by Carl V Phillips
I’m back, after some holidays and then trying to catch up on research work. I cleverly avoided the need to do some kind of new year’s deep reflection or retrospective, though I will mention that the your-year-in-review WordPress bot congratulated this blog for having so much content and readership for its short tenure. I will start with a few easy ones for a few days, mostly taking advantage of what others have written about THR over the last few weeks.
But today I will start with an often unchallenged bit of THR lying that is related to my current work, the claim that dual use (a term which usually refers to someone who both smokes and uses a low-risk alternative product) is somehow more harmful than merely reducing smoking. Today’s example comes from serial liar Stanton Glantz(*) who publicized his comments opposing honest labeling about the low risks of smokeless tobacco. As you might know, RJR has petitioned the US FDA to change the health warning labels on smokeless tobacco so that they accurately point out that ST it is much less harmful than smoking, rather than implying that it is just as bad, as the current labels do. Of course, the anti-harm-reduction forces, who prefer that people keep smoking if they are not going to obey and become abstinent, vehemently oppose this.
[*In keeping with an ongoing meta-theme of this blog, I will repeat my observation about Glanz that many of his claims appear so earnest and yet are so incredibly out of touch with the obvious reality, one might debate whether “liar” is the right term for him. This contrasts with the many obviously cynical liars in the tobacco control industry who clearly know what they are communicating is false. Arguably someone is not precisely a liar if they are so deluded that they actually believe what they are saying despite being well-read on a topic (the latter contrasting with many of the “public health” useful idiots who just repeat what they are told and are lying in claiming expertise). Of course, “grossly incompetent and out of touch with reality” is not exactly better than “liar”.]
Glantz’s testimony includes this statement:
Altering the text of the warning label to unequivocally state that smokeless tobacco presents substantially lower risks to health than cigarettes neglects the effects of dual tobacco use and the effects of smokeless tobacco use on smoking cessation, and so is fundamentally misleading consumers to underestimate the true risks associated with smokeless tobacco use.
The last bit is the usual obvious lie, since it is almost impossible for someone to underestimate the true risks of ST, as low as they are, and any correction away from the current overestimates will clearly reduce how much consumers are “fundamentally misled”. The first part is more interesting.
Those of you who have followed anti-THR over time will know the pattern of the anti-tobacco extremists drawing the same conclusion, year after year, but altering their claimed justification for the conclusion when last year’s rationalization falls apart. The current vogue is to claim that the existence of dual use means that THR is not so low risk after all. Of course, a major reason for the persistence of dual use is that the extremists have prevented consumers from getting the message “now that you are using a low-risk product some of the time, you will lower your risks a lot by switching completely.” But setting that aside, is there any basis for claiming that dual use is bad?
Someone who replaces some of their smoking with a low-risk alternative is smoking less. Smoking less reduces risk (though obviously not as much as smoking none at all). The big implicit lie — never stated, because then they would have to try to defend it, which they cannot — is that reducing smoking due to dual use is not as beneficial as reducing smoking without substitution. There is simply no evidence to support this claim and no reason to believe it is true (beyond a level that is so small as to be a rounding error).
Put simply, dual use is reduced smoking, and reduced smoking reduces risk.
Even the worst-case scenario, in which someone uses a low-risk product while still smoking just as much, any additional risk is so trivial as to be inconsequential. But someone who is doing that is in a great position to start substituting, and thereby reduce their risk (if only they learned about the option), so they are still on average better off in the long run.
Of course, that worst case (as defined in terms of actually caring about health and people) is not really the worst case in the eyes of the extremists. They are bothered by the possibility that dual users do not have to suffer the pain that anti-smoking restrictions inflict on people who exclusively smoke, and they want tobacco/nicotine users to suffer.
Besides, if they really cared about discouraging dual use — rather than just using it as their anti-THR rationalization du jour, they would be supportive of a new label on ST that said something like “Exclusive use of this product is far less risky than smoking” (h/t to Gregory Conley for that observation). But, of course, they do not really want to encourage dual users to shift entirely to low-risk product use, because that would ruin their entire business model. Rather, they are just saying whatever they think will accomplish their cynical goals, without regard to whether they really believe it.
As a moderate dual user myself, I see no extra harm from cutting down, and on some days cutting out combustion completely and supplementing my recreational nicotine level accordingly. To use a phrase I picked up from the recent FDA hearing, to which you attended and spoke. I am “self titrating” and more than capable of doing so, the human body has a wonderful system of internal regulation, it knows when it’s satisfied of in distress and signals you in no uncertain terms when it’s reached its plateau of contentment or gone past it.
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Don’t forget Simon Chapman
If only that were possible (to forget him). Like others who are well known merely for being well known and obnoxious, not for ever having done anything worthwhile (the Paris Hilton types), he has to be constantly self-promoting to maintain his illusion of relevance. But if we bothered to comment on every dumb thing he says, it would take all our time. I think it is more useful to focus on people who are actually influential (for whatever unfortunate reason), like Glantz.
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Chapman repeats the lie that ecigs are designed to help smokers quit. They are not. That is now the quit or die tactic – to get them regulated as medicines. I’d say they are mainly used by smokers because i) they are virtually harmless yet they provide nicotine in a reasonably enjoyable manner ii) they are less expensive than cigarettes and iii) they get around smoking bans. The fact that many people, including myself, either drastically cut down or eventually quit, is maybe a bonus. The fact that are unintentionally far better than Pharma NRT in this respect is a source of amusement.
That one comes down to a matter of: quit *what*? They were *designed* (invented and innovated) to help people not smoke by substituting for it, and were designed to be as good as possible (so it is not unintentional that they are better than pharma products, which are designed to be bad in certain ways). In places where claims are regulated, they are cannot be *marketed* with any such claims.
This brings up an interesting point about definitions and regulations that I should probably write a post about. I will try to fit it in.
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Glantz’s lies (or delusions, whichever) are refuted by the evidence from Sweden. In the real world, it doesn’t matter what the various theoretical arguments might be – only the facts have any relevance. Sweden has the lowest smoking-related mortality rate in the developed world by a wide margin, despite there being twice as many Snus users as smokers; despite the undoubted existence of some dual-use; despite any gateway effect or youth attraction effect (if such things exist in any significant proportion). The only relevant issue is the facts. All the rest is pure debate and of no real importance once the facts become irrefutable.
It never ceases to amaze me how much the anti-THR lobby warns so often about the hypothesized speculative harms of low health impact forms of tobacco in the face of well the established high destruction and clearly understood harms of cigarette smoking. A two pack a day smoker thinking of switching to smokeless tobacco would be told, in essence (if they were honest), “sure smokeless tobacco is easily 1% as harmful as smoking, but we can’t recommend it to you because we’re concerned about that 1% somehow turning into something, and we’re just speculating about what this might be, that wipes out the 97% and makes you even worse off than continuing to smoke. So you only real option is to quit.” If you were faced with a life threatening health decision, and those were the facts, and that was was the recommendation, you’d be justified in labeling that person a complete quack.