Tobacco Center Faculty Blog

July 11, 2018

Stanton A. Glantz, PhD

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

Stanton A. Glantz, PhD

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

Stanton A. Glantz, PhD

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

Stanton A. Glantz, PhD

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:

June 11, 2018

Stanton A. Glantz, PhD

Proponents of tobacco harm reduction, including the FDA, take British psychologist’s Michael Russell's idea that, " It's not the nicotine that kills half of all long-term smokers, it’s the delivery mechanism” advanced in his 1991 paper "The future of nicotine replacement" as an article of faith, despite the fact that he simply presented it as a “hypothesis.”    In addition, as I noted before, this view was promulgated long before we knew that nicotine has many direct adverse health effects, particularly related to cardiovascular and lung disease (including, perhaps, a causative role in COPD) as well as cancer promoter.

Now Jesse Elias and Pam Ling have published a paper showing direct collaboration between Russell and the tobacco industry in their paper “Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products.”

Here is the introduction to their discussion of Russell:

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