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September 2nd, 2015:

US health watchdog to take legal action against e-cigarette makers

A health watchdog is to take legal action in California against the manufacturers of some of the best-known brands of e-cigarettes, following tests to establish the levels of toxic chemicals they contain. The Center for Environmental Health (CEH) says its tests found that nearly 90% of the companies had at least one brand that produced high levels of one or both of the cancer-causing chemicals formaldehyde and acetaldehyde.

In the first ever large lab-testing of e-cigarettes on the market, the CEH found that most – 50 of 97 products examined – contained high levels of one or both chemical. The lab tests and legal action will fuel the battle raging over e-cigarettes. While supporters say they could help thousands of people give up the far more dangerous tobacco-filled conventional cigarettes, others worry about the chemicals they contain. Such suspicions are fuelled by the involvement of major tobacco companies in the e-cigarette market. Critics say e-cigarettes may be a stalking horse for Big Tobacco, in order to rehabilitate the act of smoking.

The CEH said its lab tests of 97 e-cigarette and vaping products revealed levels of formaldehyde and acetaldehyde that violated California’s safety standards. It said this was the first time e-cigarettes had been tested by simulating their real-world use. “For decades, the tobacco industry mounted a campaign of lies about cigarettes, and now these same companies claim that their e-cigarettes are harmless,” said Michael Green, executive director of CEH. “Anyone who thinks that vaping is harmless needs to know that our testing unequivocally shows that it’s not safe to vape.

“This is especially troubling given the reckless marketing practices of the e-cigarette industry, which targets teens and young people, and deceives the public with unfounded health and safety claims. Our legal action aims to force the industry to comply with the law and create pressure to end their most abusive practices.” CEH is invoking California’s consumer protection law, known as Proposition 65. Earlier this year, the watchdog started legal action against the companies for failing to warn users about the risks of nicotine in the products.

The non-profit organisation purchased e-cigarettes, e-liquids and other vaping products from major retailers including RiteAid and 7-Eleven, and from many online retailers and Bay Area vape shops between February and July 2015. It commissioned an independent lab accredited by the American Association for Laboratory Accreditation to test 97 products, including 15 disposable “cigalikes” e-cigarettes, 32 cartridge devices and 50 refillable devices, for formaldehyde and acetaldehyde. The two chemicals are known to cause cancer and are also linked to genetic damage, birth defects and reduced fertility. The lab used standard smoking machines that simulate how consumers use the products. Almost 90% of the companies whose products were tested (21 of 24 companies) had one or more products that produced hazardous amounts of one or both of the chemicals, in violation of California law. The testing showed that 21 products produced a level of one of the chemicals at more than 10 times the state safety standard, and seven products produced one of the chemicals at more than 100 times the safety level. The CEH testing found high levels of the chemicals even in several nicotine-free varieties. For example, one nicotine-free product produced acetaldehyde at more than 13 times the state legal safety threshold and formaldehyde at more than 74 times the threshold.

Men in China face increasing tobacco-related cancer risks

In China, smoking now causes nearly a quarter of all cancers in adult males. The finding comes from a large study published early online in Cancer, a peer-reviewed journal of the American Cancer Society, as part of a Special Issue on Lung Cancer in China. High uptake rates of cigarette smoking in teenaged males and continued use in adulthood foreshadow even greater tobacco-related cancer risks for the nation.

Tobacco-related deaths have been declining steadily in most developed countries; however, China now produces and consumes about 40 percent of the world’s cigarettes, with much of the rapid increase taking place since the early 1980s, involving almost exclusively only men.

To get a sense of the current smoking-related cancer risks in China, a research team led jointly by Professor Zhengming Chen, DPhil, of the University of Oxford in the UK and Professor Liming Li, MD, of the Chinese Academy of Medical Sciences in China, analyzed data from a nationwide prospective study called the China Kadoorie Biobank, which recruited 210,259 men and 302,632 women aged 30 to 79 years from 10 areas of China from 2004 to 2008. The study recorded approximately 18,000 new cancers during seven years of follow-up.

Among the major findings:

· Sixty-eight percent of men in the study were smokers, and they had a 44 percent increased risk of developing cancer compared with nonsmokers.
· This excess risk accounted for 23 percent of all cancers that arose between the ages of 40 and 79 years, with significantly elevated risks of cancers of the lung, liver, stomach, esophagus, and a collection of five other minor sites.
· Among ex-smokers (6.7%) who had stopped by choice, there was little excess cancer risk within 15 years after quitting.
· In contrast to men, only three percent of females in the study were smokers, and they experienced a 42 percent increased risk of cancer compared with nonsmokers.
· Smoking causes an estimated 435,000 new cancers (360,000 in men and 75,000 in women) each year in China.

“The tobacco-related cancer risks among men are expected to increase substantially during the next few decades as a delayed effect of the recent rise in cigarette use, unless there is widespread cessation among adult smokers,” the authors wrote. The study also noted that the first generation of men in China to experience the full extent of tobacco risks will probably be those who were born during the 1970s or 1980s, who reached adulthood when cigarette consumption was high. By contrast, this is the least exposure for the female generation in China. “If smoking rates remain low in women, tobacco may soon be responsible for most of the difference in life expectancy between men and women in China. Widespread smoking cessation offers China one of the most effective, and cost-effective, strategies for avoiding cancer and premature death over the next few decades” said Professor Zhengming Chen, the lead author and principal investigator of the China Kadoorie Biobank.

Brain Differences Seen With Combined Cannabis, Tobacco Use

The use of cannabis and tobacco in combination may have unique effects on the brain and memory that in some ways contradict established neural responses, a new study suggests.

Imaging showed smaller hippocampal volumes, and testing showed worse memory among participants who used cannabis alone or with tobacco in comparison with nonusers, but smaller volumes were associated with better memory among users of marijuana plus tobacco.

The findings underscore the need to include the likelihood of comorbid tobacco use in cannabis research.

“Approximately 70% of individuals who use marijuana also use tobacco,” said principal investigator Francesca Filbey, PhD, director of cognitive neuroscience of addictive behaviors at the Center for Brain Health, in New York City, in a press statement.

“Our findings exemplify why the effects of marijuana on the brain may not generalize to the vast majority of the marijuana-using population, because most studies do not account for tobacco use.”

Their report was published this month in the journal Behavioural Brain Research.

Total Hippocampal Volumes

The study involved four groups of adults from two larger studies conducted at the University of New Mexico, in Albuquerque, which included cannabis-only users (n = 36), tobacco-only users (n = 19), combined cannabis and tobacco users (n = 19), and non–using healthy control participants (n = 16).

Criteria for cannabis users’ inclusion was reported use of cannabis at least four times per week during the past 6 months, verified by urinalysis. Tobacco users’ criteria included having used tobacco 10 or more times daily, verified by carbon monoxide breath monitor, and having had fewer than 3 months of abstinence in the past year.

After controlling for brain size and recent alcohol use, MRI showed smaller total hippocampal volumes among participants who used cannabis and tobacco, compared with the tobacco-only users and the control participants.

Interestingly, the reductions in hippocampus size in the combination group of cannabis and tobacco users were not significantly different from those of users of cannabis alone.

“It was surprising that this was not significantly different,” Dr Filbey told Medscape Medical News. “It is possible that with a large sample size, we may be able to detect a difference.”

Even more unexpected were findings showing that although in the nonuser control individuals, there was a trend linking larger hippocampal volume with improvements on memory scores, the users of cannabis and tobacco in combination showed worse memory and delayed recall scores that were associated with larger, not smaller, hippocampal volumes (P = .05 and P = .04, respectively), with scores improving with smaller hippocampal size.

“Taken together, the [cannabis and tobacco] users exhibited abnormal links between hippocampal volume and memory scores, and these relationships significantly deviated from the same patterns among control subjects,” the authors write.

The cannabis and tobacco users nevertheless had the smallest hippocampal volumes of the four groups, and they also had the lowest memory performance.

Dr Filbey speculated that the abnormal findings on hippocampal size and memory in cannabis and tobacco users could stem from an effect seen before with nicotine.

“It is possible that we may be seeing cognitive-enhancing effects of nicotine on memory function that is greater in those with smaller hippocampal volumes,” she said.

“Studies have found that this enhancing effect from nicotine is greater in those with greater impairment.”

Unusual Neuronal Effect

The findings suggest that a highly unusual neuronal effect can take place with the combination of cannabis and tobacco use, said Frank J. Vocci, PhD, coeditor of the American Society of Addiction Medicine’s Journal of Addiction Medicine and president of Friends Research Institute, Inc, in Baltimore, Maryland.

“This is certainly counterintuitive,” he told Medscape Medical News. “It strikes me as odd that you would get essentially a good response in the combination users group [in terms of memory], so there clearly is something going on that isn’t quite understood between nicotine and marijuana users and memory that has to be worked out,” he said.

“Small hippocampal volume is not considered to have a beneficial effect, so it certainly is an intriguing finding and needs replication in a larger study.”

The study’s authors have disclosed no relevant financial relationships. Dr Vocci has been a consultant for Reckitt-Benckiser Pharmaceuticals and for generic manufacturers of buprenorphine products. He has also been an investigator and consultant for buprenorphine studies funded by Braeburn Pharmaceuticals and Titan Pharmaceuticals. All of Dr Vocci’s consulting fees go to his employer, Friends Research Institute, Inc.

The truth about the tobacco industry …in its own words

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HK Customs detects smuggling of 7 mln HK dollars illicit cigarettes

Xinhua Editor: Gu Liping

Hong Kong Customs detected a suspected smuggling case involving illicit cigarettes worth about 7 million HK dollars (about 900,000 U.S. dollars) with a duty potential of about 5 million HK dollars, a Customs spokesmam said here on Tuesday.

Customs officers intercepted an incoming lorry at Lok Ma Chau Control Point on Tuesday, and they found about 2.6 million sticks of suspected illicit cigarettes in 210 carton boxes after thorough inspection. A 40-year-old male driver was arrested.

The spokesman said the operation showed the effectiveness of the enforcement strategy, especially the escalated enforcement actions against smuggling activities at source.

Under the Import and Export Ordinance, smuggling is a serious offence in Hong Kong. The maximum penalty is a fine of 2 million HK dollars and imprisonment for seven years.

Could Tobacco Carveout Kill TPP?

By Matthew Fleming and Niels Lesniewski

The Trans-Pacific Partnership’s rocky road in Congress faces a fresh threat from tobacco-state senators.

A brief trip down memory lane: Trade Promotion Authority passed with 62 votes in June, paving the way for a simple-majority threshold for the 12-nation trade deal.

But to get there, TPA required legislative jujitsu packaged with other bills, complex vote sequences and a ping-pong with the House to draw enough votes.

TPA endured one Democratic filibuster. It dealt with a messy human trafficking provision as well as language combating currency manipulation. It sustained vociferous opposition from most Democrats and unions and Republican opposition to the relinquishment of Congressional power.

And despite all of that, it’s tobacco’s status as a significant cash crop in Kentucky that could snuff out TPP in the end.

Reuters reported the administration had been considering allowing tobacco to be carved out of the investor-state dispute settlement, which, among other things, would give tobacco companies little protection against stiff regulation by trade partners, like Australia’s ban on branded cigarette packs.

Senate Majority Leader Mitch McConnell of Kentucky, along with Republican Sens. Richard M. Burr and Thom Tillis of North Carolina, have repeatedly protested even the vague notion of a provision targeting tobacco.

Both in person and through correspondence, McConnell has pressed U.S. Trade Representative Michael Froman throughout the negotiations to ensure there is no provision targeting tobacco, even citing the crop’s role in “important biomedical research.”

“As you know, I am very optimistic about the potential for Kentucky’s manufacturing workers and farmers — including its thousands of tobacco growers — to benefit from new export opportunities facilitated by a completed TPP agreement,” McConnell wrote in a July 30 letter to Froman. “It is essential as you work to finalize the TPP, you allow Kentucky tobacco to realize the same economic benefits and export potential other U.S. agricultural commodities will enjoy with a successful agreement.”

Needless to say, not many things happen in the Senate if the majority leader doesn’t want them to happen, and he’s calling tobacco protections “essential.”

It’s unclear where Kentucky’s junior senator stands: Rand Paul, a Republican running for reelection as well as the GOP presidential nomination. His office did not respond to multiple requests for comment.

Burr, who sits on the Finance Committee, which includes trade in its jurisdiction, told CQ Roll Call he’d received assurances from Froman that tobacco would not be excluded from protections in the deal.

Burr, who took the strongest position out of the three senators, asked again from Froman for reassurance that tobacco would be treated differently and vowed to do everything possible to derail the trade legislation if tobacco isn’t protected.

“I was told it wouldn’t be in there, that I didn’t need to worry about it,” Burr told CQ Roll Call. “And that was before I cast a crucial vote on TPA, which changed the [vote threshold] from 60 to 51. I made a promise to him before that if it was in there I’d do everything in my power to kill the TPP. And I will.”

Tillis argued in a letter to Froman in early August that a tobacco carveout would set a dangerous precedent for future trade deals and could scare away would-be supporters of the deal.

“A number of my colleagues share my view that the TPP can be a net positive in the long run,” Tillis wrote. “I am confident, however, that the path toward ratification will be significantly endangered if the administration or one of our trading partners impose their biases by targeting specific industries for exclusion.”

A spokesperson for the U.S. Trade Representative wouldn’t speak directly to the carveout in a statement to CQ Roll Call, saying only that “We are working proactively to promote the interests of American farmers and preventing discrimination against them, while ensuring that the FDA and health authorities of other countries can implement tobacco regulations to protect public health.”

Leading journal questions Public Health England’s stance on e-cigarettes

E-cigarettes: setting out the available evidence for the public Public Health England (PHE) is deeply disappointed with the BMJ’s news story: “Leading journal questions Public Health England’s stance on e-cigarettes”. The Lancet editorial, to which this news story refers, contained a number of assertions that PHE has refuted in a published response. [1]

The authors of PHE’s expert review on e-cigarettes [2] have set out the evidence for the estimate that e-cigarettes are around 95% safer than smoking. [3] This evidence includes the facts that: 1) the constituents of cigarette smoke that harm health – including carcinogens – are either absent in e-cigarette vapour or, if present, they are mostly at levels much below 5% of smoking doses; and 2) the main chemicals present in e-cigarettes only have not been associated with any serious risk.

The Lancet, and the BMJ news story both focus their criticisms on the study by Nutt et al. which is cited in PHE’s review. We disagree strongly with the charge that PHE’s review does not meet our standard for scientific rigour and evidence. We would add that the study by Nutt et al. was one source within an extensive peer-reviewed evidence base, on which he authors drew in reaching their conclusions on the relative safety of e-cigarettes.

PHE’s expert review clearly acknowledges that the overall evidence base on the safety of e-cigarettes is still developing. Furthermore, we have repeatedly stressed that ongoing monitoring and research are needed. But PHE has a public duty to spell out clearly that the current best estimate, based on the peer-reviewed literature, is that e-cigarettes, while not risk-free, carry only a fraction of the harm caused by smoking.

It is even more disappointing that the BMJ has followed the Lancet in ignoring the significant findings of this comprehensive expert review. These include: 1) e-cigarettes are now the most popular stop smoking aid in England and can help smokers to quit smoking or reduce their cigarette consumption; 2) while experimentation with e-cigarettes has increased among young people, regular use remains rare and almost entirely confined to those who have already smoked; and 3) there is so far no evidence that e-cigarettes are undermining the long-term decline in smoking among adults and young people.

PHE has not “fallen short of its mission” in publishing the latest evidence on e-cigarettes. The public increasingly – and mistakenly – believes that e-cigarettes are at least as harmful as smoking tobacco. This may be keeping smokers from using e-cigarettes as a tool to help them to quit smoking and compromising the potential for these products to help reduce the harm from the nation’s number one killer.

Formaldehyde Exposures Resulting From Use Of Electronic Cigarette Devices

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