How to use “chemicals” to deter dual use

How to use “chemicals” to deter dual use

I guess it’s a case of “start as you mean to go on” regarding ‘scientific research’ on e-cigarettes. The very first paper I read in 2017 has this in its conclusion:

FDA is required to publicly display information about the quantities of chemicals in cigarettes and cigarette smoke in a way that is not misleading. This information, if paired with information from advertising or FDA disclosures indicating that e-cigarette aerosol contains lower amounts of those same chemicals, could have the unfortunate effect of encouraging smokers to become dual users or increase their existing dual use under the mistaken impression that they are significantly reducing their health risks.

That’s quite a statement to make. Here smokers, don’t go dual use tobacco and e-cigs ‘cos you’re not actually reducing the harms. What a way to start 2017.

Originating from the Department of Health Behaviour in the University of North Carolina (I’m so sorry folks), the paper entitled “How Hearing about Harmful Chemicals Affects Smokers’ Interest in Dual Use of Cigarettes and E-cigarettes” goes on to ask some pointed questions related to the “amount of chemicals” in cigarettes vs e-cigarettes. In the abstract, the authors boldly claim:

Public health harm could result from widespread dual use (i.e., concurrent cigarette and e-cigarette use) were it to undermine smoking cessation.

Erm, unless I’ve been misreading the stats for the last two years, actual smoking prevalence has decreased anywhere where e-cigarette use is prevalent. How is that “undermining smoking cessation”? If anything, it’s complementing it. True, not all want to use an e-cig as a cessation method, by the same token not all want to use NRT for it either.

Perceptions of chemical exposure and resulting harms may influence dual use.

Aha! There’s the nub. Thing is folks, everything is made up of chemical constituents. It’s the levels of those constituents that may – or in the majority of cases may not – pose any significant risk. I’m reminded of Tom Pruen’s “Tale of Two Chemicals” post where he compares a common, everyday “chemical” to the oh-so-deadly Nick O’Teen. What is that common everyday chemical?

Diesel. The stuff that makes motor vehicles go vroom.

The list of “hazards” associated with diesel are extensive. As are the safety precautions needed. But yet, we as everyday consumers are exposed to the fumes of the liquid fuel, the byproduct of combusting said fuel and, on occasion, actual skin contact with it.

Ridiculous isn’t it? Now we have this “research” suggesting that by mentioning chemicals in e-cigs folk won’t want to use them!

Smokers associated higher chemical amounts in cigarettes versus e-cigarettes with greater health harms from cigarettes and thus expressed increased interest in dual use.

Those smokers would in fact be correct in that assumption. Not that this should have any regulatory bearing in the slightest, but this is US “research” where policy recommendations are rife in the discussion.

The findings suggest that disclosing amounts of chemicals in cigarette smoke and e-cigarette aerosol could unintentionally encourage dual use.

Good grief! Reading between the lines a bit here, they are suggesting that all interested parties (that is, FDA, CDC, Health Orgs, and of course not forgetting the sockpuppets) brazenly lie to discourage a form of harm reduction!

One consideration for FDA in determining how to disclose constituent information in cigarettes may be the impact of this information on use of e-cigarettes, another product that FDA now regulates and will eventually require manufacturers to report the levels of constituents.

So the FDA is to disclose the “chemical” threat in cigarettes - so bloody what? It does present them with a unique problem. If they are to present that information, then they have to present it in a similar format for e-cigarettes. Thus, the problem they face is that the amounts - and often the constituents found in e-cigarettes - are substantially lower or not present. Dual use, seen by many as a transition from combustible tobacco to a substantially less harmful alternative, is seen in the US as a threat to public health.

One public health concern about disclosing cigarette smoke constituent information to the public is that smokers may respond by initiating or increasing e-cigarette use without quitting cigarette smoking (i.e., engaging in dual use of these products).

The thing with dual use is that smokers do it because they want to. They want the sensation or the ritualistic part of smoking, usually in places where smoking is prohibited. In doing that they are replacing a cigarette. That is one less cigarette smoked. Where’s the harm in that?!

Thus, starting or increasing e-cigarette use, even if accompanied by some reduction in cigarette smoking, is unlikely to lead to improved health outcomes.

Utterly delusional.

Smokers trying to use e-cigarettes to quit smoking often use a tapering approach to reduce their cigarette smoking over time, which for some individuals may be a less successful strategy than “quitting cold turkey” for achieving successful cessation.

Good grief, these folks really don’t get it do they? Smokers, by and large, don’t want to quit and they definitely don’t want to just go ‘cold turkey’. Completely missing a vital point. Smokers do actually enjoy smoking.

The FDA is currently considering how best to publicly display information on the amounts of harmful chemicals in traditional cigarettes and e-cigarettes and whether certain tobacco products like e-cigarettes could be approved as “modified risk tobacco products” on the basis of their amounts of harmful constituents.

There’s a subtle hint that the FDA may not approve e-cigs as “modified risk tobacco products” - which I guess many of us suspected - but that isn’t the point of this post. This research used four broad scenarios:

  1. What if the amount of harmful chemicals in cigarettes was the same as in e-cigarettes
  2. What if the amount of harmful chemicals in cigarettes was about 10 times higher than in e-cigarettes
  3. What if the amount of harmful chemicals in cigarettes was about 100 times higher than in e-cigarettes
  4. What if cigarettes had harmful chemicals, but e-cigarettes did not

This then led them to the conclusion that by referring to chemicals in either cigarettes or e-cigarettes presents them with a “public health problem” where they will have to lie to prevent uptake of e-cigarettes by potential dual-users.

It’s never been about health has it?

(image credit bedya/