Friday, August 30, 2013
Hour-Long Radio Times Segment Explores Electronic Cigarettes
I was honored to participate as a guest on the Radio Times (WHYY) hour-long segment this morning on electronic cigarettes. I thought that the issues raised were fascinating and that the comments and questions from the guests were outstanding. This is worth a listen, especially for the discussion of some of the interesting marketing issues involved.
Monday, August 26, 2013
Another Tobacco Control Practitioner Tells the Public That There is No Evidence Electronic Cigarettes are Safer than Real Ones
According to a story run by WDIO-TV (Duluth, MN), a tobacco control practitioner in Duluth is telling the public that there is no evidence vaping is any safer than smoking. She is also telling the public that there is no evidence that switching to electronic cigarettes can help a smoker quit smoking.
According to the story: "Brian Annis says he smoked for years and tried everything from nicotine gum to prescribed medication to quit. But it wasn't until he found e-cigs that something actually stuck. "It helped me. It satisfies that oral fixation and that inhalation of something that I really missed with those other cessation devices," Annis said." ...
"However, not everyone is as enthusiastic as Annis. Cardiology Nurse Practitioner Jessica Zweifel helps people kick their smoking habit as the program director of Tobacco Free Services at Essentia Health. She says, like Annis, many smokers think of e-cigarettes as a less-harmful substitute to tobacco cigarettes. "Unfortunately for both of those options being less harmful or a successful cessation device, there is no evidence out there stating that these things are true," Zweifel said. She says she expects substantial research in the coming years, but until then she doesn't recommend e-cigs as a cessation tool to her clients. Instead, she offers other traditional quit tools such as counseling and nicotine gum."
The Rest of the Story
It is unfortunate that many tobacco control practitioners continue to tell the public that there is no evidence that electronic cigarettes can help a smoker quit smoking. Multiple published surveys as well as literally thousands of personal testimonials from ex-smokers who have quit with these products make it eminently clear that for some smokers, electronic cigarettes are a successful strategy for quitting smoking. No responsible tobacco control practitioner should be denying that. Especially in August 2013 when such evidence is overwhelming.
What we don't know is the percentage of smokers who quit successfully with e-cigarettes. But to deny that there is any evidence that many vapers have successfully quit smoking is an attempt to deny reality. There are thousands of vapers out there who provide evidence that electronic cigarettes can be effective for quitting smoking.
Ironically, if the cigarette companies were making the same argument in order to protect cigarette profits from the threat of electronic cigarette sales, we could attack the companies for making fraudulent claims to protect their sales. After all, how could these companies deny that many smokers have quit successfully using electronic cigarettes when their are multiple surveys and online testimonials which document that many smokers have quit successfully using electronic cigarettes? Is this statement any less false just because it is being made by tobacco control advocates, instead of by cigarette companies?
Perhaps even more unfortunate is the assertion that there is no evidence that electronic cigarettes are less harmful than tobacco cigarettes. There is plentiful scientific evidence that electronic cigarettes are less harmful than tobacco cigarettes, including toxicology studies, laboratory studies, and clinical studies.
What we don't know is the absolute level of safety of electronic cigarettes. But that they are much safer than regular cigarettes is not in dispute. And that there is no evidence that e-cigarettes are safer than tobacco cigarettes is untruthful.
Once again, if the cigarette companies were making the exact same claim - arguing that there is no evidence that smoking is any more hazardous than vaping - we would certainly be attacking them for misleading the public and undermining the public's appreciation of the hazards of cigarette smoking. This assertion is no more truthful just because it is being made by tobacco control advocates, instead of by cigarette companies.
One thing I have learned in my public health career is that when the opposition resorts to lying, it is usually because their arguments are not strong enough on their own. This appears to be the case with the opponents of electronic cigarettes. The logic, as well as the evidence, is so overwhelming that electronic cigarettes are improving the public's health that it takes outright lies to counter it. And sadly, it is to dishonesty that much of the tobacco control movement is resorting.
According to the story: "Brian Annis says he smoked for years and tried everything from nicotine gum to prescribed medication to quit. But it wasn't until he found e-cigs that something actually stuck. "It helped me. It satisfies that oral fixation and that inhalation of something that I really missed with those other cessation devices," Annis said." ...
"However, not everyone is as enthusiastic as Annis. Cardiology Nurse Practitioner Jessica Zweifel helps people kick their smoking habit as the program director of Tobacco Free Services at Essentia Health. She says, like Annis, many smokers think of e-cigarettes as a less-harmful substitute to tobacco cigarettes. "Unfortunately for both of those options being less harmful or a successful cessation device, there is no evidence out there stating that these things are true," Zweifel said. She says she expects substantial research in the coming years, but until then she doesn't recommend e-cigs as a cessation tool to her clients. Instead, she offers other traditional quit tools such as counseling and nicotine gum."
The Rest of the Story
It is unfortunate that many tobacco control practitioners continue to tell the public that there is no evidence that electronic cigarettes can help a smoker quit smoking. Multiple published surveys as well as literally thousands of personal testimonials from ex-smokers who have quit with these products make it eminently clear that for some smokers, electronic cigarettes are a successful strategy for quitting smoking. No responsible tobacco control practitioner should be denying that. Especially in August 2013 when such evidence is overwhelming.
What we don't know is the percentage of smokers who quit successfully with e-cigarettes. But to deny that there is any evidence that many vapers have successfully quit smoking is an attempt to deny reality. There are thousands of vapers out there who provide evidence that electronic cigarettes can be effective for quitting smoking.
Ironically, if the cigarette companies were making the same argument in order to protect cigarette profits from the threat of electronic cigarette sales, we could attack the companies for making fraudulent claims to protect their sales. After all, how could these companies deny that many smokers have quit successfully using electronic cigarettes when their are multiple surveys and online testimonials which document that many smokers have quit successfully using electronic cigarettes? Is this statement any less false just because it is being made by tobacco control advocates, instead of by cigarette companies?
Perhaps even more unfortunate is the assertion that there is no evidence that electronic cigarettes are less harmful than tobacco cigarettes. There is plentiful scientific evidence that electronic cigarettes are less harmful than tobacco cigarettes, including toxicology studies, laboratory studies, and clinical studies.
What we don't know is the absolute level of safety of electronic cigarettes. But that they are much safer than regular cigarettes is not in dispute. And that there is no evidence that e-cigarettes are safer than tobacco cigarettes is untruthful.
Once again, if the cigarette companies were making the exact same claim - arguing that there is no evidence that smoking is any more hazardous than vaping - we would certainly be attacking them for misleading the public and undermining the public's appreciation of the hazards of cigarette smoking. This assertion is no more truthful just because it is being made by tobacco control advocates, instead of by cigarette companies.
One thing I have learned in my public health career is that when the opposition resorts to lying, it is usually because their arguments are not strong enough on their own. This appears to be the case with the opponents of electronic cigarettes. The logic, as well as the evidence, is so overwhelming that electronic cigarettes are improving the public's health that it takes outright lies to counter it. And sadly, it is to dishonesty that much of the tobacco control movement is resorting.
Friday, August 23, 2013
Electronic Cigarettes Commentators Fail to Disclose Financial Conflicts of Interest with Big Pharma
The New York Times "Room for Debate" section Wednesday featured a debate about electronic cigarettes. I was one of six commentators who provided their perspectives on the issue. After reviewing the other commentaries, the first thing that struck me was the failure of one of the commentators to disclose an important financial conflict of interest: his receipt of funding from Big Pharma to study the effectiveness of a competitive product to electronic cigarettes.
The commentary was written by Dr. Andrew Strasser, an associate professor in the department of psychiatry at the University of Pennsylvania's Perelman School of Medicine, where he is the director of its Biobehavioral Smoking Laboratory. The commentary calls for more research and regulation of electronic cigarettes, a perspective with which I largely agree. It argues that electronic cigarettes are safer than tobacco cigarettes, a statement with which I completely agree. It calls for the FDA to set quality control standards for these products. I agree. However, the commentary goes on to assert that: "there is a paucity of research on how individuals actually use electronic cigarettes. What about those who might have a chance of quitting smoking altogether but instead end up replacing the tar and nicotine from traditional cigarettes with e-cigarettes?"
There actually has been considerable research on how vapers are using e-cigarettes and from that research, it is quite clear that the smokers using these products are not people who would otherwise have "quit smoking altogether." Most of the e-cigarette users have tried and failed to quit using traditional "FDA-approved" therapies. In fact, the reason they are attracted to e-cigarettes in the first place is that these products provide an alternative to the products which do not work or have not worked for them. So it is simply not the case that e-cigarettes are hindering smokers from quitting. In fact, it is quite the opposite as these products are providing a ray of hope to smokers who otherwise would probably not even be making further quit attempts, or at least not serious ones.
There is one other point made in the commentary with which I disagree. The column expresses concern over "the perception that electronic cigarettes are less harmful ... than traditional cigarettes." I don't understand why we should be concerned about the public holding a perception that e-cigarettes are safer than tobacco cigarettes. In fact, this is the truth. Why wouldn't we want the public to understand the truth. It would be a tragedy, in fact, if smokers were under the mistaken impression that their "real" cigarettes were as safe as the electronic ones. So I just don't understand why the public perception that e-cigarettes are safer than tobacco cigarettes is concerning.
The main problem with this commentary, however, is not the opinions it expresses, but the fact that it hides from the public an important financial conflict of interest of the author that I believe should have been disclosed.
The Rest of the Story
It turns out that the author of the commentary has received funding from a company which manufactures a competitive product to electronic cigarettes. Specifically, he has received research funding from Pfizer, the manufacturer of Chantix, a smoking cessation drug that stands to lose substantial sales if electronic cigarettes become increasingly popular. Therefore, this is a significant financial conflict of interest and I think it ought to have been disclosed in the article.
This is not the only commentary which failed to disclose a significant financial conflict of interest. The American Lung Association offered a commentary which urged smokers not to use electronic cigarettes to quit smoking. This is a devastating recommendation that, if followed, will result in increased smoking, disease, and death as thousands of smokers who would otherwise have quit smoking using e-cigarettes will instead continue smoking.
But the larger problem with the commentary is that it fails to disclose a significant financial conflict of interest: the American Lung Association has received millions of dollars of support from Big Pharma; specifically, from Pfizer.
In the second quarter of 2009 alone, the American Lung Association received more than $1.5 million from Pfizer, manufacturer of Chantix and Nicotrol. Pfizer is a sponsor of the Lung Association's Freedom from Smoking program.
The financial connection is so strong that the American Lung Association goes so far as to promote Pfizer on its web site, boasting that: "Founded in 1849, Pfizer is the world's premier biopharmaceutical company taking new approaches to better health. We discover, develop, manufacture and deliver quality, safe and effective prescription medicines to treat and help prevent disease for both people and animals. We also partner with healthcare providers, governments and local communities around the world to expand access to our medicines and to provide better quality health care and health system support. At Pfizer, colleagues in more than 90 countries work every day to help people stay happier and healthier longer and to reduce the human and economic burden of disease worldwide."
In other words, the American Lung Association is allowing Pfizer to gain a huge public relations benefit out of its financial support. It is truly a partnership, not merely a charitable contribution from Pfizer. Clearly, the ALA has become beholden to Pfizer by virtue of the money it has received. No wonder the ALA finds it such a threat that thousands of smokers are quitting by virtue of a product that is not produced by Big Pharma. Electronic cigarettes are a real threat to Pfizer's profits.
Clearly, New York Times readers have the right to know about this conflict of interest so that they can properly interpret the validity of the arguments being made by the American Lung Association.
It is valuable to engage in public debate about the complex regulatory, research, and policy issues involved with electronic cigarettes and the public's health. However, it is essential that this debate include appropriate disclosures of financial conflicts of interest that might bias the opinions or conclusions expressed in these debates. In particular, when a commentator has received financial support from a corporation that manufactures a competitive product to electronic cigarettes, that should be disclosed. Readers deserve this information so that they can properly evaluate and interpret the opinions expressed by the authors. Failure to disclose this information is effectively hiding important facts from the public.
The commentary was written by Dr. Andrew Strasser, an associate professor in the department of psychiatry at the University of Pennsylvania's Perelman School of Medicine, where he is the director of its Biobehavioral Smoking Laboratory. The commentary calls for more research and regulation of electronic cigarettes, a perspective with which I largely agree. It argues that electronic cigarettes are safer than tobacco cigarettes, a statement with which I completely agree. It calls for the FDA to set quality control standards for these products. I agree. However, the commentary goes on to assert that: "there is a paucity of research on how individuals actually use electronic cigarettes. What about those who might have a chance of quitting smoking altogether but instead end up replacing the tar and nicotine from traditional cigarettes with e-cigarettes?"
There actually has been considerable research on how vapers are using e-cigarettes and from that research, it is quite clear that the smokers using these products are not people who would otherwise have "quit smoking altogether." Most of the e-cigarette users have tried and failed to quit using traditional "FDA-approved" therapies. In fact, the reason they are attracted to e-cigarettes in the first place is that these products provide an alternative to the products which do not work or have not worked for them. So it is simply not the case that e-cigarettes are hindering smokers from quitting. In fact, it is quite the opposite as these products are providing a ray of hope to smokers who otherwise would probably not even be making further quit attempts, or at least not serious ones.
There is one other point made in the commentary with which I disagree. The column expresses concern over "the perception that electronic cigarettes are less harmful ... than traditional cigarettes." I don't understand why we should be concerned about the public holding a perception that e-cigarettes are safer than tobacco cigarettes. In fact, this is the truth. Why wouldn't we want the public to understand the truth. It would be a tragedy, in fact, if smokers were under the mistaken impression that their "real" cigarettes were as safe as the electronic ones. So I just don't understand why the public perception that e-cigarettes are safer than tobacco cigarettes is concerning.
The main problem with this commentary, however, is not the opinions it expresses, but the fact that it hides from the public an important financial conflict of interest of the author that I believe should have been disclosed.
The Rest of the Story
It turns out that the author of the commentary has received funding from a company which manufactures a competitive product to electronic cigarettes. Specifically, he has received research funding from Pfizer, the manufacturer of Chantix, a smoking cessation drug that stands to lose substantial sales if electronic cigarettes become increasingly popular. Therefore, this is a significant financial conflict of interest and I think it ought to have been disclosed in the article.
This is not the only commentary which failed to disclose a significant financial conflict of interest. The American Lung Association offered a commentary which urged smokers not to use electronic cigarettes to quit smoking. This is a devastating recommendation that, if followed, will result in increased smoking, disease, and death as thousands of smokers who would otherwise have quit smoking using e-cigarettes will instead continue smoking.
But the larger problem with the commentary is that it fails to disclose a significant financial conflict of interest: the American Lung Association has received millions of dollars of support from Big Pharma; specifically, from Pfizer.
In the second quarter of 2009 alone, the American Lung Association received more than $1.5 million from Pfizer, manufacturer of Chantix and Nicotrol. Pfizer is a sponsor of the Lung Association's Freedom from Smoking program.
The financial connection is so strong that the American Lung Association goes so far as to promote Pfizer on its web site, boasting that: "Founded in 1849, Pfizer is the world's premier biopharmaceutical company taking new approaches to better health. We discover, develop, manufacture and deliver quality, safe and effective prescription medicines to treat and help prevent disease for both people and animals. We also partner with healthcare providers, governments and local communities around the world to expand access to our medicines and to provide better quality health care and health system support. At Pfizer, colleagues in more than 90 countries work every day to help people stay happier and healthier longer and to reduce the human and economic burden of disease worldwide."
In other words, the American Lung Association is allowing Pfizer to gain a huge public relations benefit out of its financial support. It is truly a partnership, not merely a charitable contribution from Pfizer. Clearly, the ALA has become beholden to Pfizer by virtue of the money it has received. No wonder the ALA finds it such a threat that thousands of smokers are quitting by virtue of a product that is not produced by Big Pharma. Electronic cigarettes are a real threat to Pfizer's profits.
Clearly, New York Times readers have the right to know about this conflict of interest so that they can properly interpret the validity of the arguments being made by the American Lung Association.
It is valuable to engage in public debate about the complex regulatory, research, and policy issues involved with electronic cigarettes and the public's health. However, it is essential that this debate include appropriate disclosures of financial conflicts of interest that might bias the opinions or conclusions expressed in these debates. In particular, when a commentator has received financial support from a corporation that manufactures a competitive product to electronic cigarettes, that should be disclosed. Readers deserve this information so that they can properly evaluate and interpret the opinions expressed by the authors. Failure to disclose this information is effectively hiding important facts from the public.
Wednesday, August 21, 2013
New York Times Features Debate on Electronic Cigarettes
The New York Times "Room for Debate" section yesterday featured a debate about electronic cigarettes. I was honored to be one of the commentators asked to provide a perspective for the debate. In subsequent posts, I will provide commentary on the debate and the other articles.
Tuesday, August 20, 2013
Duke a Willing Collaborator in Defrauding the American Public
In agreeing to accept funding from Philip Morris for its Center for Smoking Cessation, Duke acted willingly as a collaborator in the defrauding of the American public.
A review of news articles announcing the funding of the Duke Center for Smoking Cessation by Philip Morris revealed that Philip Morris used this funding as an opportunity to improve its poor public image by making the public believe that the company was committed to getting smokers off of its products. And Duke happily gave Philip Morris a platform to make these fraudulent statements.
According to a 2008 article in the Duke Chronicle: "Bill Phelps, a spokesperson for Philip Morris, emphasized that the money was given without caveats that could influence the findings. For example, Philip Morris cannot veto publication of research from the center. "We give grants to universities for a variety of reasons," Phelps said. "Some [grants] in the past have been for smoking- and health-related research. We have given a grant to Duke... that is related to our program which is called cessation." ... Phelps ... said Philip Morris is assisting its patrons in whatever way possible. "We think that if smoking is addictive and causes serious issues... we can be helpful in that role of acquittance," he said."
The Rest of the Story
Acquittance is a perfect Freudian slip. I think the word that should have been used was "assistance." But what is behind the Philip Morris grant is actually "acquittance." The chief aim of Philip Morris in funding this research is to be acquitted for the harm it is doing in selling products that kills hundreds of thousands of people each year. And what a perfect way to achieve acquittance: by getting the Duke Center for Smoking Cessation to promote Philip Morris to the public and give it a platform for making it appear that the company is committed to getting smokers to quit using its products.
I need to make it clear that I am not blaming Philip Morris for seeking out these public relations opportunities. It is a brilliant strategy and a wise business decision. All successful companies have strong public relations as part of their marketing activities. The entity I am blaming is the Duke Center for Smoking Cessation, because without their willingness to collaborate, this defrauding of the American public could not take place.
The rest of the story is that Duke willingly is collaborating with Philip Morris in defrauding the American public by making it appear that the tobacco company is sincerely committed to getting smokers to get off its products. Of course, that is nonsense. It would be a very bad business decision, would send its stock spiraling down, would jeopardize its dominant market share, and would lead to the firing of the Philip Morris executives. The company's job is to sell cigarettes, not to convince consumers not to use its products.
However, the job of the Duke Medical Center is not to sell cigarettes. Sadly, by collaborating with Philip Morris in the defrauding of the American public, the Duke University Medical Center is actually doing more to market cigarettes than to prevent or reduce their use.
And even more sad is that they just don't get it. In defending the acceptance of Philip Morris money, the Center's director, Dr. Jed Rose, stated: "I recognize that there are widespread opinions that people have about using tobacco funding for research. But the source of the money is less relevant than the conditions [with which] the money is being given."
Baloney. It is the source of the money that is in question here, not the conditions with which it is being given. Philip Morris is not so stupid as to give money in the current decade with many strings attached. That would make it easy for the public to criticize. The brilliance of the company's public relations strategy is that it gives this money without strings attached. Thus, it has the appearance of being part of a sincere effort to undermine its business when it is actually a public relations effort.
That physicians in the Center and at Duke Medical Center are unable to see the role they are playing in undermining efforts to protect the public's health from the chief cause of preventable death is truly sad. And that they are defending it by noting that there are no strings attached is shameful.
One of the "strings" that is attached is that by accepting the money, The Center is aiding Philip Morris in deceiving the public into thinking that the company is committed to getting its customers off of its products. That would be a severe violation of their stockholders' interests and of course, the company wouldn't and arguably is not charged with the responsibility of doing that. However, as part of a medical center, the Duke Center for Smoking Cessation is charged with some important ethical responsibilities. And one of those is not collaborating with Big Tobacco in defrauding the American public. One of those is not playing a role in the public relations and marketing strategies of the deadliest consumer product.
A review of news articles announcing the funding of the Duke Center for Smoking Cessation by Philip Morris revealed that Philip Morris used this funding as an opportunity to improve its poor public image by making the public believe that the company was committed to getting smokers off of its products. And Duke happily gave Philip Morris a platform to make these fraudulent statements.
According to a 2004 article in the Duke Chronicle: "Philip
Morris USA, however, hopes to show with this grant that it recognizes
this fact and wants to help smokers who want to quit. "One of our goals is to reduce the harm caused by our products," said Jennifer Golisch, a spokesperson for Philip Morris."
According to a 2008 article in the Duke Chronicle: "Bill Phelps, a spokesperson for Philip Morris, emphasized that the money was given without caveats that could influence the findings. For example, Philip Morris cannot veto publication of research from the center. "We give grants to universities for a variety of reasons," Phelps said. "Some [grants] in the past have been for smoking- and health-related research. We have given a grant to Duke... that is related to our program which is called cessation." ... Phelps ... said Philip Morris is assisting its patrons in whatever way possible. "We think that if smoking is addictive and causes serious issues... we can be helpful in that role of acquittance," he said."
The Rest of the Story
Acquittance is a perfect Freudian slip. I think the word that should have been used was "assistance." But what is behind the Philip Morris grant is actually "acquittance." The chief aim of Philip Morris in funding this research is to be acquitted for the harm it is doing in selling products that kills hundreds of thousands of people each year. And what a perfect way to achieve acquittance: by getting the Duke Center for Smoking Cessation to promote Philip Morris to the public and give it a platform for making it appear that the company is committed to getting smokers to quit using its products.
I need to make it clear that I am not blaming Philip Morris for seeking out these public relations opportunities. It is a brilliant strategy and a wise business decision. All successful companies have strong public relations as part of their marketing activities. The entity I am blaming is the Duke Center for Smoking Cessation, because without their willingness to collaborate, this defrauding of the American public could not take place.
The rest of the story is that Duke willingly is collaborating with Philip Morris in defrauding the American public by making it appear that the tobacco company is sincerely committed to getting smokers to get off its products. Of course, that is nonsense. It would be a very bad business decision, would send its stock spiraling down, would jeopardize its dominant market share, and would lead to the firing of the Philip Morris executives. The company's job is to sell cigarettes, not to convince consumers not to use its products.
However, the job of the Duke Medical Center is not to sell cigarettes. Sadly, by collaborating with Philip Morris in the defrauding of the American public, the Duke University Medical Center is actually doing more to market cigarettes than to prevent or reduce their use.
And even more sad is that they just don't get it. In defending the acceptance of Philip Morris money, the Center's director, Dr. Jed Rose, stated: "I recognize that there are widespread opinions that people have about using tobacco funding for research. But the source of the money is less relevant than the conditions [with which] the money is being given."
Baloney. It is the source of the money that is in question here, not the conditions with which it is being given. Philip Morris is not so stupid as to give money in the current decade with many strings attached. That would make it easy for the public to criticize. The brilliance of the company's public relations strategy is that it gives this money without strings attached. Thus, it has the appearance of being part of a sincere effort to undermine its business when it is actually a public relations effort.
That physicians in the Center and at Duke Medical Center are unable to see the role they are playing in undermining efforts to protect the public's health from the chief cause of preventable death is truly sad. And that they are defending it by noting that there are no strings attached is shameful.
One of the "strings" that is attached is that by accepting the money, The Center is aiding Philip Morris in deceiving the public into thinking that the company is committed to getting its customers off of its products. That would be a severe violation of their stockholders' interests and of course, the company wouldn't and arguably is not charged with the responsibility of doing that. However, as part of a medical center, the Duke Center for Smoking Cessation is charged with some important ethical responsibilities. And one of those is not collaborating with Big Tobacco in defrauding the American public. One of those is not playing a role in the public relations and marketing strategies of the deadliest consumer product.
Monday, August 19, 2013
Duke Center for Child and Family Policy is Aiding Public Relations Efforts of Big Tobacco
Earlier this summer, I revealed that the Duke Center for Smoking Cessation is still accepting Big Tobacco funding and not prominently disclosing it.
I wrote: "Since [Judge Kessler's] decision, it has become very difficult to find an academic medical or public health institution that is willing to accept tobacco funding. There is still, however, a last refuge for tobacco industry-sponsored research. There is a last bastion of acquiescence in the historical tobacco industry scheme to gain a public relations victory by allying itself with academia and pretending to be an objective, scientific voice in the smoking debate. There is still one academic center that is allowing itself to be used as a pawn in the marketing of cigarettes. That last bastion is the Duke Center for Smoking Cessation."
Today, I reveal that another center at Duke University - the Duke Center for Child and Family Policy - is also taking Big Tobacco funding.
The Rest of the Story
At the Duke Center for Child and Family Policy, "faculty and staff work together to discover and evaluate strategies to improve outcomes for children and families and to share their discoveries with policymakers and public agencies."
One of the strategies to improve outcomes for children and families that you won't see the Center sharing with policymakers is increasing cigarette taxes or imposing financial penalties on tobacco companies to fund aggressive anti-smoking media campaigns that demonstrate to youth the role of the tobacco industry in the smoking epidemic.
The Center's hands are tied because it is funded by Philip Morris.
Moreover, by accepting this funding, the Duke Center for Child and Family Policy is serving a public relations function for Philip Morris. It is helping Philip Morris to improve its public image by associating the tobacco company with the academic name and reputation of Duke.
In United States of America v. Philip Morris USA, Inc., et al. (Civil Action No. 99-2496 [GK]), the United States District Court for the District of Columbia found that tobacco industry funding of university research has long been part of an illegal enterprise that violates federal anti-racketeering law. The Court found that tobacco industry funding of university research was essentially a public relations ploy to undermine the public’s appreciation of the harms of smoking while making it appear that the tobacco companies were concerned corporate citizens interested in advancing objective scientific research.
The most important role of industry funding of research has been to refurbish the public image – especially the scientific image – of the tobacco companies: “Robert Seligman, Vice President of R&D of Philip Morris, described how Defendants used institutional grants to refurbish their scientific image. Seligman reported that … Shook, Hardy & Bacon attorney William Shinn had stated: “CTR began to lose their luster in the mid-60’s and the tobacco industry looked around for more beneficial ways to spend their research dollars on smoking and health. It was at this time that special projects were instituted at Washington University, Harvard University, and UCLA. … The industry received a major public relation ‘plus’ when monies were given to Harvard Medical school.” (page 148)
In fact, the chief public relations advantage gained by the industry granting money to an institution is the good will associated with the university’s name: “Arnold Henson of American [Brands Tobacco Company] acknowledged that one of the main reasons for the Harvard project was the ‘PR value of the Harvard name.’” (page 148)
In the opinion of the Court, the external research funding of the tobacco companies served as a way for the tobacco companies to coordinate their fraudulent activities, in violation of federal law (page 1541).
Brown & Williamson was quite explicit in acknowledging that the Council for Tobacco Research - the major research funding arm of the tobacco industry for many years - was essentially a public relations ploy, saying that “CTR was organized as a public relations effort” (page 50).
By accepting funding from Big Tobacco, the Duke Center for Child and Family Policy is allowing itself to serve as a pawn in Philip Morris' public relations strategy.
The rest of the story is that rather than being a model for child and family policy for the nation, Duke is instead an example of exactly the opposite. It is perhaps a model, but a model for the most egregious violation of academic ethics. Duke is allowing itself and its reputation and good name to be used as a public relations ploy for a tobacco company. Duke is allowing itself to be used as a pawn in the public relations and marketing strategy of Philip Morris.
By associating its name with that of Duke University, Philip Morris is using Duke to gain public relations marketing value from that association. This is public relations 101. Using corporate funding to secure public credibility and respect. It was part of Philip Morris' (and the other tobacco companies') playbook for decades.
The rest of the story is that Duke continues to undermine its own scientific integrity and that of academia as a whole by allowing itself to serve as a pawn in the tobacco industry's public relations and marketing strategy. A university - and especially a child policy center - should not play a role in marketing the most deadly consumer product. But that is exactly what Duke is doing.
Rather than being recognized as a model for child and family policy, the Duke Center for Child and Family Policy should instead be entered into the Hall of Shame as a center that puts money over ethical integrity.
I wrote: "Since [Judge Kessler's] decision, it has become very difficult to find an academic medical or public health institution that is willing to accept tobacco funding. There is still, however, a last refuge for tobacco industry-sponsored research. There is a last bastion of acquiescence in the historical tobacco industry scheme to gain a public relations victory by allying itself with academia and pretending to be an objective, scientific voice in the smoking debate. There is still one academic center that is allowing itself to be used as a pawn in the marketing of cigarettes. That last bastion is the Duke Center for Smoking Cessation."
Today, I reveal that another center at Duke University - the Duke Center for Child and Family Policy - is also taking Big Tobacco funding.
The Rest of the Story
At the Duke Center for Child and Family Policy, "faculty and staff work together to discover and evaluate strategies to improve outcomes for children and families and to share their discoveries with policymakers and public agencies."
One of the strategies to improve outcomes for children and families that you won't see the Center sharing with policymakers is increasing cigarette taxes or imposing financial penalties on tobacco companies to fund aggressive anti-smoking media campaigns that demonstrate to youth the role of the tobacco industry in the smoking epidemic.
The Center's hands are tied because it is funded by Philip Morris.
Moreover, by accepting this funding, the Duke Center for Child and Family Policy is serving a public relations function for Philip Morris. It is helping Philip Morris to improve its public image by associating the tobacco company with the academic name and reputation of Duke.
In United States of America v. Philip Morris USA, Inc., et al. (Civil Action No. 99-2496 [GK]), the United States District Court for the District of Columbia found that tobacco industry funding of university research has long been part of an illegal enterprise that violates federal anti-racketeering law. The Court found that tobacco industry funding of university research was essentially a public relations ploy to undermine the public’s appreciation of the harms of smoking while making it appear that the tobacco companies were concerned corporate citizens interested in advancing objective scientific research.
The most important role of industry funding of research has been to refurbish the public image – especially the scientific image – of the tobacco companies: “Robert Seligman, Vice President of R&D of Philip Morris, described how Defendants used institutional grants to refurbish their scientific image. Seligman reported that … Shook, Hardy & Bacon attorney William Shinn had stated: “CTR began to lose their luster in the mid-60’s and the tobacco industry looked around for more beneficial ways to spend their research dollars on smoking and health. It was at this time that special projects were instituted at Washington University, Harvard University, and UCLA. … The industry received a major public relation ‘plus’ when monies were given to Harvard Medical school.” (page 148)
In fact, the chief public relations advantage gained by the industry granting money to an institution is the good will associated with the university’s name: “Arnold Henson of American [Brands Tobacco Company] acknowledged that one of the main reasons for the Harvard project was the ‘PR value of the Harvard name.’” (page 148)
In the opinion of the Court, the external research funding of the tobacco companies served as a way for the tobacco companies to coordinate their fraudulent activities, in violation of federal law (page 1541).
Brown & Williamson was quite explicit in acknowledging that the Council for Tobacco Research - the major research funding arm of the tobacco industry for many years - was essentially a public relations ploy, saying that “CTR was organized as a public relations effort” (page 50).
By accepting funding from Big Tobacco, the Duke Center for Child and Family Policy is allowing itself to serve as a pawn in Philip Morris' public relations strategy.
The rest of the story is that rather than being a model for child and family policy for the nation, Duke is instead an example of exactly the opposite. It is perhaps a model, but a model for the most egregious violation of academic ethics. Duke is allowing itself and its reputation and good name to be used as a public relations ploy for a tobacco company. Duke is allowing itself to be used as a pawn in the public relations and marketing strategy of Philip Morris.
By associating its name with that of Duke University, Philip Morris is using Duke to gain public relations marketing value from that association. This is public relations 101. Using corporate funding to secure public credibility and respect. It was part of Philip Morris' (and the other tobacco companies') playbook for decades.
The rest of the story is that Duke continues to undermine its own scientific integrity and that of academia as a whole by allowing itself to serve as a pawn in the tobacco industry's public relations and marketing strategy. A university - and especially a child policy center - should not play a role in marketing the most deadly consumer product. But that is exactly what Duke is doing.
Rather than being recognized as a model for child and family policy, the Duke Center for Child and Family Policy should instead be entered into the Hall of Shame as a center that puts money over ethical integrity.
Friday, August 16, 2013
American Heart Association Accused of Accepting Payments to Allow Undeserving Products to Use "Heart-Healthy" Label
The American Heart Association has been accused, in a lawsuit filed against the Campell Soup Company, of allowing products that are not heart-healthy according to its own standards to display the "Heart-Healthy" label in exchange for financial payments.
According to the AP story: "A new lawsuit is contesting the validity of the heart-healthy claims on some cans of Campbell’s soups. At the center of the federal
lawsuit is the ‘‘Heart-Check’’ certification by the American Heart
Association, and whether it rightfully conveys that a product carries
particular health benefits. The lawsuit says the nonprofit
group lets Campbell and other companies use the ‘‘Heart-Check’’ label on
products that run counter to its stated mission, in exchange for fees.
The American Heart Association says its goal is to fight cardiovascular
diseases and stroke."
"To earn its ‘‘Heart-Check’’
certification, the group’s website states that products must have no
more than 480 milligrams of sodium per serving. But the website also
notes elsewhere that ‘‘low sodium’’ is defined as having 140 milligrams
or less per serving, the lawsuit notes. ‘‘The AHA, for a fee, abandons its general, non-commercial dietary and nutritional guidelines,’’ the lawsuit states. A can of Campbell’s ‘‘Healthy
Request’’ condensed Chicken Noodle Soup, which bears the certification
mark in question, is listed as having 410 milligrams of sodium per
half-cup serving. The lawsuit notes that there are two or more servings
per can, meaning there would be at least 820 milligrams of sodium in a
can. ... The lawsuit states that the AHA’s
seal of approval misleads people into thinking in that products made by
Campbell ‘‘possess some cardiovascular benefit not enjoyed by products
that have not been certified by the AHA.’’ It states the only difference
is that Campbell pays money for the certification."
The Rest of the Story
What the American Heart Association is doing is nothing short of fraud. And the most despicable part of their behavior is that they are essentially being paid off to partner with corporations to commit this fraud. Money, not the public's health, is apparently the driving force behind the American Heart Association's actions.
I'm sorry, but there is simply no way that a can of soup that contains 820 milligrams of sodium (one half of an entire day's limit for "heart health") should have a heart-healthy label. The fraud, of course, is that the American Heart Association allows corporations to base the label on one serving of the product, rather than one can. But how many people do you know who pour out half a bottle of Campbell's soup and then put the remainder away for a different day?
By allowing companies to use very small amounts of food (in this case, just one cup) as a serving size, the American Heart Association is defrauding the American consumer. This might not be so bad if it weren't the case that the Heart Association is apparently being paid off. What a scam.
Thursday, August 15, 2013
Despite Best Efforts of Anti-Smoking Groups, Cigarette Sales Were Down 600 Million Units in First Quarter of 2013
Despite the best efforts of many anti-smoking groups, cigarette sales were down 600 million units in the first quarter of 2013. Why? Because electronic cigarettes competed successfully with tobacco cigarettes and drove their sales down.
According to an article in the Wall Street Journal: "The market for e-cigarettes, which includes more than 250 brands, has grown from the thousands of users in 2006 to several million world-wide. Analysts estimate sales could double this year to $1 billion. Some go as far as saying consumption of e-cigs could surpass consumption of traditional cigarettes in the next decade. Tobacco company executives even noted that e-cigarettes drove total industry cigarette volumes down about 600 million cigarettes, or about 1 percent, during the first quarter, excluding Internet sales—a major avenue for e-cig purchases."
This effect, which is going to reduce smoking-related disease, occurred despite the best efforts of many anti-smoking groups, which have been vigorously discouraging smokers from quitting smoking or cutting down on their cigarette consumption using e-cigarettes.
In other words, if the anti-smoking groups had their way, there would have been 600 million more cigarettes smoked in the first quarter of 2013.
The Rest of the Story
You may be wondering if you read this story correctly. It states that the anti-smoking groups are acting in a way to increase cigarette consumption, rather than decrease it. This seems ironic, if not absurd.
Nevertheless, this is not a mistake. It is true. The anti-smoking groups did everything they could to prevent this 600 million unit decline in cigarette sales. Fortunately, many smokers didn't listen to the anti-smoking groups and instead, decided to put their health first and to decrease their consumption of cigarettes.
It is sad that a successful intervention that is decreasing cigarette consumption is occurring not as a result of the actions of tobacco control groups, but in spite of their actions. In fact, the cigarette companies are playing more of a role in this substantial public health success story than the anti-smoking groups.
It's time for the anti-smoking groups to go back to the drawing board and remind themselves that they are trying to improve the public's health, not harm it.
According to an article in the Wall Street Journal: "The market for e-cigarettes, which includes more than 250 brands, has grown from the thousands of users in 2006 to several million world-wide. Analysts estimate sales could double this year to $1 billion. Some go as far as saying consumption of e-cigs could surpass consumption of traditional cigarettes in the next decade. Tobacco company executives even noted that e-cigarettes drove total industry cigarette volumes down about 600 million cigarettes, or about 1 percent, during the first quarter, excluding Internet sales—a major avenue for e-cig purchases."
This effect, which is going to reduce smoking-related disease, occurred despite the best efforts of many anti-smoking groups, which have been vigorously discouraging smokers from quitting smoking or cutting down on their cigarette consumption using e-cigarettes.
In other words, if the anti-smoking groups had their way, there would have been 600 million more cigarettes smoked in the first quarter of 2013.
The Rest of the Story
You may be wondering if you read this story correctly. It states that the anti-smoking groups are acting in a way to increase cigarette consumption, rather than decrease it. This seems ironic, if not absurd.
Nevertheless, this is not a mistake. It is true. The anti-smoking groups did everything they could to prevent this 600 million unit decline in cigarette sales. Fortunately, many smokers didn't listen to the anti-smoking groups and instead, decided to put their health first and to decrease their consumption of cigarettes.
It is sad that a successful intervention that is decreasing cigarette consumption is occurring not as a result of the actions of tobacco control groups, but in spite of their actions. In fact, the cigarette companies are playing more of a role in this substantial public health success story than the anti-smoking groups.
It's time for the anti-smoking groups to go back to the drawing board and remind themselves that they are trying to improve the public's health, not harm it.
Wednesday, August 14, 2013
American Legacy Foundation-Proclaimed "Leader" in Tobacco Control is Now Advertising Camel Cigarettes to Millions of Youth Readers
In 2007, the American Legacy Foundation, according to its website, honored Glamour and Vogue with a corporate partnership: Legacy listed Conde Nast Publications - the publisher of these magazines - as being its corporate partner. According to a Legacy report,
the Foundation reaped a significant financial benefit from this corporate partnership: substantial advertising discounts in the
company's magazines.
Moreover, the American Legacy Foundation called Conde Nast Publications - its corporate partner - a "leader" in the tobacco control movement.
The Rest of the Story
In 2013, while most cigarette advertising in magazines has gone by the wayside, Conde Nast Publications is featuring, in several of its magazines with large youth readerships, a 3-page spread advertising Camel cigarettes. According to the Campaign for Tobacco-Free Kids, these ads are reaching a total youth audience of at least 12.9 million teenagers: more than 2.2 million youth readers through Glamour and nearly 1.2 million teens through Vogue.
According to the Campaign for Tobacco-Free Kids: "The August 2013 issue of Glamour magazine features the world’s most popular boy band, One Direction, on the cover. Inside the magazine, and placed just before the story and photos on the band, there’s a huge, three-page spread of ads for R.J. Reynolds’ Camel cigarettes. The magazine’s cover no doubt is attracting many teens and tweens who make up the band’s fan base, exposing them to messages encouraging them to smoke. Glamour has more than 2.2 million teen readers, according to GfK MRI, a consumer research firm."
So thanks largely to Conde Nast Publications, we have now turned the clock back more than a decade and recreated the problem of youth exposure to cigarette advertising in magazines - a problem that had almost disappeared.
The unforgivable part of this story is that it was the American Legacy Foundation that honored Conde Nast Publications with a corporate partnership and called Conde Nast a "leader" in the tobacco control movement.
Back in 2007, I wrote: "The rest of the story is that while the American Legacy Foundation's mouth is busy complaining about how Vogue and Cosmopolitan are carrying these malicious advertisements which are directly targeting girls [the Camel No. 9 ads], the Foundation has done something very different with its financial interests: maintained a corporate partnership with these very magazines. ... So the truth of the matter is that the American Legacy Foundation is, or at least was, a corporate partner of the very companies which are carrying these supposedly despicable Camel No. 9 advertisements to our nation's girls."
"If Legacy were sincerely interested in ending the advertising of Camel No. 9 cigarettes, I should think that the first thing it would do is to end its corporate partnership with Hearst and
Conde Nast (and do so in a very vocal manner), or at very least, to issue an ultimatum to these companies that they either halt the advertising of Camel No. 9 cigarettes or Legacy will end its partnership and stop honoring these companies as public health contributors."
"While Legacy is easily able to write a stinging letter demanding that magazines cease their advertising of Camel No. 9, it does not appear to be so willing to risk its financial benefits by threatening or ending its corporate partnership with the very same magazines."
"Interestingly, while Legacy mentions that Vogue and Cosmopolitan are carrying the Camel No. 9 ads, it is careful not to mention the names of the companies that publish these magazines. Apparently, this is one benefit of a corporate partnership with Legacy: protection from public criticism."
While the rest of the tobacco control movement was working in the mid-2000s, and for decades before that - to reduce or eliminate cigarette advertising in magazines - the American Legacy Foundation was working on the opposite side of the issue, undermining the work of the rest of the tobacco control community. Sadly, they have never acknowledged this serious error. Today, given what Conde Nast is now doing, Legacy should acknowledge its mistake and issue an apology.
Today, I cannot find any evidence that Legacy is criticizing Conde Nast for its actions in helping promote Camel cigarettes to its youth readers. I've seen no evidence that Legacy is remorseful for putting its financial interests ahead of the public's health.
But I suppose it's not surprising that Legacy would not criticize Conde Nast. It's difficult to bite the hand that feeds you, and even the one that fed you.
Moreover, the American Legacy Foundation called Conde Nast Publications - its corporate partner - a "leader" in the tobacco control movement.
The Rest of the Story
In 2013, while most cigarette advertising in magazines has gone by the wayside, Conde Nast Publications is featuring, in several of its magazines with large youth readerships, a 3-page spread advertising Camel cigarettes. According to the Campaign for Tobacco-Free Kids, these ads are reaching a total youth audience of at least 12.9 million teenagers: more than 2.2 million youth readers through Glamour and nearly 1.2 million teens through Vogue.
According to the Campaign for Tobacco-Free Kids: "The August 2013 issue of Glamour magazine features the world’s most popular boy band, One Direction, on the cover. Inside the magazine, and placed just before the story and photos on the band, there’s a huge, three-page spread of ads for R.J. Reynolds’ Camel cigarettes. The magazine’s cover no doubt is attracting many teens and tweens who make up the band’s fan base, exposing them to messages encouraging them to smoke. Glamour has more than 2.2 million teen readers, according to GfK MRI, a consumer research firm."
So thanks largely to Conde Nast Publications, we have now turned the clock back more than a decade and recreated the problem of youth exposure to cigarette advertising in magazines - a problem that had almost disappeared.
The unforgivable part of this story is that it was the American Legacy Foundation that honored Conde Nast Publications with a corporate partnership and called Conde Nast a "leader" in the tobacco control movement.
Back in 2007, I wrote: "The rest of the story is that while the American Legacy Foundation's mouth is busy complaining about how Vogue and Cosmopolitan are carrying these malicious advertisements which are directly targeting girls [the Camel No. 9 ads], the Foundation has done something very different with its financial interests: maintained a corporate partnership with these very magazines. ... So the truth of the matter is that the American Legacy Foundation is, or at least was, a corporate partner of the very companies which are carrying these supposedly despicable Camel No. 9 advertisements to our nation's girls."
"If Legacy were sincerely interested in ending the advertising of Camel No. 9 cigarettes, I should think that the first thing it would do is to end its corporate partnership with Hearst and
Conde Nast (and do so in a very vocal manner), or at very least, to issue an ultimatum to these companies that they either halt the advertising of Camel No. 9 cigarettes or Legacy will end its partnership and stop honoring these companies as public health contributors."
"While Legacy is easily able to write a stinging letter demanding that magazines cease their advertising of Camel No. 9, it does not appear to be so willing to risk its financial benefits by threatening or ending its corporate partnership with the very same magazines."
"Interestingly, while Legacy mentions that Vogue and Cosmopolitan are carrying the Camel No. 9 ads, it is careful not to mention the names of the companies that publish these magazines. Apparently, this is one benefit of a corporate partnership with Legacy: protection from public criticism."
While the rest of the tobacco control movement was working in the mid-2000s, and for decades before that - to reduce or eliminate cigarette advertising in magazines - the American Legacy Foundation was working on the opposite side of the issue, undermining the work of the rest of the tobacco control community. Sadly, they have never acknowledged this serious error. Today, given what Conde Nast is now doing, Legacy should acknowledge its mistake and issue an apology.
Today, I cannot find any evidence that Legacy is criticizing Conde Nast for its actions in helping promote Camel cigarettes to its youth readers. I've seen no evidence that Legacy is remorseful for putting its financial interests ahead of the public's health.
But I suppose it's not surprising that Legacy would not criticize Conde Nast. It's difficult to bite the hand that feeds you, and even the one that fed you.
Tuesday, August 13, 2013
Gallup Poll Shows that Cold Turkey is Overwhelmingly the Most Successful Quitting Strategy, With NRT Making Little Contribution
A July Gallup poll asked former smokers to identify the strategies or methods they used to successfully quit smoking. Based on their smoking cessation recommendations to the public, if you ask any anti-smoking organization what they think would be the most common answer to this question, they will most likely say:
a. Nicotine patch;
b. Nicotine gum;
c. Nicotine inhaler; or
d. Prescription drugs.
But the public's answer to the question was essentially "None of the above." Overwhelmingly, the method identified by ex-smokers as most effective for quitting was "cold turkey."
Nearly half of successful quitters (48%) identified cold turkey quitting as the most effective strategy for them. In contrast, only 5% identified the nicotine patch, 1% identified nicotine gum, no one identified the nicotine inhaler, and 2% identified prescription drugs.
Interestingly, despite discouragement from anti-smoking groups, 3% of successful ex-smokers identified electronic cigarettes as being the most effective smoking cessation strategy, higher than the proportion identifying Chantix, Buproprion, nicotine gum, or the nicotine inhaler and only slightly behind the nicotine patch.
The Rest of the Story
There are two important findings of this survey.
First, it is very clear that despite the findings of clinical trials, when you examine the question on a population basis, cold turkey quitting is the most effective strategy and the "recommended," "FDA-approved" quitting methods are not particularly useful.
What does this mean? It demonstrates what I've been arguing for months: that although clinical trials have found that NRT and drugs are effective, the absolute cessation rates are dismally low. Thus, these approaches cannot be said to be "effective" strategies for smoking cessation on a population basis.
It also demonstrates that most clinical trials results are meaningless because they involve not just NRT or drugs but intensive intervention involving multiple medical visits, assessments, counseling, etc. When used in real-life settings, these products are not nearly as effective. And of course, that is what matters most, not the clinical trial results.
Second, these findings suggest that electronic cigarettes are an effective smoking cessation tool for many smokers. Anti-smoking groups which continue to argue that there is no evidence that electronic cigarettes can be effective for smoking cessation are ignoring the evidence and misleading the public.
(Thanks to John Polito for the tip.)
a. Nicotine patch;
b. Nicotine gum;
c. Nicotine inhaler; or
d. Prescription drugs.
But the public's answer to the question was essentially "None of the above." Overwhelmingly, the method identified by ex-smokers as most effective for quitting was "cold turkey."
Nearly half of successful quitters (48%) identified cold turkey quitting as the most effective strategy for them. In contrast, only 5% identified the nicotine patch, 1% identified nicotine gum, no one identified the nicotine inhaler, and 2% identified prescription drugs.
Interestingly, despite discouragement from anti-smoking groups, 3% of successful ex-smokers identified electronic cigarettes as being the most effective smoking cessation strategy, higher than the proportion identifying Chantix, Buproprion, nicotine gum, or the nicotine inhaler and only slightly behind the nicotine patch.
The Rest of the Story
There are two important findings of this survey.
First, it is very clear that despite the findings of clinical trials, when you examine the question on a population basis, cold turkey quitting is the most effective strategy and the "recommended," "FDA-approved" quitting methods are not particularly useful.
What does this mean? It demonstrates what I've been arguing for months: that although clinical trials have found that NRT and drugs are effective, the absolute cessation rates are dismally low. Thus, these approaches cannot be said to be "effective" strategies for smoking cessation on a population basis.
It also demonstrates that most clinical trials results are meaningless because they involve not just NRT or drugs but intensive intervention involving multiple medical visits, assessments, counseling, etc. When used in real-life settings, these products are not nearly as effective. And of course, that is what matters most, not the clinical trial results.
Second, these findings suggest that electronic cigarettes are an effective smoking cessation tool for many smokers. Anti-smoking groups which continue to argue that there is no evidence that electronic cigarettes can be effective for smoking cessation are ignoring the evidence and misleading the public.
(Thanks to John Polito for the tip.)
Monday, August 12, 2013
Why is the CDC Taking Research Funding from a Pharmaceutical Company?
When I worked at the Centers for Disease Prevention and Control (CDC) from 1993-1995, I always considered it to be an independent, objective source of public health scientific research and policy analysis. I can attest that all of the research I conducted there was independent and free of any influence from corporate interests. None of the research I conducted was funded by, or conducted in partnership with any tobacco or pharmaceutical companies, nor did we farm out any research to be funded by or associated with corporations.
It's remarkable how much things have changed since I left the agency in 1995.
Last week, the CDC published an article in its journal "Preventing Chronic Disease" that assessed the economic impact of smoke-free bar and restaurant laws. The research found that there was no adverse economic impact of these laws in the nine states studied.
This may sound innocent enough.
Consider, however, that the research was funded through the CDC Foundation, which contracted with RTI International to conduct the study. And who actually funded the study?
The Rest of the Story
The study was funded by a drug company: Pfizer.
And Pfizer wasted no time in boasting about its partnership with CDC. In the very press release that was supposedly intended to announce the important scientific results of the study, the CDC Foundation was sure to include this public relations statement from the corporation:
"Pfizer is proud to have partnered with the CDC Foundation and CDC on this important research initiative and we are very encouraged by the results,” said Freda C. Lewis-Hall, MD, FAPA, executive vice president and chief medical officer, Pfizer."
So now you know the truth. The real story behind this research is that its true purpose - from the perspective of Pfizer - was to create the public perception that Pfizer and CDC are partners.
That's all very charming, but there's just one problem. It is not appropriate for a government public health agency to partner with the very corporations about whose drugs or products that agency issues recommendations about their approval, disapproval, or use.
Suppose I were a corporation that manufactured a vaccine about which CDC was going to make a recommendation for either approval or disapproval. Wouldn't I just love the opportunity to partner with the CDC so that I could influence their decision with money, and to do it legally no less?
Well, this is exactly what the CDC is now allowing corporations to do by accepting their donations in return for the opportunity to partner with, and thus influence, the agency's decisions. And the CDC Foundation acknowledges this right on its web site, writing that two of the "added values" to corporations of partnering with the agency are:
The CDC Foundation has a large number of partnerships with Big Pharma companies, including GlaxoSmithKline, Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, Novartis, and Sanofi-Aventis. So the problem is not restricted to this one partnership with Pfizer.
The CDC Foundation also partners with the Coca-Cola Company. According to the CDC Foundation, partnerships are only accepted with "Corporations whose goals or philanthropic interests align with CDC’s work...".
In what way do Coca-Cola’s goals align with those of CDC? The CDC is in the business of trying to improve the public’s health. Coca-Cola is in the business of trying to market and sell sugar-laden soft drinks that contribute to the obesity epidemic. The CDC presumably favors school nutrition improvement. Coca-Cola has opposed virtually every piece of state legislation to improve school nutrition. The CDC presumably wants to decrease the consumption of sugar-laden soft drinks. Coca-Cola is working to sustain the sales of its sugar-laden soft drinks.
The CDC Foundation also partners with Abbott Laboratories.
How could the CDC’s partnership with Abbott Laboratories not constitute a violation of its corporate partnership policy? Abbott Laboratories is one of the leading manufacturers of infant formula, which it is pushing to pregnant women through programs such as the giveaway of infant formula in hospitals. Presumably, the CDC has a vested interest in promoting increased breastfeeding and reduced use of infant formula. This certainly appears to represent a conflict of interest.
The CDC Foundation also partners with Georgia Pacific.
How could CDC’s partnership with Georgia Pacific not constitute a conflict of interest? Georgia Pacific is one of the nation's leading corporate polluters. In what way does that align with CDC's mission and goals?
The rest of the story is that through its corporate partnerships with companies which either produce products that are causing harm to the public or which are within the scope of CDC’s public recommendations, the CDC Foundation is creating significant conflict of interests that conflict with its stated policy of avoiding such conflicts. I believe that these partnerships taint the scientific objectivity of the agency, are inconsistent with the stated mission and policy of the CDC and CDC Foundation, and represent a disservice to the public’s interest.
It's remarkable how much things have changed since I left the agency in 1995.
Last week, the CDC published an article in its journal "Preventing Chronic Disease" that assessed the economic impact of smoke-free bar and restaurant laws. The research found that there was no adverse economic impact of these laws in the nine states studied.
This may sound innocent enough.
Consider, however, that the research was funded through the CDC Foundation, which contracted with RTI International to conduct the study. And who actually funded the study?
The Rest of the Story
The study was funded by a drug company: Pfizer.
And Pfizer wasted no time in boasting about its partnership with CDC. In the very press release that was supposedly intended to announce the important scientific results of the study, the CDC Foundation was sure to include this public relations statement from the corporation:
"Pfizer is proud to have partnered with the CDC Foundation and CDC on this important research initiative and we are very encouraged by the results,” said Freda C. Lewis-Hall, MD, FAPA, executive vice president and chief medical officer, Pfizer."
So now you know the truth. The real story behind this research is that its true purpose - from the perspective of Pfizer - was to create the public perception that Pfizer and CDC are partners.
That's all very charming, but there's just one problem. It is not appropriate for a government public health agency to partner with the very corporations about whose drugs or products that agency issues recommendations about their approval, disapproval, or use.
Suppose I were a corporation that manufactured a vaccine about which CDC was going to make a recommendation for either approval or disapproval. Wouldn't I just love the opportunity to partner with the CDC so that I could influence their decision with money, and to do it legally no less?
Well, this is exactly what the CDC is now allowing corporations to do by accepting their donations in return for the opportunity to partner with, and thus influence, the agency's decisions. And the CDC Foundation acknowledges this right on its web site, writing that two of the "added values" to corporations of partnering with the agency are:
- creating "mutually beneficial collaborations with world-renowned CDC scientists"; and
- simplifying "the process of partnering with a complex federal agency."
For example, the CDC makes recommendations regarding the use of vaccines. One vaccine about which the CDC deliberated was Pfizer's Prevnar. The CDC Advisory Committee on Immunization Practices (ACIP) regularly makes recommendations regarding the use of vaccines.
Furthermore,
CDC makes recommendations regarding a wide range of other drugs,
related to the prevention and treatment of all sorts of infectious and
chronic diseases.
Through its partnership
with CDC and the CDC Foundation, Pfizer has the potential to gain an
increased corporate image among CDC staff, and therefore, to influence
decisions that the CDC makes about the approval or disapproval of Pfizer
products. I am not arguing that the influence is a conscious one. I’m
not saying that CDC will consciously say to itself: we received money
from Pfizer so let’s be extra nice to them in our formulation of public
recommendations. However, I do believe that the receipt of this funding
from Pfizer, which the CDC Foundation praises heavily in its press
release, will have the effect of improving the company’s image within
the agency, and that it could potentially have a subconscious effect on
the agency and therefore influence its actions. This is precisely how
conflicts of interest work.
If this were an
individual researcher rather than an agency, there is no question that
the partnership with Pfizer and other pharmaceutical companies would
represent a conflict of interest. I see no reason why it is not a
conflict just because the CDC is an agency rather than an individual.
The conflict of interest would be expected to work in exactly the same
way.
The CDC Foundation has a large number of partnerships with Big Pharma companies, including GlaxoSmithKline, Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, Novartis, and Sanofi-Aventis. So the problem is not restricted to this one partnership with Pfizer.
The CDC Foundation also partners with the Coca-Cola Company. According to the CDC Foundation, partnerships are only accepted with "Corporations whose goals or philanthropic interests align with CDC’s work...".
In what way do Coca-Cola’s goals align with those of CDC? The CDC is in the business of trying to improve the public’s health. Coca-Cola is in the business of trying to market and sell sugar-laden soft drinks that contribute to the obesity epidemic. The CDC presumably favors school nutrition improvement. Coca-Cola has opposed virtually every piece of state legislation to improve school nutrition. The CDC presumably wants to decrease the consumption of sugar-laden soft drinks. Coca-Cola is working to sustain the sales of its sugar-laden soft drinks.
Don’t
get me wrong. I’m not criticizing Coca-Cola. They are not in business
to reduce obesity. They are in business to sell soft drinks and I
wouldn’t argue that they should do otherwise. If anything, I commend
Coca-Cola for being brilliant enough to use its money in a way that may
soften the CDC’s stance on sugar-laden soft drinks.
The CDC Foundation also partners with Abbott Laboratories.
How could the CDC’s partnership with Abbott Laboratories not constitute a violation of its corporate partnership policy? Abbott Laboratories is one of the leading manufacturers of infant formula, which it is pushing to pregnant women through programs such as the giveaway of infant formula in hospitals. Presumably, the CDC has a vested interest in promoting increased breastfeeding and reduced use of infant formula. This certainly appears to represent a conflict of interest.
The CDC Foundation also partners with Georgia Pacific.
How could CDC’s partnership with Georgia Pacific not constitute a conflict of interest? Georgia Pacific is one of the nation's leading corporate polluters. In what way does that align with CDC's mission and goals?
The rest of the story is that through its corporate partnerships with companies which either produce products that are causing harm to the public or which are within the scope of CDC’s public recommendations, the CDC Foundation is creating significant conflict of interests that conflict with its stated policy of avoiding such conflicts. I believe that these partnerships taint the scientific objectivity of the agency, are inconsistent with the stated mission and policy of the CDC and CDC Foundation, and represent a disservice to the public’s interest.
Friday, August 09, 2013
Review of Laboratory Studies on Electronic Cigarettes Concludes that They Pose Few Health Risks and that Secondhand Vapor is Unlikely to Be Hazardous
A new study which reviews approximately 40 laboratory studies of the chemical constituents of electronic cigarette vapor concludes that these products pose few health risks and that secondhand vapor is unlikely to pose any significant health hazard.
(See: Burstyn I. Peering through the mist: What does the chemistry of contaminants in electronic cigarettes tell us about health risks. Philadelphia, PA: Drexel University School of Public Health, 2013.)
The major conclusion of the report is that vaping poses few health concerns and that "passive vaping" is unlikely to pose any health concerns.
What are the few health concerns potentially associated with vaping? The study confirms that the concerns are as I have outlined them previously:
1. Concern about potential respiratory effects of long-term inhalation of propylene glycol; and
2. Concern about long-term exposure to low, but measurable levels of formaldehyde and acrolein.
Diethylene glycol (i.e., anti-freeze) is not a health concern, despite the continuing warnings from the FDA. Neither are the presence of tobacco-specific nitrosamines, again despite the continuing warnings from the FDA. Metals also do not appear to be a major concern.
The report concludes that "secondhand vaping" is unlikely to have any significant health risks.
The Rest of the Story
This study appears to confirm my assessments of the health risks of vaping and passive vaping, which I have shared over the past several months. The issues that the FDA should focus on are:
1. Study of potential long-term respiratory effects of propylene glycol inhalation; and
2. Methods to reduce the formation of formaldehyde in electronic cigarettes.
The study demonstrates that anti-smoking advocates and groups which continue to argue that we know nothing about the potential health effects of electronic cigarettes are wrong. For example, the American Lung Association recently stated that: "Until the Obama administration and the Food and Drug Administration assert their authority to regulate e-cigarettes and force manufacturers to disclose what ingredients are in them, their safety or harm cannot be assessed."
This statement is simply untrue. We actually have a very good understanding of the ingredients in electronic cigarettes (which are nicotine, propylene glycol, glycerin, and flavorings). We also have a good understanding of the constituents in e-cigarette vapor. Moreover, the safety or harm of these products can most certainly be assessed.
While further research is necessary to assess potential long-term respiratory effects of vaping and to figure out ways to minimize exposure to certain volatile organic compounds (especially formaldehyde), there is strong evidence that:
1. Vaping is much safer than smoking;
2. Potential health risks associated with vaping are relatively small; and
3. It is unlikely that passive vaping has any significant health effects.
UPDATE (August 9th, 2013 - 9:00 a.m.) -- Stan Glantz has just released a criticism of this report, in which he argues that the TLV's (threshold limit values) are not the appropriate standard to be used in judging long-term exposures such as vaping. On this basis, he discounts the report.
I actually agree with Stan's argument. However, I disagree that the report should be discounted or that its ultimate conclusions are incorrect.
Stan is correct that the TLV's are not the appropriate standard to use for long-term, daily exposures such as vaping. These standards are for use with acute occupational exposures. They are designed for the occupational setting only. In fact, if you apply TLV's to secondhand smoke, you'll find that many of the TLV's are not reached. This doesn't mean that secondhand smoke isn't harmful.
However here's the problem: Although the report errs by comparing the exposures to TLV's, it nevertheless does provide the actual levels of exposures to each of the constituents. We can still make judgments about the magnitude of these exposures based on their absolute levels, without using any TLV threshold. Based on the observed levels of these exposures, they are unlikely to be of great concern. For example, it would take many years of exposure to formaldehyde at the exposure level observed to pose any carcinogenic risk, and that risk would be quite small. The same is true for the observed levels of metals as well as tobacco-specific nitrosamines. Most of these chemicals are present at levels that are similar in nicotine inhalers.
So I agree with Stan that the TLV limits are irrelevant, but I don't agree that the report can be thrown in the trash. We can still evaluate the absolute exposure levels observed, and those are quite small.
Once again, I think the main issues of concern are whether there are potential respiratory effects of long-term propylene glycol inhalation and whether there are ways to reduce the presence of the few volatile organic compounds, especially formaldehyde and acrolein.
(See: Burstyn I. Peering through the mist: What does the chemistry of contaminants in electronic cigarettes tell us about health risks. Philadelphia, PA: Drexel University School of Public Health, 2013.)
The major conclusion of the report is that vaping poses few health concerns and that "passive vaping" is unlikely to pose any health concerns.
What are the few health concerns potentially associated with vaping? The study confirms that the concerns are as I have outlined them previously:
1. Concern about potential respiratory effects of long-term inhalation of propylene glycol; and
2. Concern about long-term exposure to low, but measurable levels of formaldehyde and acrolein.
Diethylene glycol (i.e., anti-freeze) is not a health concern, despite the continuing warnings from the FDA. Neither are the presence of tobacco-specific nitrosamines, again despite the continuing warnings from the FDA. Metals also do not appear to be a major concern.
The report concludes that "secondhand vaping" is unlikely to have any significant health risks.
The Rest of the Story
This study appears to confirm my assessments of the health risks of vaping and passive vaping, which I have shared over the past several months. The issues that the FDA should focus on are:
1. Study of potential long-term respiratory effects of propylene glycol inhalation; and
2. Methods to reduce the formation of formaldehyde in electronic cigarettes.
The study demonstrates that anti-smoking advocates and groups which continue to argue that we know nothing about the potential health effects of electronic cigarettes are wrong. For example, the American Lung Association recently stated that: "Until the Obama administration and the Food and Drug Administration assert their authority to regulate e-cigarettes and force manufacturers to disclose what ingredients are in them, their safety or harm cannot be assessed."
This statement is simply untrue. We actually have a very good understanding of the ingredients in electronic cigarettes (which are nicotine, propylene glycol, glycerin, and flavorings). We also have a good understanding of the constituents in e-cigarette vapor. Moreover, the safety or harm of these products can most certainly be assessed.
While further research is necessary to assess potential long-term respiratory effects of vaping and to figure out ways to minimize exposure to certain volatile organic compounds (especially formaldehyde), there is strong evidence that:
1. Vaping is much safer than smoking;
2. Potential health risks associated with vaping are relatively small; and
3. It is unlikely that passive vaping has any significant health effects.
UPDATE (August 9th, 2013 - 9:00 a.m.) -- Stan Glantz has just released a criticism of this report, in which he argues that the TLV's (threshold limit values) are not the appropriate standard to be used in judging long-term exposures such as vaping. On this basis, he discounts the report.
I actually agree with Stan's argument. However, I disagree that the report should be discounted or that its ultimate conclusions are incorrect.
Stan is correct that the TLV's are not the appropriate standard to use for long-term, daily exposures such as vaping. These standards are for use with acute occupational exposures. They are designed for the occupational setting only. In fact, if you apply TLV's to secondhand smoke, you'll find that many of the TLV's are not reached. This doesn't mean that secondhand smoke isn't harmful.
However here's the problem: Although the report errs by comparing the exposures to TLV's, it nevertheless does provide the actual levels of exposures to each of the constituents. We can still make judgments about the magnitude of these exposures based on their absolute levels, without using any TLV threshold. Based on the observed levels of these exposures, they are unlikely to be of great concern. For example, it would take many years of exposure to formaldehyde at the exposure level observed to pose any carcinogenic risk, and that risk would be quite small. The same is true for the observed levels of metals as well as tobacco-specific nitrosamines. Most of these chemicals are present at levels that are similar in nicotine inhalers.
So I agree with Stan that the TLV limits are irrelevant, but I don't agree that the report can be thrown in the trash. We can still evaluate the absolute exposure levels observed, and those are quite small.
Once again, I think the main issues of concern are whether there are potential respiratory effects of long-term propylene glycol inhalation and whether there are ways to reduce the presence of the few volatile organic compounds, especially formaldehyde and acrolein.
Thursday, August 08, 2013
Proposed New York City Ordinance Declares that Electronic Cigarettes are Designed to Deter Smokers from Quitting, Then Bans the Sale of Flavored Electronic Cigarettes
Today, I reveal that a proposed New York City ordinance would ban the sale of flavored electronic cigarettes on the basis that these products are designed to deter smokers from quitting.
According to the preamble of the ordinance: "Electronic cigarette marketing is often designed to deter smokers from quitting... ."
On this basis, the ordinance goes on to ban the sale of flavored electronic cigarettes. While plain tobacco-"flavored" e-cigarettes could still be sold, the ordinance would ban the sale of a wide variety of flavored e-cigarettes. These flavors are central to the success of these products and the ordinance, if enacted, would likely decimate the sale of electronic cigarettes in New York City.
The Rest of the Story
I have to say that this statement (that electronic cigarette marketing is designed to deter smokers from quitting) is the most inane one I have heard in a long time. In fact, it is the most inane statement I've heard since Anthony Weiner declared that his having texted inappropriate photos makes him a stronger candidate for mayor of New York City.
Let's analyze the stupidity of this statement. We'll start with a simple question:
What is it that an electronic cigarette company wants its customers to do?
a. Continue smoking lots of tobacco cigarettes but try an electronic cigarette once in a while;
b. Continue smoking a moderate number of tobacco cigarettes but also a moderate number of electronic cigarettes; or
c. Completely replace tobacco cigarettes with electronic cigarettes so that the individual is buying the maximum possible number of electronic cigarette cartridges.
If you answered C, you are correct. If you answered A, then you are probably the individual who authored this inane ordinance.
It defies logic that an electronic cigarette company would want its customers to continue smoking tobacco cigarettes. If that is the marketing strategy for your company, you are going to go out of business very quickly. Of course, the objective of every e-cigarette company's marketing strategy is to encourage smokers to quit smoking and to switch completely to electronic cigarettes.
In fact, I defy the New York City council to identify one (1) electronic cigarette company that discourages its customers from quitting smoking.
The truth is that the very purpose of electronic cigarettes is the complete opposite of what the New York city council is apparently suggesting. Their purpose is to get smokers to quit smoking by completely substituting electronic cigarettes for tobacco cigarettes. All of the marketing for these products is designed not to deter smokers from quitting but to encourage smokers to quit.
The proposed ban on electronic cigarettes is equally inane.
Why would New York City want to protect the sales of the most hazardous type of tobacco product on the market - cigarettes - but ban the sale of a product (electronic cigarettes) that literally hundreds of thousands of people across the country are using in order to quit smoking and is the safest available nicotine-containing non-medical product on the market? This makes no public health sense.
Thousands of smokers have successfully quit smoking using electronic cigarettes and many more thousands have substantially cut down on the amount that they smoke. Moreover, there is no evidence that these products have become popular among youth or nonsmokers. Thus, the availability of these products is leading to substantial health improvement on a population basis without any observable downside. Why would any city council want to put an end to this?
The only entities that will be protected by this regulation are the tobacco industry, which will benefit because smokers who might otherwise have quit will continue smoking, and the pharmaceutical industry, which will benefit because smokers who might have used electronic cigarettes to quit will be forced to continue spending their money on smoking cessation drugs that are largely ineffective.
The real effect of this regulation would be to protect the conventional cigarette market from competition. And unfortunately, that competition is currently in the form of truly reduced risk products: electronic cigarettes.
According to the preamble of the ordinance: "Electronic cigarette marketing is often designed to deter smokers from quitting... ."
On this basis, the ordinance goes on to ban the sale of flavored electronic cigarettes. While plain tobacco-"flavored" e-cigarettes could still be sold, the ordinance would ban the sale of a wide variety of flavored e-cigarettes. These flavors are central to the success of these products and the ordinance, if enacted, would likely decimate the sale of electronic cigarettes in New York City.
The Rest of the Story
I have to say that this statement (that electronic cigarette marketing is designed to deter smokers from quitting) is the most inane one I have heard in a long time. In fact, it is the most inane statement I've heard since Anthony Weiner declared that his having texted inappropriate photos makes him a stronger candidate for mayor of New York City.
Let's analyze the stupidity of this statement. We'll start with a simple question:
What is it that an electronic cigarette company wants its customers to do?
a. Continue smoking lots of tobacco cigarettes but try an electronic cigarette once in a while;
b. Continue smoking a moderate number of tobacco cigarettes but also a moderate number of electronic cigarettes; or
c. Completely replace tobacco cigarettes with electronic cigarettes so that the individual is buying the maximum possible number of electronic cigarette cartridges.
If you answered C, you are correct. If you answered A, then you are probably the individual who authored this inane ordinance.
It defies logic that an electronic cigarette company would want its customers to continue smoking tobacco cigarettes. If that is the marketing strategy for your company, you are going to go out of business very quickly. Of course, the objective of every e-cigarette company's marketing strategy is to encourage smokers to quit smoking and to switch completely to electronic cigarettes.
In fact, I defy the New York City council to identify one (1) electronic cigarette company that discourages its customers from quitting smoking.
The truth is that the very purpose of electronic cigarettes is the complete opposite of what the New York city council is apparently suggesting. Their purpose is to get smokers to quit smoking by completely substituting electronic cigarettes for tobacco cigarettes. All of the marketing for these products is designed not to deter smokers from quitting but to encourage smokers to quit.
The proposed ban on electronic cigarettes is equally inane.
Why would New York City want to protect the sales of the most hazardous type of tobacco product on the market - cigarettes - but ban the sale of a product (electronic cigarettes) that literally hundreds of thousands of people across the country are using in order to quit smoking and is the safest available nicotine-containing non-medical product on the market? This makes no public health sense.
Thousands of smokers have successfully quit smoking using electronic cigarettes and many more thousands have substantially cut down on the amount that they smoke. Moreover, there is no evidence that these products have become popular among youth or nonsmokers. Thus, the availability of these products is leading to substantial health improvement on a population basis without any observable downside. Why would any city council want to put an end to this?
The only entities that will be protected by this regulation are the tobacco industry, which will benefit because smokers who might otherwise have quit will continue smoking, and the pharmaceutical industry, which will benefit because smokers who might have used electronic cigarettes to quit will be forced to continue spending their money on smoking cessation drugs that are largely ineffective.
The real effect of this regulation would be to protect the conventional cigarette market from competition. And unfortunately, that competition is currently in the form of truly reduced risk products: electronic cigarettes.
Wednesday, August 07, 2013
Canton, Massachusetts Considering Complete Ban on Electronic Cigarettes: Why Protect the Most Hazardous Tobacco Products and Ban the Fake Ones?
This coming Monday, the Canton (MA) Board of Health will consider a proposed regulation that would completely ban the sale of electronic cigarettes in the town. Unlike ordinances considered by several other cities and states that would ban the sale of electronic cigarettes to minors, this one bans the sale of electronic cigarettes altogether, even to adult smokers. If enacted, Canton would become the first city in the United States to ban the sale of electronic cigarettes.
The proposed regulation states: "All non-medical use nicotine delivery products including, but not limited to electronic cigarettes and smokeless tobacco, as defined in this regulation are prohibited from sale, without exception, in the Town of Canton."
The regulation would apparently ban the sale of not only electronic cigarettes, but also dissolvable tobacco products and snus. It also appears, by my reading, to ban the sale of all other smokeless tobacco products.
The Rest of the Story
Why would the town of Canton want to protect the sales of the most hazardous type of tobacco product on the market - cigarettes - but ban the sale of a product (electronic cigarettes) that literally hundreds of thousands of people across the country are using in order to quit smoking and is the safest available nicotine-containing non-medical product on the market?
This makes no public health sense.
Thousands of smokers have successfully quit smoking using electronic cigarettes and many more thousands have substantially cut down on the amount that they smoke. Moreover, there is no evidence that these products have become popular among youth or nonsmokers. Thus, the availability of these products is leading to substantial health improvement on a population basis without any observable downside.
Why would any board of "health" want to put an end to this?
The only entities that will be protected by this regulation are the tobacco industry, which will benefit because smokers who might otherwise have quit will continue smoking, and the pharmaceutical industry, which will benefit because smokers who might have used electronic cigarettes to quit will be forced to continue spending their money on smoking cessation drugs that are largely ineffective.
The real effect of this regulation would be to protect the conventional cigarette market from competition. And unfortunately, that competition is currently in the form of truly reduced risk products: electronic cigarettes.
Does the Canton Board of Health want to stand as the most vigorous protector of the current market of conventional cigarettes that one could ever imagine? Do they want to stand as protectors, rather than opponents, of the death and disease caused by the nation's most hazardous consumer product?
I am confident that the answer is no and I am therefore confident that once the full Board discusses the proposed regulation, it will reconsider and scrap the idea of banning electronic cigarettes.
The proposed regulation states: "All non-medical use nicotine delivery products including, but not limited to electronic cigarettes and smokeless tobacco, as defined in this regulation are prohibited from sale, without exception, in the Town of Canton."
The regulation would apparently ban the sale of not only electronic cigarettes, but also dissolvable tobacco products and snus. It also appears, by my reading, to ban the sale of all other smokeless tobacco products.
The Rest of the Story
Why would the town of Canton want to protect the sales of the most hazardous type of tobacco product on the market - cigarettes - but ban the sale of a product (electronic cigarettes) that literally hundreds of thousands of people across the country are using in order to quit smoking and is the safest available nicotine-containing non-medical product on the market?
This makes no public health sense.
Thousands of smokers have successfully quit smoking using electronic cigarettes and many more thousands have substantially cut down on the amount that they smoke. Moreover, there is no evidence that these products have become popular among youth or nonsmokers. Thus, the availability of these products is leading to substantial health improvement on a population basis without any observable downside.
Why would any board of "health" want to put an end to this?
The only entities that will be protected by this regulation are the tobacco industry, which will benefit because smokers who might otherwise have quit will continue smoking, and the pharmaceutical industry, which will benefit because smokers who might have used electronic cigarettes to quit will be forced to continue spending their money on smoking cessation drugs that are largely ineffective.
The real effect of this regulation would be to protect the conventional cigarette market from competition. And unfortunately, that competition is currently in the form of truly reduced risk products: electronic cigarettes.
Does the Canton Board of Health want to stand as the most vigorous protector of the current market of conventional cigarettes that one could ever imagine? Do they want to stand as protectors, rather than opponents, of the death and disease caused by the nation's most hazardous consumer product?
I am confident that the answer is no and I am therefore confident that once the full Board discusses the proposed regulation, it will reconsider and scrap the idea of banning electronic cigarettes.
Tuesday, August 06, 2013
Mayo Clinic Researchers Who Oppose Electronic Cigarettes Fail to Disclose Pharmaceutical Conflicts of Interest in Research
Yesterday, I revealed that a Mayo Clinic advice column which discourages smokers from quitting using electronic cigarettes and which contains false statements regarding the scientific evidence regarding these products failed to disclose the conflict of interest of the column's author with Big Pharma. Specifically, the author - Dr. Jon Ebbert of the Mayo Clinic's Nicotine Dependence Center - failed to disclose that he has received research funding from Pfizer, a pharmaceutical company that markets the very product (nicotine inhaler) that is being analyzed in the column. The column also failed to disclose that the Center's director - Dr. Richard Hurt - also has a conflict of interest because he served on the Advisory Board for Pfizer.
The Mayo Clinic - through its Nicotine Dependence Center - has been an outspoken opponent of electronic cigarettes. Another Mayo Clinic column that advises smokers not to quit using e-cigarettes also fails to disclose that the author has received Big Pharma research funding.
Today, I reveal that the problem is even worse than I thought because Dr. Hurt and Dr. Ebbert are apparently failing to disclose these relevant Big Pharma conflicts of interest in some of their research publications.
The Rest of the Story
Pfizer and GlaxoSmithKline (formerly Glaxo Wellcome) are pharmaceutical companies that manufacture smoking cessation drugs. Pfizer markets Chantix as well as Nicotrol, a nicotine inhaler. GlaxoSmithKline markets buproprion as well as a variety of nicotine replacement products (including the nicotine patch).
Thus, it is easy to easy that any researcher who has received grant funding from, or served on an advisory board for either of these companies has a conflict of interest in conducting or reporting the results of research on nicotine replacement products or other smoking cessation drugs.
It appears that as early as 2001, Dr. Hurt had received funding from Glaxo Wellcome for a clinical trial of buproprion. More recently, in a 2011 article, he acknowledged receiving funding from Pfizer. Furthermore, he acknowledged serving or having served on the advisory boards for both Pfizer and GlaxoSmithKline. A 2011 article states that he serves on an advisory board for GlaxoSmithKline. In another 2011 article, Dr. Hurt discloses that he served on an advisory board for Pfizer. Another 2011 article states that "Dr. Hurt is a member of the Scientific Advisory Board for GlaxoSmithKline and has received a medical education grant from Pfizer." A 2009 article states that Dr. Hurt "has received consulting fees from Pfizer." A 2009 article states that Dr. Hurt "serves on the Advisory Board for Pfizer."
It appears that more recently (within the past 2 years), Dr. Ebbert has also received funding from Pfizer. Dr. Ebbert is listed as a Principal Investigator on a clinical trial that is sponsored by Pfizer or in which Pfizer is collaborating. In a 2012 article, he acknowledges as follows: "Jon O. Ebbert has received support to conduct clinical trials with varenicline from Pfizer."
This brings us to the failed disclosure. In an article published online ahead of print in the journal Nicotine & Tobacco Research on July 19, 2013, Dr. Ebbert and Dr. Hurt are co-authors of a study which reports the results of a clinical trial of "nicotine patch therapy" for smokeless tobacco users. However, the paper fails to reveal any conflicts of interest. The "declaration of interests" disclosure statement reads: "None declared."
In my opinion, this is a failed disclosure because Dr. Hurt has apparently received funding from Pfizer and Glaxo Wellcome and has apparently served on advisory boards for Pfizer and GlaxoSmithKline. Moreover, Dr. Ebbert has apparently received research funding from Pfizer. Should not these conflicts of interest be disclosed since both of these companies market nicotine replacement products? If this does not represent a conflict of interest (on the part of both authors), then I'm not sure what a conflict of interest is.
There are a number of other articles that report the results of trials of smoking cessation medication that were co-authored by Dr. Hurt in recent years and which also fail to disclose any conflict of interest:
The public should take these conflicts of interest into consideration when evaluating the validity of the advice of these researchers regarding electronic cigarettes.
The Mayo Clinic - through its Nicotine Dependence Center - has been an outspoken opponent of electronic cigarettes. Another Mayo Clinic column that advises smokers not to quit using e-cigarettes also fails to disclose that the author has received Big Pharma research funding.
Today, I reveal that the problem is even worse than I thought because Dr. Hurt and Dr. Ebbert are apparently failing to disclose these relevant Big Pharma conflicts of interest in some of their research publications.
The Rest of the Story
Pfizer and GlaxoSmithKline (formerly Glaxo Wellcome) are pharmaceutical companies that manufacture smoking cessation drugs. Pfizer markets Chantix as well as Nicotrol, a nicotine inhaler. GlaxoSmithKline markets buproprion as well as a variety of nicotine replacement products (including the nicotine patch).
Thus, it is easy to easy that any researcher who has received grant funding from, or served on an advisory board for either of these companies has a conflict of interest in conducting or reporting the results of research on nicotine replacement products or other smoking cessation drugs.
It appears that as early as 2001, Dr. Hurt had received funding from Glaxo Wellcome for a clinical trial of buproprion. More recently, in a 2011 article, he acknowledged receiving funding from Pfizer. Furthermore, he acknowledged serving or having served on the advisory boards for both Pfizer and GlaxoSmithKline. A 2011 article states that he serves on an advisory board for GlaxoSmithKline. In another 2011 article, Dr. Hurt discloses that he served on an advisory board for Pfizer. Another 2011 article states that "Dr. Hurt is a member of the Scientific Advisory Board for GlaxoSmithKline and has received a medical education grant from Pfizer." A 2009 article states that Dr. Hurt "has received consulting fees from Pfizer." A 2009 article states that Dr. Hurt "serves on the Advisory Board for Pfizer."
It appears that more recently (within the past 2 years), Dr. Ebbert has also received funding from Pfizer. Dr. Ebbert is listed as a Principal Investigator on a clinical trial that is sponsored by Pfizer or in which Pfizer is collaborating. In a 2012 article, he acknowledges as follows: "Jon O. Ebbert has received support to conduct clinical trials with varenicline from Pfizer."
This brings us to the failed disclosure. In an article published online ahead of print in the journal Nicotine & Tobacco Research on July 19, 2013, Dr. Ebbert and Dr. Hurt are co-authors of a study which reports the results of a clinical trial of "nicotine patch therapy" for smokeless tobacco users. However, the paper fails to reveal any conflicts of interest. The "declaration of interests" disclosure statement reads: "None declared."
In my opinion, this is a failed disclosure because Dr. Hurt has apparently received funding from Pfizer and Glaxo Wellcome and has apparently served on advisory boards for Pfizer and GlaxoSmithKline. Moreover, Dr. Ebbert has apparently received research funding from Pfizer. Should not these conflicts of interest be disclosed since both of these companies market nicotine replacement products? If this does not represent a conflict of interest (on the part of both authors), then I'm not sure what a conflict of interest is.
There are a number of other articles that report the results of trials of smoking cessation medication that were co-authored by Dr. Hurt in recent years and which also fail to disclose any conflict of interest:
- a 2012 study that involved the use of the nicotine patch;
- a 2011 study that involved the use of methylphenidate for smoking cessation;
- a 2010 article that reviews the use of Chantix for smoking cessation;
- a 2010 study that involved the use of nicotine inhaler and buproprion; and
- a 2009 study that involved the use of buproprion.
The public should take these conflicts of interest into consideration when evaluating the validity of the advice of these researchers regarding electronic cigarettes.
Monday, August 05, 2013
Even the Mayo Clinic is Spreading Lies About Electronic Cigarettes; What is the Anti-Smoking Movement Coming To?
When you can't trust the Mayo Clinic for reliable health information, then you know that something is wrong. But a page full of lies and misleading information from the Mayo Clinic is more than I ever imagined possible.
Sadly, this occurred in the Mayo Clinic's advice to the public about electronic cigarettes, which appeared in a column published in the Chicago Tribune on August 1.
The column consisted of the Mayo Clinic's answer to a very simple question (a yes or no question, in fact) posed by a reader: "I've been a smoker for years. I'm thinking about switching to electronic cigarettes or to a nicotine inhaler because I've heard they aren't as bad for you as regular cigarettes. Is that true?"
So the reader asks a simple and important question: are electronic cigarettes safer than regular cigarettes. This is a simple, yes-or-no question. Let's see what the Mayo Clinic had to say:
"Electronic cigarettes and nicotine inhalers both deliver nicotine to your body without tobacco. But that's where the similarity ends. The two are quite different when it comes to how they're used and how much doctors know about their safety. Nicotine inhalers are a proven safe and effective way to help people stop smoking. In contrast, very little is known about the health effects of electronic cigarettes. ... The manufacturers claim that e-cigarettes are a safe alternative to tobacco cigarettes. But there are significant questions about the safety of these products."
"When the U.S. Food and Drug Administration (FDA) analyzed samples of two popular brands of e-cigarettes, they found varying amounts of nicotine and traces of toxic chemicals, including substances that are known to cause cancer. The liquid inside many e-cigarettes contains a substance called propylene glycol. It creates the e-cigarette's vapor. Other common uses of propylene glycol are in cosmetics and as an ingredient in fog machines and antifreeze. The specific health effects of this product are not clear. No studies have been done to examine the safety of e-cigarettes. As a result, there is no evidence that doctors can use to assess the impact this product may have on a person's body. Also, no convincing evidence shows that e-cigarettes are useful in helping people to eventually stop smoking. ... As with e-cigarettes, nicotine inhalers give you a dose of nicotine when you puff on them. Unlike e-cigarettes, the amount of nicotine you receive is controlled and small. And with nicotine inhalers you receive only nicotine."
The Rest of the Story
As you can see, the Mayo Clinic has failed to answer this simple question. It refuses, in fact, to address the question of whether electronic cigarettes are safer than tobacco cigarettes. In fact, by its silence on this question, I think many readers will infer that the Mayo Clinic is answering with a "No." Instead of answering the question posed, the Mayo Clinic changes the question into a comparison of electronic cigarettes and nicotine inhalers. But sadly, this is where the lies and misinformation begin.
Lie #1: "The manufacturers claim that e-cigarettes are a safe alternative to tobacco cigarettes."
Not only does the Mayo Clinic fail to substantiate this claim, but it is largely untrue. Most electronic cigarette companies either do not make health claims about their products or if they do, they simple claim that e-cigarettes are safer than tobacco cigarettes. So it is demonstrably false that "the manufacturers" claim that e-cigarettes are a safe alternative. In fact, most of the electronic cigarette companies include disclaimers on their web sites informing consumers that their products contain nicotine which may be addictive and/or that their products have not been approved by the FDA and are not for the use of minors.
For example, let's look at the blu e-cigs web site.
Here is what blu says about its product: "blu can be purchased and used by anyone over the legal smoking age in the state where they reside. It should not be used by children, pregnant or breast feeding women, people with heart disease, high blood pressure, diabetes or people taking medicines for asthma or depression. Consult your physician before using any electronic cigarette product. CALIFORNIA PROPOSITION 65: Warning: This product contains nicotine, a chemical known to the state of California to cause birth defects or other reproductive harm. ... blu liquid is made in the U.S. with domestic and imported ingredients by Johnson Creek Enterprises in Hartland Wisconsin; we maintain an organization that inspects product lines at all facilities daily. blu simulates the smoking experience without the tobacco smoke, ash and smell associated with traditional tobacco cigarettes. blu should not be used as a quit smoking device as it has not been approved by the FDA as a cessation device. blu eCigs are not a smoking cessation product and have not been evaluated by the Food and Drug Administration, nor are they intended to treat, prevent or cure any disease or condition."
I defy the Mayo Clinic to identify where in this information blu is claiming that its e-cigarettes are "a safe alternative" to tobacco cigarettes.
Now let's look at the V2 Cigs web site. Here is what they say about their product in terms of its safety: "Nicotine is addictive and can be toxic if inhaled or ingested and may cause irritation if it comes into contact with your eyes or skin. Wash immediately with soap and water upon contact. Like other products with nicotine, you should not use this product if you are pregnant or breastfeeding, have or are at risk of heart disease, high blood pressure, diabetes, if you are taking medicines for depression or asthma or if you are allergic to nicotine, propylene glycol, or any combination of inhalants. Discontinue use and consult a physician if you experience symptoms of nicotine misuse such as nausea, vomiting, dizziness, diarrhea, weakness or rapid heartbeat. This product does not treat, diagnose or cure any disease, physical ailment or condition. This product is not marketed for use as a smoking cessation product and is not intended for use by non-smokers. This product and the statements made herein have not been evaluated by the FDA, or any other health or regulatory authority. WARNING: V2 Cigs products with nicotine contain a chemical known to the state of California to cause birth defects or other reproductive harm."
This hardly looks like V2 Cigs is claiming that their product is "safe." If they acknowledge that it can cause reproductive harm, I don't see how the Mayo Clinic can assert that they are claiming it is a "safe" alternative to smoking.
Lie #2: "And with nicotine inhalers you receive only nicotine."
This is an irresponsible lie. It is simply not true that people who use nicotine inhalers are only inhaling nicotine. Many other chemicals have been identified in the nicotine inhaler vapor, including a number of known toxins and carcinogens. Even the arch-enemy of electronic cigarettes - Dr. Stanton Glantz - has acknowledged that nicotine inhalers deliver to users the following chemicals:
Lie #3: "No studies have been done to examine the safety of e-cigarettes."
There have been many studies that examined the safety of electronic cigarettes. According to the Mayo Clinic, these studies are a figment of the authors' imaginations. Apparently, the Mayo Clinic must believe that someone must have hacked into the Pub Med web site and created these fictitious studies:
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes
Health-related effects reported by electronic cigarette users in online forums
Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function
Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality
Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models
Acute effects of electronic and tobacco cigarette smoking on complete blood count
Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide
EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study
And this doesn't even include the more than 20 studies in which the chemical constituents of electronic cigarette liquids or vapor have been analyzed using gas chromatography/mass spectrometry.
Lie #4: "There is no evidence that doctors can use to assess the impact this product may have on a person's body."
There is an abundance of evidence that doctors not only can use, but must use in assessing the likely health impact of electronic cigarettes, especially in relation to tobacco cigarettes. Responsible physicians should be examining the abundant existing evidence and actually answering their patients' questions regarding these products, unlike the Mayo Clinic, which is lying about the evidence.
To start physicians off, here are just nine studies to begin with. There are a lot more, including more than 20 which have characterized the components of electronic cigarette liquids or vapor.
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes
Health-related effects reported by electronic cigarette users in online forums
Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function
Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality
Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models
Acute effects of electronic and tobacco cigarette smoking on complete blood count
Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide
EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study
Why this Need to Lie?
Why must such a reputable organization like the Mayo Clinic lie about electronic cigarettes and the scientific evidence regarding the relative safety of these products in relation to the tobacco cigarettes which are killing so many of their patients? Smokers, including the one who posed this question, deserve honest and factual answers. In fact, I would argue that telling patients the truth about the scientific evidence is one of the central ethical tenets of the practice of medicine.
While it is difficult for me to understand why lies are necessary when providing medical answers to the public, I have two hypotheses about why we are seeing so much of this going on with regards to the electronic cigarette issue.
First, many anti-smoking physicians and researchers appear to be blinded by an ideology that views anything that even looks like cigarette smoking to be evil. This leads to a pre-determined conclusion that electronic cigarettes must be harmful and that any promotion of e-cigarettes is going to lead people to smoke, rather than the opposite. When a conclusion is pre-determined, one looks only for evidence that supports one's position and discounts or discredits any evidence which doesn't support the pre-existing position.
Second, many anti-smoking physicians and researchers have financial conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs, like nicotine inhalers. Thus, there is an inherent bias whenever they make a comparison of electronic cigarettes and drug company products, such as nicotine inhalers.
It is possible that this is the case even here with the Mayo Clinic column, because the author - Dr. Jon Ebbert - has apparently participated in research that was funded by Pfizer, which markets the nicotine inhaler. In fact, Dr. Ebbert has apparently participated in a second study that was funded by Pfizer; and in a third study that was funded by Pfizer. And a fourth one as well.
Dr. Ebbert is also listed as a Principal Investigator on a clinical trial that is sponsored by Pfizer or in which Pfizer is collaborating. In a 2012 article, he acknowledges as follows: "Jon O. Ebbert has received support to conduct clinical trials with varenicline from Pfizer."
It is also important to disclose that the Director of the Nicotine Dependence Center (Dr. Ebbert is an Associate Director of the Center) apparently serves or served on the Advisory Board for Pfizer. And another Associate Director of the Center acknowledges receiving research funding from Pfizer.
Unfortunately, the Mayo Clinic article in the Chicago Tribune fails to disclose the conflicts of interest of Dr. Ebbert and of the Nicotine Dependence Center's other leadership. That Dr. Ebbert and the other leadership of the Center have or have had financial conflicts of interest with Pfizer - which markets the nicotine inhaler discussed in the article - is not disclosed. Thus, this creates the appearance that the article's misrepresentation of the research in which the chemicals delivered by nicotine inhalers were identified was influenced by this conflict of interest.
The rest of the story is that not only is this Mayo Clinic article packed with lies about the science, but it also fails to disclose a relevant conflict of interest that has the appearance of shaping the misinformation in the article.
Sadly, this occurred in the Mayo Clinic's advice to the public about electronic cigarettes, which appeared in a column published in the Chicago Tribune on August 1.
The column consisted of the Mayo Clinic's answer to a very simple question (a yes or no question, in fact) posed by a reader: "I've been a smoker for years. I'm thinking about switching to electronic cigarettes or to a nicotine inhaler because I've heard they aren't as bad for you as regular cigarettes. Is that true?"
So the reader asks a simple and important question: are electronic cigarettes safer than regular cigarettes. This is a simple, yes-or-no question. Let's see what the Mayo Clinic had to say:
"Electronic cigarettes and nicotine inhalers both deliver nicotine to your body without tobacco. But that's where the similarity ends. The two are quite different when it comes to how they're used and how much doctors know about their safety. Nicotine inhalers are a proven safe and effective way to help people stop smoking. In contrast, very little is known about the health effects of electronic cigarettes. ... The manufacturers claim that e-cigarettes are a safe alternative to tobacco cigarettes. But there are significant questions about the safety of these products."
"When the U.S. Food and Drug Administration (FDA) analyzed samples of two popular brands of e-cigarettes, they found varying amounts of nicotine and traces of toxic chemicals, including substances that are known to cause cancer. The liquid inside many e-cigarettes contains a substance called propylene glycol. It creates the e-cigarette's vapor. Other common uses of propylene glycol are in cosmetics and as an ingredient in fog machines and antifreeze. The specific health effects of this product are not clear. No studies have been done to examine the safety of e-cigarettes. As a result, there is no evidence that doctors can use to assess the impact this product may have on a person's body. Also, no convincing evidence shows that e-cigarettes are useful in helping people to eventually stop smoking. ... As with e-cigarettes, nicotine inhalers give you a dose of nicotine when you puff on them. Unlike e-cigarettes, the amount of nicotine you receive is controlled and small. And with nicotine inhalers you receive only nicotine."
The Rest of the Story
As you can see, the Mayo Clinic has failed to answer this simple question. It refuses, in fact, to address the question of whether electronic cigarettes are safer than tobacco cigarettes. In fact, by its silence on this question, I think many readers will infer that the Mayo Clinic is answering with a "No." Instead of answering the question posed, the Mayo Clinic changes the question into a comparison of electronic cigarettes and nicotine inhalers. But sadly, this is where the lies and misinformation begin.
Lie #1: "The manufacturers claim that e-cigarettes are a safe alternative to tobacco cigarettes."
Not only does the Mayo Clinic fail to substantiate this claim, but it is largely untrue. Most electronic cigarette companies either do not make health claims about their products or if they do, they simple claim that e-cigarettes are safer than tobacco cigarettes. So it is demonstrably false that "the manufacturers" claim that e-cigarettes are a safe alternative. In fact, most of the electronic cigarette companies include disclaimers on their web sites informing consumers that their products contain nicotine which may be addictive and/or that their products have not been approved by the FDA and are not for the use of minors.
For example, let's look at the blu e-cigs web site.
Here is what blu says about its product: "blu can be purchased and used by anyone over the legal smoking age in the state where they reside. It should not be used by children, pregnant or breast feeding women, people with heart disease, high blood pressure, diabetes or people taking medicines for asthma or depression. Consult your physician before using any electronic cigarette product. CALIFORNIA PROPOSITION 65: Warning: This product contains nicotine, a chemical known to the state of California to cause birth defects or other reproductive harm. ... blu liquid is made in the U.S. with domestic and imported ingredients by Johnson Creek Enterprises in Hartland Wisconsin; we maintain an organization that inspects product lines at all facilities daily. blu simulates the smoking experience without the tobacco smoke, ash and smell associated with traditional tobacco cigarettes. blu should not be used as a quit smoking device as it has not been approved by the FDA as a cessation device. blu eCigs are not a smoking cessation product and have not been evaluated by the Food and Drug Administration, nor are they intended to treat, prevent or cure any disease or condition."
I defy the Mayo Clinic to identify where in this information blu is claiming that its e-cigarettes are "a safe alternative" to tobacco cigarettes.
Now let's look at the V2 Cigs web site. Here is what they say about their product in terms of its safety: "Nicotine is addictive and can be toxic if inhaled or ingested and may cause irritation if it comes into contact with your eyes or skin. Wash immediately with soap and water upon contact. Like other products with nicotine, you should not use this product if you are pregnant or breastfeeding, have or are at risk of heart disease, high blood pressure, diabetes, if you are taking medicines for depression or asthma or if you are allergic to nicotine, propylene glycol, or any combination of inhalants. Discontinue use and consult a physician if you experience symptoms of nicotine misuse such as nausea, vomiting, dizziness, diarrhea, weakness or rapid heartbeat. This product does not treat, diagnose or cure any disease, physical ailment or condition. This product is not marketed for use as a smoking cessation product and is not intended for use by non-smokers. This product and the statements made herein have not been evaluated by the FDA, or any other health or regulatory authority. WARNING: V2 Cigs products with nicotine contain a chemical known to the state of California to cause birth defects or other reproductive harm."
This hardly looks like V2 Cigs is claiming that their product is "safe." If they acknowledge that it can cause reproductive harm, I don't see how the Mayo Clinic can assert that they are claiming it is a "safe" alternative to smoking.
Lie #2: "And with nicotine inhalers you receive only nicotine."
This is an irresponsible lie. It is simply not true that people who use nicotine inhalers are only inhaling nicotine. Many other chemicals have been identified in the nicotine inhaler vapor, including a number of known toxins and carcinogens. 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
- Lead
Lie #3: "No studies have been done to examine the safety of e-cigarettes."
There have been many studies that examined the safety of electronic cigarettes. According to the Mayo Clinic, these studies are a figment of the authors' imaginations. Apparently, the Mayo Clinic must believe that someone must have hacked into the Pub Med web site and created these fictitious studies:
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes
Health-related effects reported by electronic cigarette users in online forums
Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function
Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality
Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models
Acute effects of electronic and tobacco cigarette smoking on complete blood count
Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide
EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study
And this doesn't even include the more than 20 studies in which the chemical constituents of electronic cigarette liquids or vapor have been analyzed using gas chromatography/mass spectrometry.
Lie #4: "There is no evidence that doctors can use to assess the impact this product may have on a person's body."
There is an abundance of evidence that doctors not only can use, but must use in assessing the likely health impact of electronic cigarettes, especially in relation to tobacco cigarettes. Responsible physicians should be examining the abundant existing evidence and actually answering their patients' questions regarding these products, unlike the Mayo Clinic, which is lying about the evidence.
To start physicians off, here are just nine studies to begin with. There are a lot more, including more than 20 which have characterized the components of electronic cigarette liquids or vapor.
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes
Health-related effects reported by electronic cigarette users in online forums
Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function
Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality
Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models
Acute effects of electronic and tobacco cigarette smoking on complete blood count
Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide
EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study
Why this Need to Lie?
Why must such a reputable organization like the Mayo Clinic lie about electronic cigarettes and the scientific evidence regarding the relative safety of these products in relation to the tobacco cigarettes which are killing so many of their patients? Smokers, including the one who posed this question, deserve honest and factual answers. In fact, I would argue that telling patients the truth about the scientific evidence is one of the central ethical tenets of the practice of medicine.
While it is difficult for me to understand why lies are necessary when providing medical answers to the public, I have two hypotheses about why we are seeing so much of this going on with regards to the electronic cigarette issue.
First, many anti-smoking physicians and researchers appear to be blinded by an ideology that views anything that even looks like cigarette smoking to be evil. This leads to a pre-determined conclusion that electronic cigarettes must be harmful and that any promotion of e-cigarettes is going to lead people to smoke, rather than the opposite. When a conclusion is pre-determined, one looks only for evidence that supports one's position and discounts or discredits any evidence which doesn't support the pre-existing position.
Second, many anti-smoking physicians and researchers have financial conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs, like nicotine inhalers. Thus, there is an inherent bias whenever they make a comparison of electronic cigarettes and drug company products, such as nicotine inhalers.
It is possible that this is the case even here with the Mayo Clinic column, because the author - Dr. Jon Ebbert - has apparently participated in research that was funded by Pfizer, which markets the nicotine inhaler. In fact, Dr. Ebbert has apparently participated in a second study that was funded by Pfizer; and in a third study that was funded by Pfizer. And a fourth one as well.
Dr. Ebbert is also listed as a Principal Investigator on a clinical trial that is sponsored by Pfizer or in which Pfizer is collaborating. In a 2012 article, he acknowledges as follows: "Jon O. Ebbert has received support to conduct clinical trials with varenicline from Pfizer."
It is also important to disclose that the Director of the Nicotine Dependence Center (Dr. Ebbert is an Associate Director of the Center) apparently serves or served on the Advisory Board for Pfizer. And another Associate Director of the Center acknowledges receiving research funding from Pfizer.
Unfortunately, the Mayo Clinic article in the Chicago Tribune fails to disclose the conflicts of interest of Dr. Ebbert and of the Nicotine Dependence Center's other leadership. That Dr. Ebbert and the other leadership of the Center have or have had financial conflicts of interest with Pfizer - which markets the nicotine inhaler discussed in the article - is not disclosed. Thus, this creates the appearance that the article's misrepresentation of the research in which the chemicals delivered by nicotine inhalers were identified was influenced by this conflict of interest.
The rest of the story is that not only is this Mayo Clinic article packed with lies about the science, but it also fails to disclose a relevant conflict of interest that has the appearance of shaping the misinformation in the article.
Friday, August 02, 2013
Indonesia to Seek Compensation for Lost Sales Due to U.S. Clove Cigarettes Ban
According to an article in the Jakarta Globe, Indonesia will seek compensation from the United States for sales losses due to its ban on clove cigarettes, which was found to be a discriminatory trade practice without health justification by the World Trade Organization.
According to the article: "Indonesia will seek compensation from the United States for pulling its clove cigarettes from shelves despite a World Trade Organization (WTO) ruling that deemed the ban discriminatory. Indonesia’s trade ministry said it had lost between $200 million and $300 million annually from the 2009 ban, aimed at helping prevent youths from taking up smoking. The WTO found that the US had flouted trade rules in its health act — under which cinnamon, coffee, grape and strawberry-flavored cigarettes were also banned — because it allowed menthol-laced tobacco to stay on the market. The WTO found in favor of Indonesia’s claims that allowing domestically made menthol cigarettes and not its clove-laced cigarettes was discriminatory. ...
“It’s baffling how the US, which is always demanding other countries to abide by WTO disciplines and regulations, is now unable to correct its policy, which is clearly in violation of WTO provisions,” Pambagyo [trade ministry director general of international trade cooperation] said in a statement."
The Rest of the Story
The Family Smoking Prevention and Tobacco Control Act's ban on the sale of clove cigarettes is clearly a discriminatory trade practice, as it treats one flavoring - which is primarily manufactured outside the U.S. - differently than a like product (menthol cigarettes) that is domestically produced. Moreover, the reason for the exemption given to menthol cigarettes was specifically to protect domestic cigarette companies that sell menthol cigarettes. And the icing on the cake is that the flavorings ban advances no public health purpose because it exempts specifically those cigarettes which are actually smoked by youth, and the ban doesn't apply to any cigarette brand that had any substantial market share among youth smokers prior to the implementation of the policy.
Given that the U.S. has failed to respond definitively to the WTO's decision, it certainly seems to this observer that Indonesia is entitled to some compensation.
But I guess $200 to $300 million is a small price to pay to protect the annual sale of 62 billion menthol cigarettes in the U.S.
While it is understandable why politicians wanted to protect this domestic revenue, it is not clear why the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association lobbied so vigorously to protect the cigarette companies' domestic revenue, at the expense of a higher burden of disease and death among their so-called constituents.
According to the article: "Indonesia will seek compensation from the United States for pulling its clove cigarettes from shelves despite a World Trade Organization (WTO) ruling that deemed the ban discriminatory. Indonesia’s trade ministry said it had lost between $200 million and $300 million annually from the 2009 ban, aimed at helping prevent youths from taking up smoking. The WTO found that the US had flouted trade rules in its health act — under which cinnamon, coffee, grape and strawberry-flavored cigarettes were also banned — because it allowed menthol-laced tobacco to stay on the market. The WTO found in favor of Indonesia’s claims that allowing domestically made menthol cigarettes and not its clove-laced cigarettes was discriminatory. ...
“It’s baffling how the US, which is always demanding other countries to abide by WTO disciplines and regulations, is now unable to correct its policy, which is clearly in violation of WTO provisions,” Pambagyo [trade ministry director general of international trade cooperation] said in a statement."
The Rest of the Story
The Family Smoking Prevention and Tobacco Control Act's ban on the sale of clove cigarettes is clearly a discriminatory trade practice, as it treats one flavoring - which is primarily manufactured outside the U.S. - differently than a like product (menthol cigarettes) that is domestically produced. Moreover, the reason for the exemption given to menthol cigarettes was specifically to protect domestic cigarette companies that sell menthol cigarettes. And the icing on the cake is that the flavorings ban advances no public health purpose because it exempts specifically those cigarettes which are actually smoked by youth, and the ban doesn't apply to any cigarette brand that had any substantial market share among youth smokers prior to the implementation of the policy.
Given that the U.S. has failed to respond definitively to the WTO's decision, it certainly seems to this observer that Indonesia is entitled to some compensation.
But I guess $200 to $300 million is a small price to pay to protect the annual sale of 62 billion menthol cigarettes in the U.S.
While it is understandable why politicians wanted to protect this domestic revenue, it is not clear why the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association lobbied so vigorously to protect the cigarette companies' domestic revenue, at the expense of a higher burden of disease and death among their so-called constituents.
Thursday, August 01, 2013
PolitiFact Rhode Island Exposes Anti-Smoking Advocates' Lies
In a PolitiFact Rhode Island expose published in the Providence Journal, the lies of many anti-smoking advocates who oppose electronic cigarettes have been exposed. Specifically, many anti-smoking advocates have argued that smokers should not quit using e-cigarettes because "we have no idea what is in them." PolitiFact's "Truth-O-Meter" scored this claim as FALSE.
According to the expose: "As PolitiFact Rhode Island listened during a July 1, 2013 discussion of legislation on electronic cigarettes, a categorical remark by a state representative caught our attention. Rep. Teresa Tanzi, D-South Kingstown, declared, "We have no idea what is contained in that vapor" when an e-cigarette is used. Is there really no information available to the public, as she seemed to suggest?"
"Our exploration of her statement took us into the world of "vaping" -- the act of using an e-cigarette. ... It didn’t take us long to discover that, despite Tanzi’s assertion, there have been numerous scientific studies about the content of e-cigarette vapors. One of the leading voices in the national tug-of-war over e-cigarettes is Dr. Michael Siegel, a professor in the Department of Community Health Sciences at the Boston University School of Health, and a Brown University graduate. He co-authored a definitive academic paper in 2010 in the peer-reviewed Journal of Public Health Policy that reviewed the available science on e-cigarettes. He cited 16 studies, most of them sponsored by the industry, but all conducted by independent laboratories." ...
"Our ruling - State Rep. Teresa Tanzi said, "We have no idea what is contained in [electronic cigarette] vapor." But we found that numerous studies have identified the primary components of the vapor. ... The judges rule her claim False."
The Rest of the Story
Hopefully this will put to bed forever the common lie being spread by many anti-smoking advocates that we have no idea what is in an electronic cigarette (either the cartridge or the vapor). This misinformation has been spread by a number of anti-smoking groups and advocates, as I have documented in The Rest of the Story over the past months.
The rest of the story is that the anti-smoking movement's electronic cigarette playbook is a lie. It is simply not true that we really don't know what the ingredients in electronic cigarettes are. And it is also not true that we have no idea what chemicals are contained in electronic cigarette vapor. In fact, we have a far more precise idea of what is in electronic cigarette vapor than we do of what is in cigarette smoke.
But it appears that these anti-smoking groups (a misnomer, as Bill Godshall astutely points out) would rather that smokers continue to take their chances with the known hazards of smoking than switch to the much safer personal vaporizers.
According to the expose: "As PolitiFact Rhode Island listened during a July 1, 2013 discussion of legislation on electronic cigarettes, a categorical remark by a state representative caught our attention. Rep. Teresa Tanzi, D-South Kingstown, declared, "We have no idea what is contained in that vapor" when an e-cigarette is used. Is there really no information available to the public, as she seemed to suggest?"
"Our exploration of her statement took us into the world of "vaping" -- the act of using an e-cigarette. ... It didn’t take us long to discover that, despite Tanzi’s assertion, there have been numerous scientific studies about the content of e-cigarette vapors. One of the leading voices in the national tug-of-war over e-cigarettes is Dr. Michael Siegel, a professor in the Department of Community Health Sciences at the Boston University School of Health, and a Brown University graduate. He co-authored a definitive academic paper in 2010 in the peer-reviewed Journal of Public Health Policy that reviewed the available science on e-cigarettes. He cited 16 studies, most of them sponsored by the industry, but all conducted by independent laboratories." ...
"Our ruling - State Rep. Teresa Tanzi said, "We have no idea what is contained in [electronic cigarette] vapor." But we found that numerous studies have identified the primary components of the vapor. ... The judges rule her claim False."
The Rest of the Story
Hopefully this will put to bed forever the common lie being spread by many anti-smoking advocates that we have no idea what is in an electronic cigarette (either the cartridge or the vapor). This misinformation has been spread by a number of anti-smoking groups and advocates, as I have documented in The Rest of the Story over the past months.
The rest of the story is that the anti-smoking movement's electronic cigarette playbook is a lie. It is simply not true that we really don't know what the ingredients in electronic cigarettes are. And it is also not true that we have no idea what chemicals are contained in electronic cigarette vapor. In fact, we have a far more precise idea of what is in electronic cigarette vapor than we do of what is in cigarette smoke.
But it appears that these anti-smoking groups (a misnomer, as Bill Godshall astutely points out) would rather that smokers continue to take their chances with the known hazards of smoking than switch to the much safer personal vaporizers.
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