Friday, June 29, 2012

New Study Shows that Emission of Volatile Organic Compounds from Electronic Cigarettes is Much Lower than Tobacco Cigarettes

A study published online ahead of print in the journal Indoor Air reports the results of the first comparison of volatile organic compound levels emitted by tobacco versus electronic cigarettes.

See: Schripp T, Markewitz D, Uhde E, Salthammer T. Does e-cigarette consumption cause passive vaping? Indoor Air 2012. DOI: 10.1111/j.1600-0668.2012.00792.x.

In the study, human subjects either smoked a cigarette or used (vaped) an electronic cigarette in an experimental chamber. Concentrations of a number of volatile organic compounds were measured using gas chromatography/mass spectrometry.

Based on the chamber emissions study, 20 volatile organic compounds were identified in tobacco smoke. Of these, 6 were detected in the electronic cigarette vapor. The concentrations of these six compounds in electronic cigarette vapor ranged from 2.5% (for acetaldehyde) to 39.1% (for acetone) of the concentration in the tobacco smoke.

The exhaled air from vapers was also tested for these compounds. The only compounds detected were small amounts of nicotine and flavorings, moderate levels of glycerin, and high levels of propylene glycol.

The Rest of the Story

This study confirms that electronic cigarette use greatly reduces the user's exposure to a wide range of chemicals in tobacco smoke. The few chemicals for which exposure remains are at levels well below that of cigarette smoking. 

The only compound of significant concern was formaldehyde, but its levels were between 5 and 10 times higher in tobacco smoke than in the electronic cigarette vapor. One hypothesis is that formaldehyde may result from the heating of propylene glycol.

My sense is that in the long-run, electronic cigarettes that use glycerin as an excipient may become the standard. Using glycerin would probably avoid the production of most of the volatile organic compounds detected in this study, and would also alleviate any concerns about respiratory irritation.

The exhaled vapor from electronic cigarette smokers contained mainly propylene glycol, glycerin, and small amounts of nicotine. There does not appear to be any major concern at this point regarding any dangers of exposure to "passive vaping."

The bottom line is that electronic cigarettes show great promise as an effective smoking cessation device that greatly reduces health risks for smokers and at the same time, helps protect nonsmokers by eliminating secondhand smoke.

Previous studies have demonstrated that the number of carcinogens is greatly reduced in electronic cigarettes and the levels of the only known carcinogen in the product are at trace levels. Thus, it is quite clear that electronic cigarettes greatly reduce the carcinogenic risks associated with cigarette smoking. This study documents that electronic cigarettes also greatly reduce exposure to a wide range of volatile organic compounds, making it very likely that these devices also reduce the risks of lung disease.

Based on the findings in this study, there is every reason to believe that electronic cigarettes are much safer than tobacco cigarettes and that if smokers can quit smoking via the use of these products, they are greatly improving their health.

I don't expect anti-smoking groups to alter their position based on this scientific evidence because their opposition is based on ideological and economic grounds rather than scientific ones in the first place. However, these results should help to reassure ex-smokers who have quit using electronic cigarettes that they have done themselves a great favor and reduced their health risks substantially, despite the advice from many anti-smoking organizations and researchers that they should return to cigarette smoking rather than use an "illegitimate" tool for smoking cessation.

Thursday, June 28, 2012

Anti-Smoking Researchers Promote Bias in Tobacco Control Research: What's Happening to the Integrity of Tobacco Control Science?

As I reported yesterday, an article published online ahead of print in the journal Tobacco Control which evaluated the effect of New York City's required point-of-sale anti-smoking posters on smoking behavior and found no effect concluded: "Additional research aimed at evaluating the effect of tobacco control measures in the retail environment is necessary to provide further rationale for implementing these changes...".

These study authors are essentially urging that further research on this policy be conducted in order to find support for the policy. What they are basically saying is: "We didn't find any evidence that the policy worked, but we are committed to the policy anyway, so future researchers should try to find evidence that it worked so that we can justify it after the fact."

Tellingly, the conclusion did not state: "Additional research aimed at determining whether or not required point-of-sale anti-smoking posters are effective in deterring smoking is necessary to evaluate whether or not this policy is justified." Instead, it promotes research in order to "provide further rationale" for implementing these policies.

Frankly, at this point, I am not so surprised that anti-tobacco advocates would have a pre-determined agenda that is devoid of an evidence base. The only surprise is that these advocates would readily admit that the purpose of research is to provide a rationale for this pre-determined agenda, rather than to figure out whether the policy works or not.

It is evident that to many anti-smoking groups, the answers to these research questions are not important. The agenda has already been determined and the point of the research is not to investigate the effectiveness of the policies, but to attempt to manufacture evidence to justify the policies post-implementation.

In other words, we already know "the answers" to the research questions. It is not the truth we are looking for, but merely evidence to support the already determined answers.

The Rest of the Story

If we already know the answer, then there is no point in doing the research. This is especially true if the research is to be taxpayer-funded, as is the case with the New York City health department's study of the effectiveness of its point-of-sale anti-smoking posters.

When I entered the field of tobacco control research, I did so because there were many important questions that needed to be answered and I sought to help provide some of those answers in order to guide advocates to promulgating the most effective policies that would have the greatest effect in reducing tobacco-related morbidity and mortality. Throughout my research career in tobacco control, I have always strived to conduct research with the express purpose of determining the scientific truth and to report findings objectively. There have been numerous times when I have found "negative" results. Instead of cherry-picking around the key findings, I have simply reported the facts. It does no service to the movement and to the public to slant negative findings. If the interventions are not effective, then we don't want to be implementing them. We want to implement policies that are effective.

For example, my research on the effect of youth access laws on youth smoking showed absolutely no effect of these laws. Rather than try to slant the findings, I reported the facts and cautioned advocates not to continue spending so much money on a program that did not appear to work. Similarly, my research on the effects of smoking bans on adult smoking failed to reveal any significant effect on quitting. We reported this negative finding, rather than trying to slant it. We did not call on further research to try to overturn what we had found.

I don't exactly understand why the field has changed and why the search for the scientific truth is no longer paramount, as acknowledged by this article.

Wednesday, June 27, 2012

Article Finds No Effect of Graphic Posters on Purchase of Cigarettes or Smoking Cessation, But Recommends Policy Anyway

A study published online ahead of print in the journal Tobacco Control reports the result of an evaluation designed to measure the effectiveness of New York City's policy of requiring graphic anti-smoking posters at point-of-sale at all cigarette retail outlets. The requirement, which went into effect late in 2009, was intended to decrease smoking rates by encouraging smokers to quit at the point of sale.

The study consisted of two rounds of interviews conducted among customers leaving retail stores that sell cigarettes: one round at baseline (prior to the implementation of the policy) and one round nine months later.

The impact of the signs on quitting was assessed by asking recent quitters: "During this visit to the store or over the past 30 days, to what extent did these health warning signs help you to quit or stay quit?"

Participants were also asked: "“During this visit to the store, did these warning signs about smoking stop you from purchasing cigarettes when you were about to buy them?"

The major findings of the study were as follows:

1. "There was no difference across surveys in the signs helping recent quitters to stay quit (p=0.55)."

2. "Differences in signs prompting smokers not to purchase cigarettes achieved only borderline significance (15% to 8%, p=0.05)." [Note that this effect was in the wrong direction. More respondents reported being convinced not to buy cigarettes before the graphic posters than after.]

The study clearly states these findings: "The signs did not help recent quitters to stay quit or stop smokers from purchasing cigarettes at the current visit to the store."

The Rest of the Story

Despite these clear negative findings, the study instead concludes that: "Our results show that signage
implementation was associated with a doubling in the awareness of health warning signs and an 11% increase in stimulating thoughts about quitting."

Well, whoopity doo. It is no big deal that the signage increased awareness of the signage. And an 11% increase in stimulating "thoughts about quitting" is hardly consequential. The real issue is whether the policy resulted in smokers quitting and according to this study, it did not.

This is yet another example of a study whose findings are not in concordance with the reported study conclusion.

In fact, the study's final conclusion is as follows: "A policy requiring tobacco retailers to display graphic health warning signs increased awareness of health risks of smoking and stimulated thoughts about quitting smoking. Additional research aimed at evaluating the effect of tobacco control measures in the retail environment is necessary to provide further rationale for implementing these changes and countering legal challenges from the tobacco industry."

This stated conclusion ignores the major findings of the study and instead, cherry-picks an almost trivial set of findings: that the signage increased awareness of the signage and stimulated thoughts. It ignores the fact that the study failed to find any effect of the signage on deterring the purchase of cigarettes or leading to actual quitting. In fact, the study provides no evidence whatsoever of any impact on behavior (and only a marginal impact on attitudes to begin with). This is hardly what I would call an effective policy.

Nevertheless, the article concludes that this is an effective intervention that should be pursued elsewhere.

Tellingly, the article calls for additional research "to provide further rationale" for implementing these changes. Note that the article does not call for additional research to "find out whether these changes work." Instead, the authors have apparently come to a pre-determined conclusion, and the only purpose of additional research is to confirm those conclusions and provide support for an already decided upon policy of pushing these posters, regardless of the lack of any evidence of their effectiveness.

You can see what saddens me about the current state of tobacco control science and policy. Rather than basing policy on the existing science, we instead come to a priori conclusions about what policies we want to pursue. The goal then becomes to manufacture evidence to support the pre-ordained conclusions and support the pre-ordained agenda, instead of finding out the truth of what works and what doesn't and supporting the policies that work.

The article also calls for research to counter legal challenges from the tobacco industry. Again, the purpose of the research is to manufacture evidence that the policies work so that tobacco industry challenges can be countered, rather than to find out the truth.

Also of interest is the fact that the article doesn't mention the substance of the tobacco industry challenges to New York City's policy (even to refute them). Instead, it assumes that there is no substance to the legal challenge and no legal issues to contend with. The assumption is that the only concern of public health practitioners is to defend the policy against legal challenge, not to consider whether or not the policy is consistent with the law or not.

In fact, I think there is a strong argument that this policy is unconstitutional, as it violates the First Amendment rights of retail stores by compelling speech which is designed primarily to discourage the purchase of products sold in their stores. In addition, the policy is preempted by the Federal Cigarette Labeling and Advertising Act.

But there is no discussion of these legal issues in the paper. It is assumed that they have no merit and that public health practitioners should conduct research to counter any arguments made in the opposite direction.

This is another example of how the anti-smoking movement has recently lost its science base in favor of a pre-ordained agenda. The goal is to provide evidence that supports the agenda, rather than to find out the truth, and then to develop the agenda to focus on the policies that are found to be most effective.

Tuesday, June 26, 2012

World Health Organization Needs to Change Stance on Electronic Cigarettes; Current Position is Leading to Public Health Harm

It is clear from an article in last week's Independent Online (Malta) that the World Health Organization's (WHO) current stance on electronic cigarettes is being interpreted worldwide as an assertion that "Electronic cigarettes not considered legitimate therapy to quit smoking," as the article's title suggests.

According to the article: "Contrary to what some marketers of the electronic cigarette imply in their advertisements, the World Health Organisation (Who) does not consider it to be a legitimate therapy for smokers trying to quit. ... Who insists that the electronic cigarette is not a proven nicotine replacement therapy and that it has no scientific evidence to confirm the product’s safety and efficacy. The organisation has repeatedly stressed that marketers should refrain from suggesting that Who considers the electronic cigarette to be a safe and effective smoking cessation aid. ... Who has said it knows of no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking."

The Rest of the Story

The public would be better served by taking direction from Pete Townshend on electronic cigarettes rather than the Geneva-based WHO. To imply, in 2012, that electronic cigarettes are not a legitimate therapy to quit smoking, is as unscientific as an organization can be. And to say that there is no evidentiary basis for the claim that electronic cigarettes can help people quit smoking is to ignore the entire body of scientific evidence and literature on the topic.

At least Pete recognized the importance of quitting smoking (listen to his "After the Fire," which features the famous line "I've gotta stop smoking.") In contrast, the WHO would rather that ex-smokers who have quit using electronic cigarettes return to smoking, instead of staying quit with the use of these "illegitimate" products.

Has the WHO not seen the Polosa study, a clinical trial of electronic cigarettes among smokers with no motivation to quit, in which more than 50% of the subjects either quit or cut down substantially (by more than half) on the amount they smoked? Has the WHO not seen the results of numerous surveys and focus groups as well as the abundant anecdotal evidence of the many thousands of people who have successfully quit or greatly reduced their cigarette consumption with the help of electronic cigarettes? Does the WHO keep up at all with the current literature? Based on his blog writings, I think Pete himself is probably doing a better job of keeping up with current information than the Geneva-based WHO.

Beyond its failure to take an evidence-based position and the health damage that is doing, the WHO's approach to electronic cigarettes is also marred by an error in the criterion they are using to judge the product. The question is not whether electronic cigarettes are "safe" and effective. The question is whether they are much safer than regular cigarettes. Of course they are not safe in an absolute sense. But there is no question, based on the existing evidence, that they are much safer than regular cigarettes. If the criterion is whether they are safe in an absolute sense, then the issue is over. There is no need for any further deliberation.

But that is not the issue. The issue is that millions of smokers worldwide are desperately in need of a better approach to quitting smoking than the WHO-recommended nicotine replacement therapy. Waiting 8 years for definitive clinical trials to be conducted, when the product is already on the market and being used by literally millions of people, is not an appropriate public health policy. Taking the products off the market would essentially force thousands of ex-smokers to return to cigarette smoking. And it would deter many more thousands of smokers from saving their lives by getting off cigarettes and switching to vaping.

The WHO is taking an irresponsible and scientifically unsupportable position on electronic cigarettes. As the real "WHO" would say: "Stop Hurting People."

Monday, June 25, 2012

In Backroom Deal, St. Louis Health Director Agrees to Exempt Missouri Athletic Club from Smoking Ban

Colonel Benjamin Church Hypocrisy Hall of Shame Award

Awarded to: St. Louis Health Director Pam Walker      Gold Rank

Awarded for: Agreeing to a backroom deal that exempts the Missouri Athletic Club from a smoking ban, while arguing that all other businesses must comply with the ban for health reasons.

Other Hall of Shame Members:

Attorney General of Florida  SILVER RANK

National Anti-smoking Organization  GOLD RANK

Mayor of New York City        BLUE RANK

U.S. Senator, New Jersey   BRONZE RANK

State Senator, New York     DIAMOND RANK 


Today, I am announcing the induction of the 6th member of the Colonel Benjamin Church Hypocrisy Hall of Shame, and the second member to be inducted at the Gold level.

A smoking ban went into effect in St. Louis in 2011, barring smoking in all restaurants and other places of employment, but not including bars whose square footage is less than 2000 or private clubs without employees. The Missouri Athletic Club in St. Louis does not qualify as a small bar, nor as a private club without employees. Thus, it is subject to the smoking ban, or at least it is supposed to be subject to the ban.

According to an article in the St. Louis Post-Dispatch: "The 109-year-old downtown Missouri Athletic Club may wriggle free from the city's smoking ban. City officials have prepared an agreement which exempts the private, invitation-only establishment — long frequented by judges, attorneys and politicians — from the municipal no-smoking ordinance. The club, known as the MAC, has flouted the law since it was enacted Jan. 1, 2011, openly leaving ashtrays in the lounge, hosting hazy boxing matches and allowing men in suits to gather weekly at the bar with tumblers in one hand, cigars in the other. The city cited and fined the club twice. The citations ended up in municipal court, where attorneys began working out a deal."

"On Thursday, city Health Director Pam Walker presented a draft agreement to her advisory commission, the Joint Boards of Health and Hospitals, arguing that the nonprofit MAC is a unique entity, governed neither by rules for private clubs nor by those for businesses. If approved, the agreement would bar smoking in the employees' lounge, but allow club members to continue to smoke in four locations: The Art Lounge, in the first floor lobby; The Jack Buck Grille, inside the club's first-floor restaurant, after 2 p.m.; the private dining rooms next to the Sportsman's Club, after 2 p.m.; and in the Missouri Room, three times a year for special events." ...

"This is the whole problem with government," said Joe Finn, owner of Pat's Bar & Grill in the city's Dogtown neighborhood, adding that the ban is killing his business. "All things are equal, but some things are more equal than others. I don't have the money — I don't have the clout — to make these backroom deals." "Others wondered what such a ruling would mean for the region. Could private city veterans' halls, for instance, ask for similar exemptions? Is this kind of agreement even legal?"

"I'm not against the MAC, but I think what they're doing is illegal," said Keep St. Louis Free Director Bill Hannegan, who lobbied against the smoking ban. The state constitution, he said, bars ordinances that single out businesses. "We'd like to see the MAC fight the law, not get themselves an exemption."

The Rest of the Story

There is no ambiguity about the law and whether it applies to the Missouri Athletic Club. It applies. The Club is neither a private club without employees nor is it a bar. Thus, it is subject to the ban.

Clearly, what is happening here is exactly what Bill Hannegan (one of our own Rest of the Story readers and commenters) and Joe Finn say is happening. This is a backroom deal that, with no legal basis, excludes one establishment from the law in order to appease a privileged and influential sociopolitical class of individuals: the city's politicians.

If this were "Joe's Bar & Grill," or I should say "Pat's Bar & Grill," the matter wouldn't even be up for discussion. I'm sure that Walker wouldn't have even agreed to meet with Mr. Finn to discuss an exemption. But when politicians talk, she is suddenly ready to listen. The table is open to deals. And it's especially open to unlawful deal-making when the establishment in question has money and therefore economic and political clout.

This is the worst kind of political elitism. It is exactly the kind of back-door negotiating between government officials and private aristocracy that democratic polity despises.

And it therefore the worst kind of hypocrisy. The St. Louis Health Department is basically saying that employees and the public need to be protected from the hazards of secondhand smoke, but not if the establishment is an elitist one which serves politicians. Then, public health principles go out the window and a backroom deal can buy you an exemption from the law.

In St. Louis, the law only applies, I guess, to "lower-class" establishments that serve the 99%. Elitist joints that serve the 1% aren't subject to the same laws. They can essentially buy their way out of having to follow the law by using their political, economic, and legal clout. Threaten a lawsuit and be able to back up the threat with money and the public health department will back down. No longer will the public health principles of protecting people from the hazards of secondhand smoke be paramount.

This is hypocrisy at the highest level. If the Missouri Athletic Club is granted an exemption when there is no lawful exemption written into the city ordinance, then why shouldn't Pat's Bar & Grill and hundreds of other establishments in the city be allowed to negotiate for exemptions through their own backroom deals?

Why didn't the ordinance simply specify (in a new section - section 17) that any establishment with political and economic clout could apply for an exemption from the law through a special exception that could be arranged through a backdoor deal? That's exactly what the Health Department is doing, and that is why its director - Pam Walker - has joined this private club - the Colonel Benjamin Church Hypocrisy Hall of Shame - as a gold club member.

Tuesday, June 19, 2012

Fifth Inductee Into Colonel Benjamin Church Hypocrisy Hall of Shame: New York State Senator Kemp Hannon

Colonel Benjamin Church Hypocrisy Hall of Shame Award

Awarded to: State Senator Kemp Hannon       Diamond Rank

Awarded for: Promoting a ban on electronic cigarettes because they, rather than regular tobacco cigarettes, pose "a dangerous threat to the health and safety of New Yorkers."

Other Hall of Shame Members:

Attorney General of Florida  SILVER RANK

National Anti-smoking Organization  GOLD RANK

Mayor of New York City        BLUE RANK

U.S. Senator, New Jersey   BRONZE RANK


Today, I am announcing the induction of the 5th member of the Colonel Benjamin Church Hypocrisy Hall of Shame.

Today's award goes to New York State Senator Kemp Hannon, who has proposed legislation (Bill S07635) that would ban electronic cigarettes, while keeping the real ones, because it is the electronic ones - containing no tobacco and producing no smoke - which represent "a dangerous threat to the health and safety of New Yorkers."

According to Senator Hannon's bill: "Due to the complete lack of regulation and evaluation for safety, electronic cigarettes pose a dangerous threat to the health and safety of New Yorkers. Therefore, this bill would place a ban on the sale of such products."

The Rest of the Story

Of course, I take it that according to Senator Hannon, regular cigarettes don't pose a dangerous threat to the health and safety of New Yorkers. Because his legislation, if enacted, would result in thousands of New York ex-smokers who quit by virtue of electronic cigarettes returning to tobacco cigarette smoking.

In what possible way would that have public health benefits? In what possible way would that reduce dangerous threats to the health and safety of New Yorkers?

As the American Council on Science and Health pointed out yesterday: "there is no rational basis for banning e-cigarettes. In fact, any truly rational thought process would result in promoting the e-cigarette as the effective smoking cessation option it is. ACSH's Dr. Gilbert Ross was dumbfounded by Hannon’s proposal. “I am simply flabbergasted that such a measure, the consequences of which would condemn many thousands of New York ex-smokers back to cigarette addiction and premature death, can be proposed by the Chairman of the Health Committee of our state’s Senate,” he says. “Sen. Hannon should be expected, in that role, to know a little bit about the relative risks of smoking and modified risk products, including, of course, electronic nicotine delivery systems (ENDS, or e-cigarettes). If he doesn’t know, he should be given a quick course in preventing disease and saving lives. With this measure, the blood of smokers forced to give up e-cigarettes and resume smoking would be on his hands. Hopefully, this boneheaded measure will die a quiet death before a vote and never be heard from again.”"

For his hypocrisy in proclaiming an intention to protect New Yorkers from a dangerous threat to their health and safety while at the same time introducing legislation that would force thousands of New Yorkers to switch from electronic cigarettes to tobacco cigarettes, Senator Hannon is deserving of induction into the Colonel Benjamin Church Hypocrisy Hall of Shame.

Monday, June 18, 2012

Fourth Inductee into the Colonel Benjamin Church Hypocrisy Hall of Shame: Senator Frank Lautenberg

Colonel Benjamin Church Hypocrisy Hall of Shame Award

Awarded to: Senator Frank Lautenberg    Bronze Rank

Awarded for: Promoting a ban on electronic cigarettes but protecting the sale of regular, more dangerous cigarettes.

Other Hall of Shame Members:

Attorney General of Florida    SILVER RANK

National Anti-smoking Organization  GOLD RANK

Mayor of New York City         BLUE RANK


Today, I am announcing the induction of the 4th member of the Colonel Benjamin Church Hypocrisy Hall of Shame.

First, I have to explain the new ranking system. My son suggested that I include a ranking for each inductee into the Hall of Shame in order to indicate the magnitude and severity of the consequences of each entrant's hypocrisy. Upon my son's suggestion, the rank levels, from the mildest level of hypocrisy to the most severe, are as follows: Blue, Bronze, Silver, Gold, Diamond, and Plutonium. My son also came up with this new format for the awards.

Fourth Inductee into the Hypocrisy Hall of Shame

Senator Frank Lautenberg (D-NJ), in March 2009, announced that he wanted the FDA to take electronic cigarettes -- which deliver essentially pure nicotine (with no tar or other tobacco constituents) -- off the market. At the same time, his legislation went into effect, which provided special protection to actual tobacco-containing cigarettes and ensured that this most toxic variety of cigarettes always remains on the market and continues to kill hundreds of thousands of Americans each year.

Senator Lautenberg's call for removing the electronic cigarette from the market, as well as for providing special protection - and government approval - for the much more toxic actual tobacco-containing cigarettes - was endorsed by the American Heart Association, American Lung Association, American Cancer Society, and the Campaign for Tobacco-Free Kids.

Representative Cliff Stearns (R-FL) countered Lautenberg's call for the removal of electronic cigarettes from the marketplace, arguing that these products are designed to help smokers quit, that they have succeeded in doing so for many smokers, that they are safer than tobacco-containing cigarettes, and that they are safer for nonsmokers because they do not produce secondhand smoke.

The Rest of the Story

Senator Lautenberg is deserving of entry into the Colonel Benjamin Church Hypocrisy Hall of Shame because while touting himself as being a champion of the public's health, he demanded that the government ban what is clearly a much safer cigarette than those on the market, but that at the same time, the government allow, protect, approve, and institutionalize the really toxic ones.

This is about as idiotic and irrational an approach as I have ever seen in my 25 years in tobacco control and public health.

What Senator Lautenberg and the health groups are trying to do is ban a much less harmful type of cigarette but give an official government seal of approval to the much more toxic one that we know is killing hundreds of thousands of Americans each year. The logic of these actions completely escapes me.

Of note, The Ashtray Blog pointed out that Senator Lautenberg is the recipient of more than $128,000 from pharmaceutical companies (in 2008 alone).

The only real threat that electronic cigarettes pose is not to the public's health, but to the profits of the pharmaceutical companies, which manufacture competing products (nicotine replacement therapy). If lots of smokers turn to electronic cigarettes, rather than pharmaceuticals, in order to try to quit smoking, then the pharmaceutical companies stand to lose lots of money. So perhaps it is not surprising that Senator Lautenberg is standing up to protect the financial interests of the pharmaceutical companies over the interests of the public's health.

Electronic cigarettes pose a threat to pharmaceutical smoking cessation aids precisely because the pharmaceutical aids are so dismally ineffective. The rates of successful smoking cessation with these pharmaceuticals is less than 10%. Thus, the overwhelming majority of smokers who try to quit using pharmaceutical aids are unsuccessful.
Accordingly, there is a huge potential market for a nicotine delivery system (such as an electronic cigarette) that will be more popular with smokers. The fact that the e-cigarette system is similar to a cigarette may make it much more effective and popular for use among smokers who are trying to quit smoking.

To be sure, this is a potentially life-saving intervention. There is initial evidence that many smokers have found the e-cigarette to be an effective method for smoking cessation. Moreover, it makes sense that smokers would find it more attractive to use an e-cigarette than a nicotine patch.

Furthermore, we know that smokers almost never continue using nicotine replacement to stay off cigarettes. A very small percentage quit, but the overwhelming majority return to cigarette smoking.

In contrast, it is quite plausible that many smokers would find the e-cigarette to be an alternative to smoking and it may actually be more successful in keeping them off cigarettes. If true, this would literally save "countless lives."

But the anti-smoking movement is too much in bed with the pharmaceutical industry to allow this natural experiment to actually take place. The movement is so heavily funded by Big Pharma that it cannot risk the loss of pharmaceutical profits, even if disallowing the experiment comes at the expense of a substantial number of human lives.

While there must be oversight of the claims that e-cigarette manufacturers are making regarding the safety of the product, the attention should be focused on these claims, rather than on an outright ban on this type of cigarette.

Moreover, since the product is clearly being marketed primarily as an alternative cigarette, rather than as a smoking cessation aid, it should not fall under the regulatory jurisdiction of the FDA under the Food, Drug, and Cosmetic Act (instead, electronic cigarettes should be regulated as alternative tobacco products under the Tobacco Act).

Once again, we see that the scientific evidence base and common sense reasoning are not guiding the tobacco control movement. It is, instead, being guided largely by money. The profits of both tobacco and pharmaceutical companies are being protected at the expense of the protection of the public's health.

It is truly a tragedy.

Thursday, June 14, 2012

Smoking on Campus Could be Grounds for Expulsion for Mountaineer Students

Just as I finished writing about the trend of complete smoking bans on college campuses, word came out that West Virginia University has adopted a ban on all tobacco product use on campus, except (of course) at events such as football games. If tobacco use is such a problem, then one wonders why there needs to be an exception for smoking at football games, but as I wrote yesterday, the hypocrisy of this policy is readily evident from the discrepancy between the way tobacco use is treated compared to alcohol use.

According to an article in the Daily Athenaeum: "The policy states that signs will be posted marking non-smoking areas, and any students who violate the policy are subject to 'disciplinary sanctions, up to and including expulsion.'"

This seems like a pretty harsh sanction for placing a wad of chewing tobacco between your cheeks, especially when getting drunk by consuming a case of beer is almost certainly not treated with the same degree of harshness in punishment.

The Rest of the Story

Just two years ago, an undergraduate student at West Virginia University was killed by a fellow student who was driving while intoxicated. The accident occurred on campus, in a University garage. 

Let me just say that in my opinion, the University has a lot more urgent matters to concern itself with in terms of "unhealthy" behaviors occurring on its campus.

It seems like it would be difficult to explain to the parents of this unfortunate victim of drinking on campus that the University has found it to be a priority to stop people from stuffing chewing tobacco in their mouths on campus.

Wednesday, June 13, 2012

College Officials Demand End to Smoking on Campus; But You Can Still Drink As Much as You Want

The consequences of drinking on college campuses are enormous. In a report on the consequences of drinking on college campuses, Vice President Joe Biden pointed out that: "Crimes associated with alcohol and drug use are arguably the most prevalent crimes on college campuses today. Alcohol use and abuse is by far the most prevalent form of substance use by college students. ... With over 3,000 institutions of higher education spread across the country, few individual communities devote more than sporadic attention to an issue that in the aggregate constitutes a major, arguably the major, public health problem for college students."

Importantly, Biden's report points out that: "A national report that reviewed published studies concluded that alcohol was involved in two-thirds of college student suicides, in 90% of campus rapes and 95% of violent crime on campus." Thus, alcohol is a problem not merely because it causes harm to users, but because of the severe consequences for bystanders as well.

Despite the severe consequences of drinking on college campuses for innocent bystanders, college officials in Ohio and elsewhere are this week announcing a push not for restrictions on drinking on campus, but instead for a complete ban on tobacco use anywhere on college campuses.

An editorial in the Cleveland Plain-Dealer this past Sunday addressed this issue: "The more that's known about the dangers of smoking both to smokers and those around them, the more reasonable it seems for the Ohio Board of Regents to recommend that Ohio's public colleges ban smoking on their campuses.Currently, the state's two-year and four-year colleges and universities prohibit smoking within college buildings but allow it outside, with some restrictions. Only Miami University has a total ban on smoking. Board of Regents Chairman James Tuschman now wants trustees at Ohio's 13 other public universities and 23 community colleges to eliminate smoking campuswide. A spokesman says this resolution could be presented and voted upon at the regents' board meeting June 27 in Columbus. It's a good idea not just for public but also private colleges. College is where many students take up the noxious habit. And it's indisputable that smoking, along with secondhand smoke and noncigarette tobacco products, can lead to lung cancer and deadly respiratory diseases."

"Critics point out that college administrators haven't fervently cracked down on underage drinking, which carries its own hazards, from date rape to alcoholism. College officials could and should do far more to put an end to the scourge of underage drinking. But their failures in one arena don't mean they should fail to act in others, particularly since students tend to pick up these potentially deadly habits in response to the stress and social pressures of high school and college."

At the same time, the State University of New York Board of Trustees approved a resolution this week that supports a complete ban on tobacco use at all SUNY campuses. This includes all grounds, not only indoors but outdoors as well. As with the Ohio proposal, it includes a ban on smoking in private cars on campus. And as with the Ohio proposal, it includes a ban on smokeless tobacco use as well as cigarette smoking.

The Rest of the Story

The editorial misses the point. The argument that smoking shouldn't be banned on campuses because officials aren't also banning alcohol use is not based on the premise that policies must be consistent. Instead, it is based on the premise that it is inappropriate to legislate otherwise lawful personal behavior when that behavior has no impact on other people. In other words, there is a limit to coercive policies that can be promulgated for paternalistic reasons.

So the fact that officials aren't cracking down on underage drinking does not undermine support for banning smoking because it points out that officials are being inconsistent. It undermines support for banning smoking because it points out that officials are apparently not willing to enact policies - no matter how much they would benefit the public's health - when those policies are purely paternalistic.

In other words, the critical point is not that college officials are not cracking down on binge drinking by banning it; the point is that college officials would not crack down on binge drinking by banning it. In public health, we generally don't ban otherwise lawful behavior for purely paternalistic reasons unless that behavior could directly cause severe, immediate harm or death.

If banning tobacco use on college campuses is justified, then so is regulating what foods can or cannot be consumed on campus, how much exercise a person must get, and what types of protection must be used to prevent sexually transmitted infections.

What needs to be justified is the use of coercive restriction of lawful behavior for paternalistic purposes for one behavior, when similar actions are not being taken, and would not even be considered, for other behaviors. This is the point which the editorial misses. I have not yet read an adequate justification for the use of a coercive paternalistic policy to prevent tobacco use on campus, especially when most would agree that the same reasoning would support a ban on alcohol use on campus, which no college officials seem willing to even consider.

Tuesday, June 12, 2012

Plaintiffs in Illinois Class Action Seek Re-institution of Lawsuit, Claiming State Supreme Court Decision Was Based on False Information

A class action lawsuit filed in 2000 in Illinois alleged that Philip Morris deceived consumers into thinking that some of its cigarette brands were safer by using descriptors such as "low-tar" and "lights." The plaintiffs prevailed, winning a $10.1 billion judgment against Philip Morris in 2003. However, the case was appealed and in 2005, the Supreme Court ruled for the defense, ordering that the trial judge dismiss the case. This week, the plaintiffs have announced that the are seeking re-institution of the case based on the claim that the "factual" information provided by Philip Morris and relied upon by the Illinois Supreme court was false.

According to an article in the Madison St. Claire Record: "Attorney Stephen Tillery is arguing that a judgment in favor of cigarette maker Philip Morris was "fundamentally flawed," because it was based on "false facts advanced by Philip Morris at every step in this litigation." Madison County Circuit Judge Dennis Ruth has reset a hearing originally scheduled for Tuesday involving Tillery's petition for relief from the Illinois Supreme Court's dismissal of Price v. Philip Morris in 2005. The hearing will be held Aug. 21 in the $10.1 billion "light" cigarette labeling judgment that was later overturned. Tillery filed a brief in support of a first amended petition for relief from judgment on May 4."

"According to Tillery, the FTC never allowed "low tar" descriptors, never had a policy of permitting descriptors, never required that Philip Morris disclose test measurements, never allowed the use of descriptors through consent orders and never intended for non-parties such as Philip Morris to take guidance from consent orders. "Because Philip Morris falsely represented contrary 'facts' in the litigation and successfully convinced Justice Garman to rely on those false 'facts' to dismiss Plaintiff's claims, plaintiff's petition should be granted," Tillery wrote."

The Rest of the Story

Unfortunately for the plaintiffs, it is their side, not Philip Morris, which is erring on the facts regarding the FTC's role in propagating the low-tar myth. Let's examine the key points one-by-one:

1. The FTC never allowed "low tar" descriptors.

As part of the history of the FTC's regulation of low tar descriptors, there were two consent orders in which the FTC specifically permitted certain "low-tar" and "light" claims and set out conditions under which these claims could be made.

One of these was American Tobacco Co., FTC Docket No. C-3547 in 1994. As explained by the Illinois Supreme Court: "The agreed order provided, further, that 'presentation of the tar and/or nicotine ratings of any of respondent’s brands of cigarettes and the tar and/or nicotine ratings of any other brand (with or without an express or implied representation that respondent’s brand is ‘low,’ ‘lower,’ or ‘lowest’ in tar and/or nicotine) shall not be deemed' to violate the ban on numerical comparisons. American Tobacco, 119 F.T.C. at 11."

Another relevant consent order was issued in 1971 and involved a complaint against American Brands for implying in its advertising that certain cigarettes were low-tar: "The dispute between the FTC and American Brands was resolved in 1971, with the entry of a consent order that required American Brands to cease and desist from: Stating in advertising that any cigarette manufactured by it, or the smoke therefrom is low or lower in ‘tar’ by use of the words ‘low,’ ‘lower,’ or ‘reduced’ or like qualifying terms, unless the statement is accompanied by a clear and conspicuous disclosure of: 1. The ‘tar’ and nicotine content in milligrams of the smoke produced by the advertised cigarette; and 2. If the ‘tar’ content of the advertised brand is compared to that of another brand or brands of cigarette, (a) the ‘tar’ and nicotine content in milligrams of the smoke produced by that brand or those brands of cigarette, and (b) the ‘tar’ and nicotine content in milligrams of the lowest yield domestic cigarette.” American Brands, 79 F.T.C. at 225."

Thus, the FTC explicitly did allow the use of "low tar" descriptors, as long as the company disclosed the tar and nicotine yields of the brand.

2. The FTC never had a policy of allowing descriptors.

The FTC may not have had a policy of allowing descriptors, but it clearly did allow descriptors under certain circumstances, under its consent orders as described above.

3. The FTC never required that Philip Morris disclose test measurements.

Well, this is kind of misleading. It is technically true that the FTC did not require the disclosure of test measurements on tar and nicotine yields. However, the FTC threatened to require the release of these test measurements, and in response, all the cigarette companies voluntarily disclosed the information, which is printed each year in an FTC report on tar and nicotine yields of all the cigarette brands on the market. Had Philip Morris ever decided not to voluntarily disclose this information, it is quite clear that the FTC would have then mandated the disclosure. So in fact, there was a "de fact" requirement that cigarette companies disclose the tar and nicotine yields of their cigarette brands.

4. The FTC never allowed the use of descriptors through consent orders.

As we have just seen, this is false. In a 1971 consent order, the FTC very clearly allowed the use of low-tar descriptors, as long as the actual yield was provided to consumers and as long as any comparative statements were accompanied by the yields of the relevant products and of the lowest yield product on the market.

5. The FTC never intended for non-parties such as Philip Morris to take guidance from consent orders.

I have earlier provided an extensive discussion of why I believe that the FTC consent decrees do represent industry-wide policy, from which non-parties are to take guidance. Briefly, imagine that the FTC allowed American Brands to advertise cigarettes as low-tar according to the provisions outlined above, but later, did not allow Philip Morris to advertise cigarettes as low-tar at all. Even though the original consent order with American Brands could not be argued to hold the full force of law with regard to Philip Morris, it would be difficult to maintain that the FTC's actions were consistent with the law. This would seem to represent a clear example of unequal and inconsistent application of the law. Thus, I do not find it unreasonable for Philip Morris to assume that the consent order with American Brands provided conditions for the use of the "low-tar" terminology that could be expected to apply to it as well as American Brands.

While it is true that as a matter of the force of law, the consent order did not bind FTC from dealing differently with other companies, as a practical matter, I think that it did bind FTC. Because a federal agency cannot willy nilly apply the law differently to different companies. The reason why the consent order only had the formal force of law with American Brands was simply that American Brands was the company about which a complaint had been filed, and which was therefore party to the consent order. It was not that somehow American Brands' actions were to be regulated differently than those of other companies because of some peculiarity about American Brands that did not apply to Philip Morris and other companies.

Now is it the case that FTC could not now enforce the disclosure rules among the non-signatory companies because it did not represent an industrywide policy? I doubt it. I think if the FTC decided to, it could easily enforce the disclosure requirement and non-signatories would have no argument at all in claiming that they didn't sign the agreement so they don't need to disclose. The FTC could and would (if it had the interest in enforcing it) simply tell the companies: "Sorry - these are the rules that the industry has to follow").

I have trouble accepting the argument that FTC consent orders do not provide overall industry guidance and policy because it is, in fact, through consent orders that FTC enforces the law. FTC does not have to issue a trade regulation rule in order to set industry policy. In fact, enforcement agreements and orders are one of the primary mechanisms by which it enforces the law. And it seems illogical to argue that just because a company is not party to a particular consent order, that the company does not take general or even specific guidance from that order, particularly if the order is as specific as the 1971 consent order is in setting out the precise requirements for the use of tar/nicotine level descriptors.

For the same reason, I have trouble accepting the argument that the fact that the FTC did not ever issue a trade regulation on the issue of descriptors indicates that it never authorized cigarette companies to use these descriptor terms in their marketing. I think the consent order clearly implies a set of requirements that can reasonably be interpreted by the other cigarette companies as indicating FTC enforcement policy on this issue.

I think it's important to recognize that federal agency actions with regard to particular companies do, in fact, serve to set policy and rules for all companies. The converse seems illogical. Could a company being investigated by FTC for using the term "Lowest Tar" brand successfully convince FTC that there was nothing wrong with this action because FTC's consent order applied only to American Brands? I doubt anyone would argue that the use of the term "Lowest Tar" cigarette brand (without appropriate documentation) is lawful under the Federal Cigarette Labeling and Advertising Act, even though there is no trade regulation concerning this issue, even though the 1971 consent order applied only to American Brands, and even though the consent order did not specifically mention the term "lowest tar." I think it's safe to argue that federal law (as interpreted and enforced by the FTC) simply does not allow for the undocumented use of the term "Lowest Tar" brand, even in the absence of a trade regulation on the issue.


The rest of the story is that the plaintiffs in this case are in a very weak position. They are in a weak position because contrary to what the plaintiff's attorneys would have us believe, the blame with respect to the "low-tar" fiasco is not just in the hands of the cigarette companies. It is also in the hands of the federal government, for assuming jurisdiction over, but failing miserably to address the advertising of tar and nicotine levels to smokers.

The Price decision is reminding us, I think, that it is simply not enough to blame everything on the cigarette companies. It is a poignant reminder that the federal government has had a role to play in the tobacco epidemic in this country.

And interestingly, the federal government's complicity in this epidemic stems not so much from its failure to assert jurisdiction over tobacco products, but from its having asserted jurisdiction over aspects of tobacco in a weak and ineffective way, but in a way that ended up preempting meaningful state and local regulation as well as providing a large measure of immunity to the tobacco companies.

Monday, June 11, 2012

More Hypocrisy from Bloomberg: It's OK to Possess an Ounce of Marijuana But Not 17 Ounces of Soda

Fresh off of his induction into the Colonel Benjamin Church Hypocrisy Hall of Shame, Mayor Michael Bloomberg announced last week that he supports decriminalizing the possession of 25 grams or less of marijuana.

The Rest of the Story

It is important to note that 25 grams of marijuana is about an ounce. That's the equivalent of 56 joints. It doesn't seem to me that the possession of this quantity of marijuana is indicative of just mild, recreational use of the drug. If you ever catch me with 56 joints, you'll know that I'm up to something more than just blowing a few sticks during my lunch break.

On the other hand, possession of 17 ounces of soda seems quite harmless. It could represent nothing more than being seriously thirsty on a hot summer day. I doubt that anyone possessing 20 ounces of soda is in the business of selling smaller quantities of that soda to youths on the street.

So let's get this straight. Under Bloomberg's proposals, it would be OK to possess an ounce of marijuana, enough to make 56 joints or make a profit from selling youth gash, but not OK to possess 17 ounces of soda?

Is this sending the right message to New York City youth? That it's OK to blast a roach, but not to drink a large soda? That it's OK to get a gage up, but not to quench your thirst? That it's OK to have a Colorado cocktail, but not a Dr. Pepper? That's it's OK to bite one's lips, but not to sip fruit juice?

Mayor Bloomberg has certainly confirmed the validity of his induction into the Colonel Benjamin Church Hypocrisy Hall of Shame.

Friday, June 08, 2012

Third Inductee Into Benjamin Church Hypocrisy Hall of Shame: Mayor Michael Bloomberg

As noted here earlier this week, Mayor Michael Bloomberg has proposed regulations that ban the sale of sodas larger than 16 ounces by restaurants, delis, movie theaters and food carts in the city. According to an article at the Huffington Post: "A document outlining the proposal said it was aimed at fighting an epidemic of obesity, citing public health statistics showing that 58 percent of New York City adults and nearly 40 percent of city public school students are obese or overweight."

The Rest of the Story

Speaking at the weigh-in ceremony for the 2011 Nathan's Famous Hot Dog Eating Contest, Bloomberg proclaimed: "It is a moment for all New Yorkers and all Americans to celebrate the inalienable rights bestowed on us by our forefathers: life, liberty, and the pursuit of happiness. For the contestants assembled here, that includes consuming as many hot dogs as humanly possible."

Mayor Bloomberg's comments praising the blatant over-consumption of hot dogs were not only witnessed by the 400,000 people at the event, but by an ESPN television viewing audience of 1.95 million viewers.

The contest is not just a one-time event, but a series of regional, qualifying hot dog eating contests that leads up to the big championship event: "Nathan's Famous, Inc. has unveiled the official list of cities holding hot dog eating contests to qualify the champions who will compete in the 97th annual July Fourth International Hot Dog Eating Contest. The Nathan's Famous qualifying tour occurs each year in cities across the U.S. and beyond. This year's circuit will begin in Michigan on April 21st and visit 12 other cities before the final event takes place on July 4, 2012 at the Nathan's Famous flagship in Coney Island, NY. Qualifying events will occur at Nathan's Famous retail locations, music festivals, city centers and Major League ballparks. The top male and top female finishers from each qualifier will earn a trip to compete in the ESPN televised finals at the original Nathan's Famous in Coney Island on July Fourth. This year's live ESPN show will air on July 4th at 3PM Eastern immediately following Wimbledon."

The winner of the 2011 hot dog eating contest consumed 62 hot dogs and buns in just 10 minutes. In the female competition, the winner consumed 50 hot dogs and buns in 10 minutes.

A single Nathan's hot dog has 297 calories and 18 grams of fat. The bun contains an additional 120 calories. Thus, a single serving delivers 417 calories and 18 grams of fat. This means that the winner of the hot dog eating contest consumed 25,854 calories and 1,116 grams of fat within 10 minutes.

Thus, Mayor Bloomberg participated in a ceremony that glamorized and promoted the over-consumption of already calorie- and fat-laden food to literally millions of people, including about half a million New Yorkers.

And this is the guy who now wants to limit soda consumption to 16 ounces?

For his blatant hypocrisy, I today am inducting Mayor Michael Bloomberg into the Benjamin Church Hypocrisy Hall of Shame.

Thursday, June 07, 2012

Campaign for Tobacco-Free Kids Inducted into Benjamin Church Hypocrisy Hall of Shame; Hypocritical Position on Cigarette Tax Policy is the Final Blow

Today I am announcing that the Campaign for Tobacco-Free Kids is being officially inducted into the Benjamin Church Hypocrisy Hall of Shame in tobacco control.

While there are numerous hypocritical actions that the Campaign has taken over the years that warrant its induction into the Hall of Shame, on the occasion of its induction I choose to highlight just one of them. However, it is an important one that has had massive implications for the near destruction of effective state-level tobacco control in the United States.

The Rest of the Story

In 1988, voters in California passed Proposition 99, a ballot measure which increased the cigarette tax by 25 cents per pack and allocated the revenues toward a statewide tobacco control program that included research on the prevention and treatment of smoking-related diseases as well as smoking education and prevention campaigns. This strategy in tobacco control - increasing cigarette taxes and using the revenue to fund a comprehensive, statewide tobacco control program that directly benefits smokers - quickly became the standard in the movement.

The public health benefits of California's strategy were immense. Cigarette consumption and smoking prevalence dropped substantially in California, both among youths and adults. There is now evidence that even long-term outcomes, such as lung cancer, have declined in California thanks to the approach approved by voters in 1988. Much of the evidence for what works in tobacco control is based on the successful program in California.

California's program became a model for the nation, and tobacco control advocates embraced this approach as the gold standard in tobacco control and public health. Several other states soon followed suit. One was Massachusetts, in which a similar program was established and led to immense public health benefits, as both adult and youth smoking prevalence declined after its passage of Question 1 in 1992, which also allocated money from a cigarette tax to a comprehensive, statewide tobacco control program. Massachusetts soon followed California to become the second state with a model tobacco control program. Arizona and Oregon would follow soon thereafter.

However, in the late 1990s, there was a huge change in the tobacco control movement that led to a devastating outcome: the enactment of cigarette tax increases in order to establish comprehensive tobacco control programs came to an end. What might have become an exponential growth in these model programs and reached a tipping point (following a diffusion of innovations curve) was halted.

Instead of pursuing the strategy of urging states to enact cigarette tax increases specifically to fund comprehensive tobacco control programs, tobacco control advocates began to support cigarette tax increases for any purpose under the sun: building bridges, repairing tunnels, providing essential government services, closing budget shortfalls, etc. The use of the revenues didn't matter. All that mattered was that cigarettes be taxed at a higher rate.

This change was a pivotal moment in tobacco control history. It marked the point at which tobacco control advocates renounced the long-held-dear strategy of insisting that tobacco revenues be used specifically for tobacco-related purposes, not simply to close budget shortfalls or fund essential government programs that should have been funded through other means.

And what was the reason for this sea change in thought and strategy in tobacco control?

You're right. The Campaign for Tobacco-Free Kids. Because in the late 1990s, the Campaign abandoned the approach of only promoting initiatives to implement cigarette revenue-funded tobacco control programs. Instead, it instituted a series of campaigns throughout the country dedicated simply to raising cigarette taxes, regardless of the purpose for which the revenues would be used.

Here in New England, the Campaign spearheaded a campaign to increase the cigarette tax in every state in New England. But the thrust of the campaign was not on establishing comprehensive statewide tobacco control programs in these states. It was simply on raising cigarette taxes. The Campaign did not insist that tobacco revenues be used for tobacco-related purposes. This represented a critical change in the long-standing strategy in tobacco control.

However, it represented a much easier way to make a name for itself. It is far easier to pass a cigarette tax to close budget shortfalls than to pass a cigarette tax when the money is going to be used for a statewide tobacco control program. The Campaign took the easy way out, which made it more profitable for it in terms of having successes and attracting donations, but which destroyed the prospect of having effective statewide tobacco control programs by undermining the concept that tobacco revenues must be used for tobacco-related purposes.

There are three important reasons why the dedication of tobacco revenues for tobacco purposes is critical. First, the failure to insist upon this turns a fair cigarette tax into an unfair and regressive one. It is unfair to ask smokers to shoulder the burden of providing the revenues to fund essential government programs or to close budget shortfalls. The burdens of the tax accrue to smokers, but the benefits do not accrue specifically to smokers. However, with a dedicated tax that is used largely for research into the treatment of tobacco-related diseases (of which yesterday's failed initiative in California is a prime example), while the costs accrue to smokers, so do the benefits.

Second, raising cigarette taxes to pay for essential government programs or to close budget shortfalls (of which the recently enacted cigarette tax increase in Illinois is a prime example) ties these essential programs as well as the fiscal solvency of the state to the continued sale of cigarettes. It destroys any incentive for the state to take actions to substantially reduce cigarette consumption. It has had devastating effects on the public's health. But this is not the case when the revenues support smoking-related programs. If the revenue falls because of reduced smoking, then the program is working and less money is needed as there are fewer smokers and less of a problem.

Third, the original purpose of increasing cigarette taxes was to support cigarette-related programs. The Campaign for Tobacco-Free Kids undermined this basic principle by abandoning the long-standing strategy in tobacco control for what I see as short-term political and financial gains.

That the Campaign for Tobacco-Free Kids has abandoned the principle that tobacco revenues must be dedicated to tobacco-related purposes is evidenced by its press release the other day which praises the cigarette tax increase in Illinois, even though the revenues will be used to close a budget shortfall and provide health care for the poor. It is unfair to ask smokers to be responsible for providing health care for the poor. That is a state responsibility. By tying health care to the poor to cigarette consumption, the Campaign is now stating that continued cigarette consumption is the key to ensuring that the poor can obtain health care. It is a preposterous concept that undermines the incentive for the state to take any action that will substantially reduce cigarette smoking. 

So where does the hypocrisy come in?

At the same time that the Campaign is largely responsible for the abandonment of the principle that tobacco revenues must be used for tobacco-related purposes, the Campaign continually whines and complains about the fact that the states have abandoned this very principle. The Campaign recently bemoaned the fact that so few states are spending their cigarette tax revenue and MSA tobacco revenue on tobacco-related programs.

The Campaign writes: "A report released today by the U.S. Centers for Disease Control and Prevention confirms that states have spent a small and dwindling portion of their tobacco revenues on programs to prevent kids from smoking and help smokers quit. From 1998 to 2010, the states collected a combined $243.8 billion in revenue from legal settlements with the tobacco industry and from cigarette taxes, but appropriated only $8.1 billion for tobacco prevention and cessation programs (counting both state funding and federal grants). Total funding for these programs amounted to just 3.3 percent of the states’ tobacco revenues and less than 28 percent of the CDC’s recommended amount. This is particularly tragic because, as the report also found, states that have made sustained investments in comprehensive tobacco control programs have seen cigarette sales drop about twice as much as in the United States overall."

And the Campaign goes on to say: "most states have broken the promises they made at the time of the 1998 tobacco settlement to invest a significant portion of their settlement funds in fighting tobacco use, especially among kids. The states' failure amounts to an enormous missed opportunity to accelerate progress against tobacco use in the United States. It's also no coincidence that smoking declines have slowed at the same time that states have slashed tobacco prevention funds. For our nation to continue making progress against tobacco, states must increase funding for tobacco prevention and cessation programs."

But from the other side of its mouth, the Campaign was the entity largely responsible for the fact that the principle of tying tobacco revenues to tobacco-related spending was abandoned. It was the Campaign that promoted the elimination of that concept by supporting - throughout the nation - the use of tobacco revenues for every program under the sun, other than tobacco-related programs.

There is no organization more deserving of induction into the Benjamin Church Hypocrisy Hall of Shame in tobacco control than the Campaign for Tobacco-Free Kids.

Wednesday, June 06, 2012

Hawaii Youth Tobacco Survey Shows Folly of FDA's Current Approach to Tobacco Control

The Hawaii Department of Health has released the results of its 2011 Youth Tobacco Survey. The results have profound implications for a number of current approaches that FDA, and many anti-smoking groups nationally are taking towards controlling tobacco use among youth.

Among the current approaches being taken by the FDA are the following:

1. Regulating the sale of tobacco to minors

The FDA summarizes its efforts as follows:

"FDA is issuing a final rule that contains a broad set of federal requirements designed to significantly curb access to and the appeal of cigarettes and smokeless tobacco products to children and adolescents in the United States. The new rule became effective on June 22, 2010, and has the force and effect of law. Among other things, the rule:
  • Prohibits the sale of cigarettes or smokeless tobacco to people
    younger than 18,
  • Prohibits the sale of cigarette packages with less than 20 cigarettes,
  • Prohibits distribution of free samples of cigarettes."
The key regulations are as follows:

"Age and ID (21 CFR 1140.14, Additional Responsibilities of retailers) 

1. Cigarettes and smokeless tobacco may not be sold to anyone younger than 18 years of age;
2. Retailers must examine a photographic identification bearing the person’s birth date to verify that any person purchasing cigarettes or smokeless tobacco is at least 18 years old. Verification is not required for purchasers who are over the age of 26. 

Packaged or Unpackaged Cigarettes or Smokeless Tobacco (21 CFR 1140.14, Additional Responsibilities of retailers) 
1. Retailers may not sell single cigarettes or packages containing fewer than 20 cigarettes, except in vending machines located in facilities where the retailer ensures that no person younger than 18 years of age is permitted to enter at any time;
2. Retailers may not sell unpackaged smokeless tobacco or packages of smokeless tobacco that are smaller than packages distributed by the manufacturer for individual use;
3. Cigarettes and smokeless tobacco may not be sold through vending machines or self-service displays, except in facilities where persons under the age of 18 are prohibited from entering."

2. Banning the sale of flavored cigarettes

The FDA has banned the sale of cigarettes of which banana, strawberry, cherry, pineapple, kiwi, melon, lemon, or any other fruit or candy (other than menthol) is the characterizing flavor.

3. Scrutinizing the marketing and production of dissolvable tobacco products such as orbs and strips because of concern over youth use of these products

The FDA has placed a focus on the potential use of dissolvable tobacco products by youth and has spent hours and hours deliberating on the topic.

The Rest of the Story

Let's examine the light that the new Hawaii data shed on each of these three major approaches to the prevention of smoking by youth.

1. Regulating the sale of tobacco to minors

The FDA is pouring millions of dollars into reducing youth access to tobacco by restricting the sale of tobacco products to youth in stores, requiring ID checks, conducting compliance checks, requiring retailer training, etc.

But according to the Hawaii Youth Tobacco Survey, only a miniscule fraction of youth smokers obtain their cigarettes by purchasing them. In 2009, prior to the law, only 1.3% of middle school smokers and 5.7% of high school smokers in Hawaii obtained their cigarettes by purchasing them. Very few smokers obtained their cigarettes through vending machines (0.0% of middle school smokers and 3.0% of high school smokers).

Thus, the FDA's regulations and enforcement of youth access restrictions will do nothing to lower smoking rates! It is an utter waste of time, money, and resources. It is not going to "save countless lives" and it is not going to "protect kids from addiction." This aspect of federal tobacco policy has accomplished nothing.

2. Banning the sale of flavored cigarettes

The Hawaii Youth Tobacco Survey provides strong evidence that prior to the Family Smoking Prevention and Tobacco Control Act, youth smokers were in fact primarily using flavored cigarettes. They were using menthol cigarettes. An overwhelming majority - 78.4% - of youth smokers used menthol cigarettes as their usual brand. Sadly, this is the one flavored cigarette that was not banned by the Tobacco Act. There is no evidence that Hawaii youth were smoking banana, strawberry, cherry, pineapple, kiwi, melon, lemon, or any other fruit- or candy-flavored cigarettes, other than menthol.

Thus, the FDA's regulations and enforcement of flavored cigarette restrictions has done nothing to lower smoking rates! It is an utter waste of time, money, and resources. It is not going to "save countless lives" and it is not going to "protect kids from addiction." This aspect of federal tobacco policy has accomplished nothing.

3. Scrutinizing the marketing and production of dissolvable tobacco products such as orbs and strips because of concern over youth use of these products

The Hawaii Youth Tobacco Survey revealed that almost no youth in the state are using dissolvable tobacco products. In 2011, only 0.4% of high school students reported using orbs, only 0.7% reported using sticks, and only 0.1% reported using strips.

Once again, the FDA's efforts in this area have been a waste of time and will accomplish nothing in terms of reducing tobacco use among youth.

It is also of interest to note that in 2011, the number of youth reporting obtaining their cigarettes from pharmacies was so low that it was not reportable. This demonstrates the absurdity of the belief that banning the sale of cigarettes in pharmacies will have any effect on youth smoking rates.

The rest of the story is that when one examines the actual data, one sees a complete discrepancy between those data and the cornerstones of federal and national tobacco policy. What once was an evidence-based movement has deteriorated into a movement that is largely driven by political, economic, and ideological concerns, not pure public health concerns.

Tuesday, June 05, 2012

No More Super Sizing Soda in NYC if Mayor Bloomberg Has His Way

New York City Mayor Michael Bloomberg has proposed a city regulation that would ban the sale of soda and other sugar-laden drinks in sizes of more than 16 ounces in New York restaurants, food carts, and movie theaters. The proposal would not affect the sale of milk shakes and would not regulate the sizes of soft drinks that could be sold in grocery stores, convenience stores, gas stations, and other stores that are not considered "restaurants."

The proposal, which Bloomberg says is intended to fight the city's epidemic of obesity, will be submitted to the Board of Health, which must approve it for it to become law.

The Rest of the Story

Think this proposal would mark the end of Slurpies and Big Gulps from Seven Eleven and similar monster soda and sugar drinks from other convenience stores?

The answer is no. And that goes to show the pointlessness of the proposal. The regulation is so limited that it will have no effect on the public's health. Why ban the sale of monster sodas only in restaurants? What good is a restaurant monster soda ban if people can still walk into a Seven Eleven and purchase a 64-ounce Double Big Gulp? How often do people go out to the movies such that banning the sale of monster sodas in theaters is going to combat the city's obesity epidemic? What sense is there to ban monster sodas in delis if in those same restaurants, a person can order a humongous milk shake?

The over-riding question is this: What justification is there for a proposal that will interfere so substantially with the autonomy of businesses to decide what products to sell when there is no evidence that the proposal will do anything to improve the public's health? Especially when those products, in and of themselves, are not harmful to health.

Beyond the pointlessness of the proposal, there is a second major issue that it raises. If the government is justified in regulating the types of products which can be sold when those products - in and of themselves - are not hazardous to health - then where does one draw the line in terms of what products the government should ban?

If banning super-size sodas is the right thing to do, then certainly the city would also want to ban super size burgers and fries. A super size Big Mac value meal has 1170 calories. What possible justification is there for Bloomberg to allow such huge portion sizes of burgers and fries to be sold? After all, the city is facing an obesity epidemic. If he really means what he says - that drastic action is needed to address this obesity which is killing thousand of New Yorkers, then why is he standing by silently why New Yorkers are killing themselves on super size burgers and fries, not to mention the milk shakes that they use to wash it all down?

Moreover, once you establish the principle that the government should regulate whether products that are not inherently harmful can be sold in order to protect the public's health, then government action to regulate the sale of a host of products is now not only justified, but it becomes incumbent upon the Board of Health to regulate these products. If it is an appropriate action for the Board of Health to ban the sale of 17-ounce and larger sodas in restaurants, food carts, and theaters, then:
  • How can the Board of Health not ban the sale of chemical pesticides, when non-harmful organic pesticides are available?
  • How can the Board of Health not ban the sale of sunscreens with less than 45 SPF, since the use of lower SPF sunscreen has been shown to be a cause of a substantial number of sunburns, which puts people at risk for skin cancer?
  • How can the Board of Health not ban the sale of insect repellant containing more than 30% DEET? DEET is a known toxin that impairs central nervous system activity and has significant human health effects.
Actually, the Board of Health would be justified in regulating the percentage of DEET that can be used because DEET is an inherently harmful toxin.

This demonstrates how Bloomberg's proposed regulation is so problematic. It immediately puts the Board of Health in the position of failing to appropriately protect the public's health. Because once you justify the regulation of the sale of non-inherently hazardous products, how can you justify not regulating all such products?

The most troublesome aspect of the proposal, however, is its hypocrisy. While Bloomberg was busy banning super size sodas, he was also busy declaring last Friday "New York City Donut Day." His proclamation established a day on which donuts were given out free throughout the city. Ironically, the donut give-away came just a day after Bloomberg's announcement that he wanted to ban super size sodas.

The rest of the story is that while Mayor Bloomberg is not OK with New Yorkers consuming large sodas, he is perfectly fine with promoting the consumption of donuts.That's just the kind of hypocrisy that undermines the integrity of public health.

Monday, June 04, 2012

Announcement of the First Entrant into the Benjamin Church Hypocrisy Hall of Shame

Today I am announcing the induction of the first entrant into what I am calling the Benjamin Church Hypocrisy Hall of Shame in tobacco control, a hall to include the most striking examples of hypocrisy in the anti-smoking movement. The Benjamin Church Hypocrisy Hall of Shame is a lifetime achievement award. It does not result from just a single instance of hypocrisy, but from either a pattern of hypocrisy or a single event that is of such importance that it merits such a designation.

First, a word about the man and event after which the Hall is named.

Benjamin Church was an emigrant from England - a carpenter - who, in the mid-1600's, settled along Narragansett Bay in what is now Little Compton, Rhode Island, living adjacent to and among a group of Native Americans known as the Sakonnets. Church was the grandson of Mayflower passenger Richard Warren. At the start of King Philip's War in 1675, Plymouth colony authorities put out a call for "nonhostile" Indians to turn themselves in. In return, they would be granted amnesty. In response, several hundred Indians surrendered to authorities in Plymouth. But instead of granting them amnesty, they were rounded up and shipped off as slaves to Spain.

Benjamin Church vehemently opposed the enslavement of the Indians. In his "Entertaining Passages Relating to Philip's War," Church condemned the enslavement of Indians, calling it "an action so hateful ... that [I] opposed it to the loss of the good will and respect  of some that before were [my] good friends." (as quoted in Philbrick N. Mayflower: A Story of Courage, Community, and War. New York: Penguin Books, 2007)

The Rest of the Story

One year later, in 1676, Benjamin Church was mopping up the final Indian combatants, including King Philip himself. However, he did not have enough money to pay his soldiers. He entered into an agreement with the Plymouth authorities that for as many Indians as he could round up as prisoners to be enslaved and sent off the Caribbean sugar plantations, he and his soldiers would receive half of the sale proceeds. Church then went on to capture and enslave more Indians than any other New England military figure in history.

So just one year after condemning the enslavement of Indians, Church engaged in exactly such an enterprise, and profited from it. Apparently, enslaving Indians was wrong, unless you needed money, in which case it suddenly became acceptable.

It is this glaring example of hypocrisy after which the anti-smoking Hypocrisy Hall of Shame is named.

The First Inductee

In 1998, the Attorneys General of 46 states praised themselves for having negotiated a litigation settlement with Big Tobacco that they said had brought to tobacco companies to their knees. At the time of the settlement, Florida's Attorney General - Bob Butterworth - proclaimed that "'The Marlboro Man will be riding into the sunset on Joe Camel."

Butterworth cast himself as a hero who was fighting Big Tobacco. He had filed a lawsuit against the tobacco companies which was settled in 1995, with hundreds of millions of dollars coming into the state to be used (supposedly) for an anti-smoking campaign.

Butterworth now boasts that "he was a leader in the multi-state litigation against the tobacco industry, bringing $11 billion to the state, and was voted the top Attorney General in the nation by his peers." He also calls himself "one of Florida’s most distinguished public servants."

The Rest of the Story

In 2000, as the tobacco companies were facing a possible multi-billion dollar punitive damage judgment against them in the Engle class action lawsuit, Attorney General Bob Butterworth urged the Florida legislature to adopt a law capping the bonds that the tobacco companies would have to pay in the case of a huge punitive damage award in the Engle case, which is exactly what occurred (both the huge punitive damage award and the enactment of the law that protected the tobacco companies, limiting the amount of the appeals bond). Thus, it is clear that Butterworth's primary motivation was not protecting the public's health, but protecting the fiscal health of the state.

This action, spearheaded by the Attorney General who signed the settlement of his state's lawsuit with the tobacco industry and claimed to be motivated solely by public health concerns, turned out to give momentum to a slew of similar legislation in other states, which has limited the amount of money tobacco companies need to pay to appeal huge punitive damages awards.

In 1995 Butterworth was supposedly fighting Big Tobacco, trying to achieve justice for Florida's smokers who had been damaged by cigarettes. In 1998, he was supposedly doing the same thing for smokers throughout the nation. But in 2000, Butterworth betrayed the public's interest as well as the interest of his former clients by switching sides and fighting to protect Big Tobacco profits at the expense of the litigation rights - established by statute - of Florida citizens.

Butterworth successfully destroyed those rights, and that action spearheaded efforts across the nation to remove litigation rights from citizens, making it much more difficult to seek justice via class action lawsuits. While calling himself a "distinguished public servant," the rest of the story is that Butterworth distinguished himself by betraying the public's interest to protect the profits of wealthy corporations.

Butterworth's blatant hypocrisy makes him a perfect first inductee into the Benjamin Church Hypocrisy Hall of Shame.