Tag Archives: conjunction

Cheryl Healton lies (a lot!) to try to get NYC to restrict ecigs

by Carl V Phillips

This analysis, of this blog post, might seem a little more brutal than usual.  That is because the author, Cheryl Healton (the former head of the leading anti-tobacco organization, American Legacy Foundation — a fact that is omitted in the introduction of her in the blog in question — and now head of the public health program at NYC), knows the truth.  This is not a case of someone who is too innumerate to not know she is lying, or a useful idiot that is being used by the anti-tobacco extremists.  Healton is one of the puppet masters who manipulates her useful idiots (like New York Assemblywoman Linda Rosenthal), which she is doing in this post.  Notice in particular the many times that she lies by using literally true but highly misleading statements, the mark of someone who knows she is lying but wants to be able to pretend otherwise.

The post appears in the blog of the “NYC Coalition for a Smoke-Free City”, an obviously misnamed group since they are campaigning not against smoke, but against e-cigarette use.  The thesis is that NYC should go ahead with its proposal to prohibit e-cigarette use anywhere that smoking is prohibited.  It is remarkable how close Healton comes to lying in every single sentence.  The first few about the fact that NYC is about to act on this are true, but most everything that follows is a lie:

Who is the e-cigarette industry?  Increasingly the e-cigarette industry is owned by the tobacco industry, an industry that would not be permitted to exist were it invented tomorrow because it would violate the consumer protection laws of all states and virtually every country in the world.

As I have pointed out, this “would not be allowed to exist” claim is at best pure speculation, and probably wrong.  But apart from that, it refers to a product (cigarettes), not an industry.  If the industry came into being right now selling low-risk products like smokeless tobacco, e-cigarettes, and NRT (all of which are sold by “the tobacco industry”), it would be allowed to exist.  But, of course, this soup of words is not meant to analyze the actual claim, but to lie about e-cigarettes, suggesting they are some industry plot.  In case the innuendo is lost on the reader, she goes on to lie,

For this reason, a healthy degree of skepticism about the industry’s ultimate goal in buying up e-cigarette manufacturers and creating more “efficient” e-cigarettes should prevail as policy makers establish regulations governing them. It is quite possible that the net effect of e-cigarettes will be to induce greater youth initiation of smoking and reduce the adult cessation rate, but the jury is still out.

I cannot imagine that Healton is stupid enough to actually believe that.  It is impossible to come up with a story to explain why the existence of e-cigarettes (let alone the acquisition of a few companies that she led into that with) could cause smoking at all, let alone to cause a net increase in smoking initiation.  E-cigarettes, like any popular low-risk alternative, will replace smoking initiation, not cause it.

Both youth and adult smoking rates are at their lowest levels in decades, so much is a stake for the health of the public.

Setting aside the fact that the “so” is a non sequitur, is what she is saying is that having almost 20% of the population smoking is such a success that harm reduction should be avoided?  It appears so.

There is also much at stake for the tobacco industry as it seeks to apply its considerable marketing acumen and seemingly endless resources to maximize profit by increasing the number who start smoking by enticing youth worldwide to smoke and by trying to retain current smokers.

Complaining about “endless resources” is pretty funny coming from someone who is at the apex of the billions-per-year tobacco control industry.  But the real question is what this passage has to do with e-cigarettes at all, let alone restricting where you can use them.  It is typical tobacco control misdirection:  “Cigarette manufacturers profit from more people smoking and remaining smokers, and therefore we should restrict where people can use e-cigarettes.”  Huh??!

Who might be hurt by e-cigarettes?  The tobacco products the industry has historically manufactured and promoted as “reduced harm” are not benign products created to meet the broad range of consumer preferences in the United States, rather they are deadly products that when used as directed kill over 400,000 Americans each year and are predicted by the World Health Organization to kill a billion people worldwide this century, 10 fold more than they killed in the 20th century. To put the scope of the current tobacco-related epidemic in perspective, in a few years, global lung cancer deaths will surpass AIDS deaths as the steady march of tobacco industry marketing continues to engulf the world’s poorest nations.

Again, huh??!  Does anyone see any connection between that question and what follows?  (Yes, I realize that the reader might now be questioning my assertion that Healton is too smart to not know she is lying.)  Her allusion to historical products is the usual tobacco control canard about the introduction of “light” cigarettes four decades ago, products where there was no evidence to suggest they would be lower risk.  And yet they were actively endorsed by the public health community, not just the manufacturers.

However, a mistake by everyone a couple of generations ago about what might be lower risk tells us nothing about the present world of products that are known to be lower risk.  It is an utterly absurd and blatant lie to suggest otherwise.

None of what she says in this paragraph is true about the actual reduced harm products that have been introduced by the tobacco industry and by others.  Smokeless tobacco, e-cigarettes, and other low-risk products do not cause the harms she is citing; cigarettes do.  (Well, cigarettes cause and will cause a lot of harm, though not as much as she claims.  But that is another story).  She seems to be trying to invoke the conjunction lie, that cigarettes plus low-risk alternatives do that much harm (which implies the harm is shared, even though it is basically all caused by cigarettes), but she screws up doing even that.  She actually is claiming that the low-risk products alone cause all the harm from smoking.

Nicotine addiction is in and of itself a gateway to tobacco product use because once addicted many will broaden the products they use and included among these will be the most dangerous products like cigars, cigarettes and hookah.

It is true that people who like to use one tobacco/nicotine product often try other products.  But what she is trying to imply (carefully avoiding actually saying it) is that using e-cigarettes will cause people who would not have otherwise smoked to do so.  There is no reason to believe this would be the case, and certainly no evidence of it occurring.

And it is worth pausing to remember that the title of this post says that NYC should include e-cigarettes in its smoking place restrictions.  I have skipped a few sentences but have not left out anything that addresses that.  There has been nothing yet.  Even if the previous quote were not a lie, it would still only be an argument against letting kids use e-cigarettes, not about forbidding adults from using them at their desks or in bars.

Most tobacco-related deaths are the culmination of substantial suffering and societal cost from heart disease, emphysema or various cancers and are the direct result of nicotine addiction.  Moreover, nicotine addiction is considered by many scientists as the most intractable of all addictions as measured by the percent of ever users who become addicted and the percent who remain addicted until death. Half of lifelong smokers lose their lives to tobacco addiction and among these people nearly half die before retirement age.

A pretty good argument in favor of encouraging e-cigarette use.  The bit about “most intractable” is nonsense, of course.  The reason users have more incentive to quit, say, meth than to quit smoking is the high level of short-term damage it is doing them.  And the “half” is a made-up number that is higher than what the evidence suggests.  Most important is that claims about the “addictiveness” of smoking tells us little about e-cigarettes, given the evidence that e-cigarettes are much easier to quit.

And, once again, this has nothing to do with whether there should be a place ban on e-cigarettes.

E-cigarettes are a complex product and their availability and the regulatory framework for governing them may have different implications and considerations for youth non-smokers compared to adult smokers. E-cigarette policy could produce sharply differing results by population sub-group.  Data demonstrate that a significant swath of adolescents already are using e-cigarettes. Time will soon tell whether e-cigarettes function as one more point of entry to cigarette, cigar and hookah consumption among those using e-cigarettes initially. One thing is clear however, since cessation efforts have thus far not worked with teens, e-cigarettes will likely not do anything good for kids and may well entice many to start smoking in view of the broad array of sweet, candy flavors and slick e-cigarette marketing already blanketing the internet, mall kiosks, TV and radio, which have to date eluded regulation.

Blatant lies and clueless nonsense.  (Ok, I will admit I am starting to doubt my previous assertion that Healton really understands what she is saying.)  Skipping past the distractions that the first few sentences comprise, we have the lie that many adolescents are using e-cigarettes, a repeat of the lie that there is any reason they would cause smoking, the lie that because other cessation efforts do not work for kids that harm reduction will not work for them (it might be true, but probably is not, and it is nothing more than speculation asserted as fact), and of course the usual canard about marketing.  Once again, the biggest lie here is that this has anything to do with restricting where adults can use e-cigarettes, or anything else about adult use.

Whether e-cigarettes will offer an incremental boost to cessation rates nationally also remains to be seen.

No, it doesn’t.  Close to every e-cigarette user is either a former smoker or a current smoker who has replaced some smoking with e-cigarettes and could be persuaded to complete the transition.  Many of those who quit smoking report that they had not been able to succeed at cessation until they tried e-cigarettes, and only then did they quit.  Therefore e-cigarettes have increased cessation.  This is not really a difficult concept to understand.  (She goes on in that paragraph to lie about what the research shows, but I will stop at debunking her thesis claim.)

This is the epitome of the ANTZ tactic of declaring every negative they can concoct to be a real concern, even if there is zero evidence and even if the evidence clearly shows it is a non-issue, while denying every positive by pretending that the evidence does not exist.

We should also remain open to another highly plausible effect of e-cigarettes-that they will function in the same manner “light” cigarettes did when they were introduced in the 70′s, promoted by the tobacco industry as a step smokers could take to feel safer without actually quitting smoking. As many subsequent studies showed, in fact they were not safer and millions who would have quit had they not been introduced failed to do so costing innumerable lives.

And (setting aside the lies about “light” cigarettes themselves) there is that lie about the situations being similar again.  The obvious difference is that e-cigarette users are “actually quitting smoking”, unlike light cigarette users, and they are using a product that genuinely is low risk.  What does a public health failure of the 1970s have to do with e-cigarettes?  Absolutely nothing.  It is basically the same as saying leeches turned out to be harmful rather than helpful in treating infectious diseases, and therefore we should avoid antibiotics.

Do we really want everyone vaping where they once could smoke?  

Oh, look, she is finally addressing the question she claims to be addressing.

The proposed extension of the SFAA to e-cigarettes, which will be voted on tomorrow, also will reduce the “walking billboard” effect of thousands of New Yorkers once again lighting up in bars, subways, parks, office buildings and restaurants throughout the city. But banning e-cigarettes in some locations solely for this reason is un-American in a country that prides itself on maximizing the freedom of its adult citizens to choose to engage in a range of risky and frisky behaviors. 

Interesting.  It is not a very risky behavior, of course, but it is nice to see that New York is still part of America.

The “billboard” claim is utter nonsense, of course.  How is someone vaping in their office, rather than outside the front door, a billboard?  E-cigarettes could still be restricted on the subway and restaurants could make their own choices about what is best for their patrons and vibe.  The proposed ban would eliminate all discretion, reasonableness and common sense, going beyond a few specific restrictions that some might argue are reasonable and imposing rules that are clearly absurd and harmful.

Take a step back and see what she is doing with all of this.  She is appealing to people who are worried about kids using e-cigarettes and do not like people vaping on the subway, and trying to trick them into supporting a rule that bars cannot choose to allow their patrons to vape.  If she actually cared about kids and subways, she would propose something that affects kids (this rule would not) and would endorse a rule that just applies to the subways (which could probably be done by administrative fiat).  Notice she never once offers any reason why banning vaping in bars, private offices, and many outdoor spaces would do any good for anyone, and indeed tries to hide the fact that this regulation would impose such restrictions.  Classic tobacco control bait-and-switch.

It should be noted, however, that while we in general embrace this ethos, when it comes to public drinking we often do not. We do not embrace wandering down the street drinking a cocktail, hopping into the elevator rum and coke [sic] in hand or whipping out a flask of whiskey on a plane.

Ok, so no vaping on elevators and planes.  I suspect that even most dedicated vapers would not find those to be terribly unreasonable restrictions.  As for walking down that street, the street would be one of the few places vaping was still allowed under the restrictions.  The anti-THR people cannot even keep their own stories straight.

Do we know enough to allow vaping in public spaces?  So what are the real risks of public vaping? Is it as its promoters would like us to believe a benign, reduced harm practice that is at worst a passing fancy?

Um, no.  Its promoters think it is here to stay.  Also, the ban is mostly about private spaces, not public spaces.

Or is it a potentially toxic practice that places those in its immediate vicinity at risk. The answer is we do not completely know yet, although already studies have shown elevated nicotine levels among those exposed to secondhand vaping, and this in and of itself is ominous. Not definitively measured as yet among second hand vapers [sic] are the myriad other toxic substances which are contained in e-cigarettes. 

Cute, huh, that use of “completely” and “definitively”.  Of course we know, from ample evidence, with a very high degree of certainty that the risk to bystanders is zero or utterly trivial.   But we never know anything completely or definitively.  Someone can always use weasel words like that to intentionally trick the reader into thinking she made a statement about what we really know, rather than merely a statement about the fact that there is never proof or complete information in the real world.

And if anyone is aware of any study that shows elevated nicotine levels from people exposed to “secondhand vapor”, I would be quite interested in hearing about it.

Under these circumstances, the prudent course is to extend the SFAA to encompass e-cigarettes until, if ever, sufficient evidence exists demonstrating their safety.

Right.  And what might that be?  Oh, you say, no evidence would ever be sufficient for that.  Thought so.

And why exactly would this be prudent?  I do not think that word means what she thinks that word means.  Is it prudent to restrict a very personal freedom when there appears to be no reason to do so, just because such a reason might be found later?  (Sounds like an argument for banning, say, the building of mosques in America — there are many who would make the same “we just don’t know if this will hurt the children” arguments about that.)  Is it prudent to ensure that cigarettes remain as attractive as possible as compared to low-risk alternatives?

The only conceivable downside of not extending the SFAA to e-cigarette use is the loss of any incremental harm reduction for smokers associated with being permitted to smoke e-cigarettes in locations where smoking is now banned.

TrANTZlation:  The harm it would inflict on those not able to vape at their desk, in bars, etc. is of absolutely no consequence.  We are tobacco control.  We don’t actually care if tobacco users suffer.  In fact, we prefer it.

And, of course, making e-cigarette use less attractive creates the public health harm of encouraging smokers to keep smoking.

It is highly unlikely that such a benefit, if it in fact exists, would outweigh the harms to youth, to non-smokers exposed to vaping nicotine laden vapors and potentially other toxins, and to recovering smokers who now stay quit in part because smoking has become less ubiquitous than it was 50 years ago when the Surgeon General released the first report on Smoking and Health.

Huh?  It is highly unlikely?  Care to quantify?  I would love to hear about the harms to youth from people vaping at their desks.  What harms are caused by (barely) “nicotine laden vapors”?  What possible impact is there on “recovering smokers”?

Sadly e-cigarettes may lead to four negative outcomes: the initiation of more youth to nicotine dependence and subsequent conventional smoking; the use of e-cigarettes by current cigarette smokers who would otherwise have quit but instead use both conventional cigarettes and e-cigarettes in combination and therefore delay quitting or never quit and; the relapse to smoking by those who have already quit, first to smoking “benign” e-cigarettes and then to conventional cigarettes; and the exposure of people to e-cigarettes’ emissions unknown risks.

And how does all of this other than the last bit (a lie that has already been addressed) relate to the question at hand?

Who loses, if anyone, by extending the SFAA to e-cigarette use? Virtually no one loses. Vapers can still smoke everywhere current smokers now do. Let’s do what NYC has become known for and enact a policy that saves lives, not costs them.

Just in case the above trANTZlated passage was not clear enough, here she comes right out and says that the hardships suffered by vapers as a result of the rule do not matter.   Smoking place restrictions are designed to make smokers less happy — tobacco control advocates generally admit that these days — so obviously imposing the same restrictions on vapers will make them less happy too.  I wonder if it is a Freudian slip when she says that “vapers can still smoke” — because that is exactly what will happen:  Some would-be vapers, upon having to go out to the smoking areas anyway, will indeed smoke.  As a result, some of them will die from smoking and their blood will be on the hands of liars like Healton.

CDC lies about kids using e-cigarettes

by Carl V Phillips

In a story that is practically a carbon copy of the lies from the Florida Department of Health that I discussed a few days ago, the CDC is lying to the public about statistics on school-aged e-cigarette use.  But this time, the lies are officially coming from our nation’s government, not some second-rate local department.  (Note, by calling them “second-rate” I am giving Florida the benefit of the doubt: in my experience, state health departments start at second-rate and go down from there.)

The CDC results were published in the agency’s newsletter/blog, Morbidity and Mortality Weekly Report and the lies were blasted out to the public via this press release.  Any American who is still shocked to find that their government is lying to them is an idiot (I doubt I will insult even a single one of my readers by saying that), and yet many reporters tend to blindly transcribe what CDC says rather than, say, bothering to read beyond the headline to see that it is clear based on only what CDC themselves reported in their press release that the claims are lies.

The headline of the press release manages to fit in one lie and two misleading claims, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012″.  The biggest lie is that they report nothing about use.  All the reported statistics are about about trying the products, perhaps only once, which is obviously not the same thing (and CDC knows this).  Some statistics reported are for “ever having tried” and the others are “tried at least once in the last 30 days”.  They misidentify anyone who has tried in the last month as a current user, which is a rather blatant lie.  (Of course, some of those who tried recently may well actually be users, but there is nothing in the report that lets us conclude that even one single student is actually an e-cigarette user.)

The second sneaky lie was listing “middle school” ahead of “high school” even though the results for the former are trivial.  But it is scarier to imply that this is mostly about 12-year-olds and not 18-year-old high school students, isn’t it?

The third lie in the headline requires a bit of numeracy and data that is right there in the press release.  (This opens the question of whether our nation’s government’s top health officials are themselves innumerate.)  The number that more than doubled is for “ever tried”.  When your study population is 3/4 the same people from one observation to the next (as it the case with students who are in high school in 2012 compared to those in 2011), and the phenomenon you are studying is new enough that most of the trying is recent (as with e-cigarettes or whatever the latest offering McDonalds or Pepsico has added to their menu), then of course you are going to see a sharp increase in the number who have ever tried it.  It is almost impossible to see a decrease, and moreover, if the exact same number tried for the first time each year, that would come close to doubling the number who had ever tried.

You are with me there, right?  An 11th grader, in 2011, who tried an e-cigarette in 10th grade is still part of the “ever tried” group when he is in 12th grade in 2012.  If one of his classmates tried one for the first time in 11th grade, he joins his friend in the “ever tried” group in 2012.  Though the rate of trying was the same for this two-person population each year, the “ever tried” statistic DOUBLED!!!!  Scream it from the rooftops!

Did I mention that CDC are lying to people?

CDC apparently did not actually measure e-cigarette use.  They could have, of course.  Presumably they knew that the results would contradict the alarmist prohibitionist message they wanted to deliver, and so avoided the truth intentionally.  Actual use is clearly trivial.  If you actually wade though their breathless rhetoric to find information, you learn that 2.8% of high school students reporting trying an e-cigarette in the last month.  How many are actually using them?  If it is even as high as 1/10th of that, we are talking 0.3%.  But, hey, if you report something like that people will not be worried.  And worrying people is the goal.  So stick with “doubled!!!!!”.

Identifying the other important lies requires a bit of knowledge rather just the level of math that we can hope every subject of the studies learned many years ago.  (Am I being too optimistic about the quality of our schools?  Perhaps.  But that is off-topic.)  It turns out that almost all the e-cigarette triers had also tried cigarettes and indeed that almost 80% of them were “current smokers” (which, given CDC’s misuse of terms may be an overstatement of how much they actually smoke, though we do know that — unlike with e-cigarette trying (“hey, what is that? can I try a puff?”) — a large portion of those who puff a cigarette in a month are genuinely current smokers).  So this means that it is quite conceivable that most of those kids who tried an e-cigarette were pursuing THR!  That is, they consider themselves to be hooked on smoking and are seeking a low-risk alternative.  But we can’t have that, can we?

A comparatively minor point in the context of their more blatant lies, but still quite poisonous, is CDC converting their statistics (via the estimated size of the cohort they are studying) to “1.78 million” total students having tried e-cigarettes.  This level of precision implies that they have their result estimated so precisely that they know it to 1 part in 1000.  But their trying statistics, even if about as right as they could possibly be have precision in the range of maybe +/-20% at best.  (That is the best case scenario — when someone is lying about their statistics, always be concerned that they are lying about the data quality too.)  If they had said “almost 2 million” that would be reasonable, but even rounding to 1.8 million would imply more precision than they actually have, let alone 1.78.

Another comparatively minor but not trivial point is that quite a few high school students are of legal age to use tobacco products, and so it would be useful to break out the statistics for under-18 (which, of course, would be lower than those that include the 18- and even 19-year-olds).

It is also worth noting something that we know but apparently CDC does not:  Not all e-cigarettes even have nicotine in them.  How many of the kids tried e-cigarettes with nicotine?  No one knows.

Of course, the biggest lie is the “gateway” lie.  You know that when prohibitionists start making claims about a gateway that they have given up on pretending that a behavior is a problem in itself.  So they have to make up some reason for prohibiting it, so they claim that it leads to something that is a problem.  There is never any evidence to support those claims, about anything, as far as I have ever observed.  That is certainly the case here.  And yet the CDC makes claims that their data show that we should be worried about gateway effects even though there is no actual hint of that.

You can tell someone is starting with a conclusion and fishing for claims to support it when they contradict themselves over it within a few thousand words.  They claim both that the statistics showing almost all e-cigarette triers are smokers (or have tried cigarettes) suggests that there is a worry of a gateway and also that the statistics showing that a few (1/5th) of the (very few) younger kids who tried e-cigarettes had not tried cigarettes means that there might be a gateway.  So, guys, what would the evidence need to show to refute the claim there is a gateway?  The answer, of course, is that whatever the evidence shows, it supports the claim — this is religion, not science.

New York City lawmakers lie about e-cigarettes (in multiple ways)

by Carl V. Phillips

NYC is considering various restrictions on tobacco products, including display bans for low-risk products and raising the age for purchase to 21.  As background, see the CASAA call to action on this (and take action if you are so inclined!).

While it is not the type of lie I normally cover here, it is worth calling out the public officials who assured constituents the new proposal was not supposed to cover e-cigarettes (the inclusion was due to subtle wording); they strongly implied that this would be fixed.  Instead, the Royal Principality of Bloomberg changed the legislation to explicitly include e-cigarettes, and moreover to explicitly lie about them.

Of course, sweeping e-cigarettes into anti-smoking laws (regardless of what you might think about the validity of anti-smoking laws) is exactly the same as sweeping in smokeless tobacco, which they always intended to do.  But lies and inexcusable restrictions and punitive taxes on smokeless tobacco have become so commonplace that people tend to forget this.  Indeed, the historical acquiescence to such anti-THR measures pretty much make it inevitable that similar restrictions will be proposed for e-cigarettes.

The proposed legislation begins with the usual anti-THR conjunction lie, which recites statistics about the effects of smoking and attributes them to “tobacco use”.  No need to point out why that is a lie about the low-risk tobacco products (follow the link if you want explication).  They throw in various lies about how restrictions like this will change behavior as well as some, at best, dubious statistics about historical trends.

In discussing e-cigarettes, they actually lead off with the best argument against their restrictions,

Electronic cigarettes have emerged as an alternative to cigarettes.

Apparently they are so clueless that they do not realize that this single sentence definitively condemns their proposal, given that all of their stated goals are about reducing smoking and its health impacts.

But then they start lying:

Electronic cigarette marketing is often designed to deter smokers from quitting and to attract youth.

They do not cite a shred of evidence to support this, of course, because there is not any.  E-cigarette marketing is, of course, designed to encourage smokers to quit, as should be obvious to anyone with half a brain.  (To a lesser extent it also includes efforts to get e-cigarette users to switch brands, but it is remarkable how minimal that is compared to its focus on encouraging smokers to quit.)  Why exactly would marketing be designed to encourage people to use a competing product?  As for attracting youth, that would be a rather dumb thing to waste marketing budget on, given the very limited sales potential and the fact that young adults are quite resistant to traditional marketing.

Of course, to the ANTZ, the observation “this blog is written in English and many children can read English” means that I am writing for chiiiiiildren.  Their claims about children are always based on such tenuous connections, and therefore are  all lies.  (Perhaps 1% of the time their claims have some validity, but if you lie about something 99% of the time, you cannot expect to believed, ever.)

They do produce one shred of evidence for their next claim,

electronic cigarette use is increasing among youth and young adults

(Aside: notice the changing use of the word “youth” to sometimes collect statistics about young adults and sometimes to imply “chiiiiiiildren”.)  They mention one study in support of this.  Not that they need to.  Approximately no one used e-cigarettes five years ago and now a fair number of people do.  So of course use is increasing in every demographic — that does not mean it is substantial.  They also overlook the fact that this is a good thing, since (as they noted themselves) it is basically always in place of smoking.  Oh, also the study they cite is about high school students having tried e-cigarettes (which of course is increasing more rapidly than use), not about children actually using them.

To the consternation of some of my colleagues, putting on my researcher hat, I have to say that if NYC actually does this (which we are fighting hard against, of course), it could be quite interesting.  NYC is probably the second best (after Canada) source of data about tobacco product consumers’ inclination to turn to black markets in the face of extremist laws.  That tells us a lot about preferences, which we modelers love.  It is also a great case study in comparison to London, a generally similar city where e-cigarette use has really taken off.  (Notwithstanding the threatened creeping ban of 2016, I still hold by belief that London will be the definitive proof of concept for e-cigarette-based THR.)  If NYC imposes strict limits on e-cigarettes as compared to London, the contrasts will be even more stunning.

Need I say: don’t read too much into the previous paragraph.  I hope you might find it interesting, but CASAA is obviously fighting this proposal, and obviously would never throw New Yorkers under the bus for the sake of data (maaaybe Bostonians, but definitely not New Yorkers).  We do not want to throw the smokeless tobacco users under the bus either (and neither should those of you who are purely-vaping activists — see above), but we are going to lose on that one.  We might still win on e-cigarettes though, so step up on the CTA if you are inclined to engage in politics.

Updates: FDA, ACS, and CASAA

by Carl V Phillips

A few days ago, we reported about FDA CTP’s moves toward reducing the anti-THR lies in their public statements and otherwise shifting toward supporting the public interest.  I missed an important change that had appeared a week before, the elimination of one of the most blatant anti-THR lies to appear in FDA materials, one that stated an out-and-out falsehood that could not be cloaked in terms of being technically true like the “tobacco” conjunction lie emphasized in the previous post.

(The conjunction lie is to create a list that includes one bad exposure and implicitly blame everything on the list.  Example:  “Car and plane crashes are the leading killer of young people in America.”  Of course that toll is approximately 100% from car crashes, so it is a lie because it implies that plane crashes contribute importantly.  Similarly, anytime “tobacco” or some other conjunction of products is blamed for the toll from inhaling smoke, it constitutes the most common anti-THR lie.)

At this page, this older statement:

 To date, no tobacco products have been scientifically proven to reduce risk of tobacco-related disease, improve safety or cause less harm than other tobacco products.

was replaced with this:

To date, no tobacco products have met the requirements that would permit them to make claims of reduced risk or harm to users and nonusers of their regulated tobacco products. These requirements were put in place so that American tobacco consumers are not misled about the harms of tobacco products.

To provide context, this appears on a page title “Health Fraud” — rather ironically, given that the old statement was about as clear a fraud against health that someone could ever perpetuate — which contains information that is really directed at merchants of low-risk tobacco products.  It tells them that they are forbidden from telling anyone that everyone with half a clue knows that those products are much less risky than smoking.  That is obviously bad for public health, but it is true — they are forbidden.  However, this is presented in a child-friendly format that seems to be directed at consumers.  Given the “if you see… contact us” statement at the bottom, it seems that FDA is channeling the Stasi.

But though it seems unlikely they recruited any informants that are not already paid by the tobacco control industry, they did succeed in misleading a lot of consumers.  In fairness, it seems reasonably likely that whoever wrote the first version of this page was trying to communicate the message that was properly clarified in the second version.  But obviously the original author failed to communicate the truth to an unforgivable degree.  (Unforgivable, but not difficult to explain:  Many FDA careerists clearly do not understand the fact that there is a huge difference between “no scientific evidence” and “no FDA approval”, nor do they understand that “FDA approval” is not the same as “proof” of anything.)

Some observers still do not like the new message.  It would certainly be more precise and truthful to say “we have not approved any ‘modified risk tobacco product’ applications” or “we have not agreed to accept any such claim.”  The actor-free version of the statement, as if the institutional author of the web page is not the one making the decision and it is somehow an existential phenomenon, is rather misleading.

Also, attributing the MRTP requirement to a genuine concern about public health seems like rather a stretch, given that it was crafted by a coalition of cigarette manufacturers and anti-tobacco extremists.  But I trust that anyone seeking the truth already knows to pay no attention to “we were doing this to protect Americans” claims, whether about “public health” efforts to tax soda, ban salt, or ban e-cigarettes, or about drone aircraft assassinations, or subsidizing alternative electricity generation, or reading people’s emails; so that is kind of just a throw away.  (Note to readers: If you find yourself having a conversation with someone from another political “tribe” about such points, you should be able to identify something from this list where they agree that the government claims about doing something to protect us are bullshit.  Use that!)

But to circle back, let’s not let the details of the analysis distract from the main point:  FDA replaced a prominent, explicit anti-THR lie with something that is basically accurate.  Kudos.

By contrast, the American Cancer Society continues to damage public health.  As explored here extensively (like back from here), ACS is leading the fight to block state laws that would ban the sales of e-cigarettes to minors.  This seems to be because they want to create a situation where lots of kids are using them as an excuse for restricting adult access to these lifesaving (and cancer-eliminating) products.

Their most recent “victory” came in Oklahoma on Thursday, when such a bill was voted down.  This case is a bit more complicated than the Rhode Island or Arizona cases noted in the previous posts — there was some tinkering with the tax laws built into the bill also.  This bill was originally written by R.J. Reynolds and included provisions that would have given them a competitive advantage over other e-cigarette merchants (which CASAA opposed because we believe diversity in the marketplace is in the best interests of the consumer). CASAA worked closely with the sponsor to remove the provisions that would have favored RJR over its competitors.  (For those who do not know, this is typical — most bills are crafted by stakeholders and other interested parties, not by lawmakers themselves.  Though many merchants do support consumer-friendly bills in this arena, it is CASAA that is actually working in the legislative process to make sure bills are in consumers’ interests.)

Those of us who had the misfortune to watch the floor debate heard the opponents repeatedly identify nothing bad about the bill, but rather just kept repeating that ACS (and the American Lung Association and the American Heart Association) opposed it, so it must be bad.  After all, we should all trust them, right?

Obviously not.  They are liars who are willing to sacrifice children in order to impose harmful restrictions on adults in a free society.  Something really needs to be done about them.

So, to recap, the scoreboard for the week:

Government: removing lies, moving toward real public-interest stakeholder involvement.

Private “public health” charities: blatantly lying, ensuring children’s access to nicotine, trying to create harm in order to impose severe restrictions on the public.

CASAA and other real public health consumer advocates:  Got FDA’s attention and action.  Lost the final vote in Oklahoma, but killed the anti-competitive original version which mattered more in the long run.

Credit where due: FDA

by Carl V Phillips

I’m back.  Sorry for the long absence — for obvious reasons, the blog loses out to paid work, family vacation, and (the only bit that is actually of interest to you) preparing a presentation for and attending the Tobacco Merchants Association meeting last week.  A bit more about TMA in a later post.  Today I want to focus on what was said about and by FDA at that meeting.

First, the good news:  In a presentation at the meeting, the head of TMA, Farrell Delman, pointed out that FDA had changed their website in a few places to make clear that the CDC estimated deaths from smoking are from smoking and not tobacco.  (I did not note which specific pages Farrell showed in his talk, but here (pdf) is one example I just found.)  As regular readers know, blaming “tobacco” or “tobacco products” for the risks from smoking is probably the most pervasive anti-THR lie.  It perpetuates the misperception that smoke-free tobacco/nicotine products create a substantial health risk.

Unfortunately, the change is not universal, but I will choose to embrace Farrell’s optimism for the moment.  We can hope that the remaining instances of the misleading “tobacco” bundling language are either dated info releases that would not be appropriate to change (the government is really not allowed to memory hole past statements) or places where they have just not yet noticed they need to make the change (like here or the sidebar here — hint, hint!).

And, of course, no doubt if you followed those links you noticed various other bits of anti-THR misinformation that still remain.  But any steps in the right direction are good news.  Pervasive myths are not fixed in a day.

Also on the frustrating side was the continued emphasis, as seen in the presentation of David Ashley, the CTP science chief, of the supposed possibility that low-risk products could lead to an increase in total population health risk by attracting new users who avoid smoking because of the risks (my liberal paraphrase of a couple of much less detailed bullet points).  Simple arithmetic shows that is impossible, but FDA has to emphasize it because it is so clearly enshrined in their enabling legislation.  This relates closely to my presentation at TMA, so I will comment more in a post about that (probably at EP-ology, but I will cross-post something here).

Back to the good news:  Mitch Zeller, the new head of the FDA’s tobacco unit (CTP) presented at the meeting and took questions.  So did Ashley.  Kathy Crosby, the new head of communications, had a prominent role in a panel.  The significance of this should not be underestimated.

During the Q&A for Zeller’s presentation, CASAA questioned CTP about the lack of consumer (i.e., the primary stakeholders in all of this) representation in their proceedings.  He invited us to submit a formal request, which we will send today or tomorrow.  It appears certain that this will give us a chance to present the consumer views to CTP in a special meeting.  It is less certain whether we will have a spot on the agenda for future hearings where other stakeholder presentations (industry, etc.) are included, but we are making every effort to ensure that consumers are given a place at the table.  We will keep you posted (and might recruit you to support our request should it seem useful).

In his presentation, Zeller made clear that the top priorities for the CTP currently include the “deeming regulation” that would bring e-cigarettes and some other products under FDA jurisdiction.  (Contrary to what you sometimes read, they are not currently regulated by FDA as a tobacco product, but probably will be.)  Whether this is done in a way that makes e-cigarettes better (i.e., serves the consumers’ interest, as FDA regulation is supposed to do) or in a way that threatens innovation or their very existence (serving the interests of the anti-tobacco extremists, who want to prevent harm reduction) remains to be seen.

Another stated priority is to get through some of the backlog of applications.  Unfortunately this does not matter much for real consumer interests, since as far as we can tell the overwhelming majority of these are just “substantial equivalence” applications by cigarette makers who just want approval for some insignificant change of their products.  It does not appear that there are any “MRTP” applications pending.  (That is the misnamed category that would allow harm reduction claims about a product — it is “modified risk tobacco products”, though the products that really matter are not modifications of existing products, but entire categories that have always been very low risk compared to smoking.  The misnomer itself is an anti-THR lie because it is designed to hide the fact that different categories of products have hugely different risks, though that is not the fault of FDA, but rather of the ANTZ that wrote the legislation that created CTP and their mission.  At least lawmakers changed the ANTZ’s proposed wording that would have completely forbidden any claims comparing low risk products to smoking, an obvious attempt to prevent THR.)  We believe there is at least one MRTP application in the pipeline, though unfortunately it is not for a low-risk product.

And on a less recent note, many of you may recall that FDA rebuffed attempts by the ANTZ at University of California San Francisco to make CTP their own private activist organization by threatening to boycott if stakeholders (in that case, industry) were allowed to even present their views.  (Though, of course, they showed up at the hearing to announce they were not showing up at the hearing.  We cannot expect them to be honest even in their protests, after all.)  CTP did not make any public response to this attempt to subvert the American political system, but they clearly did not give in.

I guess the bottom line is that we are in far from a perfect world, with regard to THR-related regulation, but it looks like a much better world than existed a year ago.

Gutka is not smokeless tobacco

by Carl V Phillips

There is a popular oral dip product in India called gutka.  It was recently banned, in one way or another, across much of India, though it appears that this has had relatively little impact (other than perhaps raising the price to the extremely poor people who are most of the users).  Gutka is more popular in that country than is smoking, and is used by an absolutely enormous number of people.

Gutka, and the somewhat similar paan that is popular in Pakistan, appears to pose a very serious risk for oral cancer and other oral diseases, and perhaps other serious diseases.  The health consequences appear comparable to those from smoking, and might even be worse — in particular because, unlike with smoking, many of the serious effects appear to occur before old age.  (The “appear” caveats I keep repeating reflect the fact that most of the epidemiology about these products is so utterly lousy that precision is impossible — we had better quality information about smoking half a century ago.  But there is enough information that it is difficult to doubt that there are serious and high risks.)

So, gutka and paan are, indeed, nasty.  But what they are not — contrary to the typical portrayal — is tobacco.  Gutka does contain tobacco, and paan sometimes does (but not always), but it is not the first ingredient and may not even be the second.  The first ingredient in gutka is areca nut (also known as betel nut), and other ingredients include catechu (a derivative of the acacia tree), various flavorings, and calcium hydroxide (aka slaked lime, or just lime).  The ingredients in the one packet of it that I have that lists the ingredients (most do not) are “betelnuts, tobacco, catechu, cardamom, lime, menthol, natural & artificial flavors”.

So this is tobacco only in the sense that a Big Mac, fries, and Coke is lean beef, potatoes, and water.  The latter are major components of those products, of course.  But if they were all that was consumed, while it would not exactly be healthy eating, but it would not be all that bad.  But a funny thing happens when you consider everything in the foods (various unhealthy fats, high glycemic carbohydrates, carcinogenic products from cooking, etc.) — the meal becomes rather unhealthy.  This is a nearly perfect analogy to the deadly implications of calling gutka “tobacco”.

Something in gutka is pretty clearly quite unhealthy.  Lime is a good candidate — it is quite caustic on your skin, as you might have experienced, and is even worse for your oral mucosa.  It has fairly obvious and rapid negative effects.  But it might be that holding areca nut or catechu in your mouth for a long time is quite harmful too.  The one thing that we can be pretty sure is not causing most of the harm is tobacco.  Why?  Because it is the one of the ingredients that has been extensively studied, as an oral dip exposure, and has been found to produce minimal risk.

To be precise and careful (quite unlike most of those who write about this topic), it is possible that the interaction of tobacco with the other ingredients causes more harm than the other ingredients would cause if the tobacco were absent.  It is also possible that because of the way this particular tobacco is processed, it causes harms that American and Swedish style smokeless tobacco do not.  (There is a plausible but unsubstantiated hypothesis that the much higher concentrations of nitrosamines in some non-Western and archaic products could make them much more hazardous, though there is no evidence that it would be anywhere close to as bad as gutka is.)  Thus, we cannot conclude that the role of the tobacco is benign, but it is clearly wrong to suggest it is the main source of the problem.

Who suggests that?  Pretty much everyone.  The impetus for me writing this post was running across this newspaper story about how the gutka ban is failing due to the black market, with a headline that refers to it as “chewing tobacco”.  But it is not just bad reporters and casual observers who make the mistake.  The packets of gutka I have all display the mandated statements “tobacco kills” and “tobacco causes cancer” and what I assume are their Hindi equivalents.  I do not know whether current products still have those statements (once you ban something, it is difficult to enforce labeling regulations, after all), but the point is that the government’s official statements describe the product as “tobacco”.  This is probably the fault of the World Health Organization, since India’s policy is pretty much “do whatever WHO tells us to do”, but I actually do not know the story.  (Anyone know?  Please let me know.)

But it gets even worse than that.  The anti-THR liars have made a concerted effort to trick Westerners into believing that the apparent harms from Indian “tobacco” are relevant to Western products.  The classic example of this IARC Monograph 89, from the International Agency for Research on Cancer — a unit of WHO that primary is known for its science-by-committee declarations, and is mistakenly seen to be an authoritative and apolitical research organization.  The authors of that document — including longtime professional anti-THR activists like Stephen Hecht (already represented in this blog), Scott Tomar (who got a passing mention but seems to have disappeared), and Deborah Winn (who will likely make an appearance) — tried to bury the fact in their 626 pages that their conclusion that smokeless “tobacco” causes cancer was basically based just on studies of gutka and paan along with a single old study of an archaic American product.

I realize that this post leaves the reader with many points of curiosity that call for more information.  I will try to circle back to these sometime.  But I will conclude by creating one more:

Why did I say it was deadly to refer to gutka as tobacco?  THR in the West is about replacing smoking with smoke-free alternatives.  But in South Asia, there is a lot of room for something else that could be called THR:  The replacement of gutka and paan with smokeless tobacco (snus).  Western-style smokeless tobacco could be made domestically (and thus be affordable, though perhaps more expensive than the current products — I am not sure) and it would presumably have about the same unmeasurably low risk as snus.  Given that the impact of the local dip products is similar to that from smoking, this has similar potential to Western THR.  But — as with Westerners who think that “tobacco” or nicotine is the problem rather than smoking — this is very unlikely to be pursued so long as everyone thinks that it is the tobacco that is the problem.

“Tobacco” is still not a useful category

posted by Carl V Phillips

After two weeks and many meetings, I have a lot I want to debrief here and at EP-ology.  But right now I face a long flight and accumulated exhaustion, so a simple post to fill the gap — tempting fate by criticizing the US government just before arriving at immigration.

Starting to smoke has immediate effects on oxygen delivery and lung function, and some upper airway effects do not require much accumulated damage.  “Greatly”?  Well that is perhaps a bit strong, but it does not have a precise meaning, so just call it typical advertising hype.

However, smokeless tobacco use has no such immediate effects.  This is obviously true since it is not clear whether it has any serious health effects ever.  This is not to say that a child ought to be free to decide to use any of these products.  But since — as is the message of the original post — “children” (meaning c.17-year-olds, though the word choice is clearly intended to evoke images of 10-year-olds) are using tobacco products, there are numerous benefits from choosing smokeless rather than smoking.  Telling them that they might as well smoke is no better than directing that lie at adults.

In general, any use of the term “tobacco” to refer to an exposure is wrong.  Tobacco is the name of a plant.  It does not describe any particular exposure and indeed, there are several potentially health-affecting exposures to tobacco that are quite different from one another.  It is basically like saying “poplar trees instantly cause your health to decline greatly” — there are ways in which this is true, but it is pretty obviously a dumb thing to say without actually specifying the exposure.

Moreover, many (perhaps most) uses of the term “tobacco” to describe an exposure are not just wrong, but are lies.  They are intended to make the reader to falsely believe that (possibly true) statements about the effects of smoking apply equally to THR products.  The above statement is pretty clearly an example of that.  After all, it does not take any more effort to type “smoking” than “tobacco”.  (Yes, the term “smoking” is not technically limited to cigarette smoking.  But with absent any modifiers, that is the understood meaning, and that is a useful meaning.  That contrasts clearly with use of “tobacco”.)

It is a simple point, but no one is more in need of remedial lessons than the high school intern who writes the embarrassing @FDATobacco twitter feed.

Classic lie: US Surgeon General, 2003

posted by Carl V Phillips

Despite the temptation to focus this blog on the latest and most clever lies, we realize that there is probably more practical value in writing about some of the classic and really stupid lies.  It is painful to deal with the stupidest claims, over and over again, but not everyone has seen responses to them, so it is useful.

As a first foray into that, I will address the testimony of US Surgeon General Richard Carmona before the a House of Representatives subcommittee hearing on smokeless tobacco in 2003.  That is the one that came up in a recent post because it was used as an especially stupid source citation.

The US government was the dominant anti-THR liar when I first started documenting anti-THR lies a decade ago, and they currently hold that position.  The United Nations might or might not have edged them out for a while during the years in between, but the FDA has put them solidly in the lead again.  Long before the lies about e-cigarette chemistry research from FDA, Samet, at al. became the most-cited anti-THR lie, it was Carmona lying about smokeless tobacco.

There was good testimony given to that subcommittee too (that by Brad Rodu, John Kalmar, me, in particular), but no one cites that anymore.  And they should not cite it, unless they are interested in documenting historical thinking.  Research study results do not necessarily lose value over time, but old summaries and expert opinions cease to be relevant because knowledge changes over time.

Not that Carmona’s opinion was expert.  Far from it.  The core claim was:

No matter what you may hear today or read in press reports later, I cannot conclude that the use of any tobacco product is a safer alternative to smoking.

Someone really has to be clueless to make a claim like this.  Even the preamble clause is an embarrassment, saying, “no matter what evidence I hear, my conclusion will not change”.  But deadly lie is the rest.

It is rather difficult to believe that Carmona was actually so stupid as to believe that smokeless tobacco was not less harmful than cigarettes.  Realizing the truth did not take an expert, a genius, or even education about health science (and you might expect a Surgeon General testifying about a topic to have one or two of those characteristics).  Someone just had to know enough to reason, “let’s see: about half of the deaths from smoking are from lung diseases, and no one claims that smokeless tobacco causes any measurable risk for those; the only claim anyone ever makes about smokeless tobacco causing more risk than smoking is for oral cancer, and that would be in the order of 1% of the total risk worst case”.  A bit of grade school arithmetic will then get you to “I can conclude the use of smokeless tobacco is safer than smoking.”

As it turns out, there was already ample evidence and expert assessment that the risk was in the low-single-digit percent range compared to smoking.  There was already clear evidence that the hypothetical oral cancer risk did not exist to a measurable degree.  Indeed, there was (and is) no disease for which any measurable risk had been demonstrated for popular Western forms of smokeless tobacco.  Someone who knew the science would not have to resort to the rough-cut reasoning I proposed.  Still, even someone with only rudimentary knowledge of maths and the subject matter could use that reasoning to figure out that the risk was lower than for smoking.

This statement is not actually the stupidest thing in the testimony, though it is the only claim that is ever quoted (sometimes in a different form since the same basic claim was repeated multiple times — e.g., “Smokeless tobacco is not a safer substitute for cigarette smoking.”).  There is actually even clearer evidence that this guy — or whoever was putting words in his mouth — was a really poor thinker.

Let me start with a few statements that were once accepted throughout society that have now been relegated to the status of myth.

  • Men do not suffer from depression.
  • Domestic violence is a ‘family’ or ‘private’ matter.
  • The HIV-AIDS epidemic is of no concern to most Americans.

All of us here know that these three statements are very dangerous public health myths.  My remarks today will focus on a fourth public health myth which could have severe consequences in our nation, especially among our youth: smokeless tobacco is a good alternative to smoking. It is a myth. It is not true.

Think about the message here.  You can even set aside the really stupid list of historical “myths”, and the fact that one was a moral claim rather than a factual one, and thus cannot be called a myth, one of them was basically correct, and one of them was never really believed by experts.  (I will leave which is which as a simple exercise for the reader.)  Just consider his implicit logic:  “Some people have been wrong about things before, and that is a reason to believe that (a different group of) people are wrong about this.”

Of course, he was right about one thing:  The popular myth about the risks from smokeless tobacco did constitute a threat to public health.  But the popular belief was the very myth that he was espousing — that it is just as harmful as smoking, and therefore you might as well smoke.

The talk had a few other gems:

Each year, 440,000 people die of diseases caused by smoking or other form [sic] of tobacco use

This is another great example of the conjunction lie I noted previously — he could have said “…by smoking or other forms of tobacco use or gazing upon my face and turning to stone”, and it would still be accurate.  He was using word games to imply that some nontrivial part of that figure cited was the toll from smokeless tobacco.  Indeed, that figure was the official estimated toll from smoking alone, so he was actually saying that neither smokeless tobacco nor his gorgon-like powers were killing anyone.  That is a bit of accidental truth that is conveniently overlooked by the anti-THR liars who still quote this national embarrassment to this day.

It is difficult to not be reminded of another bit of testimony from the same year from another cabinet-level official, Colin Powell insisting that Iraq had weapons of mass destruction.  In later years, Powell has expressed serious regret and apology for making that claim, and it basically cost him his legacy as a respected statesman, though he deserves a lot of credit for the apology.  But whatever one thinks of Powell and the war, the key observation is this:  Who would be stupid enough, years later, to quote Powell’s testimony and say, “this testimony is evidence that there were WMDs in Iraq”?  And yet that is equivalent to what the anti-THR liars are doing when they quote Carmona’s embarrassing and false testimony a decade later.