Tobacco opponents say that we’ve had too little experience with e-cigarettes to know whether they are safe. While it is true that we don’t yet know the health consequences of long-term use, that should not discourage smokers from switching.
Author: Brad Rodu
It’s almost baseball season, which means it’s time for anti-tobacco extremists to start grabbing easy headlines. One especially zealous state lawmaker wants to ban smokeless tobacco by players and fans in all California ballparks (here). It’s all based on smoke and mirrors, as illustrated in a woefully inaccurate recent BBC story on smokeless tobacco and baseball.
Memorial Sloan Kettering Cancer Center researchers, led by first-author Sarah Borderud, claimed on September 22, 2014, that e-cigarettes did not help cancer patients quit smoking (media story here). They based that statement on a study they published online in Cancer, a journal of the American Cancer Society (abstract here).
The association of tobacco use and body weight has long been a matter of concern. In 2004, I collaborated with Swedish investigators to publish the first research on whether switching from cigarettes to smokeless tobacco blunts some of the weight gain normally seen with quitting via abstinence (abstract here, blog post here).
As a pathologist working at two large medical centers, I have studied the effects of smoking on health for over 20 years. I’ve published scores of papers on the impressive benefits of switching from cigarettes to safer, non-combustible forms of tobacco (such as Swedish snus). This strategy – called tobacco harm reduction – has vast potential for improving public health.
The contrast between the spin put on youth e-cigarette use data last Fall and the story told by the actual data, released last month, is startling but not surprising, given the U.S. government’s over-zealous tobacco prohibition posture.
Publishing a study of tobacco-specific nitrosamines in American smokeless tobacco products (abstracthere), Dorothy Hatsukami and colleagues at the University of Minnesota called for the FDA to issue “regulations…to reduce levels of…NNK and NNN in smokeless tobacco products to the lowest levels possible.” The authors make illogical and unscientific claims in their article and media interviews (here).
The New England Journal of Medicine yesterday published a letter claiming that vapor contains “hidden” formaldehyde at far higher levels than cigarettes (here), which made headlines worldwide. That conflicts with a report I discussed last week, documenting that formaldehyde levels in e-cigarettes were far lower than those in traditional cigarettes (here).
Researcher Naoki Kunugita at Japan’s National Institute of Public Health recently fueled anti-e-cig hysteria with this unverifiable claim: “In one brand of e-cigarette the team found more than 10 times the level of carcinogens contained in one regular cigarette.”
Recently I attended a forum on e-cigarettes, sponsored by a political organization that wanted to educate its attendees about the devices. During the discussion my opponent [from the prohibitionist American Legacy Foundation] repeated the baseless claim that there is no evidence that e-cigarettes help smokers quit.
The Monitoring the Future survey shows that past 30-day cigarette use among 12th graders dropped from 16.3% in 2013, to 13.6% in 2014, the largest single-year decline in the survey’s 39-year history (datahere).
The New York Times has added more fuel to the anti-tobacco-harm-reduction fire with a December 4 editorial (here) rehashing the somewhat slanted reporting that appeared in the paper’s news pages on November 30. In two stories that day, the Times explored issues surrounding Swedish Match’s FDA application to change the warnings on its snus products. As I noted (here), “The Times and their quoted experts did a major disservice to their audience; they failed to report the simple truth, that mouth cancer risk for Swedish snus is next to nil.”
The New York Times has published (here) a reasonably accurate portrayal of the Swedish snus experience that I have chronicled for over a decade (here, here, andhere). Reporters Matt Richtel and David Jolly examined Swedish Match’s FDA application to remove the federally mandated mouth cancer and not-safe-alternative warnings from snus products. I have discussed this landmark filing previously (here).
The British government has just released statistics on e-cigarette use (here). The Office for National Statistics reports that e-cigarettes were used by 12% of smokers and 5% of former smokers in the UK during the first quarter of this year, but the rate of use among never smokers was only 0.14%.
Acting U.S. Surgeon General Boris Lushniak recently tweeted, “@OxfordWords #Vape may be #WOTY but the increase in never-smoking youth using e-cigs is a not a trivial story.” The tweet referred to the Oxford English Dictionary’s having designated “vape” as the word of the year, and reflected a CDC report claiming that e-cigarette use among children had increased in 2013. The prevalence of e-cig use among youth who had never smoked was 0.3%.
As noted previously (here), Drs. Karl Fagerström and Tom Eissenberg have described a continuum of dependence among tobacco and nicotine products. They concluded that cigarettes are the most dependence-producing (addictive) product and that smokeless tobacco is intermediate, evidenced by clinical trials showing that quitting cigarette smoking is more difficult than quitting ST.
As early as 2004, various medical journals published articles claiming that small-community smoking bans resulted in nearly immediate reductions in heart disease. For example, the high-profile BMJ reported that hospital admissions for acute myocardial infarction (AMI) declined 40%, from 40 to 24, in Helena, Montana, after implementation of a smoke-free ordinance (here). Circulation, the journal of the American Heart Association, reported that AMI admissions dropped 27% “within months” in Pueblo, Colorado (here). Similar reports came from Bowling Green, Ohio (here), Monroe County, Indiana (here) and beyond.