Tuesday, July 21, 2015

CASAA Podcast Update July 20, 2015

CASAA's Jan Johnson and Alex Clark discuss legislative- and advocacy-related matters of current interest to CASAA members and THR (tobacco harm reduction) advocates.

Alabama Call to Action! Oppose new taxes on e-cigarettes and vapor products!

On Monday, July 13th, 2015, Alabama Governor Robert Bentley announced that the state legislature would be heading back into special session to hash out the details of the state’s budget. One of the proposals to be discussed will be a revived version of an earlier e-cigarette tax bill.

The special session will reconvene on Monday, August 3rd, 2015. It is vital that Alabama vapers and harm reduction advocates take this opportunity NOW to reach out to lawmakers urging them to oppose ANY new tax on vapor products.

Although this new tax bill has not been published and is still under review by the Legislative Fiscal Office, the Breathe Easier Alliance of Alabama has stated* that this bill is likely to impose a $0.25/milliliter tax on e-cigarettes and e-liquid containing nicotine. For a breakdown of what the added expense to consumers will be, please see the chart below.

Proposed tax per ML

In addition to hiking the cost of vapor products for consumers -- and discouraging adult smokers from switching -- such an enormous tax would threaten to close many of Alabama’s independent vapor retailers. It is estimated that 2000 people might lose their jobs and, of course, hundreds of thousands more would see their access to vapor products dramatically reduced.  

“Here’s the text of Governor Bentley’s Special Session proclamation” http://yellowhammernews.com/politics-2/heres-the-text-of-governor-bentleys-special-session-proclamation/

*“Critics warn Bentley’s proposed tobacco and e-cig tax hike could cost 2,000 jobs” http://yellowhammernews.com/politics-2/critics-warn-bentleys-proposed-tobacco-and-e-cig-tax-hike-could-cost-2000-jobs/

(Writing Tip #1) If you have a lot to say, please craft your email in a separate word doc and then copy/paste it into the field provided.  If you take too long, they system will time out and you will lose your work.
(Writing Tip #2) Although we've provided a prewritten email with compelling talking points, we would strongly encourage you to edit the email because personalized communications to legislators are far more persuasive than form letters.  At a minimum, PLEASE INSERT YOUR PERSONAL STORY (just a few sentences) in the text of your email.

Tuesday, July 14, 2015

CASAA Podcast Update July 13, 2015

CASAA's Jan Johnson and Alex Clark discuss legislative- and advocacy-related matters of current interest to CASAA members and THR (tobacco harm reduction) advocates.

Friday, July 10, 2015

Pennsylvania Call to Action: Oppose the Governor's unjustifiable 40% wholesale tax on Vapor Products and Smokeless Tobacco.

Update - 07.09.15

Although the PA State Assembly passed a budget bill in June that did not include a damaging tax on vapor products, the budget was promptly vetoed by Governor Wolf. As a result, the assembly will return to budget negotiations in order to hammer out an acceptable plan. These meetings could begin as soon as next week (week of 7/13).

Please take a moment now to send a fully editable, pre-written thank you letter to your Pennsylvania lawmakers. Please also include your personal story about how switching to low-risk, smoke-free alternatives like e-cigarettes and snus has changed your life. If you need a little inspiration, please visit our testimonials project. And if you haven’t already submitted your story, please take a moment to add it to our collection. Personal stories are incredibly powerful and help legislators understand why we are so passionate about ensuring that vapor products remain accessible, affordable, and effective.

(Writing Tip #1) If you have a lot to say, please craft your email in a separate word doc and then copy/paste it into the field provided.  If you take too long, they system will time out and you will lose your work.
(Writing Tip #2) Although we've provided a prewritten email with compelling talking points, we would strongly encourage you to edit the email because personalized communications to legislators are far more persuasive than form letters.  At a minimum, PLEASE INSERT YOUR PERSONAL STORY (just a few sentences) in the text of your email.

Thursday, July 9, 2015

Massachusetts! Take action NOW to protect adult access to vapor products from multiple threats!

Several bills are scheduled to be heard in the Joint Committee on Public Health on Tuesday, July 14th at 1:00 PM. We have provided a summary of the bills below. You will see that the proposed regulations range from obvious (prohibiting sales to minors), to predictable (public vaping ban), to dangerous (requiring burdensome testing by manufacturers that would result in all or most e-liquids being banned from sale in MA, raising the age to purchase ALL “tobacco products” to 21 -- even low-risk, smoke-free products like snus and e-cigarettes).

Legislative Summary:

HB 1954 (Same as SB 1137):
  • Redefines “tobacco products” to include “electronic cigarettes” and other vapor products
  • Prohibits the sale of “tobacco products” in any retail establishment that “operates or has a health care institution within it, such as a pharmacy, optician/optometrist, or drug store…”

HB 2050 (Same as SB 1119):
  • Redefines “tobacco products” to include “electronic cigarettes” and other vapor products
  • Prohibits the use of “tobacco products” in schools
  • Prohibits the sale of “tobacco products” to any person under the age of 18
  • Redefines “smoking” or “smoke” to include the use of “electronic cigarettes” and other vapor products.
  • Prohibits vaping in public places where smoking is currently banned.

  • Would require manufacturers to file annual reports with the MA Department of Health which identify the “concentration of any toxins contained in the vapor produced by an e-cigarette when used…”
  • Provides an outrageous fine -- $10,000 per day -- for understating the concentrations of toxins within a range to be determined by the DOH.

  • Directs the Department of Public Health to develop regulations “for restricting the marketing, labeling, and restricting youth access to so-called ‘Other Tobacco Products’.”

  • Redefines “tobacco product” to include “electronic cigarettes” and other vapor products.
  • Prohibits the sale of “tobacco products” to anyone under the age of 21.

  • Would require “tobacco retailers” to conspicuously post a sign directing customers to the Massachusetts Tobacco Cessation & Prevention Program and The Smokers Helpline.

Despite the numerous bills that CASAA opposes, there are a few that can be considered thoughtful and appropriate:

  • HB 1943 would direct the Department of Public Health to conduct a study on the use of Tobacco Harm Reduction as a means to reducing smoking rates. While the Bill as currently written is seriously problematic, CASAA is attempting to engage with the sponsor to help it meet its positive goals.
  • HB 1951 would prohibit local Boards of Health from banning the sale of legal “tobacco products.” (You may remember an incident from 2014 when Westminster, MA attempted to implement a ban on all tobacco sales.)
  • HB 3466 would prohibit sales of vapor products to anyone under the age of 18 and manages to do so without confusing vapor products with combustible cigarettes.

(Writing Tip #1) If you have a lot to say, please craft your email in a separate word doc and then copy/paste it into the field provided.  If you take too long, they system will time out and you will lose your work.
(Writing Tip #2) Although we've provided a prewritten email with compelling talking points, we would strongly encourage you to edit the email because personalized communications to legislators are far more persuasive than form letters.  At a minimum, PLEASE INSERT YOUR PERSONAL STORY (just a few sentences) in the text of your email.

Tuesday, July 7, 2015

CASAA Podcast Update July 6, 2015

CASAA's Chief Scientific Officer, Carl V Phillips, joins Jan Johnson and Alex Clark to discuss the launch of CASAA's fundraising efforts to provide a grant to research the gateway claim and legislative- and advocacy-related matters of current interest to CASAA members and THR (tobacco harm reduction) advocates.

0:45 - California - Hearing on SB 140 in the Committee on Governmental Organization on Wednesday, July 8, 2015. California residents, please see the Call to Action to send a prewritten (fully editable) email to your legislator. While the Call to Action is open to all California residents, it is particularly important that those who live in districts with a legislator who serves on the committee participate in the Call to Action. Emails were sent to people with legislators on the committee, so if you received an email, it is vital that you respond. NorCal SFATA has been doing an excellent job of providing up-to-date information on SB 140 and has also issued a NorCal SFATA Call to Action, and we strongly recommend watching their site for updates. (NorCal SFATA can be found here on Facebook.) NorCal SFATA is organizing a get-together in Sacramento starting at 10:30 a.m. (hearing at 1:30 p.m.) on Wednesday, July 8th, 2015 in front of the Capitol Building. 

2:40 - Massachusetts - Expect a Call to Action this week.

3:00 - CASAA announces a crowdsourcing plan for a new research project, to be launched Tuesday, July 7, 2015. CASAA created the Research Fund in 2013, and its inaugural project was to give a grant to Dr. Igor Burstyn to review the research regarding the chemistry of e-cigarette vapor and liquid and provide an analysis of its health implications. This is probably still the most important paper on the topic of e-cigarettes. CASAA's goal with the Research Fund is to identify very high bang-for-the-buck research that will be important for THR advocacy, and we believe we have identified another such project to provide the definitive rebuttal of the various gateway claims.

The gateway claim is a classic strategy employed by those seeking to condemn a low-risk drug or behavior but can't come up with any good reason to do so based on its actual effects. Therefore, they claim that the relatively low-risk drug/behavior causes people to go on to do something that is harmful. The current gateway claim regarding e-cigarettes is that that e-cigarettes will cause people to take up smoking. 

Some may wonder why a research paper should be done to refute such a bogus claim. The answer is that, sadly, the unsupported gateway claim is gaining traction among policy-makers and legislators. In fact, the gateway claim comes up in almost every single legislative hearing involving e-cigarettes, even those where the issue is wholly unrelated to the legislation. It's even part of the FDA's discussion. As obvious as it is that the claim is absurd, we don't have something we can point to as the definitive rebuttal of all the gateway claims. 

Phillips has published a working paper on gateway effects here that basically shows what research would be needed to provide any evidence whatsoever that a gateway effect is occurring, but this paper is a highly technical methods paper and is not optimized for advocacy purposes. The research project being proposed will be led by Dr. Karyn Heavner, who has been working with Phillips on THR for 7-8 years, and joined by Catherine Nissen and Carl V Phillips, all of whom worked together at the University of Alberta on THR issues. The research team will review all of the papers, blogs, and other claims (including testimony and postings on authoritative websites) that are being put out there as evidence that there is a gateway effect and analyze those claims. To our knowledge, not a single one of these papers or blog posts actually comes anywhere close to providing evidence that there is a gateway effect, but there is a great deal of legwork and honest analysis to be done to identify where these claims are being made, to analyze the basis for the claims being made, and to trace the sources of the claims. The hypothesis is that many statements of gateway effect claims ultimately trace back to a few papers, which papers will be identified and analyzed to see if they do or do not support a gateway effect hypothesis.

The budget for the project is $15,000, and the CASAA Board of Directors voted to match donations to the fund one-for-one (up to $7,500 in contributions), meaning that we need the community to donate $7,500 to the research fund to fully fund this project. 

11:45 - The gateway theory is increasingly reflected in news stories and, distressingly, comments by the public, the people we are trying to win over. It is important for us to refute those claims, and it would be particularly effective if we were able to provide a single link to one research paper from a journal that fully rebuts each and every one of those claims. (Discussion of how the study could be used in advocacy efforts.)

14:00 - For those who may be interested, about ten years ago, Phillips traced the origins of claims about smokeless tobacco causing oral cancer back to a “telephone game” that traced back to a single study which was not sufficient to support the claims. 

15:30 - No one seems to even make a prima facie case for why a gateway would exist, and proponents of the gateway effect don't actually explain what it is that they are claiming. They mostly just cite data that shows that many teenagers and young adults who have smoked have also tried e-cigarettes, which, of course, doesn't prove the point that they're trying to make. In other words, they interpret mere correlation as causation. Moreover, they interpret it as all being in the gateway direction, when we know that there is a causal connection in the other direction: smoking causing people to adopt e-cigarettes for THR.

18:00 - CASAA believes that tracing where the claims about gateway effects come from will be incredibly useful. 

19:00 - Donations for the Research Fund can be made by clicking the Donate button located here.

Donations in any amount are welcome. Even very modest donations are valuable -- aside from the fact that they add up, they show broad-based support. The community has always been generous in supporting CASAA efforts, especially in connection with research. The Research Fund's initial launch to fundraise to support the Burstyn study was incredibly successful, reaching full funding in a matter of days.

22:00 - For those who want more detailed information on the research plan and protocol, you can see links provided in our announcement here. CASAA made the decision to support this research because we believe it would offer an important reality check for the policy and advocacy discussion, and also because we are committed to discovering and sharing truthful and accurate information. As consumer advocates, we are uniquely interested in learning the truth and making sure that all relevant information is shared with consumers.

As always:
Submit your testimonial for the CASAA Testimonials Projectt and Join CASAA so that you receive the most up-to-date information on issues affecting you.

Join the conversation:

CASAA Research Fund Launches Fundraising for Study of Gateway Claims

The CASAA Research Fund has an opportunity to support some valuable new research which we believe will benefit e-cigarette and other tobacco harm reduction (THR) advocacy efforts. We are seeking crowdfunding and will be matching every dollar donated (up to $7,500) one-for-one.

As you probably know, one of the most common attacks on e-cigarettes, as well as snus and other THR products, is that they will be a “gateway” to smoking. The gateway claim is part of the standard playbook of people who want to ban or otherwise restrict something that poses minimal risk: They claim that it causes another behavior that poses great risk. That way they can pretend that they are motivated by concerns about health, even when that is clearly not the case.

There are frequent claims that e-cigarettes have been shown to be a gateway to smoking. All of the claims of scientific evidence that we are aware of are based on highly limited and flawed research, as demonstrated in a research methodology paper recently published by our Chief Scientific Officer, Carl V Phillips, PhD. Indeed, there has never been a credible case that any THR products cause smoking that we are aware of. Unfortunately, there is no definitive study we can point to that provides such an assessment. Dr. Phillips’s paper provides the framework for making the point, but it is a technical analysis that requires the reader to connect the dots for any specific claim.

A team led by Karyn Heavner, PhD, as Principal Investigator, working with Dr. Phillips and Catherine M Nissen has proposed conducting the research and publishing a paper or two that will review the claims that are being made and connect the dots. The full formal research proposal appears below. To summarize, the researchers will review all of the scientific studies that include claims, or are used in claims, that e-cigarettes and other THR products are a gateway to smoking. They will also review the recent prominent claims -- from websites, blogs, the popular press, and other media -- by influential institutions and individuals that say or imply there is a gateway effect from e-cigarettes. They will trace the sources of these claims. Their hypotheses are that all the claims of evidence fail and that all popular claims trace either to one of these sources, to something that does not even ostensibly provide such evidence, or nothing at all. They will document these in detail and summarize the results.

Dr. Heavner is an epidemiologist who wrote some of the earliest research on e-cigarettes in the late 2000s. Presumably everyone familiar with CASAA is familiar with Dr. Phillips and his work, which includes a similar review of claims about smokeless tobacco about ten years ago. Ms. Nissen worked with both of them at the University of Alberta.

The budget for the project is $15,000, which makes it the type of high bang-for-the-buck project that CASAA seeks to focus on funding. It will be immediately useful for our and others’ advocacy efforts to protect access to e-cigarettes and push back against unwarranted restrictions. Since CASAA will match all donations, we need $7,500 in earmarked donations to move forward with this project. (Any donations beyond this target sum are also most welcome, and will be kept in the Research Fund for future projects.)

The Research Proposal is included below. For those who are interested in hearing Dr. Phillips's thoughts on the project, you may find the CASAA Podcast Update for July 6, 2015 of some interest.


Research Proposal

Review of claims and evidence of a gateway effect for tobacco products

Study personnel

Principal investigator: Karyn Heavner, PhD

Co-investigators: Catherine M. Nissen, Carl V. Phillips, PhD

Background An increasingly frequent claim used by those who would restrict the availability of low-risk tobacco products (e-cigarettes and smokeless tobacco) is that they are a gateway to smoking. That is, they cause would-be nonsmokers to become smokers. Despite there being little apparent reason why this would happen, the claim has gained substantial political traction and it is widely said to be empirically supported. However, the claims of empirical support we are aware of do not stand up to scientific scrutiny.

Phillips recently published a paper on what empirical evidence would be needed to support a claim of a gateway effect for tobacco products: http://www.mdpi.com/1660-4601/12/5/5439/htm. In that paper he:

  • argues that the logic of the gateway claim is such an unlikely scenario that the claim should be seen as extraordinary, requiring extraordinary evidence;
  • notes the fatal flaws in reasoning of study authors and others who claim that particular evidence supports a gateway claim – in particular that they fail to discriminate between the gateway effect they claim to observe versus causation in the other direction (switching from smoking to a low-risk product for harm reduction) or the inevitable massive confounding (anyone inclined to use one tobacco product is more inclined than average to use another);
  • provides a checklist for what a particular study or analysis would need to do in order to support a gateway claim;
  • reports observing (though not based on any systematic review) that no existing claim meets those conditions or even provides generally supporting evidence, let alone extraordinary evidence;
  • makes other methodological observations, suggests methods for actually observing a gateway effect if one exists, and provides an extended example of a useful analysis.
A practical upshot of that paper is that the author reported that none of the research he identified genuinely supported the gateway claim. However, that paper did not include a systematic review of the evidence, and so cannot be said to show there is no such evidence. Moreover, it is written as a epidemiology methods paper, and thus is relatively difficult reading (being both long and technical) and requires the reader to connect the dots. Thus, using it in the practical policy debate requires the intermediate step of understanding the paper and parsing each gateway claim that is made against the methodological analysis to determine if it passes muster.
Proposed research
To fill the gaps and create a paper that is more accessible to non-scientists, we propose to conduct a literature review applying the methodology developed in the Phillips paper. The review would have two parts:
Part 1. A systematic comprehensive review of scientific papers that are purported to show a gateway effect for tobacco products. These would then be parsed against the methodology points from the Phillips paper.
The dataset would be generated using a keyword search of PubMed and Google Scholar, supplemented by snowballing from any papers referenced in the papers we find and in the dataset generated in Part 2. The latter step is critical because activist authors have recently written papers that were designed to be the basis for gateway claims – which they then made in other forums – while carefully avoiding making the gateway claims in the paper itself (an example is discussed in the Phillips paper). This search strategy might not find archival papers that played that role (e.g., a paper from the 2000s about smokeless tobacco that did not itself include gateway claims but was used to support such claims in activist documents that are now largely forgotten), but should find all such recent papers that are being invoked in the debate surrounding e-cigarettes.
The papers would be analyzed based on the considerations presented in the Phillips methodology paper, which are necessary conditions for making a valid scientific argument that study results suggest a gateway effect (more details appear in the Phillips paper and will be reprised in the new paper):
  1. Do the authors offer a clear statement of what it even means to claim a gateway effect and do they offer any suggestion of the magnitude and timing of effect they are claiming? (I.e., is the hypothesis/claim even defined?
  2. Do the authors offer a prima facie case for why a gateway would ever occur or any testimonial evidence that even one case has ever occurred? (I.e., does the gateway conclusion have plausibility, regardless of the statistical results?)
  3. Upon observing an association between smoking and low-risk product use, is there any attempt to discriminate between gateway causation and the inevitable causation in the other direction (tobacco harm reduction)?
  4. Is there a serious attempt to discriminate between the observed association being causal or confounding?
  5. Is the attempt to deal with the inevitable confounding based on a theory of the nature of the confounding and is it empirically tested, or does it just consist of throwing in whatever covariates happen to be available?
  6. Do the study results support any prediction that would be true under the gateway hypothesis but unlikely if the hypothesis is false?
  7. Is there any attempt to detect temporal ordering of behaviors? (As noted in the Phillips paper, this is neither necessary nor sufficient for a gateway, but the right ordering tends to better support the claim for obvious reasons.)
  8. Did the authors report enough different variations of their models to make clear that a conclusion that the data supports a particular hypothesis is apparently not an artifact of the specific models and results that are reported?

Our hypothesis is that none of these conditions but 7 is met for any of the existing claims of a smoking gateway. Our preliminary review finds that the only paper that meets 2 and some of the other plausibility arguments (but provides no actual evidence of an effect) is the one that claims a gateway to cocaine use.
Part 2. A structured review of activists’ claims that there is a gateway, tracing the basis for each claim. This would obviously not be comprehensive; it would be semi-systematic, based on structured review criteria but limited to claims by authoritative or respected actors, rather than simply looking at everything that happened to rank high in a search.
This step harkens back to Phillips’s “curious history of a ‘fact’” research on the claims about smokeless tobacco and oral cancer. We would catalog the claims and what empirical research they trace to. Our hypothesis is that the claims (even limiting the review to the authoritative actors) do not address considerations 1 and 2 from the above list, and the majority are not sourced to any empirical evidence. For those that do cite empirical evidence, that evidence will be reviewed in Part 1, where our hypothesis is that the conditions for it being valid evidence are not met.
Work product
Approximately four months after securing funding, we will publish a working paper reporting on the proposed research. The paper will include: a table parsing all the empirical papers from Part 1 against the listed considerations, and whatever additional analysis of them that seems useful, as well as an appendix with all the details from Part 2 and a summary of that (probably in the form of network analysis diagrams) with accompanying analysis.
After circulating the working paper for comments we will then produce at least one (though
it may require two) journal-style papers from it and submit them for journal publication, pursuing that process until it succeeds. We will also attempt to present the results at any relevant conferences we are able to attend.

Monday, July 6, 2015

California Call to Action! Oppose SB 140.

SB 140 will be heard in the Committee on Governmental Organization on Wednesday, July 8th at 1:30 PM.

Oppose SB 140 - Send an Email

Please take action now by sending a fully-editable, pre-written email to members of the committee. Please note: if you are not a resident of a district represented by a member of the committee you will be sending a message to your assembly member only.

If passed, SB 140 would, among other things:
  • Define vapor products as “tobacco products”
  • Prohibit vaping where smoking is currently banned
  • Prohibit vaping in vapor shops
  • Prohibit vaping in some private residences, group homes, and transitional housing

For those living in districts not represented by a member of the Governmental Organization Committee, please take a moment to contact the committee to politely express your opposition to SB 140 - http://agov.assembly.ca.gov/committeehome

For updates and other opportunities to take action, please follow NorCal SFATA.