Carl Phillips named CASAA Science Advisor

[Vocalek]

Great news. Carl Phillips has agreed to serve as CASAA's science advisor. He will be attending the 10th European Society for Research on Nicotine and tobacco (SRNT) conference in Italy next month, and representing CASAA's interests. If you have any ideas on points you think he should address in his presentation, please post. Thanks!

 

[JustJulie]

"Great news" is an understatement. Tremendous news! Beyond exciting news! Amazing news!

For those who may not be as familiar with Dr. Phillips, he's one of the foremost authorities in the area of tobacco Harm Reduction, which is what CASAA is all about.

Tobaccoharmreduction.org

 

[primov3]

Finally something tweet-worthy today. Great News; big fan of him and his studies.

 

[carlvphillips]

Hi, everyone. Thanks for the good words.

I would like to solicit any opinions that any of you might have about what the critical scientific (defined broadly) questions are about the phenomena of e-cigs are for my talk at the SRNT meeting in Turkey in a couple of weeks. Two other speakers are covering the chemistry/toxicology research and the surveys of users that have been done, leaving me everything else, which is more than what it seems.

The outline of my talk is pretty well done, which consists of pointing out that if we look at e-cigs for what they are (very low-risk sources of a drug that is very beneficial to many people) rather than in relation to something they are not (thinking of them as basically cigarettes, only a bit different; or as a form of nonsmoking and nothing more) we can do much better research.

I point out that "research" aimed mainly at convincing people they are unhealthful is simply unethical.

Research that hopes to figure out exactly how risk they are is literally hopeless, but it is also misguided (perhaps not intentionally, like the previous category, but still harmful)

Research looking at the average naive smoker (e.g., give a bunch of random smokers e-cigs and say "try this and tell us if you quit") is also useless, and may be intentionally unethical too.

What would be much more useful would be study of the social phenomenon and why it revitalized (or perhaps just vitalized) THR.

I will add a bit more info about the substance, esp of the last bit, as it comes together if this thread is active. The activity I would really welcome are suggestions long the lines of "why is no one looking at..." or "why do they keep doing...."

Thanks.

--Carl

 

[MagnusEunson]

Research that hopes to figure out exactly how risk they are is literally hopeless, but it is also misguided (perhaps not intentionally, like the previous category, but still harmful)

Why? I understand your position as wanting to discuss research in terms of harm reduction, that I fully understand. However, shouldn't a general understanding of what harm might still come be done from the perspective that a new smoker is made every day and that person might instead be a new vapor not coming from cigarettes?

Other than that I look forward to seeing what you and the two other speakers have to save. Good luck, safe travels, and enjoy your new position. Cheers, -Magnus

 

[Vocalek]

Well, before e-cigarettes, Carl, proponents of smokeless tobacco were fighting an uphill battle against the tobacco-company haters. By extension, that hatred bled over onto tobacco consumers.

E-cigarettes are the first alternative that did not come out of a tobacco company.

When we consumers saw the dirty tactics being used by the members of the public health community that Kristin has dubbed the ANTZ, for Anti-Nicotine and Tobacco Zealots, our eyes were opened. We learned that these lies and crazy accusations were nothiing new. They have been doing this against proven safer alternative tobacco products for years and years. We could have quit decades ago, had there not been such active campaigns to totally wipe out all tobacco products, and damn the casualties!

I for one deeply resent that. This is my life they played around with.

I find very hard not to want to go up and smack some of the self-righteous prigs who say things like, "I took an oath to do no harm." Hello? They are inflicting harm.

The ANTZ have created a false dichotemy. They want us to believe that the only choices are A. Abstinence from all forms of nicotine or C. Continue Smoking. They want to pretend that B. Better options do not exist.

In my testimony at the FDA public hearing on Modified Risk Tobacco Products (you should have been there speaking, Carl) I pointed out that they were making several false assumptions.

All smokers will decide to quit in the near future.
Nicotine is inherently harmful.
Dual use increases "addiction" (people will end up using more nicotine)
Dual use increases health risks.

Perhaps we should encourage research that challenges these assumptions. All studies should be asking about readiness to quit. (T or F? Before I joined this study, I was planning to quit cold turkey next Tuesday). All should be asking about past attempts and what tools were tried.

Some studies should be recruiting smokers who are unwilling to quit, to see what effect using an e-cigarette has on their continued smoking.

And of course there should be studies that involve smokers who really want to quit and make note how many of them have relapsed over and over and over until they have just about given up all hope.

We can check biomarkers of health such as lung function, use of asthma medication, BP, cholesterol, heart rate while people are smokers, while they are dual users, and when they completely switch to vaping. We can continue following them up and see if moving on to no nicotine liquid results in any further improvements in health (I kind of doubt it). And then check those who gave up vaping altogether (without relapsing to smoking) and determine whether their health improved any futher than those who kept vaping.

If there are objective, measurable improvements in health in those who switch from inhaling smoke to inhaling vapor it becomes more difficult for ANTZ to claim that kids who might take up vaping instead of becoming smokers will be facing the same health risks as cigarette smokers.

 

[Thulium]

The outline of my talk is pretty well done, which consists of pointing out that if we look at e-cigs for what they are (very low-risk sources of a drug that is very beneficial to many people) rather than in relation to something they are not (thinking of them as basically cigarettes, only a bit different; or as a form of nonsmoking and nothing more) we can do much better research.

Carl, I think the problem is the tendency to view e-cigs as either recreational or therapeutic at the expense of the other. Most therapies are actually a form of intervention--when someone's own ability to regulate their health through diet and exercise fails, "medicine" intervenes and does (usually with a pill) what the patient seemingly cannot do for himself.

If the question is "Are e-cigarettes a reduced harm recreational alternative to smoking or can they be used as part of a plan to quit smoking completely?", the answer is clearly "Yes"

I point out that "research" aimed mainly at convincing people they are unhealthful is simply unethical.

Unethical and short-sighted. In a rush to moralize health issues, it ignores the non-medical benefits of recreational use that are responsible for people becoming addicted to smoking in the first place! People don't START smoking because they are addicted to nicotine, but medicine only addresses the unintended consequence of addiction and ignores the intended use of tobacco altogether: Smoking as a social activity (oversimplified as "peer pressure"), recreation/relaxation/stress relief, and/or self-medicating for depression, attention deficits, etc.

What would be much more useful would be study of the social phenomenon and why it revitalized (or perhaps just vitalized) THR.

I will add a bit more info about the substance, esp of the last bit, as it comes together if this thread is active. The activity I would really welcome are suggestions long the lines of "why is no one looking at..." or "why do they keep doing...."

Thanks.

--Carl

"Why is no one looking at..." the reduced quantity of tobacco consumed. Prohibitionists like to focus on the number of milligrams of nicotine delivered by one cigarette compared to the nicotine content of dissolvables or e-liquid while ignoring that you have to burn an entire gram of tobacco (converting MOST of the nicotine into harmful "tar", delivering only 1mg of freebase nicotine) to get one milligram of nicotine by smoking, while a gram of smokeless tobacco might be a substitute for 3-8 cigarettes and a gram of e-liquid is a substitute for 10 or more smoked cigarettes.

"Why do they keep doing..." studies on 'electronic nicotine delivery systems' when we know that nicotine delivery does not assure smoking cessation and smoking replacements can be effective tools for smoking cessation even if they do not deliver nicotine?

Carl, I think that the biggest roadblock is the tendency to view Tobacco Harm Reduction and Smoking Cessation as an either/or scenario rather than recognizing that the advantage of Vaporization technology is that it is almost completely customizable for a VARIETY of applications. The social aspect you mention is juts one (very good) example: Because science has limited its view to medical and therapeutic applications of nicotine and tobacco control has focused its efforts on emphasizing the health hazards of smoking and addiction, we have ignored all the other reasons people smoke cigarettes. Nicotine addiction is just ONE reason to smoke cigarettes and since it obviously not the reason that people START smoking, it is foolhardy to assume that treating nicotine addiction is the best way to convince people to quit.

Because e-cigarettes can be used with or without nicotine, they can be used as part of a structured plan to stop smoking and/or nicotine. Although it seems that this approach may only work for people who are motivated and/or "ready" to quit, these people have the best chances of long term cessation, so we should support the use of e-cigarettes for "therapeutic" use as well as a reduced harm alternative for those who are unwilling to completely quit using recreational nicotine/tobacco. I would like to see research to determine if people who use vaporizers that resemble and/or taste like tobacco cigarettes are more or less prone to "dual use" or relapse than people who use non-tobacco flavors and vaporizers that do not resemble cigarettes.

 

[MagnusEunson]

Thulium, would you also include an expanded look at WTA solutions? -Magnus

 

[Thulium]

Thulium, would you also include an expanded look at WTA solutions? -Magnus

Certainly, but as far as I know Nicotine is the only alkaloid of tobacco that has been approved for therapeutic use because the other alkaloids and MAO Inhibitors seem to have a synergistic increase in addiction. Nicotine alone can be prescribed for therapeutic use because it is unlikely to create new addictions, but WTA e-liquid might only be safe enough to use as a reduced harm/modified risk/smoke-free alternative tobacco product that cannot be sold to children under 18.

Studies dating back to 1943 (like this one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2135415/pdf/387.pdf ) have shown that propylene glycol is a safe and effective germicide, and since more recent studies are showing that it should be safe enough for human testing I think it is a great idea to begin studies on smokers who are specifically NOT wanting to quit and/or have relapsed after quitting with FDA approved therapy but have a chronic disease caused by smoking. 8.6 Million Americans have COPD or similar illnesses--"denormalizing" smokeless tobacco while the only available FDA approved interventions have less than 50% success rates and single digit rates of long term smoking abstinence is SHAMEFUL.

 

[kristin]

The outline of my talk is pretty well done, which consists of pointing out that if we look at e-cigs for what they are (very low-risk sources of a drug that is very beneficial to many people) rather than in relation to something they are not (thinking of them as basically cigarettes, only a bit different; or as a form of nonsmoking and nothing more) we can do much better research.

They should also NOT be compared to breathing clean air. The users of this product are SMOKERS. They are already not breathing clean air and if e-cigarettes were not available, the vast majority would still be smoking. And in the extremely rare case that they weren't already smoking before using e-cigarettes, in the absence of e-cigarettes, they'd be smoking instead. People who weren't already smoking or already have an interest in smoking would NOT be interested in e-cigarettes.

I point out that "research" aimed mainly at convincing people they are unhealthful is simply unethical.

The assumption that all or even most smokers WANT to quit because they don't enjoy smoking or feel a slave to addiction is FALSE. There is a difference in KNOWING you SHOULD quit for your health and WANTING to quit. The efforts to portray e-cigarettes as unhealthful is based on the false assumption that e-cigarette users would otherwise be successful using NRT or haven't already tried NRT. Even CASAA's E-cigarette User Survey showed that most e-cigarette users (64.6%) did not start using the product to quit addiction or even to quit smoking. They stated that they started using them "To continue to have a "smoking" experience, but with reduced health risks." The fact that the e-cigarette market is growing so rapidly, in spite of the warnings by the FDA and the ANTZ, testifies to the fact that so many smokers would rather have a healthier alternative rather than be forced to quit.

So, the attempts to convince smokers that e-cigarettes are unhealthy only serves to keep them smoking. They are fooling themselves if they think e-cigarette users would otherwise be using NRT successfully and it appears self-serving to push products on us in which they have a vested interest. This is SERIOUS, because they are losing the trust of e-cigarette users who know better than what they are telling the public. It makes everything they say suspect and when the truth comes out after the research is done, they will not only look foolish, they will look unethical and greedy. It will spread to other health issues - I am already strongly suspect of anything public health claims is dangerous these days - not just e-cigarettes. They are seriously harming their credibility.

Research that hopes to figure out exactly how risk they are is literally hopeless, but it is also misguided (perhaps not intentionally, like the previous category, but still harmful)

Research on the health risks should focus on the immediately apparent REDUCED risks and any potentially known toxic ingredients, but expecting smokers to keep smoking for the next 20 years (because we've already established most e-cigarette users had no intention of quitting or found NRT ineffective) while researchers test the long-term effects of is unreasonable and unethical. (As Elaine pointed out - which does more harm?) Additionally, most drugs aren't tested for long-term effects that far out anyhow. Not even close. (See Chantix health effects in basically the same time period e-cigarettes have been on the market.) Again - do not compare it to clean air, compare it to SMOKE. The users are SMOKERS and there is no evidence that non-smokers of any age are showing significant interest in e-cigarettes. As long as tobacco cigarettes remain legally available, e-cigarettes will be a secondary after market for inveterate smokers.

Research looking at the average naive smoker (e.g., give a bunch of random smokers e-cigs and say "try this and tell us if you quit") is also useless, and may be intentionally unethical too.

Yes - designed to fail. They need to look at those who successfully switched and see about making the product even safer and even more effective rather than trying to discredit them. Handing a smoker a basic e-cigarette and expecting them to use it properly would be like handing someone who has only ever used a rotary phone an iPhone and telling them to "use it like you would your phone." It would have similar failure rates!

What would be much more useful would be study of the social phenomenon and why it revitalized (or perhaps just vitalized) THR.

And how e-cigarettes are making it very clear that smokers smoked for different reasons - not just the nicotine. Reading these forums, you see some concerned with nicotine strength, while others are more concerned with throat hit with LESS nicotine, others concerned with flavors, others concerned with vapor production, others enjoy the tinkering and still others find "something missing" even with all of those issues addressed (needing to supplement with products like snus for the other MAOIs in tobacco.) We need to get the focus off of nicotine and back to eliminating the inhalation of smoke. The evidence of failure for NRT shows that nicotine does not play as large of a part in the smoking behavior than originally thought. Sometimes I wish they had never discovered nicotine's addictive qualities, because that switched the focus to fighting addiction (and shaming smokers) rather than on getting people to not SMOKE the tobacco.

I will add a bit more info about the substance, esp of the last bit, as it comes together if this thread is active. The activity I would really welcome are suggestions long the lines of "why is no one looking at..." or "why do they keep doing...."

Why is no one looking at...
- Vapor compared to smoke instead of air
- Those who have successfully switched and why they succeeded
- What is in the exhaled vapor
- Repeat business for companies who sell "cigarette-style" e-cigarettes (how many fail and how many move to advanced models)
- Improving e-cigarette quality & effectiveness rather than criticizing current products

Why do they keep...
- Repeating the FDA press statement when it has been proven misleading and an exaggeration of the facts
- Ignoring that the health groups fighting e-cigarettes get a huge amount of funding from pharmaceutical companies with a vested interest
- Ignoring the research that shows e-cigarettes do not contain unhealthy levels of any toxins or carcinogens
- Claiming e-cigarettes will be a gateway to smoking when the exact opposite is being shown
- Claiming smokers don't want flavors when the exact opposite has been shown true and part of the reason e-cigarettes work (while ignoring similar flavors used in NRT)
- Claiming youth will want e-cigarettes while "cooler" tobacco cigarettes remain more readily available, are less of a hassle and are not seen as a "health product for older people"
- Putting the emphasis on ending addiction rather than ending smoke exposure

Thanks.

--Carl

 

[carlvphillips]

Hi. Thanks for the comments. I just posted a link to my current draft slides at the "We are CASAA" facebook group. I did not manage to incorporate all the comments yet,b ut will add some others in. Those of you who offered content: please let me know if you want to coauthor the subsequent paper with me.

 

[rolygate]

@Thulium:

.....as far as I know Nicotine is the only alkaloid of tobacco that has been approved for therapeutic use because the other alkaloids and MAO Inhibitors seem to have a synergistic increase in addiction.

I believe there is an NRT either in use or in the later stages of license approval that uses another tobacco WTA: anabasine or anabatine (I forget which) plus yerba (a herb, I think). I seem to remember it is called cig.rx or something similar. Also, that WTA is used for reduction of inflammation in rheumatoid arthritis or something like that.

Sorry - I'm mega busy today or I'd research a link...

 

[Thulium]

@Thulium:


I believe there is an NRT either in use or in the later stages of license approval that uses another tobacco WTA: anabasine or anabatine (I forget which) plus yerba (a herb, I think). I seem to remember it is called cig.rx or something similar. Also, that WTA is used for reduction of inflammation in rheumatoid arthritis or something like that.

Sorry - I'm mega busy today or I'd research a link...

I found it: How It Works | CiGRX It's a lozenge with Anatabine and Yerba Mate.


That's a great point that there certainly ARE potential therapeutic uses for the other tobacco alkaloids that are, like many other pharmacologically active ingredients found in many plants and vegetables, generally overlooked because naturally occurring foods and plants can't be patented and sold by multinational pharmaceutical corporations.

 

[Vocalek]

I found it: How It Works | CiGRX It's a lozenge with Anatabine and Yerba Mate.


That's a great point that there certainly ARE potential therapeutic uses for the other tobacco alkaloids that are, like many other pharmacologically active ingredients found in many plants and vegetables, generally overlooked because naturally occurring foods and plants can't be patented and sold by multinational pharmaceutical corporations.

And here is their newest product, an anti-inflammatory supplement containing anatabine: Anatabloc™

 

[Vocalek]

Star Scientific is conducting clinical trials on the effects of its two supplements on urge to smoke:

Study to Evaluate the Safety and Efficacy of Dietary Supplement Anatabloc in Reducing Daily Smokers' Urge to Smoke - Full Text View - ClinicalTrials.gov


Geographic area: Martinsburg WV

 

[Pamdane]

I do not know if any of my contributions will be pertinent to what you state you are seeking, but here are a few things I ponder/relate to vaping in the real world.

Vaporizers are a category that incudes the machines we parents have been using for ages. We put them in our children's rooms when they have colds. I, for one, have never questioned the liquid ingredients other than mentholatum. But even so, where are the health studies on that? Another item I would place under vaporizer is the nebulizer used by asthmatics. It can be vaped almost as we do passthroughs, or as a mask. There should be research available, done by BP no less, to support our modified down versions of both items.

An argument may be made as to how vaporizers and nebulizers compare to mods as "hooks" for bringing smoking to minors.