reviews and been found to be killing hundreds of thousands of Americans each year--to remain on the market. Let us be honest. We care enough about our kids to take the politically expedient step of making it look like we are truly protecting their health by banning e-cigarettes, but we don't care about our kids so much that we want to actually protect them by removing from the market a product that we know is going to kill half of those kids who become addicted to it."This is truly a political maneuver under the guise of a desire to protect children's health. Let's be clear. If the Board of Supervisors were sincerely committed to protecting kids, they would immediately remove cigarettes--the most deadly consumer product--from the market. Cigarettes are addicting and eventually killing more than 400,000 Americans each year. Yet you mean to tell me that in light of that, the Board of Supervisors wants to conduct a safety review for the fake cigarettes?And what's the point of such a safety review? We already have a safety review of cigarettes and know that they are deadly. And in light of that, the San Francisco Board of Supervisors nevertheless feels perfectly comfortable allowing those products to be sold. Do they think that electronic cigarettes are actually more hazardous than cigarettes? Of course not. They know full well that e-cigarettes are far safer than the real ones.Clearly, the reason why they want to ban the fake cigarettes but not the real ones is because they don't have the political courage to take the step that would most substantially protect the public's health. This is an easy opportunity to make it look like they are totally committed to protecting kids when in fact, they are apparently perfectly content to allow the most dangerous consumer product in history to be sold on retail shelves in gas stations, convenience stores, and other places that are easily accessible to kids throughout the city.This is an easy political victory because they know the vaping industry is not organized or centralized enough to fight it successfully. But if they are justified in banning e-cigarettes, then it is certainly imperative upon them - and actually much more justified - to ban real cigarettes. However, the tobacco industry is organized, centralized, and powerful.The rest of the story is that what is really going on here is that the proponents of this ordinance simply do not have the political courage to take the real action that would protect the public's health: banning cigarettes. Removing e-cigarettes from the shelves is an easy political victory that may make it seem like they desire to protect kids, but the truth is that they are apparently perfectly content with allowing deadly cigarettes to be sold to the kids who they purport to be protecting.Ultimately, this is politics, not public health.Original author: Michael Siegel
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Purported Links Between Vaping and Heart Attacks are Based on Crappy Science

Another crappy study has come along, this one again using cross-sectional data from the National Health Interview Survey to claim that e-cigarette use is associated with a higher risk of having a heart attack, developing coronary artery disease, and having depression.This study, being presented tomorrow (Monday) morning at the annual meeting of the American College of Cardiology in New Orleans, reports that "adults who report puffing e-cigarettes, or vaping, are significantly more likely to have a heart attack, coronary artery disease and depression compared with those who don’t use them or any tobacco products."These conclusions were based on a cross-sectional analysis of data from the 2014, 2016, and 2017 National Health Interview Surveys. Respondents were asked to report whether they had ever been diagnosed with having had a heart attack, coronary artery disease, or depression. The analysis found that people who reported vaping were more likely to have ever had a heart attack, to have ever been told they have coronary artery disease, or to have ever been diagnosed with depression. The analysis did control for smoking by including smoking status as a variable in the regression model.The Rest of the StoryThis is yet another example of the junk science that is rapidly being spewed out by anti-tobacco researchers who are apparently more interested in demonizing vaping than in using rigorous scientific reasoning.The problem with the study's conclusion is that this is a cross-sectional analysis and the researchers have no idea which came first: the vaping or the heart attack, heart disease, or depression.Let's consider heart attacks. It is entirely possible (and actually quite likely) that most - if not all - of the respondents who reported that they are vapers had started vaping after, not before their heart attacks. In fact, a likely explanation for the findings is that smokers who experience a heart attack are much more likely to try to quit smoking, and since switching to vaping is a common method of attempting to quit smoking, they are more likely to respond that they are vapers.The investigators claim that they have controlled for smoking. But here's the problem: smoking is not only a confounder in the analysis; it is also an effect modifier. This means that the association between vaping and having had a heart attack is different for nonsmokers and smokers. For nonsmokers, there is no association. The association only holds for former smokers and current smokers. In the presence of effect modification, treating smoking purely as a confounder will yield inaccurate results. In order to model the relationship correctly, you need to stratify the analysis on smoking status: that is, you need to report the relationship separately for nonsmokers, former smokers, and current smokers.None of the papers that have claimed vaping causes heart attacks, heart disease, stroke, or COPD have done that. They treat smoking as a confounder, but do not test for effect modification.It is unfortunate that this crappy science is being reported at scientific conferences and in scientific journals. But what makes this a real tragedy is that this junk science is being used to justify policies to regulate vaping more harshly than smoking, by: (1) heavily taxing these products; (2) banning e-cigarette flavors; and/or (3) completely banning the sale of e-cigarettes in convenience stores.The rest of the story is that rather than demonstrating that vaping causes heart attacks, heart disease, COPD, and depression, what these studies show is that when smokers get very sick, they are highly motivated to quit in order to save their lives, and many of them do so by switching to vaping.This is about 11 million lives, not 11 million lies.Original author: Michael Siegel
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Sunday Science Lesson: phenomena and measurement

by Carl V Phillips

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11 Million Lies: The Tobacco Control Movement is Committing Public Health Malpractice by Misrepresenting the Health Effects of Vaping

My colleagues and I in the tobacco control movement have based our entire careers on the principle that it is wrong to lie to the public. The bulk of our campaign against Big Tobacco was based on the contention that the cigarette companies lied to the public about the health risks of smoking. Numerous lawsuits were filed against Big Tobacco, seeking damages based on the claim that the companies are responsible because they misrepresented the health effects of their products, thus preventing smokers from making an informed choice. The name of the major youth anti-tobacco campaign is called "Truth." Clearly, honesty is the central value that has been at the core of the tobacco control movement for decades.In the last few years, however, I believe that our movement has largely abandoned truth as a central value in our campaigns against vaping. Driven by an almost puritanical inability to accept the fact that a person could obtain pleasure from nicotine without it killing them, we have made the demonization of vaping the solitary goal of the movement, at the direct expense of what I always believed was our primary goal: to make smoking history.Why is vaping so threatening to the tobacco control movement? Is it threatening because it is extremely dangerous -- basically as harmful as smoking -- and therefore is is harming the health of the nation's 11 million adult vapers?No - it's precisely the opposite. It is threatening to us because it is not as harmful as smoking. We simply cannot tolerate the fact that there are millions of adults who are deriving pleasure from, and improving their health because of, the use of a much safer form of nicotine delivery. The problem with vaping is that it is not killing anyone, so there is no punishment for the vice of being addicted to nicotine. And that's something that the tobacco control movement can simply not tolerate.I believe that it is precisely because the truth is so threatening that many anti-tobacco groups, public health agencies, physicians, and researchers have resorted to lying to the public about the health effects of vaping.The Rest of the StoryWhile the tobacco control movement is spewing numerous lies about vaping, perhaps the most damaging to the public's health is the false claim that vaping is not any safer than smoking. This is a direct affront to each one of the 11 million adult vapers in the United States who are trying to improve their health by switching from combustible tobacco use (i.e., smoking) to the use of non-tobacco-containing, non-combusted vaping products. And it is particularly offensive to the more than 2.5 million adult vapers who quit smoking completely because of these products and who are now relying on vaping to keep them from returning to smoking. For these 2.5 million ex-smokers, vaping has literally saved their lives.So it is shameful that we are now trying to take that away from them based on a complete lie: that switching to vaping is doing nothing to protect their health.Today, I highlight just a few of the individuals and organizations that are spreading the lie that vaping is no safer than smoking. Keep in mind that by definition, what these groups are saying is that smoking is no more dangerous than vaping. That's quite a claim, given the fact that smoking kills more than 400,000 people a year, contains more than 10,000 chemicals, and contains more than 60 known human carcinogens, while vaping aerosol, at worst, contains a few chemicals of concern and has not, after 12 years of use by millions of people, resulted in a single death (excepting one person who was killed due to an exploding battery, but not to the health effects of vaping itself).So here is today's top 10 examples of the individuals, groups, and researchers who are helping to spread the false assertion that cigarette smoking is no more hazardous than vaping.#1) National Center for Health Research"The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease. Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases. ... Because they are smokeless, many incorrectly assume that e-cigarettes are safer for non-smokers and the environment than traditional cigarettes. ... There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke."#2) Loyola University Medical Center"E-cigarettes are not safer than cigarettes. .. They have not been scientifically proven as healthier or safer, and the U.S. surgeon general has not approved them for use in smoking cessation." #3) South Dakota Department of Health"Vape is not safer than cigarettes."#4) Tennessee Medical Association"Despite being marketed as a safe alternative to smoking, e-cigarettes are not safer and they never have been. They have simply been marketed that way. As a result, many people believe trading a traditional combustible cigarette for vaping is going to make them healthier, and that the vaping or e-cigarette use is far less damaging health-wise."#5) Harford County Health Department"E-cigarettes are not safer than smoking tobacco."#6) Jane Goodall Institute"E-cigarettes are the biggest problem, and for the third year in a row they are the first choice among youth smokers. But contrary to popular belief, they are not safer than other tobacco products, they are actually more addictive due to the menthol component that makes them so easy to consume."#7) Des Moines Children's Hospital"It is absolutely not safer than smoking, that is a fallacy that adolescents believe because it tastes good."#8) Texas Tech University School of Pharmacy"These data suggest, from a cerebrovascular perspective, that e-Cig vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity."#9) University of Rochester Medical Center"Studies by his group and others, Rahman says, suggest that vaping is not safer than smoking: 'It’s equally bad.'"#10) East Rockaway Prevention Task Force"Too many teens, officials said, believe vaping is safer than smoking, when it’s not."Original author: Michael Siegel
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My first Patreon science lesson tutorial

Posted on 16 March 2019 by Carl V Phillips | Leave a comment

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FDA’s Campaign Against Tobacco Retailers Doesn’t Hold Up to Inspection



Today Dr. Scott Gottlieb announced a draft compliance policy predicting that ““some flavored e-cigarette products will no longer be sold at all…other flavored e-cigarette products that continue to be sold will be sold only in a manner that prevents youth access…” (here)Gottlieb has blamed a so-called youth vaping “epidemic” on illegal retail sales and “kid-friendly marketing.” (here)  Last week he spotlighted Walgreens, saying that 22% of its stores had illegal sales of tobacco products to minors “since the inception of the FDA’s retailer compliance check inspection program in 2010.”  He also listed 14 other national retail chains that had violation rates of 15% to 44%.  These shocking numbers are, in fact, inflated through the use of cumulative math covering a nine-year period. I reported on public FDA inspection data just after the program started (here) and again in 2016 (here).  In response to current FDA news, I have now analyzed the data from 2018 (available here), the year Dr. Gottlieb said youth vaping skyrocketed, based on still unpublished data from the National Youth Tobacco survey.  My findings on the 2018 FDA inspection data are illuminating.FDA contractors conducted over 146,000 retailer inspections in 2018, resulting in a national average violation rate of 12%, just one percent higher than in 2015-16 (here).  The following table contrasts the cumulative violation rate (range) reported by Dr. Gottlieb with the actual rate in 2018..nobr br { display: none } td { text-align: center} National Retailers’ Tobacco Sales Violations: “Cumulative” Versus 2018 RatesRetailerGottlieb “Cumulative” Rate (%)Actual 2018 Rate (%)Walmart15-246Walgreens15-249Family Dollar15-2411Circle K15-2412Kroger15-2413Casey’s General Stores25-34117-Eleven25-3414Shell25-3419Chevron25-3419Marathon35-4426Citgo35-4419Exxon35-4420Mobil35-4420Sunoco35-4421BP35-4424Dr. Gottlieb did not need to use inflated cumulative numbers to demonstrate that national retail chains, especially those with gas stations, are still selling tobacco products to underage youth.  Additionally, his focus on Walgreens, with a 2018 violation rate of 9%, three points lower than the national average, seems inappropriate.  Other key data points were omitted from Dr. Gottlieb’s remarks.  First, there is a large variation in state violation rates, from Georgia (2.2%), Montana (2.7%), Hawaii (3.0%) and California (4.2%) all the way to North Dakota and Michigan at 22.5%; Ohio and Nevada at 22.9%.  Retailers’ state rates were similarly diverse. For example, Walgreens and Walmarts in Georgia had much lower rates than those in Ohio.  This doesn’t absolve retailers of responsibility.  Rather, it indicates that state policies and attitudes may be contributing as significantly to underage sales as retailers.While Dr. Gottlieb’s regulatory effort is aimed ostensibly at combatting youth access to e-cigarettes, only 19% of the cited 17,500 violations in 2018 involved those products.  Cigars were the most frequent culprit (44%), followed by cigarettes (33%), with smokeless tobacco at a mere 4%.There is no excuse for a national tobacco sales violation rate of 12%; retailers everywhere must stop selling to underage youth.  Still, the federal government’s own survey data shows that more than 90% of teens who use tobacco products obtain them from social sources, such as friends or family.  Only 10% of current teen vapers buy their own e-cigs (here).  Given these facts, the FDA can’t hold retailers entirely responsible for teen e-cigarette use.Original author: Brad Rodu
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Even Norwegians do not understand how low-risk snus is

by Carl V Phillips

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Smoking is not addictive

by Carl V Phillips

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Federally Funded Authors Promote Misperceptions of Smoke-Free Tobacco Products



In their recent journal article, “U.S. adult perceptions of the harmfulness of tobacco products” (abstract here), a group of researchers from the FDA, other federal agencies, Canadian and American universities suppress important information about safer tobacco products.  G.T. Fong and 11 co-authors used federal funds to analyze the FDA Population Assessment of Tobacco and Health (PATH) Survey with respect to perceptions of eight non-cigarette tobacco products’ relative harms.  While their roughly 5,000-word treatise included three large tables, one figure, two supplemental tables, and 40 references, they included not a word about how these perceptions match up with reality.  The only time they used the word “misperception” was to suggest that Americans who view non-cigarette products as less harmful should be educated with “new information”. The authors found that “40.7% of adults believed that electronic cigarettes were less harmful than cigarettes.” In their view, “These results point to the potential value of enhancing knowledge, within the U.S. population, of the harm of tobacco products to prevent tobacco use and to encourage tobacco users to quit, through providing new information about the harms that may not be widely known and/or through countering misperceptions that may exist.” Readers of this blog know that numerous published studies document that smokeless tobacco use is vastly safer than smoking, and that the British Royal College of Physicians affirms that vaping is at least 95% less hazardous than smoking.  It is appalling that 12 government-funded researchers have published a lengthy screed without acknowledging that smoke-free products are less harmful.  Original author: Brad Rodu
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Tobacco control ratf**king

by Carl V Phillips

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Vaping research priorities – my top ten


Following up on the guest post by Louise Ross: What are the vaping research priorities? Have your say… I have now had my say and wanted to share my top 10 priorities.

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Anti-vaping activists pitch unscientific fringe positions to a national newspaper





Some veterans of the tobacco control establishment have found the public health opportunity of vaping hard to come to terms with

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Switching from Smoking to Juul Reduces Toxic Chemical Biomarkers to the Same Degree as Quitting Cold Turkey

According to a study conducted by Juul and presented Saturday at the Big-Pharma funded SRNT annual meeting, there is no difference between switching from smoking to Juul and quitting smoking cold turkey in terms of the reduction in biomarkers of toxic chemicals.In the study, a group of 90 adult smokers were randomized to either: (1) continue to smoke as usual; (2) stop smoking cold turkey; or (3) switch completely from smoking to Juul. After five days, the researchers measured the change in the level of nine different biomarkers for toxic chemicals, which indicates the level of exposure to these chemicals.The key finding of the study was that the degree of reduction in exposure to these toxic chemicals was identical for the group that quit smoking cold turkey and the group that switched from smoking to Juul.The Rest of the StoryThis study adds to the already overwhelming evidence that vaping is much safer than smoking. And it further emphasizes the degree to which the Pennsylvania Department of Health is lying about the relative health effects of smoking vs. vaping. As I reported last week, the Pennsylvania Department of Health informs the public on its web site that: "E-cigarettes, also known as e-cigs, e-hookahs, mods, vape pens, vapes or ENDS, are not safer than other tobacco products for youth."This study is significant because it did not show that toxic chemical biomarker reduction with the Juul was at some level between continuing to smoke and quitting cold turkey. Instead, the level of reduction was indistinguishable from that resulting from cold turkey cessation.In other words, if someone presented to a physician and the physician had to determine whether that person had quit smoking cold turkey five days earlier or switched to Juul five days earlier, the physician could not tell the difference, at least not based on the level of these toxic chemical biomarkers.This new study adds to a large body of existing research that casts severe doubt on the assertions of many tobacco control researchers and organizations, and many health departments, that vaping is really not all that much different from smoking in terms of health.Original author: Michael Siegel
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What are the vaping research priorities? Have your say…




Vaping: what do we need to know?

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The American Cancer Society: For and Against Tobacco 21



My op-ed about Virginia’s adoption of Tobacco 21 was published in the Richmond Times-Dispatch (available at Richmond.com hereand below).  As I have documented before (here), the American Cancer Society is out of touch with American smokers and their need for reasonable and rational ways to quit.  Further evidence is seen in the Society’s U-turn from supporting to opposing Tobacco 21 in Virginia (below) and Utah (here).  The Society complained in both states that “the devil’s in the details,” but there are no details: states simply want to move the legal age for tobacco sales from 18 to 21.  The Society should advocate for the health, and respect the rights, of American teens and smokers._______________________________________________________ Virginia has raised the minimum age for buying all nicotine products, including e-cigarettes, from 18 to 21. The bill had widespread support from state medical societies and Gov. Ralph Northam, a pediatric neurologist; and it is part of a national trend in which states are responding to the growing number of adolescents choosing to vape. But some in the public health community tried to make the perfect the enemy of the good by standing in the way of a sensible regulation that has the potential to curtail teen nicotine use, without making it harder for adult smokers to access healthier alternatives. It’s true there has been an increase in teen vaping — a problem exacerbated, in part, by older students legally buying tobacco products and selling them to their younger classmates. Raising the age from 18 to 21 will delegitimize tobacco sales to 18-year-olds and potentially disrupt high school “black markets.” Eighteen-year-olds make up 14 percent of all American high school students, but they account for one-quarter of high school smokers and smoker-vapers. Legal buyers — not manufacturers and retailers — are the primary source for tobacco products used by underage high schoolers. So Virginia’s Tobacco 21 law could make a big impact in limiting access to youth. The problem comes from the growing contingent of “anti-tobacco” activists who won’t be happy until there is simply no tobacco — or nicotine — for sale at all. Specifically, the American Cancer Society needs to start acknowledging scientific facts and abandon its “tobacco-prohibition” stance. The society opposed the sensible Tobacco 21 bill in the Virginia legislature, despite the fact that the ACS’s lobbying arm, the Cancer Action Network (CAN), endorses Tobacco 21 at the national level. CAN spokesman Brian Donohue insists, “the devil is in the details.” Similarly, the American Heart Association also supports Tobacco 21 in theory, but has been critical of the Virginia legislation. AHA spokesperson Ashley Bell said — somewhat incoherently — that youth access laws “may not be strong enough to support the current age … are not strong enough to support the enforcement of raising the age.” ACS-CAN’s Donohue added that Tobacco 21 “is a great goal, but it’s backwards.” The only thing backwards is the public health community’s flip-flopping on support for Tobacco 21. ACS-CAN is critical of the bill’s focus on youth — rather than retailers — and is insisting additional changes ought to be made such as the elimination of fines for teen buyers (currently $100 for the first violation, $250 after that), and increased fines for retailers (currently set at $500 for the first violation and up to $2,500 subsequently). But the reality is, they don’t intend to settle halfway because they want the complete elimination of nicotine and tobacco products. Efforts to stem the use of tobacco and vaping products through Tobacco 21 laws — like the one signed into law in Virginia — are growing. Hawaii, California, New Jersey, Oregon, Maine, and Massachusetts have already raised the purchase age to 21, and Alabama, Alaska, and Utah bumped it to 19. The leadership at organizations like ACS-CAN and the AHA know that the FDA punishes retailers who sell tobacco to anyone under 18. E-cigarette companies have implemented stringent age verification systems online to support these measures. No tobacco product is perfectly safe, but vaping is considered 95 percent safer than smoking. E-cigarettes not only provide a safer alternative for adult smokers; but, as the New England Journal of Medicine just confirmed, they are used more often by smokers, and they are more effective than medicinal nicotine in helping smokers quit. Each year more than 16 million Americans live with, and almost half a million die from, smoking-attributable illnesses; the total economic cost is more than $300 billion. We can’t afford to let politics interfere with sensible policies. Kudos to Governor Northam for ignoring tobacco policy u-turners in order to remove legal tobacco consumers from Virginia high schools. Original author: Brad Rodu
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Pennsylvania Department of Health Urges Parents to Lie to their Kids About the Dangers of E-Cigarettes

A basic principle of public health ethics is that we don't lie to people. Telling the truth is a critical component of the public health code of ethics. It is important not only because it is unethical to lie, but also because we greatly risk losing credibility and the public's trust if we are found to be lying. And once that public trust is lost, it is extremely difficult, if not impossible, to gain back.Therefore, it pains me today to have to report that the Pennsylvania Department of Health is urging parents to lie to their kids about e-cigarettes in order to dissuade them from vaping. In addition, the Pennsylvania Department of Health is lying to the public about the dangers of e-cigarettes and tobacco cigarettes as well.The Pennsylvania Department of Health put out a tweet that read: "E-cigarettes, e-cigs, e-hookahs, mods, vape pens or vapes—whatever you call them, they are NOT safer than other tobacco products. Learn how you can help protect you child's health by talking about the dangers of vaping → http://bit.ly/2RuVOev  #NoEcigs4Kids."On its web site, the Pennsylvania Department of Health informs the public that: "E-cigarettes, also known as e-cigs, e-hookahs, mods, vape pens, vapes or ENDS, are not safer than other tobacco products for youth."The Rest of the StoryIt is simply not true that e-cigarettes are as dangerous as tobacco cigarettes, or that vaping is as dangerous as smoking. At this point, there is abundant scientific evidence that vaping is much safer than smoking. In fact, smokers who switch to e-cigarettes experience dramatic improvement in their respiratory symptoms and lung function.The Royal College of Physicians concluded that vaping is at least 95% safer than smoking, but even if you don't agree that the risk difference can be quantified, the evidence demonstrates that e-cigarettes are a much safer product than real tobacco cigarettes. The reason for this is that e-cigarettes contain no tobacco and involve no combustion. While tobacco smoke contains more than 10,000 chemicals including more than 60 known human carcinogens, e-cigarette aerosol, at worst, contains more like 20 chemicals and perhaps 1 or 2 carcinogens. And this is only the case for e-cigarette brands that do not properly regulate the temperature of the heating coil. Studies of the aerosol of brands that have proper temperature regulation have not detected significant levels of any hazardous chemicals.There is no question that e-cigarettes are much safer than cigarettes in terms of lung damage and in terms of cancer risk. E-cigarettes have been on the market now for 12 years and have been used by millions without any identified health effects (other than some mild respiratory irritation).So what the Pennsylvania Department of Health is doing is lying to the public by telling us that vaping is no safer than smoking. Or, put another way, these health officials are asserting that cigarette smoking is no more hazardous than vaping.Were a tobacco company to make the same statement, it would be rightly accused of fraud and deception. So why can a state health department make that statement with immunity?The reason, I believe, is that most tobacco control groups no longer care about the truth and about scientific accuracy. They are more concerned with creating hysteria about vaping and scaring the public. While the ultimate goal - reducing youth vaping - may be considered to be laudable, the ends do not justify the means. Lying to kids to discourage them from engaging in a particular behavior is not the way to go. And it is not something that we condone in public health.The Department of Health's message is also deceptive because it instructs parents that by preventing their kids from vaping, they can keep their kids tobacco-free. This is highly deceptive because it implies that a youth who vapes is using tobacco. That simply isn't true as there is no tobacco in an e-cigarette. In fact, the very thing that distinguishes an e-cigarette from a real cigarette or from a heat-not-burn tobacco product is the absence of tobacco. If an e-cigarette actually contained tobacco, then it would not be an e-cigarette. It would be a heat-not-burn tobacco product.A youth who vapes is tobacco-free. They are not nicotine-free (unless they use an e-liquid that does not contain nicotine), but they are smoke-free and they are tobacco-free.I believe that one of the reasons why public health groups have been so ineffective in reaching youth with anti-vaping messages is that the kids are seeing right through these lies. Kids are not stupid. They can see with their own eyes that when someone lights up a cigarette, the health effects are immediately apparent. Smokers cough, they are typically short of breath upon exertion, they are more prone to pneumonia and upper respiratory infections, etc. But kids see plenty of other kids vaping and Juuling without any visible health effects. Today's kids are just not going to buy the lies that the Pennsylvania Department of Health and other anti-nicotine groups are selling them.Ultimately, I believe that the credibility and reputation of public health groups and agencies is going to be seriously undermined by the widespread lying and deception that is taking place regarding the relative risks of vaping compared to smoking. Disseminating false facts like this is unethical, it specifically violates the public health code of ethics, it puts the reputation of public health itself at risk, and at the end of the day, it doesn't even accomplish its intended objective of discouraging kids from vaping.If you're going to tarnish the image of public health and violate our ethical code, at least do it in a way that accomplishes some great public health objective. Lying about vaping is doing plenty of tarnishing, but nothing to protect the public's health.The rest of the story is that lying to kids isn't justified even if it did prevent them from vaping. But it is doing just the opposite, as kids see through the lies and in some ways, it makes vaping more attractive.Original author: Michael Siegel
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SRNT Under Fire for Accepting Sponsorship Money from E-Cigarette Company for Annual Meeting

Controversy is brewing in San Francisco this week as it was revealed that the Society for Research on Nicotine and Tobacco (SRNT) accepted money from an e-cigarette company to sponsor its annual meeting which is being held this week.It was reported this morning that SRNT accepted funding from GreenSmokeKloud, an e-liquid distributor whose products are competing with nicotine replacement therapy and Chantix for a share of the smoking cessation market.Critics pointed out that sponsorship of the conference by GreenSmokeKloud presents a severe conflict of interest because its products are being used for smoking cessation and the SRNT conference involves numerous presentations dealing with the effectiveness or lack of effectiveness of e-cigarettes and vaping products similar to or including those manufactured by GreenSmokeKloud.Stanley Glanton, a professor at CFSU, told The Rest of the Story that: "This is a clear-cut conflict of interest. You can't have a conference sponsored by a company that makes products which are being discussed at scientific sessions. How can we have an objective conversation about electronic cigarettes and the epidemic of youth vaping when GreenSmokeKloud signs are all over the place and conference attendees know that this company is a major sponsor of the conference?"Several tobacco control researchers pointed out that the Food and Drug Administration is actually presenting at the conference and the FDA has regulatory jurisdiction over vaping products, creating a further conflict of interest. They also pointed out that a major theme of the research being presented is what should be the appropriate role of vaping products in smoking cessation efforts and that GreenSmokeKloud has a vested interest in the outcome of those discussions."You might as well just give them a seat at the table," complained one smoking cessation researcher. "They may not be physically or consciously affecting the presentations, but subconsciously everyone knows that GreenSmokeKloud is sponsoring the conference and if we diss them in our presentations, it's unlikely that they will sponsor SRNT next year. It's inappropriate that whether SRNT can get the same sponsorship money next year may actually depend on what is said or not said in the scientific presentations."Another tobacco researcher agreed: "If the consensus at this conference is that vaping products are really not an effective smoking cessation tool and there is too much risk of youth addiction, you can bet that GreenSmokeKloud will back out of next year's conference. Let's not forget that this is a corporation whose primary goal is to make money. If their products are not cast in a positive light, they will have no incentive to return next year."Although each speaker discloses their conflicts of interest, some conference attendees have suggested that every speaker should be required to disclose that GreenSmokeKloud is a sponsor of the conference itself. According to Dr. Glanton: "It needs to be remembered that GreenSmokeKloud is casting a cloud on this entire conference. If a vaping company is sponsoring the conference, attendees should be reminded of that at the beginning of each and every presentation, especially if the talk is evaluating e-cigarettes in terms of their use in smoking cessation."The Rest of the StoryWait a minute. I apologize. I just received word that I got the story slightly wrong. GSK is indeed sponsoring the conference, but GSK doesn't stand for GreenSmokeKloud, it stands for GlaxoSmithKline, and it's not producing vaping products for smoking cessation, it's producing nicotine replacement products for smoking cessation. Also, Pfizer is another conference sponsor and they produce Chantix, a drug that is marketed for smoking cessation.Indeed, according to the official SRNT program, GlaxoSmithKline and Pfizer are both major sponsors of the conference.After the tobacco researchers quoted above were informed of my mistake, they all retracted their statements and told me that they saw nothing wrong with these pharmaceutical companies sponsoring the conference, even though they make products whose effectiveness is being discussed at the conference and their financial well-being depends on the consensus that may develop at the conference based on the content of the presentations that directly address their effectiveness."We don't see any conflict of interest here and the financial support of these corporations is necessary to continue to hold these important conferences," one of the researchers told me.Since being informed of my mistake, everything has calmed down and it is back to business as usual at the SRNT conference.Original author: Michael Siegel
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Teen Smoking-to-Vaping Is More Frequent Than Vaping-to-Smoking, Says Data in New Study



FDA Commissioner Gottlieb on February 10 tweeted, “Now, a new study, published in the Journal of the American Medical Association (JAMA), further demonstrates what we’ve seen from other data: Teens who vape are more likely to start smoking cigarettes.” (Tweet here)  The study (here), by Kaitlyn Berry at Boston University and colleagues there and at the Universities of Louisville and Southern California, appeared in JAMA Network Open.Berry et al. examined the FDA Population Assessment of Tobacco and Health (PATH) survey involving youth, which started in 2013-14 and had two follow-ups, one and two years later.  The researchers identified 6,123 youths age 12-15 years who had not used a tobacco product at enrollment.  Some of the participants first tried a tobacco product over the next two years.  Berry et al. assessed whether first use of a particular product resulted in youth ever or current (past 30 days) cigarette smoking.  They concluded that “e-cigarette use is associated with increased risk for cigarette initiation and use.”Taking a closer look at the study, New York University professors David Abrams and Ray Niaura and I produced a comment, which has been published in the journal, making the following important observations.While Berry et al., and Commissioner Gottlieb, emphasized the 4.0% probability of current smoking among e-cigarette first users, we found a reverse result buried in a supplemental table: The probability of current e-cigarette use at follow up among cigarette first users was 8.3%.  This means that twice as many first-smoking teens currently used e-cigarettes at follow-up than first-vaping teens who currently used cigarettes.  We also noted that 527 teens first used e-cigarettes during follow-up, 202 used cigarettes first, and 306 used other products.  The table shows that out of 130 current smokers at follow-up, the relative impact is 25% for first e-cigarette use and 75% for all others. .nobr br { display: none } td { text-align: center} First Use of Tobacco Products By Teens in the PATH Survey and Current Smoking at Follow-upFirst Product Used (n)Percentage Currently Smoking at Follow-up (n)E-cigarette (527)5.9% (31)Other Tobacco (306)8.2% (25)Cigarette* (202)None* (5,088)1.4% (74)All (6,123)2.1% (130)*First cigarette users were combined with nonusers by Berry et al.This is entirely relevant to the FDA public health standard.  The absolute population impact (API) can be calculated using the full denominator of 6,123 teens. This reveals that e-cigarette first use resulted in 31/6,123 or about 0.5% API, contrasted with 25+74 = 99 /6123 or 1.6 % for teens without any first e-cigarette use.  In short, the API for teens without e-cigarette first use was triple that for teens with first e-cigarette use.Drs. Abrams, Niaura and I concluded:“Even with this small impact [0.5% API], e-cigarette first use cannot be causally linked to current smoking two years later, because plausible shared liability factors have not been ruled out. As a result of the issues we raise, scientists, journalists, regulators, policymakers and the public may be misled into thinking that e-cigarette first use is a unidirectional gateway into smoking. When information about API and the opposite gateway to smoking cessation are included, a much more complete picture emerges.”We look forward to a response from Ms. Berry and her colleagues.Original author: Brad Rodu
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