Tobacco Center Faculty Blog

January 27, 2018

Stanton A. Glantz, PhD

I have been very concerned about the emerging for-profit marijuana industry turning into the new tobacco industry (reference 1, reference 2), with all the accompanying health problems that increase marijuana use will bring.  At the same time, there are some medical benefits from marijuana and Melvin Livingston and colleagues recently published an interesting paper in American Journal of Public Health that showed that the rising trend of opioid-related deaths in Colorado reversed following legalization of recreational cannabis.

Their well-done paper, “Recreational Cannabis Legalization and Opioid-Related Death in Colorado, 2000-2015,” examined the trend in deaths for 4 years before and 2 years after recreational cannabis was legalized.  As shown in the attached figure (from their paper) the rising trend in opioid deaths reversed. 

January 27, 2018

Stanton A. Glantz, PhD

Any smoking in the last 30 days is a standard measure of smoking behavior among adolescents.  This measure is used rather than daily smoking because so few adolescents smoke daily.

Despite the fact that this measure has been used for years, e-cigarette enthusiasts have been critical of the consistent research showing a gateway effect for e-cigarettes leading to cigarette smoking on the grounds than 30 day smoking is not a good measure of adolescent smoking.

Lauren Dutra and I addressed this question, which is important beyond the e-cigarette debate, in our recent paper “Thirty-day smoking in adolescence is a strong predictor of smoking in young adulthood” published in Preventive Medicine. We used the National Longitudinal Survey of Youth which recruited youth ages 12-16 in 1997 and followed them forward in time every year since then.  We found that you who smoked any days in the last month were much more likely to be smokers as young adults.  Kids who just smoked cigarettes one day a month had twice the odds of smoking as young adults as kids who did not smoke at all, with the odds of young adult smoking increasing for youth who smoked more days per month.

Here is the abstract:

January 26, 2018

Stanton A. Glantz, PhD

Allan Hackshaw and colleagues just published “Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports” in BMJ  that blows away the idea that e-cigarette users who cut down the number of cigarettes they smoke without quitting entirely will have health benefits, especially for heart disease and stroke.

Here is the BMJ press release on the paper, which sums it up nicely:

Just one cigarette a day carries much greater risk of heart disease and stroke than expected, warn experts

No safe level of smoking exists; smokers should aim to quit instead of cutting down

Smoking just one cigarette a day has a much higher risk of developing coronary heart disease and stroke than expected - about half the risk of smoking 20 per day - concludes a review of the evidence published by The BMJ today.

January 25, 2018

Stanton A. Glantz, PhD

The FDA Tobacco Products Scientific Advisory Committee (TPSAC) just voted not to accept Philip Morris' claims that its new heat-not-burn product, IQOS, is less dangeous than cigarettes.   As the press coverage (summarized below courtesy of Stan Shatenstein:), this is an important development.

As followers of this blog know, UCSF has submitted 10 public comments supporting the scientific conclusion that IQOS is not safer than conventional cigarettes and that even allowing "reduced exposure" claims would be misinterpreted as reduced harm claims.  (You can see my plain English language summary of why Philip Morris' own data does not support the claim that IQOS is safer than cigarettes.)  For the same reasons, FDA should not approve PMI's premarket application to to sell IQOS in the US because doing so would not be "good for public health," which is the standard in the law.

Other countries should not be tricked by PMI's claims.

Here is the press coverage:

January 20, 2018

Stanton A. Glantz, PhD

On January 18, 2018, Goldman Sachs reported that the FDA is expected to approve Philip Morris International's "Premarket Tobacco Product Application" (PMTA) for IQOS as early as February.  This application is different from the "Modified Risk Tobacco Product" (MRTP) that has been open for public comment and that is scheduled to be discussed at the TPSAC meeting on January 24-25 (assuming that the government is open then).  The difference between a PMTA and an MRTP is that the PMTA is an application to sell IQOS in the United States whereas the MRTP application is a request to make health claims about the IQOS. 

In both cases the law requires the FDA to determine that approving the application is “appropriate for the protection of the public health” with respect to the risks and benefits to the population as a whole, considering both users and nonusers.  Lacking this essential finding, FDA is required to deny the PMTA under section 910(c)(2)(A) of the Family Smoking Prevention and Tobacco Control Act.