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.

In a recent paper (peer-reviewed journal article!) Hatsukami (first author and lead press flack), Hecht (last author), Irina Stepanov (who frequently contributes to their lame propaganda), and a whole bunch of others reported:

Levels of magnesium in drinking water vary dramatically. Magnesium is a dangerous metal that spontaneously bursts into flame when in contact with water. We show that, independent of quantities consumed and other factors, the levels of magnesium in water affects the quantity of magnesium in the bodies of those drinking it.

Ok, they did not really write that. But they might as well have. You need to substitute “smokeless tobacco (ST)” for “drinking water” and “tobacco-specific nitrosamines (TSNAs)” for “magnesium”. But otherwise it is basically the same. The levels of TSNAs in ST do vary some, and completely unsurprisingly this affects how much is taken up by users. (To emphasize, that “unsurprisingly” means that this means that this study told us nothing we did not already have every reason to believe, and it never had a chance of telling us anything relevant to decision-making.) But just like the magnesium in drinking water — which, by the way, is in the form of harmless salts, not in the dangerous metallic form — this does not represent any apparent health risk. You see, despite Hecht and company banging on about TSNA in ST for decades, insisting that it is highly carcinogenic, they have one teensy weensy problem with their theory: Modern Western ST products do not cause a measurable risk for cancer.

What the Minnesota cabal has been saying about TSNA is similar to exploring Asian methods of teaching math as an explanation for the many Nobel Prizes won by Asians. The problem with that exercise being that Asians win very few Nobel Prizes. A rather more interesting question would be the equivalent of “why, in spite of their legendary math education, do Asians win so few Nobel Prizes?” Hecht et al. have pointedly ignored the question of why their pet deadly carcinogens do not actually seem to be causing cancer. Brad Rodu attempted to answer this years ago, suggesting that perhaps antioxidants or other chemicals in tobacco leaf protect against any molecular damage the TSNAs might be causing. There are other possible explanations also. Rodu notes his hypothesis in his post that already debunked the Hatsukami et al. claims (where you can find a bit more technical analysis than appears here). Hatsukami, Hecht, et al., by contrast, never even acknowledge the question.

The fact that the study did not — and could not possibly — show there is a health risk did not stop Hatsukami from going to the press with standard anti-THR scare tactics:

“The majority of smokeless tobacco users in the United States are not aware of the levels of cancer-causing chemicals in their smokeless tobacco products or of the tremendous variability in the levels of these chemicals across brands sold in this country,” continued Hatsukami. “At a minimum, the FDA [U.S. Food and Drug Administration] should provide smokeless tobacco consumers information about the different levels of cancer-causing chemicals in different brands of smokeless tobacco and, ideally, require levels of tobacco-specific nitrosamines be substantially reduced, if not eliminated, in all products. Levels of these chemicals in smokeless tobacco products could be readily reduced by changing manufacturing practices.”

Any lay reader would interpret that as saying “the levels in some products are dangerously high” though, as already noted by Rodu, “tremendous variability” apparently means, to these authors, the relatively modest range of .6 to 3.9 ppm. That, of course, means nothing without some context. The conveniently omitted relevant context is: The products (American and Swedish) used in the 1980s and 1990s, which produced the epidemiology that showed there no measurable cancer risk, had concentrations that ranged from higher than those numbers to enormously higher. In other words, the levels already have been substantially reduced below what was already apparently low enough.

Of course, I am sure those marketing Swedish Match and Ariva/Stonewall products are salivating(!) at the prospect of TSNA quantity labeling, given that their products are at the low end and consumers would inevitably believe that the difference across this range matters. Also I am sure that the latter appreciated the outpouring of help they got from Minnesota when FDA banned the sale of most of the Ariva/Stonewall products, which probably have the lowest levels of TSNAs of any ST product. Oh, wait, now that I think about it, I can’t quite seem to remember that outpouring. Or even a trickle.

Levels of exposure to tobacco-specific nitrosamines are associated with disease risk, according to Hatsukami. Prior studies have shown that smokeless tobacco users in the United States experience about two to three times greater risks for oral cancer compared with those who do not use these products, she said. Pancreatic cancer has also been linked to smokeless tobacco use.

Funny, I don’t recall those oral cancer studies. There was one study of now-archaic dry snuff products from the 1970s that suggested a higher relative risk than Hatsukami claims, though we will never know for sure because those products are gone. And then there were studies of the types of products that are still used which found no measurable elevation of risk. So, what, is she just splitting the difference there and making up a lie about modern products with a number that never appeared in any study result?

Moreover, there has not been a single study that looked at cancer risk as a function of TSNA level. She just made that part up out of whole cloth.

The claims about a measurable pancreatic cancer risk have not stood up to scrutiny. Maybe she thinks that “has been linked” is not really a lie because it could mean “many people thought that for a while, and ignorant/dishonest people still claim it.” It is a lie, of course, since the phrasing is obviously intended to convey a very different (false) message to the reader.

We can perhaps understand Hecht’s continuing crusade about TSNAs in terms of simple career ego: He built his reputation on warning about this class of chemicals, and cannot let that go late in his career. Of course, someone else in his position might have instead have opted to declare victory. He could claim personal credit for persuading the Swedes to establish a regulatory ceiling for TSNA levels in ST and the American manufacturers to also dramatically reduce the concentration to similar levels. He can just keep ignoring the inconvenient truth that the products did not cause a measurable risk for cancer even before those reductions. He warned and nattered and propagandized about these molecules, and the world changed as a result. You won, Dr. Hecht. The battle is over. So why do you choose to continue to rage?

But that does not explain this move by Hatsukami; she was merely along for the ride on Hecht’s crusade. This press release moves her solidly into the category of anti-THR liar. It is also further evidence that there is no longer any middle ground. Anyone who wants to remain part of tobacco control has no choice but to give up any pretense of being an honest researcher.