Senior author Eleni Linos, as well as CTCRE director Stan Glantz and myself discuss our recent paper in the BMJ and the paper’s origins.
Working at the CTCRE at UCSF allowed me to meet all sorts of medical practitioners aware of the influence of industry on the health of their patients.
One of those people I happened to meet, was Eleni Linos (now at Stanford), a dermatologist who had noticed throughout the years the influence of the tanning industry on spreading disinformation to the public on the health harms of tanning.
Lola Adekunle, Rebecca Chen, Lily Morrison, Meghan Halley, Victor Eng, Yogi Hendlin, Mackenzie R Wehner, Mary-Margaret Chren, and Eleni Linos’ paper “Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review,” challenges the invisibility of industry as it attempts to blend in its research into the scientific public record. Our paper shows the impressive discrepancy between the scientific conclusions on the health harms of tanning studies with financial links to the indoor tanning industry found, versus those of independent, non-financially-interested researchers.
Jerod Stapleton also published for the British Journal of Medicine an editorial on our article, concluding that “We must challenge industry attempts to change the conversation about tanning.” Stapleton is no stranger to the harms of tanning, having conducted significant research on the health outcomes, as well as leading a paper in JAMA Pediatrics titled “The American Suntanning Association: a “science-first organization” with a biased scientific agenda.” Indeed, according to the tanning industry’s January 2015 issue of Smart Tan, the ASA succeeded in convincing (bullying?) the CDC to remove claims of a 75% increase in melanoma risk from sunbed use that had previously been displayed on the CDC website.
In the flurry of the semester starting, I’ve been remiss in updating this blog with a couple important articles that have come out in the press discussing the environmental harms of electronic cigarette (ecig) electronic waste (ewaste).
Both The Guardian and National Geographic did excellent jobs surveying the topic and getting across the complexities as well as most important points. And I’m grateful to through interviews have been able to contribute to these articles.
I think the most important point I made in The Guardian article is the need for Extended Producer Responsibility, and how it practically works:
Hendlin said he and other environmental advocates have endorsed an Extended Producer Responsibility (EPR) model for e-cigarettes – one JUUL is considering. This would include charging users an extra deposit (ie $1.00 per pod, $5.00 per vape unit) that consumers get back when they return them, practices like returning old packaging to JUUL after receiving new pods each month, and refunding or giving credits for returned pods/vapes.https://www.theguardian.com/society/2019/aug/26/vapings-other-problem-are-e-cigarettes-creating-a-recycling-disaster
What made me want to puke however, is just before I was settling down with my popcorn to watch the (excellent!) National Geographic video they made on the effects of e-cig waste, I was subject to a 15-second propaganda piece by the grandmasters of waste and treachery themselves, Nestle. Especially as in my piece in The Conversation, I write
The two largest global brands of capsule coffee, Nespresso and Keurig, are regarded by many as environmental nightmares. Billions of the throwaway nonrecyclable plastic products currently clutter waste dumps, waterways and city streets. Both inventor of the “K-cups” John Sylvan and former Nespresso CEO Jean-Paul Gaillard have publicly bemoaned the environmental consequences of the products they once championed. Sylvan has stated that the disposable (but not biodegradable) coffee capsule is “like a cigarette for coffee, a single-serve delivery mechanism for an addictive substance.”https://theconversation.com/e-cigarettes-and-a-new-threat-how-to-dispose-of-them-105096
The comparison between cigarette butts and capsule coffee is surprisingly fitting. Both butts and capsules are intentionally designed to be convenient, single-use products. Both are also nonbiodegradable and unrecyclable. As pervasive and polluting as cigarette butts are, however, the e-waste from e-cigarettes presents an even more apt comparison.https://theconversation.com/e-cigarettes-and-a-new-threat-how-to-dispose-of-them-105096
You can imagine how I felt then, when Nestle pimps this feel-good (Spanish language!) advertisement at me, never mentioning the billions and billions and billions of plastic-metal-paper non-recyclable single-use bad-tasting coffee hits it blights the planet with each year.
My colleagues Manali Vora, Jesse Elias, and Pam Ling and I at the Center for Tobacco Control Research and Education at the University of California, San Francisco just Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review. (Also available at PubMed).
Here are some sources that have blogged about the paper:
Background. Tobacco companies have actively promoted the substitution of cigarettes with purportedly safer tobacco products (e.g., smokeless tobacco, e-cigarettes) as tobacco harm reduction (THR). Given the tobacco, e-cigarette, and pharmaceutical industries’ substantial financial interests, we quantified industry influence on support for THR.
Objectives. To analyze a comprehensive set of articles published in peer-reviewed journals assessing funding sources and support for or opposition to substitution of tobacco or nicotine products as harm reduction.
Search Methods. We searched PubMed, Embase, Web of Science, and PsycINFO with a comprehensive search string including all articles, comments, and editorials published between January 1, 1992 and July 26, 2016.
Selection Criteria. We included English-language publications published in peer-reviewed journals addressing THR in humans and excluded studies on modified cigarettes, on South Asian smokeless tobacco variants, on pregnant women, on animals, not mentioning a tobacco or nicotine product, on US Food and Drug Administration–approved nicotine replacement therapies, and on nicotine vaccines.
Data Collection and Analysis. We double-coded all articles for article type; primary product type (e.g., snus, e-cigarettes); themes for and against THR; stance on THR; THR concepts; funding or affiliation with tobacco, e-cigarette, pharmaceutical industry, or multiple industries; and each author’s country. We fit exact logistic regression models with stance on THR as the outcome (pro- vs anti-THR) and source of funding or industry affiliation as the predictor taking into account sparse data. Additional models included article type as the outcome (nonempirical or empirical) and industry funding or affiliation as predictor, and stratified analyses for empirical and nonempirical studies with stance on THR as outcome and funding source as predictor.
Main Results. Searches retrieved 826 articles, including nonempirical articles (21%), letters or commentaries (34%), editorials (5%), cross-sectional studies (15%), systematic reviews and meta-analyses (3%), and randomized controlled trials (2%). Overall, 23.9% disclosed support by industry; 49% of articles endorsed THR, 42% opposed it, and 9% took neutral or mixed positions. Support from the e-cigarette industry (odds ratio [OR] = 20.9; 95% confidence interval [CI] = 5.3, 180.7), tobacco industry (OR = 59.4; 95% CI = 10.1, +infinity), or pharmaceutical industry (OR = 2.18; 95% CI = 1.3, 3.7) was significantly associated with supportive stance on THR in analyses accounting for sparse data.
Authors’ Conclusions. Non–industry-funded articles were evenly divided in stance, while industry-funded articles favored THR. Because of their quantity, letters and comments may influence perceptions of THR when empirical studies lack consensus.
Public Health Implications. Public health practitioners and researchers need to account for industry funding when interpreting the evidence in THR debates. (Am J Public Health. Published online ahead of print May 16, 2019: e1–e8. doi:10.2105/AJPH.2019.305106)
My op-ed in the American Journal of Public Health that appeared this week discusses the new tobacco waste stream of electronic cigarette waste. Electronic waste is already the fastest growing waste stream globally. Creating a new product that has no current responsible recycling infrastructure, and that may be littered widely, contributing to plastic sinks such as the Great Pacific Gyre (garbage patch) in the Pacific Ocean, is a mistake. This op-ed discusses the problem and some of the solutions that can be taken to avoid a possible environmental health and ecological disaster.
Regarding this article and other research I am conducting, I also wrote a piece in the online academic blog/forum The Conversation on e-cigarettes as the Nespresso of tobacco products, environmentally speaking.
This article was republished by the University of California, Salon, Phys.org, The Houston Chron, the Connecticut Post, The Fresh Toast, Business Insider, EcoWatch, The Chicago Tribune, and many other news sources.
Reuters also interviewed me for a piece titled “E-cigarette policy should consider environmental effects, expert says.”
As part of my project on land rights in Latin America, a recent paper titled “Environmental justice as a (potentially) hegemonic concept: a historical look at competing interests between the MST and indigenous people in Brazil” appears in Local Environment.
Local Environment: The International Journal of Justice and Sustainability is associated with the International Council for Local Environmental Initiatives (ICLEI), the international environmental agency for local governments which evaluates and present the methods and tools necessary to achieve local sustainable development worldwide.
My article suggests that by understanding the origins of the Movimiento dos Trabalhadores Rurais sem Terra (MST) as a government-driven clash between the state-sanctioned land claims of indigenous peoples (the Kaingang, in this case) and landless peasants, groups mounting environmental justice campaigns can fruitfully work together in solidarity with other groups. Through analyzing this case study, the weakness of environmental justice movements, I claim, arises when marginalized groups are willing to accept land or other concessions not at the cost of those best off, but off the backs of groups even more marginalized than themselves.
The tendency for government concessions responding to successful protests by borrowing from the resources of the poor to redistribute them to those most fervently clamoring for change, rather than disrupting the status quo and redistributing concentrated land and wealth holdings among the rich, is precisely the problem many environmental justice movements historically and today face.
Hegemony serves as a useful analytic through which to process of distal transfer of resources (from periphery to center) indicative of colonialism. Many environmental justice crises arise from the same properties that arose during historical colonialism and its aftermath, but are not confined to it. Resolving unequal distributions of labor according to gender is another aspect which environmental justice movements such as the MST have aggressively sought to ameliorate, even if such entrenched hierarchies still are actively being deconstructed.
PLOS Medicine just published an article I wrote with Jesse Elias and Pam Ling at UCSF on “Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents.” This article discusses previously secret industry documents pointing at the disconnect between the Philip Morris’s public statements of addiction as reduced to nicotine, and their secret unpublished research showing that nicotine is a minor overall component of smoking addiction.
Public health researchers interested in helping smokers would do well to critically appraise the public statements, policies, and actions of tobacco and nicotine dealers, especially as these are strictly for-profit companies beholden to their lexical priority of fiduciary responsibility increasing shareholder value at all costs.
Rather than bandwagoning on nicotine determinism, addiction is a biopsychosocial disease with lobbying and advertising as disease vectors.
News media on the paper appears in The Outline and other interviews.
The Outline writes:
Publicly, Philip Morris has been willing to admit that cigarettes are addictive since 1998—but would only cop to the role of nicotine in forming an addiction. Yet privately, the company knew that social, psychological, and environmental factors are also central to addiction and how difficult it is to quit smoking. In other words, addiction was never just about nicotine, and Philip Morris knew it.
the researchers hope to remind public health officials that tobacco addiction is about more than just nicotine, and that there isn’t enough long-term data to show whether “reduced harm products” actually benefit public health. Even Philip Morris recognized this.
In other words, they said, PM’s ‘opportunistic’ shift from denying to affirming nicotine’s addictiveness was driven not by a substantive change in scientific understanding but by public, regulatory, and legal pressures.
While Philip Morris publicly acknowledged nicotine’s addictiveness in 2000, the study’s authors suggest that the company scapegoated the chemical as the solitary driver of addiction. By placing the blame on nicotine, company scientists drew attention away from a potential public health focus on biological, social, psychological, and environmental factors that could help people quit smoking….
For addiction researchers, public health researchers, and smokers, it’s clear that smoking is about so much more than the nicotine. But this analysis suggests that a major tobacco company attempted to steer the focus toward only nicotine, decreasing the effectiveness of interventions that could help people quit.
Susan Mayor writes in the British Journal of Medicine writes that while PM’s “Addiction Consensus Group”:
Sounds very virtuous
More like a cover up. An analysis funded by the US National Cancer Institute compared the company’s public position on addiction with what was being discussed within company walls. It found that throughout the 2000s Philip Morris reinforced the idea that nicotine’s pharmacology was the main driver of smoking addiction. But internally, company scientists were saying there was bit more to it than that. Addiction was the result of “interconnected biological, social, psychological, and environmental determinants,” with nicotine just one component.