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s2smodern

The heat and dust continues to swirl around the Foundation for a Smoke Free World https://www.smoke-freeworld.org/leadership.

Whether the negativity continues will very much depend on what it actually does, although suspicion will always dog its tracks no doubt. The WHO have weighed in with a statement urging all governments and public health bodies to steer clear and refuse any collaboration: https://www.cnbc.com/2017/09/28/who-tells-governments-to-reject-philip-morris-funded-smoking-foundation.html

The position of Derek Yach, the FSFW Director is that the best way of dealing with smoking is for industry and public health to work together. He said, "I am deeply disappointed, therefore, by WHO's complete mischaracterisation of the nature, structure and intent of the Foundation in its recent statements — and especially by its admonition to others not to work together."

He shouldn’t be that surprised though. Alex Wodak reminded me that twenty years ago, the WHO sent a memo to its Geneva staff ordering them not to attend the annual conference of the International Harm Reduction Association. At the time the Association were doing the work that WHO should have been doing to slow the spread of HIV among people who inject drugs. Eventually the WHO saw the light of day, attended the next annual conference and began to support drugs harm reduction from the late 1990s.

So here we go again. In these circumstances, it does feel like the WHO (always with its main donor, the USA, looking over its shoulder) should be renamed WHOTO – World Health Our Terms Only.

Yach too, is no stranger to controversy when he went from fighting the food industry to trying to improve matters from the inside. This from 2013,

http://www.npr.org/sections/thesalt/2013/01/28/169733003/how-one-man-tried-to-slim-down-big-soda-from-the-inside

Back then, he felt dealing with the food industry was different from Big Tobacco. The anti-tobacco formula was simple: "Demonize the industry. Tax it through the roof. Ban all forms of marketing." But you can't get the same results with sugary soft drinks, he says. If you tax them heavily enough, you can drive consumers away from those products, "but that doesn't mean you solve the obesity problem. It all depends on what they choose as that alternative." But now of course, there are serious alternatives to cigarettes.


An important study has just been published demonstrating the potential for e-cigarettes to significantly reduce the death toll from smoking in the USA.

http://tobaccocontrol.bmj.com/content/early/2017/08/30/tobaccocontrol-2017-053759?rss=1&hootPostID=14dfe76fb9cd8a063c9b509aa2075663

The headline conclusions were that switching “can yield substantial life year gains even under pessimistic assumptions regarding cessation, initiation, and relative harm.”  In particular, switching could result in nearly 6.6 million fewer smoking-related premature deaths (a reduction of 25.2%); and 86.7 million fewer life years lost due to smoking-related diseases (a reduction of 34.9%).

The authors also made this favourable assessment of heat-not-burn products,’[they] have been introduced in some countries, and these may be a better substitute for cigarettes than e-cigarettes, but have higher toxicant levels.  While they may impose greater health risks, they are still likely well within the estimates used in our pessimistic scenario”.

And overall, “our analysis shows that a strategy of replacing cigarette by e-cigarette use can yield substantial gains, even with conservative assumptions about related risks. … An endgame scenario for cigarettes that might well be within reach, if new technologies for delivering nicotine with substantially less harm, but sufficient satisfaction, are harnessed with sufficient passion and political will to aggressively phase out tobacco cigarettes”.

Here is the article from Consumer Affairs in which the lead author David Levy and Stan Glantz actually agree on some points and where Prof Glantz sort of says that if all smokers switched to e-cigarettes, they would be better off,
https://www.consumeraffairs.com/news/study-finds-vaping-could-be-a-lifesaver-100417.html


Check out Carl Phillips writing for the Daily Vaper on how vaping helps smokers quit

http://dailyvaper.com/2017/10/02/science-lesson-how-vaping-leads-to-smoking-cessation/

His key points are:

  1. Trying to quit smoking by switching to vaping improves the chance of success. Some people would have tried to quit smoking using another method and failed, but instead try switching to vaping and succeed.
  2. Vaping causes smoking cessation attempts that would not have otherwise occurred. Many smokers who would not have made a concerted attempt to quit during a particular month (or year, or perhaps ever) try because of vaping. So smoking cessation occurs not merely because switching to vaping works better than some alternative method, but because no method would have been tried without vaping.

2a. Some smokers become “accidental quitters” after they start vaping. They were not going to try to quit smoking, and also did not really plan to quit with vaping. Rather, they just start vaping and discover they are done with smoking. Arguably this is a version causing a cessation attempt (though it only becomes an “attempt” after it succeeds), but it is still useful to recognize it as a particular variation on that pathway.

  1. Ongoing vaping prevents recent ex-smokers from returning to smoking. Most people who stop smoking for a week start smoking again within six monthsor a year. But by providing a satisfying substitute, not just a temporary push to stop, vaping dramatically reduces the benefits of returning to smoking.
  2. Vaping can prevent relapse in established ex-smokers. Some ex-smokers start smoking again after a year of smoking abstinence. Some discover the option of taking up vaping, even though it did not contribute to them quitting in the first place. For them it can have the same effect as in point 3, causing temporary smoking abstinence to become permanent cessation.

Understanding the distinct causal pathways highlights the way many analyses understate the contribution of vaping to smoking cessation: They ignore some pathways. Almost all the focus in the academic literature is on the first pathway. Clinical trials measure only the first pathway, and sometimes a bit of the third. They ignore the effects of the second pathway (both versions), though it probably accounts for most cases of vaping causing smoking cessation. Trials also ignore the fourth causal pathway, which is a smaller effect but not nothing. (Clinical trials of smoking cessations also have other major flaws that are not related to this).


Commenting on this piece of research about ‘Juice Monsters’, http://www.ncbi.nlm.nih.gov/pubmed/28937746, Clive Bates says it “continues the academic trend of turning poor research and engineering naivety into clickbait by adding a sprinkling of what the authors think is street slang. ​I can't say this often enough: researchers should engage knowledgeable vapers in all experiments on the way vaping products are used”

One such person is Paul Barnes whose views expressed on Twitter  here were somewhat more direct and can be best summed as SOD OFF – for those in the know – Sub-Ohm Devices. And for those of a nervous disposition, look away now as Paul concludes “Once again, vaunted tobacco control "scientists" haven't got a fucking clue about the devices they are studying”.


Australian doctors and nurses are ramping up the pressure on the government over e-cigarettes

http://www.huffingtonpost.com.au/2017/10/04/experts-plead-with-medical-council-to-cut-through-the-smoke-surrounding-e-cigarettes_a_23233088/

http://www.danaonline.org/wp-content/uploads/2017/09/DANA-Position-Statement-on-E-Cigarettes-2017.pdf

And just a final thought on trust and big business. Any attempt by the tobacco industry to regain trust and credibility is as big an ask as the profits it still derives from selling cigarettes. Does this mean that you can never trust it even when it produces products that swathes of independent research declare to be beneficial?

Consider the car industry. Motorised vehicles been polluting the environment for decades while every attempt to reduce risk and improve health and safety (seat belts, speed limits, road calming measures etc) have not been driven (to the best of my knowledge) by the industry itself. No longer is it allowed to highlight speed in its marketing, although many ads still have cars zipping along empty mountain roads and in streets weirdly devoid of traffic (CGI?). Moreover, it has often been slow to recall dangerous vehicles, not been honest about fuel consumption figures in real driving situations and worse still, has been caught out cheating on carbon emissions, even deliberately fitting software to give false readings. Yet most major manufactures have already started or have plans to introduce electric cars which from an environmental perspective would be hugely beneficial. I know that unlike cigarettes, it isn’t the product per se kills people, it is the way the product is used, but even so, do you no longer trust Volkswagen, for example, when it announces its new electric model because of crimes against the climate?