Greetings from the SRNT Conference

[Vocalek]

When my husband drove me to the airport yesterday morning, he called me "Daniel" because I was (figuratively speaking) going into the proverbial lion's den. I am in Houston, attending the annual conference of the Society for Nicotine and tobacco Research (SRNT). This is a meeting where folks who conduct research present their results as "Papers" (lectures followed by short Q&A session) or "Posters."

In the Poster sessions, a large ballroom is divided into corridors by tack boards. Folks who have some research results to present prepare a large (typically around 6 feet long by 3 or 4 feet high) poster that describes their work. During the posters sessions, someone from the research team is supposed to be standing by the poster to greet folks and describe what their project was all about.

I have some very good news. One of the sessions was the New Investigator Award Paper session, where three young researchers present the results of their project. One of the award winners was Maciej Lukasz Goniewicz, whom as you might guess was born in Poland, but just last year moved to the UK. His paper was titled ELECTRONIC CIGARETTES DELIVER SIMILAR LEVELS OF NICOTINE AND REDUCE EXPOSURE TO COMBUSTION TOXICANTS AFTER SWITCHING FROM tobacco CIGARETTES. Four other authors are named in the credits, but the only one attending the SRNT was TPSAC member Dr. Neal Benowitz, who is considered one of the foremost experts on nicotine safety and toxicity. (There is a book by that name and Benowitz was both a contributor and the editor of the book).

Anyhow, young Dr. Goniewicz described how a group of 20 smokers was recruited and asked to substitute an e-cigarette for their regular cigarettes for two weeks. Subjects were not forbidden to smoke but were asked to report whether they smoked and how many. Saliva cotinine (a marker for nicotine levels), exhaled Carbon Monoxide (a test for whether you have inhaled smoke), and NNAL (a carcinogen that is metabolized from the tobacco-specific Nitrosamine NNK) were measured at baseline and again at 1 week and 2 weeks.

Characteristics of the group were: average age 31, 55% female, FTND (a test of nicotine dependency) score of 3.8, average # years smoked 12, and a measurement of motivation to quit of 8.7 on an 11 point scale. 55% had tried to quit smoking previously.

Carbon monoxide levels decreased across the group. The group went from an average of 16 cigarettes per day (CPD) to 1 CPD. 8 of the 20 subjects did not smoke at all. Craving to smoke was reduced, but was not statistically significant. Levels of NNAL decreased 64%, indicating little or no exposure to NNK, CEMA, SHBNA, HEMA, and HPMA. I'd tell you want these stand for, but I don't know. I just wrote them down as the appeared on screen.

Overall, this was a very positive study and seemed to be well received by the audience. I consider it an extremely good sign that a body like SRNT thought this paper was good enough to receive an award.

There was a showing this evening of the documentary film, Addiction Incorporated, that tells the story of a scientist who used to work for Phillip Morris and how he became the whistle blower in congressional hearings that touched off the mass of lawsuits against tobacco companies that ended with the Master Settlement Agreement giving tons of money to the states supposedly to reimburse them for the health care costs they incur on smokers' illnesses. Frankly, I am sure that We are Vapers will be a much better film. There were some distracting sequences of cartoon rats rafting, surfing, and dancing which was backed up by unbearbly shrill wooden flute music. Nevertheless, this audience loved it and gave it a standing ovation.

It's late. I'll try to write more tomorrow!

--Elaine

 

[ctourtelot]

Thanks for sharing that! It does seem promising.

 

[pianoguy]

Thanks for sharing that! It does seem promising.

+1

Great to hear, Elaine!

 

[TomCatt]

Looks like 'Daniel' discovered some allies already inside the den

Thanks Elaine!!

 

[Vocalek]

FDA'S CENTER FOR TOBACCO PRODUCTS: OVERVIEW AND RESEARCH PRIORITIES

FDA will be giving away buckets of money to conduct research, via grants administered though NIH. The topic of this presentation was "How can research inform regulatory questions." Some of the topics to be studied include reducing addiction, reducing toxicity, vulnerable populations (e.g. smokers with psychiatric conditions such as depression), user behavior with products; user perceptions, attitudes, and beliefs, how reductions on nicotine content affect behavior, modified risk tobacco products (effects on both users and non-users), communication (how to effectively communicate FDA's regulations), impact of social media campaigns and other non-traditional communication strategies.

FDA's challenge is to ensure that the law (i.e. the Family Smoking Prevention and Tobacco Control Act aka "Tobacco Act"), public health, and science are put together.

FDA issues guidance (which is not legally binding), and regulations (which are). There are "statutory deadlines". These are dates built into the law by which FDA much perform a particular task. For example FDA had to deliver a report on the effect of menthol on the addictiveness of cigarettes.

When FDA wants to issue a regulation, it publishes a Notice of Proposed Rule Making (NPRM) in the Federal Register. FDA also publishes these on its web site. There is an open public comment period (usually 60 days), during with any person or organization can submit data in the "public docket" on the regulations.gov web site.

FDA wants researchers to submit data and manuscripts for these. You can sign up for email updates from the FDA's Center for Tobacco Products. Sign Up for E-mail Updates on Tobacco Products

Citizens with questions can email AskCTP@fda.hhs.gov

My ears perked up when they mentioned FDA discussions with stakeholders. Then I came back to my room and looked it up. Stakeholder Discussion Series

I don't see consumers on their list. Do you?

Mitch Zeller asked a question about the "Continuum of Risk" that was talked about by the CDC presenter yesterday. I missed that particular session, but the folks from British American Tobacco told me that they were surprised to see CDC talking about that and thought it was a hopeful sign that they are beginning to think seriously about harm reduction.

Zeller also mentioned a Citizen Petition to the FDA as a way to get important issues considered. We will have to look into that one. I caught up with him outside the meeting room and he also talke me that we can dialog with the Ombudsman's Office. Another thing to look into.

SHIFTING THE TOBACCO PARIDIGM: CAN THE FDA TOBACCO CONTROL ACT LEAD TO THE END OF COMMERCIAL CIGARETTE SALES IN THE US?

This was a panel discussion moderated by Scott Lieschow (University of Arizona) with David Abrams (Legacy Foundation), Dorothy Hatsukami (a psychiatrist and nicotine researcher from University of Minnesota) and Tom Glynn of the American Cancer Society. Glynn and Hatsukami are both members of TPSAC.

Asked what the most important portion of the Tobacco Act is, one panelist answered that it was the power to issue product standards based on solid science. Some of the challenges include determining the public health impact of reduced harm products. Much of the discussion focused on reducing the nicotine content of tobacco products. The law prohibits FDA from outright banning any class of products, or from reducing the nicoitne to zero, but allows reducing the nicotine content to a level that is "not addictive." Hatsukami pointed out that there could be unintended consequences of lowering nicotine content such as dysfunction among those with psychiatric conditions, or the emergence of contraband products with higher nicotine content. Dave Abrams reported that Legacy's surveys show there is a positive response from the public about reducing nicoitne in combusted cigarettes. But sometimes the questions are loaded. "Would you support reducing the nicotine content in cigarettes if fewer children would take up smoking as a result?"

David Abrams mentioned e-cigarettes several times. He said they might be the future of cigarettes. Perhaps Jed Rose's nicotine pyruvate would become the standards. (See :
Rose JE, Turner JE, Murugesan T, Behm FM. Pulmonary delivery of nicotine pyruvate: sensory and pharmacokinetic characteristics. Poster, Society for Research on Nicotine and Tobacco 16th annual conference, Baltimore, 27 February 2010. http://www.srnt.org/conferences/2010/pdf/2010_Program.pdf)

Hatsukami said she was nervous about inhaled products and thought they should only be available by prescription. (My thought bubble: Hello? A tobacco product available by prescription? Let's be realistic here.)

They mentioned that e-cigarettes fall into a legal gray area between pharmaceutical products and tobacco productions. The question was asked whether pharmaceutical companies could decide to market their NRTs as tobacco products. Zeller said yes.

There was a brief discussion of the relative harmfullness of nicotine. Should it be on par with caffiene, or with .......[censored, name of an illegal drug that starts with "c"]? That particular question was left unanswered.

The issue was raised that if there are products that are labeled less harmful whether that would make them appealing to young smokers. (Thought bubble: Let's hope so, for their sake, if they are already smoking!)

What happens, asked one panelist, if smokers only use the less harmful products some of the time? For example, if an adult uses a less harmful product 80% of the time, and smokes 20% of the time, is that delaying quitting? (Thought bubble: At least that adult is smoking fewer cigarettes, and every little reduction helps!)

During the audience question period, Jonathan Foulds asked how long all this research was going to take. The answer was "We don't know."

I went to the mike and commented that I think we can all agree that the most beneficial thing for the health of a smoker is to quit as soon as possible. The kind of research you are talking about could take years. We have products that we know are less harmful. Swedish snus is one, dissolvable orbs can't be any more harmful than Nicorette lozenges, and e-cigarettes are proably no more harmful than a pharmaceutical nicoitne inhaler. Why don't we stop DISCOURAGING smokers from switching to these?

There were cries of outrage from the stage. Sweden has a different cultural outlook than we do. Kids might take up use of these products. People might delay quitting. *sigh* I seem to have heard this song somewhere before.

They declared the meeting out of time.

I plan to email each of these panel members to emphasize that I was not asking them to PROMOTE switching to these products--only to stop giving smokers the impression that all tobacco products are just as harmful as smoking.

How can they fail to realize that they are telling smokers, "Just keep smoking until you can quit altogether." And how can they fail to realize how much harm this does?

 

[Vocalek]

Abstracts for the second of two sessions just reviewed:

SHIFTING THE TOBACCO PARADIGM: CAN THE FDA TOBACCO CONTROL ACT
LEAD TO THE END OF COMMERCIAL CIGARETTE SALES IN THE US?

Chair: Scott J. Leischow*1
Panelists: Scott J. Leischow*1, Mitch Zeller2, Sue Curry3, and Tom Glynn4, 1The University
of Arizona; 2Pinney and Associates; 3The University of Iowa; 4American Cancer Society
The Family Smoking Prevention and Tobacco Control Act (FSPTCA) became US
law in 2009, and provisions of the Act gives the FDA wide-ranging authority to regulate
tobacco products. While the implementation of the law is in its very earliest stages, it is
clear that there are great potential for the implementation of this new law to dramatically
change the nature of tobacco products, how they are marketed, and how they are
purchased. For example, the law prevents the FDA from eliminating nicotine - the main
addicting ingredient - but does not prevent the FDA from reducing nicotine to levels
that are functionally non-addicting. Moreover, the law gives the FDA authority to restrict
the design and color of packaging, increases the visibility of tobacco use warnings
and allows for tobacco treatment assistance on the package, and gives states the
right to impose even more stringent requirements than the FDA itself. Given the many
provisions in the law, particularly the potential to virtually end the addiction potential
of cigarettes, it is possible that the Act could lead to the end of cigarettes as we have
known them. However, the tobacco industry has already begun to fight back. In order
to explore the potential of the Act to eliminate the most dangerous legal product in the
US - the cigarette - we are proposing to convene a panel of research and policy experts
to explore whether the Act could cause the elimination of the cigarette as we have known
it. The panel will also explore potential ways that the tobacco industry might undermine
such an effort. The chair of the panel will use an ‘interview-style’ approach to fostering
panelist comment and discussion that will address the interplay of science and policy
on the potential to eliminate the cigarette as a product in the US. Audience participation
will assure a discussion that could lead to new research directions and have policy
implications.

CORRESPONDING AUTHOR: Scott Leischow, The University of Arizona, 1515
N. Campbell Ave, Tucson, AZ 85745, United States, Phone: 20-665-1111, Email:
sleischow@azcc.arizona.edu

The first FDA session must have been a late addition. It is not in the book of Abstracts.

 

[BoiseMike]

I gotta stop checking in on the law and media forums. Every time I do I start wondering where to signup for the revolution. We've got government agencies out in the open planning how to coerce and regulate human behavior into what they think it should be. For our own good of course. In "the most free country in the world." I often doubt that. If we are, I feel really bad for the rest of the world. Have we grown that numb to government intrusion into our lives, using our confiscated money to do it, that there's no disgust, contempt or outrage at what our country has become?
Sorry for the rant, Vocalek. I do appreciate what you're doing. Thanks.

 

[dordas23]

Thanks for all your work for us, Vocalek. You speak for many of us who are simply inarticulate.

 

[dlsw]

There were cries of outrage from the stage. Sweden has a different cultural outlook than we do. Kids might take up use of these products. People might delay quitting. *sigh* I seem to have heard this song somewhere before.


Since when is improving the health of a nation considered a "cultural outlook"? If this is our cultural outlook, as the esteemed scientists state, we value law over human life. I would like to know which "scientific study" led them to this conclusion. Which Americans did they survey? This is supposed to be a scientific and medical community making decisions, not pseudo anthropologists and linguists.

 

[NorthOfAtlanta]

FDA'S CENTER FOR TOBACCO PRODUCTS: OVERVIEW AND RESEARCH PRIORITIES

....................

I plan to email each of these panel members to emphasize that I was not asking them to PROMOTE switching to these products--only to stop giving smokers the impression that all tobacco products are just as harmful as smoking.

How can they fail to realize that they are telling smokers, "Just keep smoking until you can quit altogether." And how can they fail to realize how much harm this does?

They totally realize what they are doing, they just want to keep us on the money generating merry go round of smoking, quitting with NRT, failing and finally quitting again. Then pain killers, breathing treatments and cancer drugs. If we use harm reduction to get off the merry go round they will no longer have a job. Not to mention the loss of sin taxes that the local state and federal governments set a nice chunk of their budgets on.

 

[rothenbj]

"I went to the mike and commented that I think we can all agree that the most beneficial thing for the health of a smoker is to quit as soon as possible. The kind of research you are talking about could take years. We have products that we know are less harmful. Swedish snus is one, dissolvable orbs can't be any more harmful than Nicorette lozenges, and e-cigarettes are proably no more harmful than a pharmaceutical nicoitne inhaler. Why don't we stop DISCOURAGING smokers from switching to these?

There were cries of outrage from the stage."

Is that the cry that gets you uninvited next conference? You know these love fests don't appreciate movers and shakers.

 

[rothenbj]

There were cries of outrage from the stage. Sweden has a different cultural outlook than we do. Kids might take up use of these products. People might delay quitting. *sigh* I seem to have heard this song somewhere before.


Since when is improving the health of a nation considered a "cultural outlook"? If this is our cultural outlook, as the esteemed scientists state, we value law over human life. I would like to know which "scientific study" led them to this conclusion. Which Americans did they survey? This is supposed to be a scientific and medical community making decisions, not pseudo anthropologists and linguists.

Since our healthist have sold us on "fill in the blank is not a safe alternative to smoking" for decades. It's hard to back off a mantra that has emanated in our culture to the point that the average Joe on the street believes smokeless is more harmful than smoking.

They totally realize what they are doing, they just want to keep us on the money generating merry go round of smoking, quitting with NRT, failing and finally quitting again. Then pain killers, breathing treatments and cancer drugs. If we use harm reduction to get off the merry go round they will no longer have a job. Not to mention the loss of sin taxes that the local state and federal governments set a nice chunk of their budgets on.

There is always the fall back position of obesity. That should keep them in business for the next millennium. They just have to figure out what they can tax that doesn't bring 80% of the population down on their heads.

 

[Vocalek]

I'm going through the book of Abstracts from the conference and came across one I figured this audience would be interested in.

POS3-107
E-CIGARETTE ABUSE LIABILITY: SUBJECTIVE, BEHAVIORAL, AND EXPOSURE EFFECTS OF SWITCHING

Vaughan W. Rees*, Jonathan Noel, Ilan Behm, and Gregory N. Connolly, Center for Global Tobacco Control, Harvard School of Public Health

BACKGROUND: Electronic cigarettes have been promoted as a safer alternative for delivering nicotine to smokers. However, the appeal of the e-cigarette (e-cig) may be limited compared with a conventional cigarette. Abuse liability of e-cig was assessed among daily smokers using a switching study design. METHODS: Participants (N=43; 35.4 yrs of age; 70% male) were regular smokers not contemplating quitting, and were naive to e-cig use. After a 72 hour baseline of usual brand of conventional cigarette use, subjects were switched for a further 11 days to a commercial e-cig product. Behavior was monitored throughout the study (smoking diary, phone interview) and follow-up lab sessions were conducted at Days 11 and 14. Puffing topography, smoking urges, nicotine withdrawal, sensory perceptions, and drug effect and liking were measured pre- and post-smoking. Exposure to nicotine was assessed via urinary cotinine pre- and post-switching. RESULTS: After 14 days, mean cigarettes smoked per day significantly decreased a relative 40.3% from 14.7 at baseline to 8.8 at Day 14 (paired t-test, p<0.001). Subjects took larger (p=.045) and longer (p=.008) puffs with the e-cig compared with xonventional. Cotinine geometric mean did not differ significantly from baseline to Day 14 (1535.9 ng/ml vs. 1391.7 ng/ml; p<.001). E-cig use reduced urges to smoke (p=.046) and withdrawal (p=.046). However, e-cig nicotine effect (p=.006) and liking (p<.001) were rated significantly lower than the conventional cigarette. CONCLUSIONS: E-cigarette use reduced smoking urges and withdrawal, but nicotine effect and liking measures suggested a less optimal e-cig nicotine reward. While conventional cigarette consumption decreased, complete switching did not occur, further suggesting limited consumer appeal. These data suggest that e-cigs have lower abuse liability compared with conventional cigarettes and are likely to be used dually with conventional cigarettes. The failure to lower exposure to tobacco toxicants, while maintaining nicotine dependence, suggests that e-cigs may provide no public health benefit. These findings support FDA regulation of e-cigarettes as Modified Risk Tobacco Products.

National Cancer Institute grant # RO1-CA-125224.

CORRESPONDING AUTHOR: Vaughan Rees, PhD, Harvard School of Public Health, Center for Global Tobacco Control, 677 Huntington Ave, Boston, MA 02115, United States, Phone: 617-496-1395, Email: vrees@hsph.harvard.edu

I must say, that Dr. Gregory Connolly has a unique talent for twisting a benefit into a drawback.

A. He decides to view cotinine levels as evidence of exposure to "tobacco toxicants" instead of as evidence of efficacy.

Measuring cotinine levels is the means commonly used to determine how much nicotine is being absorbed into the blood stream. The fact that the cotinine levels didn't differ significantly from baseline explains why the participants reduced smoking urges and withdrawal: participants were getting just about the same amount of nicotine from e-cigarettes as they got from smoking.

B. He also stubbornly refuses to see that reduced levels of smoking are a good thing, not a bad thing.

1. Every cigarette not smoked is that much less exposure the the REAL toxicants in smoke.
2. As a result, there is what the scientists like to call a "dose-response relationship" between number of cigarettes smoked and level and severity of smoking-related illnesses.
3. He also refuses to acknowledge that "dual use" (continuing to smoke while substituting a less-harmful alternative for some of the cigarettes smoked) is often a precursor to complete abstinence from smoking. It was in my case.

 

[Vocalek]

I was so looking forward to having a conversation with Dr. Ayers about this poster, but space #64 was blank. He never showed up (while I was there) to display his poster.

POS4-64

THE REACH OF E-CIGARETTES ON THE INTERNET HAS BEEN UNDERSTUDIED AND POTENTIALLY THREATENS GLOBAL HEALTH

John W. Ayers, Ph.D., M.A.*1,2,3, Benjamin M. Althouse Sc.M.4, 1Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA; 2Children’s Hospital Boston, Boston MA, USA; 3Harvard Medical School, Boston, MA, USA; 4Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

A recent commentary described the woeful state of research on the public health impact of e-cigarettes. This commentary, however, did not recognize the role of the Internet in the growth of e-cigarette use, and how novel digital surveillance may provide real-time and low-cost insight into the reach of e-cigarettes. We present timely estimates of the popularity of e-cigarettes in Australia, Canada, the United Kingdom, and United States by extending methods we have pioneered in tobacco control. E-cigarettes continue to grow more popular on the Internet. Globally there were more than 6.6 million e-cigarette queries on Google each month, with 4.2 million originating in the US followed by 700K, 200K, and 100K in the UK, CA and AU respectively. Comparing mean query levels for all of 2010 to 2011, e-cigarette queries were respectively 75% (95% confidence interval [95%CI], 45-111), 61% (95%CI, 49-73), 19% (95%CI, 12-28), and 35% (95%CI, 19-53) higher in AU, the UK, the US, and CA respectively. E-cigarette discussions on Internet blog archives are increasing at similar rates, while news trends -- avenues for traditional media advocacy -- are declining. For example, e-cigarette blog stories have increased 125% (95%CI, 61-240), 117% (95%CI, 62-206), 125% (95%CI, 54-250), and 117% (95%CI, 48-241) for AU, the UK, the US, and CA from 2010 to 2011 while news stories have decreased 32% (95%CI, 8-53), 27% (95%CI, 3-50), 15% (95%CI, 18-44), and 34% (95%CI, 10-55) in the same regions over the same period. Novel digital surveillance may serve as a principle sentinel for the reach of e-cigarettes given their limited availability at brick-and-mortar retailers. Because e-cigarettes popularity is constantly changing, this work not only provides a snapshot of recent trends but also a framework and toolkit for real-time surveillance going forward. We present a open source website providing continual updates of these trends where investigators may download these data and perform their own analysis.

This research was supported by a grant to JWA from the Institute for Global Tobacco Control with funding from the Bloomberg Initiative to Reduce Tobacco Use. JWA was also supported by a grant from Google.org and a National Institute of Child Health & Human Development Training Grant in Pediatric Emergency Medicine (5T32HD040128). A National Science Foundation Graduate Research Fellowship also supported BMA. The Bloomberg Initiative to Reduce Tobacco Use, Google.org, NICHHD and NSF had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

CORRESPONDING AUTHOR: John Ayers, Children’s Hospital | Harvard Medicine, 1 Autumn St, Boston, MA 02215, United States, Phone: 4433886138, Email: ayers.john.w@gmail.com

I wanted to ask him why he viewed the fact that e-cigarettes have allowed millions of people to escape from smoking as a threat to global health.

I wanted to show him the extra badge I was wearing throughout the conference that reads:

Think outside the pack
Save the life of a smoker

Smoke-free since
March 27, 2009

...because truth is freedom.

http://casaa.org

And then I planned to tell him how the wheezing that kept me awake at night is gone, that I no longer have a productive morning cough, and that I can enjoy a good laugh without going into an embarrassing coughing jag. Then I wanted to ask, "Can you honestly tell me that you believe that, if I had continued smoking for the past three years instead of switching, these health benefits would have magically occurred anyway?"

 

[rothenbj]

Once I saw Connolly's name as co-author, the conclusion was foregone. The "study" is just one of the stepping stones toward the "growing body of evidence" that our political scientists will later point to.

 

[rolygate]

From Vocalek's ref:
THE REACH OF E-CIGARETTES ON THE INTERNET HAS BEEN UNDERSTUDIED AND POTENTIALLY THREATENS GLOBAL HEALTH
John W. Ayers, Ph.D., M.A.

We present a open source website providing continual updates of these trends where investigators may download these data and perform their own analysis.

Any idea of this website's URL please?

 

[Vocalek]

From Vocalek's ref:
THE REACH OF E-CIGARETTES ON THE INTERNET HAS BEEN UNDERSTUDIED AND POTENTIALLY THREATENS GLOBAL HEALTH
John W. Ayers, Ph.D., M.A.


Any idea of this website's URL please?

Not a clue. But the email address for Ayers appears at the bottom of the quoted abstract. See response #14.

 

[Oban]

From Vocalek's ref:
THE REACH OF E-CIGARETTES ON THE INTERNET HAS BEEN UNDERSTUDIED AND POTENTIALLY THREATENS GLOBAL HEALTH
John W. Ayers, Ph.D., M.A.


Any idea of this website's URL please?

Here is the full text of his paper Elsevier - it looks like he is referencing google trends/google insights search as the 'open source website'

 

[Vocalek]

Here is the full text of his paper Elsevier - it looks like he is referencing google trends/google insights search as the 'open source website'

That was an earlier article, where he looked at data from 2008 through 2010. The poster references data for all of 2010 to 2011. The poster makes it sound like they have a web site of their own set aside that publishes continually updated statistics on e-cigarette web searches. But you may just be correct about them using Google tools.

 

[rolygate]

Just been told it's private access.