State of the evidence in Swedish Tobacco Control 2016

Morning all!

There is currently a furious back and forth in commentary regarding Tobacco Control, Tobacco Harm Reduction, and Tobacco Companies, following an Op-Ed letter in the NEJM (New England Journal of Medicine)

This series of communications (by no means finished) is hugely important in light of Sweden, without any credible evidence, imposing even harsher regulations on the lifesaving product snus earlier in 2016.

This is quite insane and totally counter to even the most basic notions of evidence based policy. To the best of Swedish knowledge, and using the best currently available statistical methods, 50% of total tobacco sales in Sweden is combustible tobacco and causes >98% of tobacco related disease; whereas the other 50% is sold in food grade non combustible format and accounts for <2% (in all likelihood the real burden is around 0,1%) of total disease and mortality burden in Sweden.

This is a bit of a read, and you need to follow it through, but more than well worth the time it will take, all credits to the NEJM from which these open source communications are taken with gratitude.

This is how it goes: 1st (top) is the article that started the debate. Then come 2 commentaries from McKee and also Myers from Tobacco Free Kids. After that comes the reply to them from the authors of the original article. In support of the original article and in scathing critique of the critique made by McKee there is then a series of comments made on-line in the commentaries section of NEJM, this is where the real fun starts.

This debate is totally unthinkable in Sweden, in Sweden being a scientist and pro “snus” (the food grade smokeless stuff that makes up 50% of total tobacco sales in the entire country) is by definition being a Tobacco Industry lackey and in most cases a total career suicide.

Peer pressure and organized institutional denial is so great in Sweden, to save face, that challenging the current dogma will get you ostracized, your funding will get pulled, career advancement totally out of the question and job severance a quite real likelihood, probably without even putting a dent in the armor of Tobacco Harm Reduction denial dogma.

This of course is not a very attractive option, despite the chance to be a part of saving hundreds of million smokers from an early grave, so there are not many who are willing to pick up the gauntlet.

Why the title choice? Because the only relevant scientific discussion that could be utilized to actually achieve evidence based policy in Sweden, is from outside Sweden, and disqualified in Sweden.

So officially the state of evidence in Sweden is ZERO

Anyway:

First, here is the actual article by Sharon, Green, Bayer and Fairchild (Mailman School of Public Health, Columbia University, New York), and also an audio interview (well worth 10 minutes of your time) with Amy Fairchild on August 4th 2016

Evidence, Policy, and E-Cigarettes — Will England Reframe the Debate?

Sharon H. Green, M.P.H., Ronald Bayer, Ph.D., and Amy L. Fairchild, Ph.D., M.P.H.

N Engl J Med 2016; 374:1301-1303April 7, 2016DOI: 10.1056/NEJMp1601154

Audio Interview

Interview with Dr. Amy Fairchild on public health recommendations regarding electronic cigarettes in England and the United States.

Interview with Dr. Amy Fairchild on public health recommendations regarding electronic cigarettes in England and the United States. (10:53)

Tobacco-control advocates have been embroiled in a multiyear controversy over whether electronic cigarettes threaten the goal of further reducing tobacco smoking or offer the possibility of minimizing harm for people who cannot or will not quit smoking conventional cigarettes. England and the United States have now staked out very different positions.

The international landscape was dramatically reshaped in August 2015, when Public Health England (PHE), an agency of England’s Department of Health, released a groundbreaking report, “E-cigarettes: an evidence update.” With its claim that e-cigarettes are 95% less harmful than combustible cigarettes, the report attracted headlines internationally. It recommended that smokers who cannot or will not quit smoking tobacco try e-cigarettes and expressed great concern that the public perceived the two products as posing equal risks. Strikingly, the report underscored e-cigarettes’ potential to address the challenge of health inequalities, a central mission of PHE, stating that these devices “potentially offer a wide reach, low-cost intervention to reduce smoking and improve health in these more deprived groups in society where smoking is elevated.”1

The report — written by tobacco-addiction researcher Ann McNeill of King’s College London — reflected the position on e-cigarettes that had been agreed to by the U.K. public health community. Yet the editors of the Lancet asserted that though PHE claims to protect the nation’s health and well-being, it has failed to do so with this report. Two public health scholars writing in the BMJ also denounced the report, seizing on the methodologic limitations of one of the many studies on which the evidence review had relied, underlining the potential conflicts of interests acknowledged in the paper, and roundly condemning PHE for failing to meet basic evidentiary standards. Invoking the precautionary principle, the authors asserted that e-cigarette proponents bore the burden of proving that these products are not harmful. In contrast, 12 prominent U.K. public health organizations, including Cancer Research U.K. and the British Lung Foundation, defended PHE. Their joint press release underscored a public health responsibility to encourage smokers to switch to e-cigarettes, perhaps with the help of local smoking-cessation programs.

As dramatic as the report’s recommendations appear to be, they built on the United Kingdom’s long-standing commitment to harm reduction. In 1926, the Ministry of Health’s Rolleston Committee concluded that drug addiction was an illness that should be treated by physicians, sometimes with a minimal dose of drugs in order to prevent withdrawal symptoms. When AIDS came to the United Kingdom in the 1980s, the first government report on human immunodeficiency virus (HIV) infection among injection-drug users encouraged safer drug practices. Meanwhile, the United States took a prohibitionist position. Tight narcotic regulation and refusal to provide narcotics to addicts as treatment or maintenance defined the U.S. posture for decades.

Application of harm-reduction principles to tobacco products debuted in England in the 1970s, at the Institute of Psychiatry of the Maudsley Hospital. In 1976, Michael Russell, pioneer of effective nicotine-cessation treatments, famously wrote that “People smoke for nicotine but they die from the tar,”2 suggesting that one could satisfy a nicotine craving without risking the harms caused by smoking. Professional medical bodies in the United Kingdom endorsed a harm-reduction perspective. A 2007 report by the Tobacco Advisory Group of the Royal College of Physicians made the case that strategies to protect smokers were key, since nicotine addiction is difficult to overcome and millions of people fail to quit. That report argued “that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”3

Even before e-cigarettes became widely available, the venerable and influential antitobacco organization Action on Smoking and Health (ASH) embraced the development of nicotine products that could rival the nicotine-delivery power of combustible cigarettes. Fiercely opposed to the tobacco industry, ASH had for decades called for increasingly stringent policies to reduce the prevalence of tobacco smoking by imposing higher taxes, banning advertisements, and setting strict limits on smoking in enclosed settings. In 2014, an ASH review of the evidence concluded that fears of a “gateway effect” were unsubstantiated and that e-cigarettes were being used largely by current or former cigarette smokers. Because it found little evidence that nonsmoking bystanders could be harmed by the vapor from e-cigarettes, ASH opposed inclusion of e-cigarettes in public smoke-free laws. Reinforcing his organization’s commitment to harm reduction and the primary goal of assisting smokers who could not or would not give up cigarettes, ASH’s chairman, John Moxham, said, “It would be a public health tragedy if smokers were discouraged from switching to electronic cigarettes and vapers were encouraged to go back to smoking because they don’t understand that vaping is a lot less harmful than smoking. That really would cost lives.”4 Not surprisingly, ASH applauded the findings of the PHE report.

The dominant policy perspective in the United States serves as a foil to the one embraced in England. The Campaign for Tobacco-Free Kids — ASH’s U.S. equivalent and a powerful voice in anti-tobacco advocacy — has been unequivocal in its denunciations of e-cigarettes. Similarly, the Centers for Disease Control and Prevention hosted a Public Health Grand Rounds on e-cigarettes in which all five speakers focused on the possible health risks associated with e-cigarette use. None acknowledged a potential role for e-cigarettes in reducing the tobacco burden in marginalized populations or reducing health disparities. Given the tight focus on potential risks to children and nonsmokers, e-cigarettes were out of the question. But one powerful voice for enhanced tobacco control in the United States did support the PHE report. In December 2015, the Truth Initiative (formerly the American Legacy Foundation) declared in an organizational position paper, “If prudently regulated, we believe ENDS [electronic nicotine delivery systems] hold promise as one means to move smokers to a less harmful product and reduce the devastating death and disease burden caused by combustible tobacco products.”5

What distinguishes the harm-reduction approach taken in the PHE report from the more absolutist approach adopted by U.S. policymakers today is a matter of focus. In England, where leading medical organizations regard nicotine alone as relatively benign, the pressing need to reduce the risks for current smokers frames the debate. The overwhelming focus in the United States is abstinence. It is in this broader context that the focus on children and nonsmokers must be viewed.

Will England change the international conversation about e-cigarettes? The answer will depend, in part, on what the evolving evidence suggests, and it may take years before the answers are definitive. In the end, the sorts of policies that are implemented will depend on whether whoever dominates the debate views harm reduction as opportunity or anathema.

Here are the replies to the Editor of NEJM regarding the actual subject matter

CORRESPONDENCE

Evidence, Policy, and E-Cigarettes

N Engl J Med 2016; 375:e6August 4, 2016DOI: 10.1056/NEJMc1606395

To the Editor:

In their Perspective article in the April 7 issue,1 Green et al. argue that the English approach to e-cigarettes could reframe the debate on these products. They cite our article,2 implying that we were concerned about only one of the many studies in the Public Health England (PHE) review. That study was only one of our concerns, being the only source for the widely cited “95% safer” claim, especially given questions about conflicts of interest.3 We also discussed other evidence, some not quoted in the review, that raised serious questions about the safety of these products.4 Green et al. disregard the fact that harm reduction is only one element of a comprehensive drug strategy that, as in the successful Australian model, also encompasses reduction of demand and supply. It is misleading to suggest that there is a consensus on e-cigarettes in England, given that many members of the health community have continuing reservations.5 If we are to reframe the debate, maybe we should instead look to Australia, where adult smoking rates are now under 13%, without e-cigarettes.

 

Martin McKee, M.D., D.Sc.
London School of Hygiene and Tropical Medicine, London, United Kingdom

Dr. McKee reports that he chaired the Global Health Advisory Committee of the Open Society Foundations, which support and fund narcotics harm reduction. No other potential conflict of interest relevant to this letter was reported.

5 References

    1. 1

      Green SHBayer RFairchild AL. Evidence, policy, and e-cigarettes — will England reframe the debate? N Engl J Med 2016;374:1301-1303
      Free Full Text | Web of Science | Medline

    1. 2

      McKee MCapewell S. Evidence about electronic cigarettes: a foundation built on rock or sand? BMJ 2015;351:h4863-h4863
      CrossRef | Web of Science | Medline

    1. 3

      Gornall J. Public Health England’s troubled trail. BMJ 2015;351:h5826-h5826
      CrossRef | Web of Science | Medline

    1. 4

      Pisinger CDøssing M. A systematic review of health effects of electronic cigarettes. Prev Med 2014;69:248-260
      CrossRef | Web of Science | Medline

  1. 5

    British Medical Association. E-cigarettes. June 30, 2016 (https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/tobacco/e-cigarettes).

To the Editor:

Green, Bayer, and Fairchild misrepresent the position of the Campaign for Tobacco-Free Kids on e-cigarettes. From the beginning, our organization has called for the Food and Drug Administration (FDA) to regulate e-cigarettes. We have repeatedly stated that it is possible that e-cigarettes could benefit public health if they are properly regulated, shown to be effective at helping smokers quit smoking regular cigarettes completely, and responsibly marketed to smokers who cannot or will not otherwise quit.1,2 However, we have also raised legitimate concerns about the large and rapid increase in the use of e-cigarettes by young people in the United States and the irresponsible marketing of these products with the use of tactics similar to those long used to make regular cigarettes appealing to children.3 It is not by any definition “absolutist” to call for FDA regulation of e-cigarettes. Effective regulation by the FDA is critical to minimizing the risks posed by e-cigarettes and maximizing the potential benefits.

 

Matthew L. Myers, J.D.
Campaign for Tobacco-Free Kids, Washington, DC

No potential conflict of interest relevant to this letter was reported.

3 References

    1. 1

      Campaign for Tobacco-Free Kids. Comments submitted to the Food and Drug Administration on Docket No. FDA -2014-N-0189, RIN 0910-AG38, Proposed Rule on Deeming Tobacco Products to be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. August 8, 2014 (http://tfk.org/2014_08_14_deeming_comment).

    1. 2

      Campaign for Tobacco-Free Kids. Comments submitted to the Food and Drug Administration on Docket No. FDA-2014-N-1936: Electronic Cigarettes and the Public Health Workshop. July 2, 2015 (http://tfk.org/2015_07_02_cigarette_comments).

  1. 3

    Myers ML. Testimony to the Senate Committee on Commerce, Science, and Transportation. June 18, 2014 (https://www.commerce.senate.gov/public/_cache/files/719fb08c-fc96-4d6a-bb29-d5a80898857f/67FF5AFDCED948A4B19BE14ABCF06AFF.senate-commerce-hearing-myers-testimony-6-16-14.pdf).

 

Author replies to the critique by McKee and Myers

The authors reply: We agree with Myers regarding the need to regulate electronic cigarettes sensibly to protect public health. Rules and policies should encourage smokers to switch to lower-risk tobacco products while also preventing nonsmokers, particularly young people, from picking up these devices. Nevertheless, our intention was to contrast the broad public stances toward e-cigarettes held by major antitobacco organizations in the United Kingdom and the United States. In the United States, many advocacy organizations claim to support tobacco harm reduction but effectively endorse prohibition by regulation. Although Myers and the Campaign for Tobacco-Free Kids may believe in the potential for e-cigarettes to benefit public health if regulated properly, their messaging does not support the use of e-cigarettes for harm reduction in the ways that the U.K. Action on Smoking and Health (ASH) does. The Campaign focuses primarily on the prevention of hypothetical risks to nonsmoking children, whereas ASH’s emphasis is on improving the health of smokers who cannot or will not quit smoking cigarettes, which kill half of all long-term users, who lose more than 20 years of life, on average.

In response to McKee: we did not suggest that harm reduction is the only strategy to combat tobacco. Two of us (Bayer and Fairchild) have written extensively on laws, taxes, and campaigns to reduce the burden of tobacco. The focus in our recent article was on tobacco harm reduction, which should, of course, be implemented as part of a comprehensive drug strategy. McKee is correct in pointing out that there is not complete consensus in the United Kingdom regarding e-cigarettes, as we noted in our article. But what we underscored and what makes the United Kingdom exceptional is that many leading organizations support e-cigarettes for harm reduction. In fact, 12 prominent British organizations signed a press release supporting the PHE report. These organizations included the British Lung Foundation, Cancer Research UK, Faculty of Public Health, and the Royal College of Physicians.1

Sharon H. Green, M.P.H.
Ronald Bayer, Ph.D.
Amy L. Fairchild, Ph.D., M.P.H.
Columbia University Mailman School of Public Health, New York, NY

Since publication of their article, the authors report no further potential conflict of interest.

1 Reference

  1. 1

    Public Health England. E-cigarettes: an emerging public health consensus. September 15, 2015 (https://www.gov.uk/government/news/e-cigarettes-an-emerging-public-health-consensus).

 

Here begins the flurry of online commentary

Here are the teams playing (though playing is not an adequate term since we are quite literally talking about hundreds of millions smoker lives cut short by non availability of effective harm reduction means)

Pro Tobacco Harm Reduction (Bates and Stimson)

Anti Tobacco Harm Reduction (McKee, Chapman, Myers, Daube)

Clive Bates2016 Aug 20 11:09 a.m. (4 days ago)edited 1 of 1 people found this helpful

The author, Martin McKee, makes no less than five assertions in this short letter that demand correction:

First, that there was only one source for the claim that e-cigarettes are “95% safer” than smoking. In fact, this claim does not rely on a single source but is the consensus view of Public Health England’s expert reviewers [1] and a close variation on this claim is the consensus view of the Tobacco Advisory Group of the Royal College of Physicians and is endorsed by the College [2]:

Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure. (Section 5.5 page 87)

Second, that PHE’s work was in some way compromised by McKee’s “concerns about conflicts of interest“. To support this largely self-referential claim, he cites a piece of very poor journalism in which every accusation was denied or refuted by all involved. Please see Gornall J, 2015 including my PuBMed Commons critique of this article and a more detailed critique on my blog [3].

Third, that “other evidence, some not quoted in the review, raised serious questions about the safety of these products“. The citation for this assertion is Pisinger C, 2014. This review does not, in fact, raise any credible questions about the safety of these products, and suffered numerous basic methodological failings. For this reason, it was reviewed but then ignored in the Royal College of Physicians’ assessment of e-cigarette risk [2 – page 79]. Please see the PubMed Commons critiques of this paper [4].

Fourth, that adult smoking prevalence in Australia is “below 13%, without e-cigarettes”. Both parts of this claim are wrong. The latest official data shows an adult smoking prevalence of 16.0% in Australia [5]. No citation was provided by the author for his claim. E-cigarettes are widely used in Australia, despite a ban on sales of nicotine liquids. Australians purchase nicotine-based liquids internationally over the internet or buy on a thriving black market that has been created by Australia’s wholly unjustified de facto prohibition.

Fifth, that we “should look to Australia” for tobacco policy inspiration. We certainly should not. Australia has a disturbingly unethical policy of allowing cigarettes to be widely available for sale but tries to deny its 2.8 million smokers access to much safer products by banning nicotine-based e-cigarettes. These options have proved extremely popular and beneficial for millions of smokers in Europe and the United States trying to manage their own risks and health outcomes. Further, the author should consider the harms that arise from Australia’s anti-smoking policies in their own right, such as high and regressive taxation and stigma that arises from its campaigns to denormalise smoking.

If the author wishes to find a model country, he need not travel as far as Australia. Sweden had a smoking prevalence of 11% in 2015 – an extreme outlier in the European Union, which averages 26% prevalence on the measure used in the only consistent pan-European survey [6]. The primary reason for Sweden’s very low smoking prevalence is the use of alternative forms of nicotine (primarily snus, a smokeless tobacco) which pose minimal risks to health and have over time substituted for smoking. This exactly what we might expect from e-cigarettes and, given the recent sharp falls in adult and youth smoking in both the UK and the US, this does seem likely. Going with grain of consumers’ preferences represents a more humane way to address the risks of smoking than the battery of punitive and coercive policies favoured in Australia.

Though not an expert in nicotine policy or science, the author is a prolific commentator on the e-cigarette controversy. If he wishes to raise his game, he should start by reading an extensive critique of his own article in the BMJ (McKee M, 2015), which is at once devastating, educational, and entertaining [7].

References

[1] McNeill A. Hajek P. Underpinning evidence for the estimate that e-cigarette use is around 95% safer than smoking: authors’ note, 27 August 2015 [link]

[2] Royal College of Physicians (London) Nicotine without smoke: tobacco harm reduction 28 April 2016 [link]

[3] Bates C. Smears or science? The BMJ attack on Public Health England and its e-cigarettes evidence review, November 2015 [link]

[4] Pisinger C, 2014 Bates C. comment [here] and Zvi Herzig [here]

[5] Australian Bureau of Statistics, National Health Survey: First Results, 2014-15. Table 9.3, 8 December 2015 [link to data]

[6] European Commission, Special Eurobarometer 429, Attitudes of Europeans towards tobacco, May 2015 [link] – see page 11.

[7] Herzig Z. Response to McKee and Capewell, 9 February 2016 [link]

Competing interests: I am a longstanding advocate for ‘harm reduction’ approaches to public health. I was director of Action on Smoking and Health UK from 1997-2003. I have no competing interests with respect to any of the relevant industries.

 

  • Gerry Stimson2016 Aug 21 3:51 p.m. (3 days ago)

    Clive Bates (below) identifies five assertions by Martin McKee that need correction: there are two more, making seven in McKee’s eleven lined letter.

    First, McKee states that ‘It is misleading to suggest that there is a consensus on e-cigarettes in England, given that many members of the health community have continuing reservations’ and quotes one short BMA statement that calls for medical regulation of e-cigarettes.

    He ignores the ‘public health consensus statement’ from English public health, medical, cancer and tobacco control organisations that supports e-cigarettes for quitting smoking. The consensus statement says that ‘We all agree that e-cigarettes are significantly less harmful than smoking.’ [1, 2]. The first edition of this statement [1] explicitly challenges McKee’s position on the evidence. The consensus statement is endorsed by Public Health England, Action on Smoking and Health, the Association of Directors of Public Health, the British Lung Foundation, Cancer Research UK, the Faculty of Public Health, Fresh North East, Healthier Futures, Public Health Action, the Royal College of Physicians, the Royal Society for Public Health, the UK Centre for Tobacco and Alcohol Studies and the UK Health Forum. McKee and the BMA are minority outliers in England and the UK.

    The PHE report on e-cigarettes faced a backlash but this was from a few public health leaders including McKee who organised a behind-the-scenes campaign against the report including a critical editorial and comment in the Lancet, and an editorial in the BMJ backed up by a media campaign hostile to PHE. Emails revealed as a result of a Freedom of Information request show that this backlash was orchestrated by McKee and a handful of public health experts [3, 4].

    Second, McKee misrepresents and misunderstands drugs harm reduction. He cites Australia, and it was indeed in Australia (as in the UK) that the public health successes in preventing the spread of HIV infection and other adverse aspects of drug use were driven by harm reduction – including engaging with drug users, outreach to drug users, destigmatisation, provision of sterile needles and syringes, and methadone [5, 6, 7]. Drugs harm reduction was a public health success [4, 6]. The UK and other countries that implemented harm reduction avoided a major epidemic of drug related HIV infection of the sort that has been experienced in many countries. Drugs harm reduction was implemented despite drugs demand and supply and reduction measures, not as McKee asserts because it was part of a combined strategy including supply demand and supply reduction. McKee’s position is out of step with the Open Society Institute, of which he chairs the Global Health Advisory Committee; OSI has resourced drugs harm reduction and campaigns against the criminalisation of drugs ie those demand and supply reduction measures that maximise harm.

    1 Public health England (2015) E-cigarettes: a developing public health consensus. https://www.gov.uk/government/news/e-cigarettes-an-emerging-public-health-consensus

    2 Public health England (2016) E-cigarettes: a developing public health consensus. https://www.gov.uk/government/publications/e-cigarettes-a-developing-public-health-consensus

    3 Puddlecote D, (2016/) Correspondence between McKee and Davies Aug 15 to Oct 15. https://www.scribd.com/doc/296112057/Correspondence-Between-McKee-and-Davies-Aug-15-to-Oct-15. Accessed 07 03 2016

    4 Stimson G V (2016) A tale of two epidemics: drugs harm reduction and tobacco harm reduction, Drugs and Alcohol Today, 16, 3 2016, 1-9.

    5 Berridge V (1996) AIDS in the UK: The Making of Policy, 1981-1994. Oxford University Press.

    6 Stimson G V (1995) AIDS and injecting drug use in the United Kingdom, 1988-1993: the policy response and the prevention of the epidemic. Social Science and Medicine, 41,5, 699-716

    7 Wodak A, (2016) Hysteria about drugs and harm minimisation. It’s always the same old story. https://www.theguardian.com/commentisfree/2016/aug/11/hysteria-about-drugs-and-harm-minimisation-its-always-the-same-old-story

Simon Chapman2016 Aug 21 9:05 p.m. (3 days ago)

Clive Bates’ efforts to correct points made in Martin McKee’s letter in turn require correction and comment. Bates disputes that there was not a single source for the claim that e-cigarettes are “95% safer” than smoking (in fact Public Health England stated “95% less harmful” [1], a critical difference). Bates cites two references in support of his claim, but both of these are nothing but secondary references, with both citing the same Nutt et al [2] 95% less harmful estimate as their primary source.

Two toxicologists have written an excoriating critique of the provenance of the “95% less harmful” statement, describing its endorsement as “reckless”[3] and nothing but the consensus of the opinions of a carefully hand-picked group. The 95% estimate remains little more than a factoid – a piece of questionable information that is reported and repeated so often that it becomes accepted as fact.

We will not have an evidence-based comparison of harm until we have cohort data in the decades to come comparing mortality and morbidity outcomes from exclusive smokers versus exclusive vapers and dual users. This was how our knowledge eventually emerged of the failure other mass efforts at tobacco harm reduction: cigarette filters and the misleading lights and milds fiasco.

Bates challenges McKee’s statement that Australian smoking prevalence is “below 13%” and cites Australian Bureau of Statistics (ABS) data from 2014-15 derived from a household survey of 14,700 dwellings that shows 16% of those aged 18+ were “current” smokers (14.5% smoking daily). McKee was almost certainly referring to 2013 data from the Australian Institute of Health and Welfare’s (AIHW) ongoing national surveys based on interviews with some 28,000 respondents which showed 12.8% of age 14+ Australians smoked daily, with another 2.2% smoking less than daily[4]. The next AIHW survey will report in 2017 and with the impact of plain packaging, several 12.5% tobacco tax increases, on-going tobacco control campaigning and a downward historical trend away from smoking, there are strong expectations that the 2017 prevalence will be even lower.

Bates cites a 2015 report saying that Sweden has 11% smoking prevalence. This figure is almost certainly daily smoking prevalence data, not total smoking prevalence that Bates insists is the relevant figure that should be cited for Australia. If so, the comparable figure for Sweden should also be used. In 2012 the Swedish Ministry of Health reported to the WHO that 22% of Swedish people aged 16-84 currently smoked (11% daily and 11% less than daily) [5]. It is not credible that Sweden could have halved its smoking prevalence in three years.

Meanwhile, England with current smoking prevalence in 2015 of 18.2% in July 2016 [6 – slide 1] trails Australia, regardless of whether the ABS or AIHW data are used. Also, the proportion of English smokers who smoked in the last year and who tried to stop smoking is currently the lowest recorded in England since 2007 [6 slide 4].

Bates says that the UK and the USA where e-ecigarette use is widespread have seen “recent sharp falls” in smoking prevalence. In fact in smoking prevalence has been falling in both nations for many years prior to the advent of e-cigarettes, as it has in Australia where e-cigarettes are seldom seen. Disturbingly in the USA, the decline in youth smoking has come to a halt after 2014 [7], following continuous falls for at least a decade – well before e-cigarette use became popular. The spectacular increase in e-cigarette use in youth particularly between 2013-2015 (see Figure 1 in reference 7] was either coincident or possibly partly responsible with that halting.

Finally Bates makes gratuitous, unreferenced remarks about “harms” arising from Australia’s tobacco tax policy and “campaigns to denormalise smoking”. There are no policies or campaigns to denormalise smoking in Australian that are not also in place in the UK or the USA, as well as many other nations. When Bates was director at ASH he vigourously campaigned for tobacco taxes to be high and to keep on increasing [8]. His current views make an interesting contrast with even the CEO of British American Tobacco Australia who agrees that tax has had a major impact on reducing smoking, telling an Australian parliamentary committee in 2011 “We understand that the price going up when the excise goes up reduces consumption. We saw that last year very effectively with the increase in excise. There was a 25 per cent increase in the excise and we saw the volumes go down by about 10.2 per cent; there was about a 10.2 per cent reduction in the industry last year in Australia.” [9].

References

1 Public Health England. E-cigarettes: a new foundation for evidence-based policy and practice. Aug 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454517/Ecigarettes_a_firm_foundation_for_evidence_based_policy_and_practice.pdf

2 Nutt DJ et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res 2014;20:218-25.

3 Combes RD, Balls M. On the safety of e-cigarettes.: “I can resists anything except temptation.” ATLA 2015;42:417-25. https://www.researchgate.net/publication/289674033_On_the_Safety_of_E-cigarettes_I_can_resist_anything_except_temptation1

4 Australian Institute of Health and Welfare. National Drug Household Survey. 2014 data and references. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548784

5 Swedish Ministry for Health and Social Affairs. Reporting instrument of the WHO Framework Convention on Tobacco Control 2012 (13 April)http://www.who.int/fctc/reporting/party_reports/sweden_2012_report_final_rev.pdf

6 Smoking in England. Top line findings STS140721 5 Aug 2016 http://www.smokinginengland.info/downloadfile/?type=latest-stats&src=13(slide 1)

7 Singh T et al. Tobacco use among middle and high school students — United States, 2011–2015. http://www.cdc.gov/mmwr/volumes/65/wr/mm6514a1.htm MMWR April 15, 2016 / 65(14);361–367

8 Bates C Why tobacco taxes should be high and continue to increase. 1999 (February) http://www.ash.org.uk/files/documents/ASH_218.pdf

9 The Treasury. Post-implementation review: 25 per cent tobacco excise increase. Commonwealth of Australia 2013; Feb. http://ris.dpmc.gov.au/files/2013/05/02-25-per-cent-Excise-for-Tobacco.doc p15

  • Clive Bates2016 Aug 22 02:45 a.m. (2 days ago)edited 1 of 1 people found this helpful

    Some responses to Professor Simon Chapman:

    1. Professor Chapman criticises the Public Health England and Royal College of Physicians consensus on the relative risk of smoking and e-cigarette use by referring to a comment piece Combes RD, 2015 in the journal Alternatives to Laboratory Animals. The piece is written by a commentator who’s affiliation is an animal welfare rights campaign (FRAME), for which ATLA is the house journal, and an independent consultant. How these two came to be writing about e-cigarettes at all is not stated, but this is less important than the fact that their commentary provides little of substance to challenge the robust expert-based PHE and RCP analysis, and it provides even less to justify the colourful dismissive pull-out quotes chosen by Professor Chapman. Even though the work can be dismissed on its merits, surely the authors should have disclosed that FRAME has pharmaceutical funders [Our supporters], including companies who make and sell medical smoking cessation products.
    2. Professor Chapman confirms my view that the appropriate statistic to use for comparing Australian prevalence of current smoking is 16.0 percent based on the Australian Bureau of Statistics, National Health Survey: First Results, 2014-15 (see table 9.3). This is the latest data on the prevalence of current adult smoking.
    3. Unless it’s to make the numbers look as low as possible, I am unsure why Professors Chapman and McKee choose to refer to a survey from 2013 or why Professor Chapman didn’t disclose in his response that he is citing a survey of drug use, including illicit drug use: [see AIHW, National Drug Strategy Household Survey detailed report 2013]. Surely a neutral investigator would be concerned that a state-run survey asking about illicit drug use might have a low response rate? And further, that non-responders would be more likely to be drug users, and hence also more likely to be smokers – so distorting the prevalence systematically downwards? In fact, the response rate in this survey is just 49.1% [Explanatory notes]. While this might be the best that can be done to understand illicit drug use, it is an unnecessarily unreliable way to gauge legal activity like smoking, especially as a more recent and more reliable survey is available.
    4. The figure of 11% given for smoking in Sweden is not ‘daily smoking’ as asserted by Professor Chapman. With just a little more research before rushing out his reply, Professor Chapman could have checked the source and link I provided. The question used is: “Regarding smoking cigarettes, cigarettes, cigars, cigarillos or a pipe, which of the following applies to you?” 11% of Swedes answer affirmatively to the response: “You currently smoke“.
    5. If we are comparing national statistics, it is true that measured smoking prevalence in Britain is a little higher than in the Australia – the latest Office for National Statistics data suggests 17.5 percent of adults age 16 and over were current smokers in 2015 (derived from its special survey of e-cigarette use: E-cigarette use in Great Britain 2015). So what? The two countries are very different both today and in where they have come from and many factors explain smoking prevalence – not just tobacco control policy. But if one is to insist on such comparisons, official data from the (until now) vape-friendly United States suggests that American current adult smoking prevalence, at 15.1 percent, is now below that of Australia [source: National Center for Health Statistics, National Health Interview Survey, 1997–2015, Sample Adult Core component. Figure 8.1. Prevalence of current cigarette smoking among adults aged 18 and over: United States, 1997–2015]
    6. Regressive taxes are harmful and so is stigmatisation – I shouldn’t need to reference that for anyone working in public health. Any thoughtful policy maker will not only try to design policies that achieve a primary objective (reduce the disease attributable to smoking) but also be mindful that the policies themselves can be a source of harm or damaging in some other way. Ignoring the consequences of tobacco policies on wider measures of wellbeing is something best left to fanatics. In public health terms, these consequences may be considered ‘a price worth paying’ to reduce smoking, but they create real harms for those who continue to smoke, and in my view, those promoting them have an ethical obligation to mitigate these wider harms to the extent possible.
    7. The approach, favoured by me and many others, of supporting (or in Australia’s case of not actively obstructing) ways in which smokers can more easily move from the most dangerous products to those likely to cause minimal risk has twin advantages:
    • (1) it helps to achieve the ultimate goal of reducing cancer, cardiovascular disease, and respiratory illnesses by improving the responsiveness of smokers to conventional tobacco control policy. It does this by removing the significant barrier of having to quit nicotine completely, something many cannot do easily or choose not to do.
    • (2) It does this in a way that goes with the grain of consumer preferences and meets people where they are. This is something for public health to rediscover – public health should be about ‘enabling’, not bullying or nannying, and go about its business with humility and empathy towards those it is trying to help.

 

  • Clive Bates2016 Aug 22 10:52 a.m. (2 days ago) 1 of 1 people found this helpful

    As an aside, it’s disappointing to see Professor Chapman spreading doubt about e-cigarettes with reference to the filters and ‘light and mild’ cigarette fiasco (see the 1999 report by Martin Jarvis and me on this fiasco). This ‘science-by-analogy’ fails because it misunderstands the nicotine-seeking behaviour that underpins both smoking and vaping.

    With light and mild cigarettes, health activists were fooled into believing that these cigarettes would much be less risky, even though they are no less risky. It would be wrong to compound this error by implying that e-cigarettes are not much less risky, even though they are sure to be.

    The underlying reason for both errors is the same – nicotine users seek a roughly fixed dose of nicotine (a well-understood process, known as titration). If a vaper can obtain their desired nicotine dose without exposure to cigarette smoke toxins, then they will not suffer the smoking-related harms. With light and mild cigarettes, both nicotine and toxins were diluted equally with air to fool smoking machines. However, human smokers adjusted their behaviour to get the desired dose of nicotine and so got almost the same exposures to toxins. This is another well-understood process known as ‘compensation’. I am sure a global authority of Professor Chapman’s stature would be aware these mechanisms, so it is all the more perplexing that he should draw on this analogy in his campaign against e-cigarettes.

  • As part of his lengthy and personalised attacks on Martin McKee, Clive Bates argues that “we certainly should not” look to Australia for policy inspiration.

    This view, and some of his other comments, would have strong support from the global tobacco industry, which has ferociously opposed the evidence-based action to reduce smoking taken by successive Australian governments, and reports that we are “the darkest market in the world”. (1)

    No doubt Mr Bates will be able to discuss these issues further with tobacco industry leaders at the Global Tobacco & Nicotine Forum (“the annual industry summit”) in Brussels later this year, where as in previous years he is listed as a speaker.(2)

    References 1. Brisby D, Pramanik A, Matthews P, Kutz O, Kamaras A. Imperial Brands PLC Investor Day: Jun 8 2016. Transcript – Quality Growth: Returns and Growth – Markets that Matter [p.6] & Presentation Slides – Quality Growth: Returns and Growth – Markets that Matter . http://www.imperialbrandsplc.com/Investors/Results-centre.

    1. http://gtnf-2016.com/

 

 

  • Clive Bates2016 Aug 24 1:56 p.m. (11 hours ago) 1 of 1 people found this helpful

    In response to Professor Daube, I am pleased to have the opportunity to explain a different and less authoritarian approach to the public health challenges of smoking.

    1. But let me start with a misunderstanding. Professor Daube accuses me of a personal attack on Professor McKee. In fact, I made five specific substantive comments on Professor McKee’s short letter, to which Professor Stimson added a further two. These are corrections of fact and understanding, not a ‘personal attack’. It is important that academics understand and recognise this distinction.
    2. Professor Daube draws the reader’s attention to a link to an investor presentation by Imperial Tobacco. I am unsure what point he is trying to make. Nevertheless, the presentation paints a rosy picture of life in Australia for this tobacco company: it is “on track” (p6); it has “continued strong performance in Australia” (p15); in Australia it is “continuing to perform strongly – JPS equity driving share, revenue and profit growth” (p31). It may be a hard pill to swallow, but tobacco companies in Australia are very profitable indeed, in part because the tax regime allows them to raise underlying pre-tax prices easily. It’s a common error of activists to believe that harm to tobacco companies is a proxy for success in tobacco control (an idea sometimes known as ‘the scream test’. If it that was the case, the burgeoning profitability of tobacco companies would be a sign of utter failure in tobacco control [1].
    3. In any event, my concerns are not about the welfare of the tobacco industry in Australia or anywhere else. My concern, as I hope I made clear in my response to Professor Chapman, is the welfare of the 2.8 million Australians (16% adults) who continue to smoke despite Australia’s tobacco control efforts. For them, the serious health risks of smoking are compounded by some Australian tobacco control policies that are punitive (Australia is not alone in this) while denying them low-risk alternatives. All the harms caused by both smoking and anti-smoking policies can be mitigated and the benefits realised by making very low-risk alternatives to combustible cigarettes (for example, e-cigarettes or smokeless tobacco) available to smokers to purchase with their own money and of their own volition. Professor Daube apparently opposes this simple liberal idea.
    4. Professor Daube finishes his contribution with what I can only assume is an attempted smear in pointing out that I sometimes speak at conferences where the tobacco industry is present, as if this is, a priori, an immoral act. I speak at these events because I have an ambitious advocacy agenda about how these firms should evolve from being ‘merchants of death’ into supplying a low-risk recreational nicotine market, based on products that do not involve combustion of tobacco leaf, which the source of the disease burden. So I have a public health agenda – the formation of a market for nicotine that will not kill one billion users in the 21st Century, and that will perhaps avoid hundreds of millions of premature deaths [2]. There is a dispute about how to do this, and no doubt Professor Daube has ideas, but the policy proposals for the so-called ‘tobacco endgame’ advanced by tobacco control activists do not withstand even cursory scrutiny [3]. The preferred approach of advocates of ‘tobacco harm reduction’, among which I include myself, involves a fundamental technology transformation, a disruptive process that has started and is synergistic with well-founded tobacco control policies [4]. If, like me, you wish to see a market change fundamentally, then it makes sense to talk to and understand every significant actor in the market, rather than only those who’s convictions you already share.

    References & further reading

    [1] Bates C. Who or what is the World Health Organisation at war with? The Counterfactual, May 2016 [link].

    [2] Bates C. A billion lives? The Counterfactual, November 2015 [link] and Bates C. Are we in the endgame for smoking? The Counterfactual, February 2015 [link]

    [3] Bates C. The tobacco endgame: a critique of the policy ideas. The Counterfactual, March 2015 [link]

    [4] Bates C. A more credible endgame – creative destruction. The Counterfactual, March 2015 [link].

    As I think Professor Daube’s comment is laden with defamatory innuendo, let me repeat the disclosure statement from my initial posting:

    Competing interests: I am a longstanding advocate for ‘harm reduction’ approaches to public health. I was director of Action on Smoking and Health UK from 1997-2003. I have no competing interests with respect to any of the relevant industries.

 

 

“Snusforskning” i Sverige, oredlighet “in extremis”?

Systemiskt redlighetsbekymmer inom svensk Tobaksforskning sedan 1980 / WHO FCTC COP 7 14-16 Nov 2016

Bästa Herrar XXX, YYY och ZZZ,

Jag heter Atakan Erik Befrits och skriver till Er med anledning av den alldeles utmärkta artikeln i Dagens Nyheter. Det var otroligt uppfriskande och glädjande att uttalat få läsa att allvarliga forskningsproblem kan bestå i annat än rent tekniskt fusk.
Får jag vördsamt be er om 20 minuter av er tid att läsa nedan, flera hundra miljoner förtida dödsfall av rökning kan kanske undvikas, Tack!
“Vetenskaplig oredlighet innefattar handlingar eller underlåtelser i samband med forskning, vilka leder till falska eller förvrängda forskningsresultat eller ger vilseledande uppgifter om en persons insats i forskningen. För ansvar krävs att den vetenskapliga oredligheten begåtts uppsåtligen eller av grov oaktsamhet.” (Förslag från VR till ny skrivning)
Jag arbetar internationellt med “Tobacco Harm Reduction”.
”THR” har i form av snus i Sverige och e-cigaretter i EU och USA, visat sig väsentligen snabbare och effektivare alternativ bort från cigarettrökning än samtliga övriga interventioner sammantagna. Inte heller är de på något vis ”mutually exclusive”, och utan negativa ”gateway” effekter, tvärtom.
Då dessa cigarett-interventioner är helt separata från Public Health, och helt utan direkt kostnad för samhället (positivt skattenetto), kan man fråga sig om det överhuvud taget är etiskt försvarbart att ”Public Health” aktivt med näbbar, klor och direkta lögner motverkar förespråkande av interventionen?
Sveriges 300,000 snusande före detta rökare torde generera en samhällsbesparing på 3,600 färre dödsfall per år och 9 miljarder SEK i minskade kostnader. (Sveriges 1 miljon resterande rökare beräknas kosta 30 Miljarder per år).
Att hävda, eller ens låta påskina att dessa 300,000, eller ens en försvarlig del av dessa 300,000, vore helt rökfria om snus inte funnits, är naivt och rimligen bedrägligt och oetiskt.
Allvarliga skador av snus hos de ca 700,000 exklusiva snusare i Sverige har heller inte kunnat beläggas eller identifieras i klinisk verksamhet på över 150 år.
Sverige är det enda landet globalt där tydliga risk och hälsoekonomisk kalkyler kan göras med över 100 år av data, eller brist på data, beroende på hur man ser det, Sverige har alltså ett helt unikt ansvar, ett ansvar vi underlåtit att reflektera övergripande kring i över 30 år.
Problematiken är otroligt enkel:
  • Byte från cigaretter till snus ger helt tveklöst en riskminskning på 98% per uppmätt enhet (ej möjlig att skilja från rökslut/rökminskning)
  • Snusanvändning som separat företeelse ger en risk för skada/förtida död som är maximalt 2% av den som rökning hade medfört (ej mätbar)
  • Public Health England har som spjutspetsorgan tydligt vägt risken med e-cigarett till maximalt 5% av risken med rökning
  • Sverige har en officiell linje (2016 lagstadgad då KI vägrar lämna data) att snus är vetenskapligt bevisat farligt (har biverkningar?) och därmed absolut inte får användas för att uppnå sk ”Harm Reduction”, trots att 12,000 svenskar dör av rökning och statistiskt sett 0 svenskar dör av snus
  • Problemet är inte i Sverige där alla vet att det ljugs om snus, problemet är internationellt där folkhälsomyndigheter tar informationen från Svenska myndigheter som ”gold standard” och agerar på den givna informationen
  • Nationalekonomiska institutioner och HUI har sedan mer än 30 år färdiga beräkningar som visar att snus har i praktiken noll hälsoeffekt för aldrigrökare och samma effekt för rökare som totalt rökstopp. Punkt.
  • Ingen offentlig hälsoekonomisk beräkning/uppskattning har någonsin genomförts. Ej Socialstyrelsen, Ej Folkhälsomyndigheten, Ej TLV, Ej SBU och Ej inom hälsoekonomi från KI – av uttalat politiska skäl, det finns ingen orsak att räkna på vad vi bestämt att vi inte skall erkänna som ett alternativ. “Policy based evidence making” alltså.
Orsaken att jag skriver till Er denna Lördagsmorgon är att jag söker råd, dåd och stöd för hur att åstadkomma en visselblåsarsituation som kan ha möjlighet att påverka den nämnda globala konferensen i New Delhi i November 2016. Jag hoppas bidra till att en rimlighetsbild framkommer som kan till stor del undvika en till stor del undvikbar global folkhälsokatastrof.
Sverige kommer tveklöst (med stöd av frivilligorganisationer från USA), utan ändring, att återigen förstärka och meddela de länder där 80% av världens ca 1 miljard dagligrökare lever, och rökning fortfarande växer snabbt, att byte till lågriskprodukter är ett helt oacceptabelt och bevisat farligt alternativ till rökning.
 
En Svensk delegationen till WHO COP 6 i Moskva skrev 2014 på en deklaration som jämställer svenskt snus med indisk betelnöt och sudanesisk toombak, möjligen den enskilt mest oetiska handling som någon företagits utan att svenska forskare vågat larma om att proportioner helt saknas.
Årets konferens är tänkt att bli en slutstation för lågriskprodukter – de skall bort! Tanken är att endast cigaretter och farmaceutiska produkter (93% failure rate) skall finnas på marknaden, utöver psykosocialt stöd och denormalisering, till dess den siste rökaren har slutat eller avlidit.
Enligt WHO’s egna beräkningar kommer den föreslagna linjen inbegripa ca 1 miljard förtida dödsfall innan år 2100 av rökning, men att det samtidigt är den tveklöst bästa metoden och den enda metoden som över huvud taget är acceptabel.
 
En växande grupp internationella forskare som är oerhört kritiska till Sverige håller inte med om detta, och är övertygade om att en mer sanningsenlig ”forskningslägesangivelse” från Sverige har en reell potential att ändra det globala tobaksarbetet radikalt i positiv riktning.
Får jag vördsamt be om 15 minuter var av er tid till att snabbt skumma igenom följande brev. Ett till Folkhälsominister Maria Larsson från 2013 och ett till WHO Director General Margaret Chan från 2014. Brevet till Maria Larsson ledde till ett Regeringsbeslut som ålade KI, Socialstyrelsen och Folkhälsomyndigheten att bland annat klart redovisa läget kring skador och kostnader av snus. De duckade helt snusfrågan (Då skadorna statistiskt är noll) och har ännu inte återkommit med någon gissning.
Härav är krissituationen inför COP 7 möjlig. Den hade den inte varit möjlig med siffran 95% från Public Health England i kombination med siffran +98% om snus från KI.
Klara besked från Sverige kan alltså leda till ett ”Nödstopp” kring harm reduction utan att påverka kampen mot rökning, dubbel vinst alltså.
Finns där något att göra?
För enkelhet i referenskontroll finns ett antal undertecknare till det öppna brevet till WHO listade nedan. Jag är alltså inte en ensam knäppskalle.
Stort tack på förhand och med vänliga hälsningar
Atakan Erik Befrits
Fristående Tobaksforskare
Global Forum on Nicotine
0046 764 156046
COI: Emottager ingen betalning eller ersättning för mitt arbete men stödjer den krävande principen om ”Harm Reduction” strategier så som uttalade i FCTC (Tobakskonventionen) Artikel 1 (Use of terms), punkten d:
 
(d) “tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke;
 
Snus sänker risken/skadan av tobaksbruk med +98%. Sänker vikten konsumerad tobak med 50%. Sänker egen och annans ”exposure to tobacco smoke” med 100%, på vilket sätt passar det inte in i kategorin “harm reduction” kan man med fog fråga sig.

Signatories 26 May 2014

Dr Derek Yach

Former Executive Director, Non- Communicable Diseases
Former Head of Tobacco Free Initiative, World Health Organisation (1995-2004) 

Senior Vice President Vitality Group plc Director, Vitality Institute for Health Promotion

United States of America

Professor Dan Xiao

Director of Department Epidemiology WHO Collaborating Center for Tobacco or Health
Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital,
China

Professor Robert West

Professor of Health Psychology and Director of Tobacco Studies
Health Behaviour Research Centre, Department of Epidemiology & Public Health,

University College London United Kingdom

Professor David Abrams

Professor of Health Behavior and Society. The Johns Hopkins Bloomberg School of Public Health. Maryland. USA.
Professor of Oncology (adjunct). Georgetown University Medical Center, Lombardi Comprehensive Cancer Center. Washington DC.

United States of America

Professor Tony Axéll

Emeritus Professor Geriatric Dentistry Consultant in Oral Medicine
Sweden

Professor Pierre Bartsch

Respiratory physician, Faculty of Medicine University of Liège Belgium

Professor Linda Bauld

Professor of Health Policy
Director of the Institute for Social Marketing Deputy Director, UK Centre for Tobacco and Alcohol Studies
University of Stirling
United Kingdom

Professor Ron Borland

Nigel Gray Distinguished Fellow in Cancer Prevention at Cancer Council Victoria Professorial Fellow School of Population Health and Department of Information Systems

University of Melbourne, Australia

Professor John Britton

Professor of Epidemiology;
Director, UK Centre for Tobacco & Alcohol Studies,
Faculty of Medicine & Health Sciences University of Nottingham,
United Kingdom

Associate Professor Chris Bullen

Director, National Institute for Health Innovation
School of Population Health, University of Auckland,

New Zealand

Professor Emeritus André Castonguay

Faculty of Pharmacy Université Laval, Quebec,
Canada.

Dr Lynne Dawkins

Senior Lecturer in Psychology, Co-ordinator: Drugs and Addictive Behaviours Research Group School of Psychology,

University of East London, United Kingdom

Professor Ernest Drucker

Professor Emeritus
Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine
Mailman School of Public Health
Columbia University
United States of America

Professor Jean François Etter

Associate Professor Institut de santé globale, Faculté de médecine, Université de Genève, Switzerland

Dr Karl Fagerström

President, Fagerström Consulting AB, Vaxholm,
Sweden

Dr Konstantinos Farsalinos

Researcher, Onassis Cardiac Surgery Center, Athens, Greece
Researcher, University Hospital Gathuisberg, Leuven,

Belgium

Professor Antoine Flahault

Directeur de l’Institut de Santé Globale Faculté de Médecine, Université de Genève, Suisse/ Institute of Global Health, University of Geneva, Switzerland Professor of Public Health at the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité,

France

Dr Coral Gartner

Senior Research Fellow
University of Queensland Centre for Clinical Research
The University of Queensland, Australia

Dr Guillermo González

Psychiatrist
Comisión de Rehabilitación en Enfermedad Mental Grave
Clínica San Miguel
Madrid,
Spain

Dr Nigel Gray

Member of Special Advisory Committee on Tobacco Regulation of the World Health Organization
Honorary Senior Associate

Cancer Council Victoria Australia

Professor Peter Hajek

Professor of Clinical Psychology and Director, Health and Lifestyle Research Unit
UK Centre for Tobacco and Alcohol Studies

Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry Queen Mary University of London,

United Kingdom

Professor Wayne Hall

Director and Inaugural Chair, Centre for Youth Substance Abuse Research University of Queensland
Australia

Professor John Hughes

Professor of Psychology, Psychiatry and Family Practice
University of Vermont
United States of America

Professor Martin Jarvis

Emeritus Professor of Health Psychology Department of Epidemiology & Public Health
University College London,

United Kingdom

Professor Didier Jayle

Professeur d’addictologie
Conservatoire National des Arts et Métiers Paris,
France

Dr Martin Juneau

Directeur, Direction de la Prévention Institut de Cardiologie de Montréal Professeur Titulaire de Clinique Faculté de Médecine,

Université de Montréal, Canada

Dr Michel Kazatchkine

Member of the Global Commission on Drug Policy
Senior fellow, Global Health Program, Graduate institute, Geneva,

Switzerland

Professor Demetrios Kouretas

School of Health Sciences and Vice Rector University of Thessaly,
Greece

Professor Lynn Kozlowski

Dean, School of Public Health and Health Professions,
Professor of Community Health and Health Behavior,

University at Buffalo,
State University of New York, United States of America

Professor Eva Králíková

Institute of Hygiene and Epidemiology Centre for Tobacco-Dependence
First Faculty of Medicine
Charles University in Prague and General University Hospital in Prague,

Czech Republic

Professor Michael Kunze

Head of the Institute for Social Medicine Medical University of Vienna,
Austria

Dr Murray Laugesen

Director
Health New Zealand, Lyttelton, Christchurch,
New Zealand

Dr Jacques Le Houezec

Consultant in Public Health, Tobacco dependence, Rennes,
France
Honorary Lecturer, UK Centre for Tobacco Control Studies,

University of Nottingham, United Kingdom

Dr Kgosi Letlape

President of the Africa Medical Association Former President of the World Medical Association
Former Chairman of Council of the South African Medical Association

South Africa

Dr Karl Erik Lund

Research director
Norwegian Institute for Alcohol and Drug Research,
Oslo,
Norway

Dr Gérard Mathern

Président de l’Institut Rhône-Alpes de Tabacologie
Saint-Chamond,
France

Professor Richard Mattick

NHMRC Principal Research Fellow Immediate Past Director NDARC (2001- 2009)
National Drug and Alcohol Research Centre (NDARC)

Faculty of Medicine
The University of New South Wales, Australia

Professor Ann McNeill

Professor of Tobacco Addiction
Deputy Director, UK Centre for Tobacco and Alcohol Studies
National Addiction Centre
Institute of Psychiatry
King’s College London,
United Kingdom

Dr Hayden McRobbie

Reader in Public Health Interventions, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom

Dr Anders Milton

Former President of the Swedish Red Cross
Former President and Secretary of the Swedish Medical Association

Former Chairman of the World Medical Association
Owner & Principal Milton Consulting, Sweden

Professor Marcus Munafò

Professor of Biological Psychology
MRC Integrative Epidemiology Unit at the University of Bristol
UK Centre for Tobacco and Alcohol Studies
School of Experimental Psychology University of Bristol,
United Kingdom

Professor David Nutt

Chair of the Independent Scientific Committee on Drugs (UK) Edmund J Safra Professor of Neuropsychopharmacology

Head of the Department of Neuropsychopharmacology and Molecular Imaging
Imperial College London,
United Kingdom

Dr Gaston Ostiguy

Professeur agrégé
Directeur de la Clinique de cessation tabagique
Centre universitaire de santé McGill (CUSM)
Institut thoracique de Montréal, Canada

Professor Riccardo Polosa

Director of the Institute for Internal Medicine and Clinical Immunology, University of Catania, Italy.

Dr Lars Ramström

Director
Institute for Tobacco Studies Täby,
Sweden

Dr Martin Raw

Special Lecturer
UK Centre for Tobacco and Alcohol Studies
Division of Epidemiology and Public Health University of Nottingham,
United Kingdom

Professor Andrzej Sobczak

Department of General and Inorganic Chemistry,
Faculty of Pharmacy and Laboratory Medicine,

Medical University of Silesia, Katowice, Poland
Institute of Occupational Medicine and Environmental Health

Sosnowiec, Poland

Professor Gerry Stimson

Emeritus Professor, Imperial College London;
Visiting Professor, London School of Hygiene and Tropical Medicine United Kingdom

Professor Tim Stockwell

Director, Centre for Addictions Research of BC
Professor, Department of Psychology University of Victoria, British Columbia, Canada

Professor David Sweanor

Adjunct Professor, Faculty of Law, University of Ottawa
Special Lecturer, Division of Epidemiology and Public Health,

University of Nottingham, United Kingdom

Professor Umberto Tirelli

Director Department of Medical Oncology National Cancer Institute of Aviano
Italy

Professor Umberto Veronesi

Scientific Director
IEO Istituto Europeo di Oncologia Former Minister of Health,
Italy

Professor Kenneth Warner

Avedis Donabedian Distinguished University Professor of Public Health Professor, Health Management & Policy School of Public Health

University of Michigan United States of America

Letter to WHO Margaret Chan 2014   Highlighted MargaretChan 26 may 2014

Letter to Swedens Minister of Health 2013      MariaLarssonBrevHighlighted

Läkare mot Skademinskning i tandem med tobaksindustrin och läkemedelsindustrin

 

Vänligen finn bifogat kunnig och mycket viktig analys av särintressen som motverkar skademinskning i tobakspolitiken i USA.

Samma särintressen fungerar exakt likadant i Sverige men i Sverige är måltavlan dubbel, e-cig och snus. De 111 organisationerna som skrivit på Läkare mot Tobak och Tobaksfaktas initiativ “Tobacco Endgame 2025” har fått utbildning och utbildningsmaterial kring hur Tobakskonventionen skall och bör tolkas av just Läkare mot Tobak och Tobaksfakta, rundgång således. I informationsmaterialet till Endgame är det helt klart att snus inte på något vis är en acceptable väg från rökning. LmT och Tobaksfakta propagerar dessutom för så hårda regleringar som möjligt för både snus och e-cigaretter, då de misslyckade med försöken att få e-cigaretter totalförbjudna (http://www.tobaccoorhealthsweden.org/…/Engame_Nov2014_Utskr…)

https://www.washingtonpost.com/news/volokh-conspiracy/wp/2016/07/10/baptists-bootleggers-electronic-cigarettes-a-response-to-professor-berman/

‘Baptists, Bootleggers & Electronic Cigarettes’: A response to Professor Berman

Copyrights and credits to Washington Post and Jonathan H. Adler
 July 10 at 6:27 PM
 

The Food and Drug Administration’s decision to regulate electronic cigarettes as tobacco products under federal law could do more to benefit Big Tobacco than to safeguard public health. Major cigarette manufacturers stand to benefit from regulations that both reduce the comparative advantage of electronic cigarettes and constrain competition within the e-cigarette market. For this reason, it should be no surprise that the Big Two tobacco companies — Altria and Reynolds — supported the FDA’s proposal to begin such regulation.

In a paper forthcoming in the Yale Journal on Regulation, “Baptists, Bootleggers & Electronic Cigarettes,” Bruce Yandle, Andrew Morriss, Roger Meiners and I place the debate over the regulation of electronic cigarettes in the broader context of the history of tobacco regulation. (The full paper will be available shortly. In the meantime, an early draft is available here.)

Building on prior work by Morriss and Yandle showing that Big Tobacco has a long history of using regulation to suppress competition, we explain why it is in the interest of the big cigarette companies to suppress competition from electronic cigarettes, both to prevent the loss of tobacco consumers to e-cigarettes and to make the e-cigarette market easier for Big Tobacco to dominate, at the expense of the smaller e-cig producers that generated the new form of competition.

In short, Big Tobacco would like to use regulation to do for e-cigarette markets what has already been done to cigarette markets. In these efforts, Big Tobacco (which was the Big Four, then the Big Three and now the Big Two) has often joined forces with public health groups to support greater regulation, forming a “bootlegger and Baptist” coalition. So, for example, tobacco giant Altria joined forces with some anti-smoking groups to draft and then lobby for the Family Smoking Prevention and Tobacco Control Act. This law helped suppress competition in cigarette markets and is the source of the FDA’s purported authority to regulate e-cigs — authority that both Big Tobacco and many anti-smoking groups encouraged the FDA to use.

Professor Micah Berman of Ohio State University’s Moritz College of Law takes issue with our analysis, arguing we let “theory get out ahead of the facts on the ground.” According to Professor Berman, there is “limited evidence” that economic interests, most notably Big Tobacco, have helped push for regulation of electronic cigarettes and that evidence of “Baptist and Bootlegger” support for the FDA’s deeming rule is “lacking.” We disagree, and stand by our analysis.

Professor Berman writes that he is “not aware of any tobacco industry comments that were supportive of FDA regulation of e-cigarettes.” I suppose that is because Professor Berman did not look for them. Altria (parent company of Philip Morris, maker of Marlboro) filed comments in support of the deeming rule (available here) and made no secret of this position, declaring its support for the deeming rule on its website. (Altria’s comments are accessible both on its website and in the rulemaking docket on Regulations.gov.)

  Reynolds subsidiary RAIS filed comments in support of the FDA deeming rule as well. Further, as Professor Berman notes, Reynolds called upon the FDA to ban all “open-system” e-cigarette and vaping products. Why? Because Reynolds manufactures the popular Vuse e-cig. Should the FDA refuse to take such a drastic step, Reynolds urged it to subject e-cigarettes to the same degree of regulation as traditional cigarettes, creating a uniform regulatory environment that works to the benefit of Big Tobacco.

Producers of smoking cessation products, such as GlaxoSmithKline (which sells nicotine gum and patches), supported the FDA’s deeming rule too. This is because e-cigs compete with gums and patches as smoking cessation and reduction aids (and many smokers find e-cigs to be more effective nicotine delivery devices than gums or patches).

Whether or not one thinks the FDA deeming rule is a good idea, that Big Tobacco companies and other economic interests supported the rule should be beyond dispute. As some public health groups supported the rule as well, the claim that tobacco “bootleggers” joined pro-regulatory “Baptists” in pushing for greater e-cig regulation should be beyond dispute.

Why would Big Tobacco support the FDA’s deeming rule? Because it is in their interest. Both when the deeming rule was proposed and when it was finalized, financial analysts, such as Bonnie Herzog at Wells Fargo, judged the rule a win for Big Tobacco. Subjecting e-cigs to the same regulatory controls as cigarettes makes it more difficult for e-cigs to gain market share from cigarettes. It also channels advertising, promotion, and shelf-space-acquisition efforts into those avenues already dominated by the big producers. And Big Tobacco is not done. As we discuss in the paper, Big Tobacco stands to benefit from subjecting e-cigs to the terms of the Master Settlement Agreement (as some legislators have proposed) and greater taxes on e-cigs. It’s no surprise that Reynolds supports e-cig taxes (despite producing a popular e-cig brand of its own).

Professor Berman further argues that our work rests on the assumption that e-cigs “function as a substitute for cigarettes.” Yes and no. As noted above, we argue that Big Tobacco stands to benefit from e-cig regulation in two ways — by making e-cigs less competitive against traditional cigarettes and by making the e-cigarette market easier for Big Tobacco to dominate. Only the first of these claims rests on the assumption that e-cigs function as a substitute for cigarettes. Professor Berman does not even address the other.

That e-cigs function as a substitute — that is, that some of the demand for e-cigs comes at the expense of the demand for cigarettes — is indisputable. First, as is well-documented, the majority of e-cig users are current or former tobacco users. (See, e.g., here.) Some use e-cigs to help them quit smoking, while many others use them as a replacement for some portion of their cigarette consumption. In other words, for a substantial share of the market, e-cigs “function as a substitute for cigarettes.”

There is further evidence that regulation of e-cigarettes benefits Big Tobacco. For example, two recent studies (here and here) have found that the adoption of measures to reduce youth access to e-cigarettes results in increased teen smoking rates. This occurs because cigarettes and e-cigs function as substitutes for one another, at least in this portion of the market. This, more than flimsy “gateway” hypotheses, may explain why youth smoking rates have dropped as youth e-cig use has increased. (As a father, I’d prefer my kids use neither, but there’s also no question that smoking is far more dangerous than vaping.)

There’s lots more to take issue with in Professor Berman’s post, but the above should suffice to explain why we claim that Big Tobacco has played the role of the “bootleggers” in a “Baptist and bootlegger” coalition supporting greater regulation of e-cigarettes. This fact alone is not enough to demonstrate the the FDA’s regulations are ill-advised, but it does place the FDA’s regulatory initiative in context.

As noted above, our paper in the Yale Journal on Regulation will not be out until later this summer. Those interested can find an early draft on SSRN here. Note that the paper has been updated substantially since then.

DISCLOSURE: In 2014, I co-authored a white paper on the political economy of e-cigarette regulation for which my co-authors and I received compensation from NJOY, an e-cigarette manufacturer. NJOY exercised no control over the conclusions of that white paper, and I have not maintained any relationship, economic or otherwise, with NJOY since completing that work. All of my conclusions about e-cigarette regulation are my own.

Hur snuset förbjöds i EU utan knyst från Sverige

Gratefully nicked from Velvet Glove Iron Fist and Dick Puddlecote:

History Repeating – Snus and E-cigarettes

Dick Puddlecote has been having some fun raking over the mountain of correspondence between ASH and their friends/donors in government. E-mails reveal the vigour with which the vaper’s suppposed friends at this state-funded sockpuppet lobbied for e-cigarettes to be regulated as medicinesand then, when that failed, were determined to see Article 20 of the Tobacco Products Directive passed without amendment.

This all reminded me of some much older ASH correspondence that I looked at several years ago when I was writing The Art of Suppression. Back then, I spent a couple of afternoons at the Wellcome Library in London where there is a large collection of ASH documents going back to the group’s inception in 1971. I was looking for documents about snus and I wasn’t disappointed. There were boxes of them.

The similarities between today’s e-cigarette panic and the snus panic of the 1980s are uncanny. So uncanny that you might think that ‘public health’ people would have learned a lesson. To be fair, some have – including ASH to an extent – but if you look at the WHO, the FDA, the Lancet etc. you can hear exactly the same bogus arguments and hysterical rhetoric that were voiced in the 1980s.

20160707 Bild 1 skoalbandit

The full story is in the book but the heavily truncated version goes like this: Snus is smokeless tobacco in a pouch that goes under the top lip. It was assumed to cause cancer but doesn’t. It was assumed to be a gateway to smoking but isn’t. ASH ran a campaign to ban it in Britain and succeeded. The EU then followed. Sweden is now the only EU member state that allows the sale of snus. This graph tells a thousand words…

20160707 Bild 2 snus-smokingrates-eu

The whole thing kicked off when an American smokeless tobacco company set up a factory in Scotland to produce a brand of snus called Skoal Bandits, apparently with a government grant.

As early as 1984, Richard Peto had seen the potential of snus as a substitute for people wanting to quit smoking. In 1985, Michael Russell and colleagues (including Robert West) reported the results of new research in a letter to The Lancet. Still working on the (mistaken) assumption that snus caused oral cancer, they concluded that snus ‘could help people trying to give up smoking… If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.’

None of this appealed to ASH (then led by David Simpson). Their incomprehension is nicely illustrated by the handwritten comment of ‘Weird headline!’ next to a news story about snus being a ‘threat to cigarettes’. (nb. click to enlarge any of the following images)

01c45-weirdheadlinesnus

Such headlines were rare, however. Thanks to scare-mongering by ASH and the BMA, news reports about snus were almost entirely negative. This, from 1985, is typical. Notice that the BMA were already calling for an outright ban at this stage…

20160707 Bild 4 cancersweets

A letter from 1984 shows that ASH were aware of the harm reduction potential of snus but any glimmer of optimism was overwhelmed by the same concerns about ‘dual use’ that are expressed by anti-vaping activists today…

79373-snus-dualuse

A 1985 letter from Alexander McCall Smith, the Edinburgh-based chairman of the Association for Non-Smokers’ Rights contains another assumption that anti-vaping folk like to make. After stating that his organisation is concerned only with passive smoking and therefore has ‘precisely nothing to say about Skoal Bandits’, he goes on to say that ‘everybody knows’ that the product is ‘aimed at children’ and that ‘the whole exercise is to accustom under-age users to nicotine’.

20160707 Bild 6 non-smokersrights

Fears about the ‘gateway effect’ were commonplace. For example, in this 1985 article headlined ‘”Ban the Tobacco Bandits” Demand’…

f9858-gateway1985

In a letter dated 11 April 1985, David Simpson brings up both the gateway theory and the precautionary principle:

“We have had the matter raised in parliament and numerous times in the press but I fear that by the time there is concrete evidence that young people progress from using this product to smoking cigarettes, it will be too late for action – the usual story.”

In January 1986, Ireland banned snus. Hong Kong and Australia followed suit soon afterwards. A letter from the Australian anti-smoking campaigner Nigel Gray to the Australian Minister of Health shows the lengths to which prohibitionists go to convince people that they are not prohibitionists. ‘In relation to civil liberties’, he writes, ‘this move would not impair them at all. If individuals wish to chew tobacco they can obtain and prepare it for themselves by breaking up cigarettes.’ Hmm.

20160707 Bild 8 nigelgray

In the UK, the campaign to ban snus was led by David Simpson of ASH and Alison Hillhouse of ASH Scotland. They initially focused on the loophole in the law that allowed oral tobacco to be sold to children. When this was sensibly closed in July, a full ban was the ‘next logical step’, as a press release from the United Kingdom Coordinating Committee on Cancer Research made clear…

The Government has taken steps to ban the sale of oral snuff to people under 16 but this is unlikely to be effective in stopping the spread of this addictive habit… only a total ban on the import, manufacture and sale of oral snuff will be adequate to prevent the widespread use of this carcinogenic material.

Simpson had extensive correspondence with the Labour MP Robert Wareing who agreed to ask questions in parliament. ASH helpfully gave him the exact wordings of these questions…

20160707 Bild 9 wareingdraft1986
c3742-draftban

In June 1987, the WHO issued a press release calling for a ‘pre-emptive ban’ on snus – indeed, on all smokeless tobacco – ‘to prevent a new public health epidemic from a new form of tobacco use’.

‘Although promoted as an alternative to cigarettes, specifically in North America and Western Europe, smokeless tobacco is described by WHO a “new threat to society” – particularly to young males who are thus far the major targets in sophisticated promotional and advertising campaigns.’

20160707 Bild 11 WHO1987snusban

The UK banned the sale and manufacture of snus in 1989. The EEC followed suit in 1992. Sweden got an exemption when it joined the EU in 1995. Sweden’s smoking rate is now less than half the EU average and is the lowest in the developed world.

Viva public health!

Thankfully nicked from Christopher Snowdon;

History repeating: snus and e-cigarettes

Dick Puddlecote has been having some fun raking over the mountain of correspondence between ASH and their friends/donors in government. E-mails reveal the vigour with which the vaper’s suppposed friends at this state-funded sockpuppet lobbied for e-cigarettes to be regulated as medicines and then, when that failed, were determined to see Article 20 of the Tobacco Products Directive passed without amendment.

This all reminded me of some much older ASH correspondence that I looked at several years ago when I was writing The Art of Suppression. Back then, I spent a couple of afternoons at the Wellcome Library in London where there is a large collection of ASH documents going back to the group’s inception in 1971. I was looking for documents about snus and I wasn’t disappointed. There were boxes of them.

The similarities between today’s e-cigarette panic and the snus panic of the 1980s are uncanny. So uncanny that you might think that ‘public health’ people would have learned a lesson. To be fair, some have – including ASH to an extent – but if you look at the WHO, the FDA, the Lancet etc. you can hear exactly the same bogus arguments and hysterical rhetoric that were voiced in the 1980s.

skoalbandit.jpg


The full story is in the book but the heavily truncated version goes like this: Snus is smokeless tobacco in a pouch that goes under the top lip. It was assumed to cause cancer but doesn’t. It was assumed to be a gateway to smoking but isn’t. ASH ran a campaign to ban it in Britain and succeeded. The EU then followed. Sweden is now the only EU member state that allows the sale of snus. This graph tells a thousand words…

snus-smokingrates-eu.jpg


The whole thing kicked off when an American smokeless tobacco company set up a factory in Scotland to produce a brand of snus called Skoal Bandits, apparently with a government grant.

As early as 1984, Richard Peto had seen the potential of snus as a substitute for people wanting to quit smoking. In 1985, Michael Russell and colleagues (including Robert West) reported the results of new research in a letter to The Lancet. Still working on the (mistaken) assumption that snus caused oral cancer, they concluded that snus ‘could help people trying to give up smoking… If all smokers in Britain switched to sachets about 50,000 premature deaths per year might eventually be saved at an annual cost of less than 1,000 deaths from mouth cancer.’

None of this appealed to ASH (then led by David Simpson). Their incomprehension is nicely illustrated by the handwritten comment of ‘Weird headline!’ next to a news story about snus being a ‘threat to cigarettes’. (nb. click to enlarge any of the following images)

weirdheadlinesnus.jpg


Such headlines were rare, however. Thanks to scare-mongering by ASH and the BMA, news reports about snus were almost entirely negative. This, from 1985, is typical. Notice that the BMA were already calling for an outright ban at this stage…

cancersweets.jpg



A letter from 1984 shows that ASH were aware of the harm reduction potential of snus but any glimmer of optimism was overwhelmed by the same concerns about ‘dual use’ that are expressed by anti-vaping activists today…

snus-dualuse.jpg


A 1985 letter from Alexander McCall Smith, the Edinburgh-based chairman of the Association for Non-Smokers’ Rights contains another assumption that anti-vaping folk like to make. After stating that his organisation is concerned only with passive smoking and therefore has ‘precisely nothing to say about Skoal Bandits’, he goes on to say that ‘everybody knows’ that the product is ‘aimed at children’ and that ‘the whole exercise is to accustom under-age users to nicotine’.

non-smokersrights.jpg



Fears about the ‘gateway effect’ were commonplace. For example, in this 1985 article headlined ‘”Ban the Tobacco Bandits” Demand’…

gateway1985.jpg


In a letter dated 11 April 1985, David Simpson brings up both the gateway theory and the precautionary principle:

“We have had the matter raised in parliament and numerous times in the press but I fear that by the time there is concrete evidence that young people progress from using this product to smoking cigarettes, it will be too late for action – the usual story.”


In January 1986, Ireland banned snus. Hong Kong and Australia followed suit soon afterwards. A letter from the Australian anti-smoking campaigner Nigel Gray to the Australian Minister of Health shows the lengths to which prohibitionists go to convince people that they are not prohibitionists. ‘In relation to civil liberties’, he writes, ‘this move would not impair them at all. If individuals wish to chew tobacco they can obtain and prepare it for themselves by breaking up cigarettes.’ Hmm.

nigelgray.jpg


In the UK, the campaign to ban snus was led by David Simpson of ASH and Alison Hillhouse of ASH Scotland. They initially focused on the loophole in the law that allowed oral tobacco to be sold to children. When this was sensibly closed in July, a full ban was the ‘next logical step’, as a press release from the United Kingdom Coordinating Committee on Cancer Research made clear…

The Government has taken steps to ban the sale of oral snuff to people under 16 but this is unlikely to be effective in stopping the spread of this addictive habit… only a total ban on the import, manufacture and sale of oral snuff will be adequate to prevent the widespread use of this carcinogenic material.


Simpson had extensive correspondence with the Labour MP Robert Wareing who agreed to ask questions in parliament. ASH helpfully gave him the exact wordings of these questions…

wareingdraft1986.jpg

 

draftban.jpg


In June 1987, the WHO issued a press release calling for a ‘pre-emptive ban’ on snus – indeed, on all smokeless tobacco – ‘to prevent a new public health epidemic from a new form of tobacco use’.

‘Although promoted as an alternative to cigarettes, specifically in North America and Western Europe, smokeless tobacco is described by WHO a “new threat to society” – particularly to young males who are thus far the major targets in sophisticated promotional and advertising campaigns.’

 

WHO1987snusban.jpg


The UK banned the sale and manufacture of snus in 1989. The EEC followed suit in 1992. Sweden got an exemption when it joined the EU in 1995. Sweden’s smoking rate is now less than half the EU average and is the lowest in the developed world.

Viva public health!

Satire on antisnus/anti e-cig conference slides

With my credits to the team behind No More Casualties / NotBlowingSmoke initiatives. The original material can be found here: http://nomorecasualties.org/california-dph-national-smokeless-tobacco-summit/

During the 8th National Summit on Smokeless and Spit Tobacco, held in Albuquerque New Mexico April 18-20, 2016, California Department of Public Health employee Julie Lautsch gave a presentation titled “A Digital Game”.

Considering the slides used in the presentation, and its content, it is abundantly clear that the California Department of Public Health considers their misleading propaganda and our attempts to set the record straight nothing more than “A Digital Game”. Except in this “game”, the lives of millions of smokers are at risk but evidently they couldn’t care less about how many smokers die. Since we do not have the script, text, or recorded presentation that goes along with these slides we decided to make a valiant attempt at filling in the blanks.

ca-dph-julie-lautsch-01

SLIDE 1 BELOW : Hi, I’m Julie Lautsch and I’m with the California Department of Public Wealth. I’m here today to present you with a very misleading and twisted version of the truth in order to preserve the continuation of my job.

During this presentation I will highlight just how bad we got our behinds kicked by these nasty people who call themselves “vapers” and who are always out to find new ways to obsolete our funding because they have found a way to quit smoking that they are now trying to share with the rest of the world.

But for this presentation in particular I will focus on just a handful of these “vapers” who have become a real serious problem to our public health propaganda campaigns, not just ours from the CA-DPH. Today I will be talking about how we think of this as a “digital game” and how we hope to win that game at any cost, no matter how many more nasty smokers need to die. It’s about numbers for us, not lives. Let’s stay the course.

ca-dph-julie-lautsch-02

SLIDE 2 BELOW : This was us then and it still is us now. We, public health advocates and organizations have self elected to be clueless when it comes to vapor products and these things they call electronic cigarettes. After many decades of waging our war on smoking and smokers we’re all still very baffled at the fact that these aerosol inhaling deviants are extremely resistant to having us drag them into our war.

As many of you here today know, we are well aware of the safer alternative that electronic cigarettes and vapor products are. But we can never admit to that lest we end up without funding and jobs. We’ve worked too darn hard to get where we are today and we’re not going to give it up without a fight.

Just as we always say, our best advice is to always plead ignorance of the facts while presenting our own interpretation as the one and only set of facts that we support. Luckily the folks in the lower ranks of our organizations have bought into it so we really only need to focus on everyone else.

ca-dph-julie-lautsch-03

SLIDE 3 BELOW : We, in Public Health circles, have always feared that these cloud craving ex-smokers would unite and form an opposition to our otherwise nefarious tobacco control activities. Unfortunately they have done exactly that.

We already had major issues with those trouble makers from CASAA, those evil industry people from SFATA, and that handsome young man from the American Vaping Association. And then there was this Vaping Militia thing that we recently heard of which involves crazy people trying to shoot at us with toy guns, from what I have been told.

We really didn’t need another things trying to peal away the layers of our lies but as it stands, this Not Blowing Smoke thing happened to us overnight and we’re still trying to figure out what the heck happened. As such we will be focusing on them a lot in my presentation today as they have rapidly become a thorn in our side.

ca-dph-julie-lautsch-04

SLIDE 4 BELOW : Looking at the other side of our war we can clearly see that every time we try and pass legislation to destroy this vaping phenomena there’s a contingent of advocates calling their paint-fume sucking ilk to action. A lot of the times they are able to pull the rug out from under us. They have even gone so far as to question our theory about how vaping is a gateway to smoking.

They have not yet clued in we get away with that fear tactic because we really just call it a theory. After all, we have no proof and evidence of the contrary exists out there already. But we wouldn’t be in public health if we weren’t skilled at pretending it doesn’t exist, right?

I think this Gregory Conley fellow can be blamed for many of our day to day sufferings from other vapor advocates. If it wasn’t for his persistence and annoying testimonies a lot of these other folks would not have gotten together and united against our efforts to undermine one of the most promising life saving technologies of the past century; electronic cigarettes.

ca-dph-julie-lautsch-05

SLIDE 5 BELOW : With this growing mass of former smokers trying to help other smokers switch to a much safer alternative we were fighting a losing battle. A battle that we feel could best be waged out there in the mainstream public. If we could just get the public to believe these vapor emission devices were harmful we would have a shot at eroding their support base. It was bad enough that even non-smokers would ask one of these vaper people “gosh, what is that and why does it smell so nice?” but having legislators listen to this mainstream support for vaping really was where we had to draw the line.

So we set out to do what we in public health do best when things are not longer working in our favor; blow a metric ton of taxpayer dollars, create a problem in search of a solution, and bring out the big public relations guns.

The first thing we did was publish this “State Health Officer’s Report on E-Cigarettes” in which we collected every single lie and half-truth we have supported since we dragged all these vapor products into the war we’ve been waging on smokers. We even went as far as to claim these products were a “Community Health Threat”. Fear works. Fear always works. We have learned that in the past decades and we’re very good at it.

ca-dph-julie-lautsch-07

SLIDE 6 BELOW : We proceeded to enlist the help of the TobaccoFreeCA page on Facebook to help push our propaganda out to the masses in a modern digital way. We even held a press conference with Dr. Ron Chapman to make everything look like real serious and stuff.

The best part was the whole narrative we came up with, “Protect your family from e-cigarettes”. Combined with the lies that we mislabeled as facts there would be nothing these vaping clowns could do about it and we’d be on our way to securing more continued funding for our war on smokers.

We blew a lot of tax payer money on getting our message out through major placements in the mainstream media such as the LA Times, WIRED, CNN, WSJ, TIME, and of course the Sacramento Bee, our beloved newspaper that goes out of its way to protect our interests. Such a media onslaught was needed and we didn’t care at what cost. Smokers be damned and those anti-freeze loving liquid lickers be damned too!

ca-dph-julie-lautsch-08

SLIDE 7 BELOW : Then came the part we never expected. Our intel and years of briefing on the subject had not prepared us for the sarcastic sense of humor these formaldehyde hoovers appear to possess. Almost immediately upon the rollout of our propaganda they started circulating a parody of our well crafted message.

Their message was that families needed to be protected from Dr. Ron Chapman and the CDPH. You don’t need to protect your family from us. That’s what we’re getting paid to do and anyone who messes with that gets the sharp end of our PR stick.

We want to thank our friends in the media for not questioning whether a department with a backlog of 11,000 elder abuse complaints should be wasting time releasing a report on vaping. And since Ron resigned in disgrace shortly after the report was released, let us take this opportunity to say, “Bye Ron!”

In an online social media campaign they attempted to twist our message back into what might otherwise be considered the truth. Except as you all know, we in in public health would never use that ugly word. Truth is what we tell people. Even if we’re wrong. We don’t want any debate about it and we sure don’t want to be questioned on it.

ca-dph-julie-lautsch-09

SLIDE 8 BELOW : It was time to really dig deep so we put an RFP out to ask for the entire production of a massive media assault on the general public. We had about $7 million of tax payer money to blow on it so why not get the best we could? Our next move is what we internally referred to as our “The Empire Strikes Back” project. But we had a much better branding and a real cool name for it:

STILL BLOWING SMOKE

We had a really cool website built and we created a few videos and TV commercials that were designed to promote the use of vapor products to minors. We all know that these diacetyl addicts aren’t marketing to minors but we can. And we get away with it as the only entity in existence that does. We made all the text sound scary and every word needed to instill fear into any living soul that watched it. And I think we were highly successful in creating all that.

ca-dph-julie-lautsch-12

SLIDE 9 BELOW : In our pursuit of fear mongering we even used pictures of a baby in a cage on the Still Blowing Smoke website. Not sure who came up with that or its relevancy but it was creepy as hell so of course we all agreed to use it.

The other thing that was instrumental and critical to our campaign was to avoid the general public having any sympathy for the small businesses that form this “vapor industry” that they speak of. We can’t have the mainstream public feeling sorry for these small entrepreneurs and the jobs they create. And we certainly want all these mom & pop stores out of business now that it’s really affecting our bottom line. So we came up with a way to blame it all on the Big Tobacco companies. Nobody has any sympathy for them, not even current smokers. So they were the perfect veil for us to throw over the entire industry and hide the fact that Big Tobacco’s actual foothold in the vapor industry is marginal at best.

ca-dph-julie-lautsch-13

SLIDE 10 BELOW: Also important to our Still Blowing Smoke campaign was putting up these huge billboards all over California. A tactic that was later adopted by public health and tobacco control organizations in other States. They learned from the best, shall we say. In addition to those big boys we added advertising on gas pumps, digital media, and of course, our propaganda commercials on TV.

We made sure we used a sound track for the commercials that guaranteed to peak the interest of children because we wanted them to see the children in our commercial and the vapor pens that they were holding in their hands. It’s a guaranteed way to upset parents and scare the living daylights out of them every time our commercials ran. Unfortunately it was also a reason for man parents to switch to another channel. But we live in a free country and that’s their choice. I just hope they thought that they were looking at e-cigarette ads made by the industry or Big Tobacco so that the now misinformed public could support our claims that these flavored vapor lovers were marketing to their children.

ca-dph-julie-lautsch-14

SLIDE 11 BELOW : And we had our biggest push ever online as part of our fear campaign. We readily admit that public health is not very well versed in things that are online but that’s why we blew so much money on professional PR agencies to help us do this for us. We took out banner ads on newspaper websites, mainstream media websites, and of course the various “social media” properties that are part of our large network of tobacco control freakery.

We had been told that the online world is one where we might be met with skepticism and perhaps a little hostility. But we in public health are fearless. We can be fearless because we are the ones spreading fear to others. Except sometimes the thing you don’t fear do come around to bite you and unfortunately that is exactly what happened to us and the campaign we cared so much about. Not to mention the truckload of tax payer dollars that we had thrown at it.

We also gravely underestimated the network that these vape heads had. A single loose lipped journalist spilled some beans about our campaign to the wrong people and that’s what set into motion a series of events that has since spawned off two studies that were published in the British Medical Journal as well as the topic of my presentation here today.

ca-dph-julie-lautsch-15

SLIDE 12 BELOW : When this guy, Stefan Didak, heard about our campaign getting ready to launch he set out to find our Still Blowing Smoke website and proceeded to spend 38 hours non-stop to build a website similar to ours (but with faster and better navigation) and launched it within minutes of us launching ours. He called it:

NOT BLOWING SMOKE

Turns out that he had crazy SEO skills and immediately noticed that our prestigious PR firm completely forgot to register any social media accounts in the name of our campaign. So, instead, he did that and caused massive confusion as online traffic got routed to his website instead of ours. He pearled back the layers of our lies and presented everyone with factual and scientific information and a month later even helped expose how our MSA funding mechanisms really work.

Recently a scientific study was published in the British Medical Journal that shows exactly how the NOT Blowing Smoke campaign has destroyed all the online potential of our STILL Blowing Smoke campaign. And it was over for us within merely two days.

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SLIDE 13 BELOW : The social media campaign by NOT Blowing Smoke completely decimated us and put our $7 million tax payer funded campaign to shame. They struck us on Twitter, on Facebook, on Instagram, and on Facebook. It got so bad and so confusing that even our own PR team started sharing the material put out by NOT Blowing Smoke while pretending they were Still Blowing Smoke. We called the PR team and had them remove the shares so we could save face.

The SEO voodoo that NOT Blowing Smoke used really angered us because all the search results for our campaign led to the top results to their campaign. But we have something they didn’t have; money! So we started throwing a ton of money at getting Google ad placement. That helped us at least stay in view for a while. Screw the 100,000 visitors that NOT Blowing Smokegot in the first 24 hours. We have endless supplies of tax payer money!

It was highly inconsiderate by the NOT Blowing Smoke folks to do this to our well crafted and nicely designed wrappers around the lies we were telling people. Did they think it was just a game or do they really care about the lives of smokers? Either way, we now consider it a game and we don’t care what we have to do to win it.

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SLIDE 14 BELOW : To make matters worse, the NOT Blowing Smoke counter-campaign took off so fast and so hard that many others out there started creating parodies of our fear mongering lies and deceitful information. Some of these mod blowers were creating fake press releases that included links to NOT Blowing Smoke. Others started mocking us in social media. People created videos similar to our Still Blowing Smoke campaign but with the NOT Blowing Smokelogo and completely different messaging.

Suppressing the truth is hard work and all of us work very hard on that every day. Seeing our efforts undone by the actions of these battery sucking ding dongs. There was no way we could allow this effort to assist in uniting more of these people against us. What if they started to register to vote and used their influence? What if they started to inform the public that we’ve been lying about vapor for years? What if they could reach beyond the choir and harm our tobacco control efforts? Clearly, there was no way we could allow this to ever happen.

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SLIDE 15 BELOW : Through our TobaccoFreeCA account we decided to fight back on social media by having a question and answers sessions while posting more of our misleading information. This seemed like a really good idea at the time but we are unlikely to decide on doing more of this any time soon.

We expected a lot of our anti-smoking fans to join in and help us but instead our discussions got infested by these flavored vapor addicts. They were educated and well spoken. They knew how to poke through the veil of our lies and posted dozens and dozens of scientific studies that showed that vapor was safer than smoking and that everything we’ve been saying was all wrong. It was really a sad day seeing how our counter-offensive got derailed that way.

And we violated one of our own rules; Tobacco control and public health should never engage in an open discussion with people who can easily prove us wrong. Every time we do it backfires on us. Let our suffering be a lesson to you all. You are much more effective dictating the lies from above and not engaging in any discussion with the stakeholders of these products. Or the smokers and former smokers who are stakeholders in the choices for their own health.

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SLIDE 16 BELOW : In order to defend ourselves and the choice of failing with the public questions and answers section we cherry pick a few comments we received that can be perceived as hostile and we use those to label every other vapers as raving violent nutcrackers. It’s a strategy that we always use to make ourselves look better and our opponents look worse.

Let me give you an example. Because a lot of well respected people started publishing about the misleading propaganda we have been putting out we use their articles along with the cherry picked comments from a few derailed vapers in order to paint a very negative picture of those who don’t agree with us and challenge our authority.

For example, here we use an article in Forbes Magazine, written by Sally Satel, titled “Their Product is Doubt – Deceptive Government Campaign Against Electronic Cigarettes”. Putting the crazy comments alongside of it will make Mrs. Satel look like she’s part of that. It’s pretty clever of us! And how dare she expose the truth and call our campaign deceptive. That’s so uncalled for. It’s unfair to us and we’re offended greatly by this. So we will stop at nothing to smear people like her.

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SLIDE 17 BELOW : Because all the truth put out by NOT Blowing Smoke was getting more traction in the mainstream media it was time to fight fire with fire using our own public relations and media contacts. We found VOX more than willing to write an article that helped us put a new term out; Big Vapor.

Because NOT Blowing Smoke was so effective in communicating that vaping is all about small business and not big tobacco we had to come up with a whole new message and “Big Vapor” sounded really good to us.

Unfortunately that didn’t last very long either. Large numbers of vapers contacted the author of the piece and some had conversations with her and as a result her follow-up articles were suddenly way more balanced than we would’ve liked to see. It’s always a sad day for us when a reporter, a journalist, or anyone else starts learning the truth and seeing just how we’ve been misleading them all along. It makes our jobs much harder.

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SLIDE 18 BELOW : Considering that we still had money left to blow on futile and fruitless campaigns we decided to strike back on social media. This time with a fresh new look and a fresh new hashtag that we believe was a strong carrier for our misleading messages; #trulyfree.

But enough about our #trulyfree campaign because it was over before it got started. These annoying swarms of vapers, and I swear they are multiplying by the day, suppressed our message by once again communicating the truth out there. So to avoid me talking too much about another embarrassing failure on our part, at the tax payer expense, let’s talk about this NOT Blowing Smoke phenomena because I spent a lot of time putting their material on my slides. That and they are really getting under our skin.

While we were foaming at the mouth about them they professionalized, turned the movement into a full blown non-profit and started getting to a point where now they have become a real serious threat to us. Why else would we spend so much time talking about them? It used to be vapers talking about OUR material and actions. Now we are talking about THEIR material and actions..

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SLIDE 19 BELOW : In the meantime these NOT Blowing Smoke folks expanded their team and their reach. They launched new projects like FDARegs.info and VapersVotingGuide.com. They started raising funds for something that we have been fearing for a long time. And they just kept growing and growing and gaining more ground and getting more traction. We have never seen such a thing and we’re very concerned that this will not stop.

We were happy that Dr. Robert Jackler from Stanford University went on the attack against NOT Blowing Smoke people in a publication he did in the British Medical Journal, “Electronic cigarette marketers manipulate antitobacco advertisements to promote vaping”.

He even managed to accuse them of messing with a campaign that we all know they weren’t responsible for. But that’s the great thing about being well funded and being in public health, we get to lie through our teeth if we want to all the time. And often get away with it.

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SLIDE 20 BELOW : In March of 2016, NOT Blowing Smoke launched a national campaign aimed at undoing our misleading propaganda even more. They called it their “No More Casualties”campaign and are saying we are engaged in our ideological war on smoking and that our actions to prohibit vaping and limit access to these products is causing casualties. How dare they tell the truth! We don’t like that.

They are providing free content that includes posters, flyers, radio and TV commercials, and the whole kitchen sink. What a smart move. I think they must have learned that from us. We want this campaign destroyed. We want NOT Blowing Smoke destroyed. They are getting way too much in our way and if we don’t take care of it now we may have a very big painful problem on our hands that will require us to come up with even more tax payer money to deal with it.

Maybe we should come up with a way to make it look like they are the cause of all the tax payer money being wasted? It’s just an idea.

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SLIDE 21 BELOW : At the risk of us sounding like a broken record we decided to drop a few more millions of tax payer money into a continuation of our Still Blowing Smoke campaign even though we don’t stand much of a chance with it.

This time around we added new things to our website about formaldehyde and diacetyl and created these nifty TV commercials that once again attempt to blame Big Tobacco for everything and another video that is meant to perpetuate the lie about how vapor products lead to smoking in teens. We even used real teens in the video. And we actually made them vape too!

And these stupid vapers are still blaming their own industry about potential possible, yet not probable, appeal to minors while we get away without being blamed for marketing to children with our really cool imagery and musical tunes.

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SLIDE 22 BELOW : Just you wait for our next move. For now I will just show a blank slide because we haven’t figured it out yet. We will be here in the corner crying for a while longer. Maybe people will take pity on us and give us more money. For now, just crying and doing presentations like these in which we wail about NOT Blowing Smoke until even our own public health friends get sick and tired of hearing about it.

In the meantime, let us all keep thinking of this as nothing more than a digital game…. in which real smokers die. But it’s not like we care about that. We just pretend we do.

Weekly update on THR in the media (Bill Godshall)

With credits and gratitude to Bill Godshall, vigilant as ever!

CigdeathSnusdeath

Please note that the anti-nicotine lobby complex in Sweden (Tax funded organizations all run by the same group of less than 30 people) including Tobaksfakta, Doctors against Tobacco, Psychologists against Tobacco, Teachers against Tobacco, Dental care against Tobacco, Nurses against Tobacco, Professional organizations against Tobacco…………………… have all conspicuously omitted to even mention the RCP report from this week, and the PHE policy shift that started in August 2015.

Royal College of Physicians issues 200 page report advocating smokers switch to vaping

Royal College of Physicians – Nicotine Without Smoke: Tobacco Harm Reduction
https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

Promote e-cigarettes widely as substitute for smoking says new RCP report
https://www.rcplondon.ac.uk/news/promote-e-cigarettes-widely-substitute-smoking-says-new-rcp-report
http://bit.ly/21f0Gjf

John Britton: Nicotine without smoke – putting electronic cigarettes in context
http://www.bmj.com/content/353/bmj.i1745

Cancer Research UK: Reducing the harm of tobacco, could e-cigarettes be part of the solution?
http://scienceblog.cancerresearchuk.org/2016/04/28/reducing-the-harm-of-tobacco-could-e-cigarettes-be-part-of-the-solution/

Cancer group lauds report encouraging vaping use
http://www.belfasttelegraph.co.uk/news/uk/cancer-group-lauds-report-encouraging-vaping-use-34666257.html

Mike Siegel: Royal College of Physicians report recommends widespread promotion of electronic cigarettes for smoking cessation
http://tobaccoanalysis.blogspot.com/2016/04/royal-college-of-physicians-report.html

AVA: Switch to vaping to avoid ‘almost all of the harm from smoking,’ says Royal College of Physicians
http://vaping.info/news/2016/switch-to-vaping-to-avoid-almost-all-of-the-harm-from-smoking-says-royal-college-of-physicians

Vaping Vindicated: The evidence that vaping helps wean smokers off tobacco is overwhelming. The NHS should embrace it as a route to better public health
http://www.thetimes.co.uk/tto/opinion/leaders/article4739974.ece

E-cigarettes should be offered to smokers, say doctors
http://www.bbc.com/news/health-36139618

UK doctors urge wide promotion of e-cigs to help smokers quit
http://uk.reuters.com/article/uk-health-ecigarettes-britain-idUKKCN0XO2UT

Doctors warn of big tobacco firms entering e-cigarette market
http://www.theguardian.com/society/2016/apr/28/doctors-warn-big-tobacco-firms-e-cigarette-market-rcp-industry

Doctors body strongly promotes e-cigarettes as healthier alternative to smoking as EU rules make them weaker
http://www.telegraph.co.uk/news/2016/04/27/eu-to-make-e-cigarettes-weaker/

E-cigarettes could save millions, say doctors
http://www.thetimes.co.uk/article/e-cigarettes-can-save-millions-by-helping-people-quit-say-doctors-6gvpjwkb6

E-cigarettes ‘much less harmful than smoking and should be encouraged’
http://www.independent.co.uk/life-style/health-and-families/health-news/e-cigarettes-much-less-harmful-than-smoking-and-should-be-encouraged-major-report-concludes-a7003891.html

A major medical group just threw its weight behind e-cigs
http://www.businessinsider.com/royal-college-of-physicians-tells-smokers-to-switch-to-e-cigarettes-2016-4

GPs advised to ‘promote e-cigarettes widely’ as smoking substitute
http://www.gponline.com/gps-advised-promote-e-cigarettes-widely-smoking-substitute/health-promotion/smoking-cessation/article/1393012

Royal College of Physicians study finds e-cigarettes should be widely promoted as substitute for smoking
http://www.cityam.com/239853/royal-college-of-physicians-study-finds-e-cigarettes-should-be-widely-promoted-as-substitute-for-smoking-

E-cigarettes help save lives, says Royal College of Physicians
http://www.theregister.co.uk/2016/04/28/royal_college_of_physicians_ecigarettes_report/

Scotland Herald View: Progress on vaping
http://www.heraldscotland.com/opinion/14456499.Herald_View__Progress_on_vaping/

Scotsman: Vaping must be allowed to work
http://www.scotsman.com/news/politics/leader-comment-third-place-would-be-new-scottish-labour-low-1-4112910

Why e-cigarettes should be ‘widely promoted’ as a substitute for smoking
http://www.walesonline.co.uk/news/health/e-cigarettes-should-widely-promoted-11252398

Vaping is about reducing harm, not being harmless
http://motherboard.vice.com/read/vaping-is-about-reducing-harm-not-being-harmless-e-cigarettes-news-royal-college-of-physicians

Are e-cigarettes good or bad for you? Everything smokers need to know
http://www.express.co.uk/life-style/health/665268/E-cigarettes-Do-E-cigs-Help-Or-Harm-Smokers-Benefits-Risks-Good-or-Bad

UK medical body backs e-cigarettes (from AAP in Australia)
https://au.news.yahoo.com/a/31457496/uk-medical-body-backs-e-cigarettes/?cmp=st

American news coverage of RCP report

UK report advocates substituting e-cigarettes for tobacco (Godshall comments)
http://www.wsj.com/articles/u-k-report-advocates-substituting-e-cigarettes-for-tobacco-1461807845

British Medical groups says smokers should switch to electronic cigarettes
http://www.nytimes.com/2016/04/28/health/e-cigarettes-vaping-quitting-smoking-royal-college-of-physicians.html
Note that Obama’s CDC responded to RCP report by deceitfully and falsely claiming “There is currently no conclusive scientific evidence supporting the use of e-cigarettes as a safe and effective cessation tool at the population level. The science thus far indicates most e-cigarette users continue to smoke conventional cigarettes.”

Jacob Sullum – Royal College of Physicians: Vaping Can ‘Prevent Almost All The Harm From Smoking’
http://reason.com/blog/2016/04/28/royal-college-of-physicians-says-e-cigar
http://www.forbes.com/sites/jacobsullum/2016/04/28/royal-college-of-physicians-says-e-cigarettes-can-prevent-almost-all-the-harm-from-smoking/#1a14b1a1f46b

British study on electronic cigarettes promotes significant reduced-harm promise of products
http://m.journalnow.com/news/local/british-study-on-electronic-cigarettes-promotes-significant-reduced-harm-promise/article_96358be2-4088-5c88-8b5f-db3b1d4f8ccf.html?mode=jqm

Taking an abstinence-only approach to vaping undermines public health
(previous THR opponent Andre Picard warms up to vaping)
http://www.theglobeandmail.com/news/national/taking-an-abstinence-only-approach-to-vaping-undermines-public-health/article29780829/

E-cigs ‘good for public health’, say doctors
http://www.webmd.boots.com/news/20160428/e-cigs-public-health

British scientists think vaping has ‘huge potential’
http://gizmodo.com/british-scientists-think-vaping-has-huge-potential-1773584827

E-cigarettes can help smokers quit, UK group declares
http://www.medpagetoday.com/Pulmonology/Smoking/57589
(responding to RCP report, Big Pharma funded ALA’s Erika Sward deceitfully claimed that comparing interpretations of scientific evidence on vaping by DHHS/ALA and PHE/RCP is like comparing “apples to oranges” due to different e-cig laws, and claimed FDA’s Deeming Ban is needed before it can be determined if e-cigs help smokers quit).

E-cigarette study doesn’t convince Nova Scotia’s top doctor
http://www.cbc.ca/news/canada/nova-scotia/e-cigarettes-vaping-smoking-robert-strang-1.3557764

Legacy lies initiative spins RCP e-cig endorsement by falsely claiming “US and UK policy makers and scientists have the same goal: ending the tobacco epidemic and dramatically reducing the deaths, disease, addiction and toxicity from combustible tobacco use.”  But since 2009, Legacy, CTFK, ACS, AHA, ALA, AAP and Obama’s DHHS have tried to ban the sale of lifesaving vapor products by repeating many false fear mongering claims about vaping (all of which has protected cigarette markets).
http://truthinitiative.org/news/what-we-can-learn-uk-experience-e-cigarette-regulation

FDA Deeming Ban

Venable: House Appropriations Committee approves new e-cigarette “grandfather date”;
Currently marketed products would be spared
http://www.lexology.com/library/detail.aspx?g=7e640e60-340f-4c5f-bbbb-7232686c00b6

Watch/listen to US House Appropriations Cmte’s 4/19/16 debate and vote to support the Cole/Sanford amendment to prevent FDA from banning >99% of vapor products
https://www.youtube.com/watch?v=ZLSw–e_V7s

Wasserman Schultz slammed for opposition to e-cigarettes
http://dailycaller.com/2016/04/21/wasserman-schultz-slammed-for-opposition-to-e-cigarettes/

Mike Siegel: DNC Chair mistakenly claims that Cole amendment will make it harder to regulate e-cigarettes
http://tobaccoanalysis.blogspot.com/2016/04/dnc-chair-mistakenly-claims-that-cole.html

Clive Bates: The tobacco control high command has lost its way – what we learn from its views on FDA priorities
http://www.clivebates.com/?p=3905

Joel Nitzkin: What drives tobacco policy?
http://ntr.oxfordjournals.org/content/early/2016/04/19/ntr.ntw104.short
http://ntr.oxfordjournals.org/content/early/2016/04/19/ntr.ntw104.full.pdf?keytype=ref&ijkey=iflKpog6Q2x9V5z

Heartland Institute vaping experts react to House vote loosening proposed e-cigarette regulations
https://www.heartland.org/press-releases/2016/04/20/heartland-institute-vaping-experts-react-house-vote-loosening-proposed-e-c

FDA vapor prohibitionist Mitch Zeller obfuscates on FDA vapor ban and THR at NATO http://www.cspdailynews.com/category-news/tobacco/articles/4-takeaways-zeller-s-nato-show-session
http://www.cspdailynews.com/category-news/tobacco/articles/blog-4-things-we-wish-zeller-had-discussed-nato

Tampa Tribune editorial: FDA still blowing smoke
http://www.tbo.com/list/news-opinion-editorials/editorial-fda-still-blowing-smoke-20160425/

FDA/NIDA funded researchers cite dozens of studies finding vapor products have improved public health, advocate public policies to encourage smokers to switch to vapor products; but repeatedly claim vaping “may” benefit smokers, propose absurd evaluation framework, and fail to acknowledge the disastrous vapor prohibition policy of Obama’s DHHS since FDA unlawfully banned the lifesaving products in 2009.  “A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products”
http://onlinelibrary.wiley.com/doi/10.1111/add.13394/abstract
(for full text of Levy et al study, please send request via e-mail)

FDA/NIDA funded researchers issue press release urging FDA to be “open-minded” about e-cigarette regulation; but don’t express opposition to FDA’s proposed Deeming Regulation, which protects cigarettes by banning >99% of nicotine vapor products.
http://www.eurekalert.org/pub_releases/2016-04/gumc-ttc042116.php

E-cigarettes: FDA ‘should be open-minded about regulation’ (re Levy et al study)
http://www.medicalnewstoday.com/articles/309536.php

E-cigarettes may actually help people quit smoking, saving many lives (re Levy et al)
http://www.medicaldaily.com/e-cigarettes-quit-smoking-save-lives-383713

E-cigarette use can potentially reduce deaths from cigarette smoking (re Levy et al)
http://www.news-medical.net/news/20160425/E-cigarette-usec2a0can-potentially-reduce-deaths-from-cigarette-smoking.aspx

FDA funded study finds e-cigarettes are more beneficial than harmful (re Levy et al)
http://www.examiner.com/article/fda-funded-study-shows-e-cigarettes-are-more-beneficial-than-harmful

ACSH: On e-cigarettes, tobacco control experts ask FDA to focus on the good
http://acsh.org/news/2016/04/25/on-e-cigarettes-tobacco-control-experts-ask-fda-to-focus-on-the-good/

US Senators Jeff Merkley (D-OR) and Richard Blumenthal (D-CT) keep protecting cigarettes by conflating lifesaving vapor products with deadly cigarettes, repeating lies about vaping and FDA’s Deeming Ban, lobbying White House to ban vapor products.
http://thehill.com/blogs/congress-blog/healthcare/277544-the-time-is-now-to-finalize-the-tobacco-and-nicotine

US Senator Sherrod Brown (D-OH) protects cigarettes by lobbying White House to impose FDA’s vapor deeming ban
http://wset.com/news/connect-to-congress/senator-calls-for-fda-oversight-of-e-cigarettes

Obama’s CDC and Big Pharma financed AAP again falsely claim e-cigs are target marketed to teens (to lobby for FDA’s Deeming Ban); study unsurprisingly finds teens who vaped were more likely to see a online vaping ad, but CDC/AAP deceitfully conflate lifesaving vapor products with highly addictive and deadly cigarettes, and falsely claim ads lure teens to vape (even though vast majority of vapers were/are smokers)  http://pediatrics.aappublications.org/content/early/2016/04/21/peds.2015-4155
www.reuters.com/article/us-health-ecigarettes-internet-advertisi-idUSKCN0XM08T

Clueless and/or biased news media repeat CDC/AAP’s false allegations that online e-cig ads lure teens to vape
http://www.reuters.com/article/us-health-ecigarettes-internet-advertisi-idUSKCN0XM08T
http://www.nbcnews.com/health/heart-health/e-cigarette-ads-get-through-teens-study-finds-n562066
http://www.techtimes.com/articles/153611/20160426/this-is-how-ads-lure-kids-to-start-using-e-cigarettes.htm
https://consumer.healthday.com/cancer-information-5/smoking-cessation-news-628/e-cigarette-ads-may-help-lure-teens-to-the-habit-710203.html
http://www.csmonitor.com/USA/Justice/2016/0426/E-cigarettes-help-adults-quit-smoking-but-they-encourage-teens-to-start

FDA/NIH activist researchers falsely insinuate that e-cig advertising causes teens to vape
http://www.jahonline.org/article/S1054-139X%2816%2900064-1/abstract?cc=y=

Mike Siegel: Simultaneously published studies demonstrate severe bias in e-cigarette research (by CDC and AAP)
http://tobaccoanalysis.blogspot.com/2016/04/simultaneously-published-studies.html

Big Pharma financed vapor prohibitionist CTFK’s Matt Myers repeats CDC’s false claims about online e-cig ads to lobby for FDA’s vapor Deeming Ban
http://www.tobaccofreekids.org/press_releases/post/2016_04_25_cdc

Legacy lies intiative repeats CDC’s false fear mongering claims about online e-cig ads to lobby for FDA’s vapor Deeming Ban
http://truthinitiative.org/news/new-research-affirms-need-fda-regulate-online-e-cigarette-ads

Clive Bates rebuts CDC study that falsely insinuates e-cig ads cause teens to vape
http://www.ncbi.nlm.nih.gov/pubmed/26741522

FDA funded anti vaping junk scientists repeat disproved false claims about OTP and vapor products as factual, rely upon inaccurate and unreliable Nielsen data (that doesn’t track sales at vape shops, tobacco specialty stores on online) to falsely claim e-cigs are more addictive than smokeless tobacco, poorly attempt to estimate price elasticities. http://www.bizjournals.com/buffalo/news/2016/04/18/cigarette-company-reports-8-5m-in-revenue-but.html

DHHS funded activists falsely claim (in study title) their study of 21 dual little cigar and cigarette smokers supports FDA’s Deeming Regulation, which would ban many cigars and prompt dual cigar/cigarette smokers to switch back to exclusive cigarette smoking
http://tobaccocontrol.bmj.com/content/early/2016/04/27/tobaccocontrol-2015-052633.abstract

Legacy lies initiative falsely claims hookah is just as addictive and more harmful than cigarette smoking to lobby for FDA’s cigarette protecting Deeming Ban, banning hookah bars and taxing hookah.
http://truthinitiative.org/news/truth-about-hookah
http://truthinitiative.org/news/where-we-stand-hookah

FDA/NCI funded Stan Glantz greatly exaggerates risks and use of hookah to lobby for FDA Deeming Ban
https://tobacco.ucsf.edu/fda-should-regulate-manufacturing-and-marketing-hookah-tobacco-prevent-misperceptions-harm-and-widespread-use

DHHS lies about smokeless tobacco

Brad Rodu: In the FDA’s new anti-smokeless tobacco campaign, #TheRealCost is to taxpayers and public health
http://rodutobaccotruth.blogspot.com/2016/04/in-fdas-new-anti-smokeless-tobacco.html
Rodu exposes and debunks false claim by FDA’s Mitch Zeller (fabricated by CDC’s Jane Henley and ACS’s Michael Thun) that “Each year in the U.S., more than 2,300 people are diagnosed with oral, esophageal and pancreatic cancer due to smokeless tobacco use.”

Brad Rodu: Curt Shilling’s public service announcement is a Major League blooper
http://rodutobaccotruth.blogspot.com/2016/04/curt-schillings-public-service.html

Clueless and/or biased media and minor league baseball repeat FDA false claims about smokeless tobacco without fact checking
http://www.counselheal.com/articles/23291/20160421/smokeless-tobacco-cancer-link-found-why-fda-hates-chews-dips.htm
http://www.philly.com/philly/health/20160424_Minor-league_baseball_joins_no-tobacco_effort.html

More FDA

Federal lawsuit charges former FDA Commissioner Margaret Hamburg, her husband Peter Brown, his hedge-fund company Renaissance Technologies, and Johnson & Johnson of RICO violations.  Lawsuit claims all defendants conspired and financially benefited from Hamburg’s actions at FDA regarding J&J’s drug Levaquin, claims Renaissance Technologies owned hundreds of millions of dollars worth of J&J stock as Hamburg served at FDA, claims Hamburg failed to disclose financial conflict of interest during Congressional confirmation, claims Brown’s income increased from $10 million in 2008 to $125 million in 2011, claims Hamburg was appointed to head FDA due to political contributions by Hamburg and Brown to Hillary Clinton and Barack Obama.  https://www.scribd.com/doc/309957583/Amended-Levaquin-complaint
http://ahrp.org/former-fda-commissioner-charged-in-federal-racketeering-lawsuit/
Lawsuit also claims Renaissance Technologies owned $360 million of Lorillard (maker of Newport) stock in 2011, when FDA unlawfully banned and demonized e-cigarettes, and when FDA was under pressure to ban menthol cigarettes, indicating Hamburg, Brown, Renaissance Technologies (and Lorillard) profited from Hamburg’s/FDA’s decisions to unlawfully ban and lie about e-cigs and to not ban menthol cigarettes.

US DOT

Competitive Enterprise Institute and CASAA sue US DOT challenging airline vaping ban
http://thehill.com/policy/transportation/278087-e-cigarette-ban-on-flights-being-challenged-in-lawsuit

Pentagon

US Defense Dept conflates low risk tobacco products with deadly cigarettes,
expands tobacco/vapor product usage bans, increase prices.
http://www.reuters.com/article/us-usa-military-tobacco-idUSKCN0XN2VP

Business

Altria reports adjusted .5% cigarette shipment volume decline in 1Q16 (compared to 1% US industry wide cigarette volume decline in 1Q16), and a 7.8% smokeless tobacco shipment volume increase in 1Q16.
http://investor.altria.com/phoenix.zhtml?src=topnav&c=80855&p=irol-quarterlyearnings
http://media.corporate-ir.net/media_files/IROL/80/80855/2016_Altria.pdf

Reynolds American reports 35.1% RJR cigarette volume increase in 1Q16 (due largely to acquisition of Newport), 3.3% American Snuff moist snuff volume increase, and an estimated 5% moist snuff industry volume growth.
http://www.reynoldsamerican.com/About-Us/Press-Releases/Press-Release-Details-/2016/RAI-delivers-exceptional-1Q16-performance-Results-demonstrate-transformational-nature-of-Lorillard-acquisition/default.aspx

BAT reports 3.6% cigarette volume increase in 1Q16 (with most increases in Asia)
http://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO72TJQU

Japan Tobacco International launches first tank e-cigarettes across the UK
http://www.cityam.com/239824/japan-tobacco-international-launches-first-tank-e-cigarette-across-the-uk
http://www.wholesalenews.co.uk/news/a-smarter-way-to-vape-jti-launches-logic-pro-tank-system-with-multi-million-pound-campaign.html

Smoke signals: Philip Morris, healthy company? (on PMI’s new heat not burn products)
http://www.economist.com/news/business/21697275-philip-morris-health-company-smoke-signals

Imperial to cut 375 jobs at Greensboro cigarette plant (previously owned by Lorillard)
http://www.journalnow.com/news/local/itg-brands-confirms-plans-to-cut-workers-one-third-of/article_88d64063-a8e5-57a9-afb7-7c31d37937c7.html

Litigation

Tobacco giants hit with $35.5 million award in trial over lawyers deadly cancer (FL)
http://blog.cvn.com/tobacco-giants-hit-with-33.5m-award-in-trial-over-lawyers-deadly-cancer
http://postoncourts.blog.palmbeachpost.com/2016/04/27/cigarette-makers-ordered-to-pay-delray-widow-29-million-in-husbands-death/

Reynolds hit with $13 million verdict in smoker death trial (FL)
https://www.law360.com/articles/788028

Taxation

Cigarette industry funded Mackinac anti cigarette tax activists exaggerate black market impact of cigarette tax hikes in OK and other states with low cigarette taxes
http://www.tulsaworld.com/opinion/readersforum/jonathan-small-and-michael-lafaive-cigarette-tax-hike-will-increase/article_24d2ddc7-95de-56e9-b8f1-329502163b87.html

California

CASAA asks California vapers to urge Gov. Brown to veto cigarette protecting anti vaping legislation (SBX2-5)
http://blog.casaa.org/2016/03/ca-make-call-now-to-stop-sbx2-5.html

California Assembly passes bill (AB 1594) to ban the use of all tobacco and vapor products on the property of all public colleges and universities, $100 fine for violators
http://halfwheel.com/california-public-college-university-tobacco-ban-advances/113155
http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_1551-1600/ab_1594_bill_20160331_amended_asm_v97.pdf
http://www.latimes.com/politics/la-pol-sac-essential-poli-assembly-approves-ban-on-smoking-e-cigarette-use-1461617253-htmlstory.html
http://www.csmonitor.com/USA/USA-Update/2016/0426/California-campuses-graduate-from-smoke-free-to-tobacco-free

Massachusetts

MA Senate approves anti vaping bill (S2234) with 32-2 vote
http://halfwheel.com/massachusetts-senate-approves-increase-to-tobacco-purchase-age/113428
https://malegislature.gov/Bills/189/Senate/S2234

CASAA asks Massachusetts vapers to oppose anti vaping bill (S2234) that would ban vaping everywhere smoking is banned, ban vapor product sales at stores with pharmacies, increase minimum age for vapor product sales to 21, ban vapor product sampling.
http://blog.casaa.org/2016/04/ma-take-action-to-oppose-misguided.html
https://malegislature.gov/Bills/189/Senate/S2234

MA Governor Baker backs increase in minimum age for tobacco sales to 21 http://www.capecod.com/newscenter/gov-baker-backing-plan-to-ban-under-21-purchase-of-tobacco/

Washington State

Local e-cigarette stores say new state regulations are positive for business
http://kimatv.com/news/local/local-e-cigarette-stores-say-new-state-regulations-are-positive-for-business

Vaping Bans

Ontario to ban vaping, medical pot, in places where smoking is banned
http://www.theglobeandmail.com/news/national/ontario-to-ban-vaping-medical-pot-in-places-where-tobacco-prohibited/article29130629/

DeKalb County City (GA) Mayor Ted Terry wants to ban e-cigarettes, decriminalize marijuana
http://www.ajc.com/news/news/local/dekalb-county-city-wants-to-ban-e-cigarettes-decri/nrBF4/

More Minimum Age

Chautauqua County (NY) legislature increases minimum age for tobacco and vapor product sales to 21
http://halfwheel.com/chautauqua-county-n-y-says-yes-to-tobacco-purchase-age-increase/113322

CASAA asks Chautauqua County (NY) vapers to oppose increasing minimum age for vapor sales to 21
http://blog.casaa.org/2016/03/local-alert-chautauqua-co-ny-take.html

CASAA asks Albany County (NY) vapers to oppose increasing minimum age for vapor sales to 21
http://blog.casaa.org/2016/02/albany-co-ny-local-alert-take-action-to.html

Portland (ME) City Council to consider raising minimum age for sales of tobacco (and probably vapor) products to 21
http://www.pressherald.com/2016/04/25/portland-council-advances-plan-to-raise-age-for-buying-tobacco/

Publicity

Newsweek issues Special Edition called Vape Nation, but magazine cover calls vaping a vice, and shows clouds of vapor as a marijuana leaf
http://onnewsstandsnow.com/collections/newsweek/products/newsweek-vape-nation?variant=17972702468
http://www.newsweek.com/vaping-big-tobacco-big-gamble-future-451074

EU/UK TPD

Clive Bates: E-cigarette impact assessment exposes useless and illegal policy (UK/EU)
http://www.clivebates.com/?p=3921

Tobacco lobbyists demand say in EU debate on . . . . tobacco lobbying
http://www.politico.eu/article/tobacco-lobbyists-demand-say-in-eu-debate-on-tobacco-lobbying-european-parliament-european-ombudsman-emily-oreilly/

BBC Video – The EU in 10 objects: The e-cigarette
http://www.bbc.co.uk/programmes/p03rr1nn

Improving Public Health: The role of local authorities in reducing smoking
Conference – Tuesday May 17, 2016, Grand Wellington Hotel, London
https://www.publicpolicyexchange.co.uk/events/GE17-PPE?ss=bk&tg=bp1
https://www.publicpolicyexchange.co.uk/book.php?event=GE17-PPE&ss=lk&tg=1

India

Sally Satel: What’s really killing India’s smokers
Misinformation about e-cigarettes and vaping presents a growing threat to public health.
http://www.wsj.com/articles/whats-really-killing-indias-smokers-1461600409

Jacob Sullum: Indian merchant gets three years of ‘rigorous imprisonment’ for selling e-cigarettes
http://reason.com/blog/2016/04/27/indian-merchant-gets-three-years-for-sel

THR Research

ERF and AEMSA post 900 e-vapor studies in Existing Research Citations list
http://e-researchfoundation.org/direct-from-the-experts/current-studies-2/

Ron Borland and Coral Gartner: Rethinking therapeutic and recreational nicotine products: a commentary on Hatsukami et al
http://tobaccocontrol.bmj.com/content/25/3/245.full

Study finds indoor vaping ‘unlikely’ to pose a health risk to bystanders
http://www.huffingtonpost.co.uk/entry/study-finds-indoor-vaping-unlikely-to-pose-a-health-risk-to-bystanders_uk_57173bd1e4b0f22f021a6362
http://www.sciencecodex.com/new_study_finds_exhaled_ecigarette_vapour_particles_disappear_within_seconds-180599

More THR Education and Advocacy

Gerry Stimson: Public health should step aside. Vapers are now leading the fight against smoking. (UK and worldwide)
https://health.spectator.co.uk/public-health-should-step-aside-vapers-are-now-leading-the-way-against-smoking/

Previous THR opponent RSPH publishes The Pleasure Principle by Sarah Jakes (UK)
https://www.rsph.org.uk/en/about-us/latest-news/press-releases/press-release1.cfm/pid/FA9FF2F8-7ABA-4085-860402EEC46E9349

Dave Sweanor: We can be heroes
http://vaporvoicemagazine.com/we-can-be-heroes/

Interview with Bill Godshall: Fighting for Vapor (pages 34/35)
http://vaporvoicemagazine.com/digital/22016/

Leicester vapers talk about quitting smoking with e-cigarettes (UK)
https://www.youtube.com/watch?v=LQ2ybMIkRjM&feature=youtu.be

The Heartland Institute – The Vaping Wars: Brian Fojtik and Victoria Vasconcellos
(streamed on April 20)
https://www.youtube.com/watch?v=CyrboQICqWI

Vapor Product Safety

Brooklyn kiosk owners claim teen blinded by exploding e-cigarette was at fault
http://www.nydailynews.com/new-york/brooklyn/brooklyn-e-cigarette-kiosk-owners-claim-blinded-teen-fault-article-1.2617162

Smoking Cessation

Australian Court forces drug regulator to consider BAT’s nicotine inhaler application
http://www.smh.com.au/federal-politics/political-news/federal-court-forces-drug-regulator-to-consider-nicotine-inhaler-case-20160421-goc3kx.html

Court rules Health Canada unfairly blocked quit smoking aid after Pfizer complained
http://www.theglobeandmail.com/news/national/court-rules-health-canada-unfairly-blocked-quit-smoking-aid-after-pfizer-complaint/article29707496/

Pfizer and GSK funded study claims verenicline and buproprian not associated with
neuropsychiatric adverse events
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30272-0/abstract
http://www.businesswire.com/news/home/20160422006045/en/CHANTIX%C2%AECHAMPIX%C2%AE-varenicline-Results-Largest-Global-Clinical-Trial Pfizer press release
http://www.medpagetoday.com/Pulmonology/Smoking/57511?xid=NL_breakingnews_2016-04-25&eun=g220600d0r
http://www.science20.com/news_articles/debunked_claims_that_chantix_and_zyban_smoking_cessation_drugs_boost_risk_of_psychiatric_side_effects-171140
http://bigstory.ap.org/article/26333c9e6b43446aaadef59a3ece9378/study-no-suicide-risk-anti-smoking-pills-chantix-zyban
https://consumer.healthday.com/cancer-information-5/smoking-cessation-news-628/study-doesn-t-find-link-between-anti-smoking-drugs-and-mental-health-side-effects-710238.html

Increasing tobacco harm

Health Canada looks at forcing tobacco companies to make cigarettes more harmful
http://news.nationalpost.com/news/canada/health-canada-looks-at-forcing-tobacco-companies-to-make-cigarettes-less-addictive

More Junk Science, Propaganda and Lies

UAE University’s Mohammad Al Houqani falsely claims e-cigarettes more harmful than cigarettes at purported anti smoking conference in Dubai
http://gulfnews.com/xpress/news/e-cigarettes-more-harmful-than-traditional-smoking-1.1718099

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