CASAA is truly grassroots, not a 'front group'

I recently came across a blog post about e-cigarettes that had this in the comments:

What strikes me about CASAA is that the board is stacked with power players: lawyers, smokeless tobacco lobbyists and web marketing experts. Not a random assortment of Americans, but exactly what a company would seek out as a PR front.

Once I stopped laughing at "stacked with power players" and picked myself up off the floor, I wanted to set the record straight.

CASAA, The Consumer Advocates for Smoke-free Alternatives Association, was formed in 2009 on an online e-cigarette enthusiast forum. Here is a thread discussing the creation of the organization, before it even had a name: ECO - Organization Charter: Administration and here you can see a lot of the democratic process that went into the name and organization. Clearly, CASAA was not formed by e-cigarette or tobacco companies as a "PR front."

My two days in Wisconsin's capitol

Tuesday and Wednesday this week, I drove to Madison (a total of 708 miles for two round trips) to testify before two legislative committees regarding exempting e-cigarettes from indoor smoking bans. These bills (SB 440 and AB 762) seek to clarify that e-cigarette use is not included in the smoking bans and to preempt smaller municipalities from including e-cigarettes in their bans. Believe it or not, after 4 1/2 years with CASAA, this is the first time I've actually had the opportunity to testify regarding e-cigarettes. Happily, this was a bill that I could support.

Medsafe in New Zealand apparently banned cigarettes

According to a recent news story by 3 News in New Zealand, "Medsafe has ruled that nicotine for inhalation is a medicine and insists that more research needs to be done before they can be sold in New Zealand." Based on this criteria, cigarettes - which deliver nicotine (along with 4,000+ other chemicals) for inhalation - are a medicine and are banned for sale.

Curiously, this is not actually the case. While cigarettes, which deliver nicotine for inhalation and are clearly hazardous to public health, remain legal to sell, e-cigarettes containing just nicotine and no toxic levels of any chemicals are banned for sale there.

"It's a start but there's a way to go before, really, there's going to be enough information for us to know about how safe these products are and how effective they are," said Dr. Stewart Jessamine about e-cigarettes.

Dr. Stewart seems to have forgotten that smoking "is the leading cause of preventable death in New Zealand, accounting for around 4300 to 4600 deaths per year." These 4600 smokers obviously could not or would not quit using Medsafe-approved "nicotine medicine" products and will continue to smoke, so why is Medsafe not fast-tracking the research and approval of a product which contains just 3 low-risk main ingredients: nicotine, propylene glycol and food flavoring? A product which has been on the market - world-wide - for several years without any reported serious adverse affects or deaths? How "safe and effective" do they need to be proven to try to prevent those 4300 to 4600 annual smoking-related deaths? How long is "a way to go" to get the information they need? One year? Two years? Or rather just 4600 more deaths? Just 9200 more deaths?

The good news from the article is the study being done by Dr. Chris Bullen at Auckland University, which will hopefully contribute to the reversal of not only Medsafe's e-cigarette policy, but other irresponsible e-cigarette sale bans currently in place around the world.

“We are going to recruit 650 people in New Zealand for this trial, so we think at the end of this study, the evidence will suggest one way or the other, do they help people quit smoking,” said Bullen.

The news piece also included little-publicized information about New Zealand anti-smoking campaigner Dr. Murray Laugesen, who has completed his own tests on e-cigarettes and is convinced that they cause less harm than traditional cigarettes.

"All around the emmissions score for e-cigarettes is about less than 1% of what it is for...an ordinary cigarette," Laugesen said.

Hundreds of thousands of e-cigarette users are reporting success switching from using hazardous traditional cigarettes to e-cigarettes without serious adverse events. Even if they only worked for half of New Zealand's smokers or had only 50% of the health risks of smoking, that could mean 2300 prevented smoking-related deaths a year or more. E-cigarettes can't possibly be any less effective than Chantix (Champix,) with a failure rate of 86% after 12 months nor more dangerous, with hundreds of Chantix-related suicides, murders and heart attacks reported; in the nearly identical time period e-cigarettes have also been on the market with no reports of serious adverse events. In spite of the increasingly obvious unknowns of Chantix, Medsafe continues to endorse its use, while banning another product which has shown no evidence of safety issues.

Luckily, in the U.S., the FDA was stopped short (by court order) of being able to follow in Medsafe's footsteps and treat e-cigarettes as a nicotine medicine, rather than what they really are - a much, much safer alternative to smoking for people who cannot or will not quit using "nicotine as medicine." As a result (and in spite of numerous ANTZ and FDA scare tactics) hundreds of thousands of U.S. smokers have access to a much safer product and are now smoke-free. CASAA is working to keep it that way.

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.