June 6, 2019
Dharma Bhatta and I just published “Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health” in Journal of the American Heart Association. Like earlier analyses, we found an independent effect of e-cigarette use on risk of having had a heart attack (myocardial infarction) when controlling for smoking and other clinical and demographic factors.
The odds of having had a heart attack among daily e-cigarette users were more than doubled compared to people who neither used e-cigs not smoked cigarettes. We also found a statistically significant dose-response, with people who used e-cigs daily having higher risks than nondaily, former, or never users.
While the point estimates of the risks of former, nondaily, and daily e-cigarette use are lower than the comparable numbers for smoking cigarettes, the “margins of error” (95% confidence intervals) for e-cigarettes and cigarettes overlap, suggesting that for heart attacks, the risks of e-cigs and cigarettes are comparable.
This finding is what one would expect based on what is known about the biological effects of e‐cigarette use.
June 3, 2019
The core principle that undermines the tobacco industry, the FDA, and our friends in England ‘s idea that there is a “hard core” of smokers who “can not or will not quit” and that the existence of this group should drive policy.
Under this logic, e-cigarettes, IQOS, and smokeless tobacco all continue to be promoted as the better alternative than “abandoning all the smokers to die.”
Now there is yet another study showing that, in response to tried and true tobacco control policies (smokefree laws, strong media, taxes, warning labels and plain packaging) the remaining smokers are smoking less and quitting more.
That’s just the opposite of what the hardening hypothesis predicts.
It is particularly important to reject these new “less risky” products because their net effect is to reduce quitting, increase initiation, promote relapse and generally prolong the tobacco epidemic.
It is time for the FDA, England, and everyone else to abandon this outdated idea and stop promoting these product.
June 3, 2019
While Mitch McConnell's bill raising the federal age for selling tobacco products did not include state preemption as I was worried it would, it still contains a very dangeous provision requiring states to raise their legal ages to 21 by amending the Synar Ammendment to raise the age from 18 to 21.
The Synar Amendment, passed in 1992 by Congress, requires states to reduce sales of tobacco to youth under 18 or risk losing some of their Substance Abuse and Mental Health funding from the federal government. Unfortunately, the tobacco companies used Synar to get a lot of bad state laws passed that ended up blocking effective tobacco control measures. (You can read the details for 33 of the states here.) The McConnell bill could start that process all over again by creating a rush to pass state legislation raising the age to 21 together with a lot of bad technical details that will actually make it easier for Juul, Philip Morris, and RJ Reynolds to continue preying ok kids by simply overwhelming the health groups in state legislatures.
June 2, 2019
The tobacco companies (including e-cig companies) work through surrogates to claim that bans on the sale of flavored tobacco products limits freedom, the case just got stronger that flavor bans help people quit smoking (which improves lives and reduces tobacco company profits).
Specifically, Michael Chaiton and his colleagues followed smokers beginning before Ontario Canada ended the sale of menthol cigarettes until a year later and found that more menthol smokers quit than smokers who did not use menthol cigarettes. Because the tobacco companies have not pushed menthol as hard in Canada than the US, menthol use is lower, so the benefits of a ban on menthol would be even higher in the US than in Canada.
As they point out in their paper,
June 1, 2019
My colleagues at UCSF, Stanford and Georgia State University have submitted this public comment to the FDA. The Regulations.gov tracking number is 1k3-9a7v-3arc. A PDF of the comment is here and the four attachments are here (1, 2,