Category: News This Week

A public health expert in the US has said that according to a study, making a serious attempt to quit smoking is associated with a significant (41 percent) increase in heart attack risk.

Dr. Michael Siegel, a Professor in the Department of Community Health Sciences, Boston University School of Public Health, wasn’t attempting to discourage smokers from attempting to quit their habit – far from it; he was pointing out how it was possible for studies to arrive at perverse findings.

Siegel’s focus was on a recent study that, according to news coverage, had used cross-sectional data from the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) and found that ever use of e-cigarettes increased the risk of reporting ever having had a heart attack, while controlling for age, gender, body mass index, history of diabetes, and smoking status. The news articles had reported that the study found a 59 percent increase in heart attack risk associated with the use of e-cigarettes.

On his blog, The Rest of the Story, Siegel points out that it is irresponsible to use the results of this cross-sectional study to conclude (or even suggest) that e-cigarette use increases heart attack or stroke risk because the study assessed only the relationship between ‘ever’ having used e-cigarettes and ‘ever’ having had a heart attack. The study had no information on whether the heart attacks or the e-cigarette use had come first.

Referring to his own take on quit attempts being associated with a 41 percent increase in heart attack risk, Siegel said that he had used the 2016 BRFSS and modeled the risk of having had a heart attack as a function of having tried to quit smoking (and succeeding for at least one day). He had controlled for age, gender, body mass index, diabetes, and smoking status.

‘Obviously, what is going on here is not that quitting smoking increases your risk of having a heart attack,’ he said. ‘Instead, what is happening is that smokers who experience a heart attack are more likely to try to quit smoking.

‘But the same reasoning used by researchers to conclude that vaping increases heart attack risk supports the conclusion that trying to quit smoking increases heart attack risk.’

The Ethiopian parliament on Tuesday passed what is thought to be the most stringent tobacco-and-nicotine control legislation in Africa, according to a story in The Premium Times.

The Food and Medicine Administration Proclamation, which was passed unanimously by parliament, will require public places and work places to be tobacco-smoke free.

The new law will restrict the sale of flavored tobacco products.

It will ban tobacco advertising and promotions, and require graphic health warnings to be applied to 70 per cent of the front and back of all tobacco products.

And it will prohibit tobacco sales to anyone under the age of 21.

In addition, the law will ban the sale of heated tobacco products, electronic cigarettes and shisha.

A study funded by the US’ National Institutes of Health is testing whether nicotine patches can improve memory and functioning in people who have mild memory loss or Mild Cognitive Impairment (MCI), according to a story at globenewswire.com.

The largest and longest-running study of its kind, the MIND (Memory Improvement through Nicotine Dosing) Study is looking for 300 volunteers at sites across the US who have mild memory loss but are otherwise healthy, non-smokers and over the age of 55.

“The MIND Study will provide valuable information for researchers with regard to early memory loss that is associated with normal aging and early Alzheimer’s disease, but we need volunteers if we are going to succeed,” said Dr. Paul Newhouse, MD, director of the Vanderbilt Center for Cognitive Medicine and lead investigator for the MIND Study.

The story said that, according to the Alzheimer’s Association, about one in five people aged 65 or older had mild memory loss or MCI and were more likely to develop Alzheimer’s disease or other dementias.

Although currently there was no FDA-approved medication indicated to treat this condition, it was known that nicotine stimulated an area in the brain known to be important for thinking and memory, and scientists believed it could be an effective treatment for adults with MCI.

“People often think nicotine is addictive and harmful because it is in tobacco products, but it’s safe when used in patch form,” Newhouse said. “Nicotine is an inexpensive, readily-available treatment that could have significant benefits for people experiencing mild memory impairment.”

Potential study volunteers can learn more by visiting MINDStudy.org or calling 1-866-MIND-150.

A story in pharmacynews.com.au has thrown some cold water – but not much – on a widely-reported UK study (see Quitting with e-cigarettes, January 31) that found that nicotine-containing electronic cigarettes were almost twice as effective as nicotine patches and gum in helping smokers quit their habit.

But there was a ‘catch’, the story said. A year after quitting tobacco 80 percent of those who had switched to e-cigarettes were still vaping, while nine percent who had used nicotine replacement therapy (NRT) were still using NRT.

But that seems to be the limit of the cold water.

The findings were significant because the NRT users tended to cease treatment prematurely and had higher rates of relapse, Dr. Ryan Courtney (PhD) of the National Drug and Alcohol Research Centre in Sydney, NSW, was quoted as saying.

“Vaporised nicotine products seem to have quite high user acceptability in terms of the act of using your hands, the sensory-motor aspects,” said Courtney, who is also a senior lecturer in health behaviour science at the University of NSW. “And [users] do actually get enjoyment out of using vaporised nicotine products.”

But he said the long-term health risks of vaping were unknown, and that GPs and patients should continue to exercise caution.

“From a harm-reduction approach, vaporised nicotine products frequently do present as a potentially safer option, but there haven’t been the long-term studies that have looked at outcomes,” he said.

A public health expert in the US has been moved to ask a pointed question of the American Lung Association.

Writing on his blog, The Rest of the Story, Dr. Michael Siegel (pictured) asked whether the Association really hated smokers so much that it wanted to discourage them from making quit attempts using electronic cigarettes, despite new clinical trial evidence of their superiority to nicotine replacement therapy (NRT).

On Saturday, Siegel, who is a Professor in the Department of Community Health Sciences, Boston University School of Public Health, referred to a one-year randomized, clinical trial that was published in the New England Journal of Medicine and in which e-cigarettes were compared to NRT as aids to smoking cessation.

This, the most definitive study yet on the effectiveness of electronic cigarettes for smoking cessation, found that one-year smoking cessation rates with e-cigarettes were nearly twice those obtained using NRT, Siegel said.

This was great news for smokers, as it suggested that switching to vaping was another smoking cessation option that could be added to those already available.

Siegel quoted the Association as responding to the study’s results by saying that the US Food and Drug Administration had not found any e-cigarette to be safe and effective in helping smokers quit. ‘We only support methods that are FDA approved and regulated,’ it said. ‘Switching to e-cigarettes does not mean quitting. Quitting means truly ending the addiction to nicotine, which is very difficult.’

In other words, Siegel said, the Association was saying that despite this clinical trial’s demonstrating that e-cigarettes are probably much more effective than NRT for smoking cessation, they would rather smokers continued smoking than make a quit attempt using electronic cigarettes.

Under a proposal before Hawaii’s state Legislature, cigarette sales would be effectively banned outright by 2024, according to a Hawaii News Now story.

The ban would go into effect progressively, starting with raising the minimum age for buying cigarettes from 21 to 30 in 2020.

By 2022, no one under 50 could buy cigarettes.

And two years later, no one under 100 would be allowed to buy cigarettes.

The story rated the measure, House Bill 1509, as a long shot. It said it had passed its first reading last week, a procedural hurdle, and had been assigned to committees. But it didn’t yet have a hearing.

That didn’t mean it wouldn’t get one, the story went on to say, especially after news of the proposal started generating headlines nationally.

The authors of the bill, two Democratic representatives and a Republican, said the proposed ban simply made sense.

“The cigarette is considered the deadliest artifact in human history,” they wrote in the preamble to the measure. “The cigarette is an unreasonably dangerous and defective productive, killing half of its long-term users.”

About 13 percent of Hawaii adults are smokers, which is lower than the national average of 17 percent.

Hawaii also has one of the nation’s highest cigarette taxes, at $3.20 a pack. And more than a decade ago, the Hawaii Legislature significantly expanded smoke-free zones, and included e-cigarettes in those prohibitions three years ago.

The measure before lawmakers that would ban cigarette sales would not include e-cigarettes.

They keep coming. Another positive study concerning vaping has been completed. On. Jan. 30, The New England Journal of Medicine published a predominantly U.K.-based study that finds that “e-cigarettes [are] more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.”

For the study, scientists randomly assigned adults attending the U.K. National Health Service stop-smoking services to either nicotine-replacement therapies (NRT) products of their choice, including product combinations or an electronic nicotine delivery system (ENDS) starter pack, with a recommendation to buy their own flavors and strengths of e-liquids. The treatment plans also included weekly behavioral support for a minimum of 4 weeks.

The researchers wanted test subjects to have sustained abstinence for 1 year, which was validated biochemically during the patient’s final visit. A total of 886 participants were involved. The 1-year abstinence rate was 18.0 percent in the ENDS group, according to the study, as compared with 9.9 percent in the NRT group.

Among subjects with 1-year abstinence, those in the ENDS group were more likely than those in the NRT group to use their assigned product at 52 weeks (80 percent [63 of 79 participants] vs. 9 percent [4 of 44 participants]), according to the study. Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3 percent, vs. 51.2 percent in the NRT group) and nausea more frequently in the nicotine-replacement group (37.9 percent, vs. 31.3 percent in the e-cigarette group).The researchers hail from Queen Mary University of London; King’s College London; London South Bank University, London; the University of York, York; Leicester City Council, Leicester; and the Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

A letter signed by representatives from 19 advocacy groups was sent to U.S. President Donald Trump today urging him to immediately end the U.S. Food and Drug Administration’s (FDA) “aggressive regulatory assault” on the vapor industry.

“From inaction on pending product approvals, to threatening letters sent to American manufacturers, and promises to begin new rulemaking that would make illegal certain consumer products, this FDA is currently pursuing several policies that are more extreme than those contemplated by the Obama administration,” the letter reads. “FDA Commissioner Scott Gottlieb’s effort to curb the $6.6 billion electronic cigarette industry and an even larger reduced risk tobacco alternatives market is inconsistent with your clearly articulated deregulatory objectives and will destroy jobs, limit consumer freedoms, and harm public health.”

The signatories were: Grover Norquist, president, Americans for Tax Reform (ATR); Lisa Nelson, CEO, ALEC Action; Norm Singleton, president, Campaign for Liberty; Tom Schatz, president, Citizens Against Government Waste; Michelle Minton, senior fellow, Competitive Enterprise Institute; Jeff Stier, senior fellow, Consumer Choice Center; Kenneth T. Cuccinelli II, director of Regulatory Action Center, FreedomWorks and former Attorney General of Virginia; Henry I. Miller, founding director of the Office of Biotechnology, FDA; Naomi Lopez Bauman, director of Healthcare Policy, Goldwater Institute; Mario H. Lopez, president, Hispanic Leadership Fund; Julie Gunlock, director of Center for Progress and Innovation, Independent Women’s Forum; Bob McClure, president and CEO, The James Madison Institute; Seton Motley, president, Less Government; Pete Sepp, president, National Taxpayers Union; Douglas Kellogg, director, Ohioans for Tax Reform; Henry I. Miller, former director, Office of Biotechnology, FDA; Carrie L. Wade, director of Harm Reduction Policy, R Street Institute; Paul Gessing, president, Rio Grande Foundation; and Tim Andrews, executive director, Taxpayers Protection Alliance.

The letter explains that vapor products do not contain tobacco and deliver nicotine without the combustion or tar that is found in traditional cigarettes. There are also numerous studies that have found that vapor products are at least 95 percent less harmful than combustible cigarettes. The letter also states that Gottlieb and the FDA Center for Tobacco Products Director Mitch Zeller, and Surgeon General Jerome Adams have acknowledged the harm reduction potential of e-cigarettes.

“Unfortunately, a spike in the use of these products by teens has resulted in regulatory panic and significant government overreach. Commissioner Gottlieb has already pressured major manufacturers of e-cigarettes to remove many products from convenience store shelves, suggested that more than one hundred thousand retailers limit adult access to these products, and threatened to use agency power to remove thousands of legal products from the market,” the letter reads. “We do not write you today urging your administration to ignore the concerns about the use of e-cigarettes by teens. We do, however, urge your administration to subject the FDA’s response and actions to much closer scrutiny and examine it within the context of your broader deregulatory and pro-jobs agenda.”

When President Trump signed Executive Order 13771 “Reducing Regulation and Controlling Regulatory Costs” he directed departments and agencies to not only eliminate at least two regulations for every new one created but to sensibly manage costs. The deregulatory efforts led to over $33 billion in savings through October of last year, according to the letter. Nearly every department and agency identified harmful regulations and worked to untangle and repeal them. One glaring exception has been the FDA.

“It’s important that we hold the president accountable for the promises he made in the 2016 campaign and initial days of his administration,” said Paul Blair, director of strategic initiatives for ATR. “Regardless of one’s politics, it’s clear that across every department and agency, the deregulatory agenda is being fully implemented. That’s just not happening at the FDA and we want the president to know that conservatives are fed up.”

Blair goes on to say that vapers are passionate consumers and more importantly they represent millions of voters, adding that they believe they’ve made a personal decision to improve their health. “There is a broad coalition in support of our efforts here, it’s not just [ATR’s] discontent at the FDA,” he says. “I want the President to understand that even though ATR has been out in front of this issue for years, we’re not alone in recognizing the importance of getting regulations for the tobacco and vapor industry right.”

It is likely that the impact of the FDA’s proposed, pending, and possible new guidance and rules for vapor products will amount to billions of dollars in lost economic activity and costs, according to the letter. Blair says it’s inexcusable. “At this point, a Hillary Clinton presidency would have been no different for the industry than Trump’s, all thanks to Scott Gottlieb’s misguided crusade.”

All China’s domestic airlines have been ordered to prohibit immediately smoking and vaping in cockpits, and to punish severely crew members who violate the ban, according to a China Daily story citing a notice issued by the Civil Aviation Administration of China (CAAC).

The CAAC has ordered airlines to suspend crew members who smoke or vape in cockpits for 12 months for a first offense and for 36 months for repeat offenses. Other crew members who fail to intervene when a member of a cockpit crew is smoking [or, presumably, vaping] were said to be liable to a six-months’ suspension.

The CAA said that if smoking [and vaping] on a plane resulted in serious consequences, the penalty would be more severe and would be recorded in crew members’ files.

Smoking was banned in the passenger cabin and toilets of all aircraft in October 2017, but individual airlines had the option to permit smoking in the cockpit for two years. The recent cockpit ban accelerates the original time frame.

Originally, the rules would not have taken effect until the end of this year, said Zhang Qihuai, a Beijing lawyer specializing in civil aviation. But only Chongqing Airlines and China West Air had implemented the cockpit ban.

In July, news reports said that an Air China co-pilot who was vaping during a flight from Hong Kong to Dalian, Liaoning province, wanted to turn off the air circulation fan. But he switched off the aircraft’s air conditioning by accident, which diffused smoke [presumably vapor] throughout the cabin and led to the deployment of oxygen masks and an emergency descent.

The aircraft climbed to its cruising altitude and the flight continued once the problem was identified.

There were 153 passengers and nine crew onboard. No injuries were reported.

Zhang said he believed this incident triggered the early enforcement of the regulation.

“If heavy smokers among the passengers can forgo their habit during flights, there is no reason to make the crew an exception, especially since they are responsible for the safety of all on board,” Zhang said.

In the tobacco harm reduction debate, civility has gone up in smoke, according to a vaping advocate writing at filtermag.org.

‘In the pursuit of reducing the harms caused by cigarettes, those of us who advocate for vaping as a public-health harm reduction tool are constantly battling with bullying and harassment, “justified” by moral outrage,’ said Dr. Carrie Wade, who is a senior fellow and the harm reduction policy director for the R Street Institute.

Wade said that during her first foray into this arena, at the US E-Cig summit in 2017, she was surprised at the level of vitriol she witnessed, at the jeering and boos as different opinions, approaches and research were presented.

Since then she had experienced such attacks, with the most recent on January 15 when she and her fellow panelists were invited by a state tax board to present on tobacco harm reduction and epidemiology, only to be openly mocked when answering questions from board members.

But Wade admitted that there were bad actors on both sides. ‘Those who advocate for, or produce and sell e-cigarettes or e-liquids, are also too often guilty of incivility,’ she said…

‘Accounts of harm reduction advocates behaving badly are often shared, and there is vitriol on both sides — just look at any Twitter debate around the issue (and yes, I’m ashamed to admit that I’ve taken the bait a couple times myself). It’s easy for those of us on either side of the debate to imagine that the unprofessionalism is one-sided, but that is not the case.’

Wade pointed out that the major charity Cancer Research UK (CRUK) had recently adopted strict anti-bullying and harassment policies – though these had not been born out of a need to protect those who espoused tobacco harm reduction.

‘Anti-bullying and harassment policies should perhaps become much more widespread,’ she said. ‘After all, progress rarely happens without some degree of conflict, but I would argue that it never happens without a willingness to remain civil, to find common ground and compromises. The US surgeon general has correctly pointed this out, stating that personal attacks make future discussion or collaboration unlikely.’