Tuesday, May 25, 2010

SmokeFree Wisconsin not about public health

In a recent blog post, I addressed a recent blog post by SmokeFree Wisconsin regarding smokeless tobacco products.

After a few readers questioned the logic of refusing to do "less harm" in promoting the use of smokeless tobacco over smoked tobacco, the author replied,
Our priorities include proving for smoke-free environments, increasing the price of tobacco, and ensuring there is a strong, comprehensive tobacco prevention and control program.

To serve those priorities we partner to collect data, data which indicates that smokeless use is already on the rise in WI. We use data which shows that the burden of tobacco is NOT reduced by the use smokeless products.

We are not exposing smokers to any risks. We pass policies, we don't do treatment.

Smokeless is not less harmful. Period.

So, where is the goal of protecting public health in this statement?

Where is the accountability that in setting policies, they affect public behavior?

Since when did it become "the burden of tobacco" over the burden of smoking and it's affect on public health?

Where is the science that proves that smokeless is not less harmful than smoking? There is plenty of science that proves the greatest exposure to toxins and carcinogens is in the smoke - we see it in the news and in public statements from groups such as the American Lung Association and the American Cancer Society.

If what SmokeFree Wisconsin says is true about smokeless tobacco, wouldn't the opposite also be true? That smoking is no more dangerous than smokeless tobacco? So why the need for indoor smoking bans, if the smoke isn't the real danger?

In its policy to put eradicating any tobacco use as a priority over getting people to quit smoking, SmokeFree Wisconsin completely ignores valid, scientific research and urges people who use tobacco products to continue to use only its most dangerous form - smoking.

Because if smokeless tobacco is no less dangerous, why switch from smoking?

Tuesday, May 18, 2010

SmokeFree Wisconsin Doesn't Believe in Reducing Harm for Smokers

In a May 6, 2010 blog post, SmokeFree Wisconsin applauded the new, larger warnings on smokeless tobacco products.

That would have been fine and dandy, if not for these comments by the author:
This product is not a safe alternative to cigarettes. This product can cause mouth cancer This product can cause gum disease and tooth loss....
The implication here is that you can dance the night away with Snus in your mouth and never have to go out for a cigarette and miss you favorite song.

I couldn't help but comment and surprisingly, my comment was accepted for once:
And WHY that is a bad thing? If they are using snus (which is scientifically shown to be up to 98% less dangerous than smoking tobacco) instead of smoking, wouldn't that be better for the smoker's health? Especially if they would already be smoking?

I understand you want everyone to avoid tobacco products completely, but that isn't going to happen. If offered the choice between deadly tobacco smoke and the far safer smokeless tobacco products, why lie to them and tell them smokeless products are just as bad? All you are doing is (encouraging) the use of a far deadlier product, because people will think they may as well keep smoking.

Granted, we don't want kids to start using tobacco products, but by misrepresenting the comparative safety of smokeless alternatives, you are exposing actual smokers to far greater risks.

The author's reply:
The studies of which you refer are in reference to Swedish Snus, a product which is entirely unlike American made Snus. Moreover public health has a duty and responsibility to "do no harm." The ethics which guide the profession do not promote "doing less harm."
Thanks for your comment.

And my comment back (we'll see if it gets posted):
No offense, Erich, but baloney.

If that were the case, public health wouldn't advise people to use low-fat and sugar-free foods - they'd be telling them not to eat it at all. People would be told not to drive at all, because seatbelts would only "do less harm" and aren't 100% safe.

Reduced harm/risk has been around for years in foods and other public health and safety, why not tobacco?

To tell people to just keep smoking, because smokeless tobacco isn't 100% safe make no sense. I know you want people to quit altogether, but that isn't what is happening with over 20% of the U.S. population who still smoke. By making smokers believe that smokeless alternatives are no safer than smoking, they will just keep smoking, while they could have been breaking their habit of smoking and reducing their health risks.

I'm not talking about encouraging non-smokers to use smokeless tobacco - that'd be irresponsible.

I'm talking about COMMITTED SMOKERS, who are already pumping 4,000 toxic chemicals and 60 carcinogens into their bodies and can't or won't quit. If they won't quit smoking, can you really argue that it isn't the duty of public health officials to alert them to the fact that smokeless products lack up to 98% of those chemicals and carcinogens found in tobacco smoke? (And we know it's the SMOKE, otherwise indoor bans would include smokeless tobacco. Or is this "TobaccoFree Wisconsin" now?)

How is that any different from telling someone to use low-fat products, which aren't as good as abstaining altogether, but at least LESS detrimental to their health?

Not informing smokers that many smokeless tobacco products are up to 98% safer than smoking is like telling a morbidly obese person that they may as well eat Ben and Jerry's, because low-fat yogurt still has "some fat."

I guess it's pretty much self-explanatory. These smokefree "public health" groups are no longer about real public health or even about the "smoke." They are about tobacco abstinence - PERIOD. And it doesn't matter who gets hurt in their rush to force that ideal. How many smokers will die because these groups refused to "do less harm?"

The argument against encouraging committed smokers to switch to reduced harm products, because they can't encourage "doing less harm," holds no water. Seatbelts, helmets, low-fat and reduced calorie foods - are all products meant to do "less harm" to or reduce harm for the user. Doctors regularly prescribe treatments that are risky or dangerous in the hope to save a patient's life. If it were not for the use of deadly chemicals, which make the patient extremely ill and could kill them, many cancer patients would not be survivors today.

So don't try to tell me that public health cannot reconcile itself with "doing less harm."

Saturday, May 15, 2010

Are Electronic Cigarettes Safer than Traditional Cigarettes?

by Kristin Noll-Marsh

Recently, there has been media coverage about the safety of electronic cigarettes, which may be confusing and a bit scary. Even groups like the American Lung Association and American Heart Association are attempting to remove them from the market. They claim that there is no "proof" that electronic cigarettes are any safer than traditional cigarettes.

Does this claim make sense? Read more and decide for yourself.

Electronic cigarettes were intended to be a less-toxic (or “safer”) option to smoking tobacco cigarettes, but not a treatment for nicotine addiction.

Chinese pharmacist Hon Lik invented the e-cigarette in 2003 with a patented ultrasonic technology. Hon Lik was inspired to invent this smoking alternative, because his father was dying from lung cancer. Since then, most e-cigarette manufacturers use a heating element that vaporizes the nicotine liquid instead.

Read more: http://emerging-business-markets.suite101.com/article.cfm/sources_for_imported_ecigarettes#ixzz0TNTSptUJ

It’s well documented that currently available treatments for smokers, nicotine replacement therapies such as patches and gums, are largely ineffective, with just a 7.2% success rate after 12 months. This is largely due to the fact that smokers aren’t just addicted to the nicotine; they are addicted to the actual habit and ritual of smoking a cigarette. It is a comfort system for them. That is even stronger than nicotine addiction.

However, the greatest danger in cigarette smoking is not the nicotine. Nicotine, while highly addictive, is a stimulant similar to caffeine and non-toxic in low, intermittent doses, which is why it can be used in nicotine replacement therapies. Nicotine, by itself, does NOT cause cancer, but is known to have some minor health effects. Cigarette smoke, on the other hand, contains more than just nicotine. It contains thousands of toxic chemicals and over 60 known carcinogens.

Hon Lik seems to have believed that there could be an option for smokers, to still have the act of smoking, while limiting exposure to the chemicals, toxins and carcinogens found in tobacco smoke. He had to have known that the smoker would still need relief from the nicotine addiction; so to get them to switch to the less toxic electronic cigarettes, he had to include doses of nicotine.

Read more: http://www.drugs.com/sfx/nicotine-side-effects.html

Diethylene glycol
You may have heard that the FDA announced that diethylene glycol, an ingredient in antifreeze, is found in electronic cigarettes. This is a gross exaggeration. The FDA found a non-toxic amount (approx. 1%) of diethylene glycol in just one Smoking Everywhere-brand prefilled cartridge.

Diethylene glycol is a toxic substance used in anti-freeze, but it is not used in the manufacture of electronic cigarette liquid. Because it used in tobacco processing, cheaper, less refined nicotine may become contaminated with traces of diethylene glycol. It is the most likely explanation of how one cartridge may have been contaminated. The other 17 cartridges were not found to have been contaminated with diethylene glycol. Subsequent testing of other electronic cigarettes found no diethylene glycol, so it appears that the one cartridge was an anomoly.

Read more:

Propylene Glycol
Propylene glycol is commonly confused in the media with diethylene glycol as the "toxic chemical found in antifreeze" the FDA found. (Anti-freeze is actually most commonly made with ethylene glycol.) While propylene glycol can be found in some antifreeze, it is actually added to it to make it less toxic to children and animals.

“Antifreeze typically contains ethylene glycol as its active ingredient, but some manufacturers market propylene glycol-based antifreeze, which is less toxic to humans and pets. The acute, or short-term, toxicity of propylene glycol, especially in humans, is substantially lower than that of ethylene glycol. Regardless of which active ingredient the spent antifreeze contains, heavy metals contaminate the antifreeze during service. When contaminated, particularly with lead, used antifreeze can be considered hazardous and should be reused, recycled, or disposed of properly.”

Read more:

Propylene glycol is actually approved for human consumption by the FDA and approved for human inhalation by the EPA. It is a common ingredient in many foods and medicines, such as McCormick (and other brand) imitation food flavoring, toothpaste, cough syrup, hand sanitizer, lotions, cosmetics, asthma inhalers and more.

Read more:

Tobacco-specific Nitrosamines (TSNAs)
The FDA announced that it's analysis found “carcinogens” in the samples tested. These tobacco-specific nitrosamines are created during the curing and processing of tobacco and would be expected to be found, in trace amounts, in nicotine extracted from processed tobacco. In tobacco smoke, they are found in high concentration and are a leading cause of tobacco-related cancers. These carcinogens were found in just trace amounts in the electronic cigarette liquid and are also found in other tobacco and nicotine products, including nicotine replacement pharmaceuticals such as nicotine patches, gum and inhalers. A study at Oxford concluded that the highest levels of these nitrosamines are found in the reaction of tobacco smoke and minimal in NRTs. Testing of Ruyan electronic cigarettes by Health New Zealand found electronic cigarette TSNAs are comparable to the levels found in the FDA-approved nicotine patch.
Absolute safety does not exist for any drug, but
relative to lethal tobacco smoke emissions, Ruyan
e-cigarette emissions appear to be several
magnitudes safer. E-cigarettes are akin to a
medicinal nicotine inhalator in safety, dose, and
addiction potential. - Dr. Murray Laugesen, Health New Zealand
Read more:

Most companies use water-based, food-grade flavorings for their liquids. They make up a very small percentage of the total liquid content. These have been approved by the FDA for ingestion, but the effect of long-term inhalation has not been tested.

Most of the ingredients in electronic cigarette liquid has been tested and approved for long-term exposure in humans, but not when they are all mixed together. There are also no set minimal standards for manufacturing and the FDA has not approved any liquid for sale or use. The FDA wants to classify electronic cigarettes as a drug and drug delivery device for smoking cessation and wants appropriate studies done to show that they are safe. It is unklnown if the FDA will compare the safety of electronic cigarettes to that of smoking tobacco cigarettes long term or to using NRTs short term, to quit smoking.

Injuries and Illness Attributed to Electronic Cigarettes:
Electronic cigarettes have been on the world market for over 5 years and in the U.S. for over 2 years. To date, there have been no public reports or complaints of injury or illness attributed to electronic cigarette use.

Compare that to complaints against the FDA-Approved smoking cessation drug, Chantix. Since it's introduction to the market 4 years ago, there have been numerous complaints of erratic behavior, suicidal impulses, violent behavior and over 50 deaths/suicides reportedly attributed to the drug.

Read More: http://www.fda.gov/drugs/drugsafety/publichealthadvisories/ucm051136

Traditional Cigarette Toxicity:
Various, peer-reviewed studies show that traditional cigarette smoke contains 4,000 or more chemicals - many of them highly toxic. They also show that approximately 60 of those chemicals are human carcinogens/TNSAs.

Read More: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm

The typical electronic cigarette liquid contains water, propylene glycol, glycerin, nicotine & food-grade flavoring, none of which are found in toxic levels nor known carcinogens.

Now you have the facts. You decide, for yourself, if you think electronic cigarettes are safe (or at least safer than tobacco cigarettes) for you.

Wednesday, May 12, 2010

Why do anti-smoking groups oppose tobacco harm reduction?

An excellent speech by Christopher Snowdon, author of "Velvet Glove, Iron Fist"
Similarly, Americans for Nonsmokers’ Rights - in a press release titled Electronic Cigarettes are NOT a safe alternative! - criticised the e-cigarette specifically because it mimics the act of smoking and because it contains nicotine. Only pharmaceutical nicotine products escape criticism, partly because they are marketed as a medicinal cure for a ‘disease’ and partly because they administer nicotine without providing pleasure. This has led to a somewhat inconsistent view of nicotine, described as being perfectly safe in pharmaceutical products but highly toxic in e-cigarettes, snus and other tobacco products. The EPA describes it as “acutely toxic (Category 1) by all routes of exposure (oral, dermal and inhalation)” while the MHRA says thats “nicotine, while addictive, is actually a very safe drug.”
Read Full Story

Wednesday, May 5, 2010

Electronic Cigarette Users Fighting Back

Petition Aims to Save Lives

Tobacco smokers aren't known as a politically active group. Even though they make up over 20% of the adult population in the U.S. and make a significant contribution to federal and state revenues, after years of being vilified and desocialized, they've pretty much accepted that the rest of the population won't acknowledge them until they either quit smoking or die.

Their electronic cigarette-using counterparts, however, have no intention of going so quietly into the night. They believe their devices are the antithesis of tobacco cigarettes and are life-savers worthy of a petition against moves by the FDA and numerous anti-smoking groups to remove electronic cigarettes from the market.

Electronic cigarettes have been on the market worldwide for over five years.1 Some models look like a traditional cigarette, but they are actually made from a battery-powered heating element that vaporizes a water-based, flavored nicotine solution into an inhalable mist.2

As of this writing, nearly 600 people had signed and commented on the six-day-old petition posted at EcigsSaveLives.info and they have pledged to withdraw any further financial contributions to organizations, such as the American Lung Association and the American Cancer Society, until those groups reverse their current policies against e-cigarettes.3

The petition, written by the Vapers Coalition4, quoted the named organizations' own statements about the dangers of tobacco smoking and pointed out how, according to published test results, electronic cigarettes are no more of a danger to smokers than FDA-approved smoking cessation products.

As word spreads, the petition numbers are growing and organizers hope to reach at least 10,000 signatures by September 1, 2010. They intend to hand-deliver a hard copy of the petition to each organization and are encouraging petitioners to send their own individually signed hard copy, as well.

Comments on the petition ranged from testimonials of the benefits of electronic cigarettes to angry accusations of financial interests winning out over public health. Many promised to get their friends and families to support boycotting the health organizations and others warned that removing electronic cigarettes from the market would have devastating consequences.

"I am a 1 1/2 year user of PV's (e-cigs) and have been tobacco free for over a year," wrote petitioner Brenda Wood. If a ban were to take effect, I know I would revert to tobacco, as NONE of the NRT's on the market worked for me, and some made me very, very ill."

Mark Watkinson made an appeal on behalf of his father writing, "My father is dying from his habit. If he doesn't switch to an E Cigarette he may be dead in as little as 2-5 years. Please don't ban this life saving device. Nothing can be worse health wise than the legal tobacco cigarette!"

Alluding to federal and state tobacco tax revenues and the multi-billion dollar smoking cessation industry, petitioner George Seder wrote, "Which conflict of interest are you going to side with? Smokers who want to stay healthy or special interests who depend financially on misery and death?"

Electronic cigarette users are adamant that they have finally found a way to painlessly replace tobacco smoking with a product that has been shown, through testing and real-life application, to be multitudes safer than smoking. Unlike tobacco cigarettes, petitioners say electronic cigarettes are worth fighting for.


1. A Historical Timeline of Electronic Cigarettes,http://www.casaa.org/resources

2. http://en.wikipedia.org/wiki/Electronic_cigarette

3. http://EcigsSaveLives.info

4. http://VapersCoalition.org

Monday, May 3, 2010

Up in Smoke: How Will Our Tobacco Policies of Today Be Viewed by Future Generations?

In the history of the United States of America there have been more than a few public policies that leave today's generation incredulous.

We look back at the great issues our ancestors faced such as slavery, civil rights, Prohibition, Suffrage, the relocation and assimilation of Native Americans, discrimination, child labor and the wholesale destruction of our natural resources and wonder, "What the heck were they thinking?"

If you looked closely at any situation where a minority group was openly discriminated against and endangered, it usually can be explained with one word - greed. Behind every law or policy, someone stood to gain or lose financially.

Look at today's tobacco policies and cigarette smokers.

Here we have a product that the CDC states "is the single most preventable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million have a serious illness caused by smoking. Despite these risks, approximately 46 million U.S. adults smoke cigarettes." 1

Yet, rather than remove the deadly product, government officials offered regulation. The tobacco industry was banned from advertising in most media outlets, from sponsoring high-profile sports and ordered to redesign packaging with visible health warnings in an attempt to "protect" consumers. Higher and higher taxes were imposed, with the dual intent of making the price of cigarettes less appealing and to finance the health costs associated with smoking. In spite of this, people not only continued to smoke, new smokers continued to start smoking every day.

Anti-tobacco advocates weren't satisfied with the government's efforts, so they formed health organizations intended to educate smokers and support their efforts to quit. This heightened awareness of the health risks (plus the discovery in the 1950's that smoking was linked to lung cancer) prompted an unprecedented number of smokers to try quitting, but the success rates were less than stellar. This stumped the health groups. People knew that smoking was bad for them, why didn't they just quit?

Researchers finally pinpointed nicotine as being the ingredient in cigarettes that made quitting so difficult. Pharmaceutical companies developed "nicotine replacement therapies" designed to temporarily give smokers the nicotine they craved while they attempted to quit. Smokers had to be convinced that nicotine wasn't the dangerous component of smoking - just the addictive one. A new industry was created around smoking cessation, however, the products only worked for a tiny number of smokers. Over 97% of smokers would either bounce back and forth between smoking and the smoking cessation products or simply give up and go back to smoking. Obviously, helping smokers wasn't working, so maybe guilting or punishing them into quitting would.

Along came reports about "second-hand" and "third-hand" smoke. Based on some questionable research, the health advocates announced that smokers were not just hurting themselves, but also hurting those around them - even from simply touching them after smoking. Suddenly, "anti-tobacco" groups became "anti- smoking" prohibitionists, intent on banning any form of smoking or nicotine use and the attempts to help smokers turned into attempts to de-socialize and de-normalize them. Additional taxes on cigarettes were called "sin tax" and smokers were the sinners.

No serious attempts were made to remove the root cause of all of this trouble - cigarettes. The tobacco companies still made their profits, because smokers still had nothing to help them quit successfully. Sure, more token changes were done to make a good showing to their constituents. They banned flavors that no one really bought anyhow while the most profitable flavor - menthol - remained on the market; cartoon characters and other advertising that supposedly influenced children (even though research showed that stress, peer behavior and smoking family members were the largest influence for new smokers) were censored; smoking in public places was banned and any new recreational products containing nicotine were protested and pulled from the market as a "gateway" to smoking. Nicotine, while shown to be relatively harmless absent the tobacco smoke, was simultaneously vilified in the form of any new "reduced harm" smokeless products while being promoted as an "FDA-approved" pharmaceutical treatment.

That's not to say that the earlier, genuine efforts of the government and health organizations didn't have any impact. In the 1950's, more than half of the population in the U.S. smoked cigarettes. 2 As of 2009, that number had been reduced to approximately 21%, but that was an INCREASE from 19.8% in 2007 and it has remained constant since. The CDC placed the blame on state governments putting little or nothing of their $203.5 billion in tobacco-related revenue towards smoking-cessation programs. One has to wonder where all of that money was going instead.3

Of course, by this time there were many more groups making profits from smokers than just Big Tobacco. Federal and state governments now had billions of dollars coming in from the "sin tax." Big Pharma now had a multi-billion dollar per year smoking cessation industry and was donating huge amounts to the anti-smoking groups, who along with the medical community happily peddled their smoking cessation products. Anti-smoking groups, while mostly not for profit, still employed thousands and paid their leaders and lobbyists handsomely. Suddenly, the livelihood of all of these organizations was inextricably tied to tobacco and to smokers continuing to smoke.

So, where did that leave the smokers? Well, they were left with half-hearted attempts to help them quit, costly and ineffective "treatments," life as a social outcast and the privilege paying higher and higher prices to expedite an early death.

Then the electronic cigarette arrived.

Developed by a Chinese inventor in 2003 after his father, a heavy smoker, died of cancer (or so the story goes) the electronic cigarette was already a worldwide, multi-million dollar industry by the time the first shipments hit U.S. shores. While the concept was nothing new, the enterprising Chinese were the first to put it all together in a simple yet brilliant device.

Manufacturers put a small amount of medical-grade nicotine into propylene glycol - which was already recognized as safe by the FDA and the EPA - added appealing flavors and then put the solution in to a cartridge. The user attached the cartridge to a small heating element, which was powered by a cigarette-shaped battery, then inhaled the vapor created by the heated nicotine solution. To complete the illusion, the Chinese cleverly added an LED that lights up when the user inhales from the device. They marketed them to committed smokers - those who had no intention of quitting - as a less hazardous alternative to tobacco cigarettes. Smokers got their (relatively safe) nicotine with the sensations of smoking and without the toxic levels of chemicals and carcinogens found in tobacco smoke.

Seems like win-win, right?

Governments should have been happy that smokers would no longer be overwhelming the health care system. Anti-smoking and healthcare groups should have been happy that smokers would no longer inhaling or exposing bystanders to 4,000 chemicals and 50+ human carcinogens. Big Tobacco should have been happy it could now extract the nicotine from their plants, make their own electronic cigarettes and sell consumers a low-risk, recreational product. Big Pharma had the opportunity to make their own electronic cigarettes, develop a step-down plan and sell consumers a highly effective smoking cessation program.

Smokers would have been happy to satisfy their desire to smoke, without the guilt, cost and health hazards associated with tobacco smoking. Smoking, no longer defined only as burning tobacco leaves, would have been able to step out of the penalty box and back into mainstream society; no longer a public health hazard and as socially acceptable as enjoying a glass of wine or a jolt of espresso. Future generations should have been able to look at their history books and see how humanity made one of the most significant advances for public health in decades.

Instead, history may record that greed once again won out over the public's best interest.

Incredibly, the FDA, numerous state governments and a plethora of health and anti-smoking groups came out in full force AGAINST electronic cigarettes. The results of testing by the FDA and several independent labs, which showed that electronic cigarettes "use the same nicotine, with about the same level of trace contaminants as FDA approved NRT products"4 were twisted or completely ignored. Instead the FDA dramatically announced that the devices "contain carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze" and left the public to assume that the levels found were dangerous to humans.5

The FDA used the publicity to justify its declaration that electronic cigarettes were "unapproved drug delivery devices" and would be blocked from the market until they were shown to meet stringent smoking cessation standards. Public health organizations, followed by state legislators (with a sharp prod from the former), used the FDA announcement as a spring board and called for the immediate removal of electronic cigarettes from the market until they received FDA approval.

The former smokers who now used electronic cigarettes and the current smokers who found out about the devices via the FDA press statement weren't buying the spin though. The number of smokers switching to electronic cigarettes and then becoming "e-cig evangelists" to other smokers continued to rise.

When angry and confused consumers called and emailed groups like the American Lung Association, providing positive testimony of their experience with electronic cigarettes and demanding to know why the groups opposed a product that could save so many lives, they were met with canned responses such as: "The FDA hasn't approved them as smoking cessation devices." "We don't know what's in them." "They found antifreeze and carcinogens in them." "Quitting is better."

All of these answers completely ignored the fact that there had been no reports of injury or illness attributed to electronic cigarettes since they were introduced 5 years earlier; several tests (including the FDA test) had shown that the health risks of electronic cigarettes were comparable to FDA-approved smoking cessation products and tens of thousands times less hazardous than tobacco cigarettes; that electronic cigarettes were intended to be a safer smoking replacement for committed smokers and not a treatment for nicotine addiction; and that anecdotal reports from users claimed that the product was a successful replacement for tobacco smoking and improving their health, unlike the FDA-approved smoking cessation products.

One's first instinct is to ask. "What were they thinking??" But if history is any indication, that question has already been answered. One just needs to "follow the money."

So, today we sit at crossroads. History is being made in public health. All we can do now is imagine how future generations will look back upon the players in tobacco policies today. Will they see them as innovative and forward-thinking public health advocates who embraced a life-saving device or will they be revealed as self-serving and corrupt special interest groups - willing to sacrifice the lives of their fellow citizens in order to make a few bucks?Only time will tell.

1. Centers for Disease Control and Prevention, http://www.cdc.gov/chronicdisease/resources/publications/AAG/osh.htm
2. Smoking Statistics, http://www.smokingstatistics.org/Smoking_Statistics_Since_1950.asp
3. U.S. News and World Report, http://health.usnews.com/health-news/family-health/cancer/articles/2009/11/12/progress-in-stamping-out-smoking-has-stalled.html
4. American Association of Public Health Physicians, http://www.aaphp.org/special/joelstobac/2010/Petition/20100207FDAPetition2.pdf
5. U.S. Food and Drug Administration, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173222.htm