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)

Lies in an Extra-Moral Sense

In doing some background research for my book, I remembered that I had read about a year ago of a US Congressman who was working to get rid of the imperative for US health insurers to take patients with preexisting conditions, who shortly thereafter was diagnosed with prostate cancer. The poetic justice was obvious, and I was ready to incorporate the story into mine, to demonstrate the hypocrisy of the political landscape around medical issues, and the demonizing of illness, making it into some Biblical or New Age Law of Attraction bullshit.

And then I noticed that as I went to retrieve this information, that the first hit that came up was from a notoriously provocative website, “The Daily KOS.” I read the article, but it seemed more lukewarm than I remembered in terms of evidence, so I went back and watched the original CNN interview with the supposed damning evidence of hypocrisy of the US Representative from Alabama, Republican Mo Brooks scorning those with preexisting conditions.

In fact, the Daily KOS had cherry-picked Brooks’ words out of context, completely mangling his meaning, which amounted to: those who have lived risk-prone lives should have to pay more than people who have done their best to take care of themselves, and many people are sick “through no fault of their own,” and “we must take care of them.” We can quibble with if we agree with that, but Brooks’ statement looked nothing like the fire and brimstone irony Daily KOS was insinuating.

Shoddy reporting helps no one, and making people whose political ideas you may not agree with into hyperbolic monsters reduces credibility, creates mutual antagonism, and is part of why America is divided. It’s time for journalistic ethics to make a comeback.

Disposable is NOT Environmental

I was perusing Kickstarter when I happened upon a solution to a problem that I didn’t know was that big of a deal: spices going bad. As it turns out, it’s not that big of a deal, it’s what could easily be classified as a “first world problem.”

Spices, because we live in a commodified society with more supply than demand, often sell us large quantities of pre-picked, pre-ground spices. Moreover, these spices are picked from around the world, very far from where we live, and so by the time we use much of them, they lose some of their pungency.

For the same reason that many people grind their own coffee beans, and in many parts of the world including Europe, their own grains, many people still grind their own spices. (Full disclosure, wherever possible, I grind my own spices too – they taste way better fresh that way; no pre-ground spice, no matter how well packed, will taste as good). There is no secret to this. A couple of good kitchen tools, and you’re good to go with most spices. It keeps the nutrients fresh and less degraded (though of course, from picking a spice, it’s shelf-life starts ticking away), and much more pungent and enticing.

Yet, this Kickstarter doesn’t say, “hey, I’d like to make some money by selling you high quality spices, but you’ll still have to grind them yourselves and take an extra minute of delight every time you cook!” No, instead, it fails to see that good cooking, by its nature is a meditation, not something to create a lot of trash with for convenience’s sake. It is a fail because it does not understand that gourmands who like fresh spices are happy to take the extra 30 seconds and grind their own pepper, ginger, or nutmeg. Instead, it grinds the spices already, prematurely, and puts all of its heft on the claim that it has found a better “preserving” mechanism, better than glass containers, but somehow stopping short of formaldehyde.

By appealing to “design” this company is yet another hipster gourmand appropriation of disposable trashy production in order to pull the wool over consumers’ eyes. They have the gall not to merely discuss how their throw away, potion enough for a bachelor(ette) only spice capsules, but to call their product “revolutionary” for its ability to “keep spice fresher at the molecular level.” At the molecular level! I love it–they don’t explain what they mean (except through appealing to the boogieman of “oxidation”) by saying “molecular,” other than that it has become the new buzzword after “neuro” and “nano.” But hey, if you’re already in the business of commodifying trends, why not throw in meaningless buzzwords to prey on consumer gullibility?

Beyond their appeals to their product perhaps rightly being “more flavorful,” than old forgotten spices, they also make the much more suspect claim of it being more “affordable” as well. But worst – and here it’s just a blatant lie – they also claim that their throwaway aluminum pod peel trash wrapper is also more “sustainable.” And that’s why I’m calling bullshit on Occo, and all products like them that attempt to solve a non-problem for people who have more money than they know what to do with, by creating more trash for future generations.

For fun, let’s take a look at some of their misleading and fallacious sustainability claims:

(1) That aluminum is “the most recyclable material in the world”

(1) A: The price for aluminum is higher today than it has been in many years. That’s why there have been, for the first time a rash of thefts of aluminum bleacher seats at parks. So I ask the very Instagrammable Connie and Lisa: do you know what bauxite is? (The raw material from where aluminum comes from). Have you ever been to a bauxite mine? How about a bauxite processing plant? Ever breathed in those fumes? No, because otherwise, you would avoid aluminum like the plague that it is.

Sorry to burst your bubble, but disposable aluminum (where do you even discuss recycling, and the fact that in many jurisdictions your customers may not even have adequate access to recycling facilities?) is a loser. It’s an environmental nightmare, not the paragon of recyclability you paint it as.

Anything that can be used more than once, or say, used many, many times, for years, is more sustainable than something that is only used once. Period. You don’t have to be an industrial ecologist to do the math and realize that even in the best case scenario, if you melt something down, you’re using a tremendous amount of energy to do so, (coming from where?), and then refashioning that raw material into another thing–losing material and energy along the way.

(2) “Saving food waste” claim.

(2) A: Another fallacy is that Occo is helping reduce food waste and saving the planet by selling expensive spices in high quantities in disposable aluminum. The company even does a masterful deflection of using a loaded label against the waste in bulk food items (they call it the “Movie Soda Mark-Up”), that strikes a chord with their Millennial audience of single, big income, no children. They say that food waste is created because people buy more than what they need, and when people are more minimalistic (I love the movement of minimalism, but detest the way it has become commodified to sell more crap that people don’t need to them in the name of minimalism!). But I truly have to question how true this is around spices: what percentage of the 40% of food waste boils down to spices? 1%? 0.5%? If so, that would boil down to 0.4-0.2% of food waste blamable on too many spices. And this is a generous estimate. Nice try, but this is a clear case of the misuse and abuse of pulling on legitimate environmentalist heartstrings.

 

To sum up: the problem with this scheme and so many like it is that there’s no money in simply telling people to go quality over quantity; and to buy less instead of buying more. The “super premium” segment of the nouveau riche, always eager to virtue signal their “style” and “taste” is one of the leading contributors to ecological disaster and climate chaos.

To falsely claim some sort of ecological currency in doing so, should be met with a healthy dose of reality and opprobrium. There are enough charlatans around; the last thing we need is more cannibalism of truth by poseur minimalists willing to say any ecological lie to make a quick buck.

P.S. After writing this, I just found some more spurious reasoning from these poster-children for the Dunning-Kruger effect (a little bit of knowledge is dangerous–you might actually think you know something when that’s not the case). I’m not going to comment on it, I’ll just put it here:

Thoughts and Prayers and Regulations

There is an epidemic of thoughts and prayers in America. It seems the more politicians think and pray, the more school shootings happen, the more places of worship get gunned and burned down, and the more people die.

Maybe to reverse this trend, politicians need to stop sending their thoughts and quit praying, and instead begin doing their jobs: defending the commonweal against those who would sacrifice it for profit.

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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Everybody loves postdocs

Although many young academics rightfully complain of being used for their expertise while failing to receive either the remuneration or job security fitting to their contribution, it is always humorous to hear statements that openly admit this unspoken condition.

Upon my usual investigations of the Industry Documents, I came across a RJ Reynolds’s tobacco company document emphasizing the point. Their Biochemical/Biobehavior devision wrote:

Screen Shot 2017-08-28 at 13.44.21

This document is from 1987. The same remains true today 30 years later–both for private industry and universities. Postdocs are still the oft-unsung heroes and heroines of research innovation and everyday scientific inquiry. But the ability to influence the scientific community through giving early-career researchers temporary jobs working for the tobacco industry also interested RJR by drawing talent that would then go on to work for other esteemed firms and universities.

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The diffusion effect of getting researchers at the waist of the hourglass in their careers, would allow their postdoctoral research program to also bring recognition to RJR for their scientific endeavors, increasing their prestige.

Thus, for RJR, the manipulation of the postdoc is double: cheap high quality labor, and prestige by association, when the postdocs continue their careers as successful researchers, always marking on their resumes that they spent a postdoctoral research period at RJR’s research facilities.

New paper published in Annals of Internal Medicine picked up by Reuters

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Today, with co-authors Pamela M. Ling and Jesse Elias, our paper “The Pharmaceuticalization of the Tobacco Industry” appears in the Annals of Internal Medicine.

Our interview with Reuters is available here.

This work contributes to the study of industrial epidemics, and how corporations, instead of dying a quiet death as the world wakes up to the inutility of their products for life, metastasize into other structures to clean up the messes they continue to create–and to charge taxpayers for it (in this case, by getting government health care like the NHS in the UK, to pay for their so-called reduced-harm nicotine products).