July 11, 2018
Dorie Apollonio and I recently published "Marketing with tobacco pack onserts: a qualitative analysis of tobacco industry documents" in Tobacco Control. This paper uses previously secret internal tobacco industry documents to understand how the industry uses onserts (little booklets attached to the outside of cigarette packs) to "educate" consumers about their products. Like many things, the industry has developed an excellent understanding about how to use onserts to communicate effectively with consumers. Equally important, they have learned how to coummincate ineffectively Not surprsingly, they use the ineffective approaches when pretending to communicate health information.
Regulatory agencies like the FDA and its counterparts outside the USA can learn a lot for this paper in terms of how they could require the tobacco companies to use onserts in a way to better and effectively inform consumers about the real risks of their products.
Two key points:
July 11, 2018
My UCSF colleagues recently submitted this public comment to the FDA on its proposed Nicotine Product Standard. A PDF version of the comment is here.
The FDA needs to look beyond nicotine alone in developing its standard for nicotine delivery in tobacco products
Docket No. FDA-2017-N-6189
Jesse Elias, MA, Yogi Hale Hendlin, PhD, Pamela M. Ling, MD, MPH
University of California, San Francisco
June 12, 2018
The FDA is considering its proposed nicotine product standard as part of its “comprehensive nicotine policy.” The FDA’s description of this proposal to date appears to focus narrowly on the pharmacological properties of nicotine. By reducing nicotine delivery in cigarettes, this standard would encourage smokers to switch to other nicotine delivery systems, including those made by tobacco companies, so as to reduce the harm caused by tobacco products. In the best case scenario, reduced-nicotine cigarettes will prompt smokers to quit smoking altogether, and cease use of all tobacco products. Second best, smokers will switch to non-combustible tobacco products yet maintain their nicotine addiction.
June 20, 2018
In November, 2017 I published “Philip Morris hides data in plain sight on dangers of new heat-not-burn product” in The Conversation that pointed out that the results from 24 clinical medical tests that PMI submitted to the FDA actually showed that IQOS was not detectably less dangerous than conventional cigarettes.
In reviewing all the information that PMI submitted to the FDA, the FDA’s Tobacco Products Scientific Advisory Committee voted unanimously (with one abstention) against approving PMI’s reduced risk claim.
I was surprised that PMI did not immediately have a come back.
Now, they (sort of, but not really) do. On June 15, 2018 PMI put out a press release, “Philip Morris (PM) Announces Positive Results from New Clinical Study on IQOS,” that says “all eight of the primary clinical risk endpoints moved in the same direction as observed for smoking cessation in the group who switched to IQOS, with statistically significant changes in five of the eight endpoints compared with on-going smoking.”
June 19, 2018
Despite the overwhelming support to uphold San Francisco’s ban on selling flavored tobacco products, with 68.4% of voters supporting the law despite a $12 million campaign to overturn it by RJ Reynolds (part of British American Tobacco), health advocates should not relax yet.
RJR may, of course, also sue, but suits against similar laws have failed elsewhere and the San Francisco City Attorney took care to learn from these earlier legal challenges to write a well-crafted law that is designed to withstand legal attack.
More important, based on experience implementing clean indoor air laws, I would not be surprised if RJR (and perhaps other tobacco interests) engages in a campaign to undermine the law by encouraging merchants not to comply, publicizing non-compliance, then working to get the law ignored or repealed.
It is, therefore, that the San Francisco Health Department and health advocates take an active role in educating merchants and consumers (something, ironically, that the political campaign for Prop E contributed to) and be ready to take formal enforcement actions against non-compliant businesses after a reasonable warning period.
Being proactive in implementation will ensure success which, after a while, will become routine. Anything less leaves the door open to ongoing problems.
June 11, 2018
One of the arguments coming from Public Health England and the other e-cig cheerleaders there is that youth use is very low.
A new study using data collected in the UK between June 2015 and April 2016 of schoolchildren (mean age 14.1, n=499) shows that, like everywhere else, a substantial number of kids using e-cigarettes have never smoked cigarettes. In fact, at 52.6%, this is the highest fraction of never smokers reported by adolescent e-cig users.
This observation, combined with the substantially stronger gateway effect for smoking McNeill and colleagues reported in their longitudinal study of UK youth, may be another reflection of the likelihood that all the enthusiasm for e-cigs among much (but not all) of the British health establishment is recruiting kids to a lifetime of nicotine addiction.
The new paper is “More than half of adolescent E-Cigarette users had never smoked a cigarette: findings from a study of school children in the UK” by Fulton E, Gokal K, Griffiths S, Wild S ( Public Health. 2018 Jun 2;161:33-35. doi: 10.1016/j.puhe.2018.04.014. [Epub ahead of print]).
Here is the abstract: