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All Reason.com articles with the "Public Health" tag.



Published: Fri, 20 Oct 2017 00:00:00 -0400

Last Build Date: Fri, 20 Oct 2017 10:26:57 -0400

 



Brickbat: The Tick

Fri, 15 Sep 2017 04:00:00 -0400

(image) Members of Japan's Miyazaki prefectural government say that in retrospect it was a bad idea to bring a deadly tick with them to a press conference to warn about the dangers of a tick-borne disease. The tick got away, and even with help from the reporters at the press conference, officials were unable to find it.




Fixating on Adolescent Vaping Could Be Deadly for Adult Smokers

Thu, 07 Sep 2017 14:50:00 -0400

The first surgeon general's report on e-cigarettes, published last December, could have highlighted the enormous harm-reducing potential of products that simulate smoking but do not contain tobacco or burn anything. Instead Surgeon General Vivek Murthy sounded the alarm about adolescent vaping, which he called "a major public health concern." A critique of Murthy's report, published online yesterday by Harm Reduction Journal, shows how dangerously misguided his concerns were. "The majority of e-cigarette use among US youth is infrequent and experimental, and minimal among never-smoking youth," note Italian internist and tobacco researcher Riccardo Polosa and his co-authors. "Additionally, the majority of the very small proportion of US youth who do use an e-cigarette frequently are actually using e-cigarettes that do not contain nicotine." Polosa et al. also point out that "the increasing prevalence of e-cigarette use between 2010 and 2015 has coincided with the sharpest declines in the smoking rate among US youth and young adults on record." Murthy, who was removed from his post in April but has not been permanently replaced yet, focused on the share of teenagers who report using an e-cigarette in the previous month, which rose "an astounding 900 percent" (from 1.5 percent to 16 percent) between 2011 and 2015, as measured by the National Youth Tobacco Survey (NYTS). Digging more deeply into the survey data, Polosa et al. show that relatively few teenagers vape frequently and almost all of those who do are current or former smokers. In the 2015 NYTS, for example, just 0.6 percent of middle school students and 2.5 percent of high school students reported vaping on 20 or more days in the previous month. According to the 2014 Monitoring the Future Study (MTF), less than 1 percent of teenagers who vape that often are never-smokers. The MTF data also indicate that most adolescents who vape use nicotine-free e-liquids, which makes Murthy's fear that they will get hooked on the drug and later graduate to smoking seem even more fanciful. On the face of it, nothing like that seems to be happening. As Polosa and his colleagues point out, "the increasing rate of ever-use of e-cigarettes among US youth has coincided with the sharpest declines in youth smoking rates in many decades." That is true for young adults as well as teenagers. The coincidence of these opposing trends does not necessarily mean that e-cigarettes have hastened the decline in smoking. But it is a plausible possibility that should not be overlooked by public health officials who want to reduce smoking-related morbidity and mortality, since e-cigarettes are far less hazardous than the conventional kind. Even in the rare instances where teenagers who have never tried tobacco take up vaping, they are far better off in terms of health risks if they otherwise would be smoking. As Polosa et al. note, "e-cigarettes may have the potential to reduce the likelihood of smoking initiation among youth who may be especially at risk for initiating smoking in the absence of e-cigarettes." The studies that Murthy cited as evidence that vaping leads to smoking show only that teenagers who try the former are more likely to try the latter. "There was no evidence that adolescents were regular e-cigarette users at baseline," Polosa et al. note, "and no evidence that they were smoking cigarettes regularly at follow-up." Even if some teenagers go through a vaping phase before becoming regular smokers, that does not necessarily mean the experience of vaping makes them more inclined to smoke. An attraction to both forms of nicotine consumption could be a function of personality and circumstance. If e-cigarettes are a gateway to the real thing, that gateway is so tiny that its impact cannot be seen in smoking trends. "At the very least," Polosa et al. observe, "available data appear reassuring that e-cigarettes are not decelerating, let alone reversing, declining rates of youth smoking." Although Murthy conceded that vaping is less hazardous than smoking, he obsc[...]



FDA Lies About Vaping While the CDC Inches Toward the Truth

Thu, 31 Aug 2017 14:15:00 -0400

Between 2011 and 2016, according to survey data from the U.S. Centers for Disease Control and Prevention, cigarette smoking by teenagers fell by half, cigar smoking fell by a third, pipe smoking fell by two-thirds, and smokeless tobacco use fell by a quarter. Yet according to the Food and Drug Administration, there were "no significant declines in overall high school tobacco use" during that period. How is that possible? Let me answer that riddle by posing another one. If you call an e-cigarette a tobacco product, and the incidence of past-month vaping among high school students more than sextupled from 2011 to 2016, how does that affect the trend in overall tobacco use? The answer is that it does not affect the trend in overall tobacco use at all, because calling an e-cigarette a tobacco product does not make it a tobacco product. Yet that is what FDA does, partly for regulatory reasons. E-cigarette fluid often contains nicotine derived from tobacco, which supposedly transforms a tobacco-free product into a tobacco product, giving the FDA authority to regulate it. The FDA maintains that pretense even when reporting what is happening in the real world. The result, as Boston University public health professor Michael Siegel notes on his tobacco policy blog, is an alternative reality where dramatic declines in adolescent tobacco consumption never happened. The CDC plays the same game, falsely claiming "current use of any tobacco product did not change significantly" among high school students from 2011 to 2016. This blatant misrepresentation magnifies a problem (underage tobacco use) that the FDA and the CDC are charged with addressing, making their work seem more urgent and more worthy of funding. It also conflates e-cigarettes, a noncombustible, tobacco-free alternative to conventional cigarettes, with products that are far more dangerous, obscuring the enormous harm-reducing potential of this innovation. By lumping e-cigarettes in with tobacco products, the FDA and CDC may hope to scare kids away from them. But the message to current smokers—that they might as well keep puffing away, since all these nicotine sources are essentially the same—is potentially deadly. A new CDC webpage about e-cigarettes gives some ground on that score, conceding that "e-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products." But by insisting that e-cigarettes be a "complete substitute," the CDC dismisses the health benefits of smoking less, even if the number of cigarettes per day does not fall to zero. "Dual use is not an effective way to safeguard your health," the CDC says. "Because smoking even a few cigarettes a day can be dangerous, quitting smoking completely is very important to protect your health." This slippery formulation deliberately obscures the fact that smoking a few cigarettes a day is less dangerous than smoking a pack or two a day. If e-cigarettes help smokers make that change, they are reducing tobacco-related harm. The CDC's discussion of how the health hazards of vaping compare to those of smoking is similarly misleading. "Are e-cigarettes less harmful than regular cigarettes?" it asks. "Yes—but that doesn't mean e-cigarettes are safe. E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents." Sadly, it counts as an improvement that the CDC is willing to explicitly say e-cigarettes are less harmful than regular cigarettes instead of dodging the question entirely. But you would not guess from its gloss that vaping is something like 95 percent safer than smoking, that potentially harmful substances in e-cigarette aerosol are typically present only in trace amounts, or that smo[...]



Why Handwashing Is Key to Ballpark Food Safety

Sat, 19 Aug 2017 08:00:00 -0400

In an interesting before-you-reach-for-that-hot-dog style report released last week, Sports Illustrated compared and ranked the food-safety climate at every Major League Baseball park in the United States. Seattle's Safeco Field came in first, while Tampa Bay's Tropicana Field brought up the rear. My favorite (and hometown) ballpark, Boston's Fenway, ranked second. Among its conclusions, the report found "almost a third of the league's stadiums had over 100 total violations, including both Los Angeles clubs. One Chicago stadium failed its routine inspection for the second summer in a row. Eighteen ballparks had critical violations in at least a quarter of their concession stands." Some of the violations reported are objectively gross: "Camden Yards had evidence of rodent infestation at eight different food entities and Yankee Stadium had 14 stands overrun with filth flies." The SI report updates the first such study, published by ESPN in 2009. Food safety at sporting events has long intrigued me. The first time I ever really thought about food safety is intimately tied to sports. The year was 1980. I was seven years old. As I watched an episode of Quincy, M.E.—titled "Deadly Arena"—I saw the title character engage in what IMDB characterizes as "a race against time to find the source of" a botulism outbreak at a sports stadium "before the field becomes littered with bodies." Some of the best stadium food I've eaten in the years since has been the Ichiroll (an Ichiro Suzuki-themed sushi roll) and the grasshoppers at Safeco. The worst food I've ever eaten at a sporting event—football, rather than baseball—was a crab and cheese pretzel at FedEx Field in Maryland. But the relative tastiness of a stadium's food doesn't have much if anything to do with the safety of that food. "The real risk, it seems to me at the ballpark, is the handling of food," said UCLA Prof. Michael Roberts—with whom I serve on the board of the Academy of Food Law & Policy—in comments to SI. "That's where you've got handlers cooking the food, handing it out, managing refrigeration and heating. … So it seems that the most important players in this would be local level, the county inspectors, the folks that are there to ensure quality and safety measures are being followed." Others SI spoke with echoed Roberts. And I will, too. He's exactly right. Data back him up. Nearly six out of every ten cases of foodborne illness in this country are caused by norovirus, which is transmitted most often from person to person due to poor handwashing after using a restroom. According to a 2016 article published in the Journal of Food Protection, every state requires workers to wash their hands after using a restroom. Requiring foodservice employees to wash their hands after using a restroom is—in a bubble—smart lawmaking. But other rules may offset the handwashing rule. For example, fire-safety laws requiring that bathroom doors open inward, rather than outward, means in most cases that a person must touch a door handle before they leave a restroom. So a foodservice worker may do everything they're supposed to—washing their hands before leaving a restroom—but their best efforts may be foiled by having to share a bathroom-door handle (and the associated germs) with people who don't wash their hands. The FDA's model food code recognizes the potential for re-contamination after washing one's hands. "TO avoid recontaminating their hands ... FOOD EMPLOYEES may use disposable paper towels or similar clean barriers when touching surfaces such as manually operated faucet handles on a HANDWASHING SINK or the handle of a restroom door," it states. But many foodservice establishments are swapping out environmentally unsound disposable paper towels for efficient, modern air dryers. As more and more restaurants move to fancy Dyson-style air driers, fewer and fewer restaurants even have paper towels in their restrooms, making it difficult to open a bathroom door without touching the[...]



Researchers Highlight the Government's Complicity in Heroin Deaths

Fri, 04 Aug 2017 17:01:00 -0400

This week a presidential commission and the Justice Department sounded the alarm about recent increases in opioid-related deaths. One of the most striking features of this problem is that heroin-related deaths have been rising faster than heroin use since 2010, which means heroin use is becoming more dangerous, thanks partly to adulteration with fentanyl, a synthetic narcotic that is roughly 40 times as potent. Drug warriors claim that development is driven by consumer demand because addicts are always looking for a better high. New research reported in The International Journal of Drug Policy (IJDP), which recently devoted a special section to "U.S. Heroin in Transition," tells a different story. The IJDP articles implicate the war on drugs in making heroin more hazardous, but they also provide reasons to hope that harm-reduction policies can mitigate that effect. According to the official narrative, intravenous drug users seek out fentanyl-fortified heroin, notwithstanding the substantial risk of a fatal overdose, because they prefer its psychoactive effects. "The users know they could die," a DEA official told the Worcester Telegram & Gazette in 2014. "They're chasing the dragon. They're looking for the ultimate high." Last year a vice cop in East Providence, Rhode Island, told a local paper "heroin cut with fentanyl gives the user a more intense high," and addicts "want that ultimate high, taking them right to the edge." A few months later, a DEA agent told the New Haven Register "the users know that they could die from taking this heroin," but "they want the ultimate high," so they ignore the risk. Brown University medical anthropologist Jennifer J. Carroll and her collaborators interviewed 149 opioid users in Rhode Island and found very little support for such claims. "Our findings directly contradict this narrative," they report in their IJDP article. "Interviewed heroin users overwhelmingly indicated that they prefer to avoid fentanyl-contaminated heroin whenever possible....When they do encounter fentanyl-contaminated heroin, many users report greatly disliking and often fearing the unpredictability of its effects." The initial effects of fentanyl are more intense than heroin's, but not necessarily in a good way. The interviewees described the experience as overwhelming and incapacitating, and "a general consensus emerged that the effects of fentanyl are distinctly uncomfortable or distressing," with many users describing an unpleasant "pins and needles" sensation in their faces and limbs. Another drawback of injected fentanyl is that its effects last only a half-hour to an hour, compared to four to five hours for heroin. And then there is the risk of sudden death. "The high potency of fentanyl means that only a minuscule amount (less than 2 mg, the equivalent of two grains of salt) can lead to overdose and death," Brown epidemiologist Brandon Marshall and his co-authors note elsewhere in the same issue of the IJDP. They add that "fentanyl causes rapid and more profound respiratory depression than other opioid analgesics, which significantly narrows the window of opportunity for reversal with naloxone," an opioid antagonist used to treat overdoses. An Australian study found that "the overall risk for fentanyl-related overdose was nearly 4.5 times higher than risk for overdose with other opioids." Contrary to the accounts of cops and DEA agents, the Rhode Island opioid users interviewed by Carroll and her colleagues did not blithely dismiss this risk. "Participants who were aware of fentanyl universally described it as dangerous and potentially deadly," Carroll et al. write. "People are dropping like flies," one heroin user said. "I don't want to die," said another, explaining why he buys heroin only from a dealer he trusts not to sell him fentanyl-laced powder. Others said they try to avoid fentanyl and take "test hits"—small trial doses—whenever they suspect it is present. "Among illicit opioid user[...]



A Cap on Nicotine in Cigarettes Would Be Hazardous to Health

Wed, 02 Aug 2017 15:20:00 -0400

Robert Proctor, the historian of science who wrote the fascinating 1999 book The Nazi War on Cancer, loves the Food and Drug Administration's idea of "reducing the nicotine in cigarettes to a nonaddictive level." Writing in The New York Times, Proctor, now a professor at Stanford, calls the FDA's proposal "exceptionally good news for tobacco control, and for human health." In fact, he says, "a legal cap on the nicotine in cigarettes could be one of the most important interventions in human health history." I don't think this intervention would work out the way Proctor imagines. His op-ed piece is an excellent example of expecting good intentions to ensure good outcomes, even when experience tells us the policy is bound to backfire. "Cigarettes with nonaddictive nicotine levels would be radically different from what used to be known as 'low tar' or 'light' cigarettes, marketing gimmicks now barred by law," Proctor assures us. "Those cigarettes were advertised as delivering less nicotine and tar into the lungs, even though there was no actual reduction." Although it is by no means clear that "there was no actual reduction," it's true that "light" cigarettes were at best only slightly less harmful than regular cigarettes. But the reason for that casts doubt on the logic of the proposal Proctor is championing. It turned out that smokers who switched to "light" cigarettes tended to engage in "compensatory behavior" that boosted nicotine delivery and moved them closer to their usual dose. They smoked more cigarettes, took more puffs from each one, took bigger puffs, or held the smoke deeper and longer. They even subconsciously covered the tiny filter holes that helped reduce a cigarette's machine-measured tar and nicotine yields. The upshot is that "light" cigarettes did not offer anything like the health advantage implied by those official, government-certified numbers. The problem was that tobacco companies reduced nicotine along with tar, when what they should have done was reduce tar while keeping nicotine the same. E-cigarettes embody the latter approach taken to its logical conclusion: They deliver nicotine with no tar at all, since they do not contain tobacco and do not rely on combustion. To its credit, the FDA has finally begun to recognize the huge potential health benefit of reducing the toxins and carcinogens that smokers absorb along with nicotine. In the case of conventional cigarettes, however, the agency is considering the opposite approach: forcing smokers to absorb more toxins and carcinogens for any given dose of nicotine. The aim, as Proctor says, is to "make addiction virtually impossible," so that "kids might start smoking, but they wouldn't have trouble quitting." But what about the 30 million or so Americans who already smoke cigarettes? Deliberately increasing their exposure to the dangerous compounds generated by burning tobacco is neither ethical nor sensible, even (or especially) from a "public health" perspective. There are other problems with the FDA's proposal, aside from its health-damaging paternalism. Proctor notes that "sales were disappointing" when Philip Morris introduced three brands of nicotine-free cigarettes in the 1980s, "in part because high-nicotine cigarettes remained on the market." But forcing cigarette manufacturers to dramatically reduce nicotine levels would stimulate a black market supplied by smuggled imports and illicitly manufactured smokes. Smokers could dodge the cap on nicotine by turning to the black market, spiking their cigarettes with liquid nicotine, or rolling their own using full-strength tobacco. As longtime British anti-smoking activist Clive Bates notes, it is not even clear that the FDA has the authority to mandate the nearly complete removal of nicotine from cigarettes. The Family Smoking Prevention and Tobacco Control Act bars the agency from "banning all cigarettes" or "requiring the reduction of nicotine yields of a toba[...]



The FDA Warms to Vaping

Wed, 02 Aug 2017 00:01:00 -0400

On the face of it, the decision that the Food and Drug Administration (FDA) announced on Friday, extending by four years a crucial deadline for e-cigarette manufacturers to seek approval of their products, was no more than a stay of execution. But the FDA also signaled a new receptiveness to vaping as a harm-reducing alternative to smoking, which suggests this reprieve could turn into a commutation. That would be good news for smokers who want to quit and for anyone sincerely interested in helping them. For too long American public health officials have been unreasonably hostile to e-cigarettes, which are far less hazardous than the conventional kind and offer a closer simulation of the real thing than nicotine gum or patches do. Scott Gottlieb, the new FDA commissioner, seems to appreciate the public health potential of this innovation. "The overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes," he says. "Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources, needs to be the cornerstone of our efforts—and we believe it's vital that we pursue this common ground." Gottlieb's vision of nonaddictive cigarettes involves mandating a gradual reduction in nicotine content, which would increase the risks that smokers face by forcing them to absorb more toxins and carcinogens for the same dose of nicotine. But his interest in less dangerous alternatives to cigarettes is encouraging. The FDA says "a key piece" of its new approach is "demonstrating a greater awareness that nicotine—while highly addictive—is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes." The agency wants to strike "an appropriate balance between regulation and encouraging development of innovative tobacco products that may be less dangerous than cigarettes." Toward that end, the FDA is giving e-cigarette companies until August 8, 2022, to apply for permission to keep their products on the market under regulations published last year, rather than the original deadline of November 8, 2018. The agency says it will use the extra time to seek additional public comment and develop clearer guidance for the industry. The 2016 regulations require manufacturers of vaping equipment and e-liquids to demonstrate that approval of their products "would be appropriate for the protection of the public health." It is not clear what that means in practice, but the FDA projected that applications would cost hundreds of thousands of dollars per product, and many observers thought that was an underestimate. To give you a sense of how expensive and burdensome the process was expected to be, the FDA anticipated that it would receive applications for just a tiny percentage of existing products. The implication was that the regulations would drive the vast majority of companies out of business. If the FDA is serious about making "less harmful sources" of nicotine "the cornerstone of our efforts," it will develop transparent, straightforward, and practical criteria for approval of current and new vaping products. Standing between smokers and products that can save their lives is surely not "appropriate for the protection of the public health." Nor is making those products less appealing by arbitrarily restricting flavors. Since supposedly "kid-friendly" e-liquids are very popular among adults who switch from smoking to vaping, it's a bit worrisome that the FDA plans to solicit public comment on regulation of flavors, which it acknowledges may be "helping some smokers switch to potentially less harmful forms of nicotine delivery." A recent BMJ study suggests that e-cigarettes have accelerated the downward trend in smoking and may account for the fir[...]



Embracing Harm Reduction, FDA Gives E-Cigarette Industry a Regulatory Reprieve

Fri, 28 Jul 2017 13:15:00 -0400

Today the Food and Drug Administration (FDA) said it is giving manufacturers of electronic cigarettes until August 8, 2022, to apply for approval of their products under regulations announced last year, which were widely expected to drive most companies out of business. The original deadline was November 8, 2018, and the four-year extension is supposed to provide more time for public comment and industry guidance as part of a "comprehensive regulatory plan" that aims to strike "an appropriate balance between regulation and encouraging development of innovative tobacco products that may be less dangerous than cigarettes." The agency says "a key piece of the FDA's approach is demonstrating a greater awareness that nicotine—while highly addictive—is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes." That is music to the ears of harm-reduction advocates who see vaping as a life-saving alternative to smoking and viewed the original FDA rules as misguided, heavy-handed, and potentially deadly meddling that effectively gave conventional cigarettes an advantage over competing sources of nicotine that are much less dangerous. In addition to providing regulatory relief for the e-cigarette industry, the FDA will be investigating the possibility of mandating a gradual reduction in the nicotine levels of combustible cigarettes. The idea is to make cigarettes less addictive for new smokers, but the policy is apt to hurt current smokers by forcing them to absorb more toxins and carcinogens along with their usual dose of nicotine. The FDA "intends to issue an Advance Notice of Proposed Rulemaking (ANPRM) to seek input on the potential public health benefits and any possible adverse effects of lowering nicotine in cigarettes." The FDA's new commissioner, Scott Gottlieb, sees a nicotine-reduction mandate as complementing the agency's new receptivity to harm-reducing cigarette alternatives. "The overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes," Gottlieb says. "Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources, needs to be the cornerstone of our efforts—and we believe it's vital that we pursue this common ground." The FDA also seems to be contemplating flavor regulations that might favor e-cigarettes over the real thing. It says it will "seek public comment on the role that flavors (including menthol) in tobacco products play in attracting youth and may play in helping some smokers switch to potentially less harmful forms of nicotine delivery." The Family Smoking Prevention and Tobacco Control Act, the law that gave the FDA authority to regulate tobacco products, banned most "characterizing flavors" from cigarettes but made an exception for menthol, by far the most popular one (and, not coincidentally, a big moneymaker for Philip Morris, which supported the law). It sounds like the FDA might be reconsidering that exception, while at the same time recognizing that so-called kid-friendly e-cigarette flavors are in fact very popular with adults who switch from smoking to vaping. The FDA says it will use the reprieve it is giving e-cigarette companies to clarify what will be required to keep their products on the market. The agency also plans to develop product standards that address battery hazards and help keep e-cigarette liquids away from children. Over all, it looks like the FDA under Gottlieb will be taking a much more practical approach to e-cigarette regulation that recognizes the realities of the existing market and the relative hazards of different nicotine sources. Instead of wrecking an industry that seems to be accelerating the downward trend in smoking, [...]



New Study Provides Strong Evidence That E-Cigarettes Boost Smoking Cessation

Thu, 27 Jul 2017 17:15:00 -0400

A new study, based on data from a large survey of current and former smokers in the United States, provides some of the strongest evidence yet that electronic cigarettes are helping Americans move from the first group to the second. The study, reported this month in the BMJ, finds that quit attempt and smoking cessation rates both increased significantly during the period when e-cigarette sales took off. Furthermore, these changes were entirely attributable to increased quitting among e-cigarette users, who were more likely to try and more likely to succeed than smokers who did not vape. The researchers, led by University of California at San Diego public health professor Shu-Hong Zhu, found that 45.9 percent of smokers reported quit attempts in the 2014-15 Current Population Survey, up from 41.4 percent in 2010-11. The percentage who stopped smoking for at least three months also rose, from 4.5 percent to 5.6 percent. "This is the first time in almost a quarter of a century that the smoking cessation rate in the US has increased at the population level," Zhu and his colleagues write. "The 1.1 percentage point increase in cessation rate...might appear small, but it represents approximately 350 000 additional US smokers who quit in 2014-15." What happened during this period that might account for the change? Zhu et al. note that e-cigarette use in the U.S. "became noticeable around 2010 and increased dramatically by 2014." That correlation is reinforced by the researchers' subgroup analysis of the 2014-15 data, which found that 65 percent of smokers who had used e-cigarettes in the previous year had tried quitting, compared to 40 percent of the other smokers. "Numerically speaking," the authors say, "it was this e-cigarette user subgroup that raised the overall quit attempt rate for 2014-15, and thus the rate was statistically significantly higher than in all previous survey years." Vapers also had a higher cessation rate than nonvapers in 2014-15: 8.2 percent vs. 4.8 percent. "Again," Zhu et al. write, "the 2014-15 survey had a noticeably higher overall cessation rate because the e-cigarette user subgroup had a higher cessation rate than those who did not report e-cigarette use in the past year." Since this is an observational study rather than a randomized, controlled experiment, alternative explanations are possible. But the researchers persuasively argue that neither the 2009 increase in the federal tobacco tax nor the TIPS From Former Smokers ad campaign that began in 2012 can adequately explain the increase in smoking cessation, especially in light of the stark subgroup differences. The impact of the tax hike was relatively small and short-lived, Zhu et al. say, while it is hard to see why the anti-smoking ads would have had an impact only on smokers "who happened to use e-cigarettes in 2014-15." Still, smokers who try vaping may differ from those who do not in ways that make them more likely to quit. "Given that the e-cigarette user subgroup was the only group that had statistically significantly higher rates in 2014-15," Zhu et al. say, "it is tempting to attribute the increase in the overall smoking cessation rate in 2014-15 solely to e-cigarette use. However, e-cigarette use itself could be an indicator of motivation to quit smoking, which would predict a higher quit rate. Thus, attributing the full 73% relative difference to e-cigarettes is likely an overestimate of their effect." These results nevertheless should allay fears that e-cigarettes might somehow make smoking more common than it would otherwise be. To the contrary, the vaping alternative seems to be accelerating the downward trend in the smoking rate, which in this survey fell from 21 percent in 2001-02 to less than 14 percent in 2014-15. Any regulatory policy that makes e-cigarettes less accessible or less appealing to smokers, such[...]



Curbing Traffic Stops Would Save Lives

Thu, 20 Jul 2017 00:15:00 -0400

Last weekend, in the wee hours of the night, Chicago police stopped a car carrying four people. When officers approached it, they saw a passenger holding a gun. The outcome was a familiar one: an 18-year-old man was shot by police. Too often, traffic stops lead to tragedy. Philando Castile was shot to death in his car by a police officer in Minnesota. Last week, a mistrial was declared for a University of Cincinnati officer prosecuted for killing 43-year-old Samuel DuBose, whose car had a missing front license plate. Sandra Bland, yanked out of her car by a Texas state trooper after allegedly failing to signal a lane change, died in jail. All three victims were black. Cops are also at risk. In March, a police officer died in a shootout with a passenger who ran from a car that had been pulled over in Tecumseh, Okla. In June, a police lieutenant was fatally gunned down after a stop in Newport, Arkansas. When an officer stops and approaches a vehicle, both the cop and the driver are vulnerable. Any wrong move or misjudgment can turn the encounter deadly. "Traffic stops and domestic violence are the highest-risk calls—you have no idea what you're walking into," John Gnagey, executive director of the National Tactical Officers Association, told the Orlando Sentinel in 2010. Even when motorists get off unharmed, the experience can be frightening, infuriating or humiliating. Stops breed fear and distrust of law enforcement, particularly among minorities. So why do cops rely so much on the practice? Enforcing traffic laws is a large share of what they do. Ignoring motorists who drive too fast or ignore signals could foster chaos on the road. But there are other ways to combat bad driving. University of California, Berkeley law professor Christopher Kutz points out that police in France do traffic stops at less than one-third the rate that American cops do. In England and Wales, it's one-fourth. The obvious alternative is using cameras. Speeders and red-light runners can be detected and ticketed by electronic means. Upon paying the fine, says Kutz, the offenders could be required to show that they are licensed and insured. I've gotten citations from red-light and speed cameras, and while I resented the fines, I was grateful that I wasn't detained on the roadside by an armed officer. The time I got a mere warning for (barely) failing to come to a complete stop on an empty suburban street after midnight was considerably less pleasant. Being a gray-haired white male, I've been pulled over only three times in my adult life. Castile, 32, had been through that experience 49 times—and "was rarely ticketed for the reason he was stopped," according to the StarTribune of Minneapolis-St. Paul. Joel Anderson, an African-American reporter for BuzzFeed, said on Twitter last month that he's been stopped more than 30 times since he started driving—including five times for seatbelt violations when he was wearing his seatbelt. Traffic stops are often an excuse for cops to search a car for drugs and guns. Curtailing police reliance on this pretext would free motorists from being dragooned to "consent" to searches for which the cops lack probable cause. True, the change would let criminals operate at less risk. But hassling the innocent to catch the guilty is an abuse of our constitutional principles. In Illinois last year, police conducted 2.17 million traffic stops. Just 8,938 yielded contraband—one bust for every 242 stops. The rare instances when police find evidence of a crime, Kutz told me, "don't justify the enormous social costs of widespread police interventions." This is an extremely inefficient way of detecting drug and gun crimes. It's also often discriminatory. "Minorities are more likely to be asked for consent to search, and less likely to have contraband," notes Karen Sheley, police p[...]



Brickbat: Ain't That a Kick in the Ass

Fri, 07 Jul 2017 04:00:00 -0400

(image) U.S. Air Force Medical Services has warned patients who had colonoscopies and endoscopies at an Air Force medical center in Qatar between 2008 and 2016 they may have been exposed to HIV, hepatitis and other blood-borne disease. Officials say equipment used in those procedures was not properly cleaned.




Report on 'Children' Killed by Guns Hypes Accidents, Which Are Rare and Declining

Tue, 20 Jun 2017 09:15:00 -0400

"Guns Kill Almost 1,300 US Children Annually," says the headline over a CNN story that begins with the case of a third-grader accidentally shot in the stomach at school by another student, describes a baby accidentally shot by his father, and closes with warnings about safe storage of firearms. The story creates a very misleading impression, since nearly four-fifth of the fatalities involved teenagers and most were homicides. The CNN story was based on a study recently published in the journal Pediatrics that analyzed data on gun-related injuries and deaths among minors from 2002 through 2014. According to a table from the study, 78 percent of the deaths occurred among 13-to-17-year-olds, 53 percent were homicides, and 38 percent were suicides. Less than 4 percent were accidents involving children 12 or younger, so the examples cited by CNN are far from typical. This sort of misrepresentation is an old trick among gun controllers, as David B. Kopel noted in Reason 24 years ago. "Gun-control advocates are hammering at the issue of children and guns as never before," Kopel wrote, "in the hope that it will be easier to enact gun controls aimed at adults in an atmosphere of panic about children." He pointed out that claims about "children" killed by guns conflate accidents involving little kids, which were relatively rare then and are even less common now, with suicides and gun violence involving teenagers. The circumstances matter, of course, because solutions that might make sense for one sort of gun death may be irrelevant to another. Safe gun storage and handling, for example, can keep third-graders from taking guns to school in their backpacks and prevent infants from being injured by careless rifle cleaning. But they cannot reasonably be expected to have much of an impact on gang violence. The authors of the Pediatrics study found that 40 percent of the homicides involving teenagers grew out of "arguments" (presumably including black-market disputes, a phenomenon created by drug prohibition), 31 percent were "precipitated by another crime," 21 percent were gang-related, 9 percent were drive-by shootings, and 7 percent killed bystanders. Some of those categories overlap. The homicide rate among minors (17 or younger) rose by 17 percent from 2002 to 2007, then fell by 36 percent from 2007 to 2014. The suicide rate, by contrast, fell by 23 percent from 2002 to 2007, then rose by 60 percent from 2007 to 2014. Deaths from gun accidents, the scenario emphasized by CNN, fell steadily during the study period. In fact, the researchers note, "unintentional firearm death rates have been steadily declining for several decades." Although misleading reporting on scientific studies can often be traced to the researchers themselves (or to hyperbolic university press departments), that does not seem to be the case here. "There isn't a single issue in isolation that increases the likelihood of gun death," the lead author, CDC researcher Katherine Fowler, told The New York Times. "Children are at a higher risk of violence if they have academic problems, encouragements to be aggressive, and limited adult supervision. The likelihood of violence is also higher in communities with high levels of instability, gang activity, drug sales, unemployment, or poverty." CNN, by contrast, interviewed Stephen Hargarten, a professor of emergency medicine at the Medical College of Wisconsin, who "likened gun violence in America to a disease." Among the causes, he said, are "the social constructs of companies that make these products that are available to children, that can be used very easily by children."[...]



As Vaping Exploded Among Teenagers, Smoking Fell by Half

Mon, 19 Jun 2017 09:15:00 -0400

Survey data published last week cast further doubt on warnings that e-cigarettes are a gateway to the real thing for teenagers. Between 2011 and 2016, according to the National Youth Tobacco Survey (NYTS), the share of high school students who reported smoking cigarettes in the previous month fell from almost 16 percent to 8 percent, even as past-month use of e-cigarettes rose dramatically. The incidence of past-month cigarette smoking among high school students in the NYTS, which is conducted by the U.S. Centers for Disease Control and Prevention (CDC), fell from 9.3 percent to 8 percent last year, continuing a downward trend that began in the late 1990s. The incidence of past-month vaping, which rose steadily from 1.5 percent in 2011 to 16 percent in 2015, also fell last year, to 11 percent. From 2011 to 2016, in other words, e-cigarette use more than septupled, while cigarette smoking was cut in half. "The rate of decline in youth smoking is unprecedented," writes Boston University public health professor Michael Siegel on his tobacco policy blog. "This despite the rapid rise in e-cigarette experimentation. These data are simply not consistent with the hypothesis that vaping is going to re-normalize smoking and that e-cigarettes are a gateway to youth smoking." In theory, it is possible that adolescent smoking would have declined even faster if e-cigarettes had never been introduced. But on the face of it, these trends do not look like evidence that vaping entices teenagers who otherwise never would have tried tobacco into a nicotine habit that ultimately leads to smoking. Making that scenario even more unlikely, most nonsmoking teenagers who vape use nicotine-free e-liquids, and very few of them vape often enough to get hooked on nicotine in any case. If anything, it looks like e-cigarettes have taken the place of the conventional kind for at least some teenagers who otherwise would be smoking. That is unambiguously an improvement from a public health perspective, since smoking is far more dangerous than vaping. Yet the CDC continues to talk as if there is little or no difference between smoking and vaping as far as health hazards go. "Current use of any tobacco product did not change significantly during 2011–2016 among high or middle school students," says the article on the latest NYTS data in the CDC's Morbidity and Mortality Weekly Report. That is true only if you classify e-cigarettes, which contain no tobacco, as tobacco products, which they aren't. The report's authors concede that "combustible tobacco product use declined" during this period but obscure the significance of that development. "Use of tobacco products in any form is unsafe," they say, ignoring the enormous difference between combustible cigarettes and alternatives such as e-cigarettes, which are something like 95 percent safer. By exaggerating the threat posed by adolescent experimentation with vaping (and experimentation is all it typically amounts to), the CDC hopes to justify policies that will make e-cigarettes less accessible and less appealing to adult smokers. "Sustained efforts to implement proven tobacco control policies and strategies are critical to preventing youth use of all tobacco products," say the authors of the NYTS report, citing the Food and Drug Administration's regulation of e-cigarettes as an example. But the FDA's rules threaten to cripple an industry that could help millions of smokers prolong their lives by switching to a far less hazardous source of nicotine. The CDC therefore is endangering public health when it rationalizes those regulations as sensible safeguards against adolescent vaping.[...]



Coroner Says Everyone Should Avoid Energy Drinks, Which Kill at Random

Mon, 22 May 2017 10:00:00 -0400

Last week a South Carolina coroner blamed a teenager's sudden death on caffeine-induced arrhythmia, prompting yet another burst of alarmist warnings about the dangers posed by energy drinks. As usual, the stories either glossed over or misrepresented the amount of caffeine these products contain compared to other, less controversial beverages. Davis Cripe, a student at Spring Hill High School in Chapin, collapsed during art class on the afternoon of April 26 and was rushed to Palmetto Health Baptist Parkridge Hospital, where he was pronounced dead about an hour later. Cripe's friends reported that he had drunk a McDonald's latte, a large Mountain Dew, and an unspecified energy drink over the course of two hours. Richland County Coroner Gary Watts attributed Cripe's death to a "caffeine-induced cardiac event causing a probable arrhythmia." Watts, who announced his findings at a news conference that also featured Cripe's grieving father, conceded that his conclusion was debatable. "I realize this is a controversial scenario," he said. "There are are obviously people that don't think this can happen—that you can have this arrhythmia caused by caffeine." One reason to doubt Watts' determination is that Cripe does not seem to have consumed a very large dose of caffeine. According to the website Caffeine Informer, a McDonald's latte contains 142 milligrams of caffeine, a large (20-ounce) bottle of Mountain Dew has 90, and the most popular energy drinks contain 10 milligrams per fluid ounce, or 160 milligrams in a 16-ounce can. That's a total of less than 400 milligrams, which is the daily limit recommended by the Food and Drug Administration (FDA) for adults. A lethal dose of caffeine is estimated to be somewhere between 5 and 10 grams—i.e., between 5,000 and 10,000 milligrams—for an adult. Cripe was 16 and weighed about 200 pounds. Watts acknowledged that Cripe did not consume very much caffeine. "This is not a caffeine overdose," he told Reuters. "We're not saying that it was the total amount of caffeine in the system. It was just the way that it was ingested over that short period of time, and the chugging of the energy drink at the end was what the issue was with the cardiac arrhythmia." Millions of teenagers chug energy drinks, of course, but very few of them die afterward. So assuming Watts is right, Cripe must have been especially sensitive to caffeine. Yet Watts said Cripe seemed perfectly healthy and there was no evidence of previously undetected cardiovascular disease. The coroner suggested that energy drinks kill at random. "This is what's dangerous about this," he said. "You can have five people line up and all of them do the exact same thing with him that day, drink more, and it may not have any type of effect on them at all. It's not something that just because you drink one drink or three drinks [it] is necessarily going to have this effect." The implication that energy drinks kill something like one out of six teenagers who consume them obviously has no basis in reality. Yet for some reason Watts wants people to think that energy drink consumers face Russian roulette odds. "Our purpose here today is to let people know, especially our young kids in school, that these drinks can be dangerous," he said. "Be very careful with how you use them, and how many you drink on a daily basis." But since Watts is saying even one can might be lethal, complete abstinence would seem to be the only prudent course. That does appear to be Watts' message. "These drinks can be very dangerous," he said. "I'm telling my friends and family, 'Don't drink them.'" Yet he also claimed that "the purpose here today is not to slam Mountain Dew, not to slam cafe lattes, or energy drinks." [...]



Harm Reduction an Alternative to Incoherent Opioid Addiction Policies

Wed, 19 Apr 2017 00:05:00 -0400

You can't pick up a newspaper, turn on the TV or radio, or access any online news source without encountering headlines screaming "opioid epidemic." There is the alarming rise in the number of chronic pain patients who have become addicted to opioids. And the explosion, in recent years, of opioid prescriptions by health care providers now under government pressure to curtail their prescribing. This pressure has driven many opioid addicts to the illicit drug market to avoid the pains of withdrawal. There, according to the Centers for Disease Control and Prevention (CDC), they often find opioid heroin cheaper and sometimes more readily available despite a 50-year "War on Drugs." Thus they become heroin addicts. Media hysteria begets calls to action. Politicians and the administrative state devise new laws to control this "evil plague." As a surgeon who regularly prescribes painkillers for patients suffering from postoperative pain or painful conditions, I see a painful cognitive dissonance. Begin with US policy towards heroin. Originally developed in the 1870s, diacetyl-morphine was marketed under the brand name Heroin, by the Bayer pharmaceutical company. Despite pleas by the Surgeon General and the American Medical Association to keep it legal, Heroin was banned in the US in 1924 because political leaders believed it the drug corrupted an individual's moral character. Meanwhile, dilaudid, 3 to 4 times more potent than morphine, is legal and is routinely administered for pain both as an oral and an injectable agent. Fentanyl, or Duragesic, is legal, too, although it is more than 50 times the potency of morphine. There is even greater cognitive dissonance with methadone, the powerful opioid approved for use in the US in 1947 and commonly used in this country to treat addiction to heroin and other opioids. Chronic users of opioids develop a tolerance, requiring ever-increasing doses to achieve the desired effect. A low, oral dose of methadone binds with enough of a person's opioid receptors to prevent withdrawal symptoms yet not produce the euphoric effects. The idea behind "methadone maintenance" programs is to transfer the addiction from heroin or another opioid. Because they do not experience the euphoria and "escape" of their chosen opioid, methadone addicts can resume a normal, productive—even conventional—life. Some can be tapered off from methadone and "detoxified." But many remain on methadone, sometimes for their entire lives. To put things in proper perspective, chronic alcohol use is much more dangerous. Chronic use can cause cirrhosis of the liver, cardiomyopathy (heart failure from damaged heart muscle), encephalopathy and dementia, chronic pancreatic inflammation, and has been linked to cancer of the stomach and the esophagus. In addition, one can overdose on alcohol as well—which may cause a person to stop breathing, become hypoxic, and die. And here's where the cognitive dissonance comes in: it is perfectly acceptable and permissible—even public policy—to allow people to be chronically addicted to the opioid methadone. The side-effects of prolonged use are considered serious yet tolerable. But it is unacceptable and counter to public policy for a person to be chronically addicted to any other opioid, even if that person self-doses to prevent withdrawal while avoiding the "high" in order to lead a peaceful and productive life. The concept of "harm reduction" as an approach to substance abuse has gained increased acceptance by health care practitioners as well public health and government authorities. Harm reduction approaches chemical dependency in a non-judgmental and realistic way, leaving drug prohibition in place. The s[...]