Wednesday, April 01, 2015

New Pilot Study Finds High Cessation Rate among Smokers Making First Purchase at Vape Shops in Italy

A new study published in the International Journal of Environmental Research and Public Health reports high rates of smoking cessation at one-year follow-up among smokers visiting a vape shop for the first time. The study was conducted in Catania by Dr. Riccardo Polosa and colleagues.

Smokers who were first time visitors to one of seven vape shops in Catania were followed for one year to determine their smoking status after their first vape shop purchases. A total of 71 smokers were recruited into the study.

The follow-up rate was 69%. Those lost to follow-up were assumed to be continuing smokers. The researchers report the proportion of smokers who had quit smoking or reduced substantially (by 80% or more) at the one-year follow-up.

The quit rate at one-year follow-up was 40.8%. The proportion of heavy reducers at one-year follow-up was 15.5%. Thus, the combined proportion of quitters and heavy reducers was 56.3%. An additional 10% of smokers reduced their cigarette consumption by at least 50%. Just more than one-third of the smokers were considered to be "treatment failures."

The authors conclude that "smokers purchasing e-cigarettes from vape shops with professional advice and support can achieve high success rates.

The Rest of the Story

This is the first study I am aware of that specifically examines the effectiveness of the types of vaping devices sold at vape shops. The study is not only measuring the effectiveness of the device type but also the potential benefits of the social and technical support provided by vape shops. Moreover, the sample is biased because it is self-selected: the smokers were motivated enough to seek out and visit a vape shop. Nevertheless, this study reports very high rates of smoking cessation under these conditions.

To be clear, the results of this study are not relevant to the overall effectiveness of e-cigarettes for smoking cessation. However, the study does suggest that for a subset of smokers who are highly motivated to quit and who visit vape shops to purchase e-cigarettes, a very high rate of smoking cessation can potentially be achieved.

This study adds to the growing body of evidence that among a subset of smokers, electronic cigarettes can be quite effective for achieving smoking cessation or substantial reduction in cigarette consumption. The study also suggests that the types of devices available at vape shops and/or the support and assistance provided at these shops may enhance the chances of quitting success.

Unfortunately, despite the great promise of vape shops for enhancing smoking cessation, the proposed FDA deeming regulations would essentially shut down the tens of thousands of vape shops in the United States. These are small businesses that generally do not have the resources necessary to conduct the research and prepare the applications that would be required by the FDA in order to keep their products on the market. Unless the FDA makes drastic changes before promulgating its final regulations, the potential promise of vape shops in enhancing smoking cessation will not be realized.

Tuesday, March 31, 2015

E-Cigarette Opponent Uses Cross-Sectional Study to Conclude that E-Cigs are a Gateway to Smoking

On his blog Sunday, Stan Glantz cited a new UK study as supporting the conclusion that e-cigarettes are a gateway to smoking among youth.

The study was a cross-sectional survey of nonsmoking 10-11 year-old children in Wales. They reported on their e-cigarette use and on their intentions to smoke in the future. The study found that users of e-cigarettes were significantly more likely to have intentions to smoke.

Specifically: "Having used an e-cigarette was associated with intentions to smoke (OR=3.21; 95% CI 1.66 to 6.23). While few children reported that they would smoke in 2 years’ time, children who had used an e-cigarette were less likely to report that they definitely would not smoke tobacco in 2 years’ time and were more likely to say that they might."

From these findings, Glantz concludes: "While a cross-sectional study, susceptibility to smoking is a well-validated measure of future smoking, so the results support the gateway effect."

The Rest of the Story

Because this is a cross-sectional study, it is unable to determine the direction of causality. Which came first? The e-cigarette use or the intention to smoke?

While Glantz reports the result as e-cigarette users being more likely to have intentions to smoke, the results could just as easily presented as youth with intentions to smoke being more likely to try e-cigarettes.

Clearly, except for Stan, one cannot discern from this study whether youth who try e-cigarettes then develop an intention to smoke or whether youth with a predisposition to smoking are more likely to experiment with e-cigarettes.

That Stan draws a conclusion anyway suggests that he has come to a pre-determined conclusion and is twisting the data to support this conclusion.

However, it is entirely possible that what these results indicate is that e-cigarettes appeal much more to kids who are highly predisposed to try tobacco cigarettes. In fact, it is possible that by diverting these youth to e-cigarettes and their flavorings, e-cigarette experimentation may actually prevent youth from smoking. After all, once they try the sweet flavors of e-cigarettes, it would be extremely difficult to imagine them then transitioning to a Marlboro cigarette.

The rest of the story is that many e-cigarette opponents have drawn a pre-determined conclusion that e-cigarettes are evil and are therefore so biased that they are skewing the interpretation of scientific studies to support their pre-determined conclusions, even when the science does not support these conclusions.

This is another way of saying that ideology has taken over for science in the anti-smoking movement.

Thursday, March 26, 2015

California Department of Public Health E-Cigarette Web Site is Full of Lies; Why Can't They Just Tell the Truth?

I never thought I would say this, but in March 2015, public health officials are telling more lies to the public about the health effects of smoking than the tobacco industry.

I took the time to review the web site that the California Department of Public Health put together about electronic cigarettes and tobacco cigarettes and was appalled to find that the site is full of lies.

Here they are (these are not direct quotes but assertions that are clearly insinuated):

1. E-cigarettes are no healthier than tobacco cigarettes.

This is blatantly false. Farsalinos et al. published a paper just today showing that the levels of TSNAs in e-cigarettes are two to three orders of magnitude lower than in tobacco cigarettes. Polosa et al. have shown that switching from cigarettes to e-cigarettes leads to dramatic improvement in respiratory symptoms and lung function. The scientific evidence is overwhelming: cigarette smoking is far more harmful than vaping. There really is no question about this. The California Department of Public Health is disseminating a blatant lie.

2. E-cigarettes turn kids into addicts.

There is absolutely no evidence to support this contention. In fact, the existing evidence shows that e-cigarettes are much less addictive than real cigarettes and that their addictive potential is more comparable with nicotine replacement therapy. Despite the dramatic increase in e-cigarette experimentation among youth, there is no evidence that there is any substantial proportion of these youth who have become e-cigarette addicts. The evidence shows, on the contrary, that most youth use is social use and that a pattern of addictive use of these products has not yet appeared among adolescents.

3. E-cigarettes are more harmful than real cigarettes because they contain more particles.

This is a bizarre conclusion that is completely false. Asthma inhalers deliver numerous particles to the lungs as well, but that doesn't mean that puffing on an inhaler is more dangerous than smoking. The statement is not only a lie, but is an embarrassment to science itself.

4. Vaping causes asthma attacks.

There is no evidence that vaping contributes to asthma exacerbation. On the contrary, asthmatic smokers who switch to e-cigarettes have been found to experience a significant reduction in their respiratory symptoms and an improvement in their lung function. Rather than exacerbating asthma, switching from cigarettes to e-cigarettes greatly improves asthma.

5. E-cigarettes cause heart attacks.

There is absolutely no evidence to suggest that e-cigarettes have ever caused any individual to suffer a heart attack.

6. Vaping causes as much lung inflammation as smoking.

There is no evidence to support this. On the contrary, while smoking causes enough inflammation to obstruct air flow in the lungs, vaping has been shown not to cause obstruction that is detectable through spirometry.

7. Nicotine is as addictive as heroin.

This is an absurd and false assertion. Nicotine itself is certainly not as addictive as heroin. When was the last time you saw a nicotine patch user who was hopelessly addicted to the patch? It is smoking that is perhaps as addictive as heroin, not nicotine. Everything about the smoking experience contributes to its strong addictive power, including the way the nicotine is delivered and the behavioral, social, and physical stimuli associated with the behavior.

The Rest of the Story

Why can't the California Department of Public Health simply tell the truth?

Probably because they realize they don't have a leg to stand on. Almost every reputable scientist - and even the tobacco companies themselves - know that smoking is certainly more hazardous than vaping, which involves no tobacco and no combustion. But that message is not consistent with the ideology that the California DPH apparently holds. So rather than abandon that ideology, they chose instead to lie.

The overwhelming scientific evidence that switching from smoking to vaping results in dramatic improvement in respiratory symptoms and lung function is also inconsistent with the health department's apparent ideology. So they chose to lie about that too.

Demonizing nicotine is apparently part of the health department's ideology. So instead of telling the truth - that smoking is as addictive as heroin - they lie and tell the public that nicotine by itself is more addictive than heroin.  

Apparently, it is also not consistent with the health department's ideology that vaping is actually less destructive to the airways than smoking. So despite the evidence that vaping causes no observable changes in spirometric measures of lung function, the health department chose to lie and tell the public that vaping actually causes the same amount of lung inflammation than smoking. That's complete rubbish.

There is no evidence, nor any reason to believe that e-cigarettes cause heart disease leading to heart attacks. But that's not a good sound bite when you're trying to demonize e-cigs, so instead, the health department chose to lie and tell the public that e-cigarettes do cause heart attacks.

To be clear, I fully support measures to educate kids about the truth about e-cigarettes. I do think there is a need for educational campaigns that inform kids that e-cigarettes, while safer than cigarettes, do not merely deliver harmless water vapor. However, why do we need to lie to get this message across?

Is there no room for the truth in the tobacco control movement anymore?

Wednesday, March 25, 2015

California Department of Public Health Running Campaign to Keep Smokers from Switching to Electronic Cigarettes

I was absolutely shocked when I viewed the new print ad campaign coming from the California Department of Public Health, which Stan Glantz had touted as being outstanding. The campaign could not be any more advantageous for the combustible cigarette industry than if cigarette manufacturers had designed the campaign themselves. But to top off this sad story, the cigarette companies are not spewing forth the same false and misleading propaganda, even though it would benefit their cigarette sales. Instead, it is the California state health department that is doing the industry's bidding. This is a startling and sad retreat from the days when California was truly a leader in tobacco control.

In a press release touting the campaign, the director of the California Department of Public Health - Dr. Karen Smith - stated: "California has been a world leader in tobacco use prevention and cessation since 1990, with one of the lowest youth and adult smoking rates in the nation. The aggressive marketing and escalating use of e-cigarettes threatens to erode that progress."

Some of the text from the print ad campaign reads as follows:

"Sure, e-cigs are healthier, if inhaling toxic chemicals sounds healthier to you. Wake up."

"It's the next generation cigarette. For the next generation of addicts."

"Big Tobacco calls e-cigs a smarter alternative to smoking. We can trust them, right?"

The Rest of the Story

Unfortunately, the California Department of Public Health has it all wrong. It is the California state health department that needs to wake up, not the public. Literally millions of vapers out there know the truth: that e-cigarettes are indeed healthier than tobacco cigarettes and that these products are a smarter alternative to smoking. And these vapers also realize that even if they do become addicted to e-cigarettes, it is still much better than smoking. In fact, it is an addiction that just might save their lives. The vapers out there have woken up. It is the state public health officials in California who are need of the wake up call.

Dr. Smith has it all wrong when she states that the escalating use of e-cigarettes is going to erode progress in reducing adult smoking rates. That is an inane statement because the more the use of e-cigarettes among adults escalates, the lower and lower cigarette consumption will fall. A dramatic escalation in the use of e-cigarettes among adult smokers would in fact create much greater progress in decreasing adult cigarette consumption than we have seen in years.

Even the use of e-cigarettes among youth is not eroding the progress in reducing youth smoking. There is no evidence that e-cigarettes are a gateway to smoking. In fact, the current evidence suggests the opposite: that flavored e-cigarettes may actually be deterring youth from smoking the real, non-flavored, unpalatable tobacco cigarettes.

This campaign is extremely destructive to public health because it is sharply deterring smokers from quitting smoking by switching to electronic cigarettes. Instead of trying to quit using these innovative, tobacco-free products, many smokers in California will now decide that they might as well just keep smoking. After all, if e-cigarettes are not healthier than tobacco cigarettes, then what's the point in making the switch? If e-cigarettes are not a smarter choice than tobacco cigarettes, then why quit smoking?

The worst part of the campaign is its dishonesty. It is lying to the public by asserting that electronic cigarettes are not healthier than tobacco cigarettes.

In other words, the rest of the story is that the California Department of Public Health is actually spending taxpayer money to try to convince the public that smoking is no more hazardous than using non-tobacco-containing, non-combusted electronic cigarettes, which have been shown to drastically reduce exposure to the tens of thousands of toxins and more than 60 carcinogens in tobacco smoke and to immediately improve respiratory health among smokers who switch to them, even if used together with cigarettes.

The rest of the story is that the California state health department is lying to the public and that lie is going to cause tremendous public health damage.

Why is it that the California and Washington state health departments are spending so much money to protect tobacco cigarette profits?

Apparently, public health officials in these states are so blinded by anti-nicotine ideology that there are unable to separate out the issue of addiction from the issue of disease and death. They are now engaged in an ideological fight against addiction in and of itself, even if that fight results in an actual increase in disease and death.

It is a very sad day for me: it is stomach-curdling for me to see supposedly anti-smoking officials lose sight of what they are supposed to be fighting. We in public health are supposed to be trying to reduce disease and save lives, not engage in an ideological battle against the concept of the use of an addictive substance.


ADDENDUM: Fortunately, several vaping groups are running a counter-campaign that helps to correct the lies being spread by the California Department of Public Health.

Tuesday, March 24, 2015

Washington Governor and Legislature Seeking to Protect Cigarette Profits; Legislation Would Decimate Public Health by Increasing Cigarette Consumption

Under the guise of acting to "protect the children," the Washington State Governor and legislature are poised to protect cigarette profits at the expense of the public's health.

A new bill, introduced last week in the House, would impose the strictest regulations on e-cigarettes of any state in the country. In addition to banning the sale of e-cigarettes to minors, requiring labeling changes, and requiring child-proof packaging of e-liquids (which are reasonable), the bill would also: (1) ban flavorings - other than tobacco and menthol; (2) ban online e-cigarette sales; and (3) impose a 95% tax on e-cigarettes and all e-cigarette accessories (e.g., batteries); and (4) require the name and address of every purchaser of e-cigarettes to be recorded and saved for five years.

The Rest of the Story

This is one of the worst examples of window dressing that I've ever seen in tobacco control. The legislation makes it look like these politicians are deeply concerned about the health of Washington's children, but in reality, it shows a lack of courage to actually take on Big Tobacco and confront the real problem causing the prospects for early death and chronic disease among children in Washington state.

If the Washington governor and legislature were truly concerned about the health of the state's children, they would immediately impose a 95% tax on real cigarettes, require real cigarette purchasers' names and addresses to be recorded and saved for five years, and establish a cigarette tax revenue-funded comprehensive statewide tobacco prevention program accompanied by an aggressive anti-smoking media campaign.

Instead, these politicians are going after an easy target - the vaping industry - so that they can make it appear that they really care about children's health.

But I call baloney on them.

This legislation is a dream come true for cigarette companies, cigarette sales, and cigarette profits in the state of Washington. The fake cigarettes are being treated far more harshly than the real ones, which are the ones actually killing people in Washington and actually threatening the lives and health of Washington adolescents.

Why should the name of every e-cigarette purchaser need to be recorded, while anyone can just walk up to a counter at the local convenience store and purchase a pack of cigarettes without giving out their name or address?

Why should the tax on e-cigarettes be massively raised, while the tax on real cigarettes remain unchanged?

Let's be very clear. This bill is going to do very little good, but a lot of harm.

First of all, while e-cigarette use among youth is definitely concerning, there is no evidence that it is actually causing any significant harm. The bulk of the current evidence suggests that electronic cigarettes are deterring youth away from smoking real cigarettes, which in the long run may actually have a positive effect on their health. Moreover, there is no evidence that youth, even those who are "current" e-cigarette users, use them any more than occasionally. To be sure, some of the measures in the proposed legislation, such as its restrictions on the sale of e-cigarettes to minors and its requirements for child-proof packaging make sense. However, the rest of the legislation is dramatic overkill which is going to all but destroy the e-cigarette industry in Washington.

With the banning of flavors, most vape shops will be forced to go out of business. With the banning of internet sales, all vaping businesses without brick-and-mortar sales will be forced out of business. Not only will this legislation have a devastating financial impact on small businesses, but it will also significantly harm the public's health. 

Why? Because it will undoubtedly make it more difficult and less enticing for smokers to try to quit smoking. E-cigarettes have become one of the primary methods by which many smokers try to quit. By greatly limiting the availability of these products, greatly increasing their price, and taking away all the interesting flavors, the incentive for smokers to quit via electronic cigarettes will be all but completely destroyed. As a result, smoking in Washington will increase, as will the diseases and deaths that are associated with cigarette consumption. Many vapers will simply return to smoking once their favored products are taken off the market. The effects on the public's health will be stark and immediate.

The rest of the story is that Washington politicians pushing this legislation are essentially calling for a ban on all existing electronic cigarettes. Why? Because every electronic cigarette contains flavors. In fact, the presence of flavors is the only distinguishing characteristic of different brands of e-liquids or cartridges.

The ingredients of virtually every electronic cigarette liquid on the market are:

1. Nicotine
2. Propylene glycol and/or glycerin
3. Flavors

That's it! That's basically all there is.

For example, let's take a look at the ingredient list for some of the major e-cigarette brands on the market:

VUSE: nicotine, PG, VG, water, flavorings
Blu: nicotine, PG, VG, water, citric acid, flavorings
Mark Ten: nicotine, PG, VG, flavorings
V2: nicotine, PG, flavorings
LOGIC: nicotine, PG, water, flavorings
NJOY: nicotine, PG, VG, flavorings

Virtually every electronic cigarette consists of nicotine, PG and/or VG, and flavorings, plus or minus a little water and perhaps citric acid. It is the flavor that makes the brand. In most cases, even the "tobacco"-flavored electronic cigarettes contain flavorings.

It's easy to see that a ban on flavors is essentially a ban on electronic cigarettes. It would ban virtually every electronic cigarette currently on the market. Moreover, it would mean that there could only be one type of electronic cigarette liquid, which would have to contain just nicotine and propylene glycol and/or glycerine, and there would be no way for different liquids to distinguish themselves. The product would completely lose its appeal to smokers and the cigarette market would be protected forever. Menthol, mint, and wintergreen would be the only way to distinguish between e-cigarette brands. Thus, there would really be only four possible e-cigarette "brands" available. This would completely undermine the market and remove any competitive advantage over tobacco cigarettes.

Such a regulatory action would remove the ability of companies to market their products and would eliminate the taste and appeal of the product, handing the entire cigarette category over to Big Tobacco.

In my opinion, a ban on flavors in electronic cigarettes would completely destroy the electronic cigarette market. If the Washington legislature is going to ban the flavors in e-cigarettes, then it might as well just ban the product entirely.

Why would these public officials support an action that will end the great electronic cigarette experiment and permanently hand the entire cigarette market over to Big Tobacco?

If any of my readers can find out, please let me know because it is baffling to understand why public officials would want to protect cigarettes from the most serious competition they have ever faced. If this flavoring ban is enacted, the Washington legislature will have the rare role of being the hero of the cigarette promotion movement.

Monday, March 23, 2015

March E-Cigarette Madness: Regional Results for Worst E-Cigarette Lie

Today, I reveal the brackets and the regional finalists for the 2015 Rest of the Story Worst E-Cigarette Lie Championship. Those who have been following the Rest of the Story recently will recognize that there were a huge number of eligible contestants and that the work of the selection committee was difficult. The semifinalists and finalists will be revealed over the coming days. Criteria for selection included: (1) the extent of the misinformation provided to the public about e-cigarettes; and (2) the amount of probable damage to the public's health resulting by the misinformation.


WEST REGIONAL

University of California, San Francisco (UCSF) vs. California Department of Public Health

UCSF: In an article published in USA Today, Dr. Stanton Glantz stated definitively that electronic cigarettes are a gateway to smoking. He was quoted as stating: "There's no question that e-cigarettes are a gateway to smoking."

California Department of Health Services: The California Department of Health Services (CDHS), under a grant funded by the Centers for Disease Control and Prevention (CDC), produced a brochure entitled "Protect Your Family from E-Cigarettes: The Facts You Need to Know," which claimed that: (1) "E-cigarettes are just as addictive as regular cigarettes" and (2) "Studies show that e-cigarettes do not help people quit smoking cigarettes."

SOUTH REGIONAL

Centers for Disease Control and Prevention (CDC) vs. Greenville (SC) Health System

CDC: The CDC misrepresented cross-sectional CDC survey data as conclusive evidence that electronic cigarettes are a gateway to smoking. Specifically, CDC Director Dr. Thomas Frieden stated: "Use of e-cigarettes in youth doubled just in the past year, and many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." In addition, Dr. Frieden was quoted as stating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."

Greenville Health System: On the Greenville Health System blog, a respiratory therapist wrote: "I strongly oppose the use of e-cigarettes. It is unregulated and could potentially be more dangerous than a regular cigarette." Clearly, this claim that cigarette smoking might be healthier than vaping is a lie.


MIDWEST REGIONAL 

Mayo Clinic vs. University of Kentucky (Tobacco-Free UK)

Mayo Clinic: The Mayo Clinic stated that: "with nicotine inhalers you receive only nicotine." Even the arch-enemy of electronic cigarettes - Dr. Stanton Glantz - has acknowledged that nicotine inhalers deliver to users the following chemicals: Formaldehyde; Acetaldehyde; o-methylbenzene; Cadmium; Nickel; and Lead. In fact, I have shown that nicotine inhalers actually deliver higher amounts of six carcinogens than electronic cigarettes. The Mayo Clinic also stated that: "No studies have been done to examine the safety of e-cigarettes." However, there have been many studies that examined the safety of electronic cigarettes.

University of Kentucky Tobacco-Free Task Force: Tobacco-Free UK at the University of Kentucky warned the campus community that electronic cigarettes cause cancer. The text of its poster stated that "it causes cancer." The Tobacco-Free UK organization appears to be a UK Tobacco-Free Task Force, which is headed up by Ellen Hahn, a professor who has made misleading claims about electronic cigarettes.

EAST REGIONAL

Food and Drug Administration (FDA) vs. American Lung Association (ALA)

FDA: The FDA stated, in its proposed deeming regulations: "Many consumers believe that e-cigarettes are "safe" tobacco products or are "safer" than cigarettes. FDA has not made such a determination and conclusive research is not available." That the FDA is not sure whether smoking is any more hazardous than vaping does not say a lot for the agency's scientific standards.

ALA: A CNN Opinion page featured an op-ed on electronic cigarettes from Harold Wimmer, the president and CEO of the American Lung Association. In the piece, Wimmer argued that Big Tobacco companies are using electronic cigarettes to create "new nicotine addicts" and that they are enticing youth with flavors such as bubble gum and cotton candy. According to the American Lung Association piece: "Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap'n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes." However, none of the three tobacco companies which market electronic cigarettes in the U.S. are selling electronic cigarettes with bubble gum, cap'n crunch, or cotton candy flavors. In fact, the disposable electronic cigarettes being sold by Big Tobacco companies (i.e., the ones most likely to be purchased by youth) are available solely in classic tobacco or menthol flavors.

THE WINNERS

West Regional: California Department of Health Services defeats UCSF

Since Dr. Glantz is recognized as an arch-enemy of electronic cigarettes, his lie about e-cigarettes being a gateway to smoking is less likely to cause damage. However, the California Department of Health Services, as a large and respected state health department, is likely to be causing public health damage with its false assertions that e-cigarettes are as addictive as tobacco cigarettes and that e-cigarettes do not help people quit smoking.

South Regional: CDC defeats Greenville Health System

The CDC simply carries too much weight. Its false claim that e-cigarettes are a gateway to smoking was picked up by media outlets throughout the country and is influencing state and local public health policy and causing substantial public health damage.

Midwest Regional: Mayo Clinic defeats University of Kentucky Tobacco-Free Task Force

The Mayo Clinic carries tremendous weight and thus its public misinformation about e-cigarettes is more damaging to the public's health.

East Regional:  FDA defeats American Lung Association

The FDA has perhaps the most influence on the electronic cigarette issue of any governmental organization. It defeated the ALA because its false and misleading pronouncements about electronic cigarettes have caused enormous public health damage.

SEMIFINAL MATCHUPS

1. California Department of Health Services vs. Mayo Clinic

2. CDC vs. FDA

Thursday, March 19, 2015

New Commentary Argues that Electronic Cigarette Use Can Improve Respiratory Health Among Smokers

In a commentary published yesterday in BMC Medicine, Dr. Riccardo Polosa of the University of Catania reviews existing evidence regarding the respiratory effects of electronic cigarette use. He concludes that switching to electronic cigarettes "can reverse harm from tobacco smoking."

The key findings were as follows:

 "Long-term changes in lung function have been monitored for up to 1 year in a large group of ‘healthy’ smokers who were invited to quit or reduce their tobacco consumption by switching to a first generation EC. Significant early positive changes from baseline of a sensitive measure of obstruction in the more peripheral airways (i.e., forced expiratory flow measured between 25% and 75% of FVC) were already detected at 3 months after switching in those who completely gave up tobacco smoking, with steady progressive improvements being observed also at 6 and 12 months (Polosa R, unpublished observation)." ... 

"In the only clinical study conducted to ascertain efficacy and safety of EC use in asthma, substantial improvements in respiratory physiology and subjective asthma outcomes have been reported [20]. Exposure to e-vapor in this vulnerable population did not trigger any asthma attacks." ...

"The reported improvements of respiratory patients who have become regular ECs users are consistent with findings from a large internet survey of regular EC users diagnosed with asthma and COPD [2]. An improvement in symptoms of asthma and COPD after switching was reported in 65.4% and 75.7% of the respondents, respectively."

Dr. Polosa concludes that: "Taken together, these findings provide emerging evidence that EC use can reverse harm from tobacco smoking."

The Rest of the Story

It is important to note that among the asthmatic smokers that Dr. Polosa studied, improvement in respiratory symptoms and lung function were observed even among dual users. This finding demonstrates that contrary to the claims of many anti-smoking advocates, the substantial reduction in cigarette consumption that often results from e-cigarette trial is associated with health improvement.

This should dispel the myth being propagated by the anti-smoking community that dual use is a negative outcome of electronic cigarette use among smokers. On the contrary, cigarette smokers who become vapers appear to experience substantial improvement in their respiratory health, even if they are unable to quit smoking completely.

This research also provides important evidence that electronic cigarettes are beneficial for the public's health, a key criterion that has to be met in order for these products to be approved as "new tobacco products" under the proposed FDA deeming regulations.

Tuesday, March 17, 2015

Anti-Smoking Group and Advocate Want Conflicted Scientists to Sit on FDA Tobacco Advisory Panel

Recently, the FDA announced that in compliance with a court ruling, it would re-constitute its Tobacco Products Scientific Advisory Committee (TPSAC) by eliminating members with significant conflicts of interest by virtue of their previous financial relationships with pharmaceutical companies.

Apparently, the four TPSAC members who were removed from the Committee (or who had already left the Committee) were Jonathan Samet, Claudia Barone, Joanna Cohen, and Suchitra Krishnan-Sarin.

In response, the Campaign for Tobacco-Free Kids and Dr. Stan Glantz blasted the FDA for complying with the court decision. Apparently, they would like to see scientists with Big Pharma conflicts of interest sitting on a federal advisory panel that makes policy regarding the very drugs produced by these companies.

The Campaign for Tobacco-Free Kids wrote: "It is deeply troubling that the FDA today removed several extraordinarily qualified members of its Tobacco Products Scientific Advisory Committee (TPSAC) based on a misguided and overreaching court ruling that is under appeal. The FDA’s action demonstrates that the court decision and FDA’s overly cautious interpretation of that decision will deprive the agency of advice from many of the nation’s foremost and most credible scientific experts and undermine the FDA’s ability to do its job. It is essential that the FDA both aggressively pursue its appeal of the court decision in question and, in the interim, apply that ruling in a way that does not impair its tobacco advisory committee."

Glantz wrote: "Last week the FDA fired or forced the resignations of several highly qualified and respected scientists from its Tobacco Products Scientific Advisory Committee because of an overly cautious reaction to a misguided court decision  Like its decision to discount the health benefits of reduced smoking by the "lost pleasure" smokers experience when they stop or do not start smoking, this action sets a terrible precedent not only for tobacco control but public health in general."

The Rest of the Story

Both the Campaign for Tobacco-Free Kids and Dr. Glantz appear to have a misunderstanding of federal law. According to the Federal Advisory Committee Act, all federal advisory panels (including TPSAC) must be "fairly balanced in terms of the points of view represented and the functions to be performed," and its members cannot have severe financial conflicts of interest such that the committee's assessments, reports, or recommendations and decisions will be "inappropriately influenced . . . by any special interest."

Following this law, a D.C. district court ruled that the presence of the above members of TPSAC violated federal law because these members had significant financial conflicts of interest with Big Pharma.

It is essential that federal expert and advisory panels not contain members with significant conflicts of interest with corporations such as pharmaceutical companies because these conflicts of interest may influence, or have the appearance of influencing the recommendations and decisions of these panels. Do we really want a scientist who worked for Pfizer to make decisions about the use of a drug produced by Pfizer? Do we want a researcher who received grant funding from GlaxoSmithKline to make recommendations regarding whether a drug manufactured by that very company should be approved?

Both the Campaign for Tobacco-Free Kids and Dr. Glantz appear to misunderstand the importance of eliminating these conflicts of interest. Their arguments are based on the contention that the scientists in question were of the highest integrity and that they could contribute significantly to the panel. But it is not the integrity nor the potential contributions of these scientists that is in question. The only thing in question is whether they have conflicts of interest that, according to federal law, should preclude them from serving on a federal panel that will likely make decisions that affect the financial status of the very companies with whom these scientists have had financial relationships.

Here is a brief summary of the apparent financial conflicts of interest we are talking about:

Dr. Samet: According to the original complaint filed by Lorillard and R.J. Reynolds: "During the last decade, Dr. Samet has received grant support for research and writing from GSK on at least six occasions, including in 2010. In addition, he formerly led the Institute for Global Tobacco Control, which is [was] funded by GSK and Pfizer. Moreover, until 2009, Dr. Samet received regular honoraria from Pfizer for his service on the Pfizer Global Tobacco Advisory Board."

Dr. Barone: According to her C.V., Dr. Barone and two of her colleagues received a $400,000 educational grant from Pfizer, covering the period 2010-2013.

Dr. Cohen: According to her C.V., Dr. Cohen works for the Institute for Global Tobacco Control. She is now the director. The problem is that the Institute for Global Tobacco Control apparently received funding from GlaxoSmithKline and Pfizer. However, that funding appears to have been received before Dr. Cohen came to the Institute. Thus, I cannot understand in this case why Dr. Cohen should be precluded from serving on TPSAC.

Dr. Suchitra Krishnan-Sarin: According to a 2011 C.V., Dr. Krishnan-Sarin received a GRAND award from Pfizer covering the years 2011-2013. Also listed is Pfizer funding for a clinical trial conducted in 2003-2004.

While Glantz and the Campaign for Tobacco-Free Kids argue that the removal of conflicted members will impede the work of the FDA, the assurance that federal expert panels and advisory boards be free from financial conflicts of interest actually enhances the work of these bodies by eliminating a major potential source of bias and by ensuring that there is no appearance of a conflicted panel.

In summary, I see no reason that Dr. Cohen should not be able to serve on the TPSAC panel. However, the other three members do have significant financial conflicts of interest that should preclude them from serving on TPSAC.

Finally, this has nothing to do with the integrity, character, or potential value to the committee of the conflicted scientists. The only issue here is the conflicts of interest.

Monday, March 16, 2015

Disingenuous As Can Be: Campaign for Tobacco-Free Kids Urges States to Raise Tobacco Sales Age to 21

In a press release issued last week, the Campaign for Tobacco-Free Kids has called on state and local governments throughout the country to raise the legal purchase age for cigarettes from age 18 to age 21. This recommendation comes on the heels of an Institute of Medicine report which concluded that raising the legal age to 21 nationally would reduce smoking prevalence by 12% and smoking-related deaths by 10%.

In urging states and localities to raise the legal purchase age to 21, the Campaign cited a 1986 Philip Morris document which "made it clear decades ago that the industry knew a higher age of sale would hurt the peddling of its deadly products. “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20),” that report noted."

The Campaign for Tobacco-Free Kids writes: "The ages of 18 to 21 are a critical period when many smokers move from experimental smoking to regular, daily use. While half of adult smokers become daily smokers before 18, four out of five do so before they turn 21. Increasing the tobacco sale age to 21 will help prevent these young people from ever starting to smoke."

The Rest of the Story

So how is the Campaign for Tobacco-Free Kids being disingenuous?

What they fail to tell you in this press release is that the Campaign for Tobacco-Free Kids actively prevented the FDA from raising the age of cigarette sales nationally to anything above 18! The Campaign agreed to this restriction - which completely ties the FDA's hands - in order to appease Philip Morris when it was negotiating the Family Smoking Prevention and Tobacco Control Act.

So the rest of the story is that it is thanks to the Campaign for Tobacco-Free Kids that the FDA does not have the authority to raise the legal sales age for cigarettes. And this is the reason why the Campaign is calling for action at the state and local level, rather than at the national level. Given that the FDA supposedly has regulatory jurisdiction over cigarettes, that agency should obviously have the authority to regulate the age of sale for tobacco products. But the Campaign for Tobacco-Free Kids took away that authority in order to appease Philip Morris, the very company whose document the Campaign cites in its press release as opposing such a move because it would significantly hurt its sales.

The truth of the matter is that in appeasing Philip Morris and tying the hands of the FDA, the Campaign for Tobacco-Free Kids did more to protect cigarette sales than anything Big Tobacco could have dreamed for. Now, instead of the FDA being able to respond to the IOM report by increasing the legal age to 21, the Campaign has to try to go state-by-state and city-by-city to convince hundreds of localities to enact such a measure. Obviously, a measure like this is only going to be feasible and effective if it is enacted at the federal level. It was the Campaign for Tobacco-Free Kids which made that an impossibility.

More than any other group (with the exception of Philip Morris), the Campaign for Tobacco-Free Kids has helped to protect cigarette sales and make sure that the next generation will not be tobacco-free. Yet they have the gall to pretend to be a great protector of children's health, while hiding from the public the fact that they were the ones who actually prevented the next generation from being tobacco-free by ensuring that the age of cigarette sales could not be raised to 21 nationally.

The Campaign for Tobacco-Free Kids could not be more disingenuous if it tried.

Friday, March 13, 2015

The Complete Blindness of Some E-Cigarette Opponents: Re-Normalization Hypothesis Defies Science and Logic, Ideology Prevents Them from Thinking Straight

In a position statement on electronic cigarettes published by the Canadian Pediatric Society, Dr. Richard Stanwick, its past president, opines that electronic cigarettes are a "gateway" to smoking that will renormalize smoking by "representing smoking as a socially acceptable public practice."

Later in the same statement, Dr. Stanwick complains that "Both the size and value of the e-cigarette industry are expanding rapidly. Currently estimated to be worth more than $2 billion in the United States alone, e-cigarette sales are expected to surpass conventional cigarette sales over the next decade."

Dr. Stanwick goes on to state: "Health advocates have achieved truly historic successes in curbing tobacco use ... through a variety of effective public policy interventions. E-cigarettes have the potential to undermine this framework."

The Rest of the Story

This same argument has been repeated by many groups and advocates that oppose electronic cigarettes. And the rest of the story is that the argument is ridiculous. It makes no sense, is illogical, and is internally inconsistent.

If electronic cigarette sales surpass conventional cigarette sales over the next decade, as Dr. Stanwick seems to predict, then electronic cigarettes will go down in history as the single most effect intervention ever to reduce cigarette smoking. Imagine: a 50% drop in cigarette consumption. That would be an unprecedented public health victory. Never before has any public health or anti-smoking intervention resulted in a smoking reduction of that magnitude.

Moreover, if cigarette sales are cut in half, then smoking will be completely denormalized. Nothing denormalizes smoking more than having very few people smoking.

You can't have it both ways. You can't argue that electronic cigarettes are a huge gateway to smoking that is going to renormalize smoking and at the same time acknowledge that electronic cigarette sales are going to reduce cigarette sales in half over the next decade. The argument makes no sense and is internally inconsistent. If electronic cigarettes are so successful as a public health intervention that they take over half of the overall cigarette market, it will be a tremendous public health victory of historic proportions that will have greatly reduced cigarette use, denormalized smoking, and saved lives.

This story demonstrates that many electronic cigarette opponents have lost the ability to think straight. They are so blinded by ideology that they seem incapable of making a coherent argument. They are talking complete nonsense.

And in fact, I believe that the reason so many e-cigarette opponents are talking such nonsense is that they don't have a leg to stand on. They can't rely on the actual scientific evidence and on coherent arguments because the facts do not support the contention that electronic cigarettes are renormalizing smoking. So they are left with crafting nonsense arguments that fly in the face of their own lack of logic.

The truth is that electronic cigarettes do appear to be a gateway: a gateway away from smoking and towards vaping. This means that electronic cigarettes are denormalizing smoking. The only thing electronic cigarettes may be normalizing is vaping.

The argument that electronic cigarettes are renormalizing smoking makes no sense, is unsupported by evidence, and should be completely abandoned before any more damage is done to the public's health.

Wednesday, March 11, 2015

New Study Provides Evidence that Switching to E-Cigarettes Can Enhance Smoking Cessation, Even for Dual Users

Electronic cigarette opponents have long argued that dual use offers no health benefits to smokers. Dual use refers to the use of both e-cigarettes and tobacco cigarettes. While clinical trials show that a small proportion of electronic cigarette users are able to quit completely, a quite large proportion of these smokers are able to substantially reduce their cigarette consumption. Anti-smoking advocates have widely argued that this reduction in consumption offers no health benefits. I have already debunked that myth by showing that substantial reductions in cigarette consumption can produce dramatic improvements in respiratory health, especially among smokers with asthma or other forms of obstructive lung disease.

Today, I present new evidence that beyond the direct respiratory health improvement, switching to e-cigarettes, even partially (i.e., dual use), can significantly enhance the prospects of a smoker quitting completely.

The Rest of the Story

A study published online ahead of print this month in the journal Nicotine & Tobacco Research demonstrates that smokers who are able to reduce the number of cigarettes smoked per day are more likely to eventually quit smoking.

The authors report the major findings as follows: "The intervention trials that reported effect sizes found that every one percent decrease in CPD or carbon monoxide (CO) was associated with a 3% to 4% increase in the odds of cessation. The naturalistic studies found that ordinal (e.g., quartile) increases in participants’ magnitude of reduction in CPD were associated with 50% to 290% increases in the odds of cessation."

By these numbers, if an electronic cigarette user (a dual user) cut down her cigarette intake by 80% - which is not uncommon among smokers who use e-cigarettes - her odds of quitting could increase by as much as 320%.

Of course, in these studies nicotine replacement therapy was used to achieve the initial reduction in cigarette consumption. However, there is no reason to believe that a dramatic reduction in cigarette consumption achieved through the use of electronic cigarettes would not also increase the odds of eventual cessation.

All in all, these results suggest that rather than being a bad result of e-cigarette trial, dual use may instead be a bridge to eventual smoking cessation.

This is important because it means that anti-smoking groups which are encouraging dual users to return to smoking by telling them it is no better than smoking exclusively are harming the health of the public, both directly and in terms of impeding smoking cessation.

Thursday, March 05, 2015

Public Policy Maker Becomes the First to Embrace Vaping as a Public Health Strategy to Combat Cigarette Smoking

I have waited a long time for this, but it has finally happened. A public policy maker has become the first to publicly embrace vaping as a public health strategy to combat cigarette smoking. Alameda County Board of Supervisors member Nate Miley was present at the ribbon-cutting ceremony for the opening of a new vaping store called Ready, Set, Vape in Castro Valley.

Supervisor Miley noted the controversy over e-cigarettes, but emphasized that he could not help but support an intervention that is helping smokers get off deadly cigarettes.

My relationship with Supervisor Miley goes back to 1992, when - as an Oakland City Council member - Nate played the lead role in spearheading the campaign to enact a smoke-free restaurant ordinance for the city of Oakland.

I already had an incredible amount of respect for Nate Miley, but this action increases that respect and appreciation even further. It was a courageous action and a true sign of leadership.

Finally, a public policy maker is willing to stand up against the destruction and deaths being caused by cigarette smoking. The FDA might not be willing. The CDC might not be willing. State health departments might not be willing. But Nate Miley is. Congratulations to him!

Wednesday, March 04, 2015

My Interview with the Texas E-Cigarette and Vaping Association

The Texas E-Cigarette and Vaping Association was kind enough to conduct an interview with me on electronic cigarettes. You can listen to the interview here.

Tuesday, March 03, 2015

Study Finds Almost No Hazardous Chemicals in Aerosol of Blu or Sky-Cig E-Cigarettes

A study published in journal Regulatory Toxicology and Pharmacology reports that the two brands of electronic cigarettes tested - Blu and Sky Cigs - contain levels of hazardous chemicals that are almost all indistinguishable from levels in ambient air. The few chemicals that were detected were present at levels between 50 and 900 times lower than that in cigarette smoke.

The study highlights were as follows:
  • "The e-cigarettes contained and delivered mostly glycerin and/or PG and water.
  • Aerosol nicotine content was 85% lower than the cigarette smoke nicotine.
  • The levels of HPHCs in aerosol were consistent with the air blanks.
  • Mainstream cigarette smoke HPHCs (∼3000 μg/puff) were 1500 times higher than e-cigarette HPHCs.
  • No significant contribution of tested HPHC classes was found for the e-cigarettes."
The authors conclude that: "The deliveries of HPHCs tested for these e-cigarette products were similar to the study air blanks rather than to deliveries from conventional cigarettes; no significant contribution of cigarette smoke HPHCs from any of the compound classes tested was found for the e-cigarettes. Thus, the results of this study support previous researchers’ discussion of e-cigarette products’ potential for reduced exposure compared to cigarette smoke."

The Rest of the Story

This study adds to the abundant and growing body of evidence that electronic cigarettes are orders of magnitude safer than tobacco cigarettes and suggests that brands of e-cigarettes that do not overheat the e-liquid may be associated with very minor absolute health risks.

This should put an end to the assertions of many e-cigarette opponents that electronic cigarettes are not any safer than tobacco cigarettes. It exposes those public statements as being lies.

This research also demonstrates how misguided the FDA is in its scientific judgment. Despite all of the evidence, with numerous studies demonstrating results similar to those above, with studies showing rapid clinical improvement in smokers who switch to e-cigarettes, and with studies showing that the acute cardiovascular and pulmonary effects of smoking due not occur with vaping, the FDA is not sure that smoking is not any more hazardous than vaping.

In the deeming regulation proposal, the FDA stated: "Many consumers believe that e-cigarettes are "safe" tobacco products or are "safer" than cigarettes. FDA has not made such a determination and conclusive research is not available." Clearly, the FDA does not believe that there is sufficient evidence at the present time to conclude that cigarette smoking is any more hazardous than vaping. 

Furthermore, one of the problems noted in the deeming regulations was the fact that: "The vast majority of the respondents who were aware of these products indicated that they believed e-cigarettes were less harmful than traditional cigarettes...". Once again, the FDA is stating that smoking may not be any more hazardous than vaping.

Combined with the existing body of scientific evidence, this study blows out of the water the argument of e-cigarette opponents that we have no idea how hazardous vaping is and that we can't be sure that vaping is significantly safer than smoking.

Nevertheless, I'm sure electronic cigarette opponents will continue to make these assertions because they are being primarily motivated by ideology and not by science.

Monday, March 02, 2015

Anti-Smoking Advocate Claims that Vaping One Cartridge is The Same Thing as Smoking 1 1/2 Packs of Cigarettes

In an article published in the Ft. Wayne (IN) Health Sentinel, the executive director of the Indiana Youth Institute was quoted as stating: "If you used the entire (e-liquid) canister at one time, it would be the same as smoking 1 1/2 packs of cigarettes at one time."

The Rest of the Story

While it may be true that vaping one full cartridge of e-liquid is approximately equivalent to smoking 1 1/2 packs of cigarettes in terms of nicotine intake, it is certainly not true that vaping one cartridge of e-liquid is the same as smoking 1 1/2 packs of cigarettes. While vaping one cartridge will expose you to nicotine, propylene glycol and/or glycerin, flavorings, and potentially to some by-products such as formaldehyde and acrolein, smoking 1 1/2 packs of cigarettes will expose you to more than 10,000 chemicals, including more than 60 known carcinogens, as well as to radioactivity. So the statement that vaping one cartridge is the same as smoking 1 1/2 packs of cigarettes is blatantly false.

Once again, The Rest of the Story has caught an e-cigarette opponent lying about the relative health risks of smoking and vaping. This lie is a particularly damaging one because it insinuates that smoking is no more hazardous than inhaling vapor from a device which contains no tobacco and involves no combustion. The statement seriously undermines the public's appreciation of the severe hazards of cigarette smoking.

Why is it that e-cigarette opponents are apparently forced to lie in order to support their opposition to these products? The answer, I think, is that the truth simply does not support their position. The truth - based on current scientific evidence - is that e-cigarettes are helping millions of smokers in the U.S. to either quit or significantly cut down on the amount they smoke. And they are doing this without undermining smoking cessation, without causing ex-smokers to return to smoking, and without serving as a gateway to youth smoking.

Therefore, in order to craft a tenable position against e-cigarettes, its opponents have no choice but to fabricate evidence, to mislead the public, and to lie in their public statements. Telling the truth just doesn't provide support for their position; thus, the need to distort the science and/or lie to the public.

Friday, February 27, 2015

Study Blows Out of the Water the Claim that Substantially Reducing Cigarette Smoking Has No Health Benefits

One of the most dramatic effects that has been observed in a large proportion of e-cigarette users who are not successful in quitting completely is a substantial reduction in the amount of cigarettes that they smoke. In fact, studies have shown that a solid majority of e-cigarette users are successful either in quitting or in reducing their cigarette consumption substantially. By substantially, I mean reductions around the order of 75% to 90% or higher.

A key argument used by e-cigarette opponents to demonize these products is that these huge smoking reductions have no health benefits because unless you quit completely, you are not improving your health. The opponents have to make this argument because if it were true that these substantial reductions in smoking were improving the health of smokers, then the public health benefit of these products would be enormous.

E-cigarette opponents have therefore attacked the phenomenon of "dual use" of both cigarettes and e--cigarettes as being a bad thing that does nothing for health. This allows them to include as benefits of e-cigarettes only complete cessation.

For example, on his blog, Dr. Stan Glantz argued that reductions in cigarette consumption are not a "meaningful clinical outcome."

The truth about this question is vital, as it has implications for most of the millions of vapers in the country. If dual use has no benefits, then any vaper who is not able to quit completely might as well just return to cigarette smoking.

And, in fact, if smokers/vapers believe what researchers like Dr. Glantz are saying, they are likely to indeed return to cigarette smoking.

However, the claim that there are no health benefits of substantially reducing cigarette consumption is one of the greatest myths in the anti-smoking movement.

The Rest of the Story

First of all, even if there were no direct health benefits from substantially reducing one's cigarette consumption, it would still have health benefits. Research has demonstrated that reducing cigarette consumption enhances the likelihood of complete smoking cessation. In other words, it is a first step along a pathway to cessation. This approach works for a large percentage of smokers. In fact, a study published earlier this week showed that using varenicline for smoking reduction is an effective technique for getting smokers to quit completely. If this works for varenicline, then it would be expected to work for electronic cigarettes as well.

But it turns out that beyond the above health benefit of substantial smoking reduction, there is, in fact, a clinically meaningful direct and immediate benefit.

The dangerous myth that has been disseminated by electronic cigarette opponents is based on the observation that a number of studies have found that severe smoking reduction does not reduce the risk for heart disease and is associated with only small reductions in cancer risk.

But what these e-cigarette opponents are forgetting (or ignoring and suppressing) is that smoking does not only cause heart disease and cancer. It also causes lung disease, and there is no question that severe smoking reduction decreases the rate of progression of lung disease and produces a dramatic improvement in respiratory symptoms. Any smoker who has accomplished such a reduction can tell you this.

This fact is demonstrated by a study which reports that asthmatic smokers who switched partially to e-cigarettes, thus becoming dual users, experienced a significant improvement both in their respiratory symptoms and their lung function. Dual users also experienced a significant reduction in asthma exacerbations.

It makes sense that even severe reductions in cigarette consumption will not decrease heart disease risk because the adverse processes caused by smoking that lead to heart disease saturate at very low levels of exposure. However, the risk of cancer is generally linearly related to carcinogen dose (this has been established for lung cancer), so one would expect to see some cancer risk benefit. But the area where one would expect to see the greatest benefit is respiratory health. It is the ongoing insults due to smoking that lead to progression of chronic obstructive lung disease. Greatly reducing smoking will slow that progression. But most importantly, greatly reducing cigarette consumption will improve respiratory symptoms in smokers who are experiencing them.

In my own clinical experience, substantial smoking reduction unequivocally was associated with significant health benefits. These patients experienced a dramatic reduction in their respiratory symptoms, often making a significant difference in their quality of life.

There is no reason for e-cigarette opponents to continue to lie to the public about what they say is a complete lack of health benefit from substantial reduction in cigarette consumption. This propaganda is undoubtedly causing public health harm by convincing many smokers who cannot quit completely that it is not even worth cutting down.

Thursday, February 26, 2015

Anti--Smoking Groups' Campaign of Deception About E-Cigarettes Has Completely Undermined the Public's Appreciation of the Severe Hazards of Smoking

For decades, public health organizations have attempted to educate the public about the severe hazards associated with cigarette smoking, with tremendous success. However, in the past year or two, many of these same organizations have succeeded in completely undermining the public's appreciation of how hazardous smoking is. They have accomplished this, albeit unintentionally, through a campaign of deception about the hazards of electronic cigarettes.

In their zeal to demonize e-cigarettes, they have not only resorted to misleading and even lying to the public, but have done substantial public health damage. This damage comes in two forms. First, they have succeeded in convincing many smokers not to attempt to quit smoking. Second, they have succeeded in convincing about 50% of the public that smoking is not as hazardous as they previously thought.

The Rest of the Story

Today, I reveal a shocking finding that was reported two days ago in the American Journal of Preventive Medicine: Of all adults who have heard of electronic cigarettes, a whopping 49% believe that smoking is no more hazardous than using e-cigarettes, which contain no tobacco, involve no combustion, and have been found to significantly improve respiratory health in smokers who switch to them, even partially.

This undermining of the public's appreciation of the hazards of smoking has already taken its toll: smokers are being convinced not to quit. Many of them actually believe the propaganda coming from anti-smoking groups and researchers, and these smokers have therefore decided they might as well continue smoking rather than switch to electronic cigarettes. After all, if e-cigarettes are just as harmful as tobacco cigarettes, then what's the point of quitting smoking by substituting e-cigarettes?

In addition, for the same reason, some ex-smokers who have quit using e-cigarettes are deciding they might as well return to cigarette smoking.

Ironically, the roles of Big Tobacco and the anti-smoking community have completely switched. For years, we in public health tried to convince the public of how harmful smoking is, and the tobacco companies tried to undermine that. Now, the tobacco companies are telling the public that smoking is far more harmful than vaping, and it is the anti-smoking groups which are trying to completely undermine that understanding. And these new data demonstrate that they are succeeding.

Wednesday, February 25, 2015

Wall Street Journal Op-Ed Exposes Campaign of Deception About E-Cigarettes, Shows How Anti-Smoking Groups are Harming the Public's Health

My op-ed, entitled "The Misbegotten Crusade Against E-Cigarettes," appears today in the Wall Street Journal.

In the piece, I argue that many anti-smoking and health groups, including the CDC and the California Department of Public Health, have been waging a war against e-cigarettes, but that this war is based on a campaign of deception. These groups are misleading the public, and sometimes even lying about the relative health effects and effectiveness of electronic cigarettes.

Further, I argue that this campaign of deception is working. E-cigarette use is tailing off or even decreasing, and this is due to the misleading information which is scaring smokers into thinking that vaping is just as hazardous as smoking, thus removing any incentive to quit smoking using e-cigarettes. This, I argue, is doing profound harm to the public's health.

In the piece, I also share my initial impressions about e-cigarettes, to demonstrate that I understand why anti-smoking groups are reacting in the way they are. However, whereas I changed my mind when I saw the scientific evidence and actually took the time to talk to vapers, many of the anti-smoking groups are so blinded by ideology that they have come to a pre-determined conclusion and don't actually care about the scientific evidence. Or, they are displaying the confirmation bias, where they interpret the evidence to fit their pre-existing conclusions.

Here is a brief excerpt from the piece:

"When electronic cigarettes came to the U.S. about 2007, I was skeptical. My assumption was they were a ploy by the tobacco industry to hook more people into smoking under the guise of being a safer product—the notorious low-tar cigarette scam all over again. But as I talked to many e-cigarette users, known as “vapers,” conducted research (Journal of Public Health Policy, 2011) and reviewed a growing body of scientific evidence, I became convinced that e-cigarettes have dramatic potential for reducing disease and death caused by smoking."

"Yet many in the antismoking movement—in which I have been involved for decades—are conducting a misleading campaign against these products. And this campaign may be doing harm to public health."

"The most common claim about e-cigarettes is that they are a “gateway” to smoking. In September 2013 Thomas Frieden , director of the Centers for Disease Control and Prevention, said “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” He added that electronic cigarettes are “condemning many kids to struggling with a lifelong addiction to nicotine.”"

"These statements had no basis in fact when he made them, and the evidence is that they are bogus. One recent study in the American Journal of Preventive Medicine (January 2015) suggests that e-cigarettes are not acting as a gateway to smoking among youth. Another study in the journal Drug and Alcohol Dependence (February 2015) suggests the addictive potential of e-cigarettes is substantially lower than that of tobacco cigarettes." ...

"Bloomberg Business reported last summer that e-cigarette sales began to slip in the U.S., and their use by smokers may even be declining in the U.K. The percentage of the public that believes smoking is more hazardous than electronic cigarettes has fallen to 65% in 2013 from 85% in 2010, according to a 2014 study in the American Journal of Preventive Medicine."

"This is a tremendous lost opportunity. Vaping technology—or something like it that may be developed—has the potential to be one of the greatest antismoking breakthroughs. I would hate to see its promise wasted because of misinformation by the very public-health authorities who should be in the vanguard of reducing the harm from cigarettes."

Tuesday, February 24, 2015

Tomorrow's SRNT Annual Meeting: Brought to You by Pfizer

Tomorrow marks the start of the annual meeting of the Society for Research on Nicotine and Tobacco (SRNT) in Philadelphia.

According to the 2015 meeting program, a  major purpose of the conference is: "Through scientific exchange, integrate current research with implications for clinical practice." Specifically, a major focus of the conference is discussing recommendations for the treatment of smoking addiction, including the use of drugs such as Chantix and newer alternatives such as electronic cigarettes.

In fact, there will be at least 12 presentations on the use of Chantix for smoking cessation. In addition, there will be one talk on the potential suicide risk that has been observed in post-marketing studies of Chantix users. However, that talk is based on a published paper which concludes that "there is consistent evidence that varenicline either does not cause increased suicide outcomes, or if it does, the effect is very small." That paper makes recommendations for the labeling of the drug.

In addition, there will be nearly 20 presentations on electronic cigarettes.

The Rest of the Story

This would be an awesome conference if it represented an objective, unbiased, and non-conflicted view of the scientific evidence regarding the benefits and risks of Chantix as well as the evidence regarding the relative safety and effectiveness of its chief competitor: electronic cigarettes.

So there's just one problem:

The conference is sponsored by ...

... you guessed it

Pfizer - the manufacturer of Chantix, the very drug whose clinical use will be discussed at the conference.

While there is nothing wrong with conducting clinical trials or other research studies funded by pharmaceutical companies, there is something wrong with having such companies sponsor scientific meetings at which clinical recommendations for the use of their very drugs are going to be discussed in what is supposed to be an objective manner.

By accepting the Pfizer sponsorship, SRNT is sacrificing the scientific integrity of the conference.

There is no way that the conference can objectively consider the role of Chantix (or electronic cigarettes, a Chantix competitor) as part of a broad, national strategy for smoking cessation when the conference is being funded by the very manufacturer of one of these products.

Can you imagine if this conference were being sponsored by independent (not related to Big Tobacco) electronic cigarette companies? There would be an outrage in the anti-smoking community. People would immediately question the objectivity of the conference, especially as it pertains to the discussion of the role of e-cigarettes in national smoking cessation strategy and in clinical recommendations.

In fact, I would agree that if the conference were sponsored by electronic cigarette companies, that would preclude the possibility of truly objective consideration of the appropriate role of electronic cigarettes in a national smoking cessation strategy as well as an objective consideration of clinical recommendations for the use of electronic cigarettes.

The bias introduced by the Big Pharma sponsorship of the conference is readily apparent. While there are multiple talks about the role of Chantix in smoking cessation, noticeably absent from the conference program are the following talks:
  1. Suicidal ideation and completed suicide as adverse side effects of Chantix: should varenicline be taken off the market or its warning label be strengthened?;
  2. Case reports of varenicline-related deaths among patients with no prior history of depression;
  3. Population-based data show that smoking cessation drugs are not effective;
  4. Population-based data show that cold turkey quitting remains the most effective strategy;
  5. Problems of blinding in clinical trials of smoking cessation drugs; and
  6. Weaknesses of the transtheoretical model in explaining the process of smoking cessation: the need for anti-smoking media campaigns rather than smoking cessation drugs as the mainstay for a national smoking cessation strategy.
In fact, the one talk that addresses the suicide risk associated with Chantix (and concludes that there may not be any risk) is being presented by a researcher who has received research funding and consulting fees from Pfizer!

Specifically, Dr. John Hughes - who will apparently tell the audience that there is no major suicide risk associated with Chantix - has conflicts of interest by virtue of his having consultancies, honoraria, and research grants/contracts with many pharmaceutical companies, including Pfizer.

It is completely inappropriate to have this conflicted scientist be the one to opine on the potentially fatal observed side effects of Chantix.

In a 2008 article published in the journal Drug and Alcohol Dependence (Volume 98, Issue 3, 1 December 2008, Pages 169-178), Dr. Hughes disclosed that: "In the last 3 years he has received research grants from the National Institute on Health and Pfizer Pharmaceuticals and Sanofi-Synthelabo Pharmaceuticals both of whom are developing smoking cessation treatments. In the last three years, he has accepted honoraria or consulting fees from the following profit or non-profit institutions regarding nicotine or other drug abuse topics: Academy for Educational Development, Acrux DDS; American College of Chest Physicians, Adelphi Consulting, Aradigm; Atrium, Baltimore Research, Campus Consulting, Cambridge Press, Cline, Davis and Mann; Concepts in HealthCare, Constella Group; Consultants in Behavior Change; Cowen Inc, Cygnus, Edelman, Fagerstrom Consulting; Free and Clear; Healthwise, Health Learning Systems, International Marketing Systems, Insyght; Johns Hopkins University; Maine Medical Center, McNeil, Medicus, Nabi, National Institutes on Health; NCI Consulting, Pfizer Pharmaceuticals; Pinney Associates; Research Triangle Institute, Shire Health London; Temple University of Health Sciences; University of Arkansas, University of Auckland; University of Cantabria; University of Greifswald; University of Kentucky, University of Memphis, Warner Pharmaceuticals, Wolters Press, Xenova, and ZS Associates."

Thus, Dr. Hughes is essentially a walking conflict of interest with Big Pharma.

More recently, in a 2015 paper, Dr. Hughes discloses as follows: "Dr Hughes reports receiving personal fees from Alere/Free and Clear, Cicatelli, DLA Piper, Dorrffermeyer, Embera, Equinox, GlaxoSmithKline, Healthwise, Nicoventures, Pfizer, Pro Ed, Publicis, Selecta, and nonfinancial support from Swedish Match." Moreover, that paper presents the results of a clinical trial that was funded by Pfizer.

The rest of the story is that although its main purpose is presumably to foster objective scientific consideration of the issues regarding nicotine and tobacco control, SRNT is apparently heavily funded by the pharmaceutical industry. This funding, in my view, creates a substantial conflict of interest that precludes the objective consideration of many important scientific issues; in particular, the role of smoking cessation drugs as part of national or international tobacco control strategies.

This is in no way to fault the individual scientists who will present on these issues at the conference. Nor is it to suggest that any wrongdoing is occurring. It is merely to point out that the pharmaceutical sponsorship creates, by its very existence, an unavoidable bias that precludes a truly objective consideration of any scientific issue that may have significant implications for the profitability of smoking cessation drugs, and therefore, for their manufacturers who are conference sponsors.

It is also important to point out that bias does not necessarily have to be conscious. In fact, the most concerning bias is that which could arise subconsciously by virtue of the sponsorship of the conference by Big Pharma.

Monday, February 23, 2015

Anti-Smoking Groups' Demonization of Electronic Cigarettes is Leading to Devastating Consequences

According to an article in the Gloucester (UK) Citizen, the health scare over electronic cigarettes has led many adoption agencies in the UK to prohibit anyone who uses e-cigarettes from adopting children. In fact, some districts preclude anyone who has used an e-cigarette in the past 12 months from adopting.

According to the article:

"A couple has been stopped from adopting a child after the would-be father was seen smoking an e-cigarette. The decision by social workers at Staffordshire County Council came after the pair had passed a long series of tests to qualify as parents. They were told they could not adopt if either of them had used an e-cigarette in the past 12 months – despite experts saying that ‘vaping’ poses little or no threat to children in the home. The couple told The Mail on Sunday: “When there are so many children desperate for a family and a stable home, to put up such trivial barriers is ridiculous.” According to its investigation at least 13 councils in England ban e-cigarette users from fostering or adopting young children." ... 

"Abigail’ and ‘Brian’, who do not want to give their real names, approached the council in December 2013 after several failed IVF attempts costing over £20,000. By last September, having undergone medicals and interviews, and having proved they were of sound character and financially capable of raising a child, the pair thought they were on track to adopt. But when a social worker saw Brian using an e-cigarette, everything changed. Brian, 45, said: ‘By then I’d stopped smoking completely and hadn’t had a real cigarette in months. I was using e-cigarettes as a cessation aid, to ease the nicotine cravings.’"

The Rest of the Story

This story really turns my stomach. Moreover, it is just heartbreaking. How misguided this policy is. How devastating the consequences. Due to the anti-smoking groups' dissemination of false and misleading information about the hypothetical consquences of vaping, actual harm is being done to many people.

This story reveals that not only is this harm being done to smokers who have decided to continue smoking rather than engage in a behavior that many health advocates say is as dangerous as smoking, but serious harm is also being done to smokers who have successfully quit using electronic cigarettes.

In other words, smokers who quit successfully using e-cigarettes are actually being punished for using e-cigarettes rather than an "FDA-approved" method.

The sad reality is that despite the most important ethical principle of medicine and public health being "to do no harm," the anti-smoking movement is doing tremendous harm, both to the public's health and to the lives of many ex-smokers.

That health is hardly the paramount value in tobacco control in 2015 is demonstrated by the fact that it's not the fact that you quit that is important, it's that you quit "the right way."

Thursday, February 19, 2015

Washington Governor Asserts that Smoking May Be No More Hazardous than Vaping

According to a "fact sheet" on electronic cigarettes put out by the office of Washington governor Jay Inslee, cigarette smoking may be no more hazardous than using a product which merely heats nicotine and propylene glycol, contains no tobacco, and involves no combustion.

According to the policy brief:

"“Vaping” may not be safer than smoking traditional cigarettes."

What is the reasoning behind the governor's proclamation that smoking is no more hazardous than vaping?

"E-cigarettes emit more than water vapor."

The policy brief goes on to state that:

"Former smokers and new smokers may be attracted to e-cigarettes because of unproven claims that they are safer and more accepted than traditional cigarettes."

Governor Inslee concludes by calling for taxes on e-cigarettes and restriction of e-cigarette flavors.

The Rest of the Story

I find it despicable that a state governor is publicly asserting that cigarette smoking may not be any more hazardous than vaping, given the abudant scientific evidence that electronic cigarettes are far less damaging to health than real ones.

The governor's action is undermining decades of public education about the severe hazards of smoking. Moreover, is essentially lying to the public, since it is widely accepted by reputable scientists that vaping is less hazardous than smoking.

The governor wants some of the tax revenue from the imposition of an e-cigarette tax to go to smoking prevention programs. But what's the point of having a smoking prevention program if, out of the other side of your mouth, you are telling the public that smoking is probably not very hazardous (since vaping is almost certainly not very hazardous)?

And why would you want to put a tax on e-cigarettes when such a tax will certainly result in more smokers sticking with their deadly smoking, rather than switching to e-cigarettes and potentially saving their lives?

The stated purpose of the e-cigarette tax is to prevent e-cigarette use. But preventing e-cigarette use - among adults - is tantamount to a campaign to encourage cigarette smoking because realistically, this is the alternative for most smokers who are considering using e-cigarettes. These folks are not deciding between NRT, Chantix, Zyban, electronic cigarettes, and smoking. They are almost by definition accepting the fact that they do not believe they can quit smoking using the traditional methods. So the choice is essentially electronic cigarettes or continued smoking. Why does the governor of Washington want smokers to choose continued smoking?

The governor's actions are essentially promoting cigarette use and protecting cigarette profits at the expense of the improvement of the public's health.

While one part of his proposed legislation - the restrictions on selling e-cigarettes to minors - makes sense, the other two major provisions - the e-cigarette tax and the limitation of flavors - would significantly harm the public's health by promoting cigarette smoking.

It is one thing for a state to do nothing about preventing smoking. That is completely unacceptable. But for a state to make public statements and push for legislation that would promote smoking is almost sickening to me. It really turns my stomach to think that this is what the anti-smoking movement has come to.

Wednesday, February 18, 2015

Utah Department of Health Refuses to Acknowledge that Cigarette Smoking is Any More Hazardous than Vaping

In 2015, even the cigarette companies readily acknowledge that cigarette smoking is much more hazardous than vaping, which involves no tobacco and no combustion.

Not so for the Utah Department of Health.

In a "fact" sheet, the Department asks the question "Are e-cigarettes worse or better than regular cigarettes?" and then answers it by stating:

"Since e-cigarettes are not yet regulated as tobacco products, there is very little information about the ingredients of liquids or the approximate exposure to harmful and potentially harmful constituents when using e-cigarettes over the short-term or long-term. While several studies found lower levels of carcinogens in the e-cigarette aerosol compared to smoke emitted by traditional cigarettes, both the mainstream and the secondhand e-cigarette aerosol have been found to contain chemicals known to cause cancer, birth defects or other reproductive harm, including acetaldehyde, formaldehyde, lead and nicotine. Nicotine is both a highly addictive drug and a neurotoxin that can cause nausea, vomiting, sweating, and an increased heart rate. Even though nicotine levels in e-cigarette refill solutions are often high enough to be fatal to small children, the FDA does not regulate e-liquid manufacturing. Recently, Salt Lake County Health Department partnered with the Center for Human Toxicology at the University of Utah to measure the amount of nicotine in 153 e-liquid samples the department obtained from retailers around the county.  In the study, 61% of the e-liquid samples differed by at least 10% from the labeled nicotine content, with discrepancies ranging from 88% less to 840% more than stated."

The Rest of the Story

It is quite clear that the Utah Department of Health is unwilling to acknowledge that e-cigarettes are safer than real cigarettes. 
The Department provides a long-winded response to the simple question of whether e-cigarettes are safer than tobacco cigarettes, but none of the response actually answers the question directly. However, the response seems to imply that it is the Department's opinion that e-cigarettes are not safer than tobacco cigarettes, and I certainly believe that most readers will interpret the answer in that way.

Why is this public health department so afraid to acknowledge the truth: that e-cigarettes are much safer than tobacco cigarettes?

I don't believe it is because the health officials are inept scientists who cannot tell the difference between nicotine and tens of thousands of chemicals and nicotine plus a couple of chemicals. Instead, I believe it is because there is a firmly entrenched ideology that anything which looks like smoking is terrible and so cannot in any way be condoned.

This is reminiscent of other harm reduction debates, where opponents cannot bring themselves to supporting a much less hazardous alternative to drug use, despite the enormous public health benefits. Perhaps the best example are opponents to the use of methadone for heroin addicts. These opponents of methadone argue that addicts are still remaining addicted to an opiate, and all opiates are hazardous. That may be true, but the use of methadone instead of heroin has been documented to have enormous public health benefits. No needle use. No spreading of AIDS, hepatitis, and other infections. No risk of thrombophlebitis, abscesses, and endocarditis. No need to commit crimes to support the drug activity.

Sadly, opponents of e-cigarettes are relying on arguments that are nearly identical to those which were used by opponents of methadone. And in both cases, I believe that the arguments are largely driven by ideology, rather than science.

Tuesday, February 17, 2015

Washington State Health Director Corrects Statement about Electronic Cigarettes; Hopefully Other Health Officials Will Show the Same Integrity

Today, I applaud Dr. John Wiesman - Secretary of the Department of Health for the state of Washington - for his immediate correction of his statement which I noted yesterday.

As I wrote yesterday, in a press release issued last week by Washington governor Jay Inslee, the state's Secretary of Health (Dr. John Wiesman) was quoted as stating that active smoking is no more hazardous than vaping. The press release quoted Dr. Wiesman as follows: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safer, but scientific evidence suggests they are not."

Apparently, immediately after becoming aware of my critique of this statement, Dr. Wiesman corrected it. The statement now reads: "This is an urgent health concern that must be immediately addressed. Many kids believe e-cigarettes are safe, but scientific evidence suggests they are not."

By changing "safer" to "safe," the statement has been corrected because it is indeed true that electronic cigarettes are not safe in an absolute sense.

The Rest of the Story 

I applaud Dr. Wiesman for his immediate response and correction. This demonstrates tremendous scientific integrity, and I greatly respect him for that.

Anyone can make mistakes (I have made plenty), but a willingness to correct such mistakes is what is most important.

Now, I hope that the other anti-smoking and health groups which have made false or misleading statements about electronic cigarettes will correct those statements. Unfortunately, this is unlikely to occur, as while Dr. Wiesman merely made a mistake, the misleading statements by many other health groups are part of a deliberate campaign to demonize e-cigarettes.