TobaccoHarmReduction.org
Original Article |
Our Response |
Tobacco company funds U of A prof: Researcher endorses chewing tobacco |
The subheadline is utterly absurd, implying an endorsement without caveat. A reader might actually miss the buried and brief mention of Dr. Phillips's work and the very specific circumstances under which he endorses chewing tobacco (as a substitute for cigarettes). This would be similar to writing "U of A prof enjoys cutting people" about a surgeon. |
| Susan Ruttan The Edmonton Journal Tuesday, November 08, 2005 EDMONTON - The University of Alberta has approved a grant from a tobacco company for a new faculty member who champions smokeless tobacco as a safe alternative to smoking. |
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| Prof. Carl Phillips, a public health researcher who came to the U of A in the summer from the University of Texas, has a $1.5-million US research grant from the U.S. Smokeless Tobacco Company, makers of Copenhagen and Skoal and other brands of chewing tobacco. The university itself will take 15 per cent of the money for its administrative costs. | To clarify, Copenhagen and Skoal are not normally chewed. These are examples of the most popular form of smokeless tobacco, moist snuff, that is placed (without chewing) between the gum and lip or cheek. |
| Les Hagen, spokesman for the Edmonton-based
anti-smoking group Action on Smoking and Health, condemns the grant.
"The university should not be accepting contributions from the tobacco industry under any conditions," Hagen said. "That kind of money carries a lot of influence." |
For a general discussion of the vacuousness of Hagen's point (and the curious fact that the head of Action on Smoking and Health is trying to derail our efforts to reduce smoking), see our overview about ethics and funding (coming soon). And before anyone should be willing to consider Mr. Hagen an arbiter of ethics in funding, we think he should provide a complete disclosure of the sources and disposition of the monies he controls. |
| Dr. Andrew Greenshaw, the university's associate vice-president research, said the university has no policy against taking grants from tobacco companies. | |
| The tobacco grant was processed like all others, Greenshaw said. It was approved by an ethics board, then by himself and the dean of medicine. Phillips is an assistant professor of public health in the faculty of medicine. | In spite of Dr. Phillips telling the author, Susan Ruttan, his correct rank (associate professor), as well as it appearing on the University web pages and in the signature of his email (Dr. Phillips and Ms. Ruttan exchanged emails), she still got it wrong. This should not inspire confidence in the rest of the "facts" in the article. |
| Greenshaw said he's satisfied the funding came without strings attached, so Phillips can do research without direction from the company and publish it in professional journals. "It's important for this kind of research to go on because the results of studies like this will help to inform public policy and the decisions that government will make," he said. | |
| In the United States, public health departments at universities such as Harvard and Johns Hopkins have policies prohibiting grants from the tobacco industry. | Many American universities do accept tobacco industry funding (1).
It is curious that the writer does not consider Canadian universities appropriate examples to compare to the
University of Alberta; perhaps it is simply that very few of them would support her implication of a controversy.
In a November 2004 survey, it was found that all 16 Canadian medical schools had no policy of rejecting funding
from tobacco sources (2). With few exceptions, Canadian universities have carefully examined
the ethics of accepting this funding and have found that if the funding is unrestricted, the likelihood of
undue influence is minimized.
Many, if not most, of the U.S. universities that have policies prohibiting tobacco industry funding do so because money from the extremely well-funded anti-tobacco activists often comes with major strings attached, including forbidding the university from accepting any research support from the industry. In other words, anti-tobacco advocates explicitly try to prevent free inquiry into the topic, so we have to ask, who is exerting inappropriate influence? Fortunately, the tide seems to be turning in favor of freedom of inquiry. One major American university, The Ohio State University, had grants from anti-tobacco advocates that forbad taking tobacco industry money. A researcher was offered a research grant from a cigarette company, and the university decided (at the highest levels) that it was inappropriate for one funder to presume to censor inquiry elsewhere in the university, so they accepted the tobacco industry grant and told the other funder that if they insisted on trying to interfere with other research funding, they could withdraw their money. |
| Phillips, 39, is an expert in health policy and epidemiology. He contends
that claims that smokeless tobacco causes mouth cancers are "mostly a myth."
"In spite of what everybody thinks that they know, smokeless tobacco creates a very, very low risk of any life-threatening disease," Phillips said. |
It is nice that the editorial eventually reported a few words about the actual substance of our work. It is, however, necessary to clarify the sloppy (we'll go with the charitable interpretation) reporting. The word "myth" was used by Phillips to refer to the notion that ST creates a major risk of oral cancer or that any such risk could somehow be near close to the risks from smoking. It also refers to mistaken impression that smokeless tobacco creates a particularly large risk of oral cancer – there is no doubt that smoking is the much bigger contributor. There is overwhelming evidence that the risk of oral cancer from ST is, at most, very low. However, the limitations of health science mean that we cannot rule out the possibility that ST causes oral cancer at some low rate, and thus we would not use the word "myth" in that context, but rather say the evidence does not tend to support the claim that there is an association. (These topics will be taken up in more detail in our FAQ when it is posted.) |
| His research looks at disease rates and compares the health risks of smokeless tobacco to those of cigarette smoking. Phillips believes chewing tobacco is a safe substitute for smoking. | This is the most significant of the several misquotes in the article, and is a common straw man that gets used by anti-harm-reduction advocates. Neither Dr. Phillips nor anyone else we are aware of believes that ST (chewing or otherwise) is perfectly safe. ST is so much less harmful than cigarettes that switching from smoking to ST use is almost as good as quitting, but that does not mean that ST (or any other way of getting nicotine) is perfectly safe. |
| Such views contradict those of almost every public health agency in North America. | Unfortunately this is true. That is, those organizations' positions are not true, but it is true that
many organizations' views grossly contradict the science. If Ms. Ruttan had been interested in reporting on the subject,
rather than editorializing about funding, this would have been a good angle to start with. See, for example,
our recent study. We find it curious that when most scientists
present a finding that could correct a widespread misconception in their field, the local newspaper hails them as local
heroes, but we are the subject of editorial attack. Perhaps the praise is reserved for fields like astrophysics, where
there are no local activists who exert influence over the newspaper's editorial policy.
We are proud, though rather frustrated, to be the ones trying to tell the truth in the face of such widespread misinformation. Fortunately, science is not ultimately decided by poll. Eventually, those public health agencies will have to change their position (though we are not optimistic that they will concede that they were wrong in the first place). |
| "Smokeless tobacco ... is highly addictive and is definitely not harmless," said Lisa Hedges, a consultant with the tobacco reduction unit of the Alberta Alcohol and Drug Abuse Commission. | AADAC is a stellar example of a public health agency promoting action based on erroneous evidence. Their 2004 Tobacco Basics Handbook is a textbook example of amassing claims with no evidential backing. Curiously enough, the smokeless section of the handbook was overseen by the same Steve Patterson who ostensibly represents an independent voice later in the article. Despite the many respected human studies regarding the possible effects of using smokeless tobacco, Patterson chose to reference the disputed smokeless tobacco-oral cancer association with one study involving rats (3) and the other the patterns of smokeless use among baseball players (4). In the latter study, the only reference to cancer is not part of the study but occurs only in the introduction and takes the form of referring to one anomalous result involving an archaic tobacco product and method of use (5). This is even worse than the usual misinformation, which at least usually cites the one study that actually found an increase in oral cancer among people who used ST (more about this in the FAQ). |
| "Spit tobacco contains 28 known cancer-causing agents. One tin of spit tobacco is equivalent to smoking 60 cigarettes." | The term "spit tobacco" is both unprofessionally derogatory and demonstrates substantial unfamiliarity
with modern products. These points are made in detail in Dr. Rodu's letter to the editor.
The rest of the statement is equally absurd. We are fairly certain we know the source of the 28 number, and Hedges is misinterpreting what that report says, but that is actually beside the point. Every bit of plant matter (including tobacco, or whatever you ate at lunch today) contains countless chemicals, many of which can cause cancer. The question of whether something is bad for you cannot be answered by simply noting that it contains a chemical that is bad for you (in some dose, delivered in a particular way). The question is ultimately answered by looking at how people are affected, and the answer for ST is clearly that any cancer risk is very small. The "equivalent" claim makes even less sense. We cannot even guess what this means; we assume that Hedges is simply so used to making assertions without having to defend them that she does not know what it means either. |
| Hedges said smokeless tobacco use can lead to cancer of the mouth, throat, esophagus and stomach, and affects the cardiovascular system. | The scientific evidence disagrees. Unless the statement is designed to be literally true but misleading (using the word "can" to mean "could theoretically, though we do not have evidence that it does") Hedges is again wrong or was misquoted. As Dr. Rodu points out in his letter, and we will describe in more detail in the FAQ, the link to mouth cancer is ambiguous and any risk is small, the evidence about throat/esophageal cancer suggests no or extremely small risk, and we are aware of no one even trying to claim a risk of stomach cancer (there is no evidence of such an association). The known effects on the cardiovascular system (temporarily increasing pulse rate, etc.) are similar to those of coffee, and risks of life threatening cadiovascular disease, while well worth investigating more, are speculative. |
| Albertans buy 40 per cent of the smokeless tobacco sold in Canada. | |
| AADAC launched a campaign against its use two years ago. | This is truly unfortunate. The institution seems to have lost touch with its mission of making people healthier, and is no longer pro-health, but is just blindly anti-tobacco. An effective campaign against smokeless tobacco will stop some smokers from switching, and will almost certainly kill many more people than it saves. |
| Health Canada requires smokeless tobacco packages to carry warning labels saying the product causes cancer and mouth diseases, is highly addictive, and isn't a safe substitute for cigarettes. | While these warnings provide great benefit to the industry (they make it difficult to consumers to sue them for product liability), it is not clear they benefit people's health. The misleading statements certainly do not benefit people's knowledge. |
| Dr. Steve Patterson, a U of A dentistry professor and director of the dental
school's tobacco cessation clinic, rejects Phillips's idea of getting smokers to
switch to smokeless tobacco.
It's true that smokeless tobacco doesn't cause the lung problems smoking does, Patterson said, but it does cause oral cancers that are fatal in 50 per cent of cases. |
We have to wonder whether Dr. Patterson made such an illogical statement or whether Ms. Ruttan misstated what he said. Either way, it should be obvious that the mortality rate from oral cancer has no bearing on whether a harm reduction strategy is a good idea, so no further response on our part is needed. We will note, however, that even though it actually has no bearing on the topic at hand, Dr. Patterson gets his statistic wrong: the five year survival rate for oral cancer has been steadily improving and is currently about 60 per cent in North America (6). |
| "You'd be reducing your risk of those (lung) problems, but you'd be trading it for a risk of other things, " he said. |
It appears from this and the preceding that Dr. Patterson (if he was quoted correctly) is trying to perpetuate the myth that
if you switch from smoking to ST, your lung disease risk will go down but your oral cancer risk will go up. Even setting
aside that lung disease is a much bigger risk than oral cancer, or that this ignores the many other smoking-related diseases,
there is absolutely no doubt that smoking creates a much larger risk for oral cancer than does ST use. There is no trade!
Though we make this point in more detail elsewhere, it is worth repeating: There is no trade. ST reduces your risk of dying from every smoking-related disease. We have to wonder if Dr. Patterson is ignorant of the clear scientific evidence in an area where he claims expertise, if he is intentionally trying to mislead people, or if what he said was misconstrued to support the editorial position of the article (we notice that the Journal did not print a correction letter from him to indicate the latter). |
| The appropriate way to help someone quit is to give them nicotine in a patch, gum or inhaler, he said. The addictive nicotine does little harm to the body, Patterson said. |
"Appropriate" is simply a fancy way of saying "I think it is better". This statement is ambiguous, but it must mean one of
two things: Either Dr. Patterson is recommending tools to aid nicotine cessation (which is fine if it works, but it very
rarely does), or he is suggesting that pharmaceutical products are better reduced-harm products for long-term nicotine use.
There is no evidence to support the latter claim. As Dr. Phillips noted in his letter to
the Gateway (and we will detail in the FAQ), it is certainly possible that pharmaceutical products that substitute for
smoking could be made and sold. Unfortunately, the products you can currently buy in the pharmacy do not deliver enough
nicotine fast enough to be a good substitute and are quite expensive. There is no evidence that smokers are interested
in switching. By contrast, ST use has substantially replaced smoking among Swedish men, so there is evidence that that
substitution works. Moreover, there is no evidence about the health effects of long-term use of pharmaceutical nicotine
products, so it is pure speculation (possibly true, but still merely speculation) to imply that they are less harmful than
ST. Naturally, anyone who is genuinely interested in improving people's health (as we are) will embrace the possibility of replacing smoking with ST, pharmaceutical products, or anything else. It is only those who have lost touch with the health goal, and are more interested in promoting or vilifying certain products that prejudge which harm reducing alternative is better. (We notice that this and the other Journal editorials, which are so obsessed with funding, did not mention whether Patterson, Hagan, AADAC, or anyone else mentioned receives financial support from the big pharmaceutical companies that stand to profit if their products are declared the only "appropriate" substitute for smoking. The Journal, of course, receives advertising revenue from those companies. Not that we would suggest that there is anything wrong with such research funding or advertising, as long as everyone is honest about disclosing it as we are about our funding from the smokeless tobacco industry. We have seen no such disclosures.) |
| Neil Collishaw, the Ottawa-based research director for Physicians for a
Smoke-Free Canada, said even though smokeless tobacco isn't inhaled, its carcinogenic chemicals can enter the body through the lining of the
mouth.
sruttan@thejournal.canwest.com |
This is another case of scientific language being used to hide the fact that something is irrelevant. We would like to think that those interested in "a smoke-free Canada" would embrace substitutes for cigarettes, so we will not assume that Collishaw was trying to attack ST. We will simply point out that, as with the count-the-carcinogens game, this observation is not relevant if we have data on how actual ST use affects actual people's health. Health scientists have the data. There is very very little effect. (Version beta.00) |
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