MD Anderson Cancer Center lies about and e-cigarettes and other tobacco products

by Elaine Keller

In a press release dated November 7, 2013, the University of Texas MD Anderson Cancer Center purported to debunk myths about tobacco. However, the end result was to perpetuate some myths and to introduce a few new ones.

The first heading is Tobacco Myth #1: Almost no one smokes any more. Lewis Foxhall, M.D., vice president for health policy at MD Anderson makes a good point that although the prevalence rate has been reduced from 42% of adults in 1964 to 19% of adults in 2011, the number of adults who smoke is still too high.

The details tell a more interesting story, though.  Most of that decrease happened a long time ago, and the number of smokers hovered around 46 million from 1990 through 2009, with the small reductions in the percentage of the population who smokes matched by increases in the size of the population.  It turns out that the decrease in the percentage roughly matched the increase in the popularity of smokeless tobacco as a substitute for many years, though it was difficult to conclude with confidence that THR was responsible for the progress. This changed when use of e-cigarettes began rising, and the number of adult smokers began dropping in 2010 (to 45.3 million) and continued into 2011 (to 43.8 million). (Source)

Continuing under the first heading, long-time ANTZ Ellen R. Gritz proceeds to perpetuate the myth that “the exorbitant and seemingly unlimited advertising dollars spent by tobacco companies” is the driving force behind youth initiation of smoking.  The obviously-false premise that no one actually likes to use tobacco, forces the ANTZ to concoct the tired myth that advertising must exert some magical power over people.

The basic claim is silly on its face, and the details make it worse.  Tobacco advertising is one of the most highly regulated forms of marketing. Cigarette ads were banned from television on April 1, 1970, which was a huge gift to the tobacco companies, who could save the cost of advertising without losing customers to their rivals who were also forbidden from spending much.  It is not clear that total sales were reduced much at all.  But having a large enough advertising budget became pretty easy, since without buying television ads, but far the most expensive advertising, and later not being able to buy many other types of ads, there was not all that much to spend on.

And where are kids seeing these ads?  According to Ad Age Media News, R.J. Reynolds states that “the company will only advertise in magazines where at least 85% of readers are 18 and older when data are available on readers older than 12. For magazines that offer only data on readers 18 and older, the company buys ads if the median age of the audience is 23 or older. Lorillard, the third largest maker of cigarettes, has similar restrictions on its magazine advertising. The largest tobacco company in the U.S., Philip Morris USA, a subsidiary of Altria, does not advertise tobacco in print, according to spokesperson.” (Source)

The next heading, Tobacco Myth #2: e-Cigarettes, cigars and hookahs are safe alternatives implies that smoking tobacco cigarettes is no more hazardous than using any of the three named alternatives. The press release continues, “Fact: All tobacco products, including e-cigarettes and hookahs, have nicotine. And it’s nicotine’s highly addictive properties that make these products harmful.”

False: Nicotine is not what makes smoking harmful. What makes smoking harmful is the tar (solid particles in the smoke), carbon monoxide, and other chemicals of combustion that cause the lung disease, heart attacks, strokes, and cancers linked to smoking. Nicotine does not cause any of these diseases. In addition, this blog has repeatedly explained the several reasons why the “highly addictive” is also nonsense.

Nicotine is not 100% safe — it poses basically the same risks as caffeine and other mild stimulants. It does cause a temporary increase in heart rate and blood pressure, but it does not cause hypertension. Nicotine is probably harmful to a developing fetus (though the research on the effects of nicotine ex-smoking is limited) and it is claimed to have detrimental effects on the adolescent brain, but the support for this is quite thin.

Cigars and pipes are intended to be smoked without inhaling. Research shows that smoking-caused disease risks are lower by about half among cigar and pipe smokers who don’t inhale than they are among cigarette smokers. E-cigarettes do not produce smoke at all, and as far as we can tell are close to harmless for a non-pregnant adult.  Moreover, nicotine also has beneficial effects. (Source)

Under the same heading, Alexander Prokhorov, director of the Tobacco Outreach Education Program at MD Anderson tells some whoppers. “The tobacco industry comes up with these new products to recruit new, younger smokers, and, they advertise them as less harmful than conventional cigarettes.”

First of all, e-cigarettes were invented (multiple times) as anti-smoking efforts by people outside the tobacco industry, most recently by a Chinese pharmacist  who wanted to quit smoking, but was unable to tolerate nicotine abstinence, even after watching his father die of lung cancer. It is even more absurd to make that claim about cigars and pipes, which predate cigarettes by centuries.

And if Prokhorov does not know that e-cigarette (and cigar and pipe tobacco) companies cannot advertise their products as less harmful than conventional cigarettes, I have to wonder: On what planet has he been living? If an e-cigarette company makes health claims, the FDA can order their products to be removed from the market until after they undergo the lengthy and costly New Drug Approval process. What company would not simply comply with the request to remove the health claims?

Prokhorov’s last statement, “But once a young person gets acquainted with nicotine, it’s more likely he or she will try other tobacco products,” is the classic argument of someone who knows there is nothing wrong with the drug he is attacking. There is no basis for the belief that e-cigarette use leads to smoking conventional cigarettes. The same fear was expressed when the FDA was considering approval of nicotine replacement therapy products. Despite the fact that nicotine patches, gum, and lozenges were not only approved, but became available over the counter, there are no known cases of new nicotine addictions attributed to their use. Researchers looked at the issue as it relates to e-cigarette use and determined that due to the slower elevation of nicotine in the blood stream from e-cigarettes, they are unlikely to hook new users. (Source)

“At this time, it’s far too early to tell whether or not e-cigarettes can be used effectively as a smoking cessation device,” lied Paul Cinciripini, professor and deputy chair of behavioral science and director of the Tobacco Treatment Program at MD Anderson. That will come as surprising news to the hundreds of thousands of smokers who have effectively used e-cigarettes for smoking cessation, many of whom were very interested in quitting but found that other options all failed them.

Under Tobacco Myth #3: Infrequent, social smoking is harmless, David Wetter, Ph.D., chair of health disparities research at MD Anderson states, “If you are a former smoker, data suggests that having just a single puff can send you back to smoking.” If this overblown claim were true, it stands as a great argument for switching to e-cigarettes. Among those who totally switch to e-cigarettes, the desire to take that one puff is low, and indeed, those who use e-cigarettes that do not remind them of smoking (particularly by using non-tobacco flavors) find that when they try that single puff on a cigarettes, it is terribly unappealing.

Now if the anti-nicotine crowd manages to convince a gullible public and captured regulators that all those shelves of yummy-sounding flavors exist for the sole purpose of addicting non-smoking youth to e-cigarettes, such flavors will be banned. In that case, it is possible that former smokers will be more vulnerable to this relapse scenario because they will be stuck with e-liquid that tastes like tobacco and reminds them of smoking.

But the press release saved the biggest whopper for last: Tobacco Myth #4: Smoking outside eliminates the dangers of secondhand smoke. “Even brief secondhand smoke exposure can cause harm.”  First, if they really believed this, they would be pushing hard in favor of e-cigarettes, which do eliminate the dangers of secondhand smoke. But, of course, they know this is not really true. The reduction in air quality from outdoor smoking is far less than the reduction in air quality from being inside, where the concentration of toxins (entirely apart from smoking) is many times as high as it is outside, even if there is a whiff of cigarette smoke in the air.

William Saletan wrote about the topic in a Slate article, having looked at two studies of outdoor smoke exposure recommended by former EPA scientist James Repace as proof of the dangers of outdoor cigarette smoke exposure:  “Again, the data confirm common sense. The more open the space and the farther away you are, the lower your smoke exposure. To get the kind of exposure you’d suffer indoors, you have to stand within two feet of the smoker.  Move seven feet away, and you’re “close to background,” i.e., breathing normal air. I recommend greater distance than that, just to be safe. But you don’t need to ban smoking throughout Central Park.” If people at MD Anderson make a habit of keeping their face within two feet of others when standing outdoors (assuming they are not planning to kiss them), it might be an even more anti-social habit than their habit of lying to people about THR.