Monthly Archives: February 2015

New study: profound ignorance about the basic facts of the potential for tobacco harm reduction

by Carl V Phillips

A new research report by Kaufman et al., a group of anti-tobacco people, primarily working for the National Cancer Institute (NCI), confirms how effective anti-THR lies have been in dissuading American smokers from switching to low-risk alternatives. It is not too surprising — though still utterly pathetic — that you would never know that from reading the abstract at the link. Still, Kaufman is apparently more honest than some of her coauthors and bosses, and the useful information is clearly presented in the paper itself. Continue reading

Glantz complains about research ethics LOLOLOL

by Carl V Phillips

Yes, the man whose superpower is an inhuman ability to willfully misinterpret study results and lie to the public based on that (and who is completely immune to the effects of evidence, logical argument, authors telling him he is interpreting their studies wrong, etc.) is complaining about research ethics. In particular, he is complaining about the recent Shiffman et al. paper which demonstrated that the prospect of interesting flavors did basically nothing to entice teenage non-users toward wanting to use e-cigarettes.

Glantz wrote an extremely weak letter to the journal that published the paper which, to its credit, rejected it. The study had some definite limitations and I would say that the authors did over-conclude from their results, which Glantz tried to say (a stopped clock is right twice a day, though is seldom so deliciously ironic when it is). But the basic conclusion of the study — that interesting e-cigarette flavors provoke a collective yawn among teenagers who do not use tobacco — is solid. It is this result that flatly contradicts a favorite claim of Glantz and his cabal and that Glantz, completely unsuccessfully, tried to challenge. Continue reading

By the numbers, harm reduction is mostly about tobacco (including in India)

by Carl V Phillips

Harm Reduction International (HRI; formerly the International Harm Reduction Association, IHRA) just released a long report with the bold title, “The Global State of Harm Reduction, 2014”. Before you bother to look at it, though, I will point out that despite the broad title, it is only about heroin use and other injection drug use, and it is almost all about process (whether particular helpful government programs exist) rather than outcomes. Sadly, for this once broad-minded organization, which once also focused on harm reduction for much more common behaviors, they seem to have collapsed down to a narrow niche. They used to include in their purview sexual behavior, drug use more generally, and even let alcohol in the door. (They balked at including THR, however, because they were scared to challenge the powerful anti-tobacco lobby. That really says something, given that they are willing to challenge dictators who imprison people for advocating on behalf of injection drug users.)

Not that there is anything wrong with the narrow niche they have retreated to. The people in it are at particularly high risk, and are particularly badly treated. HRI should just stop speaking of it as if it were all of harm reduction, which it obviously is not. Even if we exclude from the term things like seat belts, and stick to the sense of “helping people who choose to engage in behaviors that there are attacked by governments and are otherwise the target of organized opprobrium campaigns” all of injection drug use is still a tiny niche. According to their numbers, they are talking about 10 to 20 million people worldwide. Compare that to over a billion smokers.

In fairness, injection drug users often lose many decades of potential life, as well as much of their potential productivity and ability to function in society. These losses are substantially due to HIV exposure and criminalization, and therefore could be dramatically reduced through harm reduction measures (providing clean needles, eliminating criminalization, offering lower-risk alternatives, etc.). This contrasts with smoking, where smokers lose only a few years of potential life, no productivity, and almost no ability to function. However, to the extent that smoking cause a loss of ability to function (apart from the health effects), it is entirely caused by the quasi-criminalization (punitive taxes that lower people’s wealth, place restrictions, etc.). And, of course, the health risks exist — more or less entirely — because people do not have access to satisfying low-risk alternatives, again thanks to organized campaigns by governments and others.

The situations are remarkably similar, they just differ in which number — the cost to the individual or the number of individuals suffering the costs — is bigger. When you multiply the losses by the population, smoking dwarfs injection drug use.

The HRI report emphasizes Asia, where problems from heroin are worst for various obvious reasons. Also in my inbox today was a call-for-papers from Harm Reduction Journal, for a special issue on harm reduction in Asia. The blurb about it is, unfortunately, restricted to HIV and injection drug use (again, not that those do not deserve attention, but they already get a lot of attention compared to tobacco-related harm reduction issues). However, I did inquire earlier about whether tobacco-related harm reduction articles would be welcome (I am an associate editor of the journal, so had advanced notice), and was told yes. [Update 05mar15: That yes became a no. They do not want my paper about tobacco harm reduction in Asia after all. Again, there is nothing wrong with a special issue specifically about IDU harm reduction in Asia — it should just not be called “harm reduction in Asia” without further qualification.]

There is a paper that I have mostly already written in various forms that I would like to submit. [Update, continued: I still want to write the paper, just not for that issue. And I have found a potential coauthor. But others are still welcome to jump in.] Mostly, but with one gap I cannot fill — and that is why I mention this here and where you come in, dear readers.

Oral dip products used by hundreds of millions of people in South Asia appear to be extremely harmful. If you believe the epidemiology that has been reported (which is pretty sketchy and biased, but is what we have), they cause life-threatening and debilitating diseases at a substantial fraction of the rate that smoking does, and which tend to occur much younger. The government response currently focuses on criminalization. If it were possible to substitute smokeless tobacco for these products — not a perfect substitute, since it is not as psychoactively potent, but similar enough to possibly work — the per capita reduction in harm would be similar to the reduction from substituting it for smoking. And, of course, it would allow people with very tough and sparse lives to continue to do a version of something they like.

There are two major barriers to this. India and other governments, driven by anti-tobacco crusaders at WHO, inaccurately designate the products that are used as “smokeless tobacco”. The products are primarily other substances, however, with tobacco sometimes included as a tertiary ingredient. The harms obviously do not come from the tobacco, since these products apparently cause a lot of harm, while smokeless tobacco does not. But it is hard to convince people to substitute smokeless tobacco for a product they are already being told is smokeless tobacco. WHO is basically sacrificing poor third-world users of these products in order to pursue their campaign of vilifying actual smokeless tobacco use in the West.

The other issue is whether it can be made affordable, and that is the one I simply do not know the answer to. The products currently used cost the equivalent of only a couple of cents per dose, which is about all that most of those who use them can afford. Using Western brand products, at a cost that is more than an order of magnitude greater, is out of the question for most of the target population. For this to work, there would need to be a domestic industry that could make product at prices that are locally affordable. India is a major tobacco leaf producer, so the raw ingredient is there, but I do not know if a local production process could be made cheap enough. Anyone out there have any idea, or know someone who does, either inside or outside of industry, and want to either be a coauthor or give me data?

Obviously this would just be a thought experiment about what could theoretically be done. But no one is likely to turn it into a political cause (or entrepreneurial business plan [Update, continued: My potential coauthor informed, very politely, that I was being rather ivory tower with this observation. He is already engaging in exactly that entrepreneurship. I should have had more faith in the market!]) without the thought experiment. And it matters. The number of people this novel form of THR could help is within an order of magnitude of the number of smokers who can benefit from THR.

Hatsukami completes her descent into Hecht-dom?

by Carl V Phillips

Dorothy Hatsukami has long been mostly honest, not bad by tobacco control standards anyway, and one of the few ANTZ careerists who acts more like a genuine research professor and less like a busybody sociopath who happens to have landed a job in a school of “public health”. Of course, she was second author with Mitch Zeller in the attempt to co-opt the term “tobacco harm reduction” to mean “moving toward abstinence, by means our cabal approves of”, and has earned no forgiveness for that. And she has often signed on to some of the anti-smokeless-tobacco lies penned by her University of Minnesota colleague, Stephen Hecht. But now she seems to be taking the lead. Continue reading

On the dangers of trusting in peer review

by Carl V Phillips

A recent CASAA effort asked our members to write a letter to Wyoming legislators opposing an amendment to their anti-tobacco laws (note the link is FYI — please do not fill out the form unless you are in Wyoming and reading this within a few days after it is posted). Someone looking at the details of what we objected to might find themselves saying, huh? (Note: this is not to be confused with the Call to Action from a few days before opposing an anti-consumer and anti-health massive increase on the smokeless tobacco tax.) The amendment was to add the following language about communication by the health department:

These programs shall include peer reviewed science based educational materials on tobacco harm reduction and the comparative risks of alternative nicotine products, vapor products, smokeless tobacco products, cigarettes and other combustible tobacco products.

What’s not to like, you might ask, about science-based educational materials about THR? It is that old devil-details thing. If RJR (who wrote the amendment) had been a little more careful and required it to say something like “scientifically accurate educational materials”, it might have been as good as it sounds on a naive quick read. But we all know what appears in the “peer-reviewed literature”, don’t we?

Basically most every statement ever made about tobacco products, no matter how contrary to the scientific evidence, no matter much of a blatant anti-THR lie, no matter how easy it is to debunk, appears somewhere in the fetishized peer-reviewed literature. Those who use the literature like a grade-schooler doing a toy research report assignment (as is sadly the case for most people writing in this area) will just say whatever they want and then find some journal article where the author asserts something similar. Since we already have evidence (example) of the anti-THR message the Wyoming Department of Health wants to communicate, it is easy to see where this goes. If the legislature actually provided the resources, it could go full-on California Lyin’ (warning: link is a PDF that takes forever to load — I think CA DPH runs their server via dial-up; other warning, in case you have not heard about California’s anti-ecig lies already: it is truly horrible).

[Aside: In fairness to the tobacco people who use references like a grade-schooler, this is the common practice in public health publishing and many other areas as well. I refuse — though often pushed to do otherwise by a coauthor or editor — to include a journal citation for a statement like “vaping is estimated to be two orders of magnitude lower risk than smoking.” How do I know that? Because I am familiar with most of the available science, in and out of journals, and have the expertise to evaluate it. I am not going to throw in a random citation to someone else saying the same thing, which adds nothing just because that opinion happened to have already appeared in a journal. The typical practice would be to just throw in a random citation, giving the false impression to naive readers that it substantiates the claim.]

But it is actually one step worse than that. Notice the reference is specifically to peer-reviewed educational materials. That could be interpreted as anything that provides information, thus being just a generic statement about what they post on their website, since that ought to be educational in the broad sense. But it could also be interpreted as meaning material that is specifically designed to be used in pedagogy. Who designs explicitly pedagogic material about tobacco products? We don’t. Industry doesn’t dare. Basically, it is just the ANTZ — and they can get anything they want into one of their own anti-tobacco “peer-reviewed journals”, of course. I do not actually know if there is official schoolish material out there, but I assume there is. If there is not, someone could just throw something together and get it successfully “peer-reviewed” no matter how bad it was.

The whole thing is kind of sad, actually, that CASAA had to oppose this (along with e-cigarette industry groups, AVA and SFATA). It is clear that RJR was trying to make sure that some government somewhere told some truth about THR, which seems like a good idea. It is just too bad that they did not try to get some real peer-review of the details, to avoid writing their amendment in a way that would basically just serve to put more force behind the lies, at least among those who are so naive as to believe in the usefulness of journal peer-review in this field.