Tag Archives: Carmona

Does the current generation of THR commentators really know so little about smokeless tobacco?

by Carl V Phillips

Not lies today, quite.  But unforgivable ignorance from those who presume to write about THR.  CNBC “reports” (which is to say, runs a free advertisement for Swedish Match; not to suggest that is a bad thing — and indeed, good for them for getting the story — but it is just so blatant it seems a bit embarrassing):

Big tobacco may be scrambling to grab a hold of the e-cigarettes market, but there’s a little-known 700-year old tobacco product from Europe that’s also seen as having big potential.

Snus (pronounced “snoose”) is similar to U.S.-style dipping tobacco. It’s a derivate of snuff with the history records showing its use dating back to the late 1400s. It’s placed inside the upper lip and is either sold loose in tins or in tiny tea bag-style pouches.

Seen as having big potential compared to e-cigarettes?  Even restricting to an inaccurate narrow definition of what snoose means, it has been reasonably popular and constantly discussed for decades, and still outsells e-cigarettes by a lot.  Note to authors: just because you personally only recently learned about something does not mean that it is news.

I trust I do not have to explain that “snus” is just the Swedish language word for snuff (aka dip, oral snuff, moist snuff), and so does not define a subcategory of smokeless tobacco, though it is also used as marketing term for ST products outside Sweden that the manufacturer wants to declare to be Swedish-style.  The author’s failure to understand this results in the later statistics in the article being garbage:  Swedish Match’s share of the U.S. “snus” market is fairly meaningless when you have no idea what the author thinks constitutes the market.  I would guess it refers to all the products whose manufacturer happens to put “snus” on the label.  But that is kind of like looking at someone’s market share for “protein bars” by looking only at products with that phrase in their labeling, ignoring all the various “energy bars”, “nutrition bars”, etc. that are the same category.

The saving grace of the article, for me anyway, was the snarky first sentence.  I can imagine that Swedish Match and the other ST manufacturers who are not in the cigarette business get pretty annoyed at the rhetoric coming from some e-cigarette advocates that suggests e-cigarettes are better than ST because ST is part of “big evil tobacco” while e-cigarettes are independent.  So you can hardly blame them for sniping back.  What many e-cigarette advocates do not seem to realize is that ST (in Sweden, the USA, and elsewhere) was popular long before cigarettes and until fairly recently was dominated by manufacturers who were not in the cigarette business, though that changed with acquisitions and expansions of cigarette brands into smokeless.  (Sound familiar?)  While I am not going to go look up the numbers, it may already be that a larger portion of e-cigarettes sales than ST sales come from companies that also make cigarettes (and if not, it will probably be the case in a year).

My attention was called to that CNBC article by an e-cigarette blogger posting a note asking if anyone had written about snus before.  Really.  I am not trying to give this individual a hard time, because s/he is merely one example of a remarkable ignorance among the e-cigarette literati about where THR came from and why we can be confident it really works (and I want to make sure that individual gets credit for learning about it and writing something, though for obvious reasons I am pretty sure s/he does not read this blog and so will never see that).

Less forgivable still are supposed scientific experts who have embraced e-cigarette based THR without ever repenting for — or even correcting — their history of lies about ST.  The worst — but by no means only — of these is NJOY’s Richard Carmona, whose lies about ST when he was Surgeon General of the United States may have killed more people than any other single anti-THR liar.  He gets paid to tout e-cigarettes now, without ever having corrected or showed remorse for those lies.

All current THR products are great for public health, but no current product is a public health miracle.  ST proved that THR works, both in terms of reducing the health risks and having a large impact in at least one population.  E-cigarettes have proved that there was pent-up demand for THR in other populations, and that new products could serve some of that demand.  But despite optimism from a year or two ago, it seems unlikely that the current version of e-cigarettes will make a much greater a dent in smoking than ST does.  Sure, if the market were frozen now, both would continue to replace smoking and provide more public health benefits than the tobacco control industry could dream of providing.  But new products are needed — and fortunately are in development.

Each new low-risk product should be embraced for what it is (and understood for what it is not — e.g., if it is not quite as low risk as ST).  Inevitably, some companies and going to try to market their THR products at the expense of other THR products (and I am not just talking about pharma), and some bloggers are going to focus on the product aficionado niche.  But these represent a lack of genuine support for THR itself, and potentially harm the cause.  What’s say we all try to push back against this THR-vs-THR balkanization.

[Update:  Related to this, here is a presumably planted article touting PMI’s pending new THR products.  Notice, to their credit, that they do not suggest anything is wrong with the other THR products but merely note that they do not appeal to everyone.  I should also clarify that the Swedish Match planted article also did not denigrate e-cigarettes (except for that “big tobacco” reference).  This is the right path for us all to follow.]

Classic lie: US Surgeon General, 2003

posted by Carl V Phillips

Despite the temptation to focus this blog on the latest and most clever lies, we realize that there is probably more practical value in writing about some of the classic and really stupid lies.  It is painful to deal with the stupidest claims, over and over again, but not everyone has seen responses to them, so it is useful.

As a first foray into that, I will address the testimony of US Surgeon General Richard Carmona before the a House of Representatives subcommittee hearing on smokeless tobacco in 2003.  That is the one that came up in a recent post because it was used as an especially stupid source citation.

The US government was the dominant anti-THR liar when I first started documenting anti-THR lies a decade ago, and they currently hold that position.  The United Nations might or might not have edged them out for a while during the years in between, but the FDA has put them solidly in the lead again.  Long before the lies about e-cigarette chemistry research from FDA, Samet, at al. became the most-cited anti-THR lie, it was Carmona lying about smokeless tobacco.

There was good testimony given to that subcommittee too (that by Brad Rodu, John Kalmar, me, in particular), but no one cites that anymore.  And they should not cite it, unless they are interested in documenting historical thinking.  Research study results do not necessarily lose value over time, but old summaries and expert opinions cease to be relevant because knowledge changes over time.

Not that Carmona’s opinion was expert.  Far from it.  The core claim was:

No matter what you may hear today or read in press reports later, I cannot conclude that the use of any tobacco product is a safer alternative to smoking.

Someone really has to be clueless to make a claim like this.  Even the preamble clause is an embarrassment, saying, “no matter what evidence I hear, my conclusion will not change”.  But deadly lie is the rest.

It is rather difficult to believe that Carmona was actually so stupid as to believe that smokeless tobacco was not less harmful than cigarettes.  Realizing the truth did not take an expert, a genius, or even education about health science (and you might expect a Surgeon General testifying about a topic to have one or two of those characteristics).  Someone just had to know enough to reason, “let’s see: about half of the deaths from smoking are from lung diseases, and no one claims that smokeless tobacco causes any measurable risk for those; the only claim anyone ever makes about smokeless tobacco causing more risk than smoking is for oral cancer, and that would be in the order of 1% of the total risk worst case”.  A bit of grade school arithmetic will then get you to “I can conclude the use of smokeless tobacco is safer than smoking.”

As it turns out, there was already ample evidence and expert assessment that the risk was in the low-single-digit percent range compared to smoking.  There was already clear evidence that the hypothetical oral cancer risk did not exist to a measurable degree.  Indeed, there was (and is) no disease for which any measurable risk had been demonstrated for popular Western forms of smokeless tobacco.  Someone who knew the science would not have to resort to the rough-cut reasoning I proposed.  Still, even someone with only rudimentary knowledge of maths and the subject matter could use that reasoning to figure out that the risk was lower than for smoking.

This statement is not actually the stupidest thing in the testimony, though it is the only claim that is ever quoted (sometimes in a different form since the same basic claim was repeated multiple times — e.g., “Smokeless tobacco is not a safer substitute for cigarette smoking.”).  There is actually even clearer evidence that this guy — or whoever was putting words in his mouth — was a really poor thinker.

Let me start with a few statements that were once accepted throughout society that have now been relegated to the status of myth.

  • Men do not suffer from depression.
  • Domestic violence is a ‘family’ or ‘private’ matter.
  • The HIV-AIDS epidemic is of no concern to most Americans.

All of us here know that these three statements are very dangerous public health myths.  My remarks today will focus on a fourth public health myth which could have severe consequences in our nation, especially among our youth: smokeless tobacco is a good alternative to smoking. It is a myth. It is not true.

Think about the message here.  You can even set aside the really stupid list of historical “myths”, and the fact that one was a moral claim rather than a factual one, and thus cannot be called a myth, one of them was basically correct, and one of them was never really believed by experts.  (I will leave which is which as a simple exercise for the reader.)  Just consider his implicit logic:  “Some people have been wrong about things before, and that is a reason to believe that (a different group of) people are wrong about this.”

Of course, he was right about one thing:  The popular myth about the risks from smokeless tobacco did constitute a threat to public health.  But the popular belief was the very myth that he was espousing — that it is just as harmful as smoking, and therefore you might as well smoke.

The talk had a few other gems:

Each year, 440,000 people die of diseases caused by smoking or other form [sic] of tobacco use

This is another great example of the conjunction lie I noted previously — he could have said “…by smoking or other forms of tobacco use or gazing upon my face and turning to stone”, and it would still be accurate.  He was using word games to imply that some nontrivial part of that figure cited was the toll from smokeless tobacco.  Indeed, that figure was the official estimated toll from smoking alone, so he was actually saying that neither smokeless tobacco nor his gorgon-like powers were killing anyone.  That is a bit of accidental truth that is conveniently overlooked by the anti-THR liars who still quote this national embarrassment to this day.

It is difficult to not be reminded of another bit of testimony from the same year from another cabinet-level official, Colin Powell insisting that Iraq had weapons of mass destruction.  In later years, Powell has expressed serious regret and apology for making that claim, and it basically cost him his legacy as a respected statesman, though he deserves a lot of credit for the apology.  But whatever one thinks of Powell and the war, the key observation is this:  Who would be stupid enough, years later, to quote Powell’s testimony and say, “this testimony is evidence that there were WMDs in Iraq”?  And yet that is equivalent to what the anti-THR liars are doing when they quote Carmona’s embarrassing and false testimony a decade later.