This is what local public health looks like, Iowa edition

by Carl V Phillips

Granted, the position statement on dissolvable tobacco products by the Iowa Counties Public Health Association matters very little to the world (though at CASAA we do like to highlight absurdities from Iowa, the new home of one of our directors).  But it tells us a lot about how phenomenally clueless “public health” people on the ground are. They should really stick with practical matters they understand, like restaurant inspections — and you do not want to think too hard about the implications if their understanding of how to do restaurant inspections is as poor as their understanding of tobacco.

Keep in mind that this statement was published this month (h/t Jan Johnson for reporting it), not two years ago.

Background: In response to increasing restrictions on the use of cigarettes and other products limited by the implementation of smoke-free air acts in multiple states, the tobacco industry has produced and begun to distribute new dissolvable products including Orbs, Strips, and Sticks, and Ariva and Stonewall tablets. Flavored tobacco products are considered the potential third wave of tobacco addiction.

Notice that they lead with the top-down “it is all about us” presumption that I analyzed in detail recently.  They then go on to mention five products.  The first three, from RJR, have been dismal failures (which is 1/3 a shame:  the Strips and Orbs are as unappealing as NRT, but the Sticks were a good product, and smokers who tried them often found them a very good substitute; I have suggested to RJR, only half-joking, that they re-launch the Sticks as “battery-free eco-friendly e-cigarettes” or something).  The other two lozenge products, from Star Scientific — very much not part of “the tobacco industry” — have been off the market for more than a year.

I have no idea what the “third wave of tobacco addiction” even means.  Despite their passive voice assertion, I have never heard that phrase before.  But I suspect it is not compatible with “all of these products sunk beneath the waves because they never caught on with consumers.”

I could probably just stop there and observe just how amazingly clueless the anti-harm-reduction industry’s local useful idiots are.  But a bit more…

Concerns regarding the potential health impacts of these products include the following.  These products are not FDA-approved cessation products. They do not help people end their addiction to nicotine.

Um, how is either one of those a health impact?  And, actually, they kind of are/were FDA approved, in the sense that FDA has jurisdiction over them but has not quashed them.  They may or may not help people end their “addiction” — given their minimal sales, it is hard to argue that there is evidence that they do, but clearly there is no evidence that they do not, as is asserted.

Dissolvable tobacco contains higher levels of nicotine than cigarettes. The typical cigarette will give the smoker a dose of between 1 and 2 milligrams of nicotine over the time it takes to smoke the cigarette (10 min or so). These products are designed to dissolve in the mouth in 3 (strips) to 10 (tablets) minutes but they can also easily be chewed or swallowed whole. Arriva delivers about a 1.5 mg dose, Stonewall delivers about 4mg.

Seriously, these are the people who presume to be offering advice to others. Swallow nicotine and very little of it gets absorbed.  The numbers for those (non-existent) products are — or, rather, were —  the nicotine content of the objects, not how much gets absorbed.  They cannot even get the time periods right (e.g., the strips dissolve in less than a minute and so give a bit of a kick, though not nearly as much as a couple of puffs on a cigarette; the lozenges, if you can stand them, last a lot longer than a cigarette).  Do you think anyone involved with this report even talked to someone who had used one of these products?

These products are intentionally marketed in colorful packages, sweet flavors, and convenient sizes that are very attractive to youth and are very easy to hide. Kids can use them at school, at home–anywhere. Their discreet form, candy-like appearance, and added flavorings may make them very attractive to children, and increase the risk of unintentional ingestion of toxic levels of nicotine. Further, access to these products may increase youth initiation and addiction to tobacco products.

Yes, that has always seemed like a concern ANTZ should have about NRT (except for that “toxic” bit — you would have to consume more product than you could shove into your mouth to get to toxic levels).  Oh, wait, you say, they were not talking about NRT?  No, they must have been, because those dissolvables had about the least appealing packaging I have ever seen, whereas NRT is pretty much packaged to look like candy.  (Btw, if you have never read the “study” at that link, you really should — I think it is the funniest thing I have ever written.)

Of course, what is most clueless about this whole 2014 position statement is that they obsess about products that were removed from the market in 2012 and yet fail to mention that the currently most interesting existing product in this whole NRT/dissolvable tobacco sector (they are basically the same niche) is RJR’s Zonnic.  They are strangely silent about the evils of the tobacco industry selling an NRT product.  It makes the tortured distinction between NRT and dissolvables a little too obvious.

Dissenters argue that tobacco products already cannot be legally sold to anyone under the age of 18; however, these products are being aggressively marketed to youth via social media channels. Youth will access these products in many ways, including from legal purchasers, just as they have done with other illicit products in the past.

Once you stop laughing (remember, this was published this month), consider that this is something we do not make a big enough deal about:  These same people who predict that e-cigarettes, etc., are going to have some horrible impact also claimed the same thing about dissolvables, which basically no one consumed.  I suspect there are more kids using meth in Iowa than ever used dissolvables.  We need to point out that they use the same dire language about everything, regardless of being proven wrong in the past.

Policy Recommendations:  To prevent tobacco-related disease and death, ICPHA recommends three measures designed to control the sale and distribution of these products within Iowa based on ordinances that were recommended by the Linn County Board of Health to the Linn County Board of Supervisors:

Read:  The biggest clueless obsessives in the word, re this issue, live here in Iowa. Thus we should defer to them.

Prohibit the sale of Dissolvable Tobacco Products;
Prohibit the sale of Buy One Get One Free Tobacco Product Offers; and Prohibit the Distribution of Smokeless Tobacco Samples at Qualified Adult-Only Facilities.

Did you catch their analysis of the dangers of BOGO and ST samples in their claims?  Neither did I.  (I left out a bit because it is tiresome to respond to the same lies all the time, but nothing about those.)  This is what public health looks like:  Write the conclusions based on whatever personal bias you happen to have; write some words above them; don’t worry if the latter have nothing to do with the former.

Oh, in case you wanted to weigh in on this:

Comments are closed.

Wouldn’t want to risk someone pointing out how clueless they are, would they?

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6 responses to “This is what local public health looks like, Iowa edition

  1. Thanks for this useful analysis of the apologies used by clueless liars to mask the financial reasons behind their health policy. More knowledgeable liars aren’t quite so useless at lying, but still need to do so for budgetary reasons; you have previously exposed them just as comprehensively.

    In the end, the principal driver for these policies is not health, it is money. It is probably much harder to analyse the financial pressures behind these lies but it is likely to be of equal or more use now; if the ‘health’ statements are exposed as lies, and financial motivation is equally well demonstrated, then the reason for lying is clearer.

    For example if cities get paid grant money to ban ecigs (as they do), and if cities depend on tobacco revenues to balance their budgets (as they do), then it is obvious why they want to kill people by preventing access to safe nicotine sources. It is probably time to put more emphasis on the financial pressures behind the lies; it must be obvious to everyone by now that there are no public health reasons to block access to or use of smokefree products.

  2. Just a small correction. Ariva and Stonewalls are back on the market. The company sold the product to former employees of Star Scientific and they are now back in production.

    http://www.csnews.com/top-story-supplier_news-star_scientific_products_get_new_life-64554.html

    What is interesting about the products is that they have been on the market since 2001 so are grandfathered into the tobacco control act of 2009. I have used them for the past few years and they are not bad, though a bit weak on the nicotine compared to swedish snus.

    • Carl V Phillips

      Hey, cool. I missed that. Not back yet, apparently, but perhaps coming soon. Great news for the hundreds of people who liked them. (Seriously – I recall that Star’s annual revenue from selling them was only in six figures.)

      It actually may be more complicated (arguably better) than grandfathering: Star applied for an MRTP ruling very early on and because CTP was not ready to deal with it (or anything) they avoided it by issuing a ruling that (contrary to the obvious reality) the products were not tobacco products and thus the application was invalid. CTP may be stuck not being able to regulate them.

      I guess if you like aspartame and can stand the slimy NRT-like texture, weak delivery is the main weakness. My personal opinion is not so good. Though I do know people who like them. Well, strictly speaking, I know one person who likes them. She will be happy if they really do reappear.

  3. Your (hilarious) paper that you linked to reminded me of an amusing event in the history of Dutch literature: a bunch of fin-de-siècle young avantgarde poets cobbled together a parody of the utter drivel that passed for literature in the Netherlands in the 19th century; managed to get it published somehow; it got reviewed in the literary magazines (although sadly not in the most important one); and lo and behold, the critics rather liked it.
    One of the literary critics was particularly enthusiastic because – the work reminded him of his own work. LOL.

    Then the big revelation, shock all around, avantgarde guys write a booklet ridiculing the literary critics, – and that’s how the drivel was (finally) gotten rid of.

    Striking parallels between ANTZ’ work and 19th-century Dutch literature include: the mindbogglingly low quality of the work; ivory tower mentality; complete lack of a sense of humor.

    I’m undecided about the ethics of submitting a fake scientific paper to a bad scientific journal to expose a field that doesn’t seem to know good from bad science.
    But if someone were to dress up as an ANTZ and participate in a talk show or something, lips pursed, spouting off the usual nonsense but just a tad worse, so that literally *everybody’s* response is ‘WTF did they really say that’ – I dunno, it probably won’t work, but it’s an amusing thought.

    I seriously worry sometimes that we’re going to see an ANTZ run into a pitchfork sometime, if the bubble isn’t burst soonish.

    • Carl V Phillips

      Thanks. There have been a few example of fake papers like that recently. We really should try it.

      The trouble with trying to sneak a parody through is find any space between “as bad as they actually are” and “blatantly goofy silly”. I mean, these are people who publish articles in which they torture the numbers to claim that most smoking is caused by depictions in movies, and that banning smoking in bars eliminates 40% of all heart attacks. Those don’t just show up somewhere as random anomalies — they are cited by others as if they are informative. In a world like this, why bother with the subtleties from my “study”, like the fact that they were twice as likely to select the nicotine solution because there were twice as many vessels of it. It is kind of like Jon Stewart et al. in the 2000s who basically just accurately reported the news from Washington and then just let it sink in (generally I hate late-night political humor because it relies on people not understanding the topic and misleading them, but it was pure gold for most of a decade because that was not necessary). I believe that Stewart declared that parody is dead.

      Hmm, I wonder… If we (whoever “we” might be) started to send a lot of fatally flawed papers out to a lot of journals, they would have to start clamping down to avoid being punked, which would be the real value. It would be sort of like their secret shoppers at tobacco retailers (or like terrorism, but probably better to stick with the former analogy).

  4. The problem with the FDA-approved oral confections (the gums and cand…, I mean “lozenges”) is that the poor intake through swallowing and the oral mucosa is that it’s not pure straight nicotine but nicotine polacrilex.The claim is that 80-90% of the nicotine bound in that polymer formulation (plastic) is readily absorbed.

    Meanwhile, straight nicotine is easily absorbed since the plastic eventually has to degrade to release it. This is quite different from the nicotine leeching from some leaves between the gums or someone having a real or electronic cigaroo.

    Did I mention that there is much more surface area for nicotine through one’s respiratory system versus one’s digestive system? The surface area within one’s own lungs is impressive, ounce-per-ounce, if you think about it.

    I sincerely doubt that any dipper of Cope will be fooled by just substitution since the delivery system is that inefficient. Or anyone who still uses real cigarettes for that matter. The irony is that these FDA-approved confections are seen as “treatments” but do nothing to address the ritual of dipping or puffing.

    And now they’re glamorizing these politically-correct, very expensive and largely ineffective confections?

    If that big bad wolf (could be named “Winston” since I’m a Harvey Keitel fan) engaged in the same marketing they’d be shamed from the market! For the rest of us it’s just more of the same passive-aggressive cowardly acts of psychological projection.

    Sounds like they can use a cigarette, preferably a vape from an E-cig: It would be more satisfying than the same emanations they’re farting out right here and right now within their closed-knit circle of fellow jenkem addicts.

    — Mark B.

    P.S. If they alter one frame of “The Hustler” I’ll, aww gosh dang it to heck! I have zero respect for ’em. No coming back from that!

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