November 9, 2011

Stanton A. Glantz, PhD

Two high profile uncritical media stories on industry-supported "harm reduction"

USA Today and the New York Times recently published articles that uncritically accepted assertions that smokeless tobacco and e-cigarettes were useful as cessation tools.  Both of these studies were funded by tobacco/e-cigarette companies that had direct financial interests in the outcome of the work.  Both Brad Rodu (smokeless tobacco) and Riccardo Polosa (e-cigarettes) also worked as consultants to the companies making products they were evaluating.

The USA Today story on Brad Rodu's "Switch and Quit" smokeless tobacco study did note that he was (and has been for years) supported by tobacco companies and included Rodu's claim that "There's absolutely no influence whatsoever" by the companies.  USA Today did not mention all the evidence of bias in industry funded studies.

In both stories, people and organizations who questioned claims that smokeless tobacco and e-cigs were useful cessation measures were painted as closed minded prohibitionists

The reality is that the big cigarette companies now own the smokeless companies and are aggressively marketing smokeless tobacco as a way to keep people smoking despite the presence of clean indoor air laws.  Our analysis of the likely effect of aggressive marketing of smokeless tobacco for harm reduction is that it is unlikely to produce any population-level benefits and could actually do harm.

Contrary to the assumptions made in these two newspaper stories (and assertions made by Rodu and like-minded people), a large longitudinal study of Air Force recruits found that, "Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87% [i.e, went from smokeless tobacco to cigarettes or dual use]), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking."

There is also new evidence that snus, the allegedly "safest" form of smokeless is more dangerous than previously though.  A large longitudinal study of snus users in Sweden found that snus more than doubled the risk of heart failure.  (Had we used this risk in our model of the population effects of promoting snus for harm reduction, we might have found increased population harm, not just no benefit.)

With regard to e-cigarettes, what the FDA was demanding (and what the e-cigarette industry successfully fought in court) was actual evidence from clinical trials that the claims that e-cigarettes actually worked for smoking cessation.  If such evidence was developed in a way that passed the usual scientific muster, people like me would not be expressing such skepticism.  In contrast, the study the NY Times featured was small and conducted with industry funding by an individual who works as a consultant to the company whose product was being evaluated.





The bottom line for me is that I don't want the smoking of e-cigs to become what regular cigs used to be. I don't accept that I should have to be exposed to the vapors or anything else being emitted into the air for the sake of supporting an addiction industry. We need to stop accommodating this epidemic. This is a nightmare that should have never been allowed to get started.

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