May 24th, 2016

Are they nuts? The dysfunction and decadence of tobacco control in one chart

Ecig acceptability

The chart of an audience poll from the Global Tobacco Dependency Treatment Summit 2016 (23-24 May 2016, twitter:#TDTSummit16) is deeply disturbing…

Continued cigarette smoking is favoured by two-thirds (66%) of the audience, rather than using an e-cigarette. Are they nuts? The question generously even allows e-cigarettes to be a ‘not ideal’ compromise, but still the majority would rather have people smoking. Who is in the audience? The summit  is…

…bringing together world leaders in tobacco control and treatment, international and national grantees, and health care professionals, to network, share best practices, inspire, and empower participants to build capacity for treating tobacco dependence around the globe

In theory, these are professionals trying to contain the ‘smoking epidemic’, but voting to extend it. If evidence was needed that “tobacco control” has become a dysfunctional and decadent enterprise on which no more money should be squandered, it is right there on this chart.

Acceptable to whom? The use of an e-cigarette instead of smoking is a private transaction undertaken by a smoker making a free-choice and executing it with a purchase from a vendor. On what basis does this audience have a locus to declare this transaction acceptable or not? Any more than they can decide whether what I had for lunch today is acceptable or not. Why are they involved?

Or then what? For those audience members who find it ‘unacceptable’, now what?  What should they do, given they are not involved directly? Throw themselves under a bus, consumed by impotent anguish? No, it’s far worse than that.  They will get busy: write misleading articles, give bad advice, make irresponsible statements and petition governments to have their preferences imposed by law over the actual adult parties to this private and personal, health-enhancing decision. That’s the disturbing thing – it’s so illiberal, intrusive and abusive – utterly lacking in empathy, humility or any concern for the people at risk.  They will try to stop people stopping smoking, just because they aren’t stopping smoking in the way this audience wants.  But why…?

Tobacco Dependence Treatment? What they were probably trying to say in the poll (but didn’t actually) is that they think is that other approaches (i.e. pharma or other medicalised approaches) would be better than e-cigarettes irrespective of whether the person wants to use that approach, whether these approaches have failed in the past, or even that the smokers concerned may consider that they don’t need ‘treatment for tobacco dependence’, they just don’t want cancer if they can avoid it. Maybe this statement, under the summit resources, offers a clue…?

Since 2012, SCLC and Pfizer IGLC (Independent Grants for Learning and Change) collaborated to award over $6.5 million in grants focused on smoking cessation to 54 organizations nationwide. A group of expert reviewers and SCLC volunteered assistance to this grants program and received no financial remuneration from Pfizer. Grant funding for the 54 awardees is provided entirely by Pfizer.

Global Bridges.  The other main partner in the summit, with Mayo Clinic, is Global Bridges. It isn’t transparent enough to declare its actual funding source on its web pages (at least that I could find) but it does mention that it is disbursing Pfizer grants internationally. Update (via @JoodiG’s tweet) – see this 2013 post by Mike Siegel: Mayo Clinic researchers who oppose electronic cigarettes fail to disclose pharmaceutical conflicts of interest in research

Protagonists in the war on nicotine. This does suggest concern over the confusion over goals in tobacco control (Who or what is the WHO at war with?)  is a problem that justifies careful examination. Confusion over goals may also be driven deliberately by pharmaceutical companies with interests in psychoactive drugs for tackling ‘tobacco dependence’, though this is no longer a reliable proxy for tackling ‘harm’. It never was in the case of smokeless tobacco – as we know the Mayo Clinic has form in misleading people about smokeless tobacco, so maybe this really is a deep confusion of objectives that has taken hold on this redoubtable pillar of the medical establishment.

Conflicts of interest.  It’s to treat pharma money with just as much caution as tobacco money.  We need to start calling out more forcefully those situations where pharma commercial interests have an obvious conflict with pathways that benefit health, and therefore – like the tobacco industry – cause smoking related ill-health.  I’m sure everyone has noticed the volume of anti-vaping propaganda that pours out of the pharma-funded health meetings like the American Thoracic Society annual congress – it would be hard not to.  But they keep getting away with it – unchallenged by journalists and, of course, from within the ‘discipline’ of ‘public health’ (the quotes are necessary).

Try not to be quite so nuts. To every participant at#TDTSummit16 who didn’t vote “A”, may I suggest that before returning to work and causing any further harm you should read this paper by two genuinely thoughtful public health experts (no quotes needed), Lynn Kozlowski (University at Buffalo, SUNY) and David Abrams (Truth Initiative):

Kozlowski LT, Abrams DB. Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction. BMC Public Health 2016;16:432. doi:10.1186/s12889-016-3079-9

Conclusions

The last 50 years of tobacco control in the U.S. have regularly engaged issues of absolute risk and harm reduction, but have done so in varying ways (see Table 1). The recognition that cigarettes were deadly when used as intended and more lethal than a number of other unsafe products combined was influential and important in the progress of tobacco control. In subsequent years, other forms of tobacco use were treated as similar to cigarettes in issues raised [42]. It is important to make clear distinctions between the classes of tobacco/nicotine products as they differ substantially in risk to the user and to focus tobacco control efforts on reducing the use of cigarettes and other combustible products (see Fig. 1). Complex models [42, 53] should be employed in tobacco control in order to not treat products with large differences in risks as if they are the same [31]. A new reframing of leading themes can align action plans to more powerfully and rapidly achieve population-level benefit and minimize harm. The goal of updating the framing with a new synthesis of management of all forms of nicotine delivery is to eliminate use of the most appealing, addictive and deadly form of tobacco delivery in our lifetime – the smoking of combustible tobacco products – and thus expeditiously prevent the premature deaths of 1 billion people projected to occur worldwide by 2100, if the contentious debate is not resolved.

Or at least think about what you just voted for.

30 comments to Are they nuts? The dysfunction and decadence of tobacco control in one chart

  • S. Anonymous

    Why is this confusing at all? Regulatory capture happens all the time. Research institutions get FDA money and swap biased findings and employment post govt / new workers into the mill in exchange. Law firms, labs, pharma and consulting firms are in there too, so there’s no level playing field to be had. It’ll take judges and cash and lawsuits.

    Regulators are not allowed to take Cigs off the market. That’s a problem. Aside from that, they will aim for the endgame they want by making all “tobacco” use increasingly unattractive, expensive and prohibitive if not prohibited. Keep in mind that nicotine, if not a tobacco product is otherwise a drug – and vaping is absolutely dead on that path. Soterra. That saved the embryonic industry, and you can’t have it both ways… It’s stupid to argue “not tobacco” unless you think there’s a zero regulation path AND big demand for non-nicotine products. There isn’t.

    The regulator math is simple, but not well known. It’s easier to control and collect from a few, large players offering a few products – which will happen by forced consolidation, driven by the economics and the balance of the safety/small business rights play. The public doesn’t want 300 airlines or 500 makers of unsafe, but allowed ‘vice’ goods. It’s also easy to have that happen in a synergistic way relative to wanting prices to double or triple for the end user. Lots of regulatory jobs, research efforts and by using illogical, but “safety justified” pre-market hurdles. 1000 companies / 5000 products / $5B revenue will consolidate to 10 companies, 50 products, $4B revenue + $4B fees/taxes. There will still be a few products, a few flavors at a few nic levels, lower demand and it’ll be a bloodbath for the industry. They will have to “game” the human impact that will rise from a shift of some vape use back to combustion. Over time, they justify a few percent more smokers for a decade with the goal of strangling demand and supply with the power to regulate and finance their budget with fees. Surprised you haven’t taken on that elegant weapon more directly… The FDA uses fees to fund their work – assessed against the industry – to fund many, many studies – unneeded largely, but lucrative, ongoing, and stilted. Not only will the researchers be proposing FDA biased projects to win each year’s tens of millions, but this tactic puffs up the cost the industry and consumer need to cover. Shifts $s to bureaucracy and university researchers, raises price, reduces use. They could be honest and say trading 10 million smokers for 10 million vapers would be great, but even better would be to take in a ton of cash and get that number down to 5 million not willing to pay $1/cig or $30/15ml and maybe the split is 2.5/2.5.
    If you want to make a difference, get some epidemiology guys, some MBAs and a few lawyers together and pick a venue… Subpeona their internal documents that calculate the human life/health cost trade-off that they can’t be honest about. Look at their studies and surprisingly predictable spikes in cancer rates tied to “filters = lkilling women” as a guide. They cannot be honest about shifting who dies over what time frame. Either they need more data to justify their life/death decisions and they’re clueless about the cost to industry (meaning the regs are junk) or they use assumptions they arent allowed to… And yes, a vaping/s smoking populace class action is very very feasible. Find one favorable venue with one state level official who gets it. The fully aware trade of killing current smoker/vapers to likely save more in the long run isn’t that tough to prove.

  • […] Summit 2016 is a big event for tobacco control. When asked if they agreed with the statement “The long-term use of non-combustible nicotine (as in e-cigarettes) is an acceptable, if not ideal, a…” 66% of the audience […]

  • Michael

    Money and ideology is a really bad combination… A north african human trader seams to be more serious and “human”.

  • G. Karl Snae

    What is also terrifying is that a majority voting (poll) like this does not take into account the “value” that we are voting for or against. Votes for life or less harm should always weigh more than those not or those in doubt.
    Voting or the valuation of the votes should rather be based on the value or harm or not it could entice. Therefore even minority votes for saving lives or make less harm should be rule instead of just majority ruling.

  • G. Karl Snae

    A slight afterthought: 40% strongly disagree (total Ignoranti to science), so you have to assume the rest or 60% are not so sure, from slightly to highly agree. Just play-thinking aloud now ;-)

  • G. Karl Snae

    What’s shocking to me about this audience poll is the ignorance of science it reveals. Audience of TDTSummit16 is confirmed to be consisting of Ignoranti majority! Well, we suspected or knew that already, but now confirmed. Just terrifying.

  • […] The chart of an audience poll from the Global Tobacco Dependency Treatment Summit 2016 (23-24 May 2016, twitter:#TDTSummit16) is deeply disturbing…  […]

  • Anonymous

    Reasonably balanced article in the Daily Mail today. Quotes PHE, British Lung Foundation, ASH and Royal College of Physicians – but sadly also a loon from the BMA

  • John Walker

    Apart from money, Pharma and taxes, there is another factor:

    TC have a binary mindset ‘ smoke or quit it ,all together ‘.

    Can be worse than pulling teeth, changing long held outdated groupthink paradigms ( in fact it can feel like you are dealing with people who have a kind of ‘addiction ‘ problem themselves,)
    And it’s obvious that there are at the top of TC some dominant mostly ageing, very fixed people.

    Am reminded of how Louis Agassiz was able to almost singlehandedly delay the aceptance of Darwins theory of evolution in the universities he had influence over for a whole generation; Evolution went against his faith, so they basically had to wait untill he was ‘ past caring’.

    • Jude

      Yes true John, so we are left with hoping for an early end for those aging fanatics who have minds of concrete, so that millions of people can have their quality of life improved, and the lives extended by accepting tobacco harm reduction, and promoting it.

      All empires eventually fall, and the tobacco control empire has had its days in the sun, and now will crumble. Tobacco control is rotten to the core, and this has been seen by those they attempt to rule, there will be no going back, no matter how much they try to ban, restrict and punish people for NOT smoking.

  • Jude

    What this question leaves me with, is more questions. If these people are happy for smokers to keep smoking, there are conclusions that can be drawn from this data.

    1. As there are no deaths or disease attributable to vaping, and no harm can be shown to be caused by vaping, these people in tobacco control are pushing for bans and restrictions based on ideology and lies. Why?

    2. If smokers keep smoking, and this is preferable to those in tobacco control, rather than them switching to vaping, then those in tobacco control have been lying for decades about the dangers of smoking, as they seem quite happy for people to continue to smoke, and indeed are encouraging people to continue to smoke rather than switch to vaping. Why?

    3. If they admit that vaping is a vastly safer alternative to smoking, and they are discouraging smokers from switching, or banning and restricting vaping, what does this say about the integrity of tobacco control ? Are these people so corrupted, and malicious, that they would see people die, so they can keep their jobs and funding ?

    Tobacco control have painted themselves into a corner, and they are getting desperate, but the truth will out.

    tick tock…………..

  • LVD

    Surprised they always protect the big-T-monopoly? I’m not, just look where their money comes from: (Pharma money sure but) most of all tobacco tax that is of course directly derived from the sales of tobacco; if you would cut out the middle man (Big Gov) it would become painfully clear who is paying them. And they can no longer do without it. Speaking of a conflict of interest.

  • Irish Lass

    At least some sensible voices are being raised against the nutters now, in the UK at least. I just watched Sunday’s Horizon programme – and was rather pleasantly surprised to get a balanced view on the BBC at long last. I only shouted at the screen a couple of times!

  • Irish Lass

    Nuts? Yes.

    But its Tobacco Control.

    Nothing new. Endlessly shocking.

  • Guy Eaton

    Yes, they are ‘nuts’. However, they are not only nuts but extremely dangerous nutters, who obviously are completely inappropriate for the work that they do. I think borderline personality disorders (BPD) probably would be the correct diagnosis. Obviously, they see vaping as a threat to the livelihoods so would evidently prefer people continue smoking. What a bunch of moronic wasters. If the question was ‘do you think it would be preferable for someone to use an electronic cigarette as opposed to taking crack cocaine’, some in the audience would ‘strongly disagree’ with this statement – it would not surprise me. What a waste of space they are. What they are saying is it is better for someone to die a slow painful death than use the ‘Devils electronic stick’ – this evil device even provides some pleasure to the lowly smoker without doing them much harm – oh, how terrible!
    These people are a complete joke. These organisations and people need to be disbanded before the kill more people with their insane advice.

    • G. Karl Snae

      Eh, your diagnosis as Borderline Personality Disorder contains too much empathy in my opinion, so something without or lack of empathy would be a more appropriate choice? ;) but I think you are on the right track though ;)

      • DP

        More likely the following definitions would fit better

        “What are the characteristics of a sociopath?
        People with antisocial personality disorder typically have no regard for right and wrong and often disregard the rights, wishes and feelings of others. Those with antisocial personality disorder tend to antagonize, manipulate or treat others either harshly or with callous indifference.”

  • Mr. Blog Dog

    Question: “Are they nuts?”

    Answer: YES!

    Next question please. :–)

  • godek

    Makes sense. TC makes a living by having an enemy.

  • DP

    Of course they vote to extend it [smoking]!

    If every smoker switched to vaping they would be out of work and the wheels would come off the gravy train.

    Tobacco control is not and will never be about eradicating smoking and health or even about helping smokers to quit.

    The joy is merely in the hunt these days and the sense of power and importance it gives them.

    To be able to bully smokers and belittle them is the end in itself.

    • Jude

      Yes, this is an accurate view of the tobacco control industry, and the very nasty people that are involved in it. The time is long past that they can claim any innocent ignorance, what these people are doing in trying to have vaping banned, restricted, or the industry destroyed, is malicious, and corrupt.

      I used to think that maybe some of these people in the tobacco control industry, were just misguided, or badly informed, but as time goes on, this is no longer a logical view. These people are corrupted by money, and a toxic ideology, which it seems they arrogantly are not even trying to hide anymore.

      The public know of the corrupt funding deals with pharmaceutical corporations, as well as the theft of taxpayer monies, to promote pharma products, (knowing the failure rates of these useless and/or dangerous products), in order that smokers keep smoking, in an endless loop to keep the gravy train running.

      Anyone who thinks this is about public “health” is naive at best, and complicit at worst.

  • I strongly suspect many/most/all of the same tobacco controllers who disagreed with that statement about long term use of noncombustible nicotine use (because e-cigarettes were cited as an example) in that survey would have responded very differently if NRT gums, lozenges and patches had been cited as an example.

    Also, had the surveyors also asked those same tobacco controllers about their past or present receipt of Big Pharma funding, and then done cross tabulations with the question/answers on e-cigarettes, I strongly suspect that Big Pharma funding recipients would comprise most/all of the respondents who inaccurately indicated e-cigs are helpful for smoking cessation.

    It appears that this survey question simply confirmed that most researchers and so-called experts can be paid off to say (and to believe if enough funding is given) whatever their funding sources want them (i.e. pay them) to say.

    That’s what propaganda and lobbying are all about. Public health be damned when there’s lots of money to be made.

  • Peter Rogerson

    Agree with everything Roger says. Having smoked for over 40 years, I tried gum, tablets, patches as well as hypnotism; the only thing to work for me was my first e-cig, bought 3 1/2 years ago. I have since bought various others but haven’t had a “smoke” since. Big P are certainly happy to continually rake in profits by selling “remedies” that don’t have any long term benefit.

  • Bryan Goldberg

    Doesn’t “Strongly agree” and “Somewhat agree” mean that the respondents support the statement?

    • Perry Rustan

      Yes it would.
      But if you look at the chart, the majority of respondents
      either “Somewhat Disagree” or “Strongly Disagree”

    • Clive Bates

      Bryan – the 14% who strongly agree are the ‘silver lining’ in this, and show there was at least some diversity in the audience. But the majority disagree (66%) or don’t know (5%) and 39% ‘srongly disagree’ that e-cigs would be an eacceptable alternative to smoking. The ‘somewhat agree’ people (19%) evidently have doubts, but about what?

      Shocking.

      • Bryan Goldberg

        Hi Clive,

        I misread the graph and believed that the vertical bars correlated with the statements A – E. Now, I’m not a statistician or graphic designer, so I don’t know if the presentation format was meant to be confusing. Thank you for clarifying and, yes, it’s shocking.

  • Roger Hall

    Why am I not surprised? All major companies by and large engage in SWOT analyses. Pharmaceutical companies would be no different. Undoubtedly e-cigs because they reduce smoking prevalence will have been identified as a risk to future profits. It seems that there is a significant chasm between the morality of Big T generating profits from selling the harm inducing tobacco and Big P who profit equally from treating the harm caused. Big P are as much part of the tobacco industry or should I say “tobacco economy” as BAT. The same applies to every organisation involved in TC especially those funded directly or indirectly by the taxes or profits generated by tobacco smoking. Far better to have TC pushing the products that are known to be less effective and have them demonize the products or THR strategies that pose the biggest threat to smoking.

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