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November 14th, 2016:

Big Tobacco wins big with vaping

Big Tobacco, with its legion of lobbyists, and evil geniuses, is almost always a step ahead of regulators and health officials. It wasn’t until May of this year that the FDA finally finalized a rule extending its authority to all nicotine products — including e-cigarettes, cigars, hookah and pipe tobacco, among others. The lack of such authority is why we saw ads for nicotine vaping products on TV, and such products sold legally to teens and kids.

When cigarette smoking rates among teens hit historic lows in the past decade, flavored products (from cigars to vaping) filled the void. When the FDA announced the oversight change, it cited research by the agency and the CDC showing current e-cigarette use among high school students has skyrocketed from 1.5 percent in 2011 to 16 percent in 2015 (an over 900 percent increase) and hookah use has risen significantly. In 2015, 3 million middle and high school students were current e-cigarette users, and data showed high school boys smoked cigars at about the same rate as cigarettes.

A separate study by the FDA and the National Institutes of Health shows that in 2013-2014, nearly 80 percent of current youth tobacco users reported using a flavored tobacco product in the past 30 days – with the availability of appealing flavors consistently cited as a reason for use, the FDA reported.

And now, a new, disturbing study shows just how successfully Big Tobacco is cultivating more nicotine addicts, and how belated the FDA was to take action to oversee the new products. The research, published in the Journal of the American Medical Association, found that teenagers with a regular vaping habit aren’t just more likely to take up smoking — they have higher odds of developing a heavy cigarette habit, Reuters reported.

Vaping devices have been advertised as way to help smokers quit, but the lead author of the study says his findings call that cessation claim into question.

“Our most recent study is the first to show that teenagers who vape not only experiment with cigarettes, but are also more likely to become regular smokers,” said Adam Leventhal, director of the University of Southern California’s Emotion and Addiction Laboratory in Los Angeles.

Rather than keeping kids and teens from smoking, the flavored nicotine products can act as bridge to smoking, said Dr. Brian Primack, a University of Pittsburgh researcher who wasn’t involved in the study.

“… young people who may not have otherwise ended up smoking started with palatable, flavored e-cigarettes — and then after they became accustomed to e-cigarette use, many transitioned to traditional cigarette smoking,” Primack told Reuters. Which is exactly what is happening.


In Nepal, health warnings cover 90 percent of cigarette packs, while Australia requires those packets be wrapped in drab, plain paper. Indonesia’s new ban on outdoor advertising brought down tobacco billboards depicting smiling, smoking youths. And India wants scary photos of rotting lungs and mouth tumors covering packets sold in the country.

Still, national drives to discourage smoking and cut back tobacco sales haven’t done enough, campaigners say. Smoking-related deaths are still rising worldwide, with 80 percent of them expected to occur in developing country populations by 2030.

“Most people in the United States think tobacco is over and done with, but it’s still the largest preventable cause of disease on the planet” killing 6 million people a year — or one person every six seconds, said John Stewart, deputy campaigns director at the Boston-based lobbying group Corporate Accountability International.

Starting Monday, representatives from at least 178 countries are meeting for five days in the Indian capital to discuss how they can further the fight against smoking and push back against tobacco company lobbyists.

Since they set down stiff regulations and guidelines in a landmark 2003 treaty called the Framework Convention on Tobacco Control — the first and only global treaty dealing with public health — most of the 180 signatories have ratified it and passed laws restricting tobacco advertising or sales.

Still, many governments remain entangled with powerful tobacco companies, while industry lobbyists continue attempts to stymie efforts to implement anti-smoking laws through bribery, misinformation and even suing national governments for lost profits, campaigners say.

“The tobacco industry is definitely feeling the heat,” Stewart said. “They’ve got their back against the wall.”

Indian courts are currently grappling with 62 lawsuits filed by tobacco companies or cigarette makers challenging laws requiring that 85 percent of all cigarette packets be covered with photos of medical horrors.

In Japan, a 10-percent hike in taxes on cigarettes has led to a 30-percent decline in smoking. But the country still has some of the lowest tax rates on cigarettes among industrialized nations, while its finance ministry owns 33 percent in Japan Tobacco.

The anti-tobacco campaign has had some success. It is widely accepted, at least among national leaders, that smoking causes cancer, cardiovascular and respiratory disease, along with a host of other harmful health impacts.

That awareness still has not trickled down to national populations, though. And campaigners say tobacco interests have shifted their focus to poorer, less educated populations in the developing world.

India — among the first to ratify the anti-tobacco treaty in 2004 — is still considered one of the biggest battlegrounds in the fight against the tobacco industry, public health specialists say.

Despite harsh laws passed more than a decade ago banning smoking in public and sales to children, smoking is still common across the country. A government survey in 2010 showed nearly 35 percent of adults were either smoking or chewing tobacco.

Meanwhile, more than 1 million Indians die each year from tobacco-related diseases that cost the country some $16 billion annually, according to the World Health Organization.

“The revenues that the government earns from tobacco taxes are far less than the billions that are spent on health care,” said Bhavna Mukhopadhyay of the Voluntary Health Association of India, a public health organization.

“Public health and the health of the tobacco industry cannot go hand in hand,” she said, noting that campaigners are now pushing for countries to make tobacco companies and their shareholders civilly and criminally liable for the harm done by tobacco.

Part of the trouble in India is “the Indian consumer is spoilt for choice,” she said, with cigarettes sold alongside chewing tobacco and cheap, hand-rolled smokes known as bidis.

The easy availability and wide choice means many smokers get hooked at a young age. Some are initiated early through the common, cultural practice of chewing something called gutka, which combines tobacco with spices, lime and betel nut and is widely sold as a mouth freshener.

Putting pictorial warnings on cigarette packets is an attempt to educate people about the risks.

“The idea was that even an illiterate person, or a child, would understand the message about the health risks from smoking,” said Monika Arora of the Public Health Foundation of India, who runs an anti-smoking campaign aimed at young Indians. Nirmala George, New Delhi, AP

Significant new developments for global tobacco control

Dr. Vera Luiza da Costa e Silva, the Head of the Convention Secretariat, of the Seventh Conference of the Parties (COP) to the WHO Framework Convention on Tobacco Control (WHO FCTC) which concluded on 12th November 2016, in Greater Noida, New Delhi, said addressing the final ceremony, “The long hours of debate and planning has produced a strong road map for global tobacco control for the future. Despite all the hard work by the Parties it is sad to see the interest, yet again, being promoted in the room.

It is determined to undermine and distract us from our goal – to fight against the tobacco epidemic that not only damages health and kills people, but also impoverishes those living in low- to middle- income countries.”

Several significant decisions were adopted in the course of the six-day session and during an intense week of discussions delegates addressed the longest agenda of any COP, indicating the enthusiasm of Parties and the growing role of tobacco control within areas of development and human rights, as well as public health.

The decisions reached, shaping the future of the Convention, is set against the stark reality that without strong tobacco control measures tobacco will kill about 1 billion people in the 21st Century. By 2030, over 80 percent of the world’s tobacco-related mortality will be in low- and- middle income countries.

Parties continue to be concerned, as expressed at COP7, by the tobacco industry’s persistent attempts to infiltrate and manipulate the workings of the Convention and the outcome of COP7. Noting with concern that the tobacco industry’s tactics at the international level affects implementation of the Convention at a country level, COP7 urged Parties to intensify multi-sectoral actions and cooperation to address strategies of the tobacco industry to undermine or subvert tobacco control. It calls on Parties to remain vigilant of tobacco industry efforts to undermine the implementation of WHO FCTC.

The decision on electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) invites Parties that have not yet banned the importation, sale and distribution of ENDS/ENNDS to consider either prohibition or regulating such products.

Parties called for further unbiased, commercially independent and scientifically-based research to ascertain the overall health impact and long-term public health risks of ENDS/ENNDS. Some Parties expressed concern at the use of health claims as a marketing tool for ENDS/ENNDS. There was also consideration that all the different devices and delivery systems should be regulated under national legislation in the same way as drugs or tobacco products, while others called for them to be banned outright. Further evidence-based scientific research is to be prepared.

The decision encourages Parties not growing tobacco to not start. It urges Parties to adopt a whole-of-government approach and participation with stakeholders to promote alternatives to tobacco growing and avoid tobacco industry obstruction in programmes meant for welfare and diversification of tobacco growing and workers and the protection of the environment, as appropriate in the national context.

Dr Vera Luiza da Costa e Silva told delegates during the closing ceremony, “We have an obligation to protect vulnerable members of the tobacco production chain – the farmers. But we do that not through encouraging more growing, as the tobacco industry does, but through the development of solid, sustainable alternatives that will promote a better future for farmers and their families.”

The Parties recognize scientific evidence has established that tobacco consumption and exposure to tobacco smoke causes death, disease and disability. The Parties adopt the report of the expert group, including a specifically designed toolkit, as a mechanism of assistance to those Parties that may require assistance in developing civil liability. It encourages Parties to consider options, including developing their legislation or liability procedures, as appropriate, and increasing their international cooperation in order to strengthen implementation of Article 19 of the WHO FCTC.

The Parties have requested further research on evidence on tobacco use and tobacco control and its consequences among girls and women, as well as boys and men, with special attention to vulnerable groups, in respect to social determinants of health.

The Parties recognize that tobacco control is related to a number of Sustainable Development Goals and targets including those related to the environment and human rights. The Parties requested the Convention Secretariat to strengthen the treaty relationship with other international agencies and frameworks, enhancing synergies towards common global health and development goals.

The Impact Assessment report, presented to COP7, reveals how implementation of the WHO FCTC is gaining force around the world. Where it is applied prevalence drops and so does demand for tobacco.

Don’t Look to E-Cigarettes as a Panacea for Smoking

To the Editor:

Re “Experts Say Vaping Alarm Is Overdone” (front page, Nov. 2):

A positive if unintended result of the e-cigarette controversy is that highlighting the relative dangers of tobacco cigarettes and e-cigarettes further deglamorizes them both. The discussion presents the public with the unpleasant truth that nicotine isn’t a recreational drug.

Addiction to nicotine in tobacco is the norm, not the exception, and smoking addiction is about compulsive behavior and suffering, not pleasure. All the current studies show that people who quit smoking enjoy improved mental health, more positive moods and better quality of life than those who continue to smoke.

Nicotine replacement comes in many forms, including e-cigarettes. It can help ease smokers out of smoking, but only if they stop completely. The case for e-cigarettes would be stronger if the United States, like the British National Health Service, offered clinical assistance to help addicted smokers quit, rather than just relying on our culture of self-help.


New York

The writer, a clinical psychologist, is director of smoking cessation services at Columbia University.

To the Editor:

E-cigarettes are not the panacea to tobacco-caused addiction, death and disease. E-cigarettes are unregulated tobacco products, and e-cigarette companies are making unproven health claims.

The Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit. Instead, almost 60 percent of all e-cigarette users continue to smoke cigarettes.

Tobacco use is the leading cause of preventable death and disease in our country, and there is real concern that if e-cigarettes delay or prevent smoking cessation, the overall burden on health caused by tobacco will remain unacceptably high.

In 2009, a bipartisan majority in Congress charged the F.D.A. with oversight over tobacco products, including new products. The agency has taken steps to use this authority, and it should proceed with its process that allows manufacturers to provide evidence to show that their products are less harmful.

Trusting the tobacco industry and circumventing robust scientific review and oversight of these products would be a mistake.


National President and Chief Exec.

American Lung Association



A global conference on tobacco control has pledged to hold the tobacco industry legally liable for health consequences of smoking and protect public health policies from the influence of tobacco companies.

Representatives from around 180 countries participating in the World Health Organization’s global tobacco control treaty negotiations on Saturday adopted a declaration in which they also vowed to prohibit or regulate the sale of e-cigarettes.

The six-day conference on the Framework Convention on Tobacco Control, or FCTC, concluded with participating countries agreeing to promote alternative livelihoods for tobacco farmers that would ensure a better future for them.

Public health activists say smoking-related deaths are still rising worldwide, with 80 percent of them expected to occur in developing countries by 2030. The WHO says that without strong control measures, tobacco will kill about 1 billion people in the 21st century.

The more than 1,500 delegates expressed their concern about persistent attempts by the tobacco industry to infiltrate the meetings in order to influence the working and the outcomes of the conference.

The declaration cautioned governments against efforts by big tobacco companies to dilute health policies, subvert measures to restrict tobacco sales and undermine the implementation of the FCTC.

“The long hours of debate and planning has produced a strong road map for global tobacco control for the future,” Vera Luiza da Costa e Silva, head of the convention secretariat, told reporters.

She said the tobacco industry was “determined to undermine and distract us from our goal – to fight against the tobacco epidemic that not only damages health and kills people, but also impoverishes those living in low- to middle-income countries.”

The conference declaration included measures to hold big tobacco companies liable for the health consequences of its products, recover health care costs and facilitate access to justice for victims of tobacco-related diseases.

Since they set down stiff regulations and guidelines in the landmark 2003 FCTC treaty – the first and only global treaty dealing with public health – most of the 180 signatories have ratified it and passed laws restricting tobacco advertising or sales.

Still, many governments remain entangled with powerful tobacco companies, while industry lobbyists continue attempts to stymie efforts to implement anti-smoking laws through bribery, misinformation and even suing national governments for lost profits, campaigners say.

Health activists hailed the decision on legal liability, saying it could set a precedent for holding other industries accountable for environmental damage or public health harms they could cause.

“The tobacco industry is the single largest barrier to tobacco control policies globally – and these negotiations were no exception,” said John Stewart, deputy campaigns director at the Boston-based lobbying group Corporate Accountability International.

Stewart said the firm stand taken by delegates, who stood up to the tobacco industry, had enabled governments to adopt “some of the strongest measures yet to protect millions of people’s lives.”

Vaping may put your smile at risk

New cell study shows e-cigarette vapors damage cells of the mouth

Here’s news that could put a frown on your face. New data show that electronic cigarettes pose a threat to cells in the mouth — and ultimately a vaper’s smile.

Electronic-cigarette use, or vaping, among teens is on the rise. The number of kids that tried vaping quadrupled between 2013 and 2015. In the United States, more kids now vape than smoke tobacco cigarettes. Ads on TV and the internet show e-cigarettes as being safe and fun. However, scientists have been turning up evidence that vaping is not harmless. And now researchers have found that e-cigarette vapors can pose risks to the gums and teeth.

Irfan Rahman works at the University of Rochester in New York. This biochemist studies the potential harm posed by-products and pollutants, including e-cigs. Last year, Rahman told Science News that many teens and young adults said vaping made their throats dry and scratchy. Some told his group that vaping made them cough and their mouths bleed. “We’ve got to start looking into these things and see what’s going on,” Rahman concluded.

E-cigarettes are battery-operated devices. A metal coil inside the device gets very hot. When a flavored liquid passes over these coils, it vaporizes into a gas that users breathe in. E-liquids contain mixtures of chemicals that produce different flavors. Most mixes contain some nicotine, too. (Nicotine is the addictive substance that gives cigarettes their “buzz.”) The liquids tend to be labeled as food grade, which means they are safe enough to eat. But heating these liquids can change their chemical composition. Experts say these chemical changes can make the vapors more toxic — more harmful — than the e-liquids themselves.

His team has now started to do just that.

The researchers have begun to probe what e-cig vapors do to cells of the mouth. They started by growing different types of human mouth cells in the lab. They looked at cells that make up the gums. They also looked at ligament cells that attach teeth to the gums. They exposed each type of cells to the chemicals from e-cigarette vapors.

Those vapors can alter the DNA in these cells, the scientists found. Exposing the cells to e-cig vapors damaged their DNA. DNA damage can change the genetic instructions that tell a cell how to grow and function. Over time, such changes might trigger the development of cancer. The vapors also can harm the cells by causing sustained inflammation.

Taken together, these changes point to a risk of cancer, gum disease and possibly tooth loss for anyone using e-cigarettes. Rahman’s team described its new findings in a paper published October 24 in the journal Oncotarget.

Inflammation — a chemical ‘red flag’ of danger

Mouth cells exposed to e-cigarette vapors gave off warning signals known as inflammatory markers. These markers signal that a process called inflammation is underway. Flavored e-cigs caused more of these inflammatory markers and signs of DNA damage to appear than did unflavored e-cig vapors. Because these flavor chemicals are not present in regular cigarettes, Rahman calls this finding especially worrisome. Indeed, he says, the flavored vapors may pose cellular risks that are unique to e-cigarettes.

Overall, Rahman saw lower levels of inflammation in cells treated with e-cig vapors than would be expected from treating cells with smoke from tobacco cigarettes. Still, that doesn’t mean e-cigs are safer than regular cigarettes, Rahman cautions, because researchers still don’t know what the long-term health effects of e-cig use might be.

Inflammatory markers are chemicals that “tell our bodies that something is going wrong. They send signals that these cells have been damaged,” explains Maciej Goniewicz. He’s a toxicologist at the Roswell Park Cancer Institute in Buffalo, N.Y. Like Rahman, he studies the health effects of e-cigarette vapors. Goniewicz was not involved in the new research on mouth cells.

Inflammation can be helpful. It helps turn on the body’s immune system. This allows it to fight off foreign invaders that don’t belong in the body, such as bacteria and viruses. Inflammation also can help the body heal itself after an injury.

But chronic inflammation, the type that doesn’t go away, is not good. And chronic inflammation is what Rahman and his colleagues worry might occur in a vaper’s mouth. Long-term inflammation of the gums can cause disease. Gum disease can destroy the tissue and bone that hold teeth in place. Severe gum disease even can lead to tooth loss.

The new research corroborates a study Goniewicz published earlier this fall. The bronchial (BRON-kee-ul) tubes are airways that lead to the lungs. Flavored e-cigarette vapors caused similar signs of inflammation to bronchial tube cells as Rahman’s group now reports in mouth cells. The e-cig vapors caused less damage to the bronchial cells than tobacco smoke did. Still, Goniewicz emphasizes, “We are seeing that the e-cigarettes do some harm to cells.”

Looking for the big picture

Fawad Javed is a dentist at the University of Rochester. Studying cells in the lab are important for several reasons, he says. “If somebody that smokes or vapes comes to me with oral disease, I need to understand why this is happening.” Javed worked with Rahman on the new study. Seeing changes on the chemical level can point dentists to the root cause of disease, he argues. And once that’s known, he explains, heath professionals can begin to figure out how to prevent disease.

In the lab, scientists can control and manipulate growing conditions. This allows them to scout for specific effects. Still, the scientists know there are many more things at play in the body than can be probed with dishes of cells in some laboratory. To get the full picture of what the new research means for oral health, scientists will have to combine what they learn in cell studies with data from human vapers.

Rahman and Javed have begun doing just that. They have started collecting samples from the mouths of vapers. Called gingival (JIN-jih-vul) crevicular (Kreh-VIC-u-ler) fluid, this watery substance comes from the tiny pockets between the gums and the teeth. That fluid shows evidence that vaping has caused similar inflammation in the saliva and gum fluid of e-cigarette users that Rahman’s team has seen in the cells they exposed in the lab.

But their work is far from over. More research is needed before they will know for sure what potential threats vaping poses to the mouth and gums, Rahman says.

Shops to be banned from displaying tobacco products

Cigarette packages will no longer be displayed in shops selling tobacco products and new regulations on their sales will be implemented, according to a statement by the Health Ministry.

The statement also said cigarette brands will no longer be visible on packages according to the new regulation.

Recep Akdağ, the health minister, said the rate of smokers over the age of 15 increased from 23.2 percent to 27.3 percent in the last four years, in a speech he delivered at parliament’s planning and budget commission.

Akdağ’s plan aims to start a serious campaign against the use of tobacco products, adding that cigarettes would be placed in closed cabinets in shops and plain packaging for cigarettes would be introduced.

The display ban came after a series of smoking regulations were implemented earlier this year under former Health Minister Mehmet Müezzinoğlu who prohibited the sale of all sorts of cigarettes on university campuses and reduced the number of outdoor public spaces for smokers.

According to a study by Ankara-based Hacettepe University, almost 100,000 people die earlier than expected in Turkey each year due to smoking-related illnesses.

India’s move away from cigarettes creates a withdrawal problem for millions of tobacco workers

SBS World News India Correspondent reports: India is taking bold steps to fight the influence of Big Tobacco, but one of the most pressing challenges remains finding alternative employment for millions of tobacco workers.

It’s just after dawn and there’s a steady flow of traffic on the road to the Hunsur tobacco market, just outside the southern Indian city of Mysore.

Big bails of the dried brown leaves are being transported to auction on the backs of small trucks, Massey Ferguson tractors and bullock-driven carts.

By 7am hundreds of farmers have arrived at the market. Cigarette maker ITC, part-owned by British American Tobacco – maker of international brands such as Benson and Hedges and Lucky Strike – will buy approximately half the tobacco that’s for sale.

Shivabasappa is a second-generation tobacco grower. If the buyers judge his crop of Virginia flue-cured tobacco to be first-class he’ll earn 150 rupees (about $3) a kilogram.

“Tobacco has made me rich,” Shivabasappa told SBS. “I am making a lot of money so I will continue to farm it.”

The Karnataka farmer knows there are moves to curb his industry, but he’s proud of what he does. It’s lucrative enough to get a bank loan and attract a wife.

And that is one of the challenges for countries trying to reduce tobacco consumption – providing alternative employment for those who rely on the industry for their livelihoods.

India is the world’s third largest producer of tobacco behind China and Brazil and millions of people in all three countries are linked to the sector.

Earlier this year, India’s government approved a crop diversification program in 10 states.

Alternative employment for tobacco farmers was one of the key issues discussed over the past week at a World Health Organisation conference in Noida, near New Delhi.

Delegates from about 180 countries met to discuss progress on the Framework Convention on Tobacco Control. In force since 2005, the treaty aims to deter tobacco use that kills approximately 6 million people every year.

“I’m pleased to say, following the adoption of the agreement, governments around the world have taken decisive steps not only to reduce tobacco use, but also to stand up to the multinational tobacco companies standing in the way of global progress,” Margaret Chan, Director-General of the WHO, wrote in the Guardian.

“The tide of tobacco use is beginning to turn. After decades of Big Tobacco targeting low and million-income countries and years of steadily increasing sales, tobacco sales show signs of dropping.”

“Where tobacco companies have tried to threaten and bully nations, governments have responded with firm measures to protect public health,” wrote Dr Chan.

The tobacco industry in India has been at war with the central government this year following a new rule stipulating that 85 per cent of cigarette packets be covered with health warnings.

And just as big tobacco fought those laws in Australia, it is challenging them in India too, with dozens of legal battles currently before the courts.

In an attempt to hold ground, India has called for backup; they want help from an international coalition of the willing.

Addressing the WHO conference, India’s health minister, JP Nadda told delegates his country couldn’t do it alone.

“Along with national will and resources, we also need the strength of international collaboration to mitigate the rising burden of the health, social and economic cost of tobacco,” he said.

Ahead of the conference, tobacco farmers protested outside the health ministry and the WHO regional office in New Delhi asking the government to boycott the meeting.

Thousands of farmers also sent the government a petition asking that no “unreasonable” proposals be adopted at the conference.

In Karnataka, one of the biggest tobacco producing states in India, farmer Shivabasappa is very aware the World Health Organisation is working with governments to curb tobacco production and consumption.

“Tobacco and cigarettes don’t cause cancer,” he says. “People who don’t smoke get cancer. It comes from alcohol and other things. Why should tobacco be banned?”

It’s unclear whether he is misinformed or unwilling to slay the golden goose.