Harm Reduction

Over a decade ago, major cigarette manufacturers were forced to take responsibility for their role in tobacco-related health care costs, in the form of the Tobacco Master Settlement Agreement. The court case set right numerous cigarette marketing practices that were misleading and harmful. Yet the ruling was a mixed bag for public health: Some marketing restrictions and increased taxes contributed to a decline in smoking rates, but Big Tobacco was ultimately granted immunity from individual lawsuits. The multi-billion dollar settlement also put the plaintiff s attorneys in the spotlight, many of whom have effectively dined out on that winning case by filing suits against other businesses. Now they re taking on the food industry.
We still have a long way to go when it comes to curtailing tobacco use worldwide, new research just published in The Lancet confirms. According to the latest estimates, nearly half of adult men in developing countries use tobacco products, while women increasingly take up smoking at younger ages, and the quit rate in most countries is far too low.
In an op-ed in the current issue of JAMA, Dr. Howard K. Koh, assistant secretary for Health for the U.S. Department of Health and Human Services (HHS), and HHS Secretary Kathleen G. Sebelius boast about the efficacy of various interventions in curbing the tobacco epidemic. Their piece specifically highlights the effectiveness of media campaigns, higher prices, and smoke-free policies in helping smokers quit. The news would be quite welcome if only it were true.
Though it s widely known that smoking cigarettes accelerates the thickening of fatty deposits that clog arteries, a new study has found that the same might also be true of eggs at least for those aged 40 and older who eat them on a regular basis. These dubious results were not only published in the journal Atherosclerosis but, sadly, they were also widely reported by the news media.
n a recent Op-Ed for Reuters, FDA Commissioner Margaret Hamburg boasted about the success of the 2009 Family Smoking Prevention and Tobacco Control Act. The news would be quite welcome if only it were true. Unfortunately, the effectiveness of the new law's various measures is nil. Its ban on candy cigarettes and requirement that cigarette makers divulge their ingredients will save exactly zero smokers. And the FDA's recent attempt to impose large graphic health warning labels on cigarette packages and ads is another empty gesture: Most studies show that such graphic labels have no impact. Dr. Hamburg's praise for the enforcement actions in the law would be appropriate, except that those rules were enacted first by the Tobacco Master Settlement Agreement in 1999.
The 2009 Family Smoking Prevention and Tobacco Control Act can take credit for banning candy-flavored cigarettes and requiring tobacco manufacturers to list their ingredients. And according to FDA Commissioner Margaret Hamburg, the law has been a success. But as ACSH's Dr. Gilbert Ross points out in an op-ed for the Washington Examiner, such legislation will save exactly zero smokers.
Over the last decade, ACSH has been quite pleased to report on the steady decline in cigarette smoking, especially among adolescents. However, as we re too frequently reminded, not all the news on this front is good. Yesterday, the Centers for Disease Control and Prevention reported that, while cigarette smoking rates decline, a growing number of Americans are turning to cigars and pipes instead. While the adult per capita cigarette consumption rate decreased by 41 percent from 2000 to 2011, the total consumption of non-cigarette combustible tobacco, including cigars, increased by 123 percent in the same time period.
The results of the first national survey to measure public awareness and the prevalence of use of electronic nicotine delivery systems (e-cigarettes) were just published in the American Journal of Public Health. The survey, conducted by the American Legacy Foundation, showed that 40.2 percent of Americans have heard of e-cigarettes and over 70 percent of this group believe they are less harmful than regular cigarettes.
A recent Gallup poll of 1,000 adults from all 50 U.S. states and the District of Columbia has revealed that more Americans believe obesity now outranks cigarette smoking as a national health problem. Although there s no doubt that obesity is a major public health concern, ACSH staffers are worried that the extensive dangers of smoking have been overshadowed by the recent uproar about the obesity epidemic. As the poll revealed, 40 percent of Americans now say obesity is an extremely serious problem to society, while only 30 percent say the same about cigarettes.
Last week, we were less than pleased by FDA commissioner Margaret Hamburg s empty boasting about the success of the 2009 Family Smoking Prevention and Tobacco Control Act. This week, ACSH scientific advisor Dr. Michael Siegel, who is on the faculty of Boston University s School of Public Health, does us one better. In a post on his blog, The Rest of the Story, Dr. Siegel evaluates each of the seven FDA actions that Dr. Hamburg claims have been effective in helping to protect public health from tobacco use.
In yet more dismal news from the smoking front, researchers at Cambridge University have found that, compared to standardized feedback, tailored online advice may be no better at helping smokers quit. The study, published in the journal Addiction, included over 1,700 smokers who were randomly assigned to receive either standardized advice on smoking cessation from a non-profit website entitled QUIT, or an individualized version developed according to participants answers to a questionnaire. Yet the results for both groups were identical: 9 percent of smokers reported that they were smoke-free for the first three months.
Researchers continue to investigate how to help smokers kick their lethal and addictive habit. Unfortunately, two recent studies involving nicotine patches and individualized therapy fall vastly short of a breakthrough. One such study, published in the American Journal of Cardiology, has shown that the nicotine patch is in fact safe for patients to use after being discharged from the hospital following a heart attack or chest pains. The concern had been that the nicotine in the patch might further constrict heart arteries that are already partially blocked.