Disciplined Language

On May 6 the Arkansas Cancer Coalition posted a disturbing op ed online written by Billy Parish their Community Outreach person. The editorial is disturbing primarily because it frames the issue of tobacco prevention in language tobacco companies use and questions the limits to tobacco prevention. Ostensibly the piece asks how we will get more Arkansans to show support for tobacco control policies. That question seems to have been rhetorical because my response disappeared from both the comments section on their website and the ACC FaceBook profile page, where I first linked to the editorial. For your amusement, my response, and answer to his question, appears below.

Handsel Art

6 May 2011

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“How we frame the question usually leads to an answer.”

The fact that you question the pandemic of tobacco related disease as some sort of libertarian issue about smokers tells me you are still under the thrall of industry propaganda. We don’t ask these kinds of questions about sanitation or hand washing requirements. We don’t carefully weigh an individual’s right to drive drunk or faster than the speed limit. Why should we phrase the question about tobacco prevention as one of personal liberties? The fact is we shouldn’t. Tobacco prevention is a matter of public health. And the only place that rights come into play is a human right to every opportunity for health and safety.

The tobacco industry loves it when we phrase the issue as a matter of personal choices made by smokers because it distracts from the much more appropriate focus of allowing, even subsidizing with our permissive laws, a predatory rogue industry responsible for an obscene majority of the death and disease on this planet. A tobacco free advocate has very little interest in interfering with anyone’s decisions. Tobacco free advocacy challenges the perception that this kind of tolerance for tobacco related disease is not and does not have to be a normal part of our lives. It is not the tobacco free advocate that blankets our parking lots with advertising. It is not the advocate who makes sure that every time a child enters a convenience store they will pass eye level logos and at every check out look up at a colorful wall of tobacco. It is not the advocate who manipulates the nicotine in their product to enhance addiction to a product so flawed that it will eventually kill half of all users because they were unable to quit. It is not the advocate spending millions challenging public health legislation to reduce tobacco use. It is not the smoker doing this either. It is the multi-national corporations whose sole aim is to profit and profit at any cost. This is the focus of tobacco prevention.

The tobacco free advocate seeks to de-normalize tobacco use in our society to the point where no one ever wants to smoke enough to become addicted, to change the social norm to where no addiction can support the demand for profit the industry needs to survive. We create tobacco free spaces not merely because secondhand smoke is deadly but also because it helps smokers quit and is the example to young people that tobacco is not normal or appropriate. We place significant taxes on tobacco not merely to offset revenue losses from tobacco related disease but also because it makes tobacco more expensive and less accessible. We regulate marketing for the same reasons, to de-normalize tobacco use.

In 2006 the tobacco industry was convicted in Federal court of racketeering and fraud for 50 years of deceit and manipulation of our laws and public opinion. To confuse tobacco prevention with something we are doing to smokers and even suggest that there is a question about the limits tobacco free advocacy should accommodate demonstrates just how effective this fraud has been and continues to be.

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World No Tobacco Day Celebrates Global Treaty

The World Health Organization (WHO) will celebrate the annual World No Tobacco Day on May 31. The 2011 theme calls attention to the Framework Convention on Tobacco Control(FCTC). The first global treaty initiated under the auspices of the WHO, the FCTC has been in force since 2005 with over 170 signatory parties to date reaffirming “the right of all people to the highest standard of health and new legal dimensions for cooperation in tobacco control.”

The United States signed on as a non-party in 2004. The Senate has yet to ratify the treaty. There had been concern that the U.S. would try to weaken provisions and doubts about the possibility for implementation. In fact, the Family Smoking and Tobacco Prevention Act of 2009, giving limited authority over tobacco to the FDA, contains provisions allowing non-voting participation by the industry on a scientific advisory panel. This compromises Article 5.3 of the FCTC conflicting with the first guiding principal of the treaty that, “There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” This seems to have been ignored when major public health groups in the U.S. collaborated with Philip Morris to pass this law.

Additionally, the treaty recommends that all tobacco advertising be banned. While other nations are proposing plain packaging and have products hidden behind counters this promises difficulty in the U.S. Unlike many countries, U.S. courts have upheld a doctrine of commercial speech for tobacco companies. Given the recent Citizens United decision, it is not clear how sympathetic the sitting Supreme Court will be to compelling public health concerns about tobacco.

The strength of the FCTC, despite the influence of the tobacco industry in this country, is a recognition of the extent and potential for harm caused by multi-national tobacco corporations. Writing in the August, 2006 Human Rights Quarterly, on The Emerging Human Right to Tobacco Control, Dr. Carolyn Dresler notes,

“In the developed world, the health effects of tobacco on the individual are well established, as are its effects on society. However, only predictions based on experience of the established tobacco consuming markets are available to warn of the impending epidemic of tobacco related death and disease that will disastrously affect individuals and society in the developing world.”

It is only with global initiatives like the FCTC can we begin to meet this challenge.

FDA Given Opportunity to ban Menthol

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20 March 2011

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Panel Releases Report on Menthol

On March 19 the FDA’s Tobacco Products Scientific Advisory Panel (TPSAP) released a draft of its report on menthol in cigarettes. Advocates had feared that the narrow scientific restrictions of the investigation would find that the menthol in cigarettes was relatively benign. But the panel, while failing to actually make the recommendation that menthol in cigarettes be eliminated, found for the larger concept of menthol’s harm in cigarettes. The panel found that menthol’s cooling effect made addicting youth easier and quitting more difficult. Virtually all tobacco products contain some menthol.

The report states, “The availability of menthol cigarettes in the marketplace could adversely affect public health through two consequences: (1) increasing the risk for the diseases caused by smoking cigarettes; and (2) increasing the number of people who smoke.” It goes on to conclude, “Removal of menthol cigarettes from the marketplace would benefit public health in the United States.” Unfortunately, the TPSAP did not make any specific suggestions on how to limit the harm to the public health.

The 2009 Family Smoking Prevention and Tobacco Control Act, giving limited authority over tobacco to the FDA, banned fruit and candy flavoring. But a political compromise charged the TPSAP to report on the public health impact of menthol in cigarettes. Many advocates opposed the compromise because 80% of African American smokers smoke menthol.

A statement released by the Campaign for Tobacco Free Kids applauded the report saying, “We urge the FDA to implement the committee's recommendation in a way that maximizes the public health benefits.” Tobacco Free Kids led several of the major public health groups in negotiations with tobacco giant Philip Morris to see successful passage of the Act.

American Legacy Foundation Distinguished Professor of Tobacco Control at UCSF, Dr. Stanton Glantz, noted that the most significant finding was that menthol, “has a complex pharmacological interaction with nicotine that affects the addictive potential of cigarettes.” He added that, “The question at this point is whether the FDA and the Obama Administration will have the backbone to ban menthol in all tobacco products (or, at least as a first step, all smoked tobacco products, which is more than just cigarettes) and whether the major health organizations will unambiguously press for such a ban.”

If the stock market is any prediction tobacco companies still have little to worry about. Lorrilard, maker of Newport, the leading menthol cigarette, saw its stock value rise 3.4% as drafts of the report were released.

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Local Control Given Setback

First the requirements of the Family Smoking Prevention and Tobacco Control Act that cigarette advertising be limited to black and white advertising where minors might view it were struck down. Now the ostensible overturning of Federal preemption for state and local authority to regulate point of purchase advertising was delivered a blow by a federal Judge in New York Wednesday, December 29.

The New york City Board of Health in 2009 voted to require tobacco retailers display graphic warnings of the dangers of tobacco use that included a number for free cessation services. However the decision delivered by U.S. District Judge Jed S. Rakoff considered that an infringement on the tobacco companies rights. “Even merchants of morbidity are entitled to the full protection of the law, for our sake as well as theirs," he said.

Tobacco free advocates were depending on Sec. 203 of the new law to allow local control preempted by the 1965 Federal Cigarette Advertising and Labeling Act. The law reads:

"Section 5 of the Federal Cigarette Labeling and Advertising Act (15 U.S.C. 1334) is amended by adding at the end the following: ‘‘(c) EXCEPTION.—Notwithstanding subsection (b), a State or locality may enact statutes and promulgate regulations, based on smoking and health, that take effect after the effective date of the Family Smoking Prevention and Tobacco Control Act, imposing specific bans or restrictions on the time, place, and manner, but not content, of the advertising or promotion of any cigarettes.’’"

Apparently the graphic content denied those that profit from the leading cause of death and disease from the full protection of the law. Thus continues the odd saga in the United States of what is known only here as commercial speech. When applied to tobacco not only does it protect corporations’ speech it protects them from liability after 1969.

Supported by the major public health groups, and tobacco giant Phillip Morris, the new federal law giving limited authority over tobacco to the FDA is turning out to be yet another significant victory for tobacco companies.

New Surgeon General's report: No Safe Exposure

Click title for link to report.

subsidy

Subsidizing the tobacco industry is not dissimilar to subsidizing any industry in a capitalist community. Industry is offered tax breaks, incentives, and opportunity for conducting business in a community as an opportunity for employment and improving commerce. We provide tax breaks in return for a positive economic impact. The unfortunate difference is that the tobacco business is an economic drain. The American Lung Association has estimated that a pack of cigarettes should cost $16.66 to simply break even for the cost to the public health.

While honest work, jobs dependent on selling cigarettes are a poor trade for $812 million in tobacco related health care costs annually in Arkansas, the litter. or the lives.

Arkansas Cancer Coalition Press Conference, Lung Cancer Awareness

Click title for link to video.

Fed's Latest Effort

Handsel Art

17 November 2010

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HHS Announces Tobacco Strategy

Earlier this month the Director of the U.S. Department of Health and Human Services, Kathleen Sebelius, announced the federal government’s latest strategy to control the leading cause of preventable death, tobacco. Headlining the announcement were the new graphic pack and ad warnings required by the Family Smoking Prevention and Tobacco Control Act giving limited authority over tobacco to the Food and Drug Administration. These 9 graphic warnings will cover 50% of any pack and 20% of advertising. In 1965 the tobacco lobby was successful in minimizing Surgeon General Luther Terry’s report that smoking caused cancer to the ubiquitous: “Smoking may be hazardous to your health.” Arguably, tobacco lobbyists still manipulate public policy.

Today 38 nations require similar or stronger warnings. Australia has required that all cigarettes be sold in plain packaging by 2012. Other nations‘ graphic pack warnings are a facet of the World Health Organizations Framework Convention on Tobacco Control. Ironically, the U.S. law requiring graphic warnings also inhibits this country’s compliance with the global treaty by including the tobacco industry on an FDA scientific advisory panel.

Requirements in the new legislation to quit using deceptive “light” and “low tar” packaging had been anticipated by the industry changing the actual language to suggestive lighter colored packaging. Actually, the elimination of the words “light” and “low tar” had been ordered by Judge Gladys Kessler in 2006 as part of her finding against the tobacco industry as racketeers. Restricting advertisements to black on white messaging were almost immediately struck down by the courts.

While the bill was supported by major public health groups, and global tobacco giant Philip Morris, not all advocates consider giving the FDA limited authority over tobacco a good idea. Dr. Heinz Ginzel, Emeritus Professor of Pharmacology and Toxicology at the University of Arkansas for Medical Sciences says, “ Any regulatory actions concerning tobacco taken under the auspices of the FDA are jeopardizing, contaminating, degrading and corrupting the declared original mission of the FDA.”

Other advocates like the National African American Tobacco Prevention Network object to a failure to include menthol flavoring while banning fruit and candy flavors. A recent press release from NAATPN states, “Our organizational stance is and has always been steeped in the historic exploitation and targeting of Black communities by the tobacco industry which began in the 1950’s when only 5% of our community smoked mentholated tobacco, and continues today because now nearly 83% of all tobacco consumed by Blacks is mentholated.” The FDA scientific advisory panel has until 2011 to determine how to regulate, if at all, menthol flavoring in tobacco.

One positive aspect of the new law is the removal of federal preemption for state and local governments to regulate point of purchase marketing. Currently the only signage or advertising mandates are legal age requirements. These are most often produced by the tobacco industry. Arkansans could now require the Quit Line be placed at point of purchase, regulate signage, or enhance any federal health warnings.

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Governor Proclaims November Lung Cancer Awareness Month

Handsel Art

14 October 2010

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Governor Proclaims November Lung Cancer Awareness Month

ACC Executive Director Cornelya Dorbin displays Governor Mike Beebe’s proclamation that November is Lung Cancer Awareness Month in Arkansas.

Calling attention to the single greatest cause of lung cancer, tobacco smoke, is one motivation the Arkansas Cancer Coalition petitioned Governor Mike Beebe to join states across the country in proclaiming November 2010 Lung Cancer Awareness Month in Arkansas.

Dr. Joycelyn Elders, former U.S. Surgeon General, calls lung cancer a “manmade disease”. At the beginning of the 20th century lung cancer was almost unheard of but today more people die from lung cancer than any other cancer. “The increase and decrease in mortality from lung cancer follows the rise and fall of cigarette use,” says the Arkansas Department of Health Tobacco Prevention and Cessation Branch Chief Dr. Carolyn Dresler. “Historically and globally, we can follow a 20 year lag in a population when cigarette sales spike and lung cancer rates peak.”

“So much of the prevention for lung cancer can be achieved through policy change,” notes ACC Lung Cancer Workgroup Chair, Dr. Thaddeus Bartter. The CDC has established Best Practices for effective tobacco prevention that include increased tobacco taxes, smoke free air, and market reform. Exemptions to Arkansas’ 4 year old clean indoor air law makes it one of the weakest protections from secondhand smoke in the nation. Even after recent tobacco tax increases, Arkansas’ is still below the national average and 27th lowest in the country. The Arkansas legislature let a bill posting the quit line at tobacco retailers die in committee in 2009.

Lung cancer data enjoys an unfortunate distinction in Arkansas. Tobacco related disease is the leading cause of death in the nation and lung cancer accounts for about a third of this morbidity. Yet Arkansas’ 2,100 lives lost to lung cancer is 42% of annual tobacco related deaths in the state.

Another motive for calling attention to lung cancer is an effort at facilitating the most current quality care to all Arkansans. African Americans start smoking later in life, smoke less, but compared to whites, are more likely to die from smoking related disease. One of the major goals of the ACC Lung Cancer Work Group is to identify strategies for dealing w disparities and at risk populations.

The Arkansas Cancer Coalition will hold a press conference in the Capitol Rotunda on November 16 at 10:30am. Representatives of the medical community, advocates, and policy makers will join the Governor in highlighting the urgent need and potential for prevention and treatment for lung cancer. Please join us in demonstrating your support for intelligent effective tobacco prevention and providing all Arkansans with quality care.

Dr. Philip Gardiner Addresses CTFA Conference

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13 September 2010

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Authority Discusses Menthol in Tobacco

“Young Blacks have found their thing, it’s menthol in general and KOOL in particular.” Philip Morris Tobacco Company, 1974

Recently Arkansans were fortunate to have Dr. Philip Gardiner speak at the Coalition for a Tobacco Free Arkansas’ annual Striking Out Tobacco in Arkansas conference. Dr. Gardiner is a public health activist concerned with issues ranging from racial disparities in health care, AIDS and cancer, to the effect of menthol in tobacco and the African American community. The National African American Tobacco Prevention Network estimates that 82% of African Americans smoke menthols. The tobacco industry has a history of advertising, discounting, and promoting menthol cigarettes most heavily in African American communities.

In 2009 Congress passed the Family Smoking Prevention and Tobacco Control Act giving limited authority to the FDA over tobacco. The Act prohibited tobacco companies from using fruit and candy flavors in tobacco in an effort to curb youth smoking but failed to eliminate the most common flavoring, menthol.

Gardiner’s presentation noted the CDC estimates smoking rates in the African American community at 22.4%. A more detailed study shows smoking rates closer to 38%. African Americans start smoking later in life, generally smoke fewer cigarettes, smoke cigarettes with a higher nicotine content compared to other ethnic groups, and are more likely to smoke menthol cigarettes. They also suffer disproportionately from tobacco related disease and death.

The FDA Tobacco Products Scientific Advisory Panel is currently studying the effect of menthol in tobacco. Menthol is used in many different products and is generally considered harmless. Dr. Gardiner’s emphasis was to broaden the concept of harm in cigarettes because it makes smoking more palatable, harder to quit, and “makes the poison go down easier.” It is the “ultimate candy flavoring”, he said.

Menthol Also Global Issue

The status of adding menthol to tobacco is at question for more reasons than the Family Smoking Prevention and Tobacco Control Act’s giving limited authority to regulate tobacco to the FDA. Globally, Article 9 of the Framework Convention on Tobacco Control proposes regulating the contents of tobacco products to eliminate any additive that is not tobacco.

The Louisville Courier-Journal quotes the President of the Lexington-based Burley Tobacco Growers Cooperative Association, Roger Quarles as saying, “The ingredients themselves (in burley tobacco) are not harmful whatsoever.” Mr. Quarles may well have missed several decades of the science surrounding tobacco and health. The problem here is that the harshness of burley tobacco smoke practically requires some flavoring to make it palatable. At issue is the 200 million pounds of burley is produced in the U.S. each year, 3/4 of which is exported. Kentucky’s 2009 burley crop was worth $274 million.

We’ll see what influences both the FDA and the Senate more, lives saved globally or dollars for a few farmers in Kentucky.

That Minty Fresh Taste in the Bile of Political Manipulation

In 2009 the Family Smoking Prevention and Tobacco Control Act was passed with huge support from status quo public health groups and opposition from tobacco companies, with the exception of Philip Morris, and a minority of tobacco prevention advocates. These minority advocates, before any particulars, knew that historically any collaboration with the tobacco cartel had been in the end only beneficial to the industry. That conclusion is being affirmed daily.

Prohibition of tobacco marketing assertions that claimed FDA approval of tobacco products was quickly struck down by the courts, as were the black and white advertising limitations. Passage of the bill was momentarily held up because while eliminating fruit and candy flavors it did not prohibit menthol flavoring for tobacco. The argument was that after passage there would be the opportunity to eliminate menthol as one of many substances in tobacco that had been proven to be a harm. Well guess what? The guidelines that dictate how and what the Tobacco Products Scientific Advisory Board can recommend may well preclude the elimination of menthol because menthol, by itself is not harmful. This at least is one of the argument that the industry will take in opposing any change in regards to menthol.

There is little doubt that menthol in tobacco is a key in the initiation of nicotine addiction. It acts as an anesthetic cooling tobacco smoke and making tobacco more palatable. Eliminating menthol in tobacco could prevent many youth from ever starting to use tobacco and make quitting more possible for other untold millions. The enormity of the potential lives saved by restricting this additive is almost incomprehensible.

One of the basic premises this bill’s advocates took was that if we knew what was in tobacco products their harm could be evaluated and the industry forced to remove them. But now it seems this harm could well be evaluated independently of tobacco. Dr. Joel Nitzkin describes the situation in a Globalink post: “In other words -- the problem is not the "science" related to menthol -- but a bureaucratic standard operating procedure adopted by FDA on the basis of an overly constrictive interpretation of the legal authority granted to them under the new FDA tobacco law.”

75% of African American smokers smoke a “menthol” brand but virtually all tobacco has to some degree menthol as an additive. The African American Caucus held up passage of the Family Smoking and Tobacco Prevention Control Act’s limited authority to regulate tobacco over the issue of restricting menthol flavoring just as the bill had eliminated fruit and candy flavors. However, objections from Philip Morris prompted supporters to compromise with the assurance that menthol could be eliminated after the bill’s passage. This may not be the case at all.

The panel has until 2012 to make its recommendations concerning menthol. This issue, if nothing else, displays quite well the irony and inanity of asking the FDA to regulate an inherently unsafe product without the authority to regulate it out of existence.

Lung Cancer in the Natural State

Handsel Art

11 June 2010

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Physicians, Laypersons Challenge Lung Cancer

Over 100 physicians, nurses, and advocates engaged Arkansas’ greatest cancer killer at the Current Care and Emerging Technologies, Lung Cancer in the Natural State Conference at the UAMS I. Dodd Wilson building in Little Rock June 11. Sponsored by the Arkansas Cancer Coalition, Stamp Out Smoking, and UAMS, the symposium was designed to be an interdigitation between medical professionals, tobacco prevention advocates, and cancer survivors and caregivers.

Making welcoming remarks were State Representative Fred Allen and Dr. Peter Emanuel with the Winthrop P. Rockefeller Cancer Center. Hematologist Dr. Mazen Safar then outlined frustration with the lack of progress in lung cancer morbidity. In the past decades research has shown that lifespan for lung cancer patients is increased as much from quitting smoking as chemotherapy.

Physician and Advocate breakout sessions dealt with topics ranging from the staging of lung cancer and stereotactic radiation to the guilt misplaced on smokers. Dr. Thaddeus Bartter, chair for the conference, noted during the Advocate’s session the enormous cost of unnecessary screening as , “Taking anatomy and trying to turn it into biology” while physicians discussed tailored therapy for patients.

Lung cancer survivor, American Cancer Society volunteer and patient advocate Joanne Blos, encouraged the hope that living, “means being a contributor and having joy.”

Co-chair for the event, J.R Few, opined that this had been a singularly significant opportunity for tobacco free advocates to learn from and join oncologists and surgeons in a front line challenge to cancer.

Pictured at the first annual Lung Cancer in the Natural State conference is surgeon Dr. Matthew Steliga addressing the statewide audience. Recognizing patients as individuals, as persons, Dr. Steliga said, “ A patient is not a carton of milk with an expiration date.”

Presentations will be available with the Arkansas Cancer Coalition at www.arcancercoalition.org.

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The presentation, Lung Cancer, or How Tobacco Changed the World can be seen here: http://www.vimeo.com/12517090

The Subtleties and Sophistication of Tobacco PR

This morning i opened up my daily Google Alert on Tobacco and happened to catch the headline, “Tobacco could help save lives, UC Davis team says”. Following up on this I read the press release concerning the UC Davis Big Bang business plan competition winners who had been awarded $15K for their proposal to use the tobacco plant as a source for vaccines. One of the members of the winning team is quoted, "I think this is an opportunity where tobacco can be used in a good sense."

Now this caught my eye for a couple of reasons. One is because I knew Davis, CA had a historical reputation for a tobacco free environment. In 1993 Davis had the only 100% smoke free policy in the nation and even today has extensive outdoor protections from secondhand smoke.

The second reason I was suspicious is because I knew that there was a bizarre use of Arkansas Master Settlement monies at the Arkansas Biosciences Institute. The MSA was the $246 billion settlement with the tobacco companies and the states for the harm caused by tobacco related disease. This has proven to have been a huge victory for the tobacco companies for the simple reason that nowhere in the agreement is it stipulated how this money is spent. Today states have only dedicated about 2.3% of MSA and tax revenue monies for tobacco control. Arkansans, however, stand alone with the Initiated Act 1 of 2000 dedicating their MSA payments toward primarily health related issues. Among these issues is the Arkansas Biosciences Institute created from 23% of the MSA to “focus on agriculture and basic and clinical scientific research that will lead to health improvement, especially in the area of tobacco-related diseases.” Now a state of the art research facility is a fantastic thing for a place like Arkansas. But early in 2004 Dr. Carole Cramer was hired as the Executive Director. Dr. Cramer’s expertise is the genetic engineering of the tobacco plant. This takes some mental agility to see that as an area of tobacco-related disease, but this is Arkansas.

So knowing of this tobacco industry coup and the smoke free distinction Davis enjoys I went to see just who could have influenced the Big Bang award. The major sponsor of the award is DLA Piper, a global law firm that represents anyone from the French gaming industry to, you guessed it, the tobacco industry. Arkansans may recall that DLA Piper senior Policy advisor Dick Armey recently came into the state to campaign against the proposed tobacco tax to fund our state's trauma system.

So now, is anyone else leery here?

The tobacco industry has a ready history of deceit and manipulation of public opinion toward tobacco and a degree of sophistication and cunning that almost baffles the imagination. This is just one more example.

Riverfest Smoke Free?

In July of last year, after much ado and the hard work of many of us, City Manager Bruce Moore signed the Little Rock Parks Commission recommended policy that Little Rock City Parks be tobacco free. The policy went into effect in October.

Now as Riverfest approaches it is questionable if the organizers of the event are going to respect this policy or continue their subsidy for the tobacco industry at the expense of the community. A quick glance at the Riverfest website cites only Arkansas clean indoor air laws with no recognition of the Parks Commission’s tobacco free policy at all.

Will we once again suffer the drifting smoke, pay for collecting the cigarette litter, and finance the corporate welfare for a rogue industry? The organizers of Riverfest may not care about the community and the entertainers but I bet their sponsors do. You can find them here. Contact the city manager’s office too. Demand not merely simple courtesy but evidence based public health policies.

It’s your air and your music, don’t share any more of it with the tobacco industry.

Tobacco Leaves on a Dollar

Dr.s Simon Chapman and Ross MacKenzie’s 2010 paper, The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, and more recently Chapman’s op ed on the marketing and promotion of NRT and pharmacopeia for tobacco cessation may well be the key to the next paradigm for effective tobacco control.

Recently there has been much attention given the ostensible “inveterate smoker”, the smoker who does not quit. It has been felt that after we raise the cost of tobacco, create tobacco free space, and eliminate tobacco marketing there still are going to be people who will not or cannot quit. This alleged population has been much of the motivation for those referring to themselves as harm reduction advocates, encouraging the promotion of forms of nicotine delivery allegedly less harmful than smoking. Chapman and Mackenzie’s work here calls into question whether that population exists at all and the validity of research funded by those marketing NRT or pharmacopeia.

He make 3 structural points: Most research is done by those interested in interventions and because of that primarily are testing their own means. In a capitalist society there is the tendency for medical means to become commodities. And lastly that these interventions are based on the erroneous assumption that there are some individuals who have an impenetrable addiction that warrants the interventions.

Yet 3/4 of all ex-smokers quit with no assistance at all. Cold turkey quitters outnumber all cessation methods combined. Studies have shown that most successful nicotine addiction was overcome with no preparation at all, that certain environmental cues prompted cessation and abstinence.

Recent genetic discoveries have suggested that there are predispositions to nicotine addiction and has been a facet of the thesis of the inveterate addict. This should not be underestimated in evaluating the risks of ever starting to use nicotine. But Chapman and Mackenzie’s research sheds light on the need to shift our perspectives toward modifying the environment beyond increased pricing, tobacco free spaces, and marketing reform. What we have been calling cessation support perhaps should not take as strong an active, or pharmaceutically interventionist, role as it does a further reformation of the environment.

The theory that some people cannot quit without intervention becomes a self fulfilling prophecy when seen with the enormous amounts spent by pharmaceutical companies, and others, advertising cessation assistance and funding research to test their products. We know that youth are more likely to start smoking if they believe quitting will be easy. Are we not re-enforcing the myth that quitting is difficult with our capitalist emphasis on marketing cessation support?

The under publicized figures surrounding cold turkey cessation point to rogue capitalism as a major factor in challenging tobacco perhaps no less than that of the tobacco industry. Somewhere in the evolution of dealing with nicotine addiction the emphasis on changing people’s perspectives on tobacco use from a social issue to a medically treatable problem a step was missed. There is little doubt that if there weren’t a dollar to be made it would not have happened.

Dr. Chapman points out that for the developing world, the growth market for tobacco companies, NRT and pharmacopeia is not a viable economic or realistic option. His paper suggests that we are far from optimizing the environmental and behavioral cues that enhance cessation and should not be dissuaded by the drive to profit in our capitalist society.

This also helps clarify where the harm reductive E cigarette clamor is coming from. Right now E cigarettes can’t decide whether they are cessation devices or that fairy tale of a safe tobacco habit. Emphasizing the fact that most people overcome nicotine without NRT shows how unwarranted another nicotine delivery device is.

400 years ago European colonial efforts to export tobacco co-opted an entheogenic plant from aboriginal Americans. In short order the plantation economy spawned the genocide of native peoples and the importation of an enslaved African population. As the leading cause of death and disease today is the capitalism surrounding tobacco today significantly different? The profit certainly isn’t.

Dismantling FDA Authority for Tobacco Begins

A Federal court in Kentucky overturned the first advertising regulations of the Philip Morris FDA bill this week. While leaving in aspects for larger health warnings and prohibiting event sponsorships, two key parts of the marketing restrictions were tossed. The bill had stipulated that only black and white advertising in mediums where children were likely to view would be allowed. This was thrown out as overly broad. You think?

Tobacco companies can continue to use their color graphics and imagery in advertising which are integral to branding and normalization of tobacco promotion.

Additionally, restricting tobacco company language claiming that FDA regulation made their product safer was tossed. This was one of the more telling and foolish parts of the bill. Detractors began much of their criticism of this legislation saying that industry marketing would take advantage of giving regulatory authority to the agency that supposedly guaranteed the health and safety of our food and drugs. In response, this ridiculous and obviously unconstitutional restriction was tacked onto the bill. “No you can’t claim that an FDA regulated cigarette is safer!” Apparently, yes you can. So why have we ruined the tenable integrity of the FDA anyway?

Philip Morris wrote this legislation. Other tobacco company lawyers cued up almost immediately to help dismantle the most potentially effective regulatory authority and thus far are successful. One can only imagine what the current Supreme Court will do for them as the suits creep upstream. What is not left to the imagination is that when all is said and done Philip Morris will have gotten almost everything it wanted without ever filing a brief.

Eradicate the Tobacco Industry?

The group Airspace ASH has been doing one of these informal online polls, "Should the tobacco industry be eradicated?" My reply of course is Absolutely! Or if I may restrain my enthusiasm suggest that removing the opportunity for massive profit could accomplish the same. The tobacco industry is an historical anomaly. No industry receives such freedom from regulation and none causes as much inherent disease, death, and correlate health care cost. None. None accidentally. None incidentally. None.

Yet the tobacco industry retains blue chip status in stock markets around the globe.

The challenge to tobacco must include opposition to the bizarre economics of permissive tobacco policies subsidizing the rogue capitalism and complexity of nicotine addiction. That is why incremental approaches to de-normalizing tobacco, (taxes, tobacco free space, market reform) are considered effective. Prohibition is not effective prevention. But prohibiting means of profitably marketing nicotine may well be. Hence, the increments.

In an age of transnational corporations it is perhaps oversimplified to call for the eradication of the tobacco industry. They have a tendency to morph and are as aggressive as the most pernicious cancer in pursuing profit. But it is most certainly a worthy goal to remove the profit for which these corporations exist. It is this predatory profit that drives the pandemic.

I do take issue with those that suggest more accessible nicotine is an appropriate response. One need not eradicate tobacco to de-normalize the popularity of nicotine addiction. But it may well be possible to regulate nicotine delivery, access, marketing, etc. to the point where tobacco use is much less desirable or socially acceptable.

Tobacco corporations are archetypical in their amorality. As we slowly inch our way toward a tobacco free society in more developed nations they open new markets on the Pacific Rim and in Africa. Talking about snus and nicotine vapor is counterproductive when transnational corporations are recruiting share croppers and new markets in the rest of the world. We will be successful in our challenge to tobacco someday but it will not be expedited by ignoring the global accommodation and predation for which the tobacco industry continues to distinguish itself.

Industry collaboration

“We cannot continue allowing hatred and disdain towards tobacco companies to interfere with and trump efforts to achieve our fundamental goal of rapidly reducing the leading cause of disease, disability and death (i.e. cigarettes). Its daily cigarette smoking that is killing millions of people, not nicotine, tobacco, or tobacco companies.”

Bill Godshall, Pennsylvania

Mr. Godshall’s exemplary missive conveniently ignores the fact that daily cigarette smoking would not occur were it not for addictive nicotine. Nicotine is inherent to tobacco. Tobacco use would not be prevalent were it not for tobacco companies, and tobacco companies would not market nicotine were it not for the profit.

Our esteemed colleague, Dr. K. H. Ginzel has noted that harm reduction is analogous to Allied forces negotiating w Hitler on the beaches of Normandy for how many lives we can accommodate for the Nazis to remain in power. Collaboration, whether complicit or duplicate, is still culpable.

It most certainly is the tobacco companies that are killing people. Tobacco has not been a benign weed on the side of the road for 400 years. Without the predatory capitalist promotion of an addictive deadly product there would be no pandemic. To assume that tobacco companies are going to rectify this with new nicotine products is ludicrous.

We already have ‘harm reduction’ policies proven to reduce the harm of prevalent use: taxes, tobacco free space, and marketing reform. And criminal proceedings for corporate executives seems promising. The best we can hope for with Reynolds, or any tobacco company, in producing NRT products is a perpetuation of the misdirection that warranted a federal conviction in a U.S. court for fraud and racketeering. A corporations’ only obligation is to profit and the tobacco industry’s profit is incompatible with the public health.

One of the best gauges of the effectiveness of tobacco free advocacy is how the industry behaves. This dubious flirtation with NRT and the incredibly overhyped E cigarette should do little more than question the efficacy of either to actually reduce use. The tobacco industry has had decades to reduce the harm they cause and have responded with fraud, smuggling, endless litigation, manipulation of policies and politicians, and an ever increasing mortality rate in the developing world.

An alliance with the tobacco industry is just that. Don’t expect any applause.

harm reduction or criminal distraction

The recent acquisition of cessation products manufacturer Niconovum by Reynolds American International reveals much in the way prevention advocates should treat a harm reduction perspective and provide greater emphasis on challenging the rogue capitalists that market nicotine. Mr. Ezekwesiri Eluchie has quite astutely pointed out that the industry is once again setting the agenda within which tobacco control advocates find themselves.

The acquisition of Niconovum displays just how much harm reduction is of necessity product centered and by definition unconcerned w the corporations that profit from the spread of nicotine addiction. Harm reduction advocates do little more than collaborate with sophisticated marketing strategies that subtly shift the onus of addiction back to the user. Until advocates can unite in recognition that it is not merely tobacco, but the rogue capitalism practiced by nicotine profiteers we must challenge, they will continue to set the agenda.

As well this casts umbrage on those that profit from NRT and pharmacological solutions to nicotine addiction and unfortunately raises questions about funding from these companies for tobacco control. Given how woefully and comparably underfunded advocates are I have no immediate solution. But Mr. Eluchie’s suggestion that we fully acknowledge the magnitude of death and disease from tobacco as simply criminal seems a very good place to start.