Thursday, November 30, 2023

Why is the National Academies Appointing Alcohol-Industry Funded Researchers to Serve on Panel to Review the Health Effects of Alcohol?

I have always thought of the National Academies (full name is the National Academies of Sciences, Engineering, and Medicine [NASEM]) as being a highly reputable, impartial entity that objectively reviews scientific issues by appointing panelists who do not have conflicts of interest with industry that could create the appearance of bias. The National Academies has a detailed policy that disallows panel members who have a conflict of interest by virtue of funding by industries whose interests could be affected by the results of the panel review.

Well, that view of the National Academies has just flown out the window. Why? Because they have recently appointed to their newly formed expert committee to review the health effects of alcohol two scientists who were principal investigators in a research grant funded by the alcohol industry. And this was not minor funding. It was funding to the tune of $67 million! 

According to the National Academies web site listing the members of the panel entitled "Review of Evidence on Alcohol and Health," the chair of the panel is Dr. Eric Rimm and a second member of the panel is Dr. Kenneth Mukamal. 

For background, this panel is being convened as part of a larger process to develop dietary guidelines and those guidelines will presumably address the issue of alcohol consumption. The alcohol industry is presumably hoping for a recommendation that moderate alcohol consumption be part of a healthy diet, based on its view that there could be some cardiovascular benefits of moderate alcohol use.

The Rest of the Story

The last person one could possibly want on this panel is someone who lobbied the alcohol industry to provide funding for a clinical trial of the health benefits of alcohol use for which he would likely serve as the principal investigator and was awarded that funding. Well, that person - Dr. Kenneth Mukamal - was indeed appointed to the panel.   

In 2017, the New York Times reported that: "the National Institutes of Health is starting a $100 million clinical trial to test for the first time whether a drink a day really does prevent heart attacks. And guess who is picking up most of the tab? Five companies that are among the world’s largest alcoholic beverage manufacturers — Anheuser-Busch InBev, Heineken, Diageo, Pernod Ricard and Carlsberg — have so far pledged $67.7 million to a foundation that raises money for the National Institutes of Health, said Margaret Murray, the director of the Global Alcohol Research Program at the National Institute on Alcohol Abuse and Alcoholism, which will oversee the study." 

The principal investigator of the study, which was called "MACH" (Moderate Alcohol and Cardiovascular Health), was Dr. Kenneth Mukamal from the Harvard Medical School. According to an article in the Harvard Crimson (and supported by numerous other articles as well as by an NIH review committee), "Mukamal and his colleagues pitched the study to alcohol industry groups at high-end hotels, telling them the study “represents a unique opportunity to show that moderate alcohol consumption is safe and lowers risk of common diseases,” the New York Times reported in March."

At a meeting with alcohol industry representatives in February 2014, Dr. Mukamal pitched the idea of a clinical trial of the benefits of drinking in an effort to solicit alcohol industry funding for the trial. In his presentation, Dr. Mukamal included a slide entitled "The Ultimate Goal." It was a newspaper headline from a Boston Globe article that stated "Mediterranean diet shows key benefits." Presumably, Dr. Mukamal was trying to convince the alcohol industry that this trial would allow the industry to reap the rewards from similar newspaper articles reporting the benefits of a diet that includes moderate alcohol consumption. In another slide, entitled "The Bottom Line," the presentation again explains that the primary purpose for the study is to "convince clinicians, patients, and policymakers that alcohol consumption in moderation is safe and a healthy part of diet..."

Later, in November 2014, Dr. Mukamal wrote an email to NIAAA stating: "I think that our chances with brewers and distillers would only go up with buy-in from other sources, including wine, if we can find any." Clearly, Dr. Mukamal was part of an effort, in collaboration with NIAAA, to seek alcohol industry funding that would support his role in the clinical trial.

Eventually, the alcohol industry contributed $67 million to which NIAAA added $33 million and the $100 million MACH trial was initiated under the leadership of Dr. Mukamal. However, the NIH halted the trial in June 2018 after an NIH review committee report concluded that:

"To understand the context that led NIAAA to embark on the MACH trial, the ACD WG considered the nature and extent of interactions among NIAAA staff, select extramural investigators, and industry representatives before FNIH received approval to secure funding to support the trial. There was early and frequent engagement among these parties which appear to be an attempt to persuade industry to support the project. Several members of NIAAA staff kept key facts hidden from other institute staff members and the FNIH. The nature of the engagement with industry representatives calls into question the impartiality of the process and thus, casts doubt that the scientific knowledge gained from the study would be actionable or believable. There were sustained interactions between the eventual principal investigator of the MACH trial and members of the NIAAA leadership prior to and during the development of FOAs for planning and main grants to fund the program. These interactions appear to have provided the eventual principal investigator with a competitive advantage not available to other applicants, and effectively steered funding to this investigator. Interactions among several NIAAA staff and industry representatives appear to intentionally bias the framing of the scientific premise in the direction of demonstrating a beneficial health effect of moderate alcohol consumption."

To make matters worse, Dr. Mukamal appears to have lied in publicly denying that he solicited funding from the alcohol industry. According to a New York Times article: "Dr. Mukamal, who has published dozens of papers on the health benefits of alcohol consumption, said he was not aware that alcohol companies were supporting the trial financially. “This isn’t anything other than a good old-fashioned N.I.H. trial,” he said. “We have had literally no contact with anyone in the alcohol industry in the planning of this.”"

Thus, not only does Dr. Mukamal have a severe conflict of interest by virtue of having colluded with NIAAA to secretly solicit and obtain alcohol company funding and by having been awarded that alcohol industry funding, but he also appears to have lied about it.

In conclusion, there is no doubt that Dr. Mukamal should be removed from the National Academies panel in order to preserve the integrity of both the panel and of the National Academies itself.

Although Dr. Rimm was not involved in the solicitation of funding, he did serve as a principal investigator of the MACH trial. Thus, he has been funded by the alcohol industry and this conflict of interest should disqualify him from participating in, much less chairing the panel. 

Dr. Rimm should be removed from the National Academies panel in order to preserve the integrity of both the panel and of the National Academies itself.

The final blow, and perhaps the biggest reason to exclude both Dr. Mukamal and Dr. Rimm from the panel, is that neither has been forthright about this conflict of interest in papers they have published subsequent to the trial. For example, in this 2020 paper of which both Dr. Mukamal and Dr. Rimm are co-authors, there is no visible disclosure that they had conducted research funded by the alcohol industry. In a section of the paper entitled "Author Relationship with Industry," two of the co-authors disclose their relationships, but Dr. Mukamal and Rimm do not. In fact, the section ends by stating: "All other authors have reported that they have no relationships relevant to the contents of this paper to disclose." However, one of the facts presented in the paper is that wine has high anti-inflammatory potential!

Furthermore, in an article that appears in this month's issue of the European Journal of Epidemiology, both Dr. Mukamal and Dr. Rimm are co-authors and neither discloses their prior research that was funded by the alcohol industry. The conflict of interest section states only that: "We declare that we have no conflicts of interest." Here, there isn't even a remote argument that the conflict of interest is not relevant to the topic of the study because the article is specifically about the health effects of moderate alcohol consumption! This conflict of interest of both investigators should have been disclosed in the paper.

It would be interesting to know whether Dr. Mukamal and Dr. Rimm disclosed their having received alcohol industry funding in the disclosure they submitted for the National Academies panel. Unfortunately, these disclosures are not made public by the National Academies.

Thursday, August 31, 2023

American Lung Association Wants to Keep Smokers Misinformed About the Relative Risks of Different Tobacco Products

In comments submitted to the FDA in response to the Center for Tobacco Products' (CTP) draft strategic plan, the American Lung Association expressed its opposition to one of the strategic goals, which was to "inform adults who smoke about the relative risks of tobacco products." This goal primarily expressed the desire of the CTP to inform smokers that electronic cigarettes are much safer than real cigarettes and therefore may be considered as a safer alternative for smokers who are unable to quit using other cessation methods.

The American Lung Association does not approve of this goal, writing: "Remove language from the description for this goal that references informing adults about the relative risk of tobacco products. As mentioned in our comments above, the description for this goal included language “and to inform adults who smoke about the relative risks of tobacco products.” The Lung Association strongly recommends this language be removed from the description.

Earlier in its comments, the Lung Association wrote: "the Lung Association strongly urges reconsideration of and revision to part of goal four, notably any promotion of the so-called “relative risk” of tobacco products. CTP should have no part in the industry’s efforts to sustain addiction through the failed and flawed notion that adult smokers should switch to e-cigarettes."

The Rest of the Story

The rest of the story is that the American Lung Association opposes telling the public the truth. 

This is highly ironic, given the extent to which the Lung Association and other tobacco control organizations went to punish the tobacco industry for lying to the public and hiding critical health information. It is also unethical because it violates the public health code of ethics, which calls for honesty and transparency in public health communications. We do not hide critical health information from the public. And we certainly do not hide information about the relative risks of various health behaviors.

Can you imagine if the American Lung Association said the same thing about methadone or buprenorphine? CTP should have no part in the drug industry's efforts to sustain addiction through the failed and flawed notion that adult heroin users should switch to methadone or buprenorphine.

How about the American Lung Association saying the same thing about needle exchange programs? CTP should have no part in the drug industry's efforts to sustain diction through the failed and flawed notion that adult heroin users should be provided with places that exchange clean needles for contaminated ones.

Or what if the American Lung Association said the same thing about condoms? CTP should have no part in the sex industry's efforts to sustain sexual behavior through the failed and flawed notion that adolescents who are having sex should use condoms.

As ridiculous and misguided those statements sound, the American Lung Association is actually making precisely the same statement regarding the use of electronic cigarettes. Even worse, the issue here is not even whether e-cigarettes should be promoted for smoking cessation. It is simply whether smokers should be told that e-cigarettes are safer than tobacco cigarettes.

This is about as damaging a recommendation as I have ever seen from a supposed public health organization. I must condemn it in the strongest terms. 

Monday, July 31, 2023

University of Maryland Doctor Tells Public He's Not Sure Smoking is Any More Hazardous than Vaping

In an article published today by ABC News, a physician from the University of Maryland is quoted as telling the public that he isn't sure that smoking is any more hazardous than vaping.

According to the article: "'We just cannot make a conclusion that it [vaping] is safer than cigarettes,' said Dr. Jason Rose, a Pulmonary and Critical Care Physician who is also the Associate Professor of Medicine and Associate Dean for Innovation & Physician Science at The University of Maryland."  

Of course, stating that you're not sure if vaping is safer than cigarettes is equivalent to saying that you're not sure smoking is any more hazardous to your health than vaping. This is obviously a ridiculous statement that is completely refuted by a multitude of scientific evidence as well as by the documented experiences of millions of ex-smokers who quit smoking by switching to vaping. Even the most vigorous opponents of e-cigarettes acknowledge that vaping is safer than smoking (as long as you are not engaging in dual use).

While the cardiovascular harms of e-cigarettes are probably moderately lower than smoking, the risks of cancer and COPD are astronomically lower. Many papers have documented the subjective and objective clinical improvement in respiratory function in smokers who quit smoking by switching to electronic cigarettes. Many papers have documented the much lower levels of carcinogens in e-cigarettes, some by actually measuring biomarkers in the blood or urine of smokers and vapers. 

Well, that is not the only guffaw in this article. In the same article, two other physicians strongly discourage smokers from quitting smoking with the use of e-cigarettes, even though e-cigarettes have been demonstrated to be the single most effective pharmacotherapeutic strategy for smoking cessation. 

According to the article: "Doctors are increasingly discouraging people from using e-cigarettes given the mounting evidence about the significant negative health impact of vaping-- even as a smoking cessation tool. For current smokers, 'there are other very powerful, safe and FDA approved interventions,' Dr. Petros Levounis, the President of the American Psychiatric Association and Chair of the Department of Psychiatry at Rutgers New Jersey Medical School, said."

Another physician is quoted as stating that e-cigarettes "are not ideal and there are other options that are proven by science that are safe and effective." This physician also fails to inform the public that e-cigarettes have been documented in clinical trials to be significantly more effective than any of those other options for smoking cessation.

To add the final blow, the article suggests that e-cigarettes can cause severe lung damage, tying e-cigarettes to the EVALI outbreak of 2019: "But studies show that e-cigarettes may cause harm by affecting the whole body. A medical condition called EVALI – E-cigarette or Vaping-use Associated Lung Injury - not only causes damage to the lungs but can also cause issues in other organs' systems."

No e-cigarette has ever been shown to cause EVALI. As the article later notes (in perhaps the only accurate statement in the whole article): "A CDC evaluation found that ingredients associated mostly with illicit THC vaping products played a major role in the 2019 EVALI outbreak that peaked in September 2019."

The article goes on to quote the parent of a teenager who suffered from EVALI. The article infers that the teenager's harrowing experience and near-death hospital admission was due to the use of e-cigarettes, failing to disclose that--almost certainly--his condition was caused by his use of illicit, black market THC oils that were spiked with vitamin E acetate.

The Rest of the Story

I am incredulous. Never did I imagine that in 2023, I would still be writing blog posts about physicians lying to the public by telling them that smoking is no more hazardous than vaping. Nor did I imagine that I would still be writing blog posts about physicians and medical groups discouraging smokers from quitting smoking by switching to e-cigarettes, even though it has been proven to be the most effective strategy for smoking cessation (with the exception of cold turkey quitting) and data show that more than 4 million ex-smokers in the U.S. quit smoking successfully by switching completely to vaping.

The lack of progress in educating physicians and the public about the relative harms of smoking compared to vaping is tragic. As a result, the health and lives of tens of thousands of Americans are being put at risk because they falsely believe that there is no benefit to quitting smoking via switching to vaping. 

A large part of the blame goes directly to the CDC--and especially the Office on Smoking and Health (where I used to work)--which have repeatedly misled the public by mis-communicating the risks of smoking compared to vaping. It is a shame that the nation's leading prevention agency--and the office responsible for tobacco prevention specifically--have carried on a campaign of deception that is now carrying into its 14th year!


Friday, July 28, 2023

Great Article on the CDC's Misinformation Campaign About Electronic Cigarettes

A very well-researched and well-documented article on the CDC's misinformation campaign about electronic cigarettes by my friend and colleague over at Handwaving Freakoutery: "Real Talk About Nicotine: How CDC Propaganda Leads to Bad Medicine and Kills People."

Medical Journal Retracts Vaping Study for Political, Rather than Scientific Reasons

The journal BMC Public Health has announced that it will be retracting a paper it published last October which concluded that the use of electronic cigarettes has helped accelerate the decline in cigarette smoking. 

The study, entitled "Population-level counterfactual trend modelling to examine the relationship between smoking prevalence and e-cigarette use among US adults," analyzed U.S. population-based data on trends in e-cigarette consumption and smoking prevalence from approximately 8 years prior to when e-cigarettes became popular in the U.S. through 2019. The authors used adult cigarette prevalence trends from 1999-2009 to establish a baseline and then generated the counterfactual (what would have been expected in the absence of e-cigarettes) by continuing these trends through 2019. They then compared the predicted trend in smoking prevalence from 2010-2019 with the actual trend. 

They found major discrepancies between the predicted and observed prevalence of smoking, with smoking rates dropping much more rapidly than expected. The magnitude of the "excess" decline in smoking correlated highly with greater prevalence of e-cigarette use. Furthermore, discrepancies between expected and observed levels of smoking were greater among subgroups with higher levels of e-cigarette use: young adults, adult males, and non-Hispanic White adults. The article concluded that: "Population-level data suggest that smoking prevalence has dropped faster than expected, in ways correlated with increased e-cigarette use."

The data were obtained from the National Health Interview Surveys, which are publicly available. The authors are affiliated with Pinney Associates, which does consulting work for Juul, an e-cigarette company in which the tobacco company Altria has a 35% stake. The authors fully disclosed the funding for the study--which was provided by Juul--as well as their conflicts of interest (i.e., their consulting work for Juul) in the paper. 

Apparently, the journal received a letter to the editor complaining that the paper's conclusions were invalid and calling for its retraction for two reasons:

1. The assumption that e-cigarette prevalence was zero in 2010 is incorrect, as e-cigarettes were widely available in the U.S. going back to 2007.  

2. The paper was funded by Juul, which has a financial interest in the results of the paper. 

However, the authors provided a supplemental table in the paper showing that even if one eliminates the assumption that e-cigarette use was zero in 2010 and simply rely on survey-measured e-cigarette prevalence values, there is still a strong and significant correlation between the discrepancy between predicted and actual smoking and the prevalence of e-cigarette use for two subgroups: males and young adults (the two groups with the highest levels of e-cigarette use).

Additionally, the authors fully disclosed their funding and conflicts of interest which were known to the journal's editorial staff and the reviewers prior to the decision to accept the manuscript for publication. Moreover, this particular journal does not have a policy that precludes consideration of papers that are funded by the tobacco industry or for which the authors report conflicts of interest.

Despite these two critical facts, the journal nevertheless wrote a letter to the authors stating that it made the decision to retract the article. On July 18, the journal told the authors that their response to the letter to the editor was not sufficient to address the letter writer's concerns. The reason given by the journal for the retraction was as follows:

The assumption that e-cigarette prevalence was zero in 2010 is not supported, and although the sensitivity analysis showed that there was still a significant correlation between the magnitude of the discrepancy between predicted and observed smoking prevalence and the level of population e-cigarette use for males and young adults when this assumption was eliminated, the relationship between cigarette use and the smoking prevalence disparity among young adults is most likely due to e-cigarette marketing.

The pivotal argument in the letter is as follows (I bolded it because of its importance): "In fact, bodies of literature are emerging globally about the effect of the tobacco industry’s marketing campaigns aimed at younger generations, using social media and influencers, which are associated with an increase in uptake of e-cigarettes (and dual use of e-cigarettes and tobacco products) in younger age groups. In my opinion, the effect of this strategic marketing seems a much more likely explanation of the association between younger age and increased e-cigarette use found by Foxon et al. than that e-cigarettes are particularly effective at helping younger age groups quit smoking."

The letter stated the final reason for the retraction as: "After careful consideration, and in light of the EBM’s feedback, the journal has taken the decision to retract the article in line with COPE guidelines. Our investigation has concluded that since the paper’s conclusions are based on assumption of ‘0’ prevalence of e-cigarette use in 2010 the results are non-significant."

The Rest of the Story

There is no valid scientific basis for the retraction of this paper. The journal states that it is retracting the article because the assumption that e-cigarette prevalence was zero in 2010 renders its results invalid. However, the results do not rely on the assumption that smoking prevalence in 2010 was zero. In fact, when the authors made no assumptions at all about e-cigarette prevalence and simply used the survey data on e-cigarette prevalence, they found a gaping difference between predicted and observed smoking prevalence among young adults and among males and in both cases, the magnitude of this gaping difference was highly and significantly correlated with the prevalence of e-cigarette use. The authors also documented to the journal editors that even if they changed the main assumption so that e-cigarette prevalence was 0 back in 2006 or 2007 or 2008 or 2009, the results were essentially unchanged. 

Moreover, the validity of the paper's findings does not rely upon any assumptions about e-cigarette prevalence in the first place. The main finding of the paper is that there is a large discrepancy between predicted and observed smoking prevalence in the past decade, with observed smoking prevalence being substantially less than would have been expected based on pre-existing trends. And the magnitude of the discrepancy is greatest among males and young adults. There needs to be some explanation for these two findings. It is beyond refutation that one critical change that occurred during the past decade was that there was a dramatic increase in adult e-cigarette use and that this increase was most dramatic among males and among young adults. Thus, even without calculating any correlation between e-cigarette prevalence and the magnitude of the smoking prevalence discrepancies one can reasonably posit that the use of e-cigarettes is a likely explanation for the greater than expected declines in adult smoking. This is especially true given data from the NHIS suggesting that during the past decade, no fewer than 4 million adult smokers quit smoking successfully using e-cigarettes.

The journal editors simply dismissed the sensitivity analysis showing that the paper's findings are not dependent upon the assumption of 0 e-cigarette use in 2010. That analysis is presented within the paper itself, yet the editors dismiss it. And the primary reason they dismiss it is because they believe there is an alternative explanation for the correlation between e-cigarette use and the discrepancy in observed vs. predicted smoking prevalence among young adults. Specifically, the editor argues that this finding is explained by e-cigarette marketing, which resulted in increases in youth e-cigarette use. But that is no explanation at all. The only thing that e-cigarette marketing might explain is why there was an increase in youth vaping. In no way does that invalidate the finding that there is a gaping discrepancy between actual and expected smoking prevalence among young adults which correlates with the magnitude of e-cigarette use.   

Moreover, the paper also found that without making any assumption about 0 e-cigarette use in 2010, there was a gaping discrepancy in observed vs. predicted smoking among males in the United States that was correlated strongly and significantly with the magnitude of e-cigarette use. The journal editors do not provide any refutation of, or alternative explanation for this finding.

Importantly, the journal editors are also incorrect when they state that they are retracting the article "in line with COPE guidelines." The relevant COPE guideline states that a paper may be retracted only if the editors "have clear evidence that the findings are unreliable, either as a result of major error (eg, miscalculation or experimental error), or as a result of fabrication (eg, of data) or falsification (eg, image manipulation)." None of those is present in this case, and the editors do not contend that a major error, miscalculation, experimental error, fabrication of data, or falsification of data is present. Thus, the editors are not adhering to COPE guidelines at all.

Essentially, the paper is being retracted because the editors do not agree with the conclusion reached by the authors given the findings presented in the paper. This is not a valid reason to retract a paper. There are always alternative explanations for a paper's findings and if editors started retracting every such paper, they would be purging about 95% of the publications in their journals.

You, like me, may find this an egregious example of an attempt to purge the scientific literature of a paper that the editors, after the fact, have decided that they don't like the study findings. You may be wondering what is really behind this because the scientific explanation given falls flat on its face.

Well, the editor has given us a clue in another statement they make in the letter to the study authors explaining that a letter to the editor has been received. That statement, which quotes a WHO document, reads: 

"At the time of writing, the evidence is insufficient to recommend the use of ENDS as cessation devices at the population level."

This conclusion is not only irrelevant to the issues at hand, but it has the appearance of revealing the true reason for the editor's disdain for this paper which they accepted for publication. Apparently, the editor sides with the WHO in believing that electronic cigarettes should not be recommended for smoking cessation. In other words, the editor appears to have a disdain for electronic cigarettes themselves, and this appears to have translated into a disdain for the article reporting the dramatic and unprecedented effects of e-cigarettes on adult smoking cessation.

I therefore read this story as indicating that the paper was retracted for essentially political, rather than scientific reasons.

Monday, July 17, 2023

American Heart Association Still Refuses to Tell the Truth About EVALI and Makes No Specific Recommendation that Youth Avoid Vaping THC Products

In an American Heart Association (AHA) "scientific statement" published this week in the journal Circulation, the AHA continues to confuse the public about the so-called EVALI (e-cigarette or vaping-associated lung injury) outbreak that occurred in 2019, suggesting that it may be due to "flavoring agents," "viruses," or "bacteria" and that no specific agent has been identified as the cause. 

Despite the fact that vitamin E acetate was found in a miraculous 94% of bronchoalveolar lavage fluids of EVALI patients, that no putative contaminant has ever been found in a non-tainted nicotine-containing e-cigarette, that the outbreak subsided quickly after illicit drug makers removed vitamin E acetate from THC oils, and that not a single EVALI case was ever demonstrated to be attributable to a store-bought (i.e., legal) electronic cigarette, the AHA continues to cloud the public's mind about the outbreak, leaving open the hysterical claim that legal e-cigarettes may cause devastating and deadly lung disease.

Perhaps more troubling, the AHA fails to make any recommendation to educate youth about the dangers of using THC vaping products, to educate youths so that they understand that vaping THC does have potentially deadly risks, or to run any public education campaign to publicize the widely recognized conclusion of the FDA that EVALI was caused specifically by vitamin E acetate oil that was added as a thickening agent to THC black-market vaping products.

Instead, by continuing to obscure the connection between THC vaping and EVALI, the AHA suggests that EVALI may be caused by legal, store-bought, nicotine-containing e-cigarettes. This undermines the important public health message that youths need: do not vape black market THC vapes off the street (or from any source). Why is it that an organization that is supposedly committed to reducing heart and lung disease would refuse to warn youth about the dangers of vaping THC products? The only apparent explanation is that this would undermine the public hysteria created by the AHA and other groups about the links between e-cigarettes and severe lung disease.

In addition to its difficulty acknowledging the truth about the lack of evidence that legal e-cigarettes pose any risk of severe, life-threatening, acute lung injury, the AHA continues to repeat other hysterical claims, such as that e-cigarettes can cause popcorn lung. This despite the absence of any cases of bronchiolitis obliterans having been reported in any e-cigarette user, not to mention the lack of evidence that popcorn lung is a problem in actual, real cigarette smokers.

The Rest of the Story

The real clincher comes near the end of the article, when - after scaring the public about all the severe, acute and chronic lung diseases that can supposedly be caused by e-cigarettes, the AHA finally tells the truth, acknowledging that the actual science precludes them from validly going beyond the weak statement that: "claims that ENDS products present absolutely no health risks are false according to the limited, but growing, evidence available." 

So the rest of the story is that the best the AHA can muster up based on solid science is that e-cigarettes are not completely harmless! I could have told you that in 2007 when they were first introduced to the U.S. market and only a handful of safety studies had been conducted. 

So now, 17 years later and after millions of dollars have been spent trying to tie e-cigarette use to every possible adverse effect under the sun, the most that the AHA can say is that based on the limited evidence available, we can conclude that e-cigarettes are not 100% safe! 

The subterfuge here is so blatant and the contrast between the science-based statements and hysteria-based statements so vivid that one has to question the intent of the organization. Is it truly trying to save the lives of adolescents who are at the greatest risk, or is it trying to drum up as much possible hysteria about e-cigarettes in the minds of the public? 

I'll suggest one thing: if the true aim is to try to save the lives of adolescents who are at the greatest risk, any further confusion of the public about the fact that EVALI was due to illegal, black market, THC vapes is irresponsible. This generation of youth needs to be warned about the risks of vaping black market products they obtain from friends or off the street, especially those which contain THC. Hiding this message only puts them at the greatest risk of harm from vaping products.

Tuesday, March 21, 2023

Idaho Public Television and State Health Officials Lie to the Public by Telling them Smoking is Not More Harmful than Vaping

In a public education campaign entitled "Do You Know Vape?" Idaho Public Television in collaboration with the state health districts is informing the public that: "Vaping is not safer than cigarette smoking."

The campaign is also making several other alarming claims, including that:

  • third-hand aerosol from vaping (i.e., particles that stick to surfaces) can cause "asthma, respiratory illness, increased risk of disease, headaches and increased risk of cancer"; and

The Rest of the Story

Rather than calling this a public "education" campaign, Idaho Public Television should more accurately call this a public "miseducation" campaign.

First, it is simply not true that vaping is no safer than smoking. There are a multitude of studies showing that vaping is much safer than smoking. I won't repeat all the evidence here but it can be found throughout my blog. Even scientists who are profoundly anti-vaping admit that vaping is much safer than smoking. 

Imagine if the tobacco industry made the same statement, except changing the syntax to read: "Cigarette smoking is no more harmful than vaping." According to the Idaho health officials, that would be a perfectly accurate statement for Big Tobacco to make. It's a wonder that the cigarette companies haven't truthfully told their customers and potential customers that: "According to health officials in Idaho, cigarette smoking poses no more health risks than just vaping, which does not contain any tobacco or involve combustion and the production of smoke." That would be a truthful statement.

Second, there is no clinical evidence that vaping causes brain, bone, or lung injury to young people. It is true that vaping THC, if it is contaminated with vitamin E acetate, can cause severe lung injury, but it is clearly the message given by this statement that e-cigarette use can cause lung injury. While it is true that in animal models, nicotine exposure can inhibit brain development, I am not aware of any clinical evidence that vaping causes brain injury among adolescents. And while it is true that in a Petri dish, e-cigarette aerosol may inhibit bone healing, I am aware of no clinical evidence that vaping causes bone injury in young people.

Third, there is absolutely no evidence that third-hand exposure to vaping aerosol causes any health effects, much less cancer.

Fourth, there is no evidence that vaping causes lung cancer.

It is a great disservice to the protection of the public's health to put out this type of misinformation. What this does is to discourage adult smokers from quitting by switching to e-cigarettes. After all, if smoking is no more dangerous than vaping, then why bother switching? You might as well stick with the real thing. This misinformation also encourages ex-smokers who have quit smoking (by switching to vaping) to return to cigarette smoking. Why bother taking the risk of getting scary diseases like popcorn lung when you can just go back to smoking and not have to worry about it? No anti-smoking group has ever put out a warning about smoking causing popcorn lung!

My own research has demonstrated that the hysterical misinformation that aims to scare the public into thinking that vaping is no safer than smoking has caused demonstrable damage to the public's health by resulting in an increase in cigarette consumption. In other words, this is harmful not only because it violates the public health code of ethics (lying is against the public health code of ethics) but because it is actually killing people.

Thursday, February 23, 2023

ISFAR Criticizes New Alcohol Guidance Issued by Canadian Centre on Substance Use and Addiction But Fails to Reveal Its Conflicts of Interest with Big Alcohol

Earlier this year, the Canadian Centre on Substance Use and Addiction released a new guidance on alcohol use. The guidance was notable for concluding that there is a dose-response relationship between the amount of alcohol one consumes and one's risk of disease or injury and therefore, greater amounts of alcohol consumption are associated with poorer health outcomes. In particular, the guidance concluded that drinking no alcohol is safer than drinking a low or moderate amount of alcohol.

The International Scientific Forum on Alcohol Research (ISFAR) has just published a stinging critique of the new guidance. The critique essentially trashes the guidance and accuses the authors of severe bias. For example, in the critique, Forum member R. Curtis Ellison stated: “I am appalled by the conclusions of the authors of this paper.  They present a pseudo-scientific amalgamation of selected studies of low scientific validity that fit their preconceived notions and ignore many high-quality studies whose results may not support their own views”. 

The Rest of the Story

The truth is that it is ISFAR that is severely biased, not the authors of the new guidance. But much worse than that, ISFAR is plagued by severe financial conflicts of interest with Big Alcohol. And even worse than that, ISFAR fails to disclose these severe conflicts of interest in its critique. They are therefore not apparent to readers or reporters, unless they go digging through the "fine print" on the website. Furthermore, many of the Forum members have conflicts of interest with Big Alcohol, and those conflicts are not revealed on the web site, not even on the page with their biographies.

For starters, ISFAR as an organization has a history of alcohol industry funding. ISFAR used to be affiliated with the Institute on Lifestyle & Health at the Boston University School of Medicine, directed by Dr. Ellison. This institute was financially supported by the alcohol industry: "Since its establishment, the Institute at Boston University has been funded by unrestricted, educational donations from more than 100 organizations, including companies in the alcoholic beverage industry and associations of grape growers, wine growers and wineries." This funding by alcohol companies apparently continued at least until 2014. In that year, Dr. Ellison admitted that: "the Institute now receives some support from the beverage industry for assistance in the development of critiques (assimilating the views of its 41 Forum members) and operating the website."

Secondly, many of the ISFAR forum members have financial conflicts of interest because they either work for the alcohol industry or have received funding from the industry. For example:

R. Curtis Ellison: As discussed above, in the past Dr. Ellison has received funding from the alcohol industry. As explained in a 2014 article in the journal Addiction: "The co-director of ISFAR, Dr R. Curtis Ellison, receives unrestricted educational donations from the industry through the Institute on Lifestyle and Health, Boston University School of Medicine, which he directs 8, and the Institute receives about 10% of its funding from the alcohol industry 9-11. For example, in 2005, it received a $50 000 grant from the Brown–Forman Corporation, a producer of wine and spirit brands, and $25 000 from the Wine Group, Inc. 12. ISFAR also worked with ICAP to organize a Symposium on Moderate Alcohol Consumption. ISFAR's other co-director serves as the Executive Director of AIM, which receives funding from the alcohol industry via a number of different mechanisms such as subscriptions and project grants 8."

Henk Hendriks: Dr. Hendriks has received funding from the alcohol industry for his work. In a recent paper, it was disclosed that: "This work was supported by an unconditional grant from the Alcohol Task Force of the European branch of the International Life Sciences Institute (ILSI Europe). Industry members of this task force are Allied Domecq, Brasseries Kronenbourg, Diageo, Heineken, and Moët et Chandon." This severe conflict of interest is not revealed in the critique, nor is it disclosed in Dr. Hendriks' biography on the ISFAR site.

Creina Stockley: Dr. Stockley is highly conflicted because she used to work for the alcohol industry. Specifically, she was with the Australian Wine Research Institute, which is the wine industry's own research institute. Although her biography mentions that she worked at the Institute until 2018, it does not reveal that the Institute is part of the alcohol industry.

Luc Djousse: Dr. Djousse's biography fails to reveal that he has received funding from the alcohol industry - specifically, the Alcoholic Beverage Medical Research Foundation.

Ramon Estruth: Dr. Estruth's biography states that he is a member of the Advisory Board for "ERAB." The reader is not told what ERAB stands for, hiding from the public the fact that ERAB is "supported by The Brewers of Europe, the voice of the brewing industry in Europe, whose members are the national brewing trade associations, representing more than 90% of European beer production."

Lynn Gretkowski: Dr. Gretkowski's biography fails to disclose that in the past, she has apparently received alcohol funding.

Arthur Klatksy: Dr. Klatsky's biography fails to disclose that in the past, he has apparently received alcohol funding.

Fulvio Mattivi: Dr. Mattivi's biography fails to disclose that he has received alcohol industry research funding.

Erik Skovenborg: Dr. Skovenborg's biography fails to disclose that he was on the Board of ERAB, which is funded by the alcohol industry.

Pierre-Louis Teissedre: Dr. Teissedre's biography fails to disclose that his research group received alcohol industry funding.

Andrew Waterhouse
: Dr. Waterhouse's biography hides the fact that he has received alcohol industry research funding.

The rest of the story is that ISFAR is little more than an alcohol industry front group that attempts to portray itself as a neutral and objective body, but which in fact has a long history of having received alcohol industry funding and which includes numerous members who have financial conflicts of interest with the alcohol industry. Furthermore, ISFAR is hiding these conflicts of interest from the public and from reporters because they are not disclosed, or not readily disclosed on the website. 

Scientifically, ISFAR doesn't have a foot to stand on either.

One major basis for the Centre's conclusions is that alcohol is a carcinogen and for at least several types of cancer, there is no threshold for the increased risk associated with alcohol consumption. According to the report:

"Cancer is the leading cause of death in Canada. However, the fact that alcohol is a carcinogen that can cause at least seven types of cancer is often unknown or overlooked. The most recent available data show that the use of alcohol causes nearly 7,000 cases of cancer deaths each year in Canada, with most cases being breast or colon cancer, followed by cancers of the rectum, mouth and throat, liver, esophagus and larynx. According to the Canadian Cancer Society, drinking less alcohol is among the top 10 behaviours to reduce cancer risk."

As there is no threshold of alcohol consumption for increased risk of at least three types of cancer, alcohol use definitively increases cancer risk among anyone who consumes it, even at low levels. Thus, it is scientifically sound to argue that drinking alcohol - even at low levels - presents greater health risks than not drinking any alcohol.

But regardless of the clarity of the science, the story here is a continuing attempt on the part of ISFAR to deceive the public, hiding its conflicts of interest with Big Alcohol, all in an effort to trash objective science and promote the interests of alcohol companies.