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



Published: Thu, 19 Jan 2017 00:00:00 -0500

Last Build Date: Thu, 19 Jan 2017 05:58:46 -0500

 



What We Don't Know About Marijuana's Risks and Benefits

Fri, 13 Jan 2017 10:00:00 -0500

The last time the National Academy of Sciences issued a report on marijuana, three states allowed medical use of the drug. Eighteen years later, there are 28 states that recognize marijuana as a medicine, and eight of them also allow recreational use. But as a new NAS report published yesterday shows, there are still big gaps in our knowledge of marijuana's risks and benefits. The 1999 report, commissioned by a drug czar who insisted there was no evidence that marijuana is medically useful, refuted that claim but highlighted the paucity of relevant research. "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation," it concluded. The new report, which takes into account studies conducted during the last two decades, is less tentative but still finds the evidence for most medical applications inconclusive. "We found conclusive or substantial evidence...for benefit from cannabis or cannabinoids for chronic pain, chemotherapy-induced nausea and vomiting, and patient-reported symptoms of spasticity associated with multiple sclerosis," the authors say. "For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects." The report notes that investigation of marijuana's medical utility has been constrained by legal and bureaucratic barriers, including continued federal prohibition and the Drug Enforcement Administration's refusal to license more than one producer of cannabis for research. "There are specific regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research," the authors say. "It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions." Last August the DEA once again refused to reclassify marijuana but agreed to start accepting applications from additional marijuana producers. As state-legal marijuana products proliferate across the country, federal prohibition prevents scientists from investigating their properties: Cannabis concentrate sales doubled in Colorado from 2015 to 2016, reaching $60.5 million in the first quarter of 2016, and yet current federal law prevents chemists from examining the composition of those products as it may relate to safety, neuroscientists from testing the effects of those products on the brain or physiology in animal models, and clinical scientists from conducting research on how these products may help or harm patients. And while between 498,170 and 721,599 units of medical and recreational cannabis edibles were sold per month in Colorado in 2015, federal law also prohibits scientists from testing those products for contaminants, understanding the effects of these products in animal models, or investigating the effects in patient populations. Regarding the potential dangers of these products, the report is mostly reassuring, finding little or no evidence that marijuana impairs the immune system or increases the risk of heart attacks, lung cancer, or chronic obstructive pulmonary disease (contrary to the claims of anti-pot activists). Regular pot smoking seems to worsen bronchitis symptoms, and marijuana consumption by pregnant women is associated with lower birth weight, although there is little evidence of a link to pregnancy complications or postnatal health problems. Marijuana use is associated with schizophrenia, suicide, poor academic performance, and abuse of other drugs, but the causal relationships remain murky. The report says "there is limited evidence of a statistical association between sustained abstinence from cannabis use and impairments in the cognitive domains of learning, memory, and attention"—i.e., effects that persist long after people have stopped using marijuana, which remains a subject of much controversy. The report notes that marijuana legalization has [...]



FDA Says Explaining the Main Advantages of E-Cigarettes Would Confuse Consumers

Wed, 11 Jan 2017 09:15:00 -0500

In a "clarification" published this week in the Federal Register, the Food and Drug Administration indicates that e-cigarettes cannot legally be sold as tools to quit smoking unless their manufacturers go through the prohibitively expensive process of getting them approved as new pharmaceutical products. The FDA also says e-cigarettes cannot legally be sold as a less hazardous alternative to the conventional kind unless their manufacturers go through the prohibitively expensive process of getting them approved as "modified risk tobacco products." The upshot is that e-cigarette companies are forbidden to be honest about the main benefits offered by their products, a form of censorship that is bound to retard the shift from smoking to vaping, thereby endangering lives that could have been saved by switching to a much less dangerous nicotine habit. The FDA's new rule is supposed to clarify when "a product made or derived from tobacco that is intended for human consumption will be subject to regulation as a drug, device, or a combination product." That can happen in two ways, one of which is "if the product is intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease." The FDA regulates nicotine products such as gum and patches as medical products, based on the dubious premise that nicotine addiction is a disease, the treatment for which is nicotine in a different form. The label on Nicorette gum, for instance, identifies it as a "stop smoking aid" that "reduces withdrawal symptoms, including nicotine craving, associated with quitting smoking." As far as the FDA is concerned, selling e-cigarettes as a competing form of nicotine replacement for smokers trying to quit (which is what they are) puts them in the same regulatory category as Nicorette: Claims related to smoking cessation have long been recognized as evidence of intended use conferring drug or device jurisdiction. Smoking cessation claims have also long been associated with intended uses of curing or treating nicotine addiction and its symptoms....Against this backdrop, smoking cessation claims on any product generally create a strong suggestion of intended therapeutic benefit to the user that generally will be difficult to overcome absent clear context indicating that the product is not intended for use to cure or treat nicotine addiction or its symptoms, or for another therapeutic purpose. The FDA does not explicitly rule out any reference or allusion to smoking cessation in the marketing of e-cigarettes. The agency even allows that "evidence may be developed showing that, in some situations, 'smoking cessation' is understood in context as referring to ending the use of traditional cigarettes and switching to a non-combustible product made or derived from tobacco." It's a mystery why new evidence would be required to prove that point, since that surely is the way that millions of people who have used e-cigarettes to quit smoking understand the concept. In any case, the FDA promises to "closely scrutinize 'smoking cessation' claims," creating a strong presumption that will encourage manufacturers to steer clear of the subject. The FDA says "the rule's treatment of smoking cessation claims as generally suggestive of a therapeutic purpose means that products marketed with such claims would generally be regulated as medical products." It adds that disclaimers of therapeutic intent generally will not be sufficient to keep e-cigarettes out of that category. Boston University public health professor Michael Siegel, an advocate of vaping as a harm-reducing alternative to smoking, questions the FDA's legal reasoning, arguing that smoking (unlike nicotine addiction), is a "health-related behavior," not a disease. Hence "a claim that e-cigarettes are intended to help someone quit smoking is not necessarily a claim that the product is intended to treat a disease." Rather, "The intention is to help alter a health-related behavior." The FDA pretends to address this argument but[...]



Trump Selects Anti-Vaccination Kook Robert Kennedy Jr. to Head Vaccination Safety Commission - Update: Not So Fast?

Tue, 10 Jan 2017 18:04:00 -0500

Sadly, the selection of Robert Kennedy Jr. by Donald Trump to head some kind of vaccination commission should not be a suprise. After all, Trump evidently met with prominent anti-vax leaders back in August; one whom described Trump as being "extremely educated on our issues." (In contrast, I have explained that Trump is an "idiotarian" with regard to vaccine safety science.) Kennedy is similarly "educated." During a promotional tour for the anti-vaccination "documentary" Trace Amounts in 2015, Robert Kennedy Jr. once declared, ""They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone," Kennedy said. "This is a holocaust, what this is doing to our country." We can all look forward to the scientific conclusions reached by fellow Kennedy commission panelists Jenny McCarthy and Jim Carrey. After his meeting with Trump today, Kennedy reportedly said, "President-elect Trump has some doubts about the current vaccine policies and he has questions about it. Kennedy added, "He says his opinion doesn't matter ... but the science does matter, and we ought to be reading the science and we ought to be debating the science." Yes, the science does matter, and perhaps once Kennedy is exposed to it, he might change his mind about the enormous benefits of vaccination versus the minor risks. Vaccination has been critical in preventing the all-too-natural holocaust of death by contagious diseases that has afflicted humanity throughout the ages. For example, infectious diseases were the leading cause of death in the United States up until 1920. A 2007 Journal of the American Medical Association review article reported that "a greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus." New vaccines developed and deployed after 1980 continued this trend toward lower disease and death rates from contagious diseases. The JAMA review noted, "Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively." The Tycho Project at the University of Pittsburgh estimates that vaccination has prevented as many 103 million cases of infectious diseases since 1924 in the United States. That's the kind of science that Kennedy and his commission will need to look at. Finally, the notion that vaccinations somehow cause autism has been thoroughly debunked many times. I will be following the Kennedy vaccine commission's deliberations with considerable interest. We do live in interesting times. *Apparently Kennedy has since apologized for likening vaccination to the murder of six million Jews by the Nazis. UPDATE: The New York Times is reporting that Kennedy may have read too much into his chat with Trump. A tweet from the Times' White House correspondet Maggie Haberman reports this statement from Trump: "The President-elect enjoyed his discussion with Robert Kennedy, Jr. on a range of issues and appreciates his thoughts and ideas. The President-elect is exploring the possibility of forming a committee on Autism, which affects so many families; however no decisions have been made at this time. The President-elect looks forward to continuing the discussion about all aspects of Autism with many groups and individuals." We do live in interesting times, don't we?[...]



Is Sugar an Addictive Poison?

Fri, 06 Jan 2017 13:30:00 -0500

The Case Against Sugar, by Gary Taubes, Knopf, 368 pp., 26.95. Less than 1 percent of Americans—1.6 million people—were diagnosed with Type 2 diabetes in 1958. As of 2014, that figure had risen to 9.3 percent, or 29.1 million. If current trends continue, the figure could rise to more than 33 percent by 2050. Something has clearly gone wrong with American health. The rising rate of diabetes is associated with the rising prevalence of obesity. Since the early 1960s, the percent of Americans who are obese—that is, whose body mass index is greater than 30—has increased from 13 percent to 35.7 percent today. (Nearly 70 percent of Americans are overweight, meaning their BMIs are over 25.) Roughly put, the prevailing theory is that rising fatness causes rising diabetes. But what if both are caused by something else? That is the intriguing and ultimately persuasive argument that Gary Taubes, author Why We Get Fat (2011) and cofounder of the Nutrition Science Initiative, makes in his new book, The Case Against Sugar. For Taubes, sugar—be it sucrose or high-fructose corn syrup—is "the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise," explains Taubes at the outset. "If this were a criminal case, The Case Against Sugar would be the argument for the prosecution." In making his case, Taubes explores the "claim that sugar is uniquely toxic—perhaps having prematurely killed more people than cigarettes or 'all wars combined,' as [diabetes epidemiologist] Kelly West put it." Taubes surveys the admittedly sparse research on sugar's psychoactive effects. For example, researchers have found that eating sugar stimulates the release of dopamine, a neurotransmitter that is also released when consuming nicotine, cocaine, heroin, or alcohol. Researchers are still debating the question of whether or not sugar is, in some sense, addictive. In the course of his exploration, Taubes devastatingly shows that most nutrition "science" is bunk. Various nutritionists have sought to blame our chronic ills on such elements of our diets as fats, cholesterol, meat, gluten and so forth. Few have focused their attention on sugar. His discussion of how nutritionists started and promoted the now-debunked notion that eating fats is a significant cause of heart disease is particularly enlightening and dismaying. Nowadays the debate over the role of fats in cardiovascular disease consists mostly of skirmishes over which fats might marginally increase risk. Interestingly, Taubes finds that a good bit of the research on fats was funded by the sugar industry. It is not just a coincidence that the low-fat food craze took off when the U.S. Department of Agriculture issued its first dietary guidelines in 1980 advising Americans to eat less fat. The added sugar that made the newly low-fat versions of prepared foods more palatable contributed to the rise in sweetener consumption. The USDA guidelines did advise Americans cut back on eating sugar, but they also stated that, "contrary to widespread opinion, too much sugar in your diet does not seem to cause diabetes." By the way, Taubes agrees since both sucrose and high-fructose corn syrup are essentially half glucose and half fructose there is no important metabolic differences between them. Taubes reviews the global history of sugar consumption. The average American today eats as much sugar in two weeks as our ancestors 200 years ago consumed in a year. The U.S. Department of Agriculture estimates that per-person annual consumption of caloric sweeteners peaked at 153.1 pounds in 1999 and fell to only 131.1 pounds in 2014. A 2014 analysis of data from 165 countries found that "gross per capita consumption of sugar correlates with diabetes prevalence." So how does eating lots of sugar cause disease? Reviewing the scientific literature, Taubes suggests that the high consumption of sugar eventually produces insulin resistance in the human body. That is, cells require higher an[...]



Adolescent Smoking Falls Again, Confounding E-Cigarette Alarmists

Wed, 14 Dec 2016 08:45:00 -0500

New survey results deal yet another blow to the hypothesis that vaping leads to smoking, showing that conventional cigarettes are less popular than ever among teenagers despite the recent surge in adolescent experimentation with e-cigarettes. In the Monitoring the Future Study, the percentages of eighth-, 10th-, and 12th-graders who reported smoking cigarettes during the previous month fell again this year, continuing a downward trend that began in the late 1990s. This survey began asking about e-cigarette use in 2014, and the share of teenagers who report vaping in the previous month has been falling since then. Among eighth-graders, past-month use fell from 8.7 percent in 2014 to 8 percent last year and 6.2 percent this year. Among 10th-graders, the rate was 16.2 percent in 2014, 14.2 percent this year, and 11 percent this year. Among 12th-graders, it fell from 17.1 percent in 2014 to 16.3 percent last year and 12.5 percent this year. According to the National Youth Tobacco Survey, past-month vaping among high school students rose dramatically between 2011 and 2015—"an astounding 900 percent," as Surgeon General Vivek Murthy recently put it. The latter survey also shows a continuing decline in adolescent smoking, which last year hit a record low. Somehow that trend has not put a damper on warnings from alarmists like Murthy that e-cigarettes might be a gateway to the real thing. Even Richard Miech, a Monitoring the Future researcher who recently pointed out that most adolescent vapers do not vape nicotine, seems unable to shake this unsupported fear. "Vaping may lead to friendship networks that encourage vapers to smoke," he says in a press release. "Also, vapers may come to believe the dangers of smoking are exaggerated if they do not experience any immediate health consequences from vaping." Maybe, but so far there is very little evidence that anything like that is happening. "Whether adolescent vaping has peaked or only paused is something we will be able to determine in the coming years," Miech says. "In the past, we have seen new drugs follow a pattern in which use increases at a fast pace during a honeymoon period and then reverses course and declines as knowledge of the substance's drawbacks became known." If vaping by teenagers is waning, maybe the panic about it, which for too long has overshadowed the tremendous harm-reducing potential of e-cigarettes for people who otherwise would be smoking, will finally abate. "At this point," writes Boston University public health professor Michael Siegel, "it is clear that whatever the risks of youth vaping may be, one of them is not the risk of progressing to smoking. If this hypothesis were true, we would simply not be seeing the historic declines in youth smoking that are occurring. Quite clearly, smoking continues to be de-normalized, not re-normalized as anti-tobacco groups and many health agencies have claimed. It appears that a culture of vaping is largely replacing a culture of smoking. If anything, it appears that the advent of e-cigarettes has accelerated the de-normalization of smoking by largely replacing it....Vaping appears not to be making smoking more cool, as claimed by the Surgeon General, the CDC, and anti-tobacco groups, but to be making smoking less cool. It also appears that there has been a plateau and now a decline in the rising fad of youth vaping, which should help ease the concerns of anti-tobacco groups that an entire generation of kids is going to be addicted to nicotine." Note: This post, which originally said Monitoring the Future first asked about e-cigarette use in 2015, has been corrected and updated with survey numbers from 2014, which were omitted from this year's MTF report.[...]



Brickbat: You Dirty Rat

Fri, 09 Dec 2016 04:00:00 -0500

(image) The federal Environmental Protection Agency has sent letters to several states and cities ordering them to stop using dry ice to kill urban rats. The dry ice is stuffed into rat burrows, and as it outgasses it suffocates the rats. The EPA says it has not approved dry ice as a pest control measure.




Surgeon General Launches E-Cigarette Scare Campaign That Will Harm Public Health

Thu, 08 Dec 2016 11:15:00 -0500

A new report from Surgeon General Vivek Murthy repackages familiar alarmism about e-cigarettes, which it depicts as a grave threat to the youth of America using the same deceptive techniques favored by U.S. Centers for Disease Control and Prevention (CDC). "To protect our nation's young people from being harmed by these products," Murthy recommends policies, such as higher taxes, vaping bans, limits on advertising, and possibly flavor restrictions, that will undermine public health by making e-cigarettes less appealing to people who currently get their nicotine from conventional cigarettes, a much more dangerous source. Murthy declares that e-cigarette use by teenagers "is now a major public health concern," noting that it rose "an astounding 900 percent" from 2011 to 2015. "These products are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco and hookahs," says Murthy, who worries that e-cigarettes "could be an avenue by which kids are addicted to nicotine" and eventually start smoking. The numbers cited by Murthy come from the CDC's National Youth Tobacco Survey, which found that the share of high school students who reported using e-cigarettes in the previous month rose from 1.5 percent in 2011 to 16 percent in 2015—an increase of 967 percent. But according to data from the Monitoring the Future Study, another government-sponsored survey of teenagers, nonsmoking adolescents almost never vape often enough to get hooked on nicotine. In the 2014 survey, just 0.7 percent of never-smoking 12th-graders reported vaping on 20 or more days in the previous month. Furthermore, adolescent vapers typically use nicotine-free e-fluid, so the share of nonsmoking teenagers who are even theoretically at risk of nicotine addiction via vaping is even smaller—something like 0.3 percent. In addition to highlighting big numbers with little public health significance, Murthy copies the CDC's habit of calling e-cigarettes "tobacco products," which they aren't. That description falsely implies that the risks posed by vaping are similar to the risks posed by smoking, when they are in fact dramatically lower. Although Murthy concedes the difference in risk, his office deliberately obscures it. "Aren't e-cigarettes safer than conventional cigarettes?" asks a "tip sheet for parents" posted today. The recommended answer is absurdly evasive: "Because your brain is still developing, scientific studies show that it isn't safe for you to use any tobacco product that contains nicotine, including e-cigarettes. Whether you get nicotine from an e-cigarette or a cigarette, it's still risky. Some e-cigarette batteries have even exploded and hurt people." Uh, thanks, Mom, but how about answering the question? This is propaganda masquerading as science, which has already warped public perceptions of the hazards posed by e-cigarettes. In a recent survey of American adults by Vanderbilt Law School professor W. Kip Viscusi, 48 percent of respondents incorrectly said e-cigarettes are either just as hazardous as the conventional kind or even more hazardous. Thirty-eight percent said e-cigarettes are less hazardous, but only 14 percent correctly said they are much less hazardous. Since Americans already tend to think e-cigarettes are much more dangerous than they actually are, Murthy's recommendation that public health agencies and medical professionals get out the word about the hazards of vaping is rather alarming, especially if his office's educational efforts are meant to be a model. Such efforts to scare people away from e-cigarettes are positively pernicious and potentially lethal to the extent that they deter smokers from making a switch that could save their lives. Treating e-cigarettes as tobacco products is especially misleading in a discussion of adolescent vapers, most of whom [...]



Brickbat: Getting Drilled

Tue, 06 Dec 2016 04:00:00 -0500

(image) The good news is that the Tomah, Wisconsin, Veterans Affairs Medical Center is offering free screenings for hepatitis and HIV to 592 veterans. The bad news is that they are doing this because a VA dentist did not properly clean equipment between patients.




FDA Salt Guidance Could Kill More People Than It Saves

Fri, 02 Dec 2016 11:10:00 -0500

The Food and Drug Administration issued proposed guidance in June to the food industry aiming to reduce the amount of sodium in many prepared foods. In its draft guidance, the agency stated: Average sodium intake in the U.S. is approximately 3,400 mg/day. The draft short-term (two-year) and long-term (10-year) voluntary targets for industry are intended to help the American public gradually reduce sodium intake to 2,300 milligrams (mg) per day, a level recommended by leading experts and the overwhelming body of scientific evidence. The targets are also intended to complement many existing efforts by food manufacturers, restaurants, and food service operations to reduce sodium in foods. The FDA further asserted: CDC has compiled a number of key studies, which continue to support the benefits of sodium reduction in lowering blood pressure. In some of these studies, researchers have estimated lowering U.S. sodium intake by about 40 percent over the next decade could save 500,000 lives and nearly $100 billion in healthcare costs. So, the science of salt is settled, right? Actually, no. The FDA asked for public comments on its draft guidelines and it evidently received sufficient pushback that it extended the deadline for comments until December 2, 2016. As I reported earlier more and more studies are calling into question that idea that reducing salt consumption at the population level will actually result in net health benefits. For example, the New England Journal of Medicine published a study in August 2014 finding that people who consume less 1,500 milligrams of sodium (about 3/4ths of a teaspoon of salt) are more likely to die than people who eat between 3,000 to 6,000 milligrams of sodium per day (1.5 and 3 teaspoons of salt). The free-market think tank, the Competitive Enterprise Institute has submitted comments that show that the FDA's confident claim that reducing salt consumption by Americans will save lives is at best, a hope, and at worst, tragically wrong. The CEI comments to the FDA nicely summarizes the relevant scientific studies. Here is the nub of the issue: Reduced sodium consumption affects different individuals in different ways. Only an estimated 17 to 25 percent of the population is "salt sensitive"—they experience higher blood pressure with increased dietary sodium—while 75 percent are considered salt resistant and will experience no change in blood pressure with altered dietary sodium. However, an estimated 11 to 16 percent of the population are inverse salt sensitive, which means reduced dietary sodium can increase their blood pressure. With this heterogeneity in response to salt, trying to force a population-wide reduction in sodium availability in order to reduce incidences of hypertension would be ineffective at best and counterproductive at worst. Among other evidence, CEI cites a 2014 metanalysis in the American Journal of Hypertension of more than two dozen sodium studies which concluded that risk of death appeared to be lowest among individuals consuming between 2,565mg and 4,796 mg of sodium a day with higher rates of death in the upper and lower range. The FDA itself notes that average daily consumption - 3,400 mg - is right in the middle of that range. CEI correctly argues: For a minority of the population, reducing dietary sodium can be an effective means of lowering cardiovascular and hypertension risk. But identifying for whom sodium restriction may be beneficial and by how much is something that individuals and their doctors must determine. For the general population, sodium reduction is, by no means, a silver bullet to reducing hypertension and has the potential to increase risks for a large portion of the population. Treat people as individuals not just as members of an undifferentiated public health herd. Let's hope that the FDA will heed this advice and w[...]



Surgeon General's Report Mistakenly Treats All Drug Use As a Problem

Fri, 18 Nov 2016 08:35:00 -0500

You might think Surgeon General Vivek Murthy, who acknowledges marijuana's medical utility, has relatively enlightened views on drug policy. But a report he released yesterday reveals that Murthy is utterly conventional in his attitude toward drinking and other kinds of recreational drug use, which he views as a problem to be minimized by the government. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health claims "addiction is a chronic brain disease" caused by exposure to psychoactive substances, even while acknowledging that the vast majority of people who consume those substances do not become addicted to them. The report describes even low-risk, harmless, and beneficial drug use as "misuse," giving the government broad license to meddle with personal choices through policies aimed at making drugs more expensive and less accessible. Murthy argues that driving down total consumption, rather than focusing on problematic use, is the most effective way to reduce the harm caused by alcohol and other drugs. As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention. Murthy's report eschews the term substance abuse, explaining that the phrase "is increasingly avoided by professionals because it can be shaming." Instead the report talks about "substance misuse," which "is now the preferred term." But substance misuse is just as judgmental, vague, and arbitrary as substance abuse. In fact, Murthy cannot quite decide what it means. On page 5 of the introduction, he says misuse occurs when people use drugs "in a manner that causes harm to the user or those around them." But elsewhere (including the very next page), the report uses a much broader definition. "Although misuse is not a diagnostic term," Murthy says, "it generally suggests use in a manner that could cause harm to the user or those around them." Could cause harm? That definition is wide enough to cover all drug use. Murthy does seem to think drug use is problematic even when it causes no problems. As an example of drug misuse, Murthy repeatedly cites a 2015 survey in which 25 percent of the respondents, representing 66.7 million Americans, reported that they had engaged in "binge drinking" during the previous month. "By definition," Murthy says, "those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol poisonings." But the government's definition of a binge—five or more drinks "on an occasion" for a man, four or more for a woman—encompasses patterns of consumption that do not harm anything except the sensibilities of public health officials. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol. Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences. As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states). Unauthorized use of prescription drugs also counts as misuse, whether or not harm results. "In 2015," Murthy says, "12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose." That makes the risk sound much bigger than it is. According to the CDC, there were 18,893 deaths involving opioid analgesics in 2014, the most recent year for which data are available. That year, according to the National Survey on Drug U[...]



Five More U.S. Jurisdictions Imposed Soda Taxes Last Week

Tue, 15 Nov 2016 11:35:00 -0500

Last week five more jurisdictions joined Berkeley and Philadelphia in imposing special taxes on soda and other soft drinks. Four of the taxes were approved on Election Day by voters in Boulder, Colorado, and three California cities: San Francisco, Oakland, and Albany. The fifth was approved last Thursday by the Cook County, Illinois, Board of Commissioners. Boulder's Ballot Issue 2H, which Eric Boehm noted last week, passed with 54 percent of the vote. It imposes an excise tax of two cents per fluid ounce on drinks that have five or more grams of added sugar in a 12-ounce serving. It does not apply to alcoholic beverages or milk products. San Francisco's Measure V, which passed with 62 percent of the vote, imposes a one-cent-per-ounce excise tax on sugar-sweetened beverages that contain more than 25 calories per 12-ounce serving. Milk products, baby formula, and meal-replacement beverages are exempt. Oakland's Measure HH, which also was favored by 62 percent of voters, imposes the same tax with the same exemptions. Albany's Measure O1, which is essentially the same as the other two California initiatives, passed with 71 percent of the vote. Cook County, which includes Chicago, has 5.2 million residents, making it the most populous U.S. jurisdiction to approve a soda tax so far. Unlike the four 2016 ballot initiatives but like Philadelphia's tax, the one-cent-per-ounce levy approved by Cook County last week applies to artificially sweetened beverages as well as soft drinks with added sugar. That approach broadens the base, raises more money, and makes the tax a bit less regressive (since consumption of sugar-sweetened drinks is especially common in low-income households, while wealthier consumers are more likely to favor diet versions). But it means drinks with zero calories (such as Diet Coke) get hit with a special tax that does not apply to drinks (such as fruit juice) that are just as fattening as regular soda. Taxing beverages without regard to calorie content makes a hash of the already dubious argument that soda taxes will reduce obesity by driving down total calorie intake. If passed through to consumers, the one-cent taxes will add 68 cents to the cost of a two-liter bottle and $1.44 cents to the cost of a 12-pack. Boulder's two-cent tax adds $1.36 and $2.88, respectively. "We understand the health threats posed by unhealthy sugary drinks, especially on low-income families," said Angelique Espinoza, manager of the Boulder soda tax campaign, after the initiative passed. "Today Boulder took an important, proactive step toward ensuring that all of us—our children in particular—have every opportunity to make better choices and to lead healthy lives." The Boulder Weekly had a different perspective: "We oppose 2H with exactly the same line of logic as we use to oppose Amendment 72 [a proposed tobacco tax increase that failed last week]. This is a sin tax that provides money for beneficial programs on the backs of a small segment of the population. We reiterate that sin taxes are regressive, and research shows they do little to curb consumption or improve public health. We hate it when people call Boulder a 'nanny state.' We hate it more when they are right."[...]



Vaping Is a Gateway to Quitting

Wed, 09 Nov 2016 00:01:00 -0500

Survey data indicate that millions of Americans have used electronic cigarettes to quit smoking, thereby dramatically reducing the health risks they face. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, is unimpressed. "The plural of anecdote is not data," Frieden recently told The New York Times. But when it comes to the dangers that vaping poses, he abandons his scientific stance, claiming without evidence that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." No doubt Frieden and other e-cigarette alarmists will latch onto a new study that supposedly shows "Flavored E-Cigarettes May Entice Teens to Smoke," as one of the predictable headlines put it. But that is not what the study, reported this week in the journal Pediatrics, actually shows. Looking at data from the 2014 National Youth Tobacco Survey, biostatistician Hongying Dai and economist Jianqiang Hao found that nonsmokers who had used an e-cigarette in the previous month were less likely than other nonsmokers to rule out trying tobacco cigarettes in the future. That is not terribly surprising, since just 3 percent of teenagers who had never smoked reported past-month e-cigarette use, a small minority that is apt to differ from the remaining 97 percent in traits, such as rebelliousness, risk aversion, and sensation seeking, that might affect the propensity to experiment with smoking. Correlation is not causation. The fact that teenagers who vape are less inclined to say they will never smoke does not mean the experience of vaping made them that way. As Dai and Hao note, "we were unable to establish causal inferences" because "the data are cross-sectional." The idea that vaping promotes smoking seems implausible in light of the fact that smoking has fallen to record lows among teenagers even as experimentation with vaping has risen dramatically. Furthermore, teenagers who vape typically use nicotine-free e-liquids, and nonsmokers rarely vape often enough to develop a nicotine habit. According to the Monitoring the Future Study, nearly two-thirds of teenagers who have tried vaping consumed "just flavoring" the last time they did it. In the same survey, less than 1 percent of never-smokers had vaped on 20 or more days in the previous month. Dai and Hao seem to view flavored e-liquids, whether or not they contain nicotine, as a menace to the youth of America. "Flavored e-cigarette use is associated with increased risks of smoking among youth," they conclude. "Comprehensive tobacco control and prevention strategies that address flavored e-cigarette products are critically needed to reduce tobacco use among youth." It is pretty clear what "address[ing] flavored e-cigarette products" means to Dai and Ho, who repeatedly note that the Food and Drug Administration does not plan to ban flavors as part of its otherwise onerous e-cigarette regulations. They worry that "widespread availability of flavored e-cigarettes will increase the use of e-cigarette products by youth" and that "the normalization of e-cigarette use among youth could also lead to e-cigarettes becoming a gateway for future smoking, marking a setback in the decades-long antismoking battle." While there is little reason to think anything like that is happening, banning flavored e-liquids would make vaping less attractive to smokers, thereby discouraging them from making a switch that could save their lives. Contrary to the claims of politicians and activists who insist that candy and fruit flavors could not possibly appeal to anyone older than 17, adults who switch to vaping overwhelmingly prefer supposedly kid-friendly e-liquids. In a 2014 survey by E-Cigarette Forum, three-quarters of adult vapers who had quit smoking or cut back s[...]



Porn-Regulating Prop 60 Faces Final Showdown Tonight in California

Tue, 08 Nov 2016 17:30:00 -0500

Today Californians vote on Proposition 60, a ballot measure sponsored by the AIDS Healthcare Foundation (AHF) that would require condom usage in adult films; empower a full-time state porn czar to monitor said films for violations (and impose steep fines); establish a licensing scheme for porn-production companies; and allow California residents to bring civil suits against porn producers or anyone with financial interests in a sex scene sans prophylactics (which could, in turn, expose porn performers real names and addresses to the public). AHF President Michael Weinstein, the main driver behind Prop 60—and the man who would be the state's first porn czar—has also repeatedly petitioned the California Division of Occupational Safety and Health (Cal/OSHA) to make condoms in porn a requirement of state workplace-safety regulations; Cal/OSHA voted against such a rule again last February. And he's the genesis of a 2012 Los Angeles County law requiring condoms in porn filmed in Los Angeles County. "He wants to be the sheriff of porn town," said Karen Fuller Tynan, a California lawyer who specializes in adult-industry case, at an AVN panel in Las Vegas in January. "He really wants to get rid of us, and wants to rule us." Weinstein, however, maintains that he's interested in stopping the spread of HIV. The porn industry, including the performers Prop 60 is ostensibly meant to protect, has been vocally opposed to the measure, as have HIV/AIDS organizations and the state Democratic, Republican, and Libertarian parties. A partial list of opponents includes adult-industry trade association the Free Speech Coalition, the San Francisco AIDS Foundation, the Los Angeles LGBT Center, the St. James Infirmary, Equality California, all seven of California's largest newspapers (the Los Angeles Times, the San Francisco Chronicle, the San Jose Mercury News, the Orange County Register, the East Bay Times, the Sacramento Bee, and the San Diego Union Tribune) and dozens of other papers. My cali peeps are tellin me #Prop60 & #Prop61 are wolves in sheep clothing (coming in one name but meaning another) and y'all should vote NO https://t.co/estYmabRDt — Questlove Gomez (@questlove) November 8, 2016 According to Prop 60 opponents, the measure presents too much of a risk to performer privacy, giving California residents "the ability to out porn performers and get paid for it," as Violet Blue put it at Engadget. ("You're incentivizing the viewer to sue us," adult actor Tommy Gunn told the Hollywood Reporter.) They also worry the law could end up ensnaring individuals who do private webcam shows from their own homes (a rising part of the porn industry) or make amateur adult-films involving real-life a lover, spouse, or friend; California couples with an exhibitionist streak could find themselves facing tens of thousands in fines. But most importantly, it's completely unnecessary—the adult-film industry is self-policing, performers are tested every 14 days, and there hasn't been a single case of on-set HIV transmission in porn since 2004, they say. Vice News Tonight reporter (and Reason alum) Michael Moynihan talked to Yes On 60 campaign manager Rick Taylor on the show's season debut Monday and asked him about his group's claims that the porn industry lies about HIV transmissions. Taylor defended the claim by saying that "none of us know, truthfully, and they don't know and I'm not gonna tell you I know. What I do know is that STDs on a daily basis gets transmitted." Here's a bit more of the exchange: Moynihan: STDs? But if this is the concern, why do the ads you guys run have three people that stated they have contracted HIV on an adult set? They're saying that in the ad. They're saying 'we contracted this on a set,' but[...]



The New York Times Highlights U.S. Officials' Irrational Hostility Toward E-Cigarettes

Wed, 02 Nov 2016 10:30:00 -0400

New York Times science reporter Sabrina Tavernise highlights the tendency of American public health officials to view e-cigarettes as a threat rather than an opportunity, even though vaping offers a much less dangerous alternative to smoking. "A growing number of scientists and policy makers say the relentless portrayal of e-cigarettes as a public health menace, however well intentioned, is a profound disservice to the 40 million American smokers who could benefit from the devices," she writes. Tavernise cites survey data indicating that the percentage of Americans who wrongly view e-cigarettes as no less hazardous than the conventional kind tripled between 2011 and 2015, from about 13 percent to nearly 40 percent. That misperception, encouraged by misleading and sometimes downright false statements from government officials and anti-smoking activists, surely discourages smokers from making a switch that could save their lives. "The unintended consequence is more lives are going to be lost," one critic tells Tavernise, who contrasts the U.S. approach with the attitude of British public health officials, who see e-cigarettes as way to dramatically reduce smoking-related disease and death. David Sweanor, a tobacco control specialist at the University of Ottawa, compares the enormous difference between the health hazards of smoking and the health hazards of vaping to "the relative risks of jumping out a fourth-story window versus taking the stairs." Although the advantage of the the latter option is obvious, he tells Tavernise, American officials "are saying: 'Look, these stairs, people could slip, they could get mugged. We just don't know yet.'" Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, tells Tavernise he is aware of smokers who say they quit with the help of e-cigarettes, "but the plural of anecdote is not data." Mitch Zeller, who as director of the FDA Center for Tobacco Products is overseeing regulations that are expected to cripple the vaping industry, is similarly dismissive. In a recorded interview that was played at last month's meeting of the Smoke-Free Alternatives Trade Association, Brad Rodu reports, Zeller said he is "absolutely aware of the anecdotal reports about individuals using e-cigarettes to help them quit, but we can't make population-level policy on the basis of anecdotal reports," because "FDA is required to use a population health standard." Rodu, a professor of medicine at the University of Louisville and a longtime tobacco harm reduction advocate, notes that we do have "population-level" data from surveys of current and former smokers. In the 2015 National Health Interview Survey, for instance, "2.5 million former smokers were current users of vapor products," which suggests e-cigarettes are a pretty popular and effective way to quit smoking. "These 2.5 million former smokers are more than anecdotes," Rodu writes. "They constitute population-level evidence." Likewise the survey data indicating that more than 6 million Europeans have quit smoking with the help of e-cigarettes, while more than 9 million have cut back. Tavernise notes that "surveys by Action on Smoking and Health, a British antismoking group, have found that half of Britain's 2.8 million e-cigarette users no longer smoke real cigarettes." She adds that another British study, published by the journal Addiction in 2014, found that "among people who are trying to quit smoking, e-cigarette users are 60 percent more likely to succeed than those who use over-the-counter nicotine therapies like gum and patches." Such observational evidence does not conclusively prove that e-cigarettes help smokers quit. Maybe the vapers who used to smoke would have quit a[...]



Tennessee Department of Health Admits It Was Wrong About Reported Huge Rise in Accidental Gun Deaths

Tue, 27 Sep 2016 21:20:00 -0400

Accidental gun deaths in Tennessee, it was reported in various places a couple of weeks back, had zoomed horrifically from 19 in 2013 to 105 in 2014.

A representative report from TV station WTOC:

Tennessee leads the country in accidental shooting deaths.

The Volunteer State ranked ninth in 2013 for deadly accidental shootings. Officials say 19 people died that year.

In 2014, the number jumped to 105.

"This idea of shooting first and asking questions later unfortunately sometimes has fatal consequences," said Beth Joslin Roth with Safe Tennessee Project, a grassroots organization dedicated to addressing the epidemic of gun-related injuries and gun violence in Tennessee.

The numbers have fluctuated some over the years, but Joslin Roth said the jump between 2013 and 2014 is unprecedented.

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Unprecedented indeed, and totally not true as it turns out.

Tennessee now admits they made a mistake in counting, and a very big one. 2014's accidental gun death numbers were in fact the lowest, by far, the state has seen this century, at 5. The next lowest was 2008's 17.

From the Tennessee Department of Health, posted last Thursday:

After manually reviewing death certificates, TDH reports five people died from accidental gunshot wounds in the state in 2014. In an additional eight cases, the manner of death was left blank or marked as pending on the death certificate but no follow-up death certificate was sent to the department; however, a review of the autopsies for those cases indicated none of those eight were accidental deaths. Incorrect data provided earlier indicated the number of accidental gunshot deaths had dramatically escalated from 19 in 2013 to 105 in 2014.

"We regret any confusion that may have arisen when data errors affected the number of deaths attributed to the accidental discharge of firearms in our state," said TDH Deputy Commissioner for Population Health Michael Warren, MD, MPH.

Three of the four stories I linked to above with the original frightening report, including the one quoted from, have not yet been corrected as of time of this posting.

As I've written before when it comes to crummy gun data or analysis, generally once a lot of people have read the original headline making a frightening claim regarding guns, the "public policy" work important to those who want to gin up anxiety about guns or optimism about gun laws has already been done, no matter later revelations, adjustments, critiques, or re-evaluations.

Hat tip: Matt Schonert