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Tobacco News Analysis And Commentary details
Listing ID: 127
Title: Tobacco News Analysis And Commentary
Description: Physician Michael Siegel who specialised in preventive medicine and public health writes about the stories behind tobacco-related news.
Category: News & Media : Analysis & Opinion
Owner:
listed on: April 02, 2008 08:27:25 AM
Number Hits: 4 times
Recent Posts:
| New Study Shows that Thirdhand Smoke is 100 Times More Dilute than Secondhand Smoke - Fri, 30 Jul 2010 11:46:00 +0000 |
| What may be the first investigation to actually measure the ambient levels of thirdhand smoke and compare them with levels of secondhand smoke, a newstudypublished in the current issue ofTobacco Controlreports that concentrations of particulate matter in thirdhand smoke were 100 times lower than in secondhand smoke, measured in the same room (see: Becquemin M. Third-hand smoking: indoor measurements of concentration and sizes of cigarette smoke particles after resuspension.Tobacco Control2010;19:347-348). Here's what the study did: "A smoking device burned 10 cigarettes in 30 minutes in a non-ventilated furnished room that was then kept closed. On the next day, for particle resuspension, we mobilised the dust on furniture, clothes and surfaces by wiping and shaking and created even more turbulence with a ventilator. An impactor (ELPI) measured the particle sizes (between 0.28 μm and 10 μm) and concentration in the air, 60 cm above the floor: on the first day before and after the cigarettes were smoked (secondhand smoke) then 4 hours later, 24 hours later, before and after resuspension manoeuvres (thirdhand smoke)." Here's what the study found: "after cigarette smoking: the airborne particles ... concentration was divided by 100 in the first 4 hours and again by 100 in the following 24 hours. After resuspension, the concentration was multiplied by 100, going back to that observed 4 hours after smoking." The study concludes: "These quantitative data support the hypothesis of a resuspension from the cigarette smoke surface contamination. However, this airborne contamination through resuspension remains much lower (100 times) than that of secondhand smoke." The Rest of the Story This study confirms that thirdhand smoke is a real phenomenon. Particles that deposit on surfaces during smoking can later become re-suspended in the air. Importantly, however, even under these conditions of extreme agitation of the deposited particles (wiping, shaking, and ventilator turbulence), the particulate concentration in the thirdhand smoke was two orders of magnitude lower than in the secondhand smoke. This study confirms what I have been asserting repeatedly since the thirdhand smoke "scare" was initiated: yes, it's true that thirdhand smoke exists, but the levels of exposure are so low that there is no substantial health risk to anyone - other than to infants or those who are extremely sensitive to tobacco smoke - and even for those groups, the risks are small compared to the secondhand smoke. Thus, thirdhand smoke becomes a theoretical, but not a practical, health concern. These data also appear to refute the claim by Action on Smoking and Health that smokers themselves pose a hazard to nonsmoking workers by bringing in particles deposited on their clothes that will later enter the air and exposes nonsmokers. The data clearly argue against policies that deny employment to smokers based on the potential health hazards of thirdhand smoke exposure among their fellow workers. These data also appear to refute the assertion that thirdhand smoke is a substantial health concern in general. If people live in a home with smokers who smoke in the home, the secondhand smoke exposure will be so much higher than the thirdhand smoke exposure that it renders the effect of the thirdhand smoke essentially meaningless. And if the only exposure is thirdhand smoke due to the smoker smoking outside the home but bringing back particles on his or her hair and clothing, then there seems to be no concern at all about significant health effects. This research should put the faddish focus on thirdhand smoke where it belongs: in the circular file. Unfortunately, the state of California is devoting millions of dollars to a research program that focuses on.... ... you guess it..... ...thirdhand smoke.  |
| Study Concludes that Higher Intensity Puffing Required for E-Cigarettes May Have Adverse Effects on Health, But Doesn't Consider Toxicity of the Vapor - Thu, 29 Jul 2010 12:03:00 +0000 |
| A newstudypublished online ahead of print in the journalNicotine and Tobacco Researchfinds that electronic cigarettes require higher intensity puffing than conventional cigarettes and concludes that this may result in adverse health effects. According to the study: "Except for one brand, higher vacuums were required to smoke e-cigarettes than conventional brands. Smoke/aerosol density was stable for conventional brands and for e-cigarettes over the first 10 puffs; however, aerosol density of e-cigarettes dropped during subsequent smoking, and higher vacuums were required to produce aerosol as the puff number increased." The study concludes: "Generally, e-cigarettes required stronger vacuums (suction) to smoke than conventional brands, and the effects of this on human health could be adverse. The amount of aerosol produced by e-cigarettes decreased during smoking, which necessitated increasing puff strength to produce aerosol. The decreased efficiency of aerosol production during e-cigarette smoking makes dosing nonuniform over time and calls into question their usefulness as nicotine delivery devices." The Rest of the Story This paper seems to be missing one major point: it is the toxicity of what you are smoking or vaping that makes it harmful, not simply how hard you are puffing. Increased intensity of puffing on electronic cigarettes compared to conventional cigarettes would only make vaping more harmful if the constituents of electronic cigarette vapor were harmful to begin with. The abstract omits any mention of the fact that conventional cigarettes contain perhaps tens of thousands of chemicals and more than 40 carcinogens while electronic cigarettes contain none of the above, other than the nicotine. It also omits mention of the fact that there are no hazardous chemicals that have been identified in electronic cigarette vapor at anything other than trace levels that are known to have significant adverse health effects. In other words, the paper is ignoring the factor which is the overwhelming determinant of the relative safety of electronic cigarettes: the chemicals present in the inhaled vapor. Instead, the paper focuses exclusively on one small aspect of the product's use: the puffing intensity. While this would be fine if the paper simply kept to a discussion of puffing intensity, it fails to do that, as the abstract's discussion section goes so far as to argue that the increased puffing intensity of electronic cigarettes may make these products more harmful to users. Why draw conclusions that are pure speculation and are not supported by any evidence within the paper itself? This editorializing makes it appear that the paper has a pre-determined conclusion about the safety of electronic cigarettes. Similarly, the paper concludes that electronic cigarettes are not a useful nicotine delivery device based solely on one factor - the lack of consistency in nicotine delivery - but ignoring the much more important evidence: whether the product has been found to be or not to be effective as used by actual human beings. Once again, the paper is drawing a conclusion that goes beyond the scope of the actual findings. This editorializing also makes it appear that the paper has a pre-determined conclusion about the effectiveness of electronic cigarettes. While the paper's findings regarding the level of puffing intensity for electronic cigarettes compared to conventional cigarettes are interesting, they clearly do not support the type of sweeping assertions that the paper makes in postulating the implications of the study.  |
| Why Do Anti-Smoking Groups and Researchers Recommend Pharmaceutical Cessation Aids for Every Patient When Unaided Quitting is More Effective? - Wed, 28 Jul 2010 12:05:00 +0000 |
| Not long ago, an NIH expert panel released a2008 update of the clinical practice guidelineregarding the treatment of tobacco use and dependence (see: Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008). The guideline recommends thateverypatient who wishes to quit be treated with pharmaceuticals, unless medically contraindicated. The guideline also recommends the use of Chantix, despiteconcernsabout its potential suicide risk, a risk that is currently being investigated by the FDA. Among the pharmaceuticals recommended by the panel are:
Many national anti-smoking groups have echoed the expert panel's recommendations. To be sure, pharmaceutical-aided smoking cessation is at the core of the national tobacco control movement's strategy and recommendations. The Rest of the Story But what does the scientific evidence show? Those who have read the Clinical Practice Guideline on smoking cessation treatment may be shocked to find out that the scientific evidence clearly shows that unaided smoking cessation is substantially more effective than pharmaceutical-aided cessation. For example,Larabiefound that smokers who quit unaided were 2.3 times more likely to succeed than those who quit using pharmaceutical aids. Contrary to the dogma expressed in the smoking cessation expert panel report, unplanned quit attempts were found to be more successful than planned quit attempts. The paper concludes that in light of this finding: "the current guidelines may be hindering, rather than assisting successful smoking cessation." This research has important implications for the type of advice that health professionals deliver to patients regarding smoking cessation. The appropriate recommendations, however, are completely at odds with those presented in the expert panel report. In a similar study byWest and Sohal, unplanned quit attempts were found to be 2.5-2.6 times more likely to be successful than planned quit attempts. To be sure, nicotine replacement therapy is known to be dismally effective in treating smoking dependence. Among smokers who are not particularly motivated to quit, the six-month success rate for nicotine replacement therapy is adismal 6.8%. Why would the NIH expert panel and major anti-smoking groups recommend drug-aided cessation when this strategy has been shown to be less effective than unaided cessation, and when even short-term success rates among unmotivated smokers are as low as 7%? This means that our national experts are recommending a treatment that fails 93% of the time! Even worse, they are recommending a treatment that fails 93% of the time when there is an alternative which has been clearly shown to be more than twice as effective. The Answer The answer to the question posed above, and in this post's title, is actually quite simple. Far from being an objective review and assessment of the best possible strategy to enhance smoking cessation among smokers in the United States, the guideline is a heavily biased analysis that is plagued by the presence of severe financial conflicts of interests among the panel's chair and at least 8 of its other members. These 9 panel members have received, or are currently receiving, funding from pharmaceutical companies. Most of the involved companies stand to gain from the clinical practice guideline's recommendations, because these companies manufacture drugs recommended by the panel. Here is the long list of financial conflicts of interest among this supposedly objective panel of expert scientists: Michael C. Fiore (panel chair): "reported that he served as an investigator on research studies at the University of Wisconsin (UW) that were supported wholly or in part by four pharmaceutical companies, and in 2005 received compensation from one pharmaceutical company. In addition, he reported that, in 1998, the UW appointed him to a named Chair, which was made possible by an unrestricted gift to the UW from GlaxoWellcome." William C. Bailey: "reported significant financial interests in the form of compensation from three different pharmaceutical companies in 2006 and two in 2007 for speaking engagements." Timothy B. Baker: "reported that he has served as a co-investigator on research studies at the University of Wisconsin that were sponsored by four pharmaceutical companies." Neal L. Benowitz: "reported significant financial interest in the form of compensation from one pharmaceutical company for each of the years 2005-2007, as well as stock ownership in one pharmaceutical company." Michael G. Goldstein: "reported that his employer received support from Bayer Pharmaceutical prior to 2005 and that he was employed by Bayer Pharmaceutical Corporation prior to January 1, 2005. His organization received payments for his professional services from two pharmaceutical companies and one commercial Internet smoking cessation site during the period 2005-2007." Harry A. Lando: "reported serving on an advisory panel for a new tobacco use cessation medication and attending 2-day meetings in 2005 and 2006 as a member of this panel." C. Tracy Orleans: "reported significant financial interests in the form of a dependent child who owns pharmaceutical stock... ." Maxine L. Stitzer: "reported participation on a pharmaceutical scientific advisory panel for a new tobacco use cessation medication." Sally Faith Dorfman: "reported her employment by Ferring Pharmaceuticals, Inc., a company whose business does not relate to treating tobacco dependence." GlaxoWellcome, which apparently endowed the Chair position that the chair of the panel enjoys, is the manufacturer of Wellbutrin, Commit lozenge, Committed Quitters, NiQuitin/Nicoderm, Nicabate, and Nicorette. The use of all of these drugs is recommended by the panel. What this means is that we basically have a group of experts who are largely financially linked with pharmaceutical companies, and who stand to gain personally if they recommend the use of pharmaceuticals as part of their smoking cessation guidelines. The more use of pharmaceuticals they recommend, the more they stand to gain. This is a conflict of interest in the ugliest way that I can imagine. It is precisely the type of thing that needs to be stopped. Ironically, it is the Department of Health and Human Services, the Public Health Service, and NIH itself which are regulating conflicts of interest among America's medical researchers. To have such a huge conflict of interest in its own supported work is unconscionable. While I find it objectionable that these agencies would allow experts with these type of financial conflicts of interest to serve on the panel, I find it equally troubling that such individuals would agree to serve. I believe that based on these conflicts, these experts should have recused themselves from service on the panel. The conflict in this case is not just a hypothetical one. It reveals itself in the extreme bias of the guideline. The analysis over-estimates the benefit of drugs in smoking cessation and overlooks population-based evidence showing that most people who quit smoking do so without pharmaceutical aids. As my colleague Dr. Lois Biener of the University of Massachusetts Boston argued in an Associated Press article about the guideline, there is little if any "real-world evidence" that when used outside the context of clinical trials, drugs produce any long-term enhancement of smoking cessation, and certainly not the magnitude of benefit as suggested by those who are touting the importance of these drugs. One national expert on smoking cessation who was not on the panel -John Polito- has suggested that the guideline is basically a "sales pitch" for the pharmaceutical industry, that the benefits of pharmaceuticals are overstated, that the value of quitting cold turkey is not considered, and that the recommendation to promote Chantix use is misguided and could cause harm. Polito has really stated it better than I could and he is right on the mark. The guideline is basically a sales pitch for the pharmaceutical industry, and it demonstrates what corporations can buy through their payments to scientific experts. What's most disturbing to me is that while the medical field continues to move to decrease the influence of pharmaceutical companies on physicians by restricting financial benefits for doctors, the tobacco control field seems to be increasingly plagued by this pharmaceutical influence. The problem is being ameliorated in medicine, but in tobacco control, it continues to get worse. The ultimate irony of all of this is that we in tobacco control have been so vehement in decrying the tobacco industry's influence on science. We have attacked and berated scientists for having financial ties to tobacco companies. We have discredited scientific conclusions based solely on the financial connections of the authors to Big Tobacco. But now, our national policies are being set by individuals who have equally strong connections to Big Pharma.  |