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November, 2016:

E-cigarettes ‘just as harmful as tobacco’ for oral health

Nov 17th, 2016
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Electronic cigarettes are often marketed as a safer alternative to conventional cigarettes. When it comes to oral health, however, new research suggests vaping may be just as harmful as smoking.

http://www.medicalnewstoday.com/articles/314190.php

In a study published in the journal Oncotarget, researchers found that the chemicals present in electronic cigarette (e-cigarette) vapor were equally as damaging – in some cases, more damaging – to mouth cells as tobacco smoke.

Such damage can lead to an array of oral health problems, including gum disease, tooth loss, and mouth cancer.

E-cigarettes are battery-operated devices containing a heating device and a cartridge that holds a liquid solution. The heating device vaporizes the liquid – usually when the user “puffs” on the device – and the resulting vapor is inhaled.

While e-cigarette liquids do not contain tobacco – a highly harmful component of conventional cigarettes – they do contain nicotine and other chemicals, including flavoring agents.

According to the Centers for Disease Control and Prevention (CDC), the use of e-cigarettes has increased in recent years, particularly among young people. In 2015, 16 percent of high-school students reported using the devices, compared with just 1.5 percent in 2011.

E-cigarettes are considered by many to be safer than conventional smoking, but because the devices are relatively new to the market, little is known about the long-term effects of vaping on health.

In particular, study leader Irfan Rahman, Ph.D., professor of environmental medicine at the University of Rochester School of Medicine and Dentistry in New York, and colleagues note that there has been limited data on how e-cigarette vapor affects oral health.

Flavored vapor worsens damage to gum tissue cells
To address this gap in research, the team exposed the gum tissue of nonsmokers to either tobacco- or menthol-flavored e-cigarette vapor.

The tobacco-flavored vapor contained 16 milligrams of nicotine, while the menthol flavor contained 13-16 milligrams of nicotine or no nicotine.

The researchers found that all e-cigarette vapor caused damage to gum tissue cells comparable to that caused by exposure to tobacco smoke.

“We showed that when the vapors from an e-cigarette are burned, it causes cells to release inflammatory proteins, which in turn aggravate stress within cells, resulting in damage that could lead to various oral diseases.”

Irfan Rahman, Ph.D.

The researchers note that nicotine is a known contributor to gum disease, but e-cigarette flavoring appeared to exacerbate the cell damage caused by e-cigarette vapor, with menthol-flavored vapor posing the most harm.

While further research is needed to investigate the long-term effects of e-cigarette use, Rahman and team believe their findings indicate that the devices may have negative implications for oral health.

“Overall, our data suggest the pathogenic role of [e-cigarette] aerosol to cells and tissues of the oral cavity, leading to compromised periodontal health,” they conclude.

E-cigarette vapor damaged, killed 53 percent of mouth cells in 3 days

Another study recently published in the Journal of Cellular Physiology builds on the findings from Rahman and colleagues, after finding a high rate of mouth cell death with exposure to e-cigarette vapor over just a few days.

To reach their findings, Dr. Mahmoud Rouabhia, of the Faculty of Dental Medicine at Université Laval in Canada, and colleagues placed epithelial cells from the mouth in a chamber that contained a liquid similar to saliva.

To simulate vaping, the researchers pumped e-cigarette vapor into the chamber at a rate of two 5-second puffs every 60 seconds for 15 minutes a day. This was performed over 1, 2, or 3 days.

On analyzing the vapor-exposed epithelial cells under a microscope, the researchers identified a significant increase in the rate of cell damage and death.

The rate of damage or death in unexposed cells is around 2 percent, the researchers note. However, they found that with exposure to e-cigarette vapor, the number of dead or dying cells rose to 18 percent, 40 percent, and 53 percent over 1, 2, and 3 days, respectively.

While the cumulative effects of the cell damage caused by e-cigarette are unclear, the researchers believe their findings are a cause for concern.

“Damage to the defensive barrier in the mouth can increase the risk of infection, inflammation, and gum disease. Over the longer term, it may also increase the risk of cancer. This is what we will be investigating in the future.”

Dr. Mahmoud Rouabhia

Think tanks with ties to tobacco arguing against plain packaging

Nov 17th, 2016
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http://www.theglobeandmail.com/life/health-and-fitness/health/think-tanks-with-ties-to-tobacco-arguing-against-plain-packaging/article32884552/

A tobacco company speaking out against a public-health measure doesn’t have the same credibility as a respected think tank or advocacy group. So those companies often work with or donate funds to organizations that publicly criticize tobacco taxes and other new regulatory measures.

Those financial relationships create the possibility for bias. Yet most of the organizations on the receiving end of tobacco donations do not clearly disclose that information when speaking about related issues.

The latest example is the current debate over plain packaging.

The federal government wants to pass new regulations that would strip brand colours and logos from tobacco products and instead require them to carry a standard plain colour and font in addition to the graphic health warnings that are currently used. The government hopes the move can stop some of the nearly 90,000 Canadians who pick up the deadly habit each year. Across the country, nearly 40,000 people die annually from tobacco-related illnesses

Not surprisingly, the three biggest tobacco companies in Canada, Imperial Tobacco Canada; Rothmans, Benson & Hedges; and JTI-Macdonald, are all opposed to the measure.

But they aren’t the only ones against the proposal. Some think tanks and advocacy groups with tobacco funding are also speaking out against plain packaging. And yet, these groups typically don’t mention their financial ties when speaking about policy.

For example, the Montreal Economic Institute published a report in September saying plain packaging “attacks the value of brands.” It included a disclaimer saying the report was “in no way” financed by tobacco. In September 2015, institute president Michel Kelly-Gagnon authored a Huffington Post article saying plain packaging drove consumption higher in Australia, where it was adopted in 2012. The article didn’t mention an industry connection.

But in an e-mail, Kelly-Gagnon said the institute has “proudly received” tobacco funding since 1998 in amounts between 2 and 4 per cent of its budget. He said in an interview that the organization recently decided to stop accepting donations from the industry because health groups use that information to criticize its work.

Then there’s the National Coalition Against Contraband Tobacco, which issued a press release in September warning about the prevalence of illegal cigarettes and how the problem will worsen with plain packaging. A letter to the editor from the coalition and published in The Globe and Mail in September also stated that plain packaging will increase the contraband market. In its official comments to the federal government on plain packaging, the coalition said there is “no doubt” the new measure “will increase the availability of the illegal product.” The document doesn’t mention financial ties to tobacco.

Online, the coalition lists its members, which include the Ontario Chamber of Commerce, Toronto Crime Stoppers and the Canadian Tobacco Manufacturers Council.

But according to documents obtained by The Globe and Mail, the coalition works closely with the country’s three major tobacco companies to shape its public statements and reports. The coalition declined an interview request and did not respond directly to questions about its ties to tobacco.

Another example dates back to May, when the Atlantic Institute for Market Studies (AIMS), a Halifax think tank, hosted a talk by Sinclair Davidson, an Australian professor and vocal plain-packaging critic. According to articles in the Sydney Morning Herald, the Institute of Public Affairs, where Davidson is a fellow, has received tobacco funding and some experts have criticized Davidson’s work as flawed.

In an e-mail, Davidson defended his work and said he was invited to speak in Canada by the Canadian Convenience Stores Association (CCSA). But according to the AIMS Facebook page, Davidson’s Halifax visit was organized by the institute in partnership with Crestview Strategy, a public-affairs firm. According to the Office of the Commissioner of Lobbying of Canada, Crestview currently lobbies on behalf of Rothmans, Benson & Hedges. (Crestview and Rothmans did not respond to questions about the visit.)

The CCSA said it does receive funding from the tobacco industry but declined to state an amount or respond to questions about Davidson’s visit.

Imperial Tobacco Canada; Rothmans, Benson & Hedges; and JTI-Macdonald declined requests to name the groups they fund, but said they work with groups that share their views.

Julia Smith, a postdoctoral research fellow at Simon Fraser University who studies tobacco control, said she is concerned organizations with financial ties to tobacco will help derail plain packaging and other health measures, in part because many believe their views are independent and unbiased. “We’ve seen the tobacco industry use these tactics in the past,” she said, noting that “in some cases, they have been successful.”

Beyond engaging vocal sources, the tobacco industry has also commissioned several reports that say plain packaging is ineffective. But independent research tells a different story.

An Australian government survey found the number of daily smokers fell from 2.7 million in 2010 to 2.5 million in 2013. The average age young people reported smoking their first full cigarette rose from 15.4 years in 2010 to 15.9 years in 2013. And a 2013 study published in the journal Tobacco Control found only a small number of retail stores sold illicit cigarettes. Before plain packaging, researchers found about 2 per cent of cigarette packages to be illicit, compared to 0.6 per cent in the months after implementation.

Think tanks and advocacy groups regularly seek to influence public policy. But policy-makers and the public deserve to know when those organizations may be representing the interests of others.

DOH wants e-cig, vapes covered by smoking ban

Nov 17th, 2016
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http://www.philstar.com/headlines/2016/11/17/1644636/doh-wants-e-cig-vapes-covered-smoking-ban

To fortify the government’s campaign against smoking, the Department of Health (DOH) has recommended to Malacañang that electronic cigarettes (e-cig) and vapes be included in the public smoking ban.

DOH spokesman Eric Tayag said the agency’s proposed executive order for the smoking ban includes e-cigs and vapes, although Republic Act 9211 or the Tobacco Regulation Act of 2003 did not cover these.

“There is now evidence that they are also threats to our health, so they should be included in the ban,” Tayag said.

The DOH is now waiting for President Duterte to sign its proposed EO that seeks to prohibit smoking in all public places across the country. This restriction is not included in RA 9211.

With the proposed ban complemented by the sin tax law, the DOH is expecting the current smoking prevalence rate of 23 percent to go down by at least 10 percent initially.

Tayag noted that while e-cigs and vapes are being marketed as tools to quit smoking, these actually encourage smoking.

He underscored that just like traditional cigarettes, these two devices also contain nicotine and other harmful substances.

“That’s how the manufacturers are marketing it – that they will help people quit smoking. But in fact, many cigarette manufacturers are now manufacturing e-cigs and vapes,” he said.

Tayag noted that since curbing smoking has been succeeding worldwide, cigarette manufacturers are producing e-cigs and vapes as “other avenue” for their business.

He said the health department worries about the grave impact of e-cigs and vapes on children, who could not differentiate them from traditional cigarettes.

The health official said he also expects tobacco manufacturers to block the inclusion of these devices in the health department’s proposed ban on cigarettes.

Surgeon general ramps up addiction battle

Nov 17th, 2016
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http://www.politico.com/story/2016/11/surgeon-general-addiction-drugs-231532

The U.S. surgeon general has released the first comprehensive report on addiction in America, and he wants it to have as much public health punch as the groundbreaking report on the dangers of tobacco 50 years ago.

In an interview with POLITICO on the eve of its release, Surgeon General Vivek Murthy said that he’s determined to make the report an action item in communities across the country, and not just put it on the shelf.

“We can’t afford not to address it,” he said. “We can’t afford to stay on the path we’re on.”

More than 20 million people in America have substance abuse problems; 78 die every day from opioids alone.

The report, released Thursday morning, is about substance abuse broadly — both alcohol and drugs, legal and illegal. But it’s the opioid epidemic that has grabbed public attention. And opioids have gradually emerged as one of Murthy’s top priorities, particularly as he’s traveled the country listening to families’ stories.

In Washington and the states, Republicans and Democrats alike have endorsed a more robust response, and Congress passed bipartisan legislation — although it’s not yet funded. But the report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health,” arrives amid heightened uncertainty about policy and access to treatment.

The incoming Trump administration has not outlined a detailed opioid policy, although Donald Trump during the campaign pledged to stop illegal drugs from flowing across the borders and to make sure people with addiction have “the assistance they need to unchain themselves.”

Beating tobacco starts with going easy on vaping

Nov 17th, 2016
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http://www.thetimes.co.uk/edition/scotland/beating-tobacco-starts-with-going-easy-on-vaping-3gtx68ptc

Stopping smoking has always been a bit of a drag. White-knuckle determination to resist the need to smoke is accompanied by a bewildering variety of inhalers, gums, sprays, patches, tablets and counselling, much of which is associated with modest success and some of which has serious adverse side-effects.

Stopping smoking remains a global health priority since it is still the leading cause of premature death and serious ill health. With the advent of e-cigarettes, quitting smoking has become fun as smokers discover a world of user-modifiable e-cigarette kits and a limitless range of flavours. In a survey of more than 22,000 vapers carried out by researchers in Glasgow, smokers typically started vaping with high-nicotine, tobacco-flavoured e-liquids before progressing to zero-nicotine fruit flavours as they moved further away from the world of smoking.

Although they have helped millions to turn their back on tobacco, e-cigarettes have attracted controversy due to fears that they may attract non-smokers and lead to renormalisation of smoking. Government bodies in Europe and the United States are imposing restrictive regulations on e-cigarette production, sales and use that will limit the range of flavours and reduce access to the modifiable e-cigarette kits that vapers seem to enjoy.

At a World Health Organisation meeting in Delhi this month on tobacco control, delegates were asked to support a worldwide ban on e-cigarettes. Here in the UK, the appetite for regulation is enormous. Almost all council areas within the UK already maintain a ban on the use of e-cigarettes at work, leaving vapers to stand in the cold.

With Brexit, the UK has the opportunity to develop regulations governing e-cigarettes that can ensure that these devices remain widely available for smokers at the same time as their appeal to non-smokers is minimised.

Flavours are important, as are retaining the user-modifiable e-cigarette tanks that allow users to produce the voluminous vaper clouds that have become so characteristic of these devices.

We need to discourage e-cigarette use by non-smokers, not by forcing people to vape in hiding but by recognising what this technology is achieving in saving smokers’ lives.

Dr Neil McKeganey is director of the Centre for Substance Use Research in Glasgow

EC consults on tobacco excise duties

Nov 17th, 2016
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https://www.cchdaily.co.uk/cch_uk/cln/news_002965_tobacco

The European Commission (EC) has opened a public consultation on the revision of Directive 2011/64/EU, which sets out EU rules on the structure and rates of excise duty applied to manufactured tobacco. EU citizens and stakeholders alike are invited to give their opinions.

Directive 2011/64/EU defines and classifies various manufactured tobacco products according to their characteristics and lays down the relevant minimum rates of excise duty for the different types of products. These rates are reviewed every four years. The EC’s last report, in December 2015, said there could be scope to improve Directive 2011/64/EU in order to reduce the administrative burden for both member states and economic operators and reduce distortions in the internal market. The report was accompanied by a proposal for the revision of the Directive.

The consultation is intended to add to the possible policy options under analysis. It closes on 16 February 2017.

Kiwi managed funds flock to discuss going tobacco free, campaigner says

Nov 16th, 2016
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http://www.sharechat.co.nz/article/c9bb7fb4/kiwi-managed-funds-flock-to-discuss-going-tobacco-free-campaigner-says.html

Bronwyn King, the Australian doctor leading a global push to encourage fund managers to exclude tobacco stocks, said she’s had approaches from six major funds in New Zealand interested in making the shift.

The move follows investor uproar earlier this year after media investigations found New Zealanders had unknowingly invested $152 million in arms manufacturers and big tobacco companies through their KiwiSaver funds, she said.

King is chief executive of Tobacco Free Portfolios and a practising radiation oncologist in Melbourne. She has already persuaded 35 Australian superannuation funds controlling nearly half of the total funds under management in that country to shun tobacco, and doesn’t know the numbers of funds that exclude tobacco in New Zealand though ANZ is a recent convert and the New Zealand Superannuation Fund was the first sovereign wealth fund in the world to do so.

King’s own epiphany came in 2010 when she and her Kiwi husband wanted to buy a house and she went to discuss her savings in the superannuation fund Health Super with a consultant. As she left, she asked whether she was meant to specify how she wanted her money invested in Health Super. The consultant replied she didn’t need to worry because she was in the default option where the decisions were made for her.

King then asked what the options were and was told there was a “greenie option” involving no investment in mining, alcohol, or tobacco.

“It was a big shock knowing I was investing in tobacco companies that were making products that killed my patients,” she told a Responsible Investment Conference in Auckland yesterday.

It turned out Health Super’s default option included investing in four of the big tobacco companies, and King shared that news with other staff members at Peter Mac, a dedicated cancer hospital. She also raised it with the chief executive and then with the super fund which had merged with Sydney-based First State Super. After a lot of discussion, it became the first Australian superannuation fund to renounce tobacco investments in 2012.

One of the biggest successes in King’s campaign came this year when AXA, the world’s second-biggest insurer, said it would sell 200 million euro of tobacco stocks and run down 1.6 billion euro of tobacco corporate bonds. King says she’s currently working with more than 100 financial institutions with four more likely to announce a similar move soon.

The tide has turned in public sentiment on the issue and fund managers who manage investors’ money are slowly waking up to that fact, she said.

The pitch that has worked best has been highlighting the tobacco industry’s exploitation of young people with an estimated 100,000 children starting smoking each day.

Not many people are aware that according to the International Labour Organisation up to 60 percent of the workforce in tobacco farming are aged under 16, she said. The average age at which Australian smokers take up the habit is 15 years and nine months – the oldest in the world. The average in the UK is just 11 years.

The percentage of boys that smoke between 13 and 16 years old is 3.7 percent in New Zealand but is much higher in emerging countries such as Indonesia where the figure is 41 percent and 52.1 percent in Papua New Guinea.

“This is not about adults making an informed choice but about children who start smoking when they’re too young to be aware of the risks,” she said.

One conference attendee said one of the problems with divestment was that tobacco stocks had done so well for investors over the years. King said that was the most difficult thing though there were signs those profits could change in the next 10 years.

“The industry has done well in the past 10 years because it has gone into the developing world before these regulations were crafted. It’s made the most of these very poor populations with large user bases and very poor levels of awareness and very poor regulatory frameworks, an industry that continues to get away with 60 percent of its workforce being child labour, externalising costs and internalising profits and not being held to account for all of these deaths is extraordinary.”

King said there’s three strong reasons behind going tobacco free: tobacco is a unique product in that it can’t be used safely with two out of three smokers dying from its use; the UN Tobacco Treaty signed by 180 countries including New Zealand requires governments and related bodies not to invest in the industry and take other measures such as plain packaging; and engagement with the industry to change its behaviour is futile.

There’s a regulatory risk for fund managers with three countries having introduced plain packaging legislation and another 20 will have by next year, King said. New Zealand has signed off on it but not yet set a date for implementation.

There’s also a litigation risk with the Quebec state government succeeding last year in a landmark class action suit against three big tobacco companies where the judge awarded C$15.6 billion in compensation to one million smokers for the health effects of the products. It is being appealed by the tobacco companies.

King said the case was one the rest of the world should watch with interest.

“If that precedent is set I can’t believe the people of New Zealand would be happy to continue to pick up the costs of the tobacco industry, it doesn’t make any sense. The truth is if we all sued at the same time the tobacco industry couldn’t even pay its own costs for one year.”

Tobacco stocks up in smoke as govt mulls FDI ban

Nov 16th, 2016
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http://economictimes.indiatimes.com/markets/stocks/news/tobacco-stocks-up-in-smoke-as-govt-mulls-fdi-ban/articleshow/55455794.cms

Shares of cigarette companies plummeted up to 20 per cent on Wednesday amid reports that the Union Cabinet is likely to consider a proposal to completely ban foreign direct investment (FDI) in the tobacco sector.

Reacting on the news, shares of Godfrey PhillipsBSE 6.81 % hit the lower circuit and closed 20 per cent down at Rs 918.80 on Wednesday. Shares of other tobacco companies such as ITCBSE 0.72 % and NTC IndustriesBSE -5.14 % slipped 4 per cent and 0.65 per cent, respectively. The benchmark BSE Sensex closed almost flat at 26,298.

The Commerce and Industry Ministry has forwarded the final note on this issue to the Union Cabinet for consideration, sources told PTI.

At present, FDI is permitted in technology collaboration in any form, including licensing for franchise, trademark, brand name and management contracts in the tobacco sector. However, it is prohibited in manufacturing of cigars, cigarettes of tobacco and tobacco substitutes.

The proposal, if approved, may be a setback for domestic cigarette manufacturers, according to the report.

The ban would also eliminate the possibility of indirect flow of overseas funds to the sector. FDI into the country grew by 29 per cent to $40 billion in 2015-16.

On a year-to-date basis, most of cigarette-related companies have been outperforming the benchmark equity indices. Stocks such as Golden TobaccoBSE 1.58 % and VST IndustriesBSE 4.29 % have risen 33.36 per cent and 33.32 per cent to Rs 65.55 and Rs 2268.25 till November 15 from Rs 49.15 and Rs 1701.30, respectively, on January 1.

 

Smoking electronic cigarettes kills large number of mouth cells

Nov 16th, 2016
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Summary: A large number of mouth cells exposed to e-cigarette vapor in the laboratory die within a few days, according to a new study.

https://www.sciencedaily.com/releases/2016/11/161116101821.htm

A large number of mouth cells exposed to e-cigarette vapor in the laboratory die within a few days, according to a study conducted by Université Laval researchers and published in the latest issue of Journal of Cellular Physiology.

Dr. Mahmoud Rouabhia and his team at Université Laval’s Faculty of Dental Medicine came to this conclusion after exposing gingival epithelial cells to e-cigarette vapor.

“Mouth epithelium is the body’s first line of defense against microbial infection,” Professor Rouabhia explains. “This epithelium protects us against several microorganisms living in our mouths.”

To simulate what happens in a person’s mouth while vaping, researchers placed epithelial cells in a small chamber containing a saliva-like liquid. Electronic cigarette vapor was pumped into the chamber at a rate of two five-second “inhalations” per minute for 15 minutes a day.

Observations under the microscope showed that the percentage of dead or dying cells, which is about 2% in unexposed cell cultures, rose to 18%, 40%, and 53% after 1, 2, and 3 days of exposure to e-cigarette vapor, respectively.

“Contrary to what one might think, e-cigarette vapor isn’t just water,” explains Dr. Rouabhia. “Although it doesn’t contain tar compounds like regular cigarette smoke, it exposes mouth tissues and the respiratory tract to compounds produced by heating the vegetable glycerin, propylene glycol, and nicotine aromas in e-cigarette liquid.”

The cumulative effects of this cell damage have not yet been documented, but they are worrying, according to Dr. Rouabhia, who is also a member of the Oral Ecology Research Group (GREB) at Université Laval: “Damage to the defensive barrier in the mouth can increase the risk of infection, inflammation, and gum disease. Over the longer term, it may also increase the risk of cancer. This is what we will be investigating in the future.”

AHA: secondhand tobacco smoke ups atherosclerosis risk

Nov 16th, 2016
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http://medicalxpress.com/news/2016-11-aha-secondhand-tobacco-ups-atherosclerosis.html

In asymptomatic never smokers, the extent of secondhand tobacco smoke (SHTS) exposure is associated with the presence and extent of atherosclerosis, according to a study published online Nov. 13 in JACC: Cardiovascular Imaging. The research was published to coincide with the annual meeting of the American Heart Association, held from Nov. 12 to 16 in New Orleans.

David F. Yankelevitz, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues administered a questionnaire to 268 never smokers, ages 40 to 80 years, assessing risk factors and extent of lifetime SHTS exposure. The participants also underwent low-dose non-gated computed tomographic scans, followed by computed tomographic angiography.

The researchers found that 48 percent of participants had coronary atherosclerosis, and it was more frequent with low-to-moderate and high versus minimal SHTS exposure (48 and 69 versus 25 percent; P < 0.0001). For any atherosclerosis, the adjusted odds ratios were 2.1 (P = 0.05) and 3.5 (P = 0.01) for low-to-moderate and high, respectively, versus minimal SHTS exposure. With increasing SHTS exposure there was an increase in the percentage of major vessels with any plaque or stenosis (P = 0.0013) and in the number with five or more involved segments (P = 0.0001).

“The presence and extent of atherosclerosis were associated with the extent of SHTS exposure even when adjusted for other risk factors, further demonstrating the causal relationship of SHTS exposure and coronary disease,” the authors write.

Several authors disclosed patents relating to the research subject matter.

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