cigarettes

U.S. Chamber of Commerce Works Globally to Fight Antismoking Measures

Source: www.nytimes.com
Author: Danny Hakim
 
01cigarette-web2-master675A demonstration against World No Tobacco Day in Jakarta, Indonesia, in 2013. The U.S. Chamber of Commerce and its foreign affiliates have joined efforts to fight antismoking laws around the world. Credit Romeo Gacad/Agence France-Presse — Getty Images

KIEV, Ukraine — A parliamentary hearing was convened here in March to consider an odd remnant of Ukraine’s corrupt, pre-revolutionary government.

Three years ago, Ukraine filed an international legal challenge against Australia, over Australia’s right to enact antismoking laws on its own soil. To a number of lawmakers, the case seemed absurd, and they wanted to investigate why it was even being pursued.

When it came time to defend the tobacco industry, a man named Taras Kachka spoke up. He argued that several “fantastic tobacco companies” had bought up Soviet-era factories and modernized them, and now they were exporting tobacco to many other countries. It was in Ukraine’s national interest, he said, to support investors in the country, even though they do not sell tobacco to Australia.

Mr. Kachka was not a tobacco lobbyist or farmer or factory owner. He was the head of a Ukrainian affiliate of the U.S. Chamber of Commerce, America’s largest trade group.

From Ukraine to Uruguay, Moldova to the Philippines, the U.S. Chamber of Commerce and its foreign affiliates have become the hammer for the tobacco industry, engaging in a worldwide effort to fight antismoking laws of all kinds, according to interviews with government ministers, lobbyists, lawmakers and public health groups in Asia, Europe, Latin America and the United States.

The U.S. Chamber’s work in support of the tobacco industry in recent years has emerged as a priority at the same time the industry has faced one of the most serious threats in its history. A global treaty, negotiated through the World Health Organization, mandates anti-smoking measures and also seeks to curb the influence of the tobacco industry in policy making. The treaty, which took effect in 2005, has been ratified by 179 countries; holdouts include Cuba, Haiti and the United States.

Facing a wave of new legislation around the world, the tobacco lobby has turned for help to the U.S. Chamber of Commerce, with the weight of American business behind it. While the chamber’s global tobacco lobbying has been largely hidden from public view, its influence has been widely felt.

Letters, emails and other documents from foreign governments, the chamber’s affiliates and antismoking groups, which were reviewed by The New York Times, show how the chamber has embraced the challenge, undertaking a three-pronged strategy in its global campaign to advance the interests of the tobacco industry.

In the capitals of far-flung nations, the chamber lobbies alongside its foreign affiliates to beat back antismoking laws.

In trade forums, the chamber pits countries against one another. The Ukrainian prime minister, Arseniy Yatsenyuk, recently revealed that his country’s case against Australia was prompted by a complaint from the U.S. Chamber.

And in Washington, Thomas J. Donohue, the chief executive of the chamber, has personally taken part in lobbying to defend the ability of the tobacco industry to sue under future international treaties, notably the Trans-Pacific Partnership, a trade agreement being negotiated between the United States and several Pacific Rim nations.

“They represent the interests of the tobacco industry,” said Dr. Vera Luiza da Costa e Silva, the head of the Secretariat that oversees the W.H.O treaty, called the Framework Convention on Tobacco Control. “They are putting their feet everywhere where there are stronger regulations coming up.”

01cigarette-web1-master315Thomas J. Donohue, the head of the U.S. Chamber of Commerce, has defended the tobacco industry’s right to sue under future international treaties. Credit Brendan Hoffman for The New York Times

The increasing global advocacy highlights the chamber’s enduring ties to the tobacco industry, which in years past centered on American regulation of cigarettes. A top executive at the tobacco giant Altria Group serves on the chamber’s board. Philip Morris International plays a leading role in the global campaign; one executive drafted a position paper used by a chamber affiliate in Brussels, while another accompanied a chamber executive to a meeting with the Philippine ambassador in Washington to lobby against a cigarette-tax increase. The cigarette makers’ payments to the chamber are not disclosed.

It is not clear how the chamber’s campaign reflects the interests of its broader membership, which includes technology companies like Google, pharmaceutical giants like Pfizer and health insurers like Anthem. And the chamber’s record in its tobacco fight is mixed, often leaving American business as the face of a losing cause, pushing a well-known toxin on poor populations whose leaders are determined to curb smoking.

The U.S. Chamber issued brief statements in response to inquiries. “The Chamber regularly reaches out to governments around the world to urge them to avoid measures that discriminate against particular companies or industries, undermine their trademarks or brands, or destroy their intellectual property,” the statement said, adding, “we’ve worked with a broad array of business organizations at home and abroad to defend these principles.”

The chamber declined to say if it supported any measures to curb smoking.

The chamber, a private nonprofit that has more than three million members and annual revenue of $165 million, spends more on lobbying than any other interest group in America. For decades, it has taken positions aimed at bolstering its members’ fortunes.

While the chamber has local outposts across the United States, it also has more than 100 affiliates around the world. Foreign branches pay dues and typically hew to the U.S. Chamber’s strategy, often advancing it on the ground. Members include both American and foreign businesses, a symbiotic relationship that magnifies the chamber’s clout.

For foreign companies, membership comes with “access to the U.S. Embassy” according to the Cambodian branch, and entree to “the U.S. government,” according to the Azerbaijan branch. Members in Hanoi get an invitation to an annual trip to “lobby Congress and the administration” in Washington.

Since Mr. Donohue took over in 1997, he has steered the chamber into positions that have alienated some members. In 2009, the chamber threatened to sue if the Environmental Protection Agency regulated greenhouse gas emissions, disputing its authority to act on climate change. That led Nike to step down from the chamber’s board, and to Apple’s departure from the group. In 2013, the American arm of the Swedish construction giant Skanska resigned, protesting the chamber’s support for what Skanska called a “chemical industry-led initiative” to lobby against green building codes.

The chamber’s tobacco lobbying has led to confusion for many countries, Dr. da Costa e Silva said, adding “there is a misconception that the American chamber of commerce represents the government of the U.S.” In some places like Estonia, the lines are blurred. The United States ambassador there, Jeffrey Levine, serves as honorary president of the chamber’s local affiliate; the affiliate quoted Philip Morris in a publication outlining its priorities.

The tobacco industry has increasingly turned to international courts to challenge antismoking laws that countries have enacted after the passage of the W.H.O. treaty. Early this year, Michael R. Bloomberg and Bill Gates set up an international fund to fight such suits. Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that administers the fund, called the chamber “the tobacco industry’s most formidable front group,” adding, “it pops up everywhere.”

In Ukraine, the chamber’s involvement was no surprise to Hanna Hopko, the lawmaker who led the hearing in Parliament. She said the chamber there had fought against antismoking laws for years.

“They were against the tobacco tax increase, they were against placing warning labels on cigarettes,” she said. “This is just business as usual for them.”

01cigarette-web3-articleLargePlain packaged tobacco products with health warnings in Sydney, Australia. Credit Andrew Quilty for The New York Times

 

Country-by-Country Strategy

More than 3,000 miles away, in Nepal, the health ministry proposed a law last year to increase the size of graphic warning labels from covering three-fourths of a cigarette pack to 90 percent. Countries like Nepal that have ratified the W.H.O. treaty are supposed to take steps to make cigarette packs less appealing.

Not long afterward, one of Nepal’s top officials, Lilamani Poudel, said he received an email from a representative of the chamber’s local affiliate in the country, warning that the proposal “would negate foreign investment” and “invite instability.”

In January, the U.S. Chamber itself weighed in. In a letter to Nepal’s deputy prime minister, a senior vice president at the chamber, Tami Overby, wrote that she was “not aware of any science-based evidence” that larger warning labels “will have any discernible impact on reducing or discouraging tobacco use.”

A 2013 Harvard study found that graphic warning labels “play a lifesaving role in highlighting the dangers of smoking and encouraging smokers to quit.”

While Nepal eventually mandated the change in warning labels, cigarette companies filed for an extension and compliance has stalled.

“Since we have to focus on responding to the devastating earthquake, we have not been able to monitor the state of law enforcement effectively,” said Shanta Bahadur Shrestha, a senior health ministry official.

The episode reflects the chamber’s country-by-country lobbying strategy. A pattern emerged in letters to seven nations: Written by either the chamber’s top international executive, Myron Brilliant, or his deputies, they introduced the chamber as “the world’s largest business federation.”

Then the letters mention a matter “of concern.” In Jamaica and Nepal, it was graphic health warnings on packages. In Uruguay, it was a plan to bar cigarettes from being displayed by retailers. The Moldovan president was warned against “extreme measures” in his country, though they included common steps like restricting smoking in public places and banning advertising where cigarettes are sold.

A proposal to raise cigarette taxes in the Philippines would open the floodgates to smugglers, the government there was told. Tax revenue has increased since the proposal became law.

“We are not cowed by them,” said Jeremias Paul, the country’s under secretary of finance. “We meet with these guys when we’re trying to encourage investment in the Philippines, so clearly they are very influential, but that doesn’t mean they will dictate their ways.”

Protecting tobacco companies is portrayed by the chamber as vital for a nation’s economic health. Uruguay’s president is warned that antismoking laws will “have a disruptive effect on the formal economy.” El Salvador’s vice president is told that “arbitrary actions” like requiring graphic health warnings in advertisements undermine “investment and economic growth.”

On the ground, the chamber’s local affiliates use hands-on tactics.

After Moldova’s health ministry proposed measures in 2013, Serghei Toncu, the head of the American Chamber of Commerce in Moldova, laid out his objections in a series of meetings held by a regulatory review panel.

“The consumption of alcohol and cigarettes is at the discretion of each person,” Mr. Toncu said at one meeting, adding that the discussion should not be about “whether smoking is harmful.”

“You do not respect us,” he told the health ministry at another.

At a third, he called the ministry’s research “flawed from the start.”

His objections were not merely plaintive cries. The American chamber has a seat on Moldova’s regulatory review panel giving it direct influence over policy making in the small country.

“The American Chamber of Commerce is a very powerful and active organization,” said Oleg Chelaru, a team leader on the staff that assists the review panel. “They played a very crucial role in analyzing and giving an opinion on this initiative.”

Mr. Toncu, who has since left the chamber, declined to comment. Mila Malairau, the chamber’s executive director, said its main objective was to make sure the industry “was consulted” in “a transparent and predictable manner.”

After recently passing in Parliament, the long-stalled measures were subject to fresh objections from the chamber and others, and have not yet been enacted.

01cigarette-web4-articleLargeProtesters displayed fake body bags at a tobacco trade show at Pasay, the Philippines, in 2013. Credit Bullit Marquez/Associated Press

 

Fighting a Trade Exception

In Washington, the U.S. Chamber’s tobacco lobbying has been visible in the negotiations over the Trans-Pacific Partnership, a priority of the Obama administration that recently received critical backing in Congress.

One of the more controversial proposals would expand the power of companies to sue countries if they violate trade rules. The U.S. Chamber has openly opposed plans to withhold such powers from tobacco companies, curbing their ability to challenge national antismoking laws. The chamber says on its website that “singling out tobacco” will “open a Pandora’s box as other governments go after their particular bêtes noires.”

The issue is still unresolved. A spokesman for the United States trade representative said negotiators would ensure that governments “can implement regulations to protect public health” while also “ensuring that our farmers are not discriminated against.”

Email traffic shows that Mr. Donohue, the chamber’s head, sought to raise the issue in 2012 directly with Ron Kirk, who was then the United States trade representative. In email exchanges between staff members of the two, Mr. Donohue specifically sought to discuss the role of tobacco in the trade agreement.

“Tom had a couple of things to raise, including urging that the tobacco text not be submitted at this round,” one of Mr. Donohue’s staff members wrote to Mr. Kirk’s staff. The emails were produced in response to a Freedom of Information request filed by the Campaign for Tobacco-Free Kids, which provided them to The Times.

Mr. Kirk is now a senior lawyer at Gibson, Dunn, a firm that counts the tobacco industry as a client. He said in an interview that during his tenure as trade representative, he met periodically with Mr. Donohue but could not recall a specific conversation on tobacco.

He said trade groups were generally concerned about “treating one industry different than you would treat anyone else, more so than doing tobacco’s bidding.”

The chamber declined to make Mr. Donohue available for an interview.

A Face-Saving Measure

In Ukraine, it was Valeriy Pyatnytskiy who signed off on the complaint against Australia in 2012, which was filed with the World Trade Organization. At the time, he was Ukraine’s chief negotiator to the W.T.O. His political career has survived the revolution and he is now an adviser to the Ukrainian prime minister, Mr. Yatsenyuk.

In a recent interview, he said that for Ukraine, the case was a matter of principle. It was about respecting the rules.

He offered a hypothetical: If Ukraine allowed Australia to use plain packaging on cigarettes, what would stop Ukraine from introducing plain packaging for wine? Then Ukrainian winemakers could better compete with French wines, because they would all be in plain bags marked red or white.

“We had this in the Soviet times,” he said. “It was absolutely plain packaging everywhere.”

Some Ukrainian officials have long been troubled by the case.

“It has nothing to do with trade laws,” said Pavlo Sheremeta, who briefly served as Ukraine’s economic minister after the revolution. “We have zero exports of tobacco to Australia, so what do we have to do with this?”

Last year, he urged the American Chamber in Kiev to reconsider.

“I wrote a formal letter, asking them, ‘Do you still keep the same position?’ ” Mr. Sheremeta said. “Basically I was suggesting a face-saving way out of this.” But when he met with chamber officials, the plain packaging case was outlined as a top priority.

They refused to back down. After Mr. Pyatnytskiy, a tobacco ally, was installed as his deputy, Mr. Sheremeta resigned.

“The world was laughing at us,” he said of the case.

Shortly after The Times discussed the case with Ukrainian government officials, there were new protests from activists. Mr. Yatsenyuk called for a review of the matter. Ukraine has since suspended its involvement, but other countries including Cuba and Honduras are continuing to pursue the case against Australia.

Andy Hunder, who took over as president of the American Chamber of Commerce in Kiev in April, said the organization was moving on, adding, “We are looking forward now.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Professional Rodeo Competitors Join Fight Against Oral Cancer

Source: www.upr.org
Author: Melissa Allison

 

The number of oral cancer deaths related to tobacco use is on the rise nationwide according to the Oral Cancer Foundation. Brian Hill is the founder of the OCF and a survivor of the disease.

Kiser-OCFCody Kiser encourages the youth to not start using tobacco to help secure good health. Oral Cancer Foundation

 

“Up until about (the year) 2000 this was primarily a disease of older men who had smoked a lot or chewed tobacco during their lifetime,” Hill said. “About that point in time we started to see a shift in the cause of the disease.”

Hill said tobacco is still a primary cause of oral cancers and adds that the oral human papillomavirus type 16 (HPV16) is new etiology that has forced the number of cases to accelerate.

According to an October 2014 study by Johns Hopkins researchers the HPV16 causes cancers of the mouth and throat and that any form of tobacco use increases the risk of the virus. The research suggests as few as three cigarettes a day can increase the risk of infection by almost one-third.

Hill created the foundation in 1999 to promote change by educating the public about risk factors that contribute to the disease. Among those risks is the use of spit tobacco.

“The world of rodeo has been the realm of sponsorship by the tobacco industry for decades,” Hill said. “With the nicotine content in a can of dip equaling approximately that of 80 cigarettes, this addiction can be one of the hardest to break. We hope to educate parents and youth about the dangers before they even get started.”

The OCF is turning to professional rodeo competitors to serve as positive role models during a national campaign.

Cody Kiser is a professional bareback bronc rider from Reno, Nevada.  He was in Delta, Utah recently where he competed at the Millard County Fairgrounds. Kiser told parents at the rodeo that nearly 15 percent of high school boys in the United States use smokeless tobacco.

“My dad was a cowboy, so I know what it’s like looking up to cowboys as heroes for my whole life. Health and fitness have always been incredibly important to my family. My dad was a positive role model in my life growing up in that regard, and the idea of using spit tobacco never appealed to me,” Kiser said. “Right now, I’m pursuing rodeo as a passion of mine, and if at the same time I can do some good in the world and set the right example for young kids who might look up to me, then I’m honored and eager to do so.”

Kiser said cowboys have a reputation that is second only to baseball players for being users of tobacco in the world of sports.  He wants to change that reputation throughout the country and in Utah, where rodeo is popular.

“From my point of view, Utah seems to be on the front lines of health and fitness,” he said.  “I’ve been very impressed with Utah as far as a healthy lifestyle, people who don’t smoke and chew so it’s good to see in Utah that they don’t do that as much.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Smoking rates are down, but a different type of tobacco use is on the rise

Source: www.huffingtonpost.com
Author: Anna Almendrala

First, the good news: Smoking rates are down significantly in 26 states. The bad news? The use of smokeless tobacco (also known as dip, snuff or chew) is up in four states, while using both cigarettes and smokeless tobacco is up significantly in five states.

“Although overall cigarette smoking prevalence has declined significantly in recent years in many states, the overall use of smokeless tobacco and concurrent cigarette and smokeless tobacco has remained unchanged in most states and increased in some states,” summed up researchers for the Centers for Disease Control, which published the data in their weekly Morbidity and Mortality report.

From 2011 to 2013, four states showed increased smokeless tobacco use: Louisiana, Montana, South Carolina and West Virginia. Only two states — Ohio and Tennessee — exhibited decreases. In terms of total use, Massachusetts and the District of Columbia reported the lowest numbers of smokeless tobacco, at 1.5 percent, in 2013. In contrast, West Virginia reported the highest use, at 9.4 percent, with Wyoming and Montana coming in second and third, at 8.8 percent and 8 percent, respectively.

Breaking down tobacco use by state helps health officials create more targeted state and local tobacco policies, explained CDC researcher Kimberly Nguyen in an email to HuffPost.

“It’s important to note that the states with lower tobacco use prevalence typically have more robust tobacco control programs and greater adoption of evidence-based population level interventions,” she wrote.

CigaretteTobacco2

 

The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

In reality, smokeless tobacco is addictive because of the nicotine it contains, and it can cause oral, esophageal and pancreatic cancer, according to the NIH’s National Cancer Institute. It may also cause other diseases like gum disease, oral lesions and precancerous patches in the mouth called leukoplakia. In no way should it be considered an aid to help people quit smoking, notes the NCI.

“Smokeless tobacco use can also increase risks for early delivery and stillbirth when used during pregnancy, cause nicotine poisoning in children, and may increase the risk for death from heart disease and stroke,” Nguyen added. “Smokeless tobacco is not a safe alternative to smoking.”

The CDC researchers aren’t sure why smokeless tobacco use is going up, but the report notes a few possible reasons.

“These increases could be attributable to increases in marketing of smokeless tobacco, the misperception that smokeless tobacco is a safe alternative to cigarettes, and the lower price of smokeless tobacco products relative to cigarettes in most states,” wrote the researchers. “In addition, the tobacco industry has marketed smokeless tobacco as an alternative in areas where smoking is otherwise prohibited.”

Just last month, the Food & Drug Administration rejected tobacco producer Swedish Match AB’s request to remove cancer warnings from their smokeless tobacco product, Snus, and replace the warnings with the claim that it is safer than cigarettes. And last week, the FDA also rejected a petition from R.J. Reynolds Tobacco Company and American Snuff Company to similarly alter the labels on their smokeless products.

To combat rising rates of smokeless tobacco use, the CDC recommend that states increase their spending on anti-tobacco programs, which include increasing the price on products, restricting tobacco advertising, increasing anti-tobacco graphics and commercials, and helping users quit their addictions. Indeed, while states will bring in more than $25 billion in settlement payments and tobacco taxes in 2015, they’re also projected to spend less than two percent of that revenue on such programs — much less than the CDC-recommended levels for each state.

FDA Advisory Committee hesitates to endorse message of safe smokeless tobacco

Source: www.medpagetoday.com
Author: Shannon Firth

An FDA advisory panel were reluctant to recommend a gentler warning label for one brand of smokeless tobacco products at a committee hearing on Friday.

snus

Swedish Match North America (SMNA), the first company to be considered for a modified risk tobacco designation by the FDA, is asking to replace a current label warning, “This product is not a safe alternative to cigarettes,” with this: “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

It also wants to drop warnings required for other smokeless tobacco products about oral cancers, tooth loss, and gum disease.

In a key vote, the eight-member FDA’s Tobacco Products Scientific Advisory Committee split 4-4 on whether the claim that snus offer a “substantially lower risk” claim relative to cigarettes is justified.

Many members said the health risks were lower for certain tobacco-related illnesses, but not for all health concerns. Those who disputed the claim argued that it could not be taken as a “global statement” — as there are known risks to pregnant women and uncertain risks for adolescents.

As for the proposed label change, the whole committee agreed that the sponsor’s statements would not suffice. Gary Giovino, PhD, chair of the department of Community Health and Health Behavior at the State University of New York at Buffalo, felt the statement was “dismissive of the health risks.” The word “but” in any sentence seems to negate the first half, he said.

Snus is a finely ground smokeless tobacco powder in a filter packet that is placed under the upper lip.

In his opening remarks on Thursday, Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products, said that in the past companies alone decided how to advertise their products — a practice which proved damaging to consumers’ health. “Now it’s the FDA who serves as the regulatory gatekeeper, standing between consumers and the companies seeking to make claims about their products.”

To meet the standards of a modified risk tobacco product, Zeller explained, “Applicants must not only demonstrate that the products, as actually used by consumers, will significantly reduce risks to individual users of those products; they must demonstrate that they will benefit the population as a whole – taking into account both users and non-users of tobacco products.”

In its application, Swedish Match has asked to revise the labels for 10 snus products. It would maintain its warning that smokeless tobacco is addictive.

Oral Safety Unproven
The committee was unmoved by the firm’s evidence related to gum disease and tooth loss and voted 8-0 against supporting a conclusion that snus products “do not pose a risk of gum diseases or tooth loss.”

Or as Thomas Novotny, MD, MPH, the graduate school of public health at the University of California San Diego State said, when explaining his vote, “It’s not causal relationships that we’re after, it’s perception of risk and the studies don’t rule that out.”

The committee’s vote was likely influenced by Scott Tomar, DMD, MPH, DrPH, of the department of Community Dentistry and Behavioral Science, at the University of Florida, who said that “advanced gingival recession can result in tooth loss.” One of the studies presented showed a relationship between gingival recession and snus use.

As to whether snus products also “do not pose risks of oral cancer” to consumers, the committee was split 3-3 with two abstentions.
“I think the data are tending towards no increased risk but I’m not quite ready to go there,” said Giovino, one of the abstainers.

Pebbles Fagan, PhD, MPH, associate professor and member of the Cancer Prevention and Control Program at the University of Hawaii, said that based on the absence of women in the larger cohort studies, she was not comfortable claiming that snus products posed no risk of oral cancer.

Can the ‘Swedish Experience’ Cross the Ocean?
Perhaps the most important questions the committee voted on was whether the proposed labeling change would help or harm consumers. Swedish Match threw the weight of its argument behind the “Swedish Experience,” a series of government, academic ,and industry studies showing a dramatic shift from cigarette smoking to snus in the mid-1990s. The firm argued that Swedish men reduced their risk of tobacco-related diseases.

But asked whether American tobacco users would likely follow suit — swapping cigarettes for snus — panel members were unconvinced.

Only one committee member said such a switch was likely, against six voting against and one abstention.

Richard O’Connor, PhD, associate professor of oncology at the Roswell Park Cancer Institute, in Buffalo New York, the lone panelist to agree that the experience in Sweden might translate to the U.S., said the data informed “a potential pattern in the U.S.”

Another subpopulation of obvious concern is adolescents. Timothy McAfee, PhD, MPH, director of the Office on Smoking and Health at the CDC, cited animals studies on tobacco addiction that showed “deleterious effects on adolescent brain development.”

On the plus side for Swedish Match, the majority of the committee felt it unlikely that nonusers of tobacco would pick up the snus habit, although three committee members abstained from this question because they did not believe there was enough data to support such a scenario.

Lars-Erik Rutqvist, the senior vice president of scientific affairs at Swedish Match said the company was pleased with the discussion at the hearing. “On the whole they seemed to accept the fact that there is a considerable risk reduction in our products and of course that’s very important. It’s part of the definition of a modified risk product.” Rutqvist added that he would expect to continue discussions with the FDA while awaiting their decision this summer.

“I look forward to the path forward for us.”

The FDA is not required to follow the advice of its advisory committee but it usually does.

April, 2015|Oral Cancer News|

Great American Spit Out warns of new tobacco lures

Source: www.orlandosentinel.com
Author: Kate Santich, Orlando Sentinel

As anti-tobacco advocates celebrate today’s Great American Spit Out — the “chew” equivalent of the Great American Smoke Out — health officials warn that new dissolvable and flavored varieties of smokeless-tobacco products are targeting teens in a mission to get them hooked.

Newly released data from state health researchers show that, while cigarette smoking among Florida youth has reached an all-time low, smokeless tobacco use has been virtually unchanged for the past decade: roughly 5.5 percent among high school students statewide.

And it’s nearly 9 percent in some counties, including Lake.

“The tobacco industry is targeting us,” said Magi Linscott, a Pensacola-area 18-year-old named National Youth Advocate for 2014 by the Campaign for Tobacco-Free Kids. “They’re trying to get a new generation of addicts.”

Recent product developments include colorfully packaged, kid-friendly flavors of tobacco-infused candy, mints, gum, breath strips and flavored toothpicks — all containing nicotine. Depending on the type, they are designed to be held in the mouth, chewed, or sucked until they dissolve and the juices swallowed.

Along with more traditional chew, snuff and a teabag-like pouch of finely ground tobacco called snus (“snoose”), smokeless products may lure users with a false sense of safety. Shannon Hughes, Tobacco Free Florida bureau chief, said young people — and their parents — may not realize the dangers of the products, which increase the risk of oral cancer by 80 percent.

“Adults think, ‘Well, at least they’re not smoking,'” Hughes said. “Yes, cigarettes do cause more systemic damage to the body. But smokeless tobacco dramatically increases the risk of oral cancer, which is horribly disfiguring, and a horrible way to die. The bottom line is: There’s no safe level of tobacco use.”

The Spit Out — aimed at raising awareness of the problem — is part of a national “Through with Chew Week.” But because no single agency sponsors the campaign, it lacks the name recognition of the Smoke Out, officials admit.

Still, Hughes and others said, the proliferation of smokeless products makes the message especially urgent.

Chew and snuff have long been popular among baseball players and in rural communities, where their use is sometimes a rite of passage. Among local high-school students surveyed last year, only 3.1 percent of those in Orange County said they currently used smokeless tobacco, while the rate was 4.2 in Osceola, 5.3 in Seminole and 8.9 percent in Lake.

Use is vastly more common for males than females and for whites than blacks or Hispanics.

“It’s part of the culture in certain areas,” Hughes said. “And it can be easier to conceal,” especially with the newer forms. It is also cheaper than cigarettes.

But the American Cancer Society warns that because U.S. tobacco sellers are not required to list what’s in their products, it’s hard to know exactly how hazardous the smokeless varieties can be.

The World Health Organization has identified at least 28 carcinogens in smokeless tobacco, and along with the heightened risk of oral cancer, there’s a 60 percent increase in the risk of esophageal and pancreatic cancers compared to non-users. The products also raise the risk of heart disease and fatal strokes and may impact reproductive health, Hughes said.

“And because youth are often most concerned with the immediate impact,” she said, “we point out that smokeless tobacco use can cause tooth decay, permanent discoloration of teeth and gingivitis leading to tooth loss.”

Perhaps most disconcerting is the increased likelihood of stepping up to more lethal forms of tobacco. Researchers found smokeless-tobacco users tend to experiment with smoking and are more likely to become addicted. The younger the user, scientists say, the more sensitivity to nicotine.

February, 2015|Oral Cancer News|

Oral cancer on rise in young people

Source: www.wwltv.com
Author: Jaclyn Kelley

Alex Dupuy is like most 15-year-old boys, except for one very special talent. Last year he stole the headlines during a bowling tournament for bowling a perfect 300. But that high wouldn’t last long.

“My son came to us one day and said I have an ulcer, and we thought, OK, let’s gargle with some salt water and we kept checking on it and it never went away,” said Nancy Dupuy, Alex’s mother.

When the sore on Alex’s tongue never cleared up, but instead started growing, his mother became concerned and took him to see the doctor.

“It has grown so rapidly that I would really like to have the tumor or whatever it was removed,” she said.

Alex was taken to Children’s Hospital for surgery, and doctors removed the sore and 30 percent of his tongue. Three days later test results came back confirming the Dupuy’s worst fears: It was cancer.

“The word aggressive stuck out to me,” Nancy Dupuy said. “The type of cancer that my son presented with was an adult cancer. It’s not usually diagnosed in young children.”

The doctors said Alex had a rapid form of squamous cell carcinoma of the tongue. Four days later he and his parents were on a plane to MD Anderson Cancer Center in Houston.

Through it all, Alex managed to stay positive.

“I felt nervous, I felt scared and I told myself, I’ll be alright,” Alex said.

In Houston Alex would have yet another surgery before starting six weeks of intense radiation.

“We would wrap his neck because the neck would be burned. The skin, the tissue was burned when it would start to break down,” Nancy Dupuy said.

Dr. Paul Friedlander, the chairman for Tulane’s ear, nose and throat department, said the number of young people with oral cancer is on the rise.

“Most of the cancers we saw were smoking, alcohol related,” Friedlander said. “Right now we’ve seen an increase in a number of people who have not been exposed to cigarettes and alcohol that have these cancers.”

And he said that’s because of the human papaloma virus, or HPV. It’s an orally transmitted virus that he says is easy to get.

“These can be transmitted through oral sexual contact or something as innocuous as an open-mouth kiss,” Friedlander said.

Friedlander said early detection is key.

“If one does have a sore on their mouth, difficulty with swallowing, hoarseness or a neck mass that persists after two or three weeks, it’s a good idea to see your local doctor,” he said.

He recommends parents consider getting their teens the HPV vaccination, which doctors say can help prevent oral cancer.

It’s something Nancy Dupuy did with Alex and his brothers after his diagnosis.

“In our case it wasn’t HPV, but just the thought of oral cancer and that there is maybe something that could have prevented it is just really worth it in the end,” she said.

Several weeks of radiation would take its toll on Alex, but his family says it’s bowling that got him through it.

“On the good days, Alex would bowl and Alex would be in a world that was just perfect, and to me that was the most important thing that helped him get through six weeks of radiation,” Nancy Dupuy said.

Thank to early detection, Alex is now in remission.

“I always thank God I am cancer free.”

December, 2014|Oral Cancer News|

Study: smoking marijuana found non-carcinogenic

Source: americanlivewire.com
Author: staff

Smoking marijuana does not appear to increase the risk of lung cancer or head-and-neck malignancies, even among heavy users, researchers reported here.

“We expected that we would find that a history of heavy marijuana use, more than 500 to 1,000 uses, would increase the risk of cancer from several years to decades after exposure to marijuana, said Donald Tashkin, M.D., of the University of California in Los Angeles.

But in fact, they reported at the American Thoracic Society meeting here, marijuana use was associated with cancer risk ratios below 1.0, indicating that a history of pot smoking had no effect on the risk for respiratory cancers. Studies have shown that marijuana contains many compounds that when burned, produce about 50% higher concentrations of some carcinogenic chemicals than tobacco cigarettes.

In addition, heavy, habitual marijuana use can produce accelerated malignant change in lung explants, and evidence on bronchial biopsies of pre-malignant histopathologic and molecular changes, Dr. Tashkin said.

The investigators had also previously shown that smoking one marijuana cigarette leads to the deposition in the lungs of four times as much tar as smoking a tobacco cigarette containing the same amount of plant material. Marijuana cigarettes are not filtered and are more loosely packed than tobacco, so there’s less filtration of the tar. In addition, pot smokers hold the smoke in their lungs about four times longer than tobacco smokers do, Dr. Tashkin pointed out.

For the population-based case-control study, they identified cancer cases among people from the ages of 18 to 59, using the Los Angeles County Cancer Surveillance Program registry.

They identified 611 people with lung cancer, 601 with cancers of the head and neck, and 1,040 controls matched by age, gender and neighborhood (as a surrogate for socioeconomic status).

They conducted extensive personal interviews to determine lifetime marijuana use, measured in joint-years, with one joint-year equivalent to 365 marijuana cigarettes. The interviewers also asked participants about tobacco use, alcohol consumption, use of other drugs, socioeconomic status, diet, occupation, and family history of cancer.

The investigators also used logistic regression to estimate the effect of marijuana use on lung cancer risk, adjusting for age, gender, race/ethnicity, education, and cumulative tobacco smoking and alcohol use.

They found that the heaviest users in the study had smoked more than 60 joint years worth of marijuana, or more than 22,000 joints in their lifetime. Moderately heavy users smoked between 11,000 and 22,000 joints.

Despite the heavy use, “in no category was there any increased risk, nor was there any suggestion that smoking more led to a higher odds ratio,” he continued. “There was no dose-responsiveness,not even a suggestion of a dose response”and in all types of cancer except one, oral cancer, the odds ratios were less than one.”

In contrast, tobacco smoking was associated with increased risk for all cancers, and there was a “powerful” dose-response relationship. People who smoked more than two packs of cigarettes per day had a 21-fold risk for cancer, as opposed to a less than one-fold risk for marijuana, Dr. Tashkin said.

“When we restricted the analysis to those who didn’t smoke any tobacco we found the same results, and when we looked for interaction between tobacco and smoking ”would marijuana increase the risk, potentiate the carcinogenic effect of tobacco”we didn’t find that, nor did we find a protective effect against the effect of tobacco, which is very important, because the majority of marijuana smokers also smoke tobacco,” he commented.

It’s possible that tetrahydrocannabinol (THC) in marijuana smoke may encourage apoptosis, or programmed cell death, causing cells to die off before they have a chance to undergo malignant transformation, he said.

Note: Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

November, 2014|Oral Cancer News|

New study claims children who use snus before age 16 are more likely to become cigarette smokers

Source: Reuters Health

Author: Shereen Jegtvig

Norwegians who started using snus before age 16 were more likely to become cigarette smokers than those who started using snus later in life, according to a new study.

Snus is moist smokeless tobacco developed in Sweden. It’s contained in a small pouch, and unlike regular chewing tobacco, it doesn’t make the user spit.

Research suggests snus has lower levels of chemicals called nitrosamines than cigarettes and may be less harmful.

In Norway, snus has become a smoking cessation aid and most older snus users are former smokers.

But snus is also becoming increasingly popular among young Norwegian adults, many of whom have not smoked cigarettes. And although research is divided, the current thinking is that snus use reduces the likelihood of taking up smoking.

The authors of the new study wanted to know more about when people start using snus, to see if that ties into whether they also begin smoking cigarettes.

“I already knew about the research investigating associations between snus use and later smoking, but discovered that snus debut age had not been mentioned in that research,” Ingeborg Lund told Reuters Health in an email.

Lund is a researcher with the Norwegian Institute for Alcohol and Drug Research – SIRUS, in Oslo. She and her colleague Janne Scheffels published their study in Nicotine and Tobacco Research.

The researchers analyzed surveys of Norwegian teenagers and adults conducted from 2005 to 2011.

Out of 8,313 people, 409 were long-term snus users who had started using snus before cigarettes or never used cigarettes. Of the snus users, 30 percent were long-term smokers.

Just over one third of the snus users started using snus before age 16. The researchers discovered those participants had two to three times the odds of becoming lifetime smokers, compared to people who began using snus after age 16.

They also found that early snus users had about the same rate of cigarette smoking as non-snus users. About 23 percent of early snus users were current smokers at the time of the survey, compared to only six percent of people who started using snus when they were older.

“Snus use seems to protect against smoking if the snus debut does not happen too early during adolescence,” Lund said.

She said it’s particularly important to keep teenagers tobacco-free until they are at least 16 years old.

“At younger ages, even if they start with a low risk product such as snus, there is a high risk that they will switch to – or add – other high-risk products, such as cigarettes,” she said. “This risk is reduced when they grow older.”

Since snus use is much less common in other countries, Lund said she doesn’t know if these results can be generalized outside of Norway and Sweden.

Lucy Popova, from the Center for Tobacco Control Research and Education at the University of California, San Francisco, told Reuters Health the new study was “interesting.” She was not involved in the research.

“Earlier initiation of snus basically makes it a gateway to tobacco use, to cigarette use in the future,” she said.

Popova explained that traditional Swedish snus is less dangerous than cigarettes.

“But it’s not harm-free, and (what) is really bad is when people start using both products because of increased rates of cardiovascular disease, pancreatic cancers and other problems,” she said.

Snus is fairly new to the U.S., and Popova said the version made in the U.S. isn’t like the traditional Swedish product.

“A research study found that it’s different from the traditional low-nitrosamine snus in Sweden – it’s not necessarily going to be as low-harm,” she said.

Popova is concerned with heavy promotion for smokeless tobacco products like snus.

“There’s been a lot of studies showing that more advertisement for tobacco products makes it more likely that children will use tobacco products,” she said, “and it’s important to keep youth tobacco-free as long as possible.”

RESEARCH SOURCE: bit.ly/1dP5O2Q Nicotine and Tobacco Research, online February 5, 2014.

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2014|Oral Cancer News|

E-Cigarettes Are in Vogue and at a Crossroads

By LIZ ALDERMAN
Published: June 12, 2013
Source: NY Times
 

PARIS — On a recent day in the shadow of the Arc de Triomphe, a line of 20 people spilled onto the sidewalk of a trendy new boutique, eager to get a taste of its latest gourmet offerings.

Olivia Foiret, the manager of ClopiNette, demonstrates filling an e-cigarette for a client.

A sign in the window promoted piña colada as the store’s flavor of the month. A woman wearing a Chanel jacket said she wanted to try peach.

But this was no temple of gastronomy. It was one of scores of electronic cigarette shops that have been springing up by the week in Paris as well as in numerous cities across Europe and the United States. Inside the ClopiNette boutique, shoppers can choose from among more than 60 flavors of nicotine liquid — including Marlboro and Lucky Strike flavors — all in varying strengths and arranged in color-coded rows. (ClopiNette is a play on “clope,” French slang for a cigarette.)

“It’s like visiting a Nespresso store,” said Anne Stephan, a lawyer specializing in health issues at a nearby law firm.

What’s driving her into the store is a desire shared by many: they want to give up smoking tobacco but don’t want to kick the smoking habit. After smoking 20 cigarettes daily for 25 years and failing to quit, Ms. Stephan said she had cut down to one a day in the three months since she began puffing on a so-called e-cig. Using technology that turns nicotine-infused propylene glycol into an inhalable vapor, e-cigarettes smoke almost like the real thing, without the ashtray odor.

While e-cigarettes are still a fraction of the $80 billion-a-year market for smoking products in the United States, the growing popularity of vaping, as the practice is known, has touched off a clash in Europe between retailers and regulators. On Wednesday, the British government announced it would begin treating e-cigarettes as medicines, “so that people using these products have the confidence they are safe, are of the right quality and work.”

E-cigarettes and other nicotine products will be licensed in Britain starting in 2016, giving manufacturers time to ensure that their products comply with all standards for medicines. The British regulator says e-cigarettes aren’t recommended for use until then, but it won’t ban them entirely. Government officials in France this month announced they might ban the e-cigarettes in public spaces. Italy is considering banning them from schools.

In the United States, the Food and Drug Administration tried to block the sale of e-cigarettes, claiming that they were unapproved “drug/device combinations.” Manufacturers successfully challenged the agency’s position, but in a 2010 ruling, a federal appeals court held that e-cigarettes could be regulated by the agency as tobacco products.

An agency spokeswoman, Stephanie Yao, said the agency was preparing to release for public comment a proposed rule to regulate additional categories of tobacco products.

Currently, the F.D.A.’s tobacco regulations apply to cigarettes, tobacco and smokeless tobacco.

“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products,” Ms. Yao said in a statement.

Health officials say their safety has not been medically proved and the devices could encourage children to take up smoking. Some antismoking advocates, who are simply annoyed to see the gadgets glowing in restaurants and bars, call for a ban on their use in public places, the same ban in force for tobacco products.

The allure is unmistakable. The actor Leonardo DiCaprio was spotted puffing on an e-cig at Chateau Marmont in West Hollywood earlier this year, while the French actress Catherine Deneuve, a longtime heavy smoker, now puffs the electronic version in Parisian restaurants and even during news conferences.

Global sales jumped 30 percent in each of the previous three years to around $2 billion in 2011, with the European market around $650 million, according to a recent analysis by Euromonitor International. Retail sales of e-cigs in the United States reached $500 million last year. Although that is only about 0.5 percent of the overall tobacco market, analysts expect those figures to double this year and continue climbing.

“E-cigarette consumption could surpass traditional cigarettes in the next decade,” said Katherine Devlin, president of the London-based Electronic Cigarette Industry Trade Association. “Growth is exponential and there are no signs it’s slowing down. So there is a huge amount at stake.”

Currently, e-cigs are distributed by more than 100 small and medium-size firms like NJOY and White Cloud. Most are manufactured by a Chinese company, Ruyan, which invented the gadget that heats the nicotine solution into a smokelike vapor. The device, which also can have an LED light to mimic the glow of a burning ash, has been registered for patents in more than 50 countries.

But now, the makers of Marlboro and other big tobacco brands are rushing to get a piece of the action — especially to make up for lost sales as tobacco smoking declines in Western countries. Last year, Lorillard bought the e-cigarette maker Blu for $135 million. British American Tobacco, RJ Reynolds and Japan Tobacco International have also taken stakes in the new industry. In April, as cigarette sales fell 5.2 percent in the first quarter from a year ago, Altria announced it would soon unveil its own electronic cigarette. Earlier this month, Reynolds American said it would introduce a revamped e-cig with an ad campaign including television commercials, which are off-limits for tobacco cigarettes.

Certainly signs of growth are there. In 2011, the latest year for which data were available, more than 20 percent of adult smokers said they had tried e-cigarettes, double the rate in 2010, according to the Centers for Disease Control and Prevention. Electronic cigarettes could account for nearly 5 percent of the value of all tobacco products in the next two decades, according to Euromonitor International. Analysts say such trends would also challenge the pharmaceutical industry, where stop-smoking products like nicotine patches and gums pulled in about $2.4 billion in 2011, not including prescription treatments.

“It’s tres à la mode,” said Olivia Foiret, the manager of the ClopiNette store on the Avenue de la Grande Armée, as customers crowded around the counter. “People want to stop smoking; they try one of these and they’re hooked.”

As an alternative to smoking tobacco, the devices have become such an attractive investment option that Sean Parker, co-founder of the now defunct music-sharing site Napster, is buying a stake in NJOY, one of the companies that makes e-cigarettes.

Mr. Parker has long donated to cancer research but is said to view the electronic devices as a safe alternative.

In December, European Union officials proposed regulating e-cigarettes and most nicotine liquids across the European Union as medical products. That would limit the nicotine content sold over the counter to 4 milligrams per milliliter — lighter than the lightest cigarette — or force manufacturers to put them through clinical trials.

The new rules could also radically affect how much money governments could take in through new taxes, a not insignificant consideration when declining tobacco sales are leaving sizable holes in national treasuries. In the first two months of 2013 alone, the Italian government, for example, reported a 132 million euro revenue shortfall from sliding cigarette sales. Nicotine liquid refills are not taxed in most European Union countries, and legislators think they could help make up some of the difference.

E-cigarette supporters say European officials are having a knee-jerk reaction that fails to recognize the devices as a “safer” alternative to smoking. They point to declarations from authorities like the Royal College of Physicians in Britain, which has said the devices can lure people away from traditional cigarettes and urged that they be made widely available. A separate 2011 study in The American Journal of Preventive Medicine said e-cigarettes “may hold promise as a smoking-cessation method.”

Retailers also protest that because they don’t market e-cigarettes to help smokers quit, e-cigarettes should not be treated as a pharmaceutical. “No one is claiming it’s medicine,” Ms. Devlin said. “It allows you to keep smoking.” They added that clinical trial requirements would make liquid nicotine commercially unviable, and are pressing for the European Union not to adopt new regulations.

European regulators cite a paucity of studies on the safety of routinely inhaling propylene glycol, a viscous chemical found in everything from asthma inhalers to antifreeze. It is deemed harmless by the Food and Drug Administration, but critics say it has not been adequately tested for chain smokers who might use the e-cigarettes during most of their waking hours.

Tonio Borg, the European commissioner for health and consumer policy, has expressed concerns that e-cigarettes, with their tasty flavors and colorful tips, could be a gateway to smoking for the young. In France, where tobacco sales fell last year to their lowest levels in a decade, a recent survey among Paris school children between the ages of 12 and 17 found that 8.1 percent of more than 3,400 surveyed had experimented with e-cigarettes.

Pascal Somosierra, 50, a dapper floral artist who decorates Parisian gems like Fouquet’s restaurant on the Champs-Élysées, said that since he bought a sleek black “Ego-C” model last month, he had been using it in his office, inside cafes and even on the Metro. “Some people look at me strangely,” said Mr. Somosierra, who said he instantly stopped his 30-year-old two-pack-a-day habit. “But I’m seen more favorably with this than when I’m smoking a regular cigarette.”

But he admits, “For a young person who doesn’t smoke, it can be tempting; there are all the flavors, and it looks cool.” He keeps his e-cigs out of reach of his children. “Think about it,” he said. “If even the company that makes Marlboro is jumping into the game, it’s a way for them to get nicotine into new smokers.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

June, 2013|Oral Cancer News|

Oral cancer cases higher in developing countries

Source: pakobserver.net
Author: staff

Oral cancer is the sixth most common cancer reported globally with roughly two thirds of these reported in developing countries, according to a report. Regardless of nationality, roughly half of long-term smokers will die from the effects of tobacco smoking, be it oral cancer, lung cancer or cardiovascular disease. In India 20 deaths per 100,000 are caused by oral cancer as compared to 10 deaths per 100,000 in the US and two deaths per 100,000 in the Middle East.

Oral cancer, as well as updates in maxillofacial reconstruction, microneurosurgery, oral trauma, and facial cosmetic and orthognathic surgery, will be reviewed at the 2nd Oral and Maxillofacial Surgery Congress to be held in Dubai from May 1-5. Organised by Imedex in association with Arab Health, this year’s meeting will provide a number of new features that explore the rapidly reshaping field of oral and facial surgery.

“The main causes of oral cancer have classically been related to smoking tobacco products and the Middle East has a higher rate of tobacco consumption then many other countries and this includes the use of the Shisha or Hookah,” said Dr Eric J Dierks, Clinical Professor of Oral and Maxillofacial Surgery at Oregon Health and Science University, USA and director of the Fellowship in Head and Neck Oncologic Surgery based at Legacy Emanuel Hospital in Portland, Oregon, who will be speaking at the congress.

“There is a myth that smoking through a Shisha pipe is safer than smoking cigarettes but this is almost certainly not the case. Several recent studies have indicated that Shisha smokers actually inhale more of the cooled smoke than would a cigarette smoker thereby increasing their exposure to carcinogens within the smoke,” he said.

To an ever greater extent, human papilloma virus (HPV) is a causative factor in cancer of sites in the oropharynx such as the tonsil or the base of the tongue, although HPV related cancer is much less common within the mouth itself. Approximately two thirds of cancers of the base of tongue and tonsil are caused by HPV and 80 per cent of these cases occur in men.

“There is no relationship between either smoking or alcohol intake with the HPV associated oropharyngeal cancer. Fortunately, HPV associated oropharyngeal cancer actually carries a much better prognosis than does a cancer in this location that is not associated with HPV. Although research is ongoing, the reason for this is as yet unclear,” Dierks said.

The early diagnosis of oral cancer is extremely important because not only is the prognosis significantly better for early stage cancer, but the treatment involved is often less extensive, Dr Dierks said.

April, 2013|Oral Cancer News|