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….
The three major types of cigars sold in the United States are large cigars, cigarillos, and little cigars.
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.”
Cigars can be as hazardous as cigarettes for those who smoke multiple cigars daily and who inhale the smoke, which probably comprise fewer than 5% of cigar smokers.
But cigar smoking poses negligable disease risks for the vast majority (probably 90%) of cigar smokers who don’t inhale the smoke, and for cigar smokers who don’t smoke cigars daily (which is probably at least 80% of the cigar smokers who have smoked in the past 30 days, which the CDC defines as “current smoker”).
And I suspect that fewer than 5% of youth that CDC defines as “current cigar smokers” are daily cigar smokers.
One of the reasons why cigar sales and past-30-day usage rates have increased is because more people (especially urban blacks) use cigars and cigar wrappers to smoke marijuana, probably because the federal, state and local governments have been cracking down on retailers of marijuana paraphernalia (e.g. shutting down head shops, prosecuting Tommy Chong for selling bongs).
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