Monthly Archives: July 2016

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…

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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’.

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

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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…

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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!