March 22, 2017
On March 15, 2017, several friends of mine, together with others, released “Ending Cigarette Use By Adults In A Generation Is Possible: The Views Of 120 Leaders In Tobacco Control,” which attracted moderate press attention.
While I agree that cigarette use could be ended in generation – actually in 5-10 years – if we could muster the political clout to implemented what we know works – I take strong exception to the pro-industry harm reduction arguments in this report. Indeed, I believe that some of the policies advocated in the report will slow progress.
As one of the 120 “leaders” who responded to the poll used to construct this document, I strongly object to the subtitle, “The views of 120 leaders in tobacco control.” The views in this report do not reflect my views. While the body of the report contains a disclaimer stating that it is only the authors’ views, the title suggests something quite different.
March 21, 2017
BAT just published its mathematical model to predict the public health impact of the growth in e-cigarette use in the UK (press release below). The basic structure of the model is pretty straightforward – people starting with cigarettes or e-cigarettes, becoming dual users, and quitting or not. (It is not wildly different in basic structure from the one Sara Kalkhoran and I published in August 2015 or the one Levy and colleagues recently published.)
I read the paper and was surprised that BAT was claiming that it showed the public health benefits of e-cigarettes in the UK. Why? As the press release says (specific text bolded below), “the proportion of all deaths due to smoking-related diseases falls from 8.4% and 8.1%, respectively” without and with e-cigarettes. (Compare the solid and dashed lines in their Figure 9.) This difference is well within the uncertainty in the prediction process. In other words, BAT’s own model says that if lots of people start using e-cigarettes, there is virtually no health benefit.
March 19, 2017
I have been following the evidence that cell phone radiation can have adverse health effects for several years and think that the evidence for adverse health effects of cell phones is about where it was in the early 1960s for cigarettes. (I use several studies showing damage to sperm as examples in my textbook Primer of Biostatistics.) I have also been impressed at how, like Big Tobacco and global warming deniers, the cell phone industry has tried to keep people in the dark about the emerging evidence.
I have also worked for decades with the California Department of Public Health and come to respect the high quality of the work they do. So I was interested to read in the newspaper a few weeks ago that in 2010 they had prepared a “guidance document” on the health effects of cell phone radiation that had been buried. The 2010 CDPH document summarized the science regarding health risks from cell phone radiation, and offered consumers precautionary recommendations.
It took seven years and a lawsuit in Superior Court brought by my colleague Joel Moskowitz from UC Berkeley (who used to work on tobacco) to force its release.
The CDPH’s cell phone guidance document offers the following conclusions and recommendations:
March 11, 2017
The evidence that e-cigarettes are just as bad as conventional cigarettes for effects on blood and blood vessels keeps piling up. Aline Sabrina Rau and colleagues at the University of Colorado just published “Electronic Cigarettes Are as Toxic to Skin Flap Survival as Tobacco Cigarettes” in the Annals of Plastic Survey.
An important factor in wound healing is adequate circulation in small blood vessels. Inadequate circulation leads to slower healing and even tissue death (necrosis). Rau and colleagues did an experiment in which they exposed rats to high levels of secondhand cigarette smoke and aerosol from two different Blu e-cigarettes, one that exposed the rats to the same level of airborne nicotine as the tobacco cigarettes and one that exposed them to twice the nicotine. The rats were exposed for 4 weeks, then surgery done, and the wound measured after another week of exposure.
Bottom line: The effects on the cigarette smoke and e-cigarette aerosol were the same, independent of the nicotine level.
Rau and colleagues explained this finding as follows:
March 11, 2017
One of the main ways that smoking increases the risk of heart disease is by activating platelets, cells in blog that stick together and form blood clots. When you cut yourself, this is a good thing, because it stops bleeding. When platelets are activated inappropriately, they stick to the lining of arteries (the endothelium) and tear it up. When a blood clot floating around in your blood stream blocks an artery in your heart it causes a heart attack; when it blocks an artery in your brain is causes a stroke.
Sara Hom and colleagues at the State University of New York, recently published “Platelet activation, adhesion, inflammation, and aggregation potential are altered in the presence of electronic cigarette extracts of variable nicotine concentrations,” which exposed human blood platelets to extracts from conventional cigarette smoke and e-cigarette aerosol. They found that both stimulated platelet activation and that this effect is due to the ultrafine particles in both, not the nicotine.
They sum their results up nicely in their paper: