Published: Sat, 24 Sep 2016 00:00:00 -0400
Last Build Date: Sat, 24 Sep 2016 18:48:05 -0400
Mon, 19 Sep 2016 00:01:00 -0400Three years ago, Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC),warned that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." That fear is one of the main justifications for the CDC's hostility toward vaping and the Food and Drug Administration's onerous new e-cigarette regulations, which are expected to cripple the industry. Yet there is no evidence that Frieden's claim is true and considerable evidence that it's not, especially since smoking rates among teenagers have fallen to record lows even as more and more of them experiment with vaping. Two new studies cast further doubt on the idea that e-cigarettes are a "gateway" to the real thing. Frieden and other e-cigarette alarmists make much of the fact that the percentage of teenagers who report vaping has risen dramatically in recent years. They like to focus on the percentage of teenagers who have ever tried e-cigarettes and the percentage who have used them in the last month, without asking how many are experimenters or occasional users and how many are daily vapers—the sort who might get hooked on nicotine and eventually progress to conventional cigarettes. It turns out there's a good reason for the CDC's lack of curiosity on this point: Survey data show that few teenagers who have never smoked use e-cigarettes and that even fewer do so on a regular basis. "Many fear that e-cigarette use by non-smoking students will lead many to nicotine addiction and subsequent cigarette smoking," notes University of Michigan health economist Kenneth Warner in anAmerican Journal of Preventive Medicine article published last month. But based on data from the Monitoring the Future Study (MTF), which surveys students in the eighth, 10th, and 12th grades, Warner finds that "non-smoking high school students are highly unlikely to use e-cigarettes" and even less likely to use them regularly. Among the 12th-graders who had never tried conventional cigarettes, 94 percent had not used an e-cigarette in the previous month. Among the never-smokers who reported using e-cigarettes in the previous month, 60 percent used them on only one or two days. Less than 1 percent of never-smokers had vaped on 20 or more days in the previous month. The MTF numbers, which are similar to the findings of British surveys, suggest it is quite unlikely that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes," because nonsmokers rarely use e-cigarettes often enough to develop a nicotine habit. Another point Warner emphasizes makes Frieden's claim even less plausible: "A large proportion of students use e-cigarettes containing no nicotine." Warner cites a 2014 study that found most never-smoking Connecticut teenagers who vaped used nicotine-free e-liquid. The significance of that point is underlined by another recently published analysis of MTF data. Richard Miech and three of his colleagues at the University of Michigan's Institute for Social Research (which conducts the survey) report in the journal Tobacco Control that nearly two-thirds of teenagers who have tried vaping consumed "just flavoring" the last time they did it. "Nicotine use came in a distant second," Miech et al. write, "at about 20 percent in 12th and 10th grade and 13 percent in 8th grade." The other options were marijuana and "don't know." Consider the CDC's practice of counting vaping as "tobacco use," which leads it to claim there has been "no decline in overall youth tobacco use since 2011," even though that is clearly not true. It was already absurd to pretend teenagers were using tobacco when they weren't, especially since the CDC used that inaccurate terminology to imply that the rising popularity of vaping somehow cancels out the health gains from the continuing decline in smoking, a far more dangerous habit. Now that it's clear the typical adolescent vaper is not even using nicotine, the CDC cannot assume any chemical connection between e-cigarettes and tobacco. In fact, as Miech et al. note, even calling[...]
Fri, 16 Sep 2016 06:30:00 -0400
(image) For several years now, the CDC has been freaking out about adolescent e-cigarette use, which it warns will boost smoking by getting teenagers hooked on nicotine in a more palatable form. But as I explain in my latest Forbes column, that does not seem to be happening, and new research suggests it probably never will:
Three years ago, Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC),warned that "many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes." That fear is one of the main justifications for the CDC's hostility toward vaping and the Food and Drug Administration's onerous new e-cigarette regulations, which are expected to cripple the industry. Yet there is no evidence that Frieden's claim is true and considerable evidence that it's not, especially since smoking rates among teenagers have fallen to record lows even as more and more of them experiment with vaping. Two new studies cast further doubt on the idea that e-cigarettes are a "gateway" to the real thing.
Fri, 02 Sep 2016 10:20:00 -0400The Food and Drug Administration (FDA), having decided to regulate tobacco-free e-cigarettes as tobacco products because they deliver tobacco-derived nicotine, now has the challenge of explaining how even nicotine-free e-liquids can qualify for the same label. E-cigarette alarmists at the U.S. Centers for Disease Control and Prevention (CDC) have a similar problem. They insist on counting vaping as "tobacco use," which leads them to claim there has been "no decline in overall youth tobacco use since 2011," even though that is clearly not true. Now a new study in the journal Tobacco Control reveals the CDC's position to be even more ridiculous than it already seemed, showing that a large majority of teenagers who vape are not only not consuming tobacco; they are not consuming nicotine either. Based on data from the 2015 Monitoring the Future Study, which surveys students in the eighth, 10th, and 12th grades, Richard Miech and three of his colleagues at the University of Michigan's Institute for Social Research (which conducts the survey) report that nearly two-thirds of teenagers who have tried vaping consumed "just flavoring" the last time they did it. "Nicotine use came in a distant second," Miech et al. write, "at about 20% in 12th and 10th grade and 13% in 8th grade." The other options were marijuana and "don't know." The survey data indicate that the more frequently teenagers vape, the more likely they are to vape nicotine. Among high school seniors, 47 percent of those who had vaped six or more times in the previous month reported consuming nicotine, compared to 23 percent of those who had vaped one to five times in the previous month. But "in no case did the prevalence of nicotine vaping reach 50% or greater." The fact that most adolescent vapers do not vape nicotine was mentioned in a summary of the 2015 survey results published last year, as Pennsylvania anti-smoking activist (and harm reduction advocate) Bill Godshall pointed out at the time. I noted that finding in a blog post last April and a column last June. But the Tobacco Control article presents more-detailed data on this question and highlights the CDC's mendacity. It was already absurd to claim teenagers were using tobacco when they weren't, especially since the CDC used that inaccurate terminology to imply that the rising popularity of vaping somehow cancels out the health gains from the continuing decline in smoking, a far more dangerous habit. Now that it's clear the typical adolescent vaper is not even using nicotine, the CDC cannot assume any chemical connection between e-cigarettes and tobacco. Furthermore, its warnings that teenagers might start smoking after they get hooked on nicotine by vaping look even more overblown than they did before. As Meich et al. note, even the practice of referring to vaporizers as "electronic nicotine delivery systems" (as both the CDC and the FDA do) is quite misleading, at least in the context of adolescent use. "The majority of US youth who use vaporisers and e-cigarettes do not vape nicotine," the authors write. "This finding challenges many common assumptions and practices." The numbers "suggest that the recent rise in adolescent vaporiser use does not necessarily indicate a nicotine epidemic," and they show how misleading the CDC's equation of vaping with tobacco use is. Meich et al. note that counting every vaper as a tobacco user doubles the supposed prevalence of tobacco use among 12th-graders and nearly triples it among 10th- and eighth-graders. If vapers are counted as tobacco users only when they vape nicotine (still a dubious maneuver), the effect is much less dramatic. "If vaporiser users are considered nicotine users only if they last vaped nicotine in the last 30 days," the researchers say, "then national estimates of nicotine prevalence increase by a much smaller percentage of 23–38% across the three grades," compared to the increases of 100 percent to 200 percent seen with the CDC's method. In referring to "national estimates of nicotine prev[...]
Mon, 22 Aug 2016 08:53:00 -0400A new experimental study—the first of its kind, according to the authors—confirms that smokers can dramatically reduce their exposure to toxins and carcinogens by switching to e-cigarettes. "They are safer," the lead author, Maciej Goniewicz, a toxicologist at the Roswell Park Cancer Institute, told Buffalo Business First. "It's the first time we have very strong evidence that we will be able now to give [smokers] that the answer is, yes, this you should consider a transition, a substitute for your tobacco cigarette that will save your life." The study, reported last week in the journal Nicotine & Tobacco Research, involved 20 Polish smokers who were encouraged to replace their cigarettes with the M201, a pen-style vaping system popular in Poland. Each week during the two-week experiment, the researchers supplied the subjects with 20 tobacco-flavored cartridges, each containing 11 milligrams of nicotine in a solution of propylene glycol and vegetable glycerin. Goniewicz and his colleagues used questionnaires and urine tests to assess the subjects at the beginning of the study, after a week, and after two weeks. Nine of the subjects stopped smoking completely, while the rest cut back, from an average of 16 cigarettes a day at the beginning of the study to an average of just one a day at the end. Based on tests for seven nicotine metabolites, the researchers found that nicotine intake stayed the same, while exposure to tobacco-related toxins and carcinogens fell. Goniewicz et al. measured biomarkers for 13 toxins and carcinogens; all but a few declined substantially after the smokers started using e-cigarettes. For example, exposure to NNK, a tobacco-specific nitrosamine "directly associated with lung cancer risk," had fallen by 64 percent after the second week. Exposure to the volatile organic compounds acrolein, ethylene oxide, benzene, and 1,3-butadiene fell by 56 percent, 61 percent, 76 percent, and 84 percent, respectively. "The observed decline in various urine toxicant biomarker levels in our study was similar to decline among smokers who have quit smoking completely and did not substitute with any other product," Goniewicz et al. write. "This observation suggests that e-cigarettes are not a significant source of exposure to those toxicants." Based on chemical analyses of e-cigarette vapor, other researchers have estimated that switching from smoking to vaping reduces health risks by at least 95 percent. Goniewicz et al. also found declines in reports of chest tightness, visual disturbances, daytime coughing, difficulty concentrating, irritability, and phlegm, although only the first two changes were statistically significant. A larger sample with a longer follow-up period probably would supply further evidence of health improvement. The authors note that a 2014 survey of 19,000 e-cigarette users "suggest[s] use of these products pose minimal side effects to users and can in fact improve reported health issues experienced when using tobacco cigarettes," including respiratory symptoms caused by asthma and chronic obstructive lung disease. "This study showed for the first time that after switching from tobacco to e-cigarettes, nicotine exposure remains unchanged, while exposure to selected carcinogens and toxicants is substantially reduced," Goniewicz et al. conclude. "These findings suggest that e-cigarettes may effectively reduce exposure to toxic and carcinogenic substances among smokers who switched to these products."[...]
Fri, 19 Aug 2016 09:16:00 -0400This week, responding to one of the lawsuits challenging its e-cigarette regulations, the Food and Drug Administration (FDA) further muddied the question of whether those regulations apply to products that do not contain tobacco-derived nicotine. The lawsuit, which was brought by Nicopure, a manufacturer of e-liquids and vaping systems, argues that such a result would be unfair, illogical, and illegal. In response, the FDA says Nicopure has failed to show that any of its nicotine-free liquids are actually covered by the regulations and therefore has no standing to challenge that aspect of the rules. At the same time, the FDA concedes that "e-liquids marketed as 'nicotine-free' may properly be considered tobacco products—or components or parts thereof—under certain circumstances." What circumstances are those? "Some e-liquids 'claiming to be nicotine-free actually contain high levels of nicotine," the FDA says, quoting its regulations. "Others are tobacco flavored, and are thus 'made or derived from tobacco' regardless of their nicotine content." Does that mean e-liquids are not subject to the FDA's burdensome, prohibitively expensive regulations as long as they do not contain nicotine or any other tobacco derivative? No, because the FDA's definition of "tobacco product" does not require nicotine or any other tobacco derivative. The Family Smoking Prevention and Tobacco Control Act, the statute that gave the FDA authority over tobacco products, defines them as products "made or derived from tobacco that [are] intended for human consumption, including any component, part, or accessory of a tobacco product." In deeming e-cigarettes to be tobacco products, the FDA defined "component or part" as "any software or assembly of materials intended or reasonably expected...to alter or affect the tobacco product's performance, composition, constituents, or characteristics" or "to be used with or for the human consumption of a tobacco product." Hence vaping equipment, whether a closed, disposable e-cigarette or an open system with a refillable tank and parts that can be switched out, is a "component or part" of a tobacco product, which means it is also a tobacco product. Does that mean a nicotine-free e-liquid is a "component or part" of a tobacco product—i.e., the vaporizer? The FDA can't or won't give a straight answer to that question. "The only nicotine-free e-liquids that the rule brings under the FDA's regulatory authority are those that are made or derived from tobacco (such as tobacco-flavored varieties) or that otherwise meet the definition of a 'component' or 'part,'" it says. "Thus, nicotine-free e-liquids not made or derived from tobacco are subject to the deeming rule only where they meet the definition of a 'component or part.'...Whether nicotine-free e-liquids meet this definition 'will be evaluated on a case-by-case basis.'" That means a company like Nicopure cannot know ahead of time which of its products are covered by the regulations. It can only find out by asking the FDA about each one, a process that will carry its own costs, even if they do not rise to the hundreds of thousands or millions of dollars that each "premarket tobacco product application" is expected to cost. The FDA's position is that Nicopure can't challenge the potential regulation of its nicotine-free e-liquids because it does not know whether they will actually be regulated. Never mind that it doesn't know because the FDA won't say.[...]
Mon, 15 Aug 2016 00:01:00 -0400The Food and Drug Administration's e-cigarette regulations, which took effect last week, immediately struck two blows against public health. As of Monday, companies that sell vaping equipment and the fluids that fill them are forbidden to share potentially lifesaving information about those products with their customers. They are also forbidden to make their products safer, more convenient, or more pleasant to use. The FDA's censorship and its ban on innovation will discourage smokers from switching to vaping, even though that switch would dramatically reduce the health risks they face. That effect will be compounded by the FDA's requirement that manufacturers obtain its approval for any vaping products they want to keep on the market for longer than two years. The cost of meeting that requirement will force many companies out of business and force those that remain to shrink their offerings, dramatically reducing competition and variety. All of this is unambiguously bad for consumers and bad for public health. Yet the FDA took none of it into account when it estimated the costs imposed by its regulations, simply assuming that good intentions would ensure good results. Although preventing fraud is the official intent of the FDA's speech restrictions, the agency's rules prohibit statements that are accurate and highly relevant to consumers choosing between smoking and vaping. Nicopure, one of the companies that is challenging the FDA's regulations in federal court, used to tell consumers that in vaping "nothing is burned," "no smoke is released," and "no ash" is generated. It also noted that the aerosol produced by e-cigarettes contains "no tar" and only "a fraction of the 4000 chemicals currently found in standard tobacco cigarettes." Although all of these statements are indisputably true, they are illegal under the FDA's reading of the Family Smoking Prevention and Tobacco Control Act. That law gave the FDA authority over tobacco products, a category to which it has arbitrarily assigned tobacco-free e-cigarettes, even when they contain nicotine that is not derived from tobacco or no nicotine at all. The Tobacco Control Act prohibits unapproved "modified risk" claims, including any "explicit or implicit representation that [a] tobacco product or its smoke does not contain or is free of a substance or contains a reduced level of a substance, or presents a reduced exposure to a substance in tobacco smoke." According to the FDA, that means e-cigarette companies are not allowed to advertise the main advantage of their products. Even describing an e-cigarette as "smokeless" or "smoke-free" is asking for trouble, since "the Agency will evaluate an [e-cigarette] manufacturer's use of 'smokeless' or 'smoke-free' (and similar descriptive terms) on a case-by-case basis." Instead of immediately banning all e-cigarettes and e-fluids, the FDA gave manufacturers a couple of years to seek approval for each of their products. But that grace period does not apply to any variations introduced after August 8, 2016, so the FDA has in effect banned product improvements. In a declaration supporting Nicopure's lawsuit, CEO Jeff Stamler notes that his company "introduced approximately 288 new e-liquid products, 6 new vaporizer products, and 23 new vaporizer components" in 2015 alone. Now any new product requires premarket approval, so "as a practical matter Nicopure will be unable to introduce new products for several years." The ban applies even to minor changes. The American Vaping Association notes that "any variation of the nicotine level, bottle size, flavor amount, ingredient type, etc. in a current product (i.e., one being marketed on August 8, 2016) will result in a 'new' product that will be illegal to sell without preapproval from the FDA." But the FDA is also blocking substantial improvements in the designs of vaping systems and their components, changes that could make them easier or cheaper to use[...]
Fri, 12 Aug 2016 06:30:00 -0400
(image) The FDA's e-cigarette regulations, which were published last May, took effect this week. As I explain in my latest Forbes column, the rules will dramatically reduce competition, variety, and innovation, retarding the replacement of smoking with a much safer alternative:
The Food and Drug Administration's e-cigarette regulations, which took effect this week, immediately struck two blows against public health. As of Monday, companies that sell vaping equipment and the fluids that fill them are forbidden to share potentially lifesaving information about those products with their customers. They are also forbidden to make their products safer, more convenient, or more pleasant to use.
The FDA's censorship and its ban on innovation will discourage smokers from switching to vaping, even though that switch would dramatically reduce the health risks they face. That effect will be compounded by the FDA's requirement that manufacturers obtain its approval for any vaping products they want to keep on the market for longer than two years. The cost of meeting that requirement will force many companies out of business and force those that remain to shrink their offerings, dramatically reducing competition and variety.
All of this is unambiguously bad for consumers and bad for public health. Yet the FDA took none of it into account when it estimated the costs imposed by its regulations, simply assuming that good intentions would ensure good results.
Tue, 26 Jul 2016 10:26:00 -0400The Food and Drug Administration's onerous e-cigarette regulations, which are expected to put all but the largest producers of vaping equipment and e-liquids out of business, are based on the counterintuitive premise that tobacco products need not contain tobacco. If they contain nicotine derived from tobacco, as the fluid that e-cigarettes turn into an aerosol often does, that's enough for the FDA to regulate them as tobacco products. But what about the many varieties of nicotine-free e-liquids, sold in disposable e-cigarettes, replaceable cartridges and bottles for refilling vaporizer tanks? Do those liquids and the systems in which they are used also qualify as tobacco products? As I explain in a recent Forbes post, the FDA seems incapable of giving a straight answer to that question, which is crucial in determining which products are subject to regulatory requirements that will prove prohibitive for most of the companies that currently offer smokers a much safer alternative to conventional cigarettes. It sounds like nicotine-free fluid still counts as a tobacco product if it can be used in vaping equipment that also can be used with fluid that contains nicotine. If so, all e-liquids sold in bottles would be treated as tobacco products, even when they contain neither tobacco nor nicotine. But if that is the FDA's (il)logic, a disposable nicotine-free e-cigarette or a closed vaping system that accepts only nicotine-free cartridges would not qualify as a tobacco product. What about nicotine that is not derived from tobacco? Various other members of the nightshade family, including eggplant, tomatoes, and green peppers, contain nicotine, which also can be synthesized in a lab. Companies such as Amaranth Vapor advertise e-liquids containing "tobacco-free nicotine." As the Manhattan Institute's Jared Meyer notes at National Review, those liquids, like the nicotine-free versions, apparently are still covered by the FDA's bizarrely broad definition of "tobacco product," because they are used in devices that also can be used to deliver tobacco-derived nicotine. But what if you had a vaporizer that worked only with "tobacco-free nicotine," combined with liquids that worked only in that device? That is the convoluted idea behind a joint project announced today by the vaporizer company Vapeix and Next Generation Labs, which makes synthetic nicotine under the TFN brand. The press release says the two companies are "leveraging the world's most advanced embedded firmware, software and hardware" to "develop both closed and open system vaping devices for Next Generation Labs' e-liquid brand customers who use TFN™ Nicotine." Lack of flexibility is a key selling point. "Through the smart technology embedded in Vapeix Powered devices," says Next Generation cofounder Ron Tully, "the vaporizers will only work with TFN brands—allowing us to create a vape market which is unequivocally disassociated from traditional vaping devices that are intended to be used with tobacco-derived nicotine." Vapeix founder Kyle Newton notes "there's currently a lot of fear in the market as vape businesses and analysts worry that regulation will stifle innovation in the industry." He hopes the joint venture will create "a new product category that will enable future innovation in a narrowing industry." I suspect the FDA will try to regulate these high-tech contraptions as tobacco products too, although whether the agency's reasoning will be upheld by the courts is another question. [...]
Mon, 27 Jun 2016 10:20:00 -0400
(image) A large survey of Europeans indicates that more than 6 million have quit smoking with the help of e-cigarettes, while more than 9 million have cut back, according to a study recently published by the journal Addiction. "These are probably the highest rates of smoking cessation and reduction ever observed in such a large population study," says the lead researcher, Konstantinos Farsalinos, a cardiologist at the Onassis Cardiac Surgery Center in Athens. "The European Union data show that the use of electronic cigarettes seems to have a positive impact on public health for two main reasons: 1) High smoking cessation and reduction rates are observed, and 2) electronic cigarette use is largely confined to smokers (current and former), with minimal use by nonsmokers."
The study, based on responses from 27,460 participants in the Eurobarometer survey, found that 48.5 million citizens of E.U. countries have tried e-cigarettes, while 7.5 million are current vapers. Within the latter group, 35 percent reported that e-cigarettes helped them quit smoking, while 32 percent said they were smoking less thanks to e-cigarettes. Such self-reports are not conclusive, since the study did not independently verify smoking status, smokers who try to quit by vaping are probably different from those who don't, and it's possible these outcomes could have been achieved without e-cigarettes. But policy makers and regulators should not lightly dismiss the experiences of millions who say e-cigarettes helped them make changes that dramatically reduced the health hazards they face.
Critics of vaping say the risk that it will lead to smoking in people who otherwise never would have used tobacco products must be weighed against the success stories of people who believe they'd still be smoking if it weren't for e-cigarettes. But this study found very little evidence of such a risk. Just 0.8 percent of respondents who had ever tried tobacco products said they had tried e-cigarettes first (which does not necessarily mean that the latter led to the former). Only 1.3 percent of never-smokers reported using e-cigarettes with nicotine-containing liquids, and only 0.09 percent did so every day. "In nonsmokers we observed some experimentation with electronic cigarettes, but regular use is minimal," says one of Farsalinos' collaborators, Jacques Le Houezec, a neuroscientist at the French National Research Institute for Health and Medical Research. "The concern that electronic cigarettes can be a gateway to smoking is largely rejected by our findings."
Mon, 20 Jun 2016 04:38:00 -0400Public statements from the U.S. Centers for Disease Control and Prevention (CDC) take an alarmist view of e-cigarettes, portraying them as a menace to the youth of America, who supposedly will start smoking again in droves once they try vaping and get hooked on nicotine. But the CDC's data tell a different story. This month CDC released the latest results from its National Youth Risk Behavior Survey (NYRBS), which is conducted every two years. The 2015 numbers show that cigarette smoking continues to fall among teenagers even as more and more of them experiment with vaping. But as usual, the CDC chose to accentuate the negative. "Current cigarette smoking is at an all-time low, which is great news," CDC Director Tom Frieden conceded. "However, it's troubling to see that students are engaging in new risk behaviors, such as using e-cigarettes. We must continue to invest in programs that help reduce all forms of tobacco use, including e-cigarettes, among youth." You see what he did there? Frieden, as is his wont, called vaping "tobacco use," even though e-cigarettes do not contain tobacco. In fact, data from the Monitoring the Future Study indicate that the e-cigarette liquids used by teenagers typically do not even contain nicotine. Even when teenagers use e-cigarettes to inhale nicotine, they face far smaller health risks than smokers do—a crucial point that the CDC recklessly and routinely obfuscates by implying that the rising popularity of vaping wipes out any public health benefit from the ongoing decline in smoking. That decline has been dramatic. According to the NYRBS, the share of high school students who reported smoking cigarettes during the previous month fell from more than 36 percent in 1997 to less than 11 percent in 2015—a 70 percent drop. Other surveys, including Monitoring the Future and the CDC's National Youth Tobacco Survey, show a similar downward trend, even as interest in e-cigarettes has increased dramatically. The CDC has been raising the alarm about rising adolescent e-cigarette experimentation since 2012, based on answers to survey questions added in 2011. Yet the NYRBS shows that past-month cigarette smoking fell from 18.1 percent in 2011 to 10.8 percent in 2015. The CDC's own numbers belie the notion that vaping is renewing interest in smoking. A study published last week in the journal Pediatrics purports to show that vaping is nevertheless renewing interest in smoking. But that is not what the study actually shows. Jessica Barrington-Trimis, a postdoctoral research associate at the University of Southern California, and her eight collaborators started with the Children's Health Study, which has been following more than 5,000 kids in Southern California since 2002. The researchers focused on 213 subjects who in 2014, when they were juniors or seniors in high school, reported that they had never smoked. Barrington-Trimis et al. got 146 of those teenagers to complete new questionnaires an average of 16 months later. They found that teenagers who had reported trying e-cigarettes in 2014 were six times as likely as those who hadn't to report in the follow-up survey that they had tried conventional cigarettes. The researchers conclude that "e-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal." Then again, it may not. While Barrington-Trimis et al. found a strong association between vaping and smoking, it does not necessarily follow that the former causes the latter. It may simply be that the sort of teenagers who are inclined to try vaping are also inclined to try smoking, and that they try the former first because it smells and tastes better and causes less discomfort. Even if e-cigarettes[...]
Fri, 17 Jun 2016 07:30:00 -0400
(image) Data released last week by the CDC show that smoking continues to decline among teenagers, reaching a record low last year. But as I explain in my latest Forbes column, the CDC is still worried that the rising popularity of e-cigarettes will renew adolescent interest in the real thing:
Public statements from the U.S. Centers for Disease Control and Prevention (CDC) take an alarmist view of e-cigarettes, portraying them as a menace to the youth of America, who supposedly will start smoking again in droves once they try vaping and get hooked on nicotine. But the CDC's data tell a different story.
Last week the CDC released the latest results from its National Youth Risk Behavior Survey (NYRBS), which is conducted every two years. The 2015 numbers show that cigarette smoking continues to fall among teenagers even as more and more of them experiment with vaping. But as usual, the CDC chose to accentuate the negative.
Fri, 17 Jun 2016 06:30:00 -0400Yesterday Philadelphia became the first major city in the United States to impose a special tax on soft drinks, but as enacted it has nothing to do with reducing obesity, the usual rationale for such levies. Unlike Berkeley, where voters approved a one-cent-per-ounce tax on sugar-sweetened drinks in 2014, Philadelphia will tax low-calorie and zero-calorie beverages at the same rate as regular soda. In fact, the tax of one-and-a-half cents per ounce could perversely encourage consumption of more calories, especially since it does not apply to juice products loaded with naturally occurring sugar. Mayor Jim Kenney, who as a councilman vigorously opposed a two-cent-per-ounce soda tax proposed by his predecessor, Michael Nutter, because of the burden it would impose on poor people, changed his mind this year, pitching an even more burdensome three-cent-per-ounce tax. But instead of presenting the highly regressive levy as a "public health" measure aimed at discouraging poor people from drinking the beverages they prefer, which is how Nutter had framed it, Kenney said the city should use the tax to pay for "universal preschool." That strategy worked, except the city council noticed that Kenney planned to divert some of the money to the general fund, so it cut his proposed rate in half and broadened the base, applying the tax to artificially sweetened as well as sugar-sweetened drinks. The upshot is that Diet Coke, with zero calories, will be taxed at the same rate as regular Coca-Cola, which has 12 calories per ounce, while orange juice, which has just as many calories per ounce, and grape juice, which has 21, will escape the tax altogether. Needless to say, this is not the way an obesity-fighting social engineer would have designed the tax, which is now simply a way for the city to raise money on the backs of poor and working-class residents. The money will be used to "help pad the City's General Fund" as well as "fund quality pre-K expansion, community schools, [and] reinvestment in parks and recreation centers." City Council President Darrell Clarke argues that the revised tax is less regressive than the one Kenney sought. "It is the view of many members of Council that a General Fund problem and citywide initiatives should not be resolved by a proposal that affects mostly low-income people with few options," he says, alluding to the fact that sugar-sweetened drinks are disproportionately popular among poor people. By taxing diet soda as well, the city council hopes to impose more of the burden on middle-class and wealthy residents. Councilwoman Jannie Blackwell says the enacted version of the tax will be "more widely spread among consumers at both ends of the income spectrum." This increase in perceived fairness, of course, comes at the cost of obliterating the rationale for taxing these particular products. What was once a supposedly noble effort to save poor people from their own bad habits has become nothing more than a money grab. In a way, that's encouraging, because Philadelphians clearly rebelled at the notion that taxes should be used to manipulate people's dietary choices, especially when poor people of color are the main targets. The condescending paternalism of Nutter's tax proposal turned people off so much that he could not get it approved. Superficial similarities aside, it turns out that what passes for high-minded resistance to "Big Soda" in Berkeley looks a lot more like arrogant meddling in Philadelphia.[...]
Tue, 31 May 2016 15:05:00 -0400The United Kingdom's National Health Service (NHS) system of socialized medicine is lagging behind the United States in offering a very useful treatment to prevent the spread of HIV, and it's doing so deliberately. The NHS has announced—or rather reaffirmed—that it will not arrange for the providing of PrEP drug treatments to citizens to help prevent the transmission of HIV. PrEP is an acronym for a drug cocktail that, when taken regularly, is hugely successful in preventing an HIV-positive person from infecting an HIV-negative person. In the United States it is increasingly being used as a prophylactic drug, especially for gay men who are sexually active but are not using condoms or are in relationships with HIV-positive men. It reduces the risk of HIV transmission to near zero. In the United Kingdom, these drugs are only prescribed as a post-sex treatment for somebody who believes he has been exposed. Essentially, it's a "Plan B" for unprotected sex in the United Kingdom, even though it can do so much more. The NHS already announced once it was not going to provide PrEP drugs as a preventative treatment, which prompted huge outrage from activists. NHS officials promised to look over its system to see if it could change the rules. This week they announced they would not, due to possible legal challenges from "proponents of other 'candidate' treatments and interventions that could be displaced by PrEP if NHS England were to commission it." Yes, that's right: These people cannot get these drugs through NHS because it could disrupt some other entrenched treatment provider who would sue. It is very much an important reminder than under a socialized medicine system, you are no longer the customer. Some very naïve supporters of nationalized healthcare have gotten it into their heads that government-controlled services eliminate corruption and profiteering in the medical system. That couldn't be further from the truth. Nationalized healthcare puts a government stamp of approval on it, as long as the right regulations are followed. This is the actual example that enemies of "big pharma" always point to: the idea that some powerful company would intervene to block treatment because it has a financial stake in the matter. But it's happening because the government controls healthcare. In America, it's also true that you're really not the "customer" in health care. Increasingly it's your insurance provider. But until the Affordable Care Act came around, we were all free to reject insurance providers that were not covering the services we needed them to. Now we can still technically do so, but we get fined for expressing our right do without. Here in the states, we can argue whether it's the role of the government to subsidize drugs that exist for the purpose of letting people have sex more safely. But in Great Britain, that's a ship that has fully sailed. The people who are being denied free access coverage to these drugs are nevertheless forced by law to pay into this national system. Then they have to pay out of their own pocket to buy these drugs online. They are not getting the treatment that they are paying for, and on top of that they have to pay extra. NHS officials did promise to keep working on it to see if there are other ways to improve or increase the distribution of PrEP. An AIDS activist group has said they're considering their own legal action.[...]
Mon, 30 May 2016 00:01:00 -0400On May 4, the day before the Food and Drug Administration officially classified e-cigarettes as "tobacco products," California did the same thing. Gov. Jerry Brown signed SBX2 5, which expands the definition of tobacco product under several statutes to include "an electronic device that delivers nicotine or other vaporized liquids to the person inhaling from the device." Among other things, the change means that vaping will be banned everywhere that smoking is prohibited and, since another bill signed by Brown raises the age for buying tobacco products from 18 to 21, adults younger than 21 will no longer be allowed to buy e-cigarettes. California's policy shift is not as consequential as the onerous FDA regulations unveiled the next day, which will shut down thousands of e-cigarette and e-liquid businesses. But it is equally misguided, and the arguments used by its supporters show that the people driving policy in this area are either remarkably clueless or brazenly dishonest. Mark Leno, the state senator who introduced SBX2 5, might be both. A riddle attributed to Abraham Lincoln asks: If you call a tail a leg, how many legs does a dog have? The answer: Four, because calling a tail a leg does not make it a leg. Likewise, legislators (or bureaucrats empowered by them) can call e-cigarettes "tobacco products," but that does not change the fact that they contain no tobacco and generate no smoke. Leno, a Democrat whose district includes San Francisco, has 18 posts on his website that mention e-cigarettes, one of which is titled "E-Cigarettes Are Tobacco Products." Visitors who click on that link in the hope of finding something resembling an argument will be disappointed. The post consists of a photograph showing Leno posing with supporters of his bill next to a placard that says "E-Cigarettes Are Tobacco Products." It's true that the nicotine e-cigarettes often are used to deliver is derived from tobacco, but that is also true of the nicotine in smoking cessation aids such as gum, patches, and inhalers, which neither the FDA nor the state of California considers tobacco products. Furthermore, Leno's definition of tobacco product includes nicotine-free e-liquids and the devices that turn them into inhalable aerosols, neither of which have anything to do with tobacco. The erroneous identification of e-cigarettes with tobacco products is closely tied to the misconception that e-cigarettes are just as dangerous as the conventional, combustible kind. "Whether you get people hooked on e-cigarettes or regular cigarettes, it's nicotine addiction and it kills," Leno told Reuters last year. "We're going to see hundreds of thousands of family members and friends die from e-cigarette use, just like we did from traditional tobacco use." No one this ill-informed has any business writing legislation that deals with e-cigarettes. Contrary to what Leno seems to think, nicotine addiction is not inherently deadly. What kills smokers is not nicotine; it's the tobacco combustion products they inhale along with nicotine. If nicotine were the cause of smoking-related disease and death, how could the FDA possibly have approved products like Nicorette gum and Nicoderm CQ as safe and effective ways to quit smoking? E-cigarettes build on the same idea, offering a less hazardous way to consume nicotine—one that is more appealing to many smokers because it more closely resembles their current habit. Although e-cigarettes probably are not quite as safe as the pharmaceutical versions of nicotine replacement, they are close. "While vaping may not be 100% safe," said a 2015 report from Public He[...]
Fri, 27 May 2016 06:48:00 -0400
(image) E-cigarettes, a.k.a. electronic nicotine delivery systems, do not contain tobacco and do not burn anything. A new California law neverthless describes them as "tobacco products." As I explain in my latest Forbes column, this misclassification undermines public health by deterring smokers from switching to a much less dangerous habit:
On May 4, the day before the Food and Drug Administration officially classified e-cigarettes as "tobacco products," California did the same thing. Gov. Jerry Brown signed SBX2 5, which expands the definition of tobacco product under several statutes to include "an electronic device that delivers nicotine or other vaporized liquids to the person inhaling from the device." Among other things, the change means that vaping will be banned everywhere that smoking is prohibited and, since another bill signed by Brown raises the age for buying tobacco products from 18 to 21, adults younger than 21 will no longer be allowed to buy e-cigarettes.
California's policy shift is not as consequential as the onerous FDA regulations unveiled the next day, which will shut down thousands of e-cigarette and e-liquid businesses. But it is equally misguided, and the arguments used by its supporters show that the people driving policy in this area are either remarkably clueless or brazenly dishonest. Mark Leno, the state senator who introduced SBX2 5, might be both.