Smoke-free air policies: past, present and future

[Vocalek]

This is an open-access article. Link to full text: Smoke-free air policies: past, present and future

In very recent times, there has been much discussion in the tobacco control community about electronic nicotine delivery systems, which use battery power to heat a glycogen and nicotine containing solution to a gas phase where it is inhaled by the user. Of course, there is also pharmaceutical grade medicinal nicotine that has been available for many years. It is not clear whether these products will yield public health gains more quickly than established tobacco control strategies such as smoke-free policies, higher tobacco taxation and increased public awareness. Proponents point out that these products are an alternative aid in smoking cessation while critics argue they may foster continued nicotine addiction and are a ‘gateway’ to promote smoking among young people and sustain the tobacco industry’s earnings.113 One analysis indicates that noncombustion low nitrosamine smokeless tobacco products are unlikely to produce much public health gain under a variety of scenarios and in some scenarios they can make public health worse depending on how much dual use with cigarettes is occurring.114

113. Melikian AA, Hoffmann D. Smokeless tobacco: a gateway to smoking or a way away from smoking. Biomarkers 2009;14(Suppl 1):85e9. Smokeless tobacco: a gateway to smoking or a way ... [Biomarkers. 2009] - PubMed - NCBI
114. Mejia AB, Ling PM, Glantz SA. Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA. Tob Control 2010;19:297e305. Quantifying the effects of promoting smokeless t... [Tob Control. 2010] - PubMed - NCBI

The first article, at least from what one can judge from the abstract, sounds as if it gives both sides of the argument.

The latter article uses a Monte Carlo simulation model to predict effects of promoting smokeless tobacco as a harm reduction and concludes: "Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level." Of course we must always remember that the output of any computer program is only as good as the data you put into it. As we say in the IT world, GIGO.

I did a search on pubmed using the parameters "Glantz SA"[Author]

The search returned 311 articles.

Here are some sample titles:

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay.
Local Nordic tobacco interests collaborated with multinational companies to maintain a united front and undermine tobacco control policies.
Movies with smoking make less money.
Cigarette smoking is a risk factor for Alzheimer's Disease: an analysis controlling for tobacco industry affiliation.
Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke.
Misleading conclusions from Altria researchers about population health effects of dual use.

 

[rolygate]

You wonder who these lies are designed for, anyone who can google would realise that a statement such as: "Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level" is the wildest fantasy; or if designed to be taken as factual, then then simply an egregious lie.

Sweden reduced the number of smokers by 40%, has the lowest number of smokers of any developed country (12%), was the first European country to reduce smoking prevalence to less than 20%, will be the first European country to reduce smoking to below 10%, has the lowest lung cancer rate in Europe, will soon have the lowest oral cancer rate in Europe, and has the lowest smoking-related mortality rate of any developed country.

All entirely due to the use of smokeless tobacco.

Of course, Sweden may not actually exist, and could be a fictional country created by the evil tobacco industry. I believe this is what Glantz et al must be hinting at. In fact what it probably needs is further clinical research by Glantz and his team, to establish whether or not Sweden exists. If Talbot can get $0.85m to watch YouTube videos, Glantz should be able to get at least $1m to research whether Sweden exists or not. Research may in fact reveal that Sweden does not exist. This would align well with other clinical research where the result could simply be obtained by looking out of the window.

 

[jtpjc]

According to Wikipedia, Sweden actually does exist. Of course, I don't know how recently that particular entry was added.

 

[Eddie.Willers]

Stanton Glantz = fruitcake

 

[mostlyclassics]

I wish I could find the article now, but apparently it's disappeared off the internet. I read it about seven years ago. The article appeared in The New England Journal of Medicine. The authors were epidemiologists specializing in health care economics.

The main point of the article was that discouraging smoking was undesirable from a health cost containment standpoint for several reasons:

• Smokers die at younger ages and thus use up fewer total health care resources over the course of their shorter lifetimes than non-smokers do.
• Smokers on average die more cheaply than non-smokers. They incur more fatal myocardial infarctions and strokes, which in most cases involve an ambulance ride to the ER, then another ride to the morgue shortly thereafter, after only a few grand worth of ER pandemonium. Chemo/surgery for lung cancer is usually cheaper than for other types of cancers.
• Fewer lifelong smokers come down with Alzheimer's and other end-of-life wasting diseases, which involve long-term and very expensive 24/7 care. And so on.

What was striking about the study was that the authors estimated that the nation's annual health care bill would eventually be about 14% higher were the United States a totally non-smoking nation.

This was not in the April Fool's edition (I doubt the NEJOM has an April Fool's edition). Also, I recollect Charles Krauthammer mentioning this study in passing on Fox News Special Report. Think what you will of Fox News Channel: the fact of the matter is that Krauthammer is an MD and does keep up on these things.

 

[DC2]

According to Wikipedia, Sweden actually does exist. Of course, I don't know how recently that particular entry was added.

I'm sorry, but I don't consider Wikipedia a reliable reference.

 

[rolygate]

The main point of the article was that discouraging smoking was undesirable from a health cost containment standpoint for several reasons.

I believe it would be extremely hard to contend that the argument smokers are very good indeed for the economy is false. Smokers provide a net benefit of tens of billions of dollars per year, when all is totalled up.

However the issue is rather different at a personal level where the suffering takes place - smokers and their families don't derive the benefit, the country does. The fact that the country benefits by their suffering is not much help to the individual.

No doubt the economic benefit is one of the most important factors that ensure smoking will never be banned, since even its opponents benefit financially from it and have even voted not to ban it. Individuals probably feel differently about the issues though. I certainly do...

Part of the problem we face is that smoking is a giant money machine. Nobody who benefits from it wants to say goodbye to that, from the pharma companies selling the chemotherapy drugs, to the 'health' groups who are in the final analysis funded by it, to the States whose budgets are artificially propped up by it.

Trying to kill off a giant money machine makes you public enemy #1 for a lot of people with power. Nobody cares about the smokers, the general view is that when they bought their first pack of cigarettes they signed a contract that gave away any and all rights they had as humans or voters or consumers. Smokers obviously have no rights, if you tried to do what is done as a matter of course to smokers to any other sub-group of society you'd be in jail before your feet touched the ground.

 

[rolygate]

I'm sorry, but I don't consider Wikipedia a reliable reference.

Yes, no doubt that is right in some or even many cases. The quality is variable because anyone can edit it.

However I think it is wrong to generalise because some articles are really very good. For example, the Wikipedia article on Regulatory Capture is outstanding, and as far as I can see, the best on the web. If you know of a better resource for an overview of this aspect of government corruption then please tell me.

It's true that the FDA section could be considerably expanded but the author presumably did not have a great deal of specific knowledge of that area.

These articles are generally good for an overview of the topic and a pointer to other resources, which is probably all you can expect. Some articles are indeed of low quality or present a less than ideal overview.

However, in some cases they do a very good job indeed and I think that an all-encompassing attack on their quality is unfair. The articles are as good as whoever wrote them, and no more.

 

[DC2]

So you're saying that you believe Sweden exists?

 

[rolygate]

It is a fantasy country that anti-tobacco fanatics can claim does not exist, and pharma certainly wishes did not exist. It is a place that does not believe in EU lies, and therefore a place that the EU Health Commission wishes did not exist.

 

[Thulium]

Stanton Glantz = fruitcake

Actually, he's more like the guy who gets paid to be an "expert" about things he (sometimes admittedly) knows nothing about so that the people with vested interests can claim they were just doing what the experts told them to do. That's how it works, you see. *facepalm*

 

[rothenbj]

"Of course, Sweden may not actually exist, and could be a fictional country created by the evil tobacco industry."

Oh Sweden exists, of course, but the cultural differences that separate it from the rest of the world make their results inconclusive when moved outside their boundaries. Thus the need for the ban in the rest of Europe. Besides, total tobacco abstinence is only a regulation or two away and perhaps one more tax hike.

 

[Vocalek]

"Of course, Sweden may not actually exist, and could be a fictional country created by the evil tobacco industry."

Oh Sweden exists, of course, but the cultural differences that separate it from the rest of the world make their results inconclusive when moved outside their boundaries. Thus the need for the ban in the rest of Europe. Besides, total tobacco abstinence is only a regulation or two away and perhaps one more tax hike.

I suspect that the reluctance on the part of US smokers to switch to snus has a lot less to do with cultural differences than the required warning labels in the US stating that the product is not a safe alternative to smoking (so you might just as well keep smoking) and that this product can cause mouth cancer (so you had better keep smoking if you want to avoid mouth cancer.)

Actually, the parenthetical phrases are not included in the warning labels, but that's what 85% of the public believes when they read them.

The only warning label that appears in Sweden says that nicotine is addictive.

 

[rothenbj]

In addition to decades of negative publicity that made it appear that smokeless was worse than smoking. That to me has trumped any denials the tobacco industry issued on smoking. After all, that information was sold to us by the supposed "good guys".

 

[TennDave]

Wait a minute- if Sweden doesn't exist.....
You mean, there's no Swedish Girls' Volley Ball Team either??

 

[DC2]

Wait a minute- if Sweden doesn't exist.....
You mean, there's no Swedish Girls' Volley Ball Team either??

Depends... do fantasies count as reality?

Because yeah, I'm 6'5" and if fantasies count, then volleyball girls will always be real.
At least in my world.

 

[TennDave]

Whew... Thanks DC2- I was worried for a minute there.

 

[Thulium]

If Sweden doesn't exist, I'm in trouble because my parents just called me from Stockholm.

 

[Vocalek]

Wait a minute- if Sweden doesn't exist.....
You mean, there's no Swedish Girls' Volley Ball Team either??

Wait! Isn't that the team whose uniforms are made by the clever tailor from "The Emperor's New Clothes"?

 

[TennDave]

Wait! Isn't that the team whose uniforms are made by the clever tailor from "The Emperor's New Clothes"?

....I wish