Thursday, February 27, 2014

FDA Has Accomplished Nothing to Make Cigarettes Safer; Not Even Denying Substantial Equivalence Application

Earlier this week, I reported that for the first time ever, the FDA has disapproved a substantial equivalence application, thus resulting in the unprecedented effect of pulling four cigarette brands off the market (four varieties of Sutra Bidis). Of course, I sarcastically hailed this action as a real life saver: by assuring that consumers won't find the unredeemably hazardous Sutra Bidis next to their safe and approved Marlboros, the FDA has certainly gone out on a limb to protect the public's health.

Today, I report that even the FDA's own report boasting about this action was in error, and that in truth, this action did not result in taking these four brands off the market.

I was informed that the company which submitted the substantial equivalence application had actually pulled these four brands from the U.S. market several years ago. The reason that the company failed to respond to the FDA's request for more information regarding the substantial equivalence application was apparently because it had no intention of re-introducing these products in the U.S.

According to the FDA's statement: "This marks the first time that we have used our authority under the Tobacco Control Act to stop the continued sale and distribution of currently marketed tobacco products because they were not found “substantially equivalent” – and it is not an action we take lightly."

Well, apparently this is not the case. The "currently marketed tobacco product" was not actually currently being marketed. While the FDA may not have taken the action lightly, they probably should have, since the action was of no consequence whatsoever, as the brands had already been pulled from the market.

Perhaps this is what happens when it takes two and half years to make a ruling on a substantial equivalence application. By the time you make your ruling, the brands about which you are ruling no longer exist.

The Rest of the Story

On a more serious note, this story merely highlights the fact that the FDA has done literally nothing in the past five years of its jurisdiction over cigarettes to protect the safety of the nation's cigarette supply. The agency has done nothing about menthol. The agency has done nothing about nicotine. The agency has done nothing to make cigarettes safer by regulating carcinogen or chemical levels or additives. The agency has, in sum, done nothing at all to make cigarettes safer.

And ironically, the FDA has failed to take the one action it could have taken to make the tobacco products availalbe on the makret a lot safer: to embrace the concept of electronic cigarettes and to propose regulations that treat these products more leniently than tobacco cigarettes, in order to motivate smokers to move away from the more toxic cigarettes to the much safer fake ones.

In fact, the two actions the FDA has taken on electronic cigarettes are exactly the opposite: actions which would have protected the most toxic tobacco cigarettes from competition by the much safer electronic ones.

First, the FDA tried to ban all electronic cigarettes. Fortunately, that didn't work. However, the agency continues to discourage electronic cigarette use and continues to have misleading information about these products on its web site.

Second, the FDA apparently tried to regulate electronic cigarettes in a manner that was inappropriately stringent and ended up protecting, instead of threatening, cigarette sales. Apparently, the Office of Management and Budget caught the FDA on that one and threw the regulations back in their lap.

At this stage, I really have to question the wisdom of having given the FDA regulatory jurisdiction over tobacco products in the first place. It was a bad idea five years ago, but it is only getting worse as the agency botches it and takes exactly the wrong actions -- protecting cigarettes rather than protecting the public's health.

Wednesday, February 26, 2014

FDA Out of Its Mind: Thinks Some Cigarette Brands May Be Safer for the Public's Health Than Others

In the 1970s, the tobacco industry perpetuated the myth that some brands of cigarettes were safer than others. Perhaps because of differences in nicotine or tar delivery. Or perhaps because of differences in additives. But the public health community knew that was hogwash and didn't buy it. In fact, eventually the federal government filed a lawsuit against the tobacco companies, arguing that their public statements insinuating that some cigarette brands are safer amount to conspiracy to commit fraud. The tobacco companies found themselves guilty of racketeering and will now have to issue a corrective statement indicating that even major differences in cigarette ingredients do not render them significantly different in terms of the overall public health risk that they pose.

In 2014, the tobacco companies have changed their behavior and have ceased and desisted from arguing that even major differences between cigarette brands render them different in terms of overall public health risk. In fact, Philip Morris has explicitly stated the following: "As of today ... there is no cigarette on the market that public health organizations endorse as offering 'reduced risk.' If smokers are concerned about the risks of cigarette smoking, the best thing to do is quit."

However, in February 2014, there is one entity that continues to reiterate the lies of the 1970s ...

... the Food and Drug Administration (FDA).

Just last week, the FDA indicated that even very small differences in cigarette brands could pose major issues of public health significance, prompting the agency to disapprove one substantial equivalence application and to hold onto thousands more for over a year.

In taking this position, the FDA is virtually on its own. Most scientists and public health practitioners disavowed such crap decades ago, when it was first spewn forth by the old Big Tobacco companies. But now, there are only two entities that are still claiming this nonsense: (1) the FDA; and (2) Stan Glantz (see his public comment to the FDA).

The Rest of the Story

The rest of the story is that regulatory power has corrupted the science at the FDA. The FDA has been infected with the virus that causes an agency to regulate for regulation's sake. The agency has created a huge bureaucracy which is accomplishing absolutely nothing to protect the public's health. It is a profound waste of time and resources. The FDA would be better off using the money being spent on substantial equivalence applications on an aggressive, anti-smoking television campaign that would actually do something to protect the public's health.

Moreover, the FDA's actions are sending the wrong message to the public. First, the FDA is indicating to the public that there is such a thing as a safer cigarette. The FDA is insinuating that even small changes in cigarette design can result in drastic differences in the public health safety of cigarettes.

Second, the FDA is sending the message that it is somehow protecting the safety of the nation's cigarette supply. We've kept those dangerous Indian cigarettes off the market so that consumers can enjoy the well-regulated, much safer, made-in-America cigarettes. This is how the FDA is protecting our nations' health!

The FDA is undermining decades of public health efforts to underscore the ubiquitous danger of cigarette smoking and the lack of value of even major design changes, such as filters and lower yields. By doing so, the agency is negating any positive effects of its own anti-smoking media campaign.

In 2014, not even the tobacco companies would dare to suggest that minor changes in cigarette design could lead to substantial improvements in the public health safety of these products. And any company that did would be charged immediately into the courtroom. But there is one entity that is still spewing this crap to the public. Shockingly, it's our own government, and its leading supposed tobacco control agency.

Tuesday, February 25, 2014

FDA Takes Major New Action to Protect the Public's Health

In what it is calling an action "to ensure the protection of the nation's public health," the FDA has announced taking an "important step" that shows its commitment "to making sure that all tobacco products that are sold and distributed to the public meet the requirements of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act)." According to the FDA, this bold new action is necessary because: "Ensuring compliance with the law is critical to FDA’s mission to protect public health."

To emphasize: "Today’s announcement is an important step for the FDA as we continue to review new product applications, make science-based decisions, and take enforcement actions to ensure the protection of the nation’s public health."

The Rest of the Story

Before reading on, readers may wish to take this short quiz to test their knowledge of this most eventful announcement by the FDA in support of its mission to protect the nation's public health:

Which of the following historic, first-time ever, unprecedented actions did the FDA take in order to ensure its protection of the nation's public health from the hazards of cigarette smoking?

A. Announced a ban on menthol flavorings in all cigarettes.
B. Announced a gradual reduction in nicotine levels in cigarettes to non-addictive levels.
C. Announced an increase in the legal purchase age for cigarettes from 18 to 21.
D. Announced a ten-year, $500 million per year anti-smoking advertising campaign that focuses on directly countering cigarette advertising.
E. Announced regulations on electronic cigarettes that carve out a special regulatory category for these products that encourages e-cigarette use over tobacco cigarette use.
F. Took four brands of bidis off the market because the company did not identify eligible predicate tobacco products.

If you guessed F, then sadly, you are quite correct.

The big, historic, evidence-based, unprecedented, bold new action taken by the FDA that it boasts is going to help ensure the protection of the nation's public health is to take four bidis off the market.

Wow! That is truly a life-saving announcement.

Thank God that we can count on the FDA to make sure that the cigarettes sold in this country are safe. God forbid that Sutra Bidis Red had been allowed onto the market. Who knows the death and destruction they would have wrought on the American people compared to the approved products, like Marlboro Kings, Camel Lights, and Newport Golds?

What a great move it was of our Congress and the national anti-smoking groups to entrust the FDA with the protection of the safety of the cigarette market. We can rest assured knowing that the safety of our Marlboros, Camels, Newports, Parliaments, and Virginia Slims is not tainted by new and untested brands like Sutra Bidis Menthol. We can sleep more soundly at night, knowing that when our children try cigarettes, they'll try safe and approved brands like Marlboro, Camel, and Newport, rather than Sutra Bidis. And it will bring us all a measure of comfort knowing that when smokers die in the future, it will be due to the known hazards of products like the approved Newports, Kools, and Winstons, rather than the substantially non-equivalent Sutra Bidis Menthol Cone.

The FDA is truly looking out for the nations' health.

Sunday, February 23, 2014

First-Page New York Times Article Highlights National Debate Over Electronic Cigarettes

Sabrina Tavernise put together an outstanding, insightful, and very well-written article about the electronic cigarette debate within the tobacco control movement for a front-page Sunday New York Times article.

The article outlines the opinions of two camps within the tobacco control movement. One camp sees these devices as a potentially effective way of getting smokers to quit and therefore producing tremendous public health gains. The other camp dismisses the overwhelmingly positive testimony of smokers who have been helped by electronic cigarettes and argues that they are actually, on the whole, being harmed by these products.

You know which camp I am in. So let's examine the argument being made by the other camp:

"The vast majority of people who smoke them now also smoke conventional cigarettes, he [Stan Glantz] said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal."

So the key argument against electronic cigarettes is that for every person who they help by getting them off of cigarettes, there is another person who they prevent from getting off cigarettes.

For Dr. Glantz's argument to be correct, then it must be the case that there are literally thousands of smokers out there who would have simply quit smoking if only it hadn't been for electronic cigarettes. Readers must recognize two important points about this argument:

1. There is absolutely no evidence to support it. Not a single study has shown that smoking cessation rates with electronic cigarettes are lower than what would have been expected in the absence of e-cigarettes. In fact, the overwhelming evidence from the existing clinical trials is that while modest in magnitude, electronic cigarettes do aid smoking cessation and compare favorably against the nicotine patch, which is currently the gold standard for smoking cessation.

2. There is no reason to believe this argument is true in the first place. The percentage of smokers who quit on their own is dismally low. Moreover, the very reason why smokers are trying electronic cigarettes is because they have failed to quit smoking with existing therapies. It is ludicrous to expect that someone who has no confidence in quitting using a traditional methods is suddenly going to quit. In fact, the evidence overwhelmingly shows that without self-efficacy, most smokers are bound to fail. So we are talking about a population of smokers who are not going to quit smoking anyway. Electronic cigarettes are their last best hope. Sure, e-cigarettes are not for everyone and many will fail. But it is simply not true that those who fail are people who would have quit smoking if only they hadn't tried electronic cigarettes.

If there were any evidence that electronic cigarettes inhibit, rather than enhance smoking cessation, I too would join Dr. Glantz's camp and oppose electronic cigarettes. But such evidence does not exist. Not a shred of it so far. Not a single study suggests that electronic cigarette use results in lower quit rates than what would occur in the absence of electronic cigarette use among smokers who try these products.

If I had to characterize the two camps, I wouldn't characterize them as optimists vs. pessimists. I would characterize them as scientists who are actually talking to vapers and considering their experiences versus those who are stuck in ivory towers. I would characterize them as scientists who are pure idealists versus those who live in the real world. And finally, I would characterize them as scientists who are paying attention to the actual scientific evidence versus those who are ignoring the evidence and basing their opinions on ideology.

Thursday, February 20, 2014

Will Stan Glantz Defend His False Accusations, or Retract His Defamatory Remarks?

As I revealed earlier this week, Stan Glantz has publicly made false accusations which imply that electronic cigarette companies have been behind the scenes orchestrating and paying for statements by a number of right-wing think tanks that are supportive of electronic cigarettes.

Here is Glantz's accusation: "the e-cigarette companies (which are, increasingly owned by cigarette companies) are mobilizing the same network of right-wing think tanks that the cigarette companies have used for years to push their policy agenda, often linked with the tobacco companies' development of the Tea Party and related groups. John Mashey, a member of the Center for Tobacco Control Research and Education's Advisory Committee, sent me a few good examples. ... The more things change the more they stay the same."

One of the key examples in question is a video on the Cato Institute site in which Jacob Grier makes a number of insightful comments that are supportive of electronic cigarettes.

Surprised that Jacob would have been paid by electronic cigarette companies to make these remarks or that his statement was orchestrated by Big Vapor, I was gratified to learn from Jacob himself that neither of these accusations from Stan are true. Jacob confirmed that the production and placement of this video were not directed by any electronic cigarette companies and he was not paid by any electronic cigarette company to make these statements.

The Rest of the Story

Sadly, Stan Glantz continues to feel the need to lie to the public in order to try to discredit opinions with which he does not agree. And while I have no problem discrediting statements by exposing the truth about financial relationships which present conflicts of interest, I do have a problem with spreading false lies that make the public believe that there is a conflict of interest present and which therefore defame the reputation of the individual. Not only is this unlawful, but it is unethical as well.

Certainly, Stan owes an apology to Jacob and he owes an apology to CATO as well.

But sadly, I have no doubt about how to answer the question I posed in the title for this post. I am sure that Stan will continue to defend his false accusations and allow them to stand, rather than to retract these defamatory remarks and apologize to Jacob and others whose reputations he defiled. Sadly, these tactics are acceptable in the tobacco control movement, as long as they are directed at tobacco companies (and now, electornic cigarette companies).

If Stan does apologize and/or retract his false accusations, please send me a cable because I want to know about it right away. But I'm not holding my breath. The truth is just too much for idealogues like Glantz to take. It is only through lies that they can discredit the overwhelming experience of tens of thousands of vapers that these products are helping them to improve their health and potentially save their lives.

Tuesday, February 18, 2014

Anti-Tobacco Researcher Accuses Electronic Cigarette Companies of Orchestrating Support by Right-Wing Think Tanks

Stan Glantz has accused electronic cigarette companies of orchestrating a campaign of support for these products by several "right-wing think tanks," as he calls them. These think tanks include the Heartland Institute, the Competitive Enterprise Institute, the CATO Institute, and the National Center for Public Policy Research.

Here is Glantz's accusation: "the e-cigarette companies (which are, increasingly owned by cigarette companies) are mobilizing the same network of right-wing think tanks that the cigarette companies have used for years to push their policy agenda, often linked with the tobacco companies' development of the Tea Party and related groups. John Mashey, a member of the Center for Tobacco Control Research and Education's Advisory Committee, sent me a few good examples. ... The more things change the more they stay the same."

The Rest of the Story

Before making an accusation like this, it is imperative that Dr. Glantz have evidence that electronic companies have mobilized these think-tanks to push their policy agenda. But the evidence that Glantz cites to support his accusation merely demonstrate that these groups have taken positions which support electronic cigarettes as a potential harm reduction strategy for tobacco control. None of the documents that Glantz cites indicate that any electronic cigarette company had anything to do with orchestrating, mobilizing, or affecting the positions taken by these groups.

The positions taken by these groups are actually very reasonable. In fact, I completely agree with their positions as stated in the op-eds and articles that Glantz cites. As it turns out, I am quoted in a number of these articles. So does this mean that I, too, am being orchestrated by electronic cigarette companies to push their policy agenda?

I happen to know many of the authors of the articles that Glantz cites. And I can tell you that the reason they support electronic cigarettes is because the scientific evidence supports these products as a reasonable harm reduction strategy, not because they are being paid off by electronic cigarette companies to take these positions. And unless Glantz has proof or documentation that these individuals have been paid off by Big Vapor, then he has no business making what is a false, public accusation.

Glantz is lucky that he didn't name any specific electronic cigarette companies. If he had, he would have opened himself up to a potential lawsuit.

The rest of the story is that once again, Glantz is lying to the public. He is so desperate to shoot down electronic cigarettes and apparently the actual evidence is so strongly against him that he has to resort to lying. The truth is not good enough.

Monday, February 17, 2014

Are You a Smoker Who Has Been Awarded Child Custody? Some Anti-Smoking Advocates Want Your Children Taken Away from You

A prominent anti-smoking advocate is urging that judges revoke child custody of smokers, even if they never smoke in the presence of their children.

According to a press release issued by Professor John Banzhaf at the George Washington University Law School: "Smokers who have been awarded full or partial custody of their children, or even simple visitation privileges, in a divorce proceeding could lose custody or have their rights curtailed as the result of a new report showing that tobacco smoke residue on furniture, rugs, draperies, etc. - often called "third-hand tobacco smoke" - can be as hazardous to a child's health as secondhand tobacco smoke, says public interest law professor John Banzhaf, who has helped obtain court orders prohibiting smoking in private homes in dozens of states."

Banzhaf is not happy with court orders that prevent smokers from smoking in the presence of their children, or even orders that require a 48-hour period of not smoking in the home prior to child visitation. Instead, a complete denial of custody to smokers may be justified, he argues, because of the recent research he alleges shows that thirdhand smoke is as harmful as secondhand smoke.

Banzhaf writes: "judicial orders, banning smoking in homes while the child is present and for a reasonable period before visitation, are designed to protect the child from the well known hazards of secondhand tobacco smoke, and have been issued in about three fourths of all the states over a period of some 20 years. But these judicial protective orders, in many states now being issued routinely, may no longer be sufficient to adequately protect a child, according to a new study at the University of California, Riverside, which found that third-hand smoke can be just as deadly as secondhand smoke." ...

"The Riverside scientists reported that third-hand smoke has been found to persist in houses, apartments and hotel rooms long after smokers move out. They say that their research shows that children in environments where smoking has been allowed in the past are still at “significant risk” for suffering from multiple health problems, "many of which may not manifest fully until later in life."

And here's the clincher:

"Prof. Banzhaf explains that this new study would provide a legal basis for a nonsmoking parent to reopen and modify a custody proceeding by arguing that a temporary ban on tobacco use by the smoking parent, or other smoking resident of the home, provides insufficient protection for the child's health. He said he would be willing to work with and assist attorneys seeking to reopen custody determinations on that legal basis. Once accepted by the courts, this new argument, and the scientific research supporting it, could result in parents who continue to smoke losing custody or visitation rights they may have previously enjoyed."

The Rest of the Story

I find this to be a disturbing and disgusting story. The idea that a child should be taken away from a loving parent, with whom a judge has ruled custody is in the best interests of that child's welfare, simply because John Banzhaf despises smokers is appalling. Don't let the false pretenses divert you. The real issue here is hatred of smokers and a desire to punish them.

There is no credible evidence that thirdhand smoke is as dangerous as secondhand smoke. In fact, there is no existing evidence that thirdhand smoke poses any health hazard for anyone other than an infant who may be crawling on the floor and ingesting dirt. And even in that situation, there is no evidence that the exposure is more harmful than secondhand smoke exposure, or that it even comes close to approaching that level of risk.

As I have explained earlier, the UC Riverside study is not credible. The researchers have made wild extrapolations from effects observed in mice. Moreover, they reached their conclusions prior to even beginning their laboratory studies. That Professor Banzhaf wants to take this junk science and use it to try to take children away from their loving parents, merely because they smoke, is despicable.

Essentially, what Banzhaf's argument means is that a parent being a smoker would be sufficient grounds for denying child custody. Why? Because thirdhand smoke is completely unavoidable if the parent smokes. Even if the smoker only smokes outside the home, he or she cannot possibly prevent thirdhand smoke exposure. Smoke deposits on the clothes and skin of a smoker. By virtue of being a smoker, that parent is going to expose the child to some degree of thirdhand smoke. So once a judge decides that a parent can be denied child custody due to thirdhand smoke exposure, it opens the door to denial of custody based solely on the fact that a parent is a smoker.

I should also add that by Banzhaf's reasoning, any parent who has a wood stove in the house should be denied child custody because there is strong evidence that wood stoves expose children to harmful chemicals. In fact, the scientific evidence for the harms of wood smoke is much stronger than that for the harms of thirdhand smoke.

Professor Banzhaf's advocacy of removing children from parents on the sole basis of the parent being a smoker is bad enough, but even worse is the complete silence of the rest of the tobacco control movement on this issue. Not a single one of the major, national tobacco control groups has spoken out in opposition to Banzhaf's suggested policy. Nor has any of the prominent tobacco control advocates in leadership positions in the movement spoken out to condemn this action.

Unfortunately, tacit disapproval is tantamount to support. The only way to put an end to this kind of nonsense is for anti-smoking groups to condemn it. That's not happening. Instead, the tobacco control groups are too busy trying to take away viable cessation options from smokers.

From inside the trenches, I can tell you that within the tobacco control movement, hatred for smokers is palpable. And sadly, it is driving our actions, positions, and policies.

Thursday, February 13, 2014

Op-Ed: Anti-Smoking Movement More Concerned with Money than Saving Lives

In an op-ed piece published in BU Today, I argue that the tobacco control movement has been co-opted by a bureaucracy of large national organizations that are more interested in putting feathers in their cap than actually saving lives from smoking.

I summarize my argument as follows: "In recent years, the tobacco control movement has squandered the opportunity to reduce smoking-related disease and death. Instead of continued progress, the tobacco control movement has largely been co-opted by a bureaucracy of national organizations that seem more concerned about bolstering their funding streams than fighting the tobacco industry. Both the government and the national tobacco control organizations have largely abandoned the fight against the tobacco industry and smoking, and instead have dedicated themselves to seeking funding for research or policy that makes little or no further contribution to the protection of the public’s health."

The piece highlights Dr. Alan Blum's documentary which reveals that the tobacco control movement has degraded into a fight for prestige and money rather than a fight against tobacco-related morbidity and mortality: "On the 50th anniversary of the 1964 report, Alan Blum, director of the Center for the Study of Tobacco and Society at the University of Alabama, released a documentary that highlights what he calls “the persistent foot-dragging, fear, and squandering of funds by public health agencies, universities, and medical associations alike in ending the smoking pandemic.” This is the real story of the modern-day tobacco control movement. It demonstrates that the tobacco problem is far from over, and that today’s leading antismoking groups have squandered the opportunity to continue Terry’s legacy."

I conclude: "While the tremendous decline in smoking since the 1964 Surgeon General’s report is worthy of celebration, the actual number of smokers has declined only from 53 million to 45 million. Clearly, the problem of cigarette smoking remains one of the most critical public health issues of our time. But to succeed, we need to rebuild a tobacco control movement that, unlike the current one, cares more about saving lives than gaining dollars."

Wednesday, February 12, 2014

Employment Discrimination Against Smokers Spreads to Obese Persons, As Predicted

For several years, the Rest of the Story has been arguing against policies by which employers refuse to hire smokers. My main argument is that this is a form of employment discrimination and is therefore unwarranted. Further, I have suggested that refusing to hire smokers opens the door to discriminating against other groups, such as obese persons.

Today, I report that the open door has been entered: Citizens Medical Center in Victoria, Texas has adopted a policy by which it will not hire anyone who is obese. Obesity is defined in the policy as a body mass index (BMI) greater than 35.

According to an article in the Texas Tribune: "A Victoria hospital already embroiled in a discrimination lawsuit filed by doctors of Indian descent has instituted a highly unusual hiring policy: It bans job applicants from employment for being too overweight. The Citizens Medical Center policy, instituted a little more than a year ago, requires potential employees to have a body mass index of less than 35 — which is 210 pounds for someone who is 5-foot-5, and 245 pounds for someone who is 5-foot-10. It states that an employee’s physique “should fit with a representational image or specific mental projection of the job of a healthcare professional,” including an appearance “free from distraction” for hospital patients."

"“The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance,” hospital chief executive David Brown said in an interview. “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.” Employment lawyers say Citizens Medical Center’s hiring policy isn’t against the law. Only the state of Michigan and six U.S. cities — including San Francisco and Washington, D.C. — ban discrimination against the overweight in hiring."

The Rest of the Story

This is blatant employment discrimination, and it is ugly. However, what readers should realize is that it is no more ugly than policies that refuse to hire smokers. My hope is that the obvious inappropriateness of this policy will open employers' eyes to the equal inappropriateness of refusing to hire smokers. Discriminatory hiring practices are simply wrong, and it is time that public health advocates starting standing up for justice for workers.

What makes the Citizens Medical Center policy particularly ugly is that they justify it by arguing that their patients don't want to see obese people people it doesn't fit with their "mental projection" of a healthcare professional. That is simply disgusting. The same thing could have been said years ago (or maybe today) about certain other groups, such as black health care workers, LGBT workers, or Jewish workers.

And importantly, the same thing is being said today, in some hospitals, about smokers. A number of hospitals refuse to hire smokers not merely to reduce health care costs, but because they don't want their patients to have to even "see" a smoker.

The only bright side to this story is that perhaps it will open the eyes of the public, the media, and employers to the fact that employment discrimination is indeed ugly and has no place in America. And that holds even if the group being discriminated against is smokers.

Tuesday, February 11, 2014

Anti-Smoking Advocate Incorrectly and Irresponsibly Tells Public that Smoking Half Pack Per Day is No Better than Smoking Two Packs Per Day

According to Dr. Stan Glantz - a leading tobacco control researcher - cutting down substantially on the amount you smoke has no health benefit. Thus, according to Dr. Glantz, smoking two packs of cigarettes per day is no more harmful than smoking a half pack per day, for example.

Dr. Glantz's comments on the lack of health benefit in cutting down on one's smoking come in response to one of the reported benefits of electronic cigarettes: that they help many smokers to cut down substantially on the amount they smoke. Glantz writes: "Dual users, who simultaneously use both products, are unlikely to see much, if any, health benefit because of the continued cigarette use, even if daily consumption drops." In other words, if you are still smoking, there are no benefits from cutting down on the amount you smoke thanks to e-cigarettes.

This is actually an important point because in published studies of the efficacy of electronic cigarettes, they reportedly helped more than half of smokers to either quit completely or cut down the amount they smoked by 50% or more. Thus, electronic cigarettes - even dual use - results in a substantial decline in cigarette consumption for the majority of users.

The Rest of the Story

The truth is that Dr. Glantz is simply wrong. He is not a medical doctor and therefore has no personal experience treating patients upon which to draw. As a physician, I can testify to the fact that when smokers substantially reduce the amount that they smoke, they experience immediate and significant health benefits.

The major problem with Dr. Glantz's argument is that he is considering only smoking-related mortality. The literature he cites deals with mortality only. However, there is more to life than simply its length. The quality of life is also important (although apparently not for smokers, according to Glantz). And cutting down the amount you smoke substantially improves the quality of life by reducing respiratory morbidity.

You see, there is no question that huge reductions in cigarette consumption improve respiratory symptoms. My patients who were able to cut down substantially on their smoking experienced immediate improvements in their ability to exercise and were able to enjoy life more because they could do more things without getting short of breath. Research confirms that respiratory symptoms improve when smokers are able to cut down the amount they smoke by at least 50%.

Long-term, there is a significant reduction in lung cancer risk associated with cutting the amount one smokes. The study that Glantz cites as showing no health benefits of smoking reduction actually found a 34% decline in lung cancer risk associated with smoking reduction.

One thing that is true is that there are no cardiovascular benefits to smoking reduction. The reason for this is that the adverse cardiovascular effects of smoking saturate at a low level of exposure. However, with carcinogenic effects as well as lung disease, there is a well-recognized dose-response relationship between exposure and disease risk. Therefore, substantial smoking reduction has no cardiovascular benefit but it does lower lung cancer risk and respiratory morbidity.

But there is another important factor that Glantz is forgetting. In the existing studies, the smokers examined had simply cut down on the amount they smoked without substituting another source of nicotine. Therefore, they were highly likely to be compensating by inhaling much more heavily on the cigarettes that they smoked. In contrast, when dual users of e-cigarettes and cigarettes cut down substantially on their smoking, they are doing so by substituting non-tobacco, nicotine cigarettes. One would expect much less, if any, compensation. Thus, the studies that Glantz cites are not quite as relevant as they would otherwise be.

A final, important benefit of smoking reduction is that it helps facilitate the possibility that a smoker will subsequently be able to quit. It reduces the level of smoking addiction. It is easier to quit from a level of 5 cigarettes per day than it is to quit from a level of 30 cigarettes per day.

The rest of the story is that it is inaccurate to tell the public that there are no benefits to substantial reduction in cigarette consumption.

But why is it irresponsible?

It is irresponsible because this advice basically tells smokers: "If you are unable to quit completely, there is no point in your trying to reduce the amount you smoke. If you are a 3-pack per day smoker and cannot quit completely, then you should just keep smoking 3 packs per day. Don't try to cut down to 1/2 pack per day because it will have no benefit."

If this was advice given by Glantz to a smoker he was treating, it would represent malpractice. Instead, it is what I consider to be public health malpractice.

There is no question that the best advice to smokers is to quit completely. But for those who are unable to do so, the use of electronic cigarettes to try to quit is sound advice. Clearly, if they quit completely with electronic cigarettes, they have accomplished a huge task in terms of improving their health. But even if they are still dual using, they may have substantially improved their health. And, they may have made it easier to quit completely at a later time.

But the truth is much too inconvenient for zealots who have adopted an abstinence-only, quit-or-die mentality. The lives and health of smokers are expendable when compared to the principle that addiction is evil and smoking is immoral. So when the truth gets in the way, anti-smoking fanatics simply lie.

Monday, February 10, 2014

Most Recent Data from UK Points to Substantial Public Health Benefits of Electronic Cigarettes

While most anti-smoking organizations continue to oppose electronic cigarettes, warning of the hypothetical risks of these products, new data from the UK suggest that in real life, e-cigarettes are producing substantial public health benefits.

Recent data (Monthly tracking of key performance indicators; Electronic cigarettes in England - latest trends) from the Smoking Toolkit Study (Cancer Research UK, UK Centre for Tobacco Control Studies) reveal the following critical points:

1. The use of electronic cigarettes has increased dramatically, ever since the fourth quarter of 2011.

2. Precisely coincident with the rise in electronic cigarette use in the UK has been a significant increase in quit smoking attempts.

3. Electronic cigarettes have surpassed nicotine replacement therapy (NRT) and other drugs as the most commonly used smoking cessation method.

4. Overall motivation to quit has increased since the dramatic rise in e-cigarette use.

5. The majority of dual users (e-cigarettes and cigarettes) are using e-cigarettes every day, and half are using at least two cartridges/disposables per day.

6. Very few nonsmokers or long-term ex-smokers are using electronic cigarettes.

Report STS140122 (Electronic cigarettes in England - latest trends) draws the following conclusions:
  • The increase in electronic cigarette use prevalence may have stalled;
  • There is no evidence that electronic cigarettes are undermining motivation to quit or reduction in smoking prevalence; and
  • Use of e-cigarettes by never smokers or long-term ex-smokers is extremely rare.

The Rest of the Story

Based on these most recent data from the UK, it appears that there just is not evidence to support the wild contentions that anti-smoking groups, advocates, and health agencies like the CDC and World Health Organization are disseminating to the public. Contrary to what Stan Glantz is telling the press, there simply is no evidence that the use of electronic cigarettes is undermining smoking cessation or impeding the decline in smoking prevalence. Nor is there evidence that electronic cigarettes are causing nonsmokers or ex-smokers to return to cigarette smoking. Moreover, there is no evidence that dual use is decreasing the motivation of smokers to quit or precluding these smokers from reaping any health benefits.

In contrast, however, to the lack of evidence that electronic cigarettes are having any negative public health effects, there is strong evidence to suggest that these products are having a substantial positive public health impact. In particular, there is evidence that not only do these products help many smokers quit smoking, but more generally, they increase population interest in smoking cessation, enhance levels of motivation to quit smoking, and lead to increased quit attempts among current smokers.

The only bad news coming out of the actual data is that the efforts of anti-smoking groups and advocates appear to be working: they are being successful in discouraging smokers from trying to quit smoking using electronic cigarettes. Ironically, the results of public health efforts have been to impede smoking cessation, lower the overall motivation of smokers to quit, and decreasing the number of quit attempts among current smokers.

In other words, the anti-smoking movement is violating the first principle of public health practice by doing public health harm.

While it is difficult for me to have to criticize anti-smoking groups because these are groups with which I have had a career-long collegial relationship, it appears that these groups are substantially harming the health of the public by impeding smoking cessation. Sadly, this means that their efforts are going to result in a significant amount of unnecessary disease and death.

This is not the way public health is supposed to be. But this is what happens when an abstinence-only mentality takes over in any area of public health, whether it be nicotine addiction or heroin addiction.

Friday, February 07, 2014

UC Riverside Scientists Release the Results of their Research on Thirdhand Smoke their Grant Application

Scientists from the University of California, Riverside have been funded to the tune of more than $400,000 to conduct research on the effects of thirdhand smoke on wound healing in mice. Today, I reveal that they have reported their results to the public. The results appear in which of the following places?

A. A journal article
B. A scientific conference abstract
C. A research monograph
D. The grant application

The Rest of the Story

Indeed, the answer is D. The results of the research are reported in the grant application itself. Once again, these researchers have demonstrated the miraculous ability to determine the results of their proposed research prior to actually conducted the experiments.

And even more magical is their ability to extrapolate their findings from mice directly to humans.

In the grant application, the researchers write: "The overall goal of this study is to identify how THS exposure affects response to injury and healing, so as to inform policy makers of the dangers of this newly recognized threat."

Interestingly, the proposal does not state: "The overall goal of this study is to identify the effect of THS exposure on healing, so as to inform policy makers whether or not THS exposure is dangerous to humans and the magnitude of such danger if it is present."

Instead, the proposal has already concluded that there are dangers to humans associated with this newly recognized threat.

Moreover, the researchers have determined that their studies will provide evidence of the hazards of thirdhand smoke exposure. No actual research is necessary for this conclusion. They write: "Our results ... will provide regulatory agencies with the experimental evidence to formulate and enforce policies to reduce exposure of infants, children, adults, elderly and workers in indoor environments where smoking occurs."

I don't know about you, but these are the researchers I am going to rely on for predictions before making my prop bets on whether the Jamaican bobsleigh team will crash before finishing its race, whether Canada will win the curling competition, and whether the U.S. or Norway will win more gold medals.

Thursday, February 06, 2014

Anti-Smoking Advocates Aiming to Destroy All the Key Elements that Make Electronic Cigarettes Successful for Smoking Cessation

In a beautifully-written and insightful open letter, Joanne at redheadfullofsteam has incisively dissected all the key elements that make electronic cigarettes such a successful innovation for smoking cessation and shown why the anti-smoking groups' desire to eliminate each one of these elements would be a disaster for public health.

Joanne writes: "In a little over a week’s time, I shall be marking my first anniversary as a user of e-cigarettes – or “vaper”. What this means is that at the same time last year, I was 26 years old and had smoked cigarettes for, literally, half my life. I enjoyed smoking. I enjoyed the sensation, the rituals associated with it, and even took pleasure in the sight of the smoke coiling lazily from the end of a cigarette. ... I had absolutely no intention whatsoever of giving up smoking. ... But then something unexpected happened. Through some rather clever direct marketing, I learned about e-cigarettes. They looked to be a way of saving some money, and so I wasted little time in ordering a starter kit consisting of a device that, once assembled, very closely resembled a cigarette. As a committed user of cigarettes, this mimicking of them was a hugely important factor in my decision to try these devices. Anything else would have made me feel too self conscious to even consider using one."

Here, right off the bat, Joanne articulates two key elements of electronic cigarettes that are critical to their success for smoking cessation. First, they resemble regular tobacco cigarettes. Second, it was the marketing of these products that led her to try them. Anti-smoking groups are bemoaning both of these elements. They complain because electronic cigarettes look like cigarettes. And many of them have called for a ban on electronic cigarette marketing. But either of these measures would destroy the entire point of this innovation. Electronic cigarettes work for smoking cessation specifically because they look like cigarettes. And smokers are enticed to try these products because of the clever marketing strategies. The electornic cigarettes would serve no purpose if they couldn't be effectively marketed to smokers.

Joanne continues: "Before long, I began to tire of the regular tobacco and menthol flavors I had been using. I began to experiment with new flavors such as apple, blueberry, gingerbread cookie, strawberry and – yes, bubble gum. As my sense of taste began to return, I was able to experience and appreciate these novel, and even fun, flavors to a degree that I had not enjoyed for some years. Yes, some of those flavors are attractive to children. But they are also incredibly and wonderfully attractive to an adult whose sense of taste has been reawakened after years of being assaulted by lit tobacco. In fact, as I began to tire of the more conventional cigarette type flavors, it was the availability of new and unusual flavors that kept me off tobacco, so much did I enjoy the experience."

Here, she articulates a critical aspect of the vaping experience that anti-smoking advocates want to destroy: the choice of flavors. Numerous anti-smoking groups have attacked e-cigarette companies for providing flavored varieties and they have called for a ban on electronic cigarette flavors. But as Joanne explains, the flavors are a key element that makes these products so attractive to smokers, especially to those who are trying to quit smoking completely.

Moreover, Joanne identifies a key point that has so far been missed by everyone: the flavors in electronic cigarettes draw the user further and further away from tobacco cigarettes, making a return to smoking much less desirable. Once the taste buds have been restored, the flavors are more appealing and tobacco becomes less appealing. Thus, banning the flavors in electronic cigarettes would render them much less effective in promoting smoking cessation.

Joanne's conclusion is better stated than anything I have written: "You need to overcome your prejudices and you need to stop confusing e-cigarettes with tobacco. ... And you need to consider that however earnestly you tell people of the harm they are visiting upon themselves, unless you can show them a palatable alternative behavior they will choose to ignore your advice. What you need to ask yourselves is not “can we risk allowing the unimpeded rise of this disruptive technology?” You should be asking “can we risk not allowing it?”"

Wednesday, February 05, 2014

Anti-Smoking Researchers Claim that Thirdhand Smoke is as Dangerous as Active Smoking

Thirdhand smoke is as dangerous as active smoking, according to anti-smoking researchers at the University of California, Riverside.

According to a Business Standard article entitled "Third-Hand Smoke Just as Lethal as First-Hand Smoke": "A scientist at the University of California, Riverside suggests that second-hand smoke and third-hand smoke are just as deadly as first-hand smoke. While first-hand smoke refers to the smoke inhaled by a smoker and second-hand smoke to the exhaled smoke and other substances emanating from the burning cigarette that can get inhaled by others, third-hand smoke is the second-hand smoke that gets left on the surfaces of objects, ages over time and becomes progressively more toxic."

The Business Standard reporter was not the only one to get this message from the study and its authors. According to an article at Medical Xpress: "Do not smoke and do not allow yourself to be exposed to smoke because second-hand smoke and third-hand smoke are just as deadly as first-hand smoke, says a scientist at the University of California, Riverside who, along with colleagues, conducted the first animal study of the effects of third-hand smoke."

The Business Standard and Medical Xpress reporters were not the only ones to get this message from the study and its authors. According to an article on the CBS Atlanta web site: "Exposure to surfaces and objects that have been saturated in cigarette smoke, labeled as “third-hand smoke,” may be as deadly as smoking the cigarette itself."

In the same article, the lead study author is quoted as stating that: "with prolonged exposure, they [children] may be at significant risk for developing more severe neurological disorders."

In addition, the authors concluded that: thirdhand smoke exposure among children causes "multiple short-term and longer health problems, many of which may not manifest fully until later in life."

To add icing to the cake, Medical News Today reported that: "researchers from this latest study say thirdhand smoke is left on surfaces and ages over time, becoming increasingly more toxic. The team suggests second and thirdhand smoke are just as harmful as firsthand smoke."

Where in the world did these reporters get the idea that thirdhand smoke could possibly be as harmful as active smoking? After all, thirdhand smoke is merely the residue from tobacco smoke that is deposited on surfaces and exposure occurs after smoking is no longer taking place.

Moreover, the study was a laboratory study involving mice. How could these reporters possibly extrapolate from a mouse study showing impairment of healing and liver damage in mice exposed to thirdhand smoke to the conclusion that thirdhand smoke is as harmful as active smoking?

The Rest of the Story

Where did the reporters get the crazy idea that this mouse experiment shows that thirdhand smoke, like active smoking, is lethal?

The answer:

From the researchers themselves!

A press release issued by UC Riverside states unequivocally that this research finds thirdhand smoke to be every bit as harmful as active smoking.

According to the press release: "Do not smoke and do not allow yourself to be exposed to smoke because second-hand smoke and third-hand smoke are just as deadly as first-hand smoke, says a scientist at the University of California, Riverside who, along with colleagues, conducted the first animal study of the effects of third-hand smoke."

This conclusion - that thirdhand smoke is deadly - was disseminated widely throughout the world. Headlines read like this:

"Third-Hand Smoke Could Kill You"

"Third-Hand Smoke Just as Deadly as First-Hand Smoke"

And all the way from Pakistan: "Third-Hand Smoke Just as Lethal as First-Hand Smoke"

Perhaps it should be no surprise that these researchers have drawn such a wild and scientifically implausible conclusion like this, one which does not follow at all from their actual research. Why? Because, as I revealed yesterday, these researchers had reached the conclusion of their study years ago, before even conducting the research! In fact, they drew their conclusions when they submitted their grant application. So it comes as no surprise to now see that they are drawing pre-determined conclusions that have nothing to do with their actual research.

The rest of the story is that this research is making a mockery out of the modern-day tobacco control movement.

But the story also has some serious and possible damaging implications.

One reason why these conclusions are so dangerous is that they may lead smokers to figure that there is no value in their smoking outside the home. If thirdhand smoke is as harmful as secondhand smoke, then why bother smoking outside?

In fact, this is precisely the way some are interpreting these findings. One article on the study is entitled: "Think smoking outdoors always protects others? This study suggests not."

If this study leads some smokers to smoke inside because they believe the researchers, who say that thirdhand smoke is no less harmful than secondhand smoke, then this could lead to serious public health harm to children.

Tuesday, February 04, 2014

California State-Funded Grant on Thirdhand Smoke Shows that Researchers Know their Conclusions Before Even Conducting the Research

For those upset because they lost money on Super Bowl bets Sunday, I have good news for you. Next year, you can call a team of UC Riverside researchers for their premonitions about the Super Bowl outcomes before placing your bets. This research team has demonstrated themselves to be able to forecast the future, as they apparently are able to determine the conclusions of their research before even conducting the experiments.

In a grant proposal that was subsequently funded by the state of California's Tobacco-Related Disease Research Program (TRDRP), Dr. Manuela Martin-Greens and colleagues from the University of California, Riverside exhibited their fortune-telling skills, claiming to know the results of their proposed lab experiments on mice before actually performing the studies.

According to the abstract of the grant proposal, the research question that the lab team is proposing to investigate is as follows: "The goal of this application is to determine the effects of Third Hand Smoke on wound healing. ... It is known that first-hand smoke and secondhand smoke (SHS) inhibit wound healing but nothing is known about the effects of third-hand smoke (THS) on wound healing. ... To address this problem, we will use mice, expose them for 6 months to THS present in their cages and, at the end of the exposure period, we will perform wounds on their backs and study the time course of healing by examining not only the wound areas but also the properties of the tissues."

Since nothing is known about the effects of third-hand smoke on wound healing, it seems very appropriate that this research team is going to investigate this research question using a mouse model to find out whether there are adverse effects of thirdhand smoke.

Surprisingly, however, the next paragraph of the grant application abstract informs grant reviewers that the researchers actually know the results of this experiment before conducting it. The researchers tell the reviewers that:

"these studies will also help adult smokers understand that their family members are severely affected if they undergo surgery and return to a THS-polluted environment because their healing process will be not only be altered but will also be significantly delayed. ... the proposed work will benefit the public by providing a better understanding of the cause of impaired healing among individuals who are constantly exposed to Third Hand Smoke, i.e. smokers themselves, children and elderly parents in households of smokers, waiters and waitresses in bars and housekeepers in hotels or houses of smokers."

Thus, before even conducting the study, these researchers have concluded that adult smokers and their family members are severely affected if they undergo surgery and return to a THS-polluted environment, because their healing process will be significantly delayed. Also, the researchers have concluded that individuals who are repeatedly exposed to thirdhand smoke have impaired healing. This includes elderly parents in households with smokers as well as housekeepers in hotels.

The Rest of the Story

This story demonstrates how low the integrity of research in the tobacco control movement has sunk. In today's tobacco control movement, we can draw conclusions before even conducting research because we are apparently capable of predicting the results of our experiments before they are carried out.

The unfortunate part of the story is that California taxpayers funded this proposal to the tune of a quarter of a million dollars. What a waste of money. They could have saved the money because the researchers had already drawn their conclusions. Why waste the money on actually conducting research when the conclusions of that research have already been drawn, and disseminated!

With this kind of foresight, these researchers could have easily won $250,000 to fund their research without having to bother the taxpayers. They could have simply put a $2,500 bet on the first score in the Super Bowl being a safety and they would have saved the state of California a quarter of a million bucks.

Were I a reviewer of this grant, I certainly would not have funded it. Instead, I would have saved the money and encouraged the researchers to publish their pre-determined conclusions without wasting taxpayer dollars to pretend to be searching for an answer to a question that they have already answered.

(Thanks to Shadow Guest for the tip.)

Monday, February 03, 2014

Anti-Smoking Groups Attack Tobacco Industry Consultants for Failed Disclosures in Medical Journal Articles

A number of anti-smoking groups are attacking two former tobacco industry consultants for failing to disclose their history of funding by the tobacco industry in a set of two commentaries they published recently in a pair of major medical journals. The journals have both responded by admonishing the authors and requiring them to publish a correction in the next issues of the journals.

The commentaries by the two former tobacco industry consultants, university professors at a major midwestern medical school, are not in any way pro-tobacco, although they do criticize a number of current anti-smoking initiatives because they are ineffective and not based on sound formative research.

The reason for the failure of these researchers to disclose their past relationships with the tobacco industry is not entirely clear, but may revolve around their interpretation of the conflict of interest disclosure form's requirements. In section 3 of the form, authors of articles are asked to disclose any financial relationships with industry that occurred within the past three years. However, neither of the two co-authors has received money from any tobacco companies since 2010.

Nevertheless, the anti-smoking groups insist that the tobacco industry funding should have been disclosed. For one, they argue that section 5 of the form insists that authors disclose any other conflicts of interest, even if they occurred prior to the past three years. Second, they argue that the history of funding by tobacco companies is well within the spirit of the disclosure requirement and that the authors have an obligation to let readers know that in the past, they have had financial relationships with Big Tobacco.

The specific financial interests of the co-authors, according to the anti-smoking groups are:

1. Between 2003 and 2008, one of the authors performed consultation services for R.J. Reynolds and Lorillard and conducted research at his medical school which was funded by R.J. Reynolds, Brown & Williamson, and Liggett. The total annual amount of his consulting payments from Big Tobacco was as high as $40,000. While the amount of grant funding received from tobacco companies is not clear, one of the anti-smoking groups has documented that the level of funding in 2005 was $400,000 and in 2004 was $1 million.

2. Between 2010 and 2012, the other co-author conducted studies using a variety of smokeless tobacco products. While the studies were not funded by a tobacco company, the study products were provided free of charge by U.S. Tobacco. Previously, this co-author did conduct tobacco industry-funded studies, which he acknowledged in a 2008 publication. This funding apparently goes all the way back to at least 2000. In addition, the researcher used to do consulting work for Star Scientific, U.S. Tobacco, Liggett, and Santa Fe Natural Tobacco Company, although none of that consulting occurred within the past three years.

While neither of the researchers could be reached for comment, sources familiar with their work told the Rest of the Story that these authors do not feel their historical funding by Big Tobacco and consulting for Big Tobacco needs to be disclosed because it occurred more than 36 months ago.

However, the anti-smoking groups did not buy this argument. One organization's spokesperson told me: "The conflict of interest form clearly asks for the disclosure of all financial relationships that could be perceived as biasing an author's opinion, and there is no 36-month limit for such disclosures. Section 5 of the form refers to any and all conflicts of interest, regardless of when they occurred. These researchers are breaking not only the spirit, but also the letter of these policies."

A spokesperson from one of the leading national anti-smoking groups commented: "The more things change, the more they stay the same. This just goes to show that the tobacco industry is still able to unduly influence medical research reporting, even if they are not currently paying their consulting scientists. These conflicts of interest were firmly established in the past and the conflicted scientists continue to do the tobacco industry's bidding."

The communications director for another national anti-smoking group added: "This just goes to show that the tobacco companies have not changed. They will go to any extent to keep America's children smoking, even paying university scientists to do their dirty work for them."

Another anti-smoking group, responding via email, told me that: "This is precisely how the tobacco industry has influenced the reporting of science. By funding research at universities and engaging professors and researchers as consultants, the industry introduced a bias that influenced these scientist's conduct and reporting of their subsequent research. While the financial relationships may have ended in the light of the public's disdain for the tobacco industry and the public revelations that came out of the DOJ lawsuit, these biases do not just disappear overnight. It is irresponsible and unethical for these researchers to hide their past financial relationships with Big Tobacco, even if the money changed hands more than 36 months ago."

The Rest of the Story

The Rest of the Story regrets to inform readers that a mistake was made in the above report. While the bulk of the report is true and accurate, there were a few minor, technical errors made:

1. The financial conflicts of interest involved in these commentaries were not with tobacco companies, but with pharmaceutical companies. Every instance where "tobacco company" appears should be replaced with "pharmaceutical company," and "Big Tobacco" should be replaced with "Big Pharma." The article errantly refers to R.J. Reynolds, Lorillard, Brown & Williamson, Star Scientific, U.S. Tobacco, Liggett, and Santa Fe Natural Tobacco Company. These companies should have been listed as Elan Pharmaceutical, SmithKline Beecham, Glaxo Wellcome, GlaxoSmithKline, Nabi Biopharmaceuticals, Pfizer, Sanofi-Synthelabo, sanofi-aventis, Lederle, Ciba-Geigy, McNeil Consumer Products, and Pharmacia. We apologize for any inconvenience these errors may have caused.

2. In contrast to what we reported above, the anti-smoking groups have not - I repeat, have not - criticized the researchers for failing to disclose their conflicts of interest. They did not argue that "section 5 of the form refers to any and all conflicts of interest, regardless of when they occurred," and that "these researchers are breaking not only the spirit, but also the letter of these policies." We apologize for having incorrectly insinuated that these anti-smoking groups are concerned about the scientific and ethical integrity of published tobacco control research.

3. Also in contrast to what we reported above, the journals in which these articles were published have not asked the authors to correct their disclosures by revealing their significant history of financial relationships with the pharmaceutical industry. 

We apologize for any inconvenience caused by these small, technical errors in our reporting.