Tobacco Harm Reduction 2010
a yearbook of recent research and analysis

Carl V. Phillips and Paul L. Bergen, editors

a production of


Paul L. Bergen, MSc (Psycholinguistics) MLIS, has alternated between studying and working in academia, and working in the book trade. He initially studied how individuals use contextual cues to determine the correct meanings of messages and now explores how messages are constructed to deliberately mislead individuals and the processing strategies that both help and hinder understanding. He has been with since its inception.

James E. Dillard, PhD, is Senior Vice President at Altria and was Senior Vice President at U.S. Smokeless Tobacco Company before it was acquired by Altria. Previously he was Director of Cardiovascular, Respiratory, and Neurology Devices at the U.S. Food and Drug Administration. Altria, parent company of the tobacco companies Philip Morris USA, U.S. Smokeless Tobacco Company, and John Middleton, lists among its mission statements to actively participate in resolving societal concerns that are relevant to its business, including supporting the development and implementation of regulations that improve public health and recognize individual consumer rights and preferences. Additionally, its stated mission includes satisfying adult consumers, part of which is developing products for smokers that are lower risk than their current cigarettes and communicating openly and honestly about the health effects of tobacco products.

James Dunworth is the IT director and a shareholder of Having had enough of the UK at the age of 21, he packed his bag and travelled abroad for four years, only returning (briefly) to first study and then teach at the University of Wales, Cardiff. He has lectured and taught in Thailand, Indonesia and the Middle East, created several websites, and has written for newspapers and magazines. At E Cigarette Direct he has reviewed, conducted, and reported on research on electronic cigarettes, and set up the Ashtray blog to provide electronic cigarette and tobacco harm reduction news. He has collected expert opinions on electronic cigarettes by conducting numerous interviews which are available online and have been translated into several languages, and has conducted several surveys of e-cigarette users.

Karen Geertsema, MSc, is an independent environmental consultant specializing in Ethnobotanical Impact Assessments and Environmental Planning. She works with the Canadian Institute of Planners and is working towards developing the first Alberta First Nation Land Use Plan, which focuses upon conservation and stewardship of flora used for Ethnobotanical purposes. Ms. Geertsema is specifically concerned with the sustainability of flora used for medicinal purposes given the intensity and pace of industrial and resource development in Alberta, and the resultant adverse impacts upon unique plant communities. She formally worked with the Ministry of Forests in British Columbia (B.C.) in Silviculture and then Ecology, and the B.C. Conservation Foundation where she managed environmental research. She worked with Carl V. Phillips’s research group, conducting research on smokeless tobacco in the Department of Public Health Sciences at the University of Alberta while in her Master’s program at the Faculty of Forestry and Agriculture.

Bill Godshall founded SmokeFree Pennsylvania in 1990, and has been its executive director since then. SmokeFree Pennsylvania has successfully advocated policies for smoke-free air, reducing tobacco marketing to youth, increasing tobacco taxes, expanding nicotine addiction treatment services, and educating smokers about less hazardous alternatives to cigarettes.. Originally a statewide grass roots organization, SmokeFree Pennsylvania has also been involved in numerous national level activities.

Jan Hamling gained a degree in mathematics at Imperial College, London University in 1978, completed a course in epidemiology in 1998, and gained a diploma in statistics from the Open University in 2005. Having previously worked as a systems analyst, she joined P.N. Lee Statistics and Computing Ltd. in 1994. She is a co-author of International Smoking Statistics and has contributed to a paper on techniques for meta-analysis, and several reviews of evidence on the health effects of smoking, environmental tobacco smoke exposure and smokeless tobacco use. She has two children and also enjoys singing and gardening.

Karyn K. Heavner, MSPH PhD, is an epidemiologist specializing in behavioral research, particularly issues of misclassification related to harm reduction (tobacco and otherwise). She completed a MSPH at the University of South Carolina, a doctorate at the University at Albany, where she focused on HIV-related harm reduction and epidemiology methods, and a postdoc at the University of Alberta where her work included tobacco harm reduction and epidemiology methods. In addition to the works represented here, Dr. Heavner recently completed the most complete population-level analysis to date that demonstrates the success of THR in one European subpopulation.

Courtney E. Heffernan has an honours degree in Philosophy from the University of Windsor and a Masters in Philosophy from the University of Waterloo. She formerly worked in the research group at the University of Alberta that included the editors of this volume. She is currently living in Edmonton with her cat, Beastly.

Peter N. Lee has, since 1979, been an independent consultant in statistics and adviser in epidemiology and toxicology to a number of tobacco, pharmaceutical and chemical companies. He has been director of P.N. Lee Statistics and Computing Ltd. since 1982. Having studied Mathematics and Statistics at Oxford University from 1962-66, he worked for the Tobacco Research Council as Statistician and Research Coordinator before going independent. He has published five books and over 200 papers on aspects of medical statistics, epidemiology and clinical trials. Smoking, environmental tobacco smoke exposure and, more recently, smokeless tobacco are special interests, and his papers review evidence on numerous potential health effects. He is the only person ever to have won the British Championship at both chess (at age 21) and bridge (at age 60). He is married with one daughter and two grandchildren.

Karl E. Lund, PhD, has been Research Director at the Norwegian Institute for Alcohol and Drug Research since 2006. He has been involved in tobacco control work since the mid 1980s, working at the Norwegian Council on Tobacco or Health (Deputy Leader), the Norwegian Institute for Public Health (Researcher), and the Norwegian Cancer Society (Director for Department of Cancer Prevention). Dr. Lund received the Norwegian Medical Association’s Award in preventive medicine in 2002. He is well published within tobacco research, has been a lecturer on tobacco topics in several countries worldwide, and has been a member of several expert committees on tobacco control including WHO’s International Agency for Cancer Research (IARC) and the executive committee of the International Society for the Prevention of Tobacco Induced Diseases. He has also been an expert witness for the plaintiff in tort liability lawsuits brought before the Norwegian Supreme Court against the tobacco industry.

Catherine M. Nissen is a researcher with She has a B.Sc. in General Science from the University of Alberta (studying biology and psychology) and anticipates further education in public health. She has made a study of misinformation in public health messages, and her THR research focuses on this area. She is a practical statistician in the Pascalian tradition (i.e., avid poker player) and also enjoys running in the river valley of her hometown, Edmonton.

Joel L. Nitzkin,MD MPH DPA, is a public health physician, Board Certified in Preventive Medicine, and has been involved in tobacco control work since the mid 1970s. He served as a local health Director (Rochester, NY), State Public Health Director (Louisiana), and President of two national public health organizations (National Association of County and City Health Officials (NACCHO) and American Association of Public Health Physicians (AAPHP). He became Chair of the AAPHP Tobacco Control Task Force in February of 2007, at the time when the U.S. was contemplating granting regulatory authority over tobacco to the Food and Drug Administration. Choosing to review the FDA proposal rather than blindly heed the calls to support it, his task force was shocked and dismayed by the pro-cigarette and anti-harm reduction provisions written into the bill (which later became law with all these provisions intact), and the degree to which the language of the bill differed from the Campaign for Tobacco Free Kids’ summary used to secure the endorsements of many other organizations. They conducted literature reviews which led to them to discovering nicotine vaporizers / electronic cigarettes, and conducted analysis which (to their surprise) caused them to become proponents of tobacco harm reduction, particularly including the use of nicotine vaporizers. AAPHP’s analyses, literature review, and conclusions are in the public domain and available for download from the Tobacco Issues page at

David O’Reilly, PhD, is Head of Public Health & Scientific Affairs at British American Tobacco (BAT). He has been with BAT since 1989 and has held various positions in both Research & Development and Corporate Affairs. In R&D he has led the company’s Strategic Product Development and Risk Characterisation functions and most recently led BAT’s global harm reduction program with the aim of the developing lower risk products and a framework for their assessment. In Corporate Affairs, Dr. O’Reilly pioneered Corporate Social Reporting for BAT, which became the first tobacco company to implement such a program, and led the development of the company’s Statement of Business Principles and Framework for CSR. In his current role as Head of Public Health & Scientific Affairs, David is responsible for global strategic engagement on harm reduction amongst the scientific and public health communities. BAT is the world’s second largest quoted tobacco group by global market share, with brands sold in more than 180 markets. BAT publicly states that they manufacture products that can be harmful to the health of their consumers. They aspire to reduce the harm caused by smoking by evolving their products to a portfolio of commercially successful lower risk products that meet consumer and societal expectations. Their approach is to pursue the research, development and test marketing of innovative tobacco products that will have consumer acceptability and will be recognized by scientific and public health communities and regulators as posing reduced risks to health.

Adrian Payne, PhD, is an independent commentator on regulatory issues relating to tobacco harm reduction. Previously he was Head of International Public Health and Scientific Affairs at British American Tobacco (BAT), and prior to that, Head of Corporate Social Responsibility. Whilst at BAT, Adrian played a key strategic role in the development and initial test marketing of Swedish-style snus under cigarette brand names in Sweden and South Africa in 2005. This initiative was undertaken in response to suggestions from some Public Health Stakeholders that snus might be a useful tool in tobacco harm reduction because of the vastly reduced health risks of this type of tobacco product compared with smoking cigarettes.

Stanton Peele is a pioneering addiction psychologist who, beginning with Love and Addiction in 1975 and in numerous books and articles since, outlined a non-drug-based model of addiction, the value of harm reduction, and the frequent occurrence of untreated, non-12-step recovery. His most recent books are 7 Tools to Beat Addiction and Addiction-Proof Your Child. He developed the Life Process Program, which is used residentially and for outpatients at St. Gregory Retreat Center.

Carl V. Phillips, MPP PhD, is an independent researcher and consultant focusing on tobacco harm reduction and on improving methods and epistemology in the health sciences. He spent most of his career as a professor of public health, with a teaching focus of how to make optimal decisions based on evidence. His work draws upon his studies in economics, ethics, philosophy of science, political science, and public health. Dr. Phillips directs the research group and works as a consultant and advisor for various organizations and companies involved with tobacco harm reduction. He also provides litigation support and other consulting on a broader range of topics related to health science. Dr. Phillips is an award-winning researcher in epidemiology methods, focusing on making epidemiologic research more useful and honest by recognizing biased analyses and quantifying uncertainty. His writings and teaching have included these topics as well as environmental health, animal agriculture, diet and nutrition, and how non-experts can critically evaluate scientific claims. He received his PhD in public policy from Harvard University, completed fellowships in health policy research at the University of Michigan and philosophy of science at the University of Minnesota, and also has degrees in math and history.

Brad Rodu, PhD, is a Professor of Medicine at the University of Louisville, holds an endowed chair in tobacco harm reduction research, and is a member of the James Graham Brown Cancer Center at U of L. For the past fifteen years Dr. Rodu has conducted research on tobacco harm reduction, involving permanent nicotine maintenance with safer tobacco products by smokers who are unable or unwilling to quit smoking with conventional cessation methods. Dr. Rodu earned his dental degree from the Ohio State University. After an oral pathology residency program at Emory University, Dr. Rodu completed fellowships at the University of Alabama at Birmingham (UAB) sponsored by the American Cancer Society and the National Cancer Institute. He was on the UAB faculty from 1981 to 2005, with appointments in several departments in the Schools of Medicine, Public Health and Dentistry. Dr. Rodu’s research is supported by unrestricted grants from tobacco manufacturers to the University of Louisville and by the Kentucky Research Challenge Trust Fund.

Christopher Snowdon is an independent author and historian whose works include Velvet Glove, Iron Fist: A History of Anti-Smoking (2009). He has a degree in history from Lancaster University and has written about a wide range of issues relating to liberty and public health for Spiked, Environment & Climate News, Pipes and Tobaccos, and The Free Society. His most recent book is The Spirit Level Delusion (published May 2010). (THR.o) is a research and education group directed by Carl V. Phillips that produces scientific research and socio-political analysis about THR and related topics, advocates for THR at the policy and grassroots level, and disseminates information through the eponymous website, the associated blog, presentations, mass media, journal articles, and other publications (e.g., this book). THR.o has contributed research in epidemiology, consumer behavior, welfare economics, mass communication, epistemology, and ethics, and attempts to translate all of these into popular education. Originally established at the Department of Public Health Sciences at the University of Alberta Medical School (later part of the School of Public Health) in 2005 and launching the website there in 2006, the group became an independent research institute in 2010. Paul Bergen, who has been a researcher with THR.o from its inception, maintains the website and is director of communications. Catherine M. Nissen is THR.o’s research coordinator. Several other contributors to this book are former students and trainees or current affiliates of the group.

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