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s2smodern

Harry Shapiro Director DrugWise

Tobacco harm reduction is on a roll right now – and I don’t mean a roll-up. Let me count the ways.

The big one of course is the announcement by Scott Gottlieb on the FDA’s revised approach to THR. Here is the full FDA news release

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm

The FDA has shifted to a more neutral position on e-cigarettes and similar products through a recognition of the role that THR plays in reducing the harms of using nicotine via cigarettes. It is saying that adults who want or need nicotine can get it from much lower risk products; that there will be rules and standards for e-cigarettes; that the Center for Tobacco Products will reconsider aspects of deeming of reduced risk products while pushing back the compliance period for e-cigarettes from 2018 to 2022.

Of course we do not live in a perfect world; the FDA is majoring on the inherently flawed idea of reduced nicotine cigarettes Click here for some informed commentary on the subject

https://www.slideshare.net/Clive_Bates/is-nicotine-reduction-a-viable-policy-for-tobacco-control-no-definitely-not

And as Clive points out, there is nothing ‘obvious’ about kid-focused flavours. “Are kid-sounding flavours actually attractive to at-risk adolescents or a retro thing for adults? Are these flavours attractive enough to change behaviour? If they do change behaviour, what is the nature of the change?  Is this change of behaviour harmful or beneficial, taking account of smoking behaviour? All that to all be fought over in the rule-making process.  If the scope of a ban on flavours is narrow (eg to trademarked candy names) then it’s not the end of the world”

And this from David Sweanor summing up the importance of the FDA announcement:

“The key thing from today’s FDA announcement in my view is what is being said on continuum of risk, encouraging innovation, backing off from onerous requirements on alternatives to cigarettes, etc. This has enormous public health potential. This is a huge switch from the ‘tobacco free world’ approach by US government agencies. It will now be very hard, for instance, for CDC and other government agencies to engage in misinformation campaigns on relative risks”.

But how will the pharma-backed anti-vaping campaign bodies react? Have their guns been silenced or just temporarily muffled?

And happy to report that the UK once again leads the way in THR with the launch of England’s Tobacco Control Plan, the first official government tobacco control plan anywhere in the world to make THR a key element in the strategy. Some relevant quotes:

We are committed to evidence-based policy making, so we aim to: 

  • Help people to quit smoking by permitting innovative technologies that minimise the risk of harm. 
  • Maximise the availability of safer alternatives to smoking” 

“The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products”. 

“PHE [Public Health England] will provide evidence based guidance for health professionals to support them in advising smokers who want to use e-cigarettes or other nicotine delivery systems to quit”

“DH [Department of Health] will, based on the evidence reviews undertaken by PHE, review policy and regulation of nicotine delivery systems to provide an environment that facilitates smokers taking action to improve their health and the health of those around them, whilst minimising any risk of new nicotine addiction in children”. 

“DH will monitor the impact of regulation and policy on e-cigarettes and novel tobacco products in England, including evidence on safety, uptake, health impact and effectiveness of these products as smoking cessation aids to inform our actions on regulating their use”. 

https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england

As reported in the British Medical Journal, a US National Institute of Health funded study conducted by the University of California at San Diego found that increased uptake of e-cigarettes has accelerated the decline in smoking, and that smokers who vape are more likely to quit than smokers who don't vape.

The researchers concluded, “The substantial increase in e-cigarette use among US adult smokers was associated with a statistically significant increase in the smoking cessation rate at the population level”.

http://www.bmj.com/content/358/bmj.j3262

Sitting alongside the FDA announcement, this could be a landmark study whose importance was underlined by a highly significant comment by Dr Stephen Shroeder of the Center for Tobacco Control Research and Education in San Francisco who observed  “The people who say that use of e-cigarettes inhibits cessation should be sobered by this paper….“They should think twice about this viewpoint.” Even Stan Glanz has not rubbished the findings.

http://abcnews.go.com/Health/cigarettes-smokers-quit/story?id=48886292

And finally in this round-up of good news and echoing the powerful presentation by Helen Redmond at GFN 2017, Australian psychiatrists are pressing for a lifting of the nicotine ban on the grounds that as those with mental health problems have very high rates of smoking, they should have access to healthier products. In a statement, they said:

“E-cigarettes … provide a safer way to deliver nicotine to those who are unable to stop smoking, thereby minimising the harms associated with smoking tobacco and reducing some of the health disparities. The RANZCP therefore supports a cautious approach that takes into account …the significant health benefits which these products present.” The Royal Australian and New Zealand College of Psychiatrists (RANZCP)

https://www.vapingpost.com/2017/07/24/australian-psychiatrists-urge-authorities-to-lift-nicotine-ban/

And to finish some nice takes on ‘Australia’s favourite moon howler’, as he is deliciously described by Mr Puddlecote. However, in the interests on evidence-based history, I must take Sir Pudd to task on one small point. He implies that in trying to hold back the tide of evidence in favour of e-cigarettes, Chapman is acting ‘Canute-like’. Alas, the erstwhile king was not trying to hold back the tide. He was trying to demonstrate that even a king cannot stop the tide coming in.

http://vaping360.com/attila-danko-simon-chapman/

http://dickpuddlecote.blogspot.co.uk/2017/07/world-class-straw-clutching.html

https://en.wikipedia.org/wiki/King_Canute_and_the_waves

But wait, perhaps I need to leave you in more reflective mood. Call it an encore when the band comes back on and plays a quiet song to send the audience on its way.

In different, but overlapping ways, David Sweanor and Roger Pielke Jnr have been reflecting on how complicated public policy issues are often reduced to over-simplified notions of ‘good or evil’ usually by those who are losing the argument and/or come at the issue from a quasi-moral viewpoint which brooks no compromise, no grey areas. Professor Pielke by the way is a political scientist with a background in environmental science. His interests include understanding the politicization of science; decision making under uncertainty and policy education for scientists in areas such as climate change.

The Hunt-Lenox Globe is reputedly the second or third oldest globe in the world currently housed in the rare book division of the New York Public Library and dates from around 1503. Looking at the area around the east coast of Asia and you will find the only known use of the phrase hic sunt dracones which as all you Latin scholars know means ‘Here Be Dragons”. This is a part of the world both unknown but obviously dangerous, so steer clear.

David takes dragons as the theme of his Ted Talk. In a sane and rational environment, faced with a public health problem, he says, you tackle it in four ways.  You try and find ways of preventing the unhealthy activity in the first place: you look at ways of stopping people who have already started; you try and prevent harm to third parties and to reduce the harm to those who cannot stop.

On the other hand, you let the flight and fight response kick in, take out the sword and take on the dragon. You have no time to respond rationally because the dragon is breathing fire and smoke in your face  – literally in this case because the dragon he is referring to is the tobacco industry. And there is no dealing with dragons whatever they may to offer even if it helps you with the massive public health problem you are facing. There is more to this so check out

https://www.youtube.com/watch?v=bYFYlLWaT-E&t=611s

Although discussing the politics of climate change, Professor Pielke’s slides on Twitter do speak to the issues of THR and battling those who take a paranoid Manichean view of the world as one where only pure good and evil exist. And by the way, there is much here that maps across to the ‘war against drugs’ too.

  1. The good and evil dichotomy
  2. The end justifies the means
  3. Unwillingness to engage in substantive policy debate
  4. Millenarian rhetoric

Roger Pielke takes his inspiration from this article from 1964 in Harpers Magazine by the American historian Richard Hoftstrader, regarded as one of the most important articles ever published by the magazine. Given the era, communist conspiracy hysteria loomed large, but in many respects, it remains as relevant now as ever. Trump is quoted as believing that global warming is a Chinese plot to undermine the US economy.

https://harpers.org/archive/1964/11/the-paranoid-style-in-american-politics/