New at Reason

After a long absence (my previous article was in 2008!), I’m back in the pages of one of my favorite publications today. Over at Reason I take a look at the FDA’s latest actions against tobacco, explain why they accomplish nothing for public health, and spell out what they imply for the future of cigars and e-cigarettes.

The article also updates the case of Hestia Tobacco, whose regulatory tribulations I profiled at The Atlantic one year ago. Unfortunately, they are no closer to coming to market than they were before. See that article for a more in-depth explanation of the laws that allow the FDA to keep new tobacco products in regulatory limbo.

Finally, be sure to check in at Michael Siegel’s blog, where he has been tearing apart the FDA’s action this week from a slightly different perspective.

Nicotine and regulatory capture

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The FDA is expected to announce very soon new regulations governing chewing tobacco, cigars, and likely electronic cigarettes. If you’ve followed my writing on this, you know I don’t think this bodes well for the quality side of the tobacco market. The law giving the agency authority over tobacco products was brokered by an alliance of Philip Morris and anti-smoking groups, and the new head of the FDA’s tobacco division, Mitch Zeller, came to the job straight from consulting for GlaxoSmithKline on nicotine replacement therapies. The agency’s record so far has been distinguished much more by its anti-competitive effects than by any actual achievement improving public health.

The Boston Globe recently interviewed Zeller to get some indication of where the agency may be headed. As expected, it appears likely that Zeller will pursue mandating the removal of nearly all nicotine from cigarettes:

1. Create a non-addictive cigarette. We have the authority given to us by Congress to reduce nicotine in cigarettes down to nearly zero,” Zeller said. Since nicotine is the addictive chemical in cigarettes, teens who start smoking products that are almost nicotine-free could, in theory, never get hooked in the first place. Researchers now have access to 9 million cigarettes with varying amounts of nicotine to start testing whether products with lower amounts will lead to less addiction among new smokers. But don’t expect an ultra-low-nicotine product for at least a few years, Zeller added, since the studies are just beginning.

A few notes on this:

1) This would obviously be good news for Zeller’s former client in the pharmaceutical industry. Removal of nicotine from cigarettes would leave smokers craving nicotine and many of them would likely turn to patches, gums, and the like. Zeller indicates in the same interview that the agency should perhaps remove warning labels from nicotine replacement therapies that discourage consumers from using them long-term, noting that using these products for life is healthier than smoking.

Even if this is good policy, Zeller’s previous job casts doubt on the FDA’s ability to consider the issue impartially. As many warned at the time of his appointment, his role as lead regulator of tobacco creates a blatant conflict of interest at the agency.

2) Mandated removal of nicotine could be good news for makers of electronic cigarettes, which now include the Big Tobacco companies. But it’s not clear that the FDA will turn a favorable eye to those, either. If the agency’s performance on cigarettes is any indication, e-cigarettes could be caught in a bureaucratic morass that keeps new products off the market with scant scientific justification.

3) Rather than turn to pharmaceuticals or e-cigarettes, at least some smokers will likely switch to cheap, low-quality cigars. Even if the FDA does not initially regulate nicotine levels in cigars, this will provide the impetus to extend the regulation. We’ve seen this before with bans on flavors or changes to tax policy when producers and consumers respond with products that technically qualify as cigars or pipe tobacco. Lawmakers and regulators then attempt to close the “loophole.” Makers of high-quality, traditional cigars would be caught in the crossfire. Whether or not one has any personal interest in cigarettes, if you enjoy an occasional pipe or cigar, then the FDA’s path should have you worried. There may be no way to produce a traditional cigar and comply with the FDA’s demands. This is the road that could lead to the complete destruction of the industry.

For more on how the FDA is getting tobacco regulation wrong, see my articles from the past year:
Who’s killing the electronic cigarette?
How the FDA is keeping new cigarettes off the market
The case against a smoke-free America

Two new cigarettes, now authorized for sale

This week the FDA sent out a press release boasting that its Center for Tobacco Products has finally issued a few decisions on new tobacco products:

For the first time since the Family Smoking Prevention and Tobacco Control Act of 2009 gave the U.S. Food and Drug Administration the authority to regulate tobacco products, the agency has authorized the marketing of two new tobacco products and denied the marketing of four others through the substantial equivalence (SE) pathway. [...]

“Today’s historic announcement marks an important step toward the FDA’s goal of reducing preventable disease and death caused by tobacco,” said FDA Commissioner Margaret A. Hamburg, M.D. “The FDA has unprecedented responsibility to protect public health by not allowing new tobacco products under FDA’s authority to come to market without FDA review.”

To put this into context, when I wrote about the FDA in March the agency had received about 3,500 new product applications. The most reasonable interpretation of the law giving the agency authority over tobacco implies that these reviews should take only 90 days, and certainly no more than 180, yet some of these have languished in a bureaucratic quagmire for years. Issuing only six decisions since 2009, with more than 100 employees at work reviewing them, is hardly an accomplishment worthy of praise.

(If you’re wondering, Hestia Tobacco, the brand I profiled for The Atlantic, remains tied up in the review process with no end in sight.)

It’s also worth emphasizing what these approvals don’t mean. They don’t mean that these two new cigarettes are any safer than products already on the market, only that they don’t raise any new questions of health. In other words, they’re just as lethal — though no more so, we are told to believe — as other cigarettes. New cigarettes like Hestia, which by any sensible standard also raise no new questions of public health, continue to be blocked. It’s difficult to see what good is accomplished by requiring them to go through this lengthy approval process.

And in the midst of this, the future of e-cigarettes remains unclear. As I explained at The Umlaut this week, this product that is indisputably safer than real cigarettes may soon fall under the same heavy-handed regulation that has brought the tobacco industry to a standstill. If that happens, the FDA will have even less to brag about that it does today.

Cato podcast on FDA tobacco regulation

While in DC this week I recorded a couple podcasts. Here’s the first, with the Cato Institute’s Caleb Brown. In it we cover FDA regulation of cigarettes, e-cigarettes, and cigars.

One minor correction: We were only discussing these inhalable products, so I misspoke when saying that current FDA regulations only cover cigarettes. The agency regulates smokeless tobacco too.

Update 5/30/13: Or if you prefer video…

Tobacco tax skepticism

My latest article for The Atlantic provides four reasons to oppose the new tobacco taxes proposed in the White House budget.

New taxes on pipes and cigars?

According to Bloomberg, President Obama will be proposing new tobacco taxes to fund pre-kindergarten programs:

Obama’s 2014 budget proposal, to be released April 10, would finance a pre-kindergarten program for 4-year-olds with higher taxes on cigarettes and other tobacco products. The president outlined the program in his annual State of the Union speech to Congress. He’s seeking to increase spending in areas such as education while Republican lawmakers are pushing for additional budget cuts as a way to reduce the federal deficit.

White House spokesman Jay Carney declined to elaborate on the proposed tobacco-tax increase. “Wait for specifics,” he told reporters at a briefing yesterday.

Never mind for now that cigarette smokers already suffered a more than doubling of the federal tax in Obama’s first year in office. The “other tobacco products” part of this proposal is reason to worry for those who enjoy pipes and cigars.

The 2009 tobacco tax increases to fund the Children’s Health Insurance Program created some significant disparities among similar products. Pipe tobacco was taxed at a far lower rate than roll-your-own (RYO). Large cigars sometimes get much more favorable treatment than small cigars. As a result, producers and consumers shifted to pipe tobacco instead of RYO and added just enough weight to small cigars to qualify as large. The distorting effects of these taxes were immediate and striking:

These changes are almost entirely a matter of legal classification. Actual consumption patterns haven’t changed in the way the chart suggests. Neither pipes nor premium cigars have enjoyed an explosion of new consumers as a result of these taxes.

Nonetheless, the government wants to fix this disparity. A report from the General Accounting Office, the source of the chart above (PDF), estimates that in the first two years of new taxes these substitution effects may have cost the treasury up to $1.1 billion.

One way to fix the disparity would be to lower taxes on RYO and small cigars, but that’s not going to happen. So don’t be at all surprised if the proposal from the Obama Administration includes tax hikes on pipe tobacco and large cigars, imposing substantial new costs on consumers and retailers.

For more, read Michael Siegel’s take on the tax proposal. And for a longer explanation of how smoking bans, higher taxes, and FDA regulation threaten the premium cigar industry, see my December article in The Atlantic.

Update 4/10/13: Via International Premium Cigar and Pipe Retailers on Facebook, this is apparently the language in the budget proposal:

Increase tobacco taxes and index for inflation

Under current law, cigarettes are taxed at a rate of $50.33 per 1,000 cigarettes. This is equivalent to just under $1.01 per pack, or approximately $22.88 per pound of tobacco. Taxes on other tobacco products range from $0.5033 per pound for chewing tobacco to $24.78 per pound of roll your-own tobacco.

The Administration proposes to increase the tax on cigarettes to $97.65 per 1,000 cigarettes, or about $1.95 per pack, increase all other tobacco taxes by about the same proportion, and index the taxes for inflation after 2014. The Administration also proposes to clarify that roll-your-own tobacco includes any processed tobacco that is removed for delivery to anyone other than a manufacturer of tobacco products or exporter. The rate increases would be effective for articles held for sale or removed after December 31, 2013.

As predicted, all loose tobacco would be treated equally, resulting in a huge tax increase for pipe smokers. Details on cigars are lacking, but it looks they would be hit too.

Markets not in everything

My article today at The Atlantic looks at the anti-competitive effects of the FDA’s regulation of tobacco:

David Sley wants to sell cigarettes. This, by his own admission, does not make him the most sympathetic person to feature in an article about excessive government regulation. Yet Sley, an aspiring entrepreneur who has spent more than two years trying to navigate the Food and Drug Administration’s new tobacco regulations, has legitimate cause to complain. The entire cigarette industry has been brought to a standstill by the FDA, forbidden from introducing any new products since March 2011. Tobacco companies contend that the agency’s actions rest on uncertain scientific and legal grounds — and, for once, they may be right.

In the article I document Sley’s attempt to launch a new cigarette brand, a process which has dragged on for more than two years without resolution. As you may remember, the Tobacco Control Act was backed and negotiated by Philip Morris, who just might have anticipated such a result.

The extremely slow approval process also bodes poorly for the premium cigar market, which is even more dynamic than that for cigarettes. Cigar lovers should pay close attention when the FDA issues its proposed rules for cigars later this year.

Read the whole thing.

Save the stogies

My forthcoming article that I’ve alluded to a couple times this week is now up at The Atlantic:

If a time traveler from the early 1990s were to arrive in the U.S. bars and restaurants of today, what would notice first? Perhaps that the food has become more interesting and varied, or that a perplexing number of diners are photographing it with their remarkable phones. The most obvious change, however, might register on the nose: the nearly complete absence of indoor smoking.

California implemented the United States’ first modern statewide smoking ban in 1998. Today twenty-nine states and 703 municipalities require bars and restaurants to be smoke-free, according to data maintained by the Americans for Nonsmokers’ Rights Foundation (North Dakota brought the tally to thirty states this month). Tobacco use has been banished from our culinary radar along with the question “smoking or non?” Most of us don’t miss it. Yet as a slew of new bans, taxes, and regulations drive smoking to the peripheries of society, it’s worth giving tobacco another look.

Read the whole thing. And for more context on some of the arguments, see my recent posts about the effects of new tobacco taxes and the failure of the FDA to establish an effective regulatory regime.

Incentives matter, tobacco taxes edition

One of the topics I’ve been researching for a forthcoming article is the effect of the higher tobacco taxes imposed by the Childrens Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA raised tobacco taxes across the board but it didn’t raise them equally; some products were hit harder than others. The most relevant disparities are between roll-your-own (RYO) tobacco and pipe tobacco, and between small cigars and large cigars.

Before CHIPRA, pipe tobacco and RYO were both taxed federally at $1.10 per pound. After CHIPRA, the former increased to $2.83 while the latter increased to $24.78. Since the two products can be treated as substitutes for each other, this naturally led to manufacturers and consumers shifting to products labeled as pipe tobacco for use in rolling cigarettes. A similar shift affected the cigar market, where it became advantageous for some producers of small cigars to slightly increase the weight of their products to qualify as large cigars. (Direct comparison of taxes on small and large cigars is complicated by the fact that small cigars are taxed by weight and large cigars by value.)

I knew that these market distortions were occurring, but I didn’t realize just how substantial they were until reading a report from the General Accounting Office (PDF) from earlier this year on the effects of CHIPRA taxes. Here in two charts is a dramatic illustration of unintended consequences at work:

At first glance this may look like booming business for producers of pipe tobacco and cigars, but of course that’s not what’s happening. The changes are almost entirely nominal. Yet since they reduce tax receipts for the government, the pressure is on now to fix the disparity by raising taxes yet again. This would be another blow to producers of traditional pipe tobacco and large cigars, as well as the retailers who sell their products.

115 employees, 3 years, 0 results

When the Food and Drug Administration was granted authority over tobacco products, many people (myself included) objected that this was an inappropriate field for the agency to be involved in. Among other reasons, it makes little sense for the FDA to approve products that are to some degree inherently dangerous. An excellent article from Michael Felberbaum of the Associated Press shows that the agency has failed to establish reasonable standards of review and has halted innovation in the parts of the industry it regulates:

Tobacco companies have introduced almost no new cigarettes or smokeless tobacco products in the U.S. in more than 18 months because the federal government has prevented them from doing so, an Associated Press review has found. [...]

Since June 2009, when the law allowing the agency to regulate tobacco went into effect, the tobacco industry has submitted nearly 3,500 product applications, according to data obtained by the AP under a Freedom of Information Act request. While none have been ruled upon, the vast majority of these products are already being sold.

A grandfather clause in the law allows products introduced between February 2007 and March 2011 that are similar to those previously on the market to be sold while under review. They can be removed from store shelves if they don’t pass muster with the agency. But 400 products submitted for review since March 2011 are being kept off the market.

The reviews, which are supposed to take 90 days, have dragged on for years in some cases. About 90 percent of applications have lingered for more than a year.

Nearly 3,500 applications over three years and zero rulings. Perhaps the agency is understaffed? Not exactly:

The [FDA's Center for Tobacco Products] has an annual budget of more than $450 million, funded by the industry, and more than 365 employees, about 115 of whom work on the application reviews.

One hundred fifteen employees and zero rulings. One wonders what they do all day.

Part of the problem is that the agency evaluates products not merely on their physical characteristics, but also on whether they may entice new smokers or discourage current smokers from quitting. Since any new product is intended to appeal to someone, it’s not clear to me how applicants can decisively prove to hostile regulators that their products meet this requirement.

Perhaps one does not feel much sympathy for the tobacco companies. But note that the FDA has signaled that it will likely soon be regulating cigars too, and imagine giving the lumbering agency veto power over all new cigar blends. If Philip Morris and Lorillard can’t push new products through the approval process, how will boutique cigar makers fare? As demonstrated by the FDA’s handling of tobacco thus far, regulation could be devastating to the premium cigar industry.This is a topic I’ll be covering in greater depth next week.

Update 12/14/12: Michael Siegel weighs in too:

The rest of the story is that the Tobacco Act is working exactly as I predicted it would: as a way to protect the existing cigarettes on the market and block any real possibility of competition from what could be truly safer products.

Is there anything a cigarette can’t do?

Today’s edition of alarmist health reporting comes from the BBC:

Women who are light smokers – including those who smoke just one cigarette a day – double their chance of sudden death, a large study suggests.

The link between heart disease and smoking is well established. The study that this article references is behind a paywall, but here is what it actually concludes:

Small to moderate amounts of cigarette consumption (1-14 per day) were associated with a significant 1.84-fold (95% CI, 1.16-2.92) increase in SCD [sudden cardiac death] risk and every 5 years of continued smoking was associated with an 8% increase in SCD risk (HR 1.08; 95% CI, 1.05-1.12, p<0.0001).

In other words, the elevated risk was found in a group of women that includes smokers who consume anywhere from one to fourteen cigarettes per day. That is a big difference! There may be (and likely are) very different levels of risk within this group. One can’t conclude from this study that smoking just one cigarette per day doubles one’s chance of dying from a heart attack. The press release for the study, reprinted at Forbes, doesn’t even make that claim. It appears to be an invention of the BBC. (Again, I haven’t seen the full study, but it’s very unlikely that there is anything in it to support the BBC’s interpretation.)

It should be obvious that smoking one cigarette a day carries a different health risk than smoking fourteen of them. In fact, the abstract for the study notes a linear relationship between quantity smoked and risk of sudden cardiac death. Yet the state of health journalism regarding tobacco products has become so degraded that reporters now ascribe near magical death-dealing qualities to the cigarette.

Smoking: More than just a vice

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Something Not Unlike Research” is a health care blog I recently came across written by two university professors. One of them, Bill Gardner, wrote this week in defense of employers choosing not to hire smokers. He concluding by noting that “Smoking is a vice that benefits no one.” I took him to task for this last line on Twitter:

“Smoking is a vice that benefits no one.” — @Bill_Gardner Oh please. I like it. It benefits me! Arrogant assumption.

To my surprise, he responded in a new post:

My point is that I do not see a compelling argument against employers choosing not to hire them. By extension, we should have no public policies protecting access to employment for smokers (or bone lugers). This is, I believe, consistent with Mill’s view that

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.

I do want to see smoking go away, and I think social pressure is what makes that happen. (“Social pressure” is not, I think what Mill means by “exercising power”.) To that end, I think it is legitimate to ban smoking in public places, and for employers to refuse to hire smokers if they judge that to be in the interest of their firms.

Having conceded that smoking may benefit Jacob’s subjective well-being, can I still say that “smoking is a vice that benefits no one”? I certainly can, if it’s understood that benefit refers to the long-term well-being of smokers, and those who depend upon them, rather than immediate subjective well-being. In that sense of benefit, there is nothing to be said for smoking or binge drinking.

(NB: The binge drinking reference is about the bone luge, which happened to be the top post on my site when he visited. The photo definitely makes his post more awesome but I’ll stick to the smoking discussion!)

I’ll elaborate in more than the 140 characters allowed by Twitter. To start, I agree with Bill that smokers shouldn’t be a protected class of worker. I think refusing to hire smokers is generally a silly policy but that’s something the market can sort out. Where we disagree is in our assessment of smoking. He says that smoking is “a vice that benefits no one” in the long term, that “there is nothing to be said for smoking,” and that “I do want to see smoking go away.”

I know where he’s coming from because I used to make the same assumptions. I grew up believing everything bad about smoking and made it through high school and college without taking a single puff from a cigarette. My interest in tobacco began shortly after I started working as a barista. In conversation with a cigar-smoking friend, I realized that he talked about his stogies the same way I talked about coffee. The varietal of the plant and the origin of the leaf mattered, a Cameroon wrapper tasting differently than one from Nicaragua. Flavors ranged from light sun-grown tobacco to deep, dark maduro, much as coffee roasts came on a spectrum from light to dark. And he suggested that there was just as much difference between the hand-rolled cigars he was smoking and the mass produced cigarettes of Big Tobacco as there was between Folgers and the small batch beans I brewed.

Perhaps, I thought, there was more to tobacco than I realized. When I eventually tried a cigar for the first time I took to it at once. Doing that required getting over my own prejudices that had led to me viewing smoking as pure vice, an unhealthy and addictive habit without redeeming qualities.

I am not addicted to tobacco. I go weeks and months without it. Of the three mood-enhancing drugs I enjoy — caffeine, alcohol, and nicotine — the last would be by far the easiest to never again partake of. It’s unlikely that my occasional indulgence in a cigar will have any significant effects on my health, though there is a small chance that it will. In exchange cigars have given me wonderful experiences, both in taste and in the friendships that have deepened over contemplative, smoke-fueled conversations. I expect that cigars are a net benefit in my life on both the short and the long view. Perhaps additional evidence could persuade me otherwise, but it can’t simply be assumed that I’m mistaken.

Admittedly I don’t fit the median profile of a smoker. However the value that smokers get out of smoking is almost never acknowledged by anti-smoking activists, who treat smoking as inherently wrong. Unlike them, and perhaps unlike Bill, I don’t want to see a completely smoke-free America. I want to see smoking substantially reduced. I’d like for people to smoke less and smoke better, using products other than cigarettes, which seem to be the most dangerous form of tobacco. (It’s also worth noting that the employment policies that inspired these posts are enforced via urine tests for nicotine, which wouldn’t discriminate between pack-a-day smokers and those who smoke rarely or those who are trying to quit with the aid of nicotine patches or gums.)

Semantics aside, activists’ unwillingness to consider the benefits of smoking leads to excessively restrictive policies. Let’s take smoking bans for example. Consider two businesses:

Business 1 is a tobacco shop with an attached lounge that offers beer and wine. Customers are allowed to smoke there. It’s a freestanding building with no immediate neighbors, so no one except customers and employees is affected by the smoking. Four people are employed serving drinks in the lounge. A smoking ban passes that forces the business to eliminate drink service. The day the ban takes effect those four employees lose their jobs.

Business 2 is a restaurant that serves Dungeness crab caught in the Pacific Northwest. Commercial fishing has one of the highest fatality rates of any occupation and crabbing in this region is often the highest of all. For comparison, the average annual fatality rate for all occupations is 4 per 100,000 workers. For fishing as a whole the rate is 115/100,000. For Dungeness crab fishermen in the Pacific Northwest the rate is 463/100,000. (Source here.) There are no proposals to forbid restaurants from serving Dungeness crab.

The comparison might seem silly, but why? Dungeness crab is delicious but it’s hardly a staple in the food supply. Fishermen are literally dying to put it on our plates. Though the level of risk associated with secondhand smoke exposure is in dispute, it would be astonishing if the danger of pouring beer in a smoky room was at all comparable to crabbing on a stormy ocean. So again, why the disparity in how we treat these workers?

The number of actual deaths resulting from Dungeness crabbing is low since it’s a small industry, but it provides a model for how we normally regulate occupational risk. We don’t ban dangerous jobs, we try to discover reasonable rules to make them safer. Safety regulations have apparently been successful in reducing the fatality rate among Alaskan Dungeness fishermen.

Let’s accept for the sake of argument that banning smoking in some places to protect patrons and employees is justified under Mill’s proviso. It’s much harder to argue that smoke-friendly businesses should be banned entirely. Our normal approach to worker safety would allow people to work in smoking venues, subject to reasonable rules about ventilation to minimize risk.

Yet exceptions to smoking bans are often unreasonably narrow, preventing consenting adults from making free exchanges with each other. This is because policy makers view smoking as inherently without value. The thought process goes something like this:

1) Smoking has no value.

2) Protecting workers has value.

3) Therefore it’s OK to ban smoking everywhere without worrying about smokers’ preferences.

This is why I vehemently object to statements such as Bill’s. They create an environment in which the rights of smokers, business owners, and workers are too easily violated. I’ve seen too many of my favorite places completely altered by smoking bans, to the dismay of owners, patrons, and employees. See my ode to one of them, the Horse Brass, in DoubleThink magazine. Business 1 above is another example; it’s an actual establishment outside of Portland.

In sketch form, here are two other arguments for how ignoring the benefits of smoking skews our thinking and leads to bad policy.

Electronic cigarettes — The view of many in tobacco control is that tobacco is inherently bad and that quitting should be smokers’ only goal. It would undeniably be a good thing if more smokers quit, but the obvious truth is that quitting is difficult and relapse is frequent. A new study concludes that even with increased use of nicotine replacement therapy and quitlines, the rate of successful cessation has remained unchanged.

E-cigarettes are a promising alternative for smokers who find it difficult to quit. They are undoubtedly safer than actual cigarettes and offer a substantial opportunity for harm reduction, whether used to quit entirely or just to reduce use of real tobacco. Their popularity is likely due in part to their similarity to cigarettes: their appearance, the ritual of lighting them up, the ability to manage nicotine levels through their use. They deliver many of the same benefits smokers’ get from cigarettes at a fraction of the health cost. Yet precisely for this reason they are treated with outright hostility by many in tobacco control, who blind themselves to e-cigarettes’ potential because of their puritanical view of smoking — including acts that mimic smoking — as inherently bad.

Flavored cigarettes — The legislation giving the FDA regulatory authority over tobacco included a ban on all flavorings except for menthol. The reprieve for menthol may only be temporary. Flavors are treated as dangerous additives but they’re essentially being banned because they make smoking more appealing and enjoyable. This is pure paternalism. If a consenting adult wants to have a clove cigarette, he should be allowed to buy a clove cigarette.

The preferences of smokers were never given a voice in this debate. Because smoking was simply assumed to have no value, smokers were dismissed as addicts who could only benefit from this legislation. Perversely, those of us who support consumer choice on menthol are accused of racism since menthol cigarettes are popular among African-Americans. It’s unclear at this point how FDA regulation may affect more artisanal forms of tobacco, but the industry is understandably worried: If the agency views tobacco as inherently bad, it’s unlikely to pass regulations in the interest of pipe and cigar consumers.

The costs of smoking are undeniably high, yet smoking has persisted even in the face of penalties as harsh as death. The habit is here to stay. Unfortunately, smoking has become synonymous with Big Tobacco and the lowly, lethal cigarette. There is much more to it than that, and more to say on its half behalf. But that will have to wait for a future post.

Two years later, no heart miracle in Oregon

I have an op/ed up today at The Oregonian addressing the question, “Whatever happened to Oregon’s heart miracle?” Oregon’s statewide smoking ban took effect in 2009 and was predicted by many advocates to result in a steep decline in the rate of heart attacks of 17% or more. I contacted the Oregon Public Health Division to see if hospital data bore this out. Unsurprisingly, it didn’t.

For those who are curious, here is the age-adjusted rate of heart attack admissions for Oregon as provided to me by the state, with percentage change from the previous year in parenthesis:

2003 198.4
2004 181.2 (8.67)
2005 166.8 (7.95)
2006 166.6 (0.12)
2007 163.4 (1.92)
2008 152.5 (6.67)
2009 141.5 (7.21)
2010 137.1 (3.11)

And here is the same data in graph form:

oregonami

As I explain in the op/ed, the drop in 2009 is on trend with those in previous years and can’t be reasonably attributed to the smoking ban, and even under the rosiest interpretation it is still less than half of what ban advocates predicted.

The task of explaining this discrepancy fell to Ty Gluckman, director of clinical excellence for Providence Heart and Vascular Institute. It was Gluckman who wrote in 2009 that “[...] it’s highly likely that Oregon’s heart attack rates are already dropping as we near the law’s one-year anniversary. If we reduce the number of acute heart attacks by 17 percent, there will be at least 1,100 fewer hospital admissions in Oregon in just one year.” I said at the time that there was no way this was going to happen. You can read his entire response here.

Undaunted by contrary data, Gluckman suggests that Oregon’s less than stunning decline in heart attacks is due to two factors. One is that many bars were already banning smoking voluntarily before the ban. Another is that over this same period Oregonians were becoming more obese. However these confounding factors hold to some extent just about everywhere, which is why the only way to test the impact of bans is by 1) looking for increased rates of decline after implementation and 2) comparing these results with control populations that were not under a ban. This is essentially the method of the RAND study cited in my article, which found no impact.

The story in Oregon is consistent with that of other large populations that experienced no noticeable decline in heart attack rates following implementation of a smoking ban. See for example this New Zealand study, omitted from the meta-analysis Gluckman cites, or the publicly available data from many national governments.

Today’s article is my third Oregonian contribution on the subject of the state smoking ban. In 2008 I argued that the ban wasn’t actually about saving lives. In 2009 I argued that the its exemptions were unduly restrictive. Finally, also in 2009, I wrote for Doublethink about the last night of legal smoking at my favorite cigar hangout, the legendary Horse Brass pub.

A toast to the Netherlands

Today is a good day for small bars in the Netherlands:

From today smokers in Holland will be allowed to light up in small owner-operated bars that are less than 753.5 square feet in size and have no other staff.

The 280 cases currently going through court for pubs allowing people to smoke inside will be dropped.

UKIP MEP for the North West Nuttall said he was “very pleased that the Netherlands authority has allowed common sense to prevail” and relax the ban.

“We know the smoking ban has had a serious detrimental effect on pubs,” he said. “It is absolutely bonkers.

“The way the ban came in was very underhand.

“I hope the Government will take what has happened in Holland on board. I hope it will happen here.

“We should have the option for smoking rooms in the UK, it should be down to the licensee.”

You know what to do.

What really happened in Starkville, revisited

About a year ago I criticized a “study” from Mississippi State University alleging that implementation of a smoking ban in Starkville, MS caused a dramatic decline in heart attacks. The problem was that the study was in fact just a press release and the data from control groups hadn’t even been collected yet. Without control groups there was no justification for asserting that the decline in heart attacks was caused by the smoking ban rather than other factors. I challenged the authors, Dr. Robert McMillen and Dr. Robert Collins, on this point and they declined to respond, saying only that they would continue their research when more data arrived.

Now the data is in and they have released another study confirming their hypothesis. To their credit they have control groups this time. What they don’t have are tests of statistical significance. I’ll hand it over to Michael Siegel:

This study violates the most fundamental principal of epidemiology and biostatistics: you must evaluate any scientific hypothesis to see whether the results could be explained by chance. In other words, you must determine whether your results are statistically significant.

A persistent flaw in studies of this type is reliance on small population sizes to extrapolate an exaggerated effect. This one appears no different. Siegel again:

I did my own calculations based on the results reported in the study and based on a conservative estimate which maximizes the likelihood of finding a statistically significant difference, I found that the difference between the two rates of decline was not even close to being statistically significant. [...]

For these findings, which are exquisitely sensitive to a simple shift in one heart attack here and one heart attack there, one must not put any confidence in their statistical meaning. Clearly, the role that these are just chance differences cannot be ruled out given the small sample size. Nevertheless, the study goes as far as telling us the exact cost savings from the heart attacks averted due to the smoking ban.

McMillen and Collins are getting closer to doing real science. Close, but still no cigar!

Bloomberg bans again!

Over at the Examiner I take a look at Michael Bloomberg’s latest attempt to make life worse for smokers, a ban in parks and beaches:

It’s no wonder that some non-smoking residents support the ban. They have nothing to lose and they’ve been hit with fear-mongering propaganda for years, such as Action on Smoking and Health’s dire warning that “If you can smell it, it could be killing you,”or even worse, uncritical reports about “thirdhand smoke,” the residue left behind on room surfaces when tobacco is lit. So firmly has the toxicity of tobacco smoke been in implanted in the public’s mind that activists no longer feel the need to demonstrate that it causes harm; the mere ability to detect its traces with fancy lab equipment is enough to raise a panic.

Whole thing here.

Thirdhand smoke is real and insignificant

This blog has previously chronicled attempts to scare people into persecuting smokers based on trumped up fears of “thirdhand smoke,” residue left on clothes and furniture after a smoker lights up. New research attempts to measure levels of this residue directly by artificially re-suspending particles left behind by a smoking device:

These quantitative data support the hypothesis of a resuspension from the cigarette smoke surface contamination. However, this airborne contamination through resuspension remains much lower (100 times) than that of secondhand smoke.

In other words, there’s nothing to worry about.