Tuesday, August 23, 2011

Safe sex vs. Safe tobacco

In the 1980's, public health groups began campaigning for "safe" sex. These campaigns promoted the use of condoms to reduce exposure to HIV and AIDS and continue to be used today to promote reduced exposure to other dangerous and debilitating sexually transmitted diseases (STD).

Rarely are the public health benefits of reducing health risks via "safe" sex questioned, even though "safe" sex is a misnomer. A 2001 NIH panel of experts examined dozens of studies and found that proper and consistent condom use reduced the incidence of STDs by 18% to 92%, depending upon the disease in question. At best case, that still leaves an 8% health risk for "safe" sex practices. For the human papilloma virus (HPV) - which has been linked to cervical cancer, the fifth most deadly cancer in the world for women - the harm reduction is even less. 

In reality, condoms contribute to "safer" sex, but do not cause sex to be 100% safe. This does not stop public health groups from promoting "safe" sex to the public and the majority of us agree that it's better to be safer, even if it's not 100% safe. Millions are still spent promoting safe sex practices, even though STDs rarely result in death. In fact, it's reported that 80% of those infected with STDs are asymptomatic and not even aware that they are infected. The CDC reports that around 18,000 people with AIDS and approximately 4,000 women with cervical cancer die annually.

On the other hand, the CDC and other health groups report that "tobacco use" (or more specifically, smoking) causes 440,000 deaths annually in the U.S. (including the highly debated second hand smoke deaths.)  Compared to smoking deaths, mouth cancer, the main health warning for smokeless tobacco use, contributes to only 8,000 deaths annually. However, according to the National Cancer Institute, researchers have been unable to determine how many of those deaths are actually caused by smokeless tobacco use. Based on one 1981 study of female chew users in the southern U.S., the NCI reports that "users of smokeless tobacco are at four times the risk of developing oral cancer than non-users." More recent research shows that smoking actually causes twice the risk of oral cancers (compared to smokeless) and factors such as alcohol abuse and dual use of smoking and smokeless seem to have reduced the link to oral cancer caused by smokeless use alone even further. In fact, the scientific research overwhelmingly shows evidence that smokeless tobacco carries very little to no health risks, at or less than 1% compared to never-users.

In spite of knowledge of this widely known research and the ready acceptance of harm reduction practices for less lethal STDs, public health officials refuse to acknowledge the obvious potential health benefits of promoting harm reduction in the form of smokeless tobacco products. In fact, they go out of their way to convince the public (and smokers) that smokeless products are just as deadly as smoking. While condoms, with a contribution of lowering health risks 18% - 92%, are required by the FDA to inform the public that condoms reduce the risk of STDs, smokeless tobacco products are required to display health warnings such as "This product is not a safe alternative to smoking," or "This product causes oral cancer." Rather than informing smokers that switching to smokeless tobacco would reduce their health risks by 99% or greater, the FDA actually prohibits smokeless tobacco companies from informing the public and forces them to misrepresent the comparative risks, causing the 440,000 people who die from smoking annually to believe that they may as well keep smoking.

Additionally, public health groups continue to lobby legislators to limit or outright ban and/or apply unwarranted "sin taxes" to smokeless products such as snus, lozenges, sticks and strips, claiming "no safe tobacco use" and over unfounded concerns that children and smokers will flock to these less deadly products rather than eschew tobacco products altogether. The concern about youth use is particularly comical, considering that banning these smokeless products would leave no competition for cigarettes, leading curious and reckless youths to smoking tobacco instead of using smokeless and increasing their health risks by 99%. Taxing these products to make them just as expensive as cigarettes also removes further incentive for current smokers - who have no intention of quitting tobacco - to switch to smokeless alternatives.

This insane double standard of approving and encouraging harm reduction for less lethal practices and denying them for tobacco must end. The "abstinence only" approach has resulted in smoking quit rates stagnating at 20% and public health efforts to stop smokeless use as an alternative could result in that percentage increasing again as smokeless products are made less available and more expensive for smokers who have already switched. Not only must the "quit or die" approach be rethought, but public health must stop misleading the public about the health risks and start encouraging inveterate smokers to switch. If they can call an 8% health risk "safe" when it comes to sex, then a less than 1% health risk from smokeless tobacco IS a "safe alternative to smoking." The great dream (lie) of total tobacco abstinence must end. Based on the scientific evidence, the time for tobacco harm reduction must be allowed its turn.

Concerned groups such as the Consumer Advocates for Smoke-free Alternatives Association (CASAA) and TobaccoHarmReduction.org are working to promote "safer" tobacco use. For more information on Tobacco Harm Reduction please visit casaa.org.

Monday, August 15, 2011

American Lung Association continues to misrepresent smokeless risks

The ALA posted an article titled "Is There an Easy Way to Quit?" on it's web site today, which is filled with typically deceptive ANTZ tactics.

Making statements such as  smokeless tobacco has "28 cancer-causing agents" and "increases the risk of developing cancer" and that e-cigarettes contain "cancer-causing agents and toxic chemicals" found in anti-freeze is not only leaving out key information, it relies upon questionable "science" and sensationalism to deceive the reader.
Smokeless Tobacco
Smokeless tobacco includes chewing tobacco, snuff, snus and some other new products. Some people think that using smokeless tobacco is a safe alternative to smoking but that’s not the case. Smokeless tobacco has 28 cancer-causing agents and it increases the risk of developing cancer in the mouth, gums, and pancreas. The amount of nicotine that is absorbed from smokeless tobacco is 3 to 4 times the amount delivered by a cigarette.

The key information left out here is that many products we consume contain "cancer-causing agents." The question is, "How much?" Hot dogs can contain "cancer-causing agents." Whole milk can contain "cancer causing agents." Potato chips and french fries can contain "cancer-causing agents."

Yet we consider these foods to be "safe," because although the "agents" are present, the risk of actually getting cancer from them is extremely low.

While there is a "risk" of developing cancer in the mouth and gums from some smokeless tobacco, the risk is extremely small - somewhere between 0% to 4% - and smokeless snus studies have not shown any increased risk of oral or other cancers. The very few studies linking smokeless tobacco to a very low risk of pancreatic cancer have contradicted themselves, so the link remains inconclusive as to whether or not there is an actual risk at all.

Yet the ALA reports these as established facts and make it sound as though the health risks are great.

Once again the ALA has ignored scientific evidence and used inflammatory language to make something sound worse than it is by reporting the statement made by the FDA rather than the scientific evidence from the actual FDA testing.
There is no scientific evidence establishing the safety of e-cigarettes. The FDA has found that these products contain cancer-causing agents and toxic chemicals, including the ingredients found in anti-freeze. While some distributors directly or indirectly market e-cigarettes for smoking cessation, there is no scientific evidence that demonstrates these products are safe or effective at helping smokers quit.

By this time, anyone who has bothered to read the actual FDA test results knows the truth vs. the spin put out by the FDA. The "cancer-causing agents" discovered in the e-cigarette cartridges tested were found in only one out of the 18 tested, were not found in the actual vapor that is inhaled and were at levels so low they were comparable to the levels of "cancer-causing agents" found in the FDA-approved nicotine patch.

Yet the ALA reports this as though e-cigarettes have been proven to cause cancer and hides the fact that the same levels of "cancer-causing agents" are found in the nicotine patch - which they endorse.

The inflammatory language used to describe the non-toxic amount of diethylene glycol detected (again in just one cartridge and not in the vapor) as "ingredients found in anti-freeze" is pure sensationalism. Diethylene glycol is also found in other FDA-approved products at non-toxic levels. Because the amount found in the one e-cigarette cartridge is so small and not in the actual vapor to which the user is exposed, the user would have to drink the contents of a few thousand cartridges per day in order to reach toxic levels.

Yet the ALA reports the presence of "ingredients found in anti-freeze" as though e-cigarettes have been shown to be just as poisonous as anti-freeze.

So let's see why using the products and methods endorsed by the ALA isn’t a good way to quit:
Nicotine Replacement Products (NRT)
NRTs includes nicotine gum, nicotine patches, nicotine lozenges and nicotine inhalers. Some people think that using NRT is a safe alternative to smoking but that’s not the case. NRT has cancer-causing agents and it increases the risk of developing oral cancer. The amount of nicotine that is absorbed from NRT is much lower than the amount delivered by a cigarette, which may contribute to a failure rate as high as 95%, greatly increasing the risk of relapse to deadly smoking. Nicotine is highly addictive and because these nicotine products are available over the counter to both adults and youth, they are easily abused, contributing to sustained addiction rather than cessation.

Chantix (Varenicline)
There is no scientific evidence establishing the long-term safety or effectiveness of varenicline. The FDA did not review varenicline for the usual 10 month period and it had not been tested in those under 18 years; those with mental illness or pregnant women and therefore is not recommended for use by these groups. The FDA has received reports of "suicidal acts and ideation, psychosis, and hostility or aggression, including homicidal ideation, were the most prominent psychiatric side effects. Multiple reports suggested that varenicline may be related to the loss of glycemic control and new onset of diabetes, heart rhythm disturbances, skin reactions, vision disturbances, seizures, abnormal muscle spasms and other movement disorders."

While some claim varenicline is "safe and effective," only 4.3% more smokers had still quit after one year compared with placebo and over 200 deaths have been linked to varenicline since its release to the public. France's government health insurance no longer subsidizes varenicline prescriptions due to questions about its safety. Canada and Australia have received more than 1,800 reports of adverse events related to varenicline as of May 2010. The number of adverse events associated with varenicline outnumber any other medication monitored by ISMP and more than twice as many deaths have been linked to varenicline than with any other medication currently on the U.S. market.

Really, American Lung Association? Compare all of that to zero reports of serious adverse events linked to e-cigarette use since they were introduced to Europe in 2004 and the U.S. in 2006.

The ALA claims that "Becoming smokefree is anything but simple, yet some folks will try almost anything that promises to a quicker, easier way to quit smoking. You can’t wave a magic wand and suddenly be done with the process of quitting." Yet millions of smokers world-wide, most of whom have tried and failed with the ALA's "safe and effective" methods, are calling e-cigarettes a "miracle" and the "easiest" method they've ever used to remain smoke-free. Sweden, where smokeless snus use is most common, boasts the lowest smoking rates in the E.U. without increased adverse health effects vs. never-smokers.

Any "fact" can be spun to appear to support an agenda. The difference is whether or not the "facts" are based on scientific evidence or if they are based upon junk science and made to sound reliable. Can you tell the difference?
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