FDA Why Isn't Vaping the FDA Center for Tobacco Product's Biggest Ally?

[pamdis]

Not even Glantz nor even Matt Myers of CFTFK will say that tobacco cigarette smoking kills all tobacco cigarette smokers immediately, as I'm sure you well know. That is quite obviously not what is meant by the phrase "smoking kills." (Were you aware of that? Because if you were, then I have to wonder why you wrote what you just did.)

I believe the operative phrase is "causal link." In other words, there has to be evidence that there's something about vaping that's currently killing people. What they're saying right now is that the only thing they can pin on vaping is that vapers are less likely to quit smoking than the general propulation of smokers. That was exactly the point of Grana, Popov and Ling's paper in JAMA Internal Medicine published in March. I'm sure we all remember this media frenzy.

One reason why the West toolkit is so helpful is that it rebuts that junk study in spades. That's what moved Deborah Kotz of the Boston Globe - even after she dismissed Siegel's objections to Grana et al. as mere "fighting words" (see my thread in media that I started today).

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Great, be my guest. Please have the discussion with Dr. Siegel, who believes that the mortality rates of smokers are largely independent of how much they smoke: Anti-Smoking Advocate Incorrectly and Irresponsibly Tells Public that Smoking Half Pack Per Day is No Better than Smoking Two Packs Per Day

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I am not conerned about whether anyone is or isn't "thrown under the bus." I am looking for the points that give us the best chance of defending vaping in the public policy arena. And the best one I can find is: "Vapers are Quitters."

You are more than welcome to argue with people like Siegel (see above link) and question every single piece of scientific data that has ever been proffered regarding tobacco cigarette smoking. Far be it from me to stop you. However I do not see this as an effective approach to getting what vapers want and need in the public policy arena.

BTW I think we may have reached the point where this discussion is no longer productive. So unless you come up with something that's new, I think I've had enough of this particular debate.

I am coming to believe that we are doing ourselves a great disservice by trying to counter specific points of the ANTZ. So, instead of simply standing up for our rights by simply stating: 1) It has not been proved harmful in any meaningful way (all on its own and divorced from the harm reduction issue, and unrelated to any comparison to smoking, and 2) Adults have a right to consume a legal product, we are now trying to silence dual users by telling them they are harming the cause. By trying to find the 'best point', we are , so to speak, feeding the ANTZ trolls and undermine ourselves by treating people who don't fall into a pattern that 'benefits the cause' as badly as ANTZ treat smokers and vapers both. We should all take a deep breath and beware the danger of sinking to the ANTZ level and becoming the same moralizers that we complain them of being. Dual users are vapers too, and crusading under the 'Vapers are Quitters' banner is throwing a large number of vapers under the bus.

 

[Roger_Lafayette]

I am coming to believe that we are doing ourselves a great disservice by trying to counter specific points of the ANTZ. So, instead of simply standing up for our rights by simply stating: 1) It has not been proved harmful in any meaningful way (all on its own and divorced from the harm reduction issue, and unrelated to any comparison to smoking, and 2) Adults have a right to consume a legal product, we are now trying to silence dual users by telling them they are harming the cause. By trying to find the 'best point', we are , so to speak, feeding the ANTZ trolls and undermine ourselves by treating people who don't fall into a pattern that 'benefits the cause' as badly as ANTZ treat smokers and vapers both. We should all take a deep breath and beware the danger of sinking to the ANTZ level and becoming the same moralizers that we complain them of being. Dual users are vapers too, and crusading under the 'Vapers are Quitters' banner is throwing a large number of vapers under the bus.

So what is our response to the argument that 5% of smokers annually quit cold turkey, and vaping is not associated with quitting?

Or do we just tell them to go fly a kite, because vaping is not harmful, and therefore it doesn't matter how many vapers quit?

Why do we even care about the West study at all, if cessation is unimportant to us?

Sounds to me as if in order to "not throw dual users under the bus," we have to take the position that tobacco cigarette smoking is just dandy doodles, and it's just fine if everyone who starts vaping is never going to quit smoking tobacco cigarettes.

I might think so. You might think so. But it's a loser.

 

[Katya]

Personally, I feel a tad uncomfortable telling people that vaping is for dual users.

I'd just as soon point to the fact that all these vapers have quit, without talking about their motives for beginning to vape in the first place.


But I feel as if that gives unnecessary ammo. to Gantz and the other ANTZ.

The longer someone has vaped, the more likely it is that they've quit. Now we have the population studies to show something like this in several European countries. Simple, easy to understand.

Speaking of cars - I want a bumper sticker that reads: Vapers are Quitters.

Ahem...

Roger, even Dr. Hamburg is OK with dual use nowadays. [A small tiny detail that Mitch Zeller was apparently unaware of at the time of the Senate hearings. Either that or he lied, which I don't think is possible, for a man of his integrity. ]

It's now OK to smoke and use NRT. Dual use and child-friendly flavorings are, apparently, only problematic when it comes to e-cigarettes. But I'm sure this will change soon. If it didn't, it would be very hypocritical.

Nicotine Replacement Therapy Labels May Change

The changes that FDA is allowing to these labels reflect the fact that although any nicotine-containing product is potentially addictive, decades of research and use have shown that NRT products sold OTC do not appear to have significant potential for abuse or dependence.

The changes being recommended by FDA include a removal of the warning that consumers should not use an NRT product if they are still smoking, chewing tobacco, using snuff or any other product that contains nicotine—including another NRT.

"The agency heard from several public health groups that the labeling for OTC NRT products may stop consumers who are trying to quit smoking from using them," says FDA Commissioner Margaret A. Hamburg, M.D. "FDA hopes the recommended changes will allow more people to use these products effectively for smoking cessation and that tobacco dependence will decline in this country."

 

[Bobbilly]

I am coming to believe that we are doing ourselves a great disservice by trying to counter specific points of the ANTZ. So, instead of simply standing up for our rights by simply stating: 1) It has not been proved harmful in any meaningful way (all on its own and divorced from the harm reduction issue, and unrelated to any comparison to smoking, and 2) Adults have a right to consume a legal product, we are now trying to silence dual users by telling them they are harming the cause. By trying to find the 'best point', we are , so to speak, feeding the ANTZ trolls and undermine ourselves by treating people who don't fall into a pattern that 'benefits the cause' as badly as ANTZ treat smokers and vapers both. We should all take a deep breath and beware the danger of sinking to the ANTZ level and becoming the same moralizers that we complain them of being. Dual users are vapers too, and crusading under the 'Vapers are Quitters' banner is throwing a large number of vapers under the bus.

While I agree there are some points that are tiring I hear, they are ones that sway public opinion and have to be countered with facts. Some though can be discounted with "yeah ok but what does that have to so with vapor?" Like there are dual users? So what? Vapourizers aren't miracle devices, neither is the patch. This is about vapour

"They are circumventing smoking bans" so what? Are they smoking where they aren't allowed? No then that's irrelevant.

 

[Roger_Lafayette]

Ahem...

Roger, even Dr. Hamburg is OK with dual use nowadays. [A small tiny detail that Mitch Zeller was apparently unaware of at the time of the Senate hearings. Either that or he lied, which I don't think is possible, for a man of his integrity. ]

It's now OK to smoke and use NRT. Dual use and child-friendly flavorings are, apparently, only problematic when it comes to e-cigarettes. But I'm sure this will change soon. If it didn't, it would be very hypocritical.

Nicotine Replacement Therapy Labels May Change

Right, but the standard is different. That's "safe and effective" cessation therapy.

The policy of the tobacco act is public health. So if a tobacco product's use leads to less quitting, then we lose. This is what Zeller was saying about vaping as a whole.

Do we want to try to get the FSPTCA repealed?

Or so we want to argue that vaping should be approved as cessation therapy, so the same standards apply? (This gets us back to Soterra, and I don't think we want to be there.)

 

[Katya]

So what is our response to the argument that 5% of smokers annually quit cold turkey, and vaping is not associated with quitting?

Or do we just tell them to go fly a kite, because vaping is not harmful, and therefore it doesn't matter how many vapers quit?

Why do we even care about the West study at all, if cessation is unimportant to us?

Sounds to me as if in order to "not throw dual users under the bus," we have to take the position that tobacco cigarette smoking is just dandy doodles, and it's just fine if everyone who starts vaping is never going to quit smoking tobacco cigarettes.

I might think so. You might think so. But it's a loser.

We tell them that an e-cigarette is a recreational tobacco product--just like any other tobacco product. And it's legal for any adult to use and enjoy as they please. That's what the Sottera decision was all about.

It's also much less harmful than the combustible tobacco products, and that's a good thing.

And if people quit combustibles and switch to e-cigs, that's an added bonus! But e-cigs are NOT a smoking cessation device--we don't want to go there, remember?

 

[Fitzie]

Interestingly, the impetus for the change in NRT labeling was three petitions submitted by the "public." FDA didn't think up the idea itself.

Nicotine-Containing Products

 

[Katya]

Interestingly, the impetus for the change in NRT labeling was three petitions submitted by the "public." FDA didn't think up the idea itself.

Nicotine-Containing Products

They quote "public health groups." Let me guess, BP? BT?

 

[Fitzie]

Nope. The answer is in the link. Just didn't seem like "public petitions" to my way of thinking. Although the Campaign for Tobacco Free Kids and their allies were involved.

 

[Katya]

Right, but the standard is different. That's "safe and effective" cessation therapy.

The policy of the tobacco act is public health. So if a tobacco product's use leads to less quitting, then we lose. This is what Zeller was saying about vaping as a whole.

Do we want to try to get the FSPTCA repealed?

Or so we want to argue that vaping should be approved as cessation therapy, so the same standards apply? (This gets us back to Soterra, and I don't think we want to be there.)

It may be safe but it ain't effective. And everyone, including Zeller and Hamburg and the CDC, knows that.

See my post below.

Now above...

 

[Katya]

Nope. The answer is in the link. Just didn't seem like "public petitions" to my way of thinking. Although the Campaign for Tobacco Free Kids and their allies were involved.

I know, I know... just couldn't help myself.

 

[Roger_Lafayette]

We tell them that an e-cigarette is a recreational tobacco product--just like any other tobacco product. And it's legal for any adult to use and enjoy as they please. That's what the Sottera decision was all about.

It's also much less harmful than the combustible tobacco products, and that's a good thing.

And if people quit combustibles and switch to e-cigs, that's an added bonus! But e-cigs are NOT a smoking cessation device--we don't want to go there, remember?

Exactly!

By definition, the dual users of NRT and tobacco cigarettes are "trying to quit." So they already count as "quit attempters [sic]" And a certain fraction of quit attempts are successful.

Dual users of two different recreational tobacco products do not "count" as "quit attempters," right?

And to the extent that the availability of a recreational tobacco product reduces the number of quit attempts, it increases the prevelance of smoking.

Therefore vaping means "less quitting and more smoking" as Glantz would say.

We may not like this line of reasoning, and we can dismiss it "ANTZ arguments," but these are positions that are accepted as factual in the science of public health, at least in the US.

We can try to overturn this understanding - heck we can go back to the '64 report and question everything (which is what it appears that some folks would like to do).

 

[pamdis]

So what is our response to the argument that 5% of smokers annually quit cold turkey, and vaping is not associated with quitting?

Or do we just tell them to go fly a kite, because vaping is not harmful, and therefore it doesn't matter how many vapers quit?

Why do we even care about the West study at all, if cessation is unimportant to us?

Sounds to me as if in order to "not throw dual users under the bus," we have to take the position that tobacco cigarette smoking is just dandy doodles, and it's just fine if everyone who starts vaping is never going to quit smoking tobacco cigarettes.

I might think so. You might think so. But it's a loser.

Yes, cessation is important. I have quit and am happy to have. Cessation studies should certainly be pointed out as rebuttal.

But, it sounds like you are trying to take a position that cessation is the only purpose for e-cigs, when it is really only one of several and mis-represents a lot of real-life vapers. It sounds a little like 'twisting the truth' in order to make a point, a road I don't think we should go down.

The argument should be more like:
1. It's most likely harmless (here's the studies)
2. It's legal
3. It's certainly less harmful than smoking (here's the studies), and therefore an excellent alternative
4. Many people quit smoking (here's the studies)
5. Many people cut down on their smoking (here's the studies)

These are all truths, and arguments worth making in tandem.

Instead of
1. It's a smoking cessation product

This is a partial truth aimed at one narrow ANTZ objection (out of many that they throw out there, not out of concern about that particular objection, but just to see what will stick in order to gain their agenda) that says to vapers that haven't quit that they are failures, and they should keep quiet about it so the rest of us can keep our right to vape.

 

[Bobbilly]

Go after the fsptca is a good way to go.

Noting cessation is a byproduct of vaporizers not the primary reason.

If NRT doesn't claim dual use as a barrier to quitting why would vaporizers be any different?

 

[Fitzie]

What I'd really like to do, is to get Congress to exempt vaping from the FSPTCA (just like the premium cigar faction is currently trying to do). But, I'd wager they began down that path some time ago (and they've got the money, influence, lawyers, etc to get them there). I never said or implied I'd like to see the FSPTCA revoked in its entirely. Cigarette smoking is bad and any obstacles thrown in BT's way to getting more people hooked on combustibles is fine by me. I mean if the government was really serious about health, why are cigarettes still legal? That's a rhetorical question by the way ....

 

[Roger_Lafayette]

Yes, cessation is important. I have quit and am happy to have. Cessation studies should certainly be pointed out as rebuttal.

But, it sounds like you are trying to take a position that cessation is the only purpose for e-cigs, when it is really only one of several and mis-represents a lot of real-life vapers. It sounds a little like 'twisting the truth' in order to make a point, a road I don't think we should go down.

The argument should be more like:
1. It's most likely harmless (here's the studies)
2. It's legal
3. It's certainly less harmful than smoking (here's the studies), and therefore an excellent alternative
4. Many people quit smoking (here's the studies)
5. Many people cut down on their smoking (here's the studies)

These are all truths, and arguments worth making in tandem.

Instead of
1. It's a smoking cessation product

This is a partial truth aimed at one narrow ANTZ objection (out of many that they throw out there, not out of concern about that particular objection, but just to see what will stick in order to gain their agenda) that says to vapers that haven't quit that they are failures, and they should keep quiet about it so the rest of us can keep our right to vape.

It's #4 that matters to mortality. If there's one thing that the public knows about smoking, it's the mortality statistics. And unless and until we can show that vaping reduces mortality, we cannot win this argument in the public policy arena.

(This is assuming that we agree with Siegel that reduced levels of smoking for individuals don't help with their expected mortality.)

In short, we must show that more people quit as a result of vaping being around, than would quit if there was no such thing as vaping.

Otherwise we are arguing that the benefits of reduced tobacco cigarette smoking (which are in the form of quality of life) must be weighed against the disadvantage of reduced cessation (which are in the form of increased mortality).

And that's a very difficult argument to make.

At the end of the day, we absolutely must emphasize cessation. I didn't say it should be the only thing we emphasize. But it's gotta be job #1, because complete cessation is the only thing that will affect mortality.

And if mortality is increasing as a result of vaping (i.e. fewer people are quitting) then we are in very deep trouble. We have lost this public health argument.

 

[Katya]

Exactly!

By definition, the dual users of NRT and tobacco cigarettes are "trying to quit." So they already count as "quit attempters [sic]" And a certain fraction of quit attempts are successful.

Sorry, but I already disagree with you right here. When I bought my first Green Smoke kit, I did so because it was advertised as a "smoke everywhere" product. I was looking for a smoking substitute in those places and situations where smoking was not allowed. At that time, I used Nicorette gums, snus or Nicotrol inhaler when I couldn't smoke, but the idea of a non-combustible cigarette that also gave me the "hand-to-mouth" satisfaction was very appealing to me. I never dreamed that it might lead to quitting.

 

[Roger_Lafayette]

Sorry, but I already disagree with you right here. When I bought my first Green Smoke kit, I did so because it was advertised as a "smoke everywhere" product. I was looking for a smoking substitute in those places and situations where smoking was not allowed. At that time, I used Nicorette gums, snus or Nicotrol inhaler when I couldn't smoke, but the idea of a non-combustible cigarette that also gave me the "hand-to-mouth" satisfaction was very appealing to me. I never dreamed that it might lead to quitting.

What does the situation of any given person have to do with this? I'm talking about public health as a whole.

To the policy makers and the academics who study public health (as you well know) we are no different than a bunch of rats in a maze, as Anja pointed out.

There isn't a darned thing that we can do about that. It's how the FSPTCA works, and it's how public health is done.

You may not view your purchase of NRT as part of a "quit attempt," but they do. And besides, they would say that NRT has already been "vetted" for this issue, i.e. that it has been studied to the point where they can conclude that it doesn't reduce the number of quitters.

 

[Fitzie]

And if mortality is increasing as a result of vaping (i.e. fewer people are quitting) then we are in very deep trouble. We have lost this public health argument.

I'm no scientist, but how would anyone go about proving that more people are dying from cigarettes because some vapers are dual users rather than "quitters"?

 

[Bobbilly]

You may not view your purchase of NRT as part of a "quit attempt," but they do. And besides, they would say that NRT has already been "vetted" for this issue, i.e. that it has been studied to the point where they can conclude that it doesn't reduce the number of quitters.

And right there applies to e cigs. It is simply a non pharmaceutical NRT with the same claim and not having to so more tests