Worth Reading: The scientific foundation for tobacco harm reduction (THR)

[Vocalek]

This article, recently published in the Harm Reduction Journal is definitely worth reading.

http://www.harmreductionjournal.com/content/pdf/1477-7517-8-19.pdf

Those of you who are new to this arena may not realize that e-cigarettes are just one tool that can be used to reduce the harm caused by smoking. Any non-combusted form of nicotine is less hazardous than inhaling smoke. Options would include e-cigarettes, snus, dissolvable tobacco products (orbs, strips, sticks) and even NRTs used long term. The concept is known as tobacco Harm Reduction (THR) and it is not warmly embraced by those working in tobacco control. They want us to have two choices:

A - Abstinence only, from all tobacco products.
C - Continue smoking -- kill yourself, see if we care.

They don't want us to have option

B - Better tobacco products

We call this the "Quit or Die" mentality.

Dr. Brad Rodu of the University of Louisville looks at where the science has led between 2006 and 2011. The folks who don't want you to have Option B are pretty much ignoring the science, even though they have "MD" and/or "PhD" or even "MPH" behind their names. Sometimes they make up their own science and get it published by their buddies running such medical journals as Tobacco Control, JAMA, and NEJM. And unfortunately, these are the folks driving the bus at the moment.

 

[CES]

thanks for the link Elaine. Will you have Roly put it in teh ECF library too?

 

[Vocalek]

I quote this excerpt from Dr. Rodu's article for the newbies among us who think we not-so-newbies are exaggerating (or perhaps a bit daft) when we claim that there is a coordinated effort to prevent us from using less risky alternatives...

"ST" stands for "smokeless tobacco".

In 2010 the American Heart Association released a policy statement on ST use. The statement was based on a literature review conducted by Piano et al. [28], which reported the following findings regarding various conditions:
Hypertension: “In summary, data from the majority of studies in this section do not support an increase in the incidence or prevalence of hypertension in ST product users.”
Myocardial Infarction: “In summary, data derived from the majority of studies conducted in Sweden, whereby snuff/snus is the major ST product used, have not demonstrated a significant increase risk of nonfatal or fatal MI...Data derived from predominately U.S. populations are equivocal.”
Stroke: “In summary, data from 2 studies (1 from the United States and 1 from Sweden) suggest that ST product use is associated with a slight increase in the risk of stroke mortality.”
Other Cardiovascular Risk Factors: “Although the data are limited, most studies have found no relationship between ST use and other biochemical risk factors for [cardiovascular diseases].”

Thus, after a comprehensive review, the Piano et al. study showed that there were no markedly increased risks among ST users for cardiovascular disease. Nevertheless, the Heart Association policy position on ST was decidedly negative: “The American Heart Association does not recommend the use of ST as an alternative to cigarette smoking or as a smoking cessation product.”

Piano MR, Benowitz NL, FitzGerald GA, Corbridge S, Heath J, Hahn E, Pechacek TF, Howard G: Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment. A policy statement from the American Heart Association. Circulation 2010, 122:1520-1544.

For some strange reason, the AHA believes that it is better for the heart health of smokers to continue inhaling smoke than it would be to switch to ST or even to use ST temporarily as a stepping stone to smoking cessation.

Just keep smoking.

 

[jtpjc]

How is it possible that all this utter stupidity goes by unnoticed by the general public. How is it possible that the media don't uncover all the obvious lies. They're all there ripe for the taking! How is it possible that you Americans take all this ....e without uproar.

Don't bother to answer. I know. It's all about the money. As soon as money is involved, truth goes out the back door.

 

[Vocalek]

The list of findings quoted above provide absolutely no objective input into a decision on whether or not to recommend switching from smoking to ST. All of their "evidence" compares the risk of ST use to no tobacco use.

This is a direct quote from the American Heart Association policy statement. Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy.

Due to the juxtaposition of the first two sentences, they seem to be saying that although ST risks are lower overall than smoking, an exception to that is that ST users have modestly higher risks of fatal MI and stroke than smokers. But is that actually the case?

We used the following search terms: smokeless tobacco, snus or snuff, cardiovascular disease, cardiovascular risk factors, hypertension, myocardial infarction, and stroke.

Notice what concept is missing from their search string. Smoking.

The evidence is not only missing; they never even went looking for it.

Quite obviously the modest risk of fatal myocardial infarction (MI) and fatal stroke compares ST users to non-users of tobacco, not to continuing smokers.

So the only reasonable recommendation they could have made from the evidence they presented is "The American Heart Association recommends that non-users do not take up the use of smokeless tobacco."

Only after showing us evidence that ST users do not have any lower risk of heart disease than smokers would it have been justifiable for them to make the statement “The American Heart Association does not recommend the use of ST as an alternative to cigarette smoking or as a smoking cessation product.”

Questions for the AHA:

What is the relative risk of heart disease in snus users who are former smokers compared with continuing smokers who don't use snus?
What is the relative risk of stroke in snus users who are former smokers compared with continuing smokers who don't use snus?

 

[rothenbj]

Now that paragraph written with proper emphasis reveals much more than the actual words-

"Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy."

First they admit that ST is safer than smoking, but omit the key words "much safer" I could even accept "may be much safer". They certainly stress the only negative they could address, potential death from MI or stroke, but they're not even on solid ground there so they add the safe word, "may". Again what they don't say, "although there is no evidence that the long term use of ST increases the risk of MI or stroke".

Everything carefully word crafted to underestimate the value of the alternative product and emphasizing the only possible negative, but not beyond "may". Why?

The last sentence says it all. The eugenicists believe they will mold future behavior. The attitude can only be read as a mission statement. "We will change your way of life to our beliefs, for the betterment of society as a whole, or we will win by attrition". That is a very dangerous approach because if they win here with this model, they'll expand it to other aspects of life they don't approve of.

 

[Vocalek]

How is it possible that all this utter stupidity goes by unnoticed by the general public. How is it possible that the media don't uncover all the obvious lies. They're all there ripe for the taking! How is it possible that you Americans take all this ....e without uproar.

Don't bother to answer. I know. It's all about the money. As soon as money is involved, truth goes out the back door.

The general public doesn't notice because all of the anti-smoker propaganda is masterfully written. It didn't dawn on me (and I live and breathe this stuff) until about the 3rd reading that the conclusion (as they say in the court system) "assumes facts not in evidence."