New Publication: Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review

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:

https://www.apha.org/news-and-media/news-releases/ajph-news-releases/2019/2019-july-issue

https://tobacco.ucsf.edu/scientific-articles-supporting-tobacco-harm-reduction-more-likely-be-industry-funded-and-lack-empirical-data

Abstract

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)

Science and Politics of Glyphosate Workshop June 6, 2019

My Erasmus University Rotterdam colleague Alessandra Arcuri and I are organizing a day-long workshop on the most used pesticide in the world: glyphosate. Glyphosate, the active ingredient in RoundUp, Monsanto’s flagship herbicide, has been linked with cancer by the International Agency for Research on Cancer (IARC) in 2015.

For more information, registration, and to submit a paper to present at the conference, please visit our website, at the Dynamics of Inclusive Prosperity Initiative.

IARC and EFSA’s differing views on glyphosate

E-cigarette e-waste litter is an environmental health harm that can be stopped before it metastasizes

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.

signal-2018-03-20-083324

Photo of a dropped Juul vape on SF MUNI by Julia McQuoid, used with permission

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.”

For my other writing on e-waste, please see my interview with Eric Lundgren in Nautilus.

 

The Elon Musk of E-waste

My new article, “Is This Man the Elon Musk of E-Waste?” in my favorite popular science online magazine Nautilus, describes the Right to Repair movement, and the necessity to move from a linear manufacturing process built on planned and perceived obsolescence to a circular economy.

If we are to combat the 99 billion pounds of e-waste produced per year, ending up incinerated, in lakes and rivers, and trashing our communities and the lives of future generations, we’re going to need to mandate manufactures of electronics such as Apple, Samsung, Microsoft, IBM, Dell, and all the other major players, to engineer products that can DIY be taken apart, repaired, and built to last.

My interview with Eric Lundgren, his last before he was sent to prison for creating 28,000 Microsoft Windows restore CDs meant for refurbishing computers that otherwise would end up as e-waste, describes the necessity for financial mechanisms to incentivize companies and consumers to place e-waste back into an (dis)assembly line of reuse, reduce, recycle.

Screen Shot 2018-07-10 at 14.52.48.jpeg

Lundgren has championed the right for electronics to be repaired rather than tossed by staging high-profile recycling demonstrations including his Guinness Book of World Records farthest driving on a single charge electric car (999 miles with 90% recycled materials including recycled hybrid batteries) and his flagship solar-powered e-waste recycling factory.

I appreciate the comment on the article made by Ryan Shaw, who wrote:

Mr. Lundgren has done more with far less than what Musk started with so I don’t think the comparison does Lundgren justice (although I am a huge Musk fan). Maybe someday if Tesla starts a car rebuild program to re-use scrapped cars the title would be, “Elon Musk is the Eric Lundgren of car manufacturing.”

New PLOS Medicine Article on Addiction

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.

Gizmodo writes:

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.

OnMedica writes:

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.

Inverse writes:

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.

Euphemisms and Dysphemisms

Here I will attempt to gather and decode euphemisms (saccharine words covering up the dismal reality, e.g., climate change for global warming) and dysphemisms (derogatory terms for neutral ones, e.g., warmist for people who acknowledge the facts of global warming) of corporate-speak.

 

“Crop Protection Agents” = pesticides

Example: Philip Morris attempting to use the natural anti-pest properties of tobacco to make the claim that tobacco is better for the environment than food crops (remember the neonicotinoid pesticides that are decimating bee and butterfly populations? They come from tobacco)

Screen Shot 2018-05-05 at 10.11.53.png

Airplanes and Death: A Study in Sound Pollution

 

I recently published an article in Berkeley’s newspaper, Berkeleyside, about the incessant overhead air traffic, and how this likely is causing significant public health effects.

Here’s the evidence  base:
https://www.ncbi.nlm.nih.gov/pubmed/25332277
https://www.ncbi.nlm.nih.gov/pubmed/22491084
https://www.ncbi.nlm.nih.gov/pubmed/26356375 “These significant associations were not attenuated after the adjustment for air pollution. The present ecological study supports the hypothesis of an association between aircraft noise exposure and mortality from cardiovascular disease, coronary heart disease, and myocardial infarction. However, the potential for ecological bias and the possibility that this association could be due to residual confounding cannot be excluded.”
https://www.ncbi.nlm.nih.gov/pubmed/20881600 “Aircraft noise was associated with mortality from myocardial infarction, with a dose-response relationship for level and duration of exposure. The association does not appear to be explained by exposure to particulate matter air pollution, education, or socioeconomic status of the municipality.”