Two recent blog posts by Carl Philips brought to me the realization that reduced-harm researchers may be looking at e-cigarette research all wrong. His first post regarding a recent study by Dr. Michael Siegel got me thinking and the second one critiquing the study actually inspired me to comment.
It seems that even well-meaning researchers don't quite "get" e-cigarettes or their users and that is hampering their efforts to analyze them and their effectiveness.
As I mentioned in my comment on the blog post, e-cigarette users posting on forums (who have successfully switched and are fans) were not necessarily looking to "quit smoking," yet they seem to be the most successful at doing just that. Researchers, however, seem to focus their efforts on smokers who are unfamiliar with e-cigarettes and are looking for a smoking/nicotine cessation alternative rather than a smoking alternative. It seems that after so many years of researching nicotine cessation products that it is difficult even for reduced harm supporters to think outside of the box when it comes to researching a product as unique as electronic cigarettes.
In researching nicotine cessation products, one would obviously want to avoid surveys of "avid fans" of a particular product, as their opinion would be biased due to their satisfaction. Those subjects would also be in a particular segment of the population that was already in the mindset of wanting to quit anything to do with smoking and not indicative of the average smoker. Based upon my observations of the "avid fans" of e-cigarettes, this is not usually the case. Most e-cigarette users posting on forums comment that they specifically were NOT trying to quit. While they may have attempted to quit using traditional NRTs in the past, the most common reasons listed for trying e-cigarettes include saving money, protesting taxes, bypassing indoor use bans and the ability to "smoke" without the same health risks. Many e-cigarette users claim that they "accidentally" quit smoking. No one starts using NRTs without the intention to quit smoking!
Most research that I have seen to date has used test subjects who were looking to quit smoking and/or were previously unfamiliar with e-cigarettes. They were given or questioned about inferior products and had little to no instruction on technique. It's no wonder that they (and researchers) were underwhelmed with the results. Conversely, e-cigarette users who have successfully switched are not your average consumer. They typically purchased "mall brands" (basic and often over-priced e-cigarettes typically found in mall kiosks or through online advertisers), saw the potential and then went online to not only discover better products, but also learned techniques for using and maintaining the devices. In doing so, they have become knowledgeable and biased - precisely the "educated" consumers which researchers would normally avoid. Yet educated consumers are the key to the e-cigarette's success.
Researchers looking to determine the efficacy and safety of e-cigarettes need to take a step back and rethink their modus operandi. Traditional NRTs have an obvious purpose for consumers - to wean smokers from nicotine in order to help them quit smoking. The purpose of e-cigarettes for each individual smoker is less clear - those who try them aren't necessarily looking to quit. So, simply testing them in the same way and with the same pool of subjects as you would traditional NRTs is looking for the answer to the wrong question. Instead of asking, "Is this product a safer and effective smoking cessation product?" they need to ask, "Is this product proving to be a safer and effective smoking alternative?"
Therefore, the best course would be to first study those who have embraced the products, not those who have never used the product or are really looking for an NRT. Look at e-cigarettes not as if they could be successful NRT products but at how they are already being successfully utilized as smoking alternatives. Researchers must to tap into the established e-cigarette community to understand why they are being chosen, how they are successfully being used as reduced harm alternatives and to determine if there have been any adverse health effects with their sustained use. This large pool of subjects can show how e-cigarettes are already being used safely and effectively both to the general public and to the smokers who most need reduced harm alternatives. If researchers look in the right place and ask the right questions, they will find the love.
Saturday, February 12, 2011
Friday, February 11, 2011
A Look at the Family Smoking Prevention and Tobacco Control Act
The FSPTCA seems to directly contradict its purpose to improve the health of smokers. Not only does it perpetuate the myth that ALL tobacco is equally dangerous, it pushes the idea of dependency itself being inherently dangerous, whether or not the addictive chemical is actually a serious health risk.
Direct quotes from the FSPTCA:
Note that it says "tobacco products" and not "smoking," even though smokeless tobacco carries very little risk of cancer, heart disease and other SERIOUS health effects.
Yes, but it does not carry high health risks by itself. The word "addictive" is used in this sentence to say "bad" or "dangerous."
Not including deaths questionably attributed to second-hand smoke, about 16.5% of all annual adult deaths in the U.S. are smokers/ex-smokers who died from smoking-related diseases (393,600 smoker deaths to 2,383,724 total U.S. adult deaths in 2007.) I cannot find data on smokers who died from non-smoking related diseases or natural causes. However, it's interesting to note that while 80-90% of lung cancer patients are smokers, only 10% of smokers actually get lung cancer. The 8,600,000 illnesses equals about 18.2% of smokers having a chronic illness related to smoking, which means 81.8% of smokers do not have smoking-related chronic diseases.
Not sure where I'm going with that one but it is interesting seeing it from a different persepective.
But it's important to note that they don't give actual statistics for smokeless tobacco and nicotine products. They are saying "tobacco" and then only give stats and health effects for "smoking," which intentionally leaves the reader thinking all tobacco use causes the same illnesses and diseases as smoking.
Tobacco dependence ITSELF is a chronic disease?
Definition of disease: "a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment."
Hmmm...didn't realize tobacco grew in my body.
SMOKING can CAUSE disease, but tobacco dependence is not a disease in and of itself. Dependence upon something not normally needed to keep the body healthy/alive would be a DISORDER: "a disturbance in physical or mental health or functions; malady or dysfunction."
Diabetics are dependent upon insulin, but insulin dependence is NOT a disease.
Exposure to radiation can cause disease, but taking risk and working at a job that exposes one to radioactive material is not a disease.
There may be underlying conditions which cause people to be more likely to become dependent upon nicotine/tobacco, but the dependency is not a disease. I suppose the same argument could be made for any chemical dependency.
This sentence is nonsensical and redundant unless you deduct from it that "quit completely" means no tobacco or nicotine use, because isn't the definition of cessation "quit completely?" What this sentence really should say is "Because the only known safe alternative to smoking is to not smoke (cessation), interventions should target all smokers (not "tobacco users") to help them quit smoking completely. "
Well...DUH.
But what they are really saying is that they see no evidence that a smoker who switches to a smokeless alternative will reduce their health risks enough to justify encouraging them to switch and only complete abstinence from tobacco and nicotine is acceptable for them. It doesn't matter that repeated attempts at abstinence means repeated exposure to smoking, while the 1-2% risk from smokeless at least keeps them from smoking.
Well.....DUH again.
Again, they are expecting something to be 100% SAFE for treating tobacco dependence, when other disorders or diseases are usually treated with drugs that are SAFER. No medical treatment can be considered 100% SAFE, because they ALL have risk. This also lumps nicotine use in with smoking. Smokers aren't considered to have "quit completely" unless they quit any form of nicotine.
Reduced harm products are seen as a possible threat - a ruse or fraud by tobacco companies. The criteria that it be considered safe for current non-smokers too makes it nearly impossible to get accepted. How can any tobacco product or even nicotine be considered acceptable for non-smokers to start using, even if it reduced risks to smokers by 99%?
So, the product not only has to reduce risk for smokers, but has to ensure that people who would otherwise avoid nicotine products because of the perceived danger won't start using them because they now perceive them to be low-risk.
This is the theory that the non-tobacco users who will start using low-risk tobacco products will so outnumber the smokers who switch that MORE people have health risks. It completely ignores the level of risks and probability. Here is what it would take for that to happen:
1000 non-users start using 1% risk products = 10 people get sick
10 current users switch to 1% risk products = 9 people get healthier
So, in the above scenario, more people who otherwise wouldn't use tobacco products got sick than people who switched from smoking got better, resulting in an increase in health risks.
The problem is, there is no evidence or even reason to believe that so many non-users will suddenly use and so few users will fail to switch even when given the truth about reduced harm alternatives. But there is no way for a company to guarantee (however unlikely) that non-users won't be at greater risk to the point where it offsets the health benefits of users switching. It's an impossible criteria for approval.
One good thing in the Act which I think was completely unintended:
Hmmm...so if the tobacco companies have research which supports the fact that smokeless tobacco is in fact safer than smoking, they can now not only say that but are REQUIRED to inform people? Awesome!
Sources:
http://www.gpo.gov/fdsys/pkg/PLAW-11...-111publ31.pdf
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf
http://opac.yale.edu/news/article.aspx?id=6138
Direct quotes from the FSPTCA:
A consensus exists within the scientific and medical communities that tobacco products are inherently dangerous and cause cancer, heart disease, and other serious adverse health effects.
Note that it says "tobacco products" and not "smoking," even though smokeless tobacco carries very little risk of cancer, heart disease and other SERIOUS health effects.
Nicotine is an addictive drug.
Yes, but it does not carry high health risks by itself. The word "addictive" is used in this sentence to say "bad" or "dangerous."
Tobacco use is the foremost preventable cause of premature death in America. It causes over 400,000 deaths in the United States each year, and approximately 8,600,000 Americans have chronic illnesses related to smoking.
Not including deaths questionably attributed to second-hand smoke, about 16.5% of all annual adult deaths in the U.S. are smokers/ex-smokers who died from smoking-related diseases (393,600 smoker deaths to 2,383,724 total U.S. adult deaths in 2007.) I cannot find data on smokers who died from non-smoking related diseases or natural causes. However, it's interesting to note that while 80-90% of lung cancer patients are smokers, only 10% of smokers actually get lung cancer. The 8,600,000 illnesses equals about 18.2% of smokers having a chronic illness related to smoking, which means 81.8% of smokers do not have smoking-related chronic diseases.
Not sure where I'm going with that one but it is interesting seeing it from a different persepective.
But it's important to note that they don't give actual statistics for smokeless tobacco and nicotine products. They are saying "tobacco" and then only give stats and health effects for "smoking," which intentionally leaves the reader thinking all tobacco use causes the same illnesses and diseases as smoking.
Tobacco dependence is a chronic disease, one that typically requires repeated interventions to achieve long-term or permanent abstinence.
Tobacco dependence ITSELF is a chronic disease?
Definition of disease: "a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment."
Hmmm...didn't realize tobacco grew in my body.
SMOKING can CAUSE disease, but tobacco dependence is not a disease in and of itself. Dependence upon something not normally needed to keep the body healthy/alive would be a DISORDER: "a disturbance in physical or mental health or functions; malady or dysfunction."
Diabetics are dependent upon insulin, but insulin dependence is NOT a disease.
Exposure to radiation can cause disease, but taking risk and working at a job that exposes one to radioactive material is not a disease.
There may be underlying conditions which cause people to be more likely to become dependent upon nicotine/tobacco, but the dependency is not a disease. I suppose the same argument could be made for any chemical dependency.
Because the only known safe alternative to smoking is cessation, interventions should target all smokers to help them quit completely.
This sentence is nonsensical and redundant unless you deduct from it that "quit completely" means no tobacco or nicotine use, because isn't the definition of cessation "quit completely?" What this sentence really should say is "Because the only known safe alternative to smoking is to not smoke (cessation), interventions should target all smokers (not "tobacco users") to help them quit smoking completely. "
Well...DUH.
But what they are really saying is that they see no evidence that a smoker who switches to a smokeless alternative will reduce their health risks enough to justify encouraging them to switch and only complete abstinence from tobacco and nicotine is acceptable for them. It doesn't matter that repeated attempts at abstinence means repeated exposure to smoking, while the 1-2% risk from smokeless at least keeps them from smoking.
Well.....DUH again.
Again, they are expecting something to be 100% SAFE for treating tobacco dependence, when other disorders or diseases are usually treated with drugs that are SAFER. No medical treatment can be considered 100% SAFE, because they ALL have risk. This also lumps nicotine use in with smoking. Smokers aren't considered to have "quit completely" unless they quit any form of nicotine.
It is essential that the Food and Drug Administration review products sold or distributed for use to reduce risks or exposures associated with tobacco products and that it be empowered to review any advertising and labeling for such products. It is also essential that manufacturers, prior to marketing such products, be required to demonstrate that such products will meet a series of rigorous criteria, and will benefit the health of the population as a whole, taking into account both users of tobacco products and persons who do not currently use tobacco products.
Reduced harm products are seen as a possible threat - a ruse or fraud by tobacco companies. The criteria that it be considered safe for current non-smokers too makes it nearly impossible to get accepted. How can any tobacco product or even nicotine be considered acceptable for non-smokers to start using, even if it reduced risks to smokers by 99%?
Unless tobacco products that purport to reduce the risks to the public of tobacco use actually reduce such risks, those products can cause substantial harm to the public health to the extent that the individuals, who would otherwise not consume tobacco products or would consume such products less, use tobacco products purporting to reduce risk.
So, the product not only has to reduce risk for smokers, but has to ensure that people who would otherwise avoid nicotine products because of the perceived danger won't start using them because they now perceive them to be low-risk.
This is the theory that the non-tobacco users who will start using low-risk tobacco products will so outnumber the smokers who switch that MORE people have health risks. It completely ignores the level of risks and probability. Here is what it would take for that to happen:
1000 non-users start using 1% risk products = 10 people get sick
10 current users switch to 1% risk products = 9 people get healthier
So, in the above scenario, more people who otherwise wouldn't use tobacco products got sick than people who switched from smoking got better, resulting in an increase in health risks.
The problem is, there is no evidence or even reason to believe that so many non-users will suddenly use and so few users will fail to switch even when given the truth about reduced harm alternatives. But there is no way for a company to guarantee (however unlikely) that non-users won't be at greater risk to the point where it offsets the health benefits of users switching. It's an impossible criteria for approval.
One good thing in the Act which I think was completely unintended:
in order to ensure that consumers are better informed, to require tobacco product manufacturers to disclose research which has not previously been made available, as well as research generated in the future, relating to the health and dependency effects or safety of tobacco products;
Hmmm...so if the tobacco companies have research which supports the fact that smokeless tobacco is in fact safer than smoking, they can now not only say that but are REQUIRED to inform people? Awesome!
Sources:
http://www.gpo.gov/fdsys/pkg/PLAW-11...-111publ31.pdf
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf
http://opac.yale.edu/news/article.aspx?id=6138
Wednesday, February 9, 2011
Tobacco Prohibition and a Law of Physics
If tobacco prohibitionists get their way, will it really be a 'win' for public health?
It's pretty obvious that the "anti-smoking" movement, based on the principle that smoking is the "leading cause of preventable deaths" in the world, has changed course. No longer is it only about the health risks of smoking. Unable (and often unwilling) to get smoking products banned in the U.S., these groups now target smokeless tobacco products; making unsubstantiated claims that these products somehow lead to smoking and must be banned to protect public health. They completely ignore, hide and even discourage the substantial research and science that contradicts their claims.
And they don't stop there.
After "wins" of banning rarely sold "flavored" cigarettes and insisting that smokeless products, such as snus and chew, display technically true (yet intentionally misleading) labels which declare that the much safer products are "not a safe alternative to smoking," they have set their sights on nearly harmless nicotine products such as tobacco lozenges and e-cigarettes. They are now somehow convinced that people accustomed to the pleasant taste and low health risks of these nicotine products will suddenly and inexplicably stop using their safer, pleasant-tasting product and switch to the harsh smoke, foul taste and increased health risks of cigarette smoking. Apparently any nicotine product, unless it is made by a pharmaceutical company and designed to get the user to wean off of nicotine, is now taboo. Anti-smoking for health reasons has now become anti-smokeless nicotine for no valid reason at all.
So, what if they get their way? What if tomorrow all tobacco and non-pharmaceutical nicotine products were removed from the market? Would this be the great victory for public health that the health groups claim it will be?
Well, let's look first at why people smoke. Most people will point to the obvious - that people are addicted to the nicotine. So why did they try smoking in the first place? Peer pressure? Parental example? Rebellion? Stress? Those could all be reasons to start. But while millions of people try smoking for various reasons, only a small percentage of them keep smoking. So, why don't they just stop like the others? If it was just that "nicotine is as addictive as heroin" as claimed, why do the vast majority of people who try smoking not become addicted? The most logical answer is that there is something about smoking, tobacco and nicotine that goes beyond the addictive nature of nicotine itself, a theory which is most simply supported by the fact that most nicotine-only products fail to actually keep smokers from smoking.
If it was just the need for nicotine, a piece of nicotine gum would be 100% effective as a tobacco replacement, yet the success rate actually hovers around 7%. Many smokers reportedly miss the mechanics themselves - the taste, the feel, the ritual and the social aspect of smoking. However e-cigarettes, which not only contain nicotine but also mimic the habits and ritual associated with smoking, reportedly still seem to be "missing something" for about 25% of users. Additionally, smokers who have been nicotine and cigarette-free for several years have been known to relapse under certain stressors or triggers - which strongly indicates that smoking is linked just as much to the smoker's mental health and less to simple chemical addiction and habit as thought.
Whether it's chemical or psychological, smokers seem to be predispositioned to smoking for various reasons. In spite of the negative health risks posed by smoking, tobacco and nicotine products seem to provide many benefits similar to various medications. Tobacco or smoking may be a stimulant for some and have a calming, stress-reducing effect on others. Some find it improves cognitive abilities or lessens attention deficit disorders. Others find it keeps them from other oral fixations such as over-eating or compulsive nail biting. The presence of nicotine and other monoamine oxidase inhibitors (MAOIs), which act as anti-depressants, in cigarette smoke suggests that those suffering from mild depression often find relief from tobacco use. Research also shows that an inordinate number of those with schizophrenia or other mental health issues are smokers and may be somehow "self-medicating."
My experience within the e-cigarette community has shown me just how different smokers (and their reasons for smoking) really are. It's reflected in the choices smokers make when actually given a choice with e-cigarettes. Suddenly they can choose the nicotine level, no nicotine, flavors, styles, sizes and the vapor production to best fit their needs. While some e-cigarette users pick up a basic e-cigarette and never have the desire to smoke again, others can't give up tobacco altogether, no matter how high the nicotine content. They seem to need something else found in tobacco other than the smoking habit or nicotine, such as the other tobacco alkaloids or MAOIs. Many in this category find that using a smokeless tobacco such as snus, along with e-cigarettes, can satisfactorily replace smoking. On the other hand, some e-cigarette users just need a higher nicotine content, while others need no nicotine at all - just the look, taste and feel of smoking.
So, smoking seems to be helping people with a great variety of mental health issues and addictive behaviors and the sense of satisfaction is determined by different factors for each individual. The drawback is that this "cure all" comes in such a deadly delivery system. The question is that in trying to keep people from harming themselves with the delivery system, by targeting even low-risk products - such as smokeless tobacco and e-cigarettes - simply because they contain nicotine, will the goal of improving public health really be achieved? What will the people who rely on smoking turn to instead? Will those with oral fixations turn to food and become obese and face other health risks? Will those looking for relief from depression or other mental health issues, smokers who may currently avoid recreational drugs such as marijuana, cocaine, heroin, prescription drugs and even alcohol, turn to even more dangerous behaviors and/or addictions? Will all of these smokers just quit tobacco and nicotine use and somehow be magically cured of all of the underlying issues that caused them to continue smoke in the first place? Is it really reasonable to expect them to stop something that works for them and simply substitute a pharmaceutical drug in its place? Are pharmaceutical drugs really free from risks and side effects themselves? Are those dependent upon tobacco-specific chemicals any more "weak" or "immoral" than those dependent upon pharmaceutical chemicals to get through their day?
The solution to the health issues related to smoking is not to remove access to nicotine and tobacco and hope all of the reasons why smokers smoked go away too. The solution is to develop and make accessible the safer products which can address the real needs of smokers, without passing moral judgment on the product or the user. Smokeless tobacco and e-cigarettes already address many of those issues with very low health risks. The majority of scientific research does not support the claims that their use will lead to smoking, so other than the irrational vilification of tobacco and nicotine and the moral judgment of the user, there is no valid reason to call for their removal.
The likelihood of cigarettes being banned for sale (and without a black market created) is slim to none. Therefore, those affected by the removal of safer tobacco and long-term nicotine products are not only current smokers, but those who for whatever reason may choose to try smoking and find themselves dependent in the future. So long as tobacco cigarettes remain available and so long as there are people who find the benefits outweigh the risks, removing safer options merely increases the health risks for those who may have otherwise sought them out. Smokers and “would-have-been” smokers deprived of all sources of tobacco or nicotine, including low risk products, will likely seek out an alternative for relief that may even more dangerous and detrimental than smoking itself.
Basic physics - for every action there is always an equal and opposite reaction. Considering the likely reaction of a ban on all tobacco and nicotine products, can prohibitionists really forsee that it will result in a "win" for public health?
It's pretty obvious that the "anti-smoking" movement, based on the principle that smoking is the "leading cause of preventable deaths" in the world, has changed course. No longer is it only about the health risks of smoking. Unable (and often unwilling) to get smoking products banned in the U.S., these groups now target smokeless tobacco products; making unsubstantiated claims that these products somehow lead to smoking and must be banned to protect public health. They completely ignore, hide and even discourage the substantial research and science that contradicts their claims.
And they don't stop there.
After "wins" of banning rarely sold "flavored" cigarettes and insisting that smokeless products, such as snus and chew, display technically true (yet intentionally misleading) labels which declare that the much safer products are "not a safe alternative to smoking," they have set their sights on nearly harmless nicotine products such as tobacco lozenges and e-cigarettes. They are now somehow convinced that people accustomed to the pleasant taste and low health risks of these nicotine products will suddenly and inexplicably stop using their safer, pleasant-tasting product and switch to the harsh smoke, foul taste and increased health risks of cigarette smoking. Apparently any nicotine product, unless it is made by a pharmaceutical company and designed to get the user to wean off of nicotine, is now taboo. Anti-smoking for health reasons has now become anti-smokeless nicotine for no valid reason at all.
So, what if they get their way? What if tomorrow all tobacco and non-pharmaceutical nicotine products were removed from the market? Would this be the great victory for public health that the health groups claim it will be?
Well, let's look first at why people smoke. Most people will point to the obvious - that people are addicted to the nicotine. So why did they try smoking in the first place? Peer pressure? Parental example? Rebellion? Stress? Those could all be reasons to start. But while millions of people try smoking for various reasons, only a small percentage of them keep smoking. So, why don't they just stop like the others? If it was just that "nicotine is as addictive as heroin" as claimed, why do the vast majority of people who try smoking not become addicted? The most logical answer is that there is something about smoking, tobacco and nicotine that goes beyond the addictive nature of nicotine itself, a theory which is most simply supported by the fact that most nicotine-only products fail to actually keep smokers from smoking.
If it was just the need for nicotine, a piece of nicotine gum would be 100% effective as a tobacco replacement, yet the success rate actually hovers around 7%. Many smokers reportedly miss the mechanics themselves - the taste, the feel, the ritual and the social aspect of smoking. However e-cigarettes, which not only contain nicotine but also mimic the habits and ritual associated with smoking, reportedly still seem to be "missing something" for about 25% of users. Additionally, smokers who have been nicotine and cigarette-free for several years have been known to relapse under certain stressors or triggers - which strongly indicates that smoking is linked just as much to the smoker's mental health and less to simple chemical addiction and habit as thought.
Whether it's chemical or psychological, smokers seem to be predispositioned to smoking for various reasons. In spite of the negative health risks posed by smoking, tobacco and nicotine products seem to provide many benefits similar to various medications. Tobacco or smoking may be a stimulant for some and have a calming, stress-reducing effect on others. Some find it improves cognitive abilities or lessens attention deficit disorders. Others find it keeps them from other oral fixations such as over-eating or compulsive nail biting. The presence of nicotine and other monoamine oxidase inhibitors (MAOIs), which act as anti-depressants, in cigarette smoke suggests that those suffering from mild depression often find relief from tobacco use. Research also shows that an inordinate number of those with schizophrenia or other mental health issues are smokers and may be somehow "self-medicating."
My experience within the e-cigarette community has shown me just how different smokers (and their reasons for smoking) really are. It's reflected in the choices smokers make when actually given a choice with e-cigarettes. Suddenly they can choose the nicotine level, no nicotine, flavors, styles, sizes and the vapor production to best fit their needs. While some e-cigarette users pick up a basic e-cigarette and never have the desire to smoke again, others can't give up tobacco altogether, no matter how high the nicotine content. They seem to need something else found in tobacco other than the smoking habit or nicotine, such as the other tobacco alkaloids or MAOIs. Many in this category find that using a smokeless tobacco such as snus, along with e-cigarettes, can satisfactorily replace smoking. On the other hand, some e-cigarette users just need a higher nicotine content, while others need no nicotine at all - just the look, taste and feel of smoking.
So, smoking seems to be helping people with a great variety of mental health issues and addictive behaviors and the sense of satisfaction is determined by different factors for each individual. The drawback is that this "cure all" comes in such a deadly delivery system. The question is that in trying to keep people from harming themselves with the delivery system, by targeting even low-risk products - such as smokeless tobacco and e-cigarettes - simply because they contain nicotine, will the goal of improving public health really be achieved? What will the people who rely on smoking turn to instead? Will those with oral fixations turn to food and become obese and face other health risks? Will those looking for relief from depression or other mental health issues, smokers who may currently avoid recreational drugs such as marijuana, cocaine, heroin, prescription drugs and even alcohol, turn to even more dangerous behaviors and/or addictions? Will all of these smokers just quit tobacco and nicotine use and somehow be magically cured of all of the underlying issues that caused them to continue smoke in the first place? Is it really reasonable to expect them to stop something that works for them and simply substitute a pharmaceutical drug in its place? Are pharmaceutical drugs really free from risks and side effects themselves? Are those dependent upon tobacco-specific chemicals any more "weak" or "immoral" than those dependent upon pharmaceutical chemicals to get through their day?
The solution to the health issues related to smoking is not to remove access to nicotine and tobacco and hope all of the reasons why smokers smoked go away too. The solution is to develop and make accessible the safer products which can address the real needs of smokers, without passing moral judgment on the product or the user. Smokeless tobacco and e-cigarettes already address many of those issues with very low health risks. The majority of scientific research does not support the claims that their use will lead to smoking, so other than the irrational vilification of tobacco and nicotine and the moral judgment of the user, there is no valid reason to call for their removal.
The likelihood of cigarettes being banned for sale (and without a black market created) is slim to none. Therefore, those affected by the removal of safer tobacco and long-term nicotine products are not only current smokers, but those who for whatever reason may choose to try smoking and find themselves dependent in the future. So long as tobacco cigarettes remain available and so long as there are people who find the benefits outweigh the risks, removing safer options merely increases the health risks for those who may have otherwise sought them out. Smokers and “would-have-been” smokers deprived of all sources of tobacco or nicotine, including low risk products, will likely seek out an alternative for relief that may even more dangerous and detrimental than smoking itself.
Basic physics - for every action there is always an equal and opposite reaction. Considering the likely reaction of a ban on all tobacco and nicotine products, can prohibitionists really forsee that it will result in a "win" for public health?
Saturday, January 29, 2011
Discovery News: How safe are e-cigarettes?
Discovery News recently published an online article regarding e-cigarettes.
Amongst other things, e-cigarette opponents continue make the claims that while they somehow know nothing about what is in e-cigarettes, in spite of 16 different reports available to them, e-cigarettes are probably more dangerous than tobacco cigarettes and are a threat to our youth. In case you don't buy their claim about safety, they argue that being addicted to anything is the problem, regardless of whether or not the product actually has been shown to have little or no health risks.
Prue Talbot is being sneaky by accusing all of those available e-cigarette studies as being suspect because they are paid for by companies. She's banking on the fact that most Americans don't realize that all of the tests and studies submitted to the FDA for approval are also paid for by the companies. That is the only way to get them tested. Who else is going to pay for them?
New York Assemblywoman Linda Rosenthal has ignored the plethora of reports emailed, faxed and mailed to her and continues to claim that e-cigarettes "are a mystery," and yet, claims that e-cigarettes contain chemicals which are more dangerous than those found in tobacco cigarettes. If they are a mystery, how does she know there are dangerous chemicals? She insists if she could quit that anyone could quit, completely ignoring the multitude of correspondence from e-cigarette users that they couldn't quit using any other method or don't wish to give up nicotine and shouldn't have to. Rosenthal snidely remarks, "If people want the easy way to just get addicted to another nicotine delivery system, I hope soon they'll have to look elsewhere." Given that e-cigarette users have told her that they have tried everything else, she seems unmoved by the fact that it leaves tobacco cigarettes as their only option.
Dr. Siegel's e-cigarette research paper clearly shows that there is nothing in e-cigarettes to make them even remotely as dangerous as tobacco cigarettes. The 4 ingredients in e-cigarettes - nicotine, propylene glycol, glycerine and artificial flavoring - are already found in tobacco cigarettes, yet e-cigarettes lack the toxic chemicals and high levels of carcinogens found in tobacco cigarettes. It's like claiming non-alcoholic beer "may" be as intoxicating (and therefore equally or more dangerous) as real beer because they both have bubbles, malt and barley. There is simply no logic to the argument.
The FDA study Talbot and Rosenthal cite found that one cartridge of eighteen was contaminated with a non-toxic amount of diethylene glycol and that the levels of carcinogens were as low as the nicotine patch. Diethylene glycol has not been found in any e-cigarettes since. If anything, the FDA test proved that there were no toxic amounts of any chemicals and extremely low carcinogens. Yet they disingenuously claim that there is a great danger to the public. If the carcinogens and non-toxic chemicals found in e-cigarettes are a danger, why are they still selling the patch?
Additionally, the double-speak of e-cigarette opponents is painfully obvious. They claim tasty flavors are a scheme to attract youth to e-cigarettes, yet ignore the fact that pharmaceutical nicotine gum and lozenges come in Cinnamon Surge, Fruit Chill, Fresh Mint, Cherry and Cappuccino flavors. Additionally, youth smoking is on the rise even though flavored cigarettes have been banned since 2006. Youth aren't anymore attracted to "safer" e-cigarettes than they are to tasty pharmaceutical gums and lozenges. Surveys of thousands of e-cigarette users found that the vast majority are former smokers between 35 and 65 years old. There is absolutely no evidence that young adults, and therefore copy cat teens, are even interested in the start-up costs and maintenance involved with e-cigarettes. It's much easier, cheaper and more "cool" to buy a pack of cigarettes.
Prue Talbot's study found leaky cartridges and inaccurate labeling. Ironically, she didn't bother to test e-cigarettes to find out what was actually in them. If quality control is an issue, then address those companies which get a failing mark, but don't throw the baby out with the bath water. The FDA has the power to regulate quality and safer designs by classifying e-cigarettes as tobacco products rather than continuing its quixotic charge to classify them as nicotine addiction treatments. This would also automatically ban sales to minors.
These simply aren't a treatment for nicotine addiction. The vast majority use them as an alternative source of nicotine that still gives them the smoking experience without the high health risks. There is nothing else on the market that can simultaneously provide relief for nicotine addiction, greatly reduce health risks and simulate smoking. If they didn't have e-cigarettes, most users would still be using tobacco cigarettes - not gums and patches. E-cigarettes are not an alternative for gums and patches, they are an alternative for tobacco cigarettes. These folks don't want to quit nicotine, they just want to quit smoking. Once people like Linda Rosenthal, Prue Talbot and their supporters get that through their thick skulls, they'll understand why their crusade is fundamentally wrong.
Let's remember that the anti-tobacco movement started because of the high health hazards linked to smoking, not the extremely low health risks of smokeless nicotine addiction. E-cigarette users may remain addicted to nicotine, but the only reason they would ever return to smoking is if these "well-meaning" anti-smoking zealots ban e-cigarettes and leave tobacco cigarettes as their only option.
Join CASAA.org and fight this insanity!
Amongst other things, e-cigarette opponents continue make the claims that while they somehow know nothing about what is in e-cigarettes, in spite of 16 different reports available to them, e-cigarettes are probably more dangerous than tobacco cigarettes and are a threat to our youth. In case you don't buy their claim about safety, they argue that being addicted to anything is the problem, regardless of whether or not the product actually has been shown to have little or no health risks.
Prue Talbot is being sneaky by accusing all of those available e-cigarette studies as being suspect because they are paid for by companies. She's banking on the fact that most Americans don't realize that all of the tests and studies submitted to the FDA for approval are also paid for by the companies. That is the only way to get them tested. Who else is going to pay for them?
New York Assemblywoman Linda Rosenthal has ignored the plethora of reports emailed, faxed and mailed to her and continues to claim that e-cigarettes "are a mystery," and yet, claims that e-cigarettes contain chemicals which are more dangerous than those found in tobacco cigarettes. If they are a mystery, how does she know there are dangerous chemicals? She insists if she could quit that anyone could quit, completely ignoring the multitude of correspondence from e-cigarette users that they couldn't quit using any other method or don't wish to give up nicotine and shouldn't have to. Rosenthal snidely remarks, "If people want the easy way to just get addicted to another nicotine delivery system, I hope soon they'll have to look elsewhere." Given that e-cigarette users have told her that they have tried everything else, she seems unmoved by the fact that it leaves tobacco cigarettes as their only option.
Dr. Siegel's e-cigarette research paper clearly shows that there is nothing in e-cigarettes to make them even remotely as dangerous as tobacco cigarettes. The 4 ingredients in e-cigarettes - nicotine, propylene glycol, glycerine and artificial flavoring - are already found in tobacco cigarettes, yet e-cigarettes lack the toxic chemicals and high levels of carcinogens found in tobacco cigarettes. It's like claiming non-alcoholic beer "may" be as intoxicating (and therefore equally or more dangerous) as real beer because they both have bubbles, malt and barley. There is simply no logic to the argument.
The FDA study Talbot and Rosenthal cite found that one cartridge of eighteen was contaminated with a non-toxic amount of diethylene glycol and that the levels of carcinogens were as low as the nicotine patch. Diethylene glycol has not been found in any e-cigarettes since. If anything, the FDA test proved that there were no toxic amounts of any chemicals and extremely low carcinogens. Yet they disingenuously claim that there is a great danger to the public. If the carcinogens and non-toxic chemicals found in e-cigarettes are a danger, why are they still selling the patch?
Additionally, the double-speak of e-cigarette opponents is painfully obvious. They claim tasty flavors are a scheme to attract youth to e-cigarettes, yet ignore the fact that pharmaceutical nicotine gum and lozenges come in Cinnamon Surge, Fruit Chill, Fresh Mint, Cherry and Cappuccino flavors. Additionally, youth smoking is on the rise even though flavored cigarettes have been banned since 2006. Youth aren't anymore attracted to "safer" e-cigarettes than they are to tasty pharmaceutical gums and lozenges. Surveys of thousands of e-cigarette users found that the vast majority are former smokers between 35 and 65 years old. There is absolutely no evidence that young adults, and therefore copy cat teens, are even interested in the start-up costs and maintenance involved with e-cigarettes. It's much easier, cheaper and more "cool" to buy a pack of cigarettes.
Prue Talbot's study found leaky cartridges and inaccurate labeling. Ironically, she didn't bother to test e-cigarettes to find out what was actually in them. If quality control is an issue, then address those companies which get a failing mark, but don't throw the baby out with the bath water. The FDA has the power to regulate quality and safer designs by classifying e-cigarettes as tobacco products rather than continuing its quixotic charge to classify them as nicotine addiction treatments. This would also automatically ban sales to minors.
These simply aren't a treatment for nicotine addiction. The vast majority use them as an alternative source of nicotine that still gives them the smoking experience without the high health risks. There is nothing else on the market that can simultaneously provide relief for nicotine addiction, greatly reduce health risks and simulate smoking. If they didn't have e-cigarettes, most users would still be using tobacco cigarettes - not gums and patches. E-cigarettes are not an alternative for gums and patches, they are an alternative for tobacco cigarettes. These folks don't want to quit nicotine, they just want to quit smoking. Once people like Linda Rosenthal, Prue Talbot and their supporters get that through their thick skulls, they'll understand why their crusade is fundamentally wrong.
Let's remember that the anti-tobacco movement started because of the high health hazards linked to smoking, not the extremely low health risks of smokeless nicotine addiction. E-cigarette users may remain addicted to nicotine, but the only reason they would ever return to smoking is if these "well-meaning" anti-smoking zealots ban e-cigarettes and leave tobacco cigarettes as their only option.
Join CASAA.org and fight this insanity!
Sunday, January 23, 2011
New York at it again - your state could be next!
The New York State Assembly Health Committee is meeting this coming Tuesday to discuss Bill AO1468.
This bill would not only ban the sale of electronic cigarettes to minors, but proposes to ban sales of any products which contain nicotine that are "not defined by law as a tobacco product or approved by the United States food and drug administration for sale as a tobacco use cessation or harm reduction product." This of course has the intended effect of banning e-cigarettes, because although the U.S. Appellate Court has supported Federal Judge Richard Leon's opinion that e-cigarettes should be regulated by the FDA as a tobacco product, the FDA still refuses to do so. Because consumers are replacing tobacco cigarettes with e-cigarettes and feel that they have "quit smoking," the FDA's stance is that makes them a drug delivery device, even though the majority users have not quit nicotine at all - just smoking. Last I knew, nicotine addiction was considered the disease, not how you got your nicotine. Quitting smoking and quitting nicotine are two very different issues.
The justification for this proposed change in the New York law is
First, let's look at the claim that e-cigarette companies fail to advertise the FDA testing. The FDA tested just two brands of electronic cigarettes. Why would other companies have to claim that the FDA testing had any relevance to their product, as their product wasn't tested by the FDA? The diethylene glycol was found in just one of the 18 tested cartridges and has not been found in any other independent tests of ANY e-cigarette brands. Additionally, neither the FDA nor any other lab has found toxic levels of ANY chemical in e-cigarettes. Expecting companies to tell consumers that there are "toxic chemicals" and "diethylene glycol" in their products is like expecting the makers of Skippy peanut butter to tell consumers there is salmonella in their product because another brand of peanut butter was once contaminated with salmonella.
Claiming that users inhale carcinogens is nothing but hypocritical spin. Are pharmaceutical companies required to warn nicotine patch users that they are "absorbing carcinogens?" The FDA tests showed that the extremely low level of carcinogens (tobacco-specific nitrosamines) found in their e-cigarette samples were nearly identical to the levels found in the FDA-approved nicotine patch. So, if those extremely low levels are of concern in e-cigarettes, they should also be of concern for nicotine patch users. In reality, if e-cigarette companies were actually allowed to report what the FDA really found, rather than the spin the FDA presented to the public, they would be able to show that the FDA tests actually showed e-cigarettes to be non-toxic and no more carcinogenic than the nicotine patch. Somehow, I don't think that's what those proposing this bull - er - bill have in mind.
This bill also pulls out the tried-and-true "save the children" tactics. These are completely unsubstantiated claims that these products appeal to and are targeted at youth. They completely ignore surveys of thousands of e-cigarette users which show the average user to be closer to 40 than 14 and offer absolutely no examples of actual sales to minors. The claim that chocolate and mint flavors are intended to "appeal to all segments of the population" (read "kids") is really saying nothing. What product doesn't try to appeal to as many consumers as possible? Additionally, nicotine gums and lozenges come in Cherry, Cappuccino, Fresh Mint, Fruit Chill and Cinnamon Surge. The Nicorette site says their products have "been developed with palatable flavors" and "sweetened with sorbitol," (another trusted product.) One can only surmise this is to make their products more appealing to all segments of the population, as well, yet no one accuses Glaxo SmithKline of marketing to youth.
The bill sponsors want e-cigarettes to come with warnings, but as of yet, there have been no serious adverse effects reported linked to e-cigarette use. The irony being, of course, that tobacco cigarettes do come with warnings and have been linked to serious health risks, yet remain perfectly legal. If New York legislators get their way they will have successfully banned a low-carcinogen, non-toxic product - one which also has been reported by thousands of users to have provided improved health benefits - and protected the market share of tobacco cigarettes.
Finally, if the FDA would have given up this quixotic charge to classify e-cigarettes as a drug delivery device (rather than an alternative tobacco product) months ago, they could already have e-cigarettes subject to the same regulations as other tobacco products - complete with warning labels and banning sales to minors. It's the FDA's own obsessive behavior, unable to move on even after losing on appeal, which has kept e-cigarettes completely unregulated!
Your tax dollars in action.
This bill would not only ban the sale of electronic cigarettes to minors, but proposes to ban sales of any products which contain nicotine that are "not defined by law as a tobacco product or approved by the United States food and drug administration for sale as a tobacco use cessation or harm reduction product." This of course has the intended effect of banning e-cigarettes, because although the U.S. Appellate Court has supported Federal Judge Richard Leon's opinion that e-cigarettes should be regulated by the FDA as a tobacco product, the FDA still refuses to do so. Because consumers are replacing tobacco cigarettes with e-cigarettes and feel that they have "quit smoking," the FDA's stance is that makes them a drug delivery device, even though the majority users have not quit nicotine at all - just smoking. Last I knew, nicotine addiction was considered the disease, not how you got your nicotine. Quitting smoking and quitting nicotine are two very different issues.
The justification for this proposed change in the New York law is
Recent advertisements have touted "e-cigarettes" as a healthier alternative to traditional tobacco consumption and as a tobacco cessation product. These electronic cigarettes are battery-operated devices that vaporize cartridges filled with nicotine, flavor and other chemicals that the user inhales. Advertisements for these products omit any mention of FDA testing that found users inhale carcinogens and toxic chemicals such as diethylene glycol, an ingredient found in antifreeze.
Given the unregulated nature of this product, there is no way of knowing the amount of nicotine in each cigarette, the amount that is delivered with each inhalation, or the contents of the vapor created in the process. "E-cigarettes" are often marketed and sold to young people and are readily available online and in shopping malls. They are produced in different flavors, such as chocolate and mint, in order to increase their appeal to all segments of the population. These products also lack any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes. These devices are often made overseas in countries with less stringent standards for product quality than exist in the United States.
First, let's look at the claim that e-cigarette companies fail to advertise the FDA testing. The FDA tested just two brands of electronic cigarettes. Why would other companies have to claim that the FDA testing had any relevance to their product, as their product wasn't tested by the FDA? The diethylene glycol was found in just one of the 18 tested cartridges and has not been found in any other independent tests of ANY e-cigarette brands. Additionally, neither the FDA nor any other lab has found toxic levels of ANY chemical in e-cigarettes. Expecting companies to tell consumers that there are "toxic chemicals" and "diethylene glycol" in their products is like expecting the makers of Skippy peanut butter to tell consumers there is salmonella in their product because another brand of peanut butter was once contaminated with salmonella.
Claiming that users inhale carcinogens is nothing but hypocritical spin. Are pharmaceutical companies required to warn nicotine patch users that they are "absorbing carcinogens?" The FDA tests showed that the extremely low level of carcinogens (tobacco-specific nitrosamines) found in their e-cigarette samples were nearly identical to the levels found in the FDA-approved nicotine patch. So, if those extremely low levels are of concern in e-cigarettes, they should also be of concern for nicotine patch users. In reality, if e-cigarette companies were actually allowed to report what the FDA really found, rather than the spin the FDA presented to the public, they would be able to show that the FDA tests actually showed e-cigarettes to be non-toxic and no more carcinogenic than the nicotine patch. Somehow, I don't think that's what those proposing this bull - er - bill have in mind.
This bill also pulls out the tried-and-true "save the children" tactics. These are completely unsubstantiated claims that these products appeal to and are targeted at youth. They completely ignore surveys of thousands of e-cigarette users which show the average user to be closer to 40 than 14 and offer absolutely no examples of actual sales to minors. The claim that chocolate and mint flavors are intended to "appeal to all segments of the population" (read "kids") is really saying nothing. What product doesn't try to appeal to as many consumers as possible? Additionally, nicotine gums and lozenges come in Cherry, Cappuccino, Fresh Mint, Fruit Chill and Cinnamon Surge. The Nicorette site says their products have "been developed with palatable flavors" and "sweetened with sorbitol," (another trusted product.) One can only surmise this is to make their products more appealing to all segments of the population, as well, yet no one accuses Glaxo SmithKline of marketing to youth.
The bill sponsors want e-cigarettes to come with warnings, but as of yet, there have been no serious adverse effects reported linked to e-cigarette use. The irony being, of course, that tobacco cigarettes do come with warnings and have been linked to serious health risks, yet remain perfectly legal. If New York legislators get their way they will have successfully banned a low-carcinogen, non-toxic product - one which also has been reported by thousands of users to have provided improved health benefits - and protected the market share of tobacco cigarettes.
Finally, if the FDA would have given up this quixotic charge to classify e-cigarettes as a drug delivery device (rather than an alternative tobacco product) months ago, they could already have e-cigarettes subject to the same regulations as other tobacco products - complete with warning labels and banning sales to minors. It's the FDA's own obsessive behavior, unable to move on even after losing on appeal, which has kept e-cigarettes completely unregulated!
Your tax dollars in action.
Wednesday, October 27, 2010
SmokeFree Wisconsin Misleading Public about Orbs risk
SmokeFree Wisconsin posted a convincing blog post implying to consumers that Camel Orbs carry a high risk of cancer, based on facts culled from a CDC report on smokeless tobacco.
What SmokeFree Wisconsin fails to tell consumers is that report is based on old-fashioned chew and snuff, NOT newer products such as lozenges, strips, sticks and snus.
Stating simply that "smokeless tobacco contains 28 known, cancer-causing toxins," is misleading and a half-truth. The CDC made this declaration about chew and snuff based mostly on a 2007 WHO report, "Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines." The tobacco products they analyzed were not the refined, fine tobacco used in Orbs and other newer smokeless tobacco products. The same levels of nitrosamines (TSNAs) found in those products have not been found in products such as Orbs and snus.
In fact, in June 2010, the Canadian Non-Smokers' Rights Association endorsed tobacco harm reduction, including the use of products such as Orbs, snus and electronic cigarettes. They released NSRA Harm Reduction Policy Analysis June-2010* which showed the true risks of cancer associated with such products were minimal, if not non-existent. Mind you - this is a report by an organization concerned for non-smokers' rights:
The report also warns that comparing products such as snus and Orbs with smokeless chew and snuff are misleading:
The report goes on to discuss lozenges very similar to Orbs:
While the pellets may contain higher amounts of nicotine, the average nicotine user tends to "self-regulate" and would simply use less pellets than they would smoke. The craving for nicotine subsides after exposure, so the user would be less likely to use as many Orbs as they would cigarettes. Additionally, the nicotine content in cigarettes varies just as widely and the low nicotine content in NRTs such as nicotine gums, lozenges and patches make them highly ineffective as a substitute for smoking.
Of course, none of these products should be in the hands of children, but claiming that these products are "not a safe alternative to cigarettes" belies the truth that they are a SAFER alternative to smoking and misleads the public into believing that smokers would not have any health benefit by switching. However, even if these smokeless products still have a 1-2% risk of adverse health effects, that still makes them 98-99% less risky than smoking.
As the Canadian report urges:
SmokeFree Wisconsin apparently believes that Wisconsin consumers do not deserve the same right.
If SmokeFree Wisconsin is truly concerned about nicotine products getting into the hands of children, they should also warn parents of another candy-like nicotine product. This product is white (Orbs are brown) and looks EXACTLY like a Tic Tac. They even have those "quitting sucks" commercials with a shark attack and other humorous scenarios that kids think are funny.
Meet the Nicotrette Mini:
Nice "trick" SmokeFree Wisconsin.
*NOTE: The NSRA Harm Reduction Policy Analysis June-2010 also has positive comments on E-cigarettes. I highly recommend reading this report for many facts about tobacco harm reduction.
What SmokeFree Wisconsin fails to tell consumers is that report is based on old-fashioned chew and snuff, NOT newer products such as lozenges, strips, sticks and snus.
Stating simply that "smokeless tobacco contains 28 known, cancer-causing toxins," is misleading and a half-truth. The CDC made this declaration about chew and snuff based mostly on a 2007 WHO report, "Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines." The tobacco products they analyzed were not the refined, fine tobacco used in Orbs and other newer smokeless tobacco products. The same levels of nitrosamines (TSNAs) found in those products have not been found in products such as Orbs and snus.
In fact, in June 2010, the Canadian Non-Smokers' Rights Association endorsed tobacco harm reduction, including the use of products such as Orbs, snus and electronic cigarettes. They released NSRA Harm Reduction Policy Analysis June-2010* which showed the true risks of cancer associated with such products were minimal, if not non-existent. Mind you - this is a report by an organization concerned for non-smokers' rights:
The risk of oral cancer varies by type of smokeless tobacco product and is much greater for dry snuff than for moist snuff. The relative risk of oral cancer from use of dry snuff is 5.9 compared to 1.2 from chewing tobacco and 1.0 from moist snuff.37 A meta-analysis in 2007 concluded that the type of smokeless tobacco used in America or Europe “carries at most a minor increased risk of oral cancer.”38 The Royal College of Physicians has concluded that “the risk of oral cancer associated with use of low-TSNA tobacco products such as Swedish snus is small, and possibly non-existent.”39
The report also warns that comparing products such as snus and Orbs with smokeless chew and snuff are misleading:
When considering studies of the health risks of smokeless tobacco, it is important to distinguish between smokeless products such as traditional spit and chew (in Canada the most popular brands are Copenhagen and Skoal) and Swedish-style snus. Most studies of the health risks of smokeless tobacco use do not make the distinction between snus and other forms of smokeless tobacco.
• Oral cancer
– The risk of oral cancer varies according to the type of smokeless tobacco. Two Swedish studies found no elevated risk of oral cancer from snus use, and the findings constituted the grounds for the removal of the oral cancer warning from snus products in Sweden in 2001.50
• Leukoplakia
– There is a very high rate of leukoplakia development from snus use, much higher than with other forms of smokeless tobacco; however, the lesions are mostly due to irritation and only rarely progress to oral cancer.51
• Heart disease
– There are very few studies of the risk of heart disease from use of Swedish snus that also correct for possible confounding variables, including smoking and exposure to second-hand smoke. Of six studies of risks of heart attack risk among long-term Swedish snus users, only one found an increased risk, and five found no increased risk over never tobacco users.52 A meta-analysis in 2009 of eleven studies, eight in Sweden and three in the US, provides consistent evidence of a small increase in risk of fatal heart attack and stroke, with no evidence of a difference in effect of the smokeless products.
The report goes on to discuss lozenges very similar to Orbs:
Small manufacturer Star Scientific has been selling two forms of dissolvable tobacco product for several years—Ariva, targeting cigarette smokers, and Stonewall, aimed at users of smokeless tobacco. Both products come in the form of a small pellet, slightly larger than a Tic Tac mint.59
Ariva and Stonewall have levels of TSNAs similar to Swedish snus.60
While the pellets may contain higher amounts of nicotine, the average nicotine user tends to "self-regulate" and would simply use less pellets than they would smoke. The craving for nicotine subsides after exposure, so the user would be less likely to use as many Orbs as they would cigarettes. Additionally, the nicotine content in cigarettes varies just as widely and the low nicotine content in NRTs such as nicotine gums, lozenges and patches make them highly ineffective as a substitute for smoking.
Of course, none of these products should be in the hands of children, but claiming that these products are "not a safe alternative to cigarettes" belies the truth that they are a SAFER alternative to smoking and misleads the public into believing that smokers would not have any health benefit by switching. However, even if these smokeless products still have a 1-2% risk of adverse health effects, that still makes them 98-99% less risky than smoking.
As the Canadian report urges:
The public has the right...to accurate information about the relative risks of using tobacco products and to make choices based on the facts. The current warning on smokeless tobacco products, “This product is not a safe alternative to smoking,” is woefully inadequate as it provides no information regarding relative risks.
SmokeFree Wisconsin apparently believes that Wisconsin consumers do not deserve the same right.
If SmokeFree Wisconsin is truly concerned about nicotine products getting into the hands of children, they should also warn parents of another candy-like nicotine product. This product is white (Orbs are brown) and looks EXACTLY like a Tic Tac. They even have those "quitting sucks" commercials with a shark attack and other humorous scenarios that kids think are funny.
Meet the Nicotrette Mini:
Nice "trick" SmokeFree Wisconsin.
*NOTE: The NSRA Harm Reduction Policy Analysis June-2010 also has positive comments on E-cigarettes. I highly recommend reading this report for many facts about tobacco harm reduction.
Tuesday, June 1, 2010
Memorial Day and the Myth of Nicotine
This holiday weekend I had the opportunity to speak to my husband's aunt regarding electronic cigarettes. She was smoking and showed interest. Ever the e-cig evangelist, I excitedly told her of the advantages of smokefree alternatives.
To my utter dismay, she told me her doctor had given her a prescription for a "low nicotine" or "no nicotine" cigarette, claiming that the nicotine was the dangerous component of smoking. (After an extensive Google search, I couldn't find a "prescription no/low nicotine cigarette," so I've concluded she meant a Nicotrol Inhaler.)
It took me several attempts to get her to understand that nicotine, absent the smoke, is relatively safe. "It's the smoke that contains all of the toxins," I told her. She was shocked, as the vilification of nicotine by the anti-tobacco groups had completely convinced her that nicotine is what killed people.
That led, of course, to a discussion about smoke-free tobacco and another surprise revelation - that smoke-free tobacco is up to 99% safer than smoking cigarettes. The real shock for her was finding out that the risk of mouth and throat cancer was actually up to 50% less than the risk from smoking. As with other typically brainwashed consumers, she believed that smokeless tobacco products actually had a HIGHER risk of mouth/throat cancer. To add to the irony, she had discouraged her occasional-smoker son from using oral tobacco, not because of the perceived health risks, but to prevent damage to his costly dental work. Consequently, he remained an occasional smoker, when simple, good dental hygiene would have reduced his health risks by 99%.
Finally, she told me that she never filled the prescription from her doctor, because insurance didn't cover it and just 30 doses cost $35. So, she continues smoking. After informing her of the truth about the health benefits of smokeless alternatives and electronic cigarettes and especially the low cost, she was quite interested in getting information on how to order.
This whole conversation graphically illustrated the tragic consequences of the lies and myths perpetuated by the groups calling themselves "public health." A 50-something year old woman, who knows that she should quit smoking for her health and well-being, would have been willing to switch to a less hazardous product had she known the facts. "Public health" failed her. Their scare tactics failed to inspire her to quit, their costly "treatments" were out of her financial means and their refusal to endorse reduced harm tobacco products (in a prohibitionist belief that any kind of nicotine use is unacceptable) needlessly exposed her to the most harmful tobacco product available.
It's my hope that groups like CASAA, the Consumer Advocates for Smoke-free Alternatives Association, will be able to fill the huge gap left by the tobacco control and public health groups, by educating committed smokers and giving them the tools and knowledge to make informed decisions about their health and well-being.
If my conversation with my husband's aunt is any indication, the myth of nicotine as the killer in cigarettes continues to be pervasive and persuasive and that is what continues killing people.
The concept of reduced harm tobacco has been around for at least 15 years. In that time, public health and tobacco control have had the opportunity to save many lives. This Memorial Day, I found myself thinking of the 6.6 million smokers who died because of the prohibitionist agenda of "public health."
To my utter dismay, she told me her doctor had given her a prescription for a "low nicotine" or "no nicotine" cigarette, claiming that the nicotine was the dangerous component of smoking. (After an extensive Google search, I couldn't find a "prescription no/low nicotine cigarette," so I've concluded she meant a Nicotrol Inhaler.)
It took me several attempts to get her to understand that nicotine, absent the smoke, is relatively safe. "It's the smoke that contains all of the toxins," I told her. She was shocked, as the vilification of nicotine by the anti-tobacco groups had completely convinced her that nicotine is what killed people.
That led, of course, to a discussion about smoke-free tobacco and another surprise revelation - that smoke-free tobacco is up to 99% safer than smoking cigarettes. The real shock for her was finding out that the risk of mouth and throat cancer was actually up to 50% less than the risk from smoking. As with other typically brainwashed consumers, she believed that smokeless tobacco products actually had a HIGHER risk of mouth/throat cancer. To add to the irony, she had discouraged her occasional-smoker son from using oral tobacco, not because of the perceived health risks, but to prevent damage to his costly dental work. Consequently, he remained an occasional smoker, when simple, good dental hygiene would have reduced his health risks by 99%.
Finally, she told me that she never filled the prescription from her doctor, because insurance didn't cover it and just 30 doses cost $35. So, she continues smoking. After informing her of the truth about the health benefits of smokeless alternatives and electronic cigarettes and especially the low cost, she was quite interested in getting information on how to order.
This whole conversation graphically illustrated the tragic consequences of the lies and myths perpetuated by the groups calling themselves "public health." A 50-something year old woman, who knows that she should quit smoking for her health and well-being, would have been willing to switch to a less hazardous product had she known the facts. "Public health" failed her. Their scare tactics failed to inspire her to quit, their costly "treatments" were out of her financial means and their refusal to endorse reduced harm tobacco products (in a prohibitionist belief that any kind of nicotine use is unacceptable) needlessly exposed her to the most harmful tobacco product available.
It's my hope that groups like CASAA, the Consumer Advocates for Smoke-free Alternatives Association, will be able to fill the huge gap left by the tobacco control and public health groups, by educating committed smokers and giving them the tools and knowledge to make informed decisions about their health and well-being.
If my conversation with my husband's aunt is any indication, the myth of nicotine as the killer in cigarettes continues to be pervasive and persuasive and that is what continues killing people.
The concept of reduced harm tobacco has been around for at least 15 years. In that time, public health and tobacco control have had the opportunity to save many lives. This Memorial Day, I found myself thinking of the 6.6 million smokers who died because of the prohibitionist agenda of "public health."
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