Tag Archives: CTFK

Smoking initiation getting older, what does it mean?

by Carl V Phillips

This is a bit tangential at the start, but it is a good science lesson and you will see how it relates to THR, particularly the common claim that there is no value in THR because everyone is just going to stop using tobacco soon.

I was monitoring the tweets from today’s tobacco control industry’s (TCI) meeting to celebrate the 50th anniversary of the U.S. Surgeon General’s report on smoking (you can find the tweets at #SGR50 if you are interested — you will need to scroll down to today to find the comments on the meeting because there will be a lot going on at that tag over the next week).  There was a lot to despise about it.  Primarily it consisted of a bunch of people who were not even born yet (and a few who were children) trying to take credit for the historical anti-smoking measure that mattered far more than any other: telling people about how risky it is.  This seems to be an attempt to distract people from the fact that what they are doing now is basically useless — except when it is harmful, as when they try to prevent THR.

Apparently several of the speakers took this celebration of a report on smoking as an excuse to attack low-risk alternatives.  A few others, notably Matt Myers of CTFK and the president of the American Academy of Pediatrics (AAP), made the claim that a large majority of smokers start as kids.  The thing is, smoking initiation in the U.S. is now almost exactly half adults and half children, as shown here.

It is not clear whether they are simply illiterate, not understanding verb tense (a large majority of current smokers started as kids, but that appears to no longer be true of those who start).  More likely they are innumerate (that would fit their historical bad science, certainly) and do not understand the basic epidemiologic concept of age/period/cohort.  It is actually quite simple, though it confuses a lot of people who have never had it explained to them when they try to understand events that are happening over time.  A cohort is a group of people born within a particular period (for simplicity, just call it a year); period refers to calendar time; age is obvious.

It turns out that if you fix two of those, it determines the third.  For example, if you want to look at people born in (cohort) 1970 when they are (age) 44, that would mean you are looking at (period) 2014.  (Yes, I know — more precisely you are looking at part of 2014 and part of 2015 for each individual, but we tend to ignore that for convenience.)  Most important, for understanding these things, is that if you are looking at a particular age range (say 12- to 17-year-olds) over changing time (as is done when we chart how many children are starting smoking each year, as in the above link), then you are talking about a series of different cohorts.  That is, it is about different (though in this case, overlapping) groups of people.

To make this more concrete, most current smokers are members of cohorts that started smoking during periods where smoking initiation was at younger ages.  But the current cohorts are not doing this, and therefore in the future more smokers will have started at later ages.  If one does not understand the concept of cohort (as is apparently the case for those speaking today), it might be difficult to understand this.

This also lets us better understand the significance of the fact that smoking initiation is shifting to older ages.  As the tobacco controllers like to brag when they are touting their accomplishments (and like to hide when they are demanding more funding), smoking initiation among children is definitely trending down.  In particular, the TCI uses this observation to claim that THR is not useful because smoking is disappearing (never mind those who are already smoking — they can just die from it).  But initiation among the population as a whole is almost keeping pace with population growth.  With an understanding of cohorts (and being able to not conflate them with periods), it is relatively easy to hypothesize an explanation for this.

Hypothesis: Aggressive anti-tobacco (not just anti-smoking) propagandizing of children is causing them to avoid it until they reach an age where they throw off the manipulations of their younger self.  At that point, however, the portion of the population inclined to try or use cigarettes or other tobacco products is barely changed.  That is, pushing initiation to a later age does not substantially change the behavior of the cohort in the long run.

To better understand this, consider two other behaviors:  If children are effectively discouraged from engaging in the risky activity that is American football, they will never play it; basically no one takes up football as an adult. But if children are effectively discouraged from engaging in the risky activity that is sex, the percentage of the population that will eventually become sexually active is barely changed.  These represent the polar cases of whether stopping early initiation stops initiation entirely, or whether it basically does not reduce eventual initiation within the cohort at all.

The TCI wants us to believe (and themselves desperately want to believe) that tobacco use is more like football — that anyone who avoids starting it as a child will never start.  But the data is suggesting it is more like sex — where the inclination is not substantially changed by delay.  That is, a relatively constant portion of each cohort that is interested (obviously, a much smaller portion for tobacco than for sex).

If the above hypothesis is correct, we would expect that causing a decrease in children initiating would cause an increase in young adults initiating a few years later.  This generally fits the data — not perfectly, but better than does tobacco control’s hypothesis that if you stop a would-be child initiation, that person will therefore never start.  (To maintain that fiction, they try to maintain the fiction that most initiation occurs in childhood, despite the very simple data that shows otherwise.)  There will be a reduction in the number of smokers in this scenario (due to the lower rate in the cohorts who are currently children), but not the cohort effect that tobacco control claims:  There will be about the same number of 24-year-old smokers each year in the future as there are now.

If the hypothesis is basically correct, there will presumably still not be perfect substitution.  The trend will be at least a little bit of the football effect, with some who avoid starting as children losing all interest before become adults. So the current tactics for blocking childhood initiation will reduce total smoking in the cohort, but it appears that it will not be very much.

Getting this right has obvious implications for THR.  First, it shows that while the 1964 Surgeon General report and related education efforts mattered a lot in lowering the inclination to smoke, the near-plateau that has been reached in initiation is not actually changing.  This is contrary to what one might naively conclude from the data on current children that ignores the rest of the cohort’s lifecycle.  Thus, THR remains the only proven method for getting smoking rates to drop much below 20% of the population.  Second, it is further evidence against the TCI’s demonic possession theory of why people smoke.  It shows that people use tobacco because they like it.  Just as delaying sexual behavior initiation does not cause people to not like sex, delaying tobacco initiation does not substantially change the number of people who like tobacco.  Thus having low-risk tobacco products will make a lot of people happier, even apart from making them less likely to smoke.

What to do with tobacco taxes?

by Carl V Phillips

This is tangential, but goes to some big-picture issue, and it is bugging me so much I want to complain about it.  It also relates to those anti-THR liars at the American Lung Association (ALA) and the Campaign for Tobacco Free Kids who seem to be spearheading these lies about economics.

Presumably due to the not-so-secret secret coordination of the ANTZ and their pet reporters, trying to create the illusion of spontaneous expressions of concern, there have been a spate of articles recently about how the government is not giving the tobacco control industry (TCI) what they think they are owed.  In this piece (a random selection from any of a hundred I could have chosen), an ALA representative suggests that all the money the states collect from the Master Settlement Agreement (MSA) should be spent on the TCI.  The mind boggles at what the TCI would do with the literally billions of dollars more every year this would represent.

The MSA is often described as a fee paid by the cigarette manufacturers, but this is a carefully engineered lie.  It is really a hidden sales tax on the price of each pack of cigarettes, that happens to be collected by the manufacturers before being paid to the government — it is paid by smokers, not industry.  This probably annoys those who do not really care about health, but only about hurting the industry (though most of them are probably too dim to see through the lie).  But it actually serves a purpose for those who want to reduce smoking rates, since like any sales tax or other price increase, it discourages consumption.

Now setting aside the question of whether such taxes are ethical and otherwise proper, let us assume that the total taxes are set at the “right” level (also setting aside the question of what that means, and the ethics and question of whether governments should even be doing this) for this goal.  Does this mean that the amount collected is exactly the “right” level (same caveat) to spend on anti-smoking efforts?  Obviously not.  There is no reason to expect any relationship whatsoever between those numbers.

You do not need a degree in economics to see that.  It is clear that even if one likes what the TCI tries to do, much of what is spent on their research and social manipulation projects is already wasted.  They have no idea what to do with the money they have.  The mind-blowing massive increase that would come from spending all tobacco taxes on them would clearly be wasted.  Of course, they would love to quintuple their salaries, but I think most everyone else would agree this counts as a waste.  [UPDATE:  I should have noted here that even the American Legacy Foundation, the anti-tobacco "charity" created with billions of dollars of MSA money, agrees that there is nothing useful to spend the money on.  They have just been hoarding the money, and spending it on lavish salaries for their executives, rather than spending it on marketing, programs, or research.  There is no clearer evidence that there simply is nothing useful (by their own measures) in anti-tobacco that is not already over-funded.]

What should the extra money be spent on, then?  It does not matter.  The TCI people are specifically complaining that it gets spent on fixing bridges.  (They are idiots.  We need to spend more on fixing bridges.  But that is not the point…)  But it does not matter whether it goes into the state’s general coffers, or is used to reduce income taxes, or is doled out to the people, or whatever.  No matter which, it has served its real purpose (caveat again).

This can go the other direction too.  As I show in this paper, the optimal tax on smokeless tobacco or e-cigarettes — optimized from any of several perspectives, including maximizing the population health effects — is zero.  (It is actually negative — that is, a subsidy — but that is unrealistic to even suggest.)  So does that mean that the optimal expenditure on efforts to discourage use of these products is zero?  The TCI certainly does not think so, and even non-ANTZ might see some value in putting a few resources into discouraging non-smoking children from using these products.

So this claim that they ought to get a larger share of the taxes, just because those taxes happen to be tobacco sales taxes, is just like most of their anti-tobacco rhetoric:  it is complete fiction and demonstrates their lack of honesty; it shows contempt for people’s understanding of science (which might be justified as a practical matter); it tries to increase people’s misunderstanding of science (which is clearly not justified as an ethical matter); and it shows their fundamental self-centeredness and general contempt for humanity.

Perhaps if they are so sure that these numbers should match, someone should propose making them match — by lowering tobacco taxes by more than 90%.  Their “logic” supports that solution to the disparity just as effectively as it supports their personal enrichment proposal.

ANTZ engineer their next anti-ecig lie: They facilitate smoking cannabis

by Carl V Phillips

I am back from the recent FDA TPSAC hearings (my live blog/commentary is not too far down the CASAA Members Facebook page for those interested).  During the public comments period (in which only special-interests, not the public, were represented this time — CASAA decided to sit this one out), the ANTZ groups (Legacy, CTFK) kept making vague references to the risks that consumers would tamper with “MRTPs”.

(For those who do not know, “MRTP”=”modified risk tobacco products”, which were the main focus of these hearings, is FDA-speak for anything that is lower risk than a standard cigarette.  It is a very misleading collection, since it includes everything from minor modifications of cigarettes that might or might not reduce risks by 10% to smokeless tobacco which is definitively demonstrated to be about 99% less risky.  It is also a dumb term since many of these products are not “modified” — they are what they have always been — they are just different.  Finally, the word “modified” could refer to either increases or decreases, so what they really mean is lower.  I am tempted to say that the government is a clear and present threat to effective communication, but they are hardly the only one so that would be a bit glib.)

My reaction to these references to tampering were WTF are they talking about?  These are consumer products, designed to be used in the quantity and with the particular behavior preferred by the consumer.  “Tamper” is a meaningless concept in that concept.

What was immediately apparent, though, is that whatever they meant, it was the next orchestrated campaign of anti-THR lies.  As I noted in the previous post, the anti-THR extremists and other ANTZ maintain semi-secret channels of communication in which they engineer talking points that can then simultaneously be stated by the various paid activists and their useful idiots at the same time, as if it were something people were really thinking.  It is the same thing political parties do (and entirely different from what honest and truth-seeking organizations and associations do).  Sometimes these talking points are so utterly inane, like the one I discuss next, that you would think that the press etc. would figure out that they are engineered lies.  (Who remembers the classic when they got their useful idiots to recite “Camel Snus packages look like cellphones (i.e., they are rectangular with rounded corners), which appeal to chiiiildren”?)

As soon as I had a chance to think about it for a few minutes, I realized that my CASAA colleagues had already picked up on some of the chatter and identified one of the meanings of these bizarre claims:  The ANTZ plan to claim that e-cigarettes should be restricted because the devices can be used for vaporizing certain cannabis products.  The reason this is a lie is not because there is not a developing technology for vaporizing a cannabis wax in devices that are quite similar to e-cigarettes — such technology is developing.  The lie is that this has any bearing whatsoever on the regulation of e-cigarettes.

First, vaping a wax requires a different atomizer and not just any cartridge/tank.  (The batteries can be the same, of course.  Batteries are batteries.)  Thus, it is not like someone can just put the wax in an e-cigarette that is designed to vape an aqueous liquid.  They need new hardware.  This contrasts with combustible tobacco products which are easily used to smoke cannabis leaf (sprinkle or roll some in, set it on fire).

Second, the liars are going to try to imply that the supply of cannabis vaping equipment can be eliminated if e-cigarettes are banned.  But see the first point: different equipment is needed, and so they are not diverting that from e-cigarettes.  But maybe we could stop cannabis users from getting, say, eGo batteries, if the e-cigarettes supply chains are banned.  Um, people, they manage to get cannabis.  Do you think that the supply chain that provides this can perhaps expand to include the hardware too?  Do you think maybe it already has?  I am sure that the ANTZ puppet masters are smart enough to know this, and thus know this new campaign is a lie, though their useful idiots include a lot of idiots (in the basic sense of the term) who can be tricked into believing that somehow the chiiiildren would not be using weed because were it not for e-cigarettes.  As I said: idiots.

One additional point:  Vaping cannabis is almost certainly less harmful than smoking it or than the devices that are normally called vaporizers in that world.  (The latter are called “heat-not-burn” when used for tobacco, and the guess is that they are perhaps about half as harmful as smoking, maybe somewhat less, but that still makes real vaping a lot less risky.)  If the ANTZ do not abandon this talking point quickly, as they usually do with their dumb claim of the month, but stick with it, we could use it to drive a wedge between them and the real public health people who support harm reduction for illicit drugs.

Thinking about this further, I realized there was a second implication to these bizarre pronouncements about the risks of tampering, this one more of a hand-tipping about a future threat, rather than a lie per se.  The statements by the ANTZ at the hearing yesterday included references to altering delivered doses.  But, of course, using your snus or modding your e-cigarette to get the dose you want is just part of using it — as I said, the notion of tampering simply makes no sense.  So, what would make that bizarre claim make sense?  If the ANTZ managed to persuade the government to impose restrictions on the physical properties of low-risk products (most likely e-cigarettes, not smokeless tobacco, for obvious reasons) such that they could not be used the way consumers wanted to use them.

So the ANTZ are tipping us off that a core part of their plan, given that they have failed in their attempt to ban e-cigarettes, is to cripple them.  Banning flavors (such that “tampering” consists of adding flavor) is an obvious example, though it does not relate to the point that they hinted at, restricting dosage.  But there are others the come to mind:  Forcing a shut-off of the device after a certain number of puffs over a certain period.  Restricting battery options or tank sizes.  And, of course, limiting nicotine strength.

So do not be surprised when these attacks on THR start flying from every direction.  You are warned.  Now make sure that we push back against the engineered “tampering” campaign any time these attacks pop up, rather than treating these as random stupid comments that will just disappear on their own.

Press Release: FCTC demands governments, researchers avoid talking to automotive industry

FOR IMMEDIATE RELEASE

Geneva, Switzerland

1 April 2013

At the eighth meeting of the delegates to the World Health Organization’s (WHO’s) Framework Convention on Traffic Control (FCTC), delegates adopted Article 5.3, which forbids signatory governments from consultation and engagement with Big Auto and other parts of the automotive industry.  Governments are also to act to ensure that independent researchers are also prevented from such engagement, using such mechanisms as political imprisonment, press censorship, and blacklisting.

The FCTC is devoted to ridding the world of the use of passenger cars by 2050 as part of WHO’s Social Programming to Eliminate Non-communicable Disease initiative.  Automobiles are the leading cause of death in age groups from 4 to 50 years, and the second leading preventable cause of death in the world today.  They are also the leading cause of obesity, exposure to second-hand smoke, and death and injuries among pedestrians and cyclists.  In addition to their immediate health effects, automobiles are the leading contributor to global warming.

The automobile industry has a long-standing practice of influencing governments and manipulating consumers, including encouraging youth uptake, advertising in youth-targeted media such as television and magazines, selling vehicles that can achieve speeds far in excess of any legal speed limit, shutting down government-approved alternative transport, and covering up newly-discovered health threats.  Indeed, the influence of the industry is so pervasive that one corrupted government recently provided a 13.6 billion euro ($17.4 billion) bailout of its domestic industry, rather than letting it fail as it should have done.

Article 5.3 also requires that all future automotive research on such topics and safety engineering should be entirely controlled by governments and FCTC’s approved list of public health researchers.  Industry and those willing to constructively engage with them will be forbidden from conducting such research.  Only by excluding the world’s best automotive engineers from the research process, replacing them with second-rate sociologists and medics, can public health’s goals be achieved.

The new rules are urgently needed due to the industry’s initiatives to substitute new “reduced risk” products, an attempt to attract new customers that can only be explained by our successful denormalization of driving.  Recent attempts by automobile manufacturers to encourage “harm reduction” represent a blatant effort to make driving appear more acceptable.  Industry wants consumers to continue to be addicted to these new products, rather than sticking with government-approved driving cessation methods like buses, trains, and reclusion, which are clinically proven to be successful for almost 5% of the population.

Despite the industry’s marketing claims, no randomized clinical trials have demonstrated that their new products are lower risk.  Instead, these efforts recall the industry’s infamous “seat belt” fraud from the 1960s and 1970s, where they claimed that the installation of these features would reduce risk.  In fact, subsequent research found that deaths and injuries from automobiles continued to increase worldwide, and are now skyrocketing.  In recent testimony in Washington, former U.S. Surgeon General Richard Carmona reported, “No matter what you may hear today or read in press reports later, I cannot conclude that driving a new Subaru Forester, with all-wheel drive and computerized traction control, eight airbags, and a roll-cage-like reinforced chassis, is a safer alternative to a rusted-out 1971 Pinto.”

The new rule will bring all governments into alignment with FCTC policy.  FCTC has always had a policy of forbidding involvement by the industry or automotive consumers, having recognized that perfect policy can only be made if interference by all the real stakeholders is avoided.  Delegates are encouraged to never so much as converse with to anyone who considers motorized transport to be beneficial to people’s welfare, except in the context of clinical interventions.

FCTC recognizes that the industry will probably mobilize their front-groups to protest these rules, using their usual misleading language about “free choice” and “honest science”.  The industry has a long history of creating fake grassroots support to claim that people simply prefer to drive in spite of the risks.  But secret industry documents have revealed that every single person who expresses interest in cars is secretly in the pay of the industry.

Delegate, Michael Myers, CEO of the Campaign for Travel-Forbidden Kids, responded to these claims by industry-funded critics:  “Individuals are persuaded by paid industry shills like Bruce Springsteen to consider cars to be cool or a way to look grown up.  People who start driving as children become slaves to the industry.  Almost none of them ever again go without owning a car after they become addicted.  Motorized transport is far more addictive than heroin or even smoking.  The only way to keep people from driving is to stop the industry from enticing them to start.”

This move by the FCTC follows on important anti-traffic efforts in several member states.  The proposed Traffic Products Directive in the European Union would prevent any personal vehicle (PV) from traveling at faster than 30 kph (equivalent to 18.6 mph or 4 mg/ml).  The US Department of Transportation requires that any automotive products either be “substantially equivalent” to technology that existed in 1980 and that any innovative products cannot be sold until 20 years of real-world data that proves their safety is accumulated.

The adoption of the new rule follows yesterday’s FCTC resolution to demand that governments devote all taxes collected on automobiles and gasoline, and other traffic-related taxes to anti-traffic efforts.  Only 0.000185% of such taxes are given to anti-traffic QUANGOs, which drastically reduces the potential income of FCTC delegates.  Indeed, the vast majority of the collections are devoted to maintaining roads and other actions that encourage driving, further evidence that governments are too heavily influenced by Big Auto.  A related proposal, to demand the elimination of all depictions of automobiles in movies and television, based on the claim that it causes 483,921.4 children to start driving each year, was rejected as being too wackadoodle for even the FCTC.

The FCTC is an international treaty, with 183 signatory countries (which include 22 who actively wanted to sign, in addition to those who were blackmailed into it with threats of losing WHO funding).  They are currently meeting in a 5-star resort hotel, thanks to revenue generated from a collection of extremely regressive taxes.

 Press Contact: FCTC Secretariat, fax (yes, we really still do have a fax machine): +41 22 791 5830, or for those living in this century:  fctcsecretariat@who.int

“Smoking” and “nicotine” are not synonyms

posted by Elaine Keller

The truthful statements in Justin Rohrlich’s story Smokeless Tobacco Advocate Rails Against ‘Frauds, Extremists, Liars’  were based on a two-hour-and-ten-minute phone interview with Smokefree Pennsylvania’s Bill Godshall. (How Rohrlich managed to gather so much information from Godshall in such a short phone call escapes me, but I digress.)

As a representative of one of the “Frauds, Extremists, Liars,” Danny McGoldrick, the Vice President of Research for the Campaign for Tobacco-Free Kids, was invited to comment, probably with the intention of bringing “balance” to the story.

To make any sense whatsoever of McGoldrick’s statements, you need the trANTZlator  that Carl recently introduced for the common Anti-Nicotine and Tobacco Zealot (ANTZ)  phrase, “smoking cessation.” Anyone who applies the common meanings of the words “smoking” and “cessation,” would think it is obvious that this phrase refers to the stopping (i.e. “cessation”) of the inhaling and exhaling of smoke.

*Gong* Wrong. When ANTZ people say “smoking cessation”, what they really mean is the act of stopping the use of any form of nicotine. Get it? Smoking = nicotine. Nicotine = smoking.

This is how Danny McGoldrick managed to testify at a legislative hearing on Tobacco Harm Reduction (THR) in Oklahoma with a straight face:

“…if the tobacco companies want to promote smokeless tobacco or anything else as a smoking cessation product, they can do this through the Food and Drug Administration like other cessation products by demonstrating with science that their products are a safe and effective way to quit smoking.”

“If the evidence is anywhere near what they claim, this should not present a problem for them,” he told the panel of lawmakers.

“There’s no evidence that people use smokeless tobacco to quit.”

There’s that bugaboo that Carl discussed in two previous posts: There is never no evidence (Part 1) and There is never no evidence (Part 2.) McGoldrick’s claim is nonsense from a scientific perspective.

If by “quit,” McGoldrick means “quit inhaling smoke,” it’s hard to believe that a man who holds the title of “Vice President of Research” was unable to track down any of the following articles, published in peer-reviewed scientific journals.

Effect of smokeless tobacco (snus) on smoking and public health in Sweden: “Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.”

Is Swedish snus associated with smoking initiation or smoking cessation? “We investigated whether Swedish snus (snuff) use was associated with smoking cessation among males participating in a large population based twin study in Sweden. Snus use was associated with smoking cessation but not initiation.”

Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation: “Swedish snus could promote smoking cessation among smokers in Serbia, that is, in a cultural setting without traditional use of oral, smokeless tobacco.”

The association of snus and smoking behaviour: a cohort analysis of Swedish males in the 1990s: “We found clear associations between the two habits. For the younger cohort (age 16-44 years), snus use contributed to approximately six smoking quitters per smoking starter attributable to snus. For the older cohort (age 45-84) there were slightly more than two quitters per starter.”

These are far from the only published scientific evidence that snus can be used for smoking cessation. If what McGoldrick really meant was that it is unlikely or unknown whether snus can be used for nicotine cessation, that’s another story. But what he said was “smoking cessation.” So either he is lying about there not being any evidence, or he is extremely incompetent at his job.

Even respected government agencies are guilty of using “smoking” and “nicotine” interchangeably, and therefore misleading the public. All FDA-approved “smoking cessation” products are aimed at a goal of nicotine cessation. There are three problems with this approach: 1) It doesn’t work for over 90% of smokers that try to quit, 2) It isn’t necessary to become abstinent from nicotine to achieve smoking abstinence, and 3) Smokers who switch to a low-risk alternative enjoy the same health improvements as those that used nicotine abstinence to stop smoking.

There are many published scientific reports on the beneficial health effects of switching to smokeless tobacco.

Smokeless tobacco: a gateway to smoking or a way away from smoking: “Sweden has low rates of smoking and a lower rate of respiratory diseases and lung cancers by comparison to other developed countries.”

Health risks of smoking compared to Swedish snus: “Although few in number, these seven studies do provide quantitative evidence that, for certain health outcomes, the health risks associated with snus are lower than those associated with smoking. Specifically, this is true for lung cancer (based on one study), for oral cancer (based on one study), for gastric cancer (based on one study), for cardiovascular disease (based on three of four studies), and for all-cause mortality (based on one study).”

Lung cancer mortality: comparing Sweden with other countries in the European Union: “There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths.”

Summary of the epidemiological evidence relating snus to health: “After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. “Snuff-dipper’s lesion” does not predict oral cancer. Snus users have increased weight, but diabetes and chronic hypertension seem unaffected. Notwithstanding unconfirmed reports of associations with reduced birthweight, and some other conditions, the evidence provides scant support for any major adverse health effect of snus.”

Again, the above are just examples. Anyone can access PubMed’s search system and find many more studies.

Rohrlich’s story states, “Danny McGoldrick just can’t wrap his head around the idea of Big Tobacco’s collective conscience telling it to guide people to smokeless for their health.”

Actually, what McGoldrick can’t wrap his head around is the concept of how Tobacco Harm Reduction works. Or perhaps he just doesn’t want to.

CDC on cigars – a great example of liar’s citations

posted by Carl V Phillips

I will come back to FDA in a few days, but we want to cover a few other things first.  One is to point out that the behavior of the FDA — in terms of both being anti-THR and junk science about tobacco/nicotine — does not represent either new or exceptional action by the US government.  The CASAA leadership just happened to be discussing this document from the US Centers for Disease Control and Prevention (CDC).  It is about cigars, which is related to THR, though not a core part of THR efforts.

There is good evidence that cigar smoking in traditional cigar style — puffing into the mouth with minimal inhalation into the lungs — is much less harmful than cigarette smoking.  Of course, the same method can be used with cigarettes too.  However, the interest in such substitution is limited and switching to smoke-free alternatives is far healthier, so there has been little interest in pursuing this.  (In addition, a lot of cigar consumption lately has been for products that are basically cigarettes and are smoked like cigarettes, as a way to avoid the punishing cigarette taxes.  That is understandable motivation, but it is not meaningful harm reduction.)

Still, that document says a lot about CDC’s approach to tobacco.  About half of the content is cited to three sources (links appear in the original if you really want to see them):

1. Campaign for Tobacco-Free Kids. The Rise of Cigars and Cigar-Smoking Harms . Washington: Campaign for Tobacco-Free Kids, 2009.

2. National Cancer Institute. Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9 . Smoking and Tobacco Control Monograph No. 9. Bethesda (MD): National Institutes of Health, National Cancer Institute, 1998.

3. American Cancer Society. Cigar Smoking . Atlanta: American Cancer Society, 2010.

This is a great example of lying with citations — putting in little footnotes that imply that the information presented is based on the best possible evidence, when actually the sources are rather useless.

You probably noticed that the first is to an anti-tobacco extremist organization, which, among other things, opposes harm reduction.  Moreover, it is not research by that organization, or even a review paper, but is just a two-page broadside.  The third reference is similar:  While ACS is thought of as a scientific organization, when it comes to this topic, they are also an extremist activist organization with little regard for honest science.  The cited webpages have a bit more content than the CTFK broadside, but not much, and do not even cite evidence for their claims.

So basically, we have an agency of the US government sourcing its scientific claims and consumer advice about a tobacco product to activist organizations whose mission is to say anything they can think of that is negative about tobacco products.  Their job description is to be biased, and that often means dishonest.  There is no possibility that CDC does not know this.  Could you imagine the State Department citing information in its travel advisories to the Middle East to anti-Islamic activists or the Department of Agriculture citing nutrition advice to anti-GMO activists?  This is similar in terms of credibility.

[You probably could, however, imagine agencies of the government deferring to other, more powerful, players for information in their areas of interest.  That observation -- and its relation to the present topic -- will be the subject of this week's Background post in a couple of days.]

At least source #2 is a real scientific review.  The problem is that it is from 1998 — very old history in a field like this.  But, funny thing: the CTFK document cites that 1998 report extensively.  So what CDC is really doing, by citing CTFK, is trying to hide the fact that all their information traces to 1998 by citing a more recent document that cites the original.  A common sneaky trick used in undergraduate term papers, brought to you by an authoritative voice of our government.

It gets worse.  The first statements that are cited to those three sources are:

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco….[1][2]

The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.[1][2][3]

There is nothing wrong with the information, of course.  What is baffling is why CDC felt a need to provide a citation for it.  What is even more baffling is that citation #1 does not even provide a definition for cigar; citation #2 probably does, but I am not going to hunt for it.  Interesting, #3 does provide a clear definition — based on tax law — but is not even cited for the first sentence.  There is also clearly no need to cite that second sentence, but if you are going to, it should be to something relevant (like the official tax or regulatory definitions).  Here is a hint for those of you who want to cite a definition:  try a dictionary.

That is mostly just amusing, but it shows a general lack of seriousness.  More serious, and equally lacking in seriousness, are the series of health and other claims that are also cited to these three sources.  And lest you think I am cherry-picking, there are no other cited sources that provide any health information.  I am not going to go into detail about the claims because, for the reasons noted above, their role in THR is limited.  Suffice it to say that there is a lot of doubt now about the conventional wisdom about the risks that existed in 1998 (that probably sounds a bit familiar for those who know the science about smokeless tobacco).

So, basically, the official word of our government is: “(a) as far as we know, nothing has been learned since 1998; (b) just go read these activists’ position statements because we just defer to them anyway.”