Galileo said, “By denying scientific principles, one may maintain any paradox”. That certainly seems to pertain to official responses to harm reduction. And there are a few paradoxes to highlight this week.
The first is prompted by an article in the Washington Examiner about how American health authorities are facing up to the epidemic of opiate deaths :
Until recently the US Federal Government has refused to support funding for drug harm reduction interventions. The opioid crisis, which has hit the USA in the past 10 years, has changed official thinking. The National Institute for Drug Abuse report that the U.S. has experienced significant increases in rates of neonatal abstinence syndrome, hepatitis C infections, and opioid-related emergency department visits and hospitalisations. Most alarming for the authorities are continued increases in overdose deaths, especially the rapid increase since 2013 in deaths involving illicitly made fentanyl and other high strength synthetic opioids. Since 2000, more than 300,000 Americans have died of an opioid overdose. Funding is now available for opiate substitute treatment, and the provision of the drug naloxone (which immediately reverses the effect of opioid overdose), while the Surgeon General has even publicly supported the provision of needle exchange.
This is all good news for those with serious drug problems, and tragic for those thousands of drug users of past decades who were left with quit or die options without any safety net to help keep them alive. Yet, since the year 2000, over seven million Americans have died from a smoking-related disease. Drug overdoses are acute and dramatic incidents, police and ambulance crews are called, the build-up of media reporting prompts political pressure for a response, usually by establishing a Task Force. By contrast, smoking-related deaths are literally a slow burn.
Here’s another thing, two cheers for the Canadian government for ‘allowing’ the legal manufacture, import and sale of vaping products both with and without nicotine, albeit with a number of disappointing downsides, not least that the new law prevents companies from informing smokers about significantly less hazardous options and fails to adequately distinguish between the relative risks of cigarettes, and e-cigarettes and other alternatives. It is a step forward however, and it is appropriate that the seat of Canadian government is in Ottawa because it was there in 1986 that the WHO launched a health promotion charter which stated that the healthiest choice should be the easiest choice for people to make - as a key guiding principle.
Now let’s hop over to British Columbia, a crucible of drug harm reduction on the North American continent, and the state which opened one of the very first drug consumption rooms in the world, the success of which paved the way for Health Canada to start approving prospective supervised-injection sites in other cities across the country. And the site of the first and only prescription heroin programme in North America. And yet, the state health authorities did everything in theirits power to prevent the Global Forum on Nicotine holding a small event earlier this year to discuss tobacco harm reduction, sinking to the depths of slandering GFN director, Professor Gerry Stimson.
And soso, to the WHO (again) and its recent a draft consultation document around tackling the global problems of non-communicable diseases (NCD) such as those caused by pollution, obesity, drinking and smoking. The opening statement declared “The 2030 Agenda for Sustainable Development, with its pledge to leave no one behind, is our boldest agenda for humanity. It will require equally bold actions from Presidents and Prime Ministers to deliver on, as one of their targets, their time-bound promise to reduce one-third of premature mortality from NCD.” The word ‘bold’ appears a number of times.
In this document the WHO sets great store in partnership with the private sector, “The 2011 Political Declaration on NCDs called for engagement with the private sector, especially in the areas of food and non-alcoholic beverage production and marketing. It was noted in 2014 that only limited progress had been made in these areas, and where the private sector had made progress in promoting products consistent with a healthy diet, such products were not always affordable, accessible, and available. Because of this limited progress, the Commission considers that a fresh working relationship must be established with the food, non-alcoholic beverage, restaurant, technology, and media industries, with the aim that all countries benefit from public-private partnerships that promote health and behavior change”.
Now we all know that this does not extend to the tobacco industry, even though working with the industry could well make products “affordable, accessible and available” for those seeking a healthier life. But are the WHO really suggesting that when it comes to counter-acting pollution, obesity and all the rest, that Big Sugar, Big Booze, Big Oil, and Big Food, who are responsible for growing the world population to balloon size through fat-laden junk food, have never sought to influence and undermine the public health policies that they would regard as detrimental to profits?? Apart from numerous conventions on the environment, there are no treaties about tackling global NCD that I could find apart from except for tobacco. Curious.
Interesting study which revealed the level of counterfeiting already underway with specific reference to the nicotine content of liquid refill bottles. The authors concluded, “We introduce 2 novel issues in the e-cigarette industry, the production of counterfeit refill fluids under a brandjacked label and inclusion of nicotine in 81.3% of the counterfeit products labelled 0 mg/ml. This study emphasizes the need for better control and monitoring of nicotine containing products and sales outlets.”
Nobody is going to argue with proportionate safety standards, but obviously, the concern is that tougher legislation will only underwrite a bogus vaping industry, except it is already here www.migvapor.com/ecig-news/fake-e-cigs/ and I also understand that some corporate lawyers are spending time trying to combat fake heat- not- burn products. But there is a horrible sense that if regulators clamp down, and more people buy devices that are so poorly made, andthat consumers are injured or killed by explosions or are made ill by liquids, then this is all ammunition for anti-tobacco harm reductionists to crow, ‘We told you they weren’t safe”.
It is no different in the world of drugs; there is no political incentive for a government pursuing tough drug control policies to expedite a route to safer drug use, unless of course there is a risk to the wider population – like the spread of HIV through drug injecting. Which is why, like the early days of vaping, it has taken a grass roots agency in the UK called The Loop to start on-site drug testing at festivals (and a high five to the police for not objecting), and they are starting up in Australia too.
Which leads to a consideration of the tragic incident in New York where a vaper died from a mechanical mod explosion. https://mobile.nytimes.com/2018/05/16/us/man-killed-vape-explosion.html.
Just to put what happened in a broader context, smoking is a major cause of residential fires. Between 2008 and 2010, an estimated annual average of 7600 smoking-related fires occurred in residential buildings in the US [US Fire Administration, 2012]. They account for only 2% of all residential building fires but for 14% of fire deaths. Globally, some 300,000 people die every year from a smoking-related fire. https://www.ucdmc.ucdavis.edu/publish/news/newsroom/2763
But despite the rarity of this type of accident given the number of devices in circulation, this vaper now questions whether the time of the mechanical mod has passed. “Mech mods are not, in the big scheme of things, dangerous. You’re far less likely to be injured by your mech mod than you are by your car, bread knife or Galaxy Note 7. Unfortunately, the media don’t care about traffic accidents, kitchen utensils or phones. They do care about e-cigarettes. And that means every time a mech mod goes badly wrong it’s going to get global press coverage. Even more unfortunately, while mechs are safer than many objects we cheerfully surround ourselves with on a daily basis they’re a lot less safe than any other variety of e-cig – and those with hybrid connectors are the least safe of all.”
Read the full post here http://www.fergusmason.com/great-mech-mods-time-say-goodbye/
A Norwegian study was published recently looking at the effect of health warnings on risk perceptions of snus. It starts with citing a flawed report from the Norwegian Institute of Public Health claiming that “snus is associated with several health risks, such as lesions of the oral cavity, adverse pregnancy outcomes, and some forms of cancer.” So the starting point for this study is the need to find the best way of informing the public based on clinically incorrect statements. about Then they conducted an online survey where participants were asked to review four warning labels:
“This tobacco product severely damages your health. Causes cancer.”
“This tobacco product can damage your health and be addictive.”
“This tobacco product can damage your health and is addictive.”
“This tobacco product damages your health and is addictive.”
To cut a tedious story short, none of these warning made much difference one way or the other to a target group of young people recruited through Facebook. But what is troubling about this study is that it deliberately set out to establish which particular piece of misleading information about snus was likely to have the most impact on young people.
From reading the esteemed work of Professors Wayne Hall and Lynn Kozlowski, I have been led into the world of moral psychology as it applies to harm reduction and the attempt to explain the root of passionately held views. The modern day moral psychology guru Jonathan Haidt argues that trying to reconcile opposing moral positions will never work if neither side is prepared to acknowledge where the other side is ‘coming from’.
I recall hearing Martin Dockrell from Public Health England remark that he put ‘popcorn’ into Google and ‘popcorn lung’ came up before err…popcorn in the search bar. ‘Popcorn lung’ is so nice and catchy, like ‘hippy crack’ (nitrous oxide, honestly) and ‘zombie spice addicts’.
We start this week with the European Court of Injustice interim ruling playing fast and snus with smokers’ health as part of a rather long blog (sorry) on what the Rand Corporation call Truth Decay. More on that below.
Brisbane’s Gold Coast is not the only venue for fun and games in a land down under. In March, the Australian Parliament published its enquiry into e-cigarettes. Clearly the ‘status quo’ outcome was a major disappointment, but there were some positive takeaways and hopefully Australian tobacco harm reduction activists might feel that the argument has moved on.
Public health is essentially concerned with prevention and when it comes to tackling global communicable diseases like smallpox, TB and other diseases, there are many public health success stories. However, preventing the development of non-communicable diseases like the fall-out from drinking, smoking and drug use is a much more challenging prospect. The early efforts at substance use prevention in the West were spearheaded by faith groups and moral reformers whose goal was total abstinence. But as we know, the subsequent legislative history in pursuit of those ambitions has been dogged by failure - Prohibition in the USA floundered, in recent years drug control policies have tended to balkanise across the world and as for a total ban on tobacco….dream on.
A disturbing proportion of the US population believe it’s the nicotine in cigarettes that causes cancer. This was the result of an analysis of FDA 2017 Health Information Trend Survey data conducted by Pinney Associates and presented at the Society for Research on Nicotine and Tobacco’s 24th annual meeting in February.
I know there are some readers of this blog who are unfamiliar with the happy-go-lucky world of international tobacco control. Here is a snippet of back story. Derek Yach was formerly an important figure in WHO tobacco control circles until he recently became head of the Foundation for a Smoke Free World (FSFW) funded in a very transparent way by Philip Morris International.
A quick check on Google Images will throw up (no pun intended) posters like these while YouTube will oblige with doom-laden videos about the iniquities of vaping. Which naturally started me thinking about this sort of campaigning in general aimed at preventing young people using drugs, alcohol, tobacco and all the other stuff we don’t want them to do - and its largely inglorious and pointless history.
This week’s must-read cones from the ever-insightful Carl Phillips who has written a superb demolition of the latest piece of suspect science from the parallel universe of Planet Glantz. The Prof attempted to show that vaping isn’t all its cracked up to be as an aid to quitting and in the process, made some basic methodological howlers. It is hard to believe that he isn’t aware of these, so the conclusion must be an attempt to muddy the waters of tobacco harm reduction, to cause confusion and doubt among regulators and the wider public - an accusation, traditionally lobbed at the tobacco industry.
So here is my half century blog post. Thanks for all the positive feedback. The cheques are in the post. Sorry I don’t do online banking.
Snus is banned across the EU, except in Sweden. Swedish Match, the leading snus manufacturer, initiated a challenge against the ban. In January 2017 the High Court in London ruled that the challenge should be heard at the European Court of Justice in Luxembourg. The hearing took place on 25 January 2018.