Stanford Talk on Industrial Epidemics

Today I gave a talk at the Stanford History of Science and Technology Workshop on Industrial Epidemics. It was a pleasure to discuss the ins and outs of public health, corporate malfeasance, and glyphosate in particular with the students and professorate of the History of Science and Technology Program. Especially rich were the insights of Robert Proctor, the coiner of the term agnotology, who has been a great inspiration for my own work.

Here’s the Abstract:

Noncommunicable diseases (NCDs) have turned out to be quite communicable; the disease vector isn’t some virus or pest, but instead the very bulwark of industrial civilization. While NCDs have always been with us as a species, their normalcy and multiplication is novel. The very system of corporate science, muscle, and capital that helped eradicate harrowing infectious diseases that threatened generations in the 20th century have left in their wake a new epidemic of chronic disease above and beyond background levels for the 21st century to clean up. The rise of chronic disease tracks directly with the rise in environmental exploitation and industrial pollutants. By virtue of epidemiology and randomized control trials, we know that certain classes of people (such as smokers, obese people, chemical manufacturing workers, farmers using pesticides) have inordinately more chronic disease than people without those exposures. Many people, especially as they age, incur multiple chronic diseases, causing them much suffering, and costing them and society extensive financial resources. Merrill Singer ( 2009, xiv) describes how syndemics represent “a set of enmeshed and mutually enhancing health problems that, working together in a context of noxious social and physical conditions, can significantly affect the overall disease burden and health status of a population.” Adopting the public health descriptor of epidemics associated with infectious disease for chronic disease conditions, framing the rise of chronic disease first in developed countries and now worldwide in terms of an epidemic caused by industrial processes, scrutinizes how corporate behavior socially determines the health of populations. This paper focuses on how these mechanisms have manifested in the agrochemical and petrochemical industries.

And my bio:

Yogi Hale Hendlin is an assistant professor in the Erasmus School of Philosophy and core faculty of the Dynamics of Inclusive Prosperity Initiative at Erasmus University Rotterdam in the Netherlands, as well as a research associate in the Environmental Health Initiative at UCSF. Yogi has been working at the intersection of public health and environmental political philosophy for 15 years and has published in journals such as MMWR, BMJ, Ambio, PLoS Medicine, The American Journal of Public Health, Tobacco Control, Environmental Philosophy, Environmental Ethics, and the Annals of Internal Medicine. Yogi’s work has been taken up in popular media outlets such as Time, National Geographic, The Guardian, BMJ, CNN, Fox, Salon, Reuters, Gizmodo, Bloomberg, Nautilus, The Revelator, and Science Daily. Yogi is currently writing a monograph titled Industrial Epidemics: Chronic Disease and the Corporate Determinants of Health.

National Geographic and Guardian Articles about Ecigarette Waste and EPR

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

ADDED BONUS:

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.

The Nespresso ad video before the cool National Geographic video. So nice (not!) that National Geographic is producing videos for Nespresso, to preempt people realizing that environmental health problems (having to do with the environmental determinants of health) are intersectional, too.

Big Tobacco, Big Pharma, Big Vape

About a decade ago, the “American Vaping Association” railed against RJReynolds (later RAI, now part of British American Tobacco (BAT)) for attempting to persuade the FDA to “ban the sale of open-system e-cigarettes, including all component parts.” Now that pretty much all of the e-cigarette companies are tobacco companies, from Altria’s 35% stake in JUUL to RAI’s Vuse being #2 in the US, the question is moot. Big Tobacco won. Open systems are on the fringe, for people like Leonardo di Caprio.

Reynolds’ play to racism and prejudice by equating Chinese manufacture with poor quality is telling. Their own products are manufactured in China. But in order to try to dissuade the FDA from allowing open tank vape systems, it plays the China card. We need to educate people to stop doing this, as 99% of the time they are being hypocritical anyways (their own products are being made in China); and also, American manufacture now is mainly robot-run anyhow. Few quality American manufacturing jobs exist, compared to the 1970’s, for example.

What remains to be seen in the indefinite postponement of the E-cigarette regulations by the FDA is whether Big Tobacco got their way; or if public health will see their day.

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)

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.

 

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)

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