A few weeks ago at the TMA (Tobacco Merchants Association) meeting in Virginia, Dr. Lawrence Deyton told a story in which he recounted his experience as the primary care physician for a veteran who almost died from battle injuries suffered in Vietnam, then AIDS (which ended in remission), then drug addiction and kidney disease, but then ended up dying of lung cancer quite likely related to his lifelong cigarette habit. As Deyton put it “”The battlefields of Vietnam didn’t kill him; his use of drugs didn’t kill him. His HIV didn’t kill him; his kidney failure was being treated. . . . It was smoking that finally took that soldier.”
The story was told to illustrate his motivation in his new position as head of the FDA’s Center for Tobacco Products.
The Center and in particular, the recent stacking of the Scientific Advisory Panel with anti-tobacco extremists has come under criticism from harm reduction advocates in its concentration on trivial concerns in comparison to the huge benefit within reach simply by advocating safer tobacco products for smokers, a conclusion that any honest health researcher would arrive at within a week of surveying the topic.
The misplaced emphasis of this department is mirrored in Deyton’s flawed interpretation which misses the crucial point that this soldier would probably still be alive today if he would have used some smokeless form of tobacco, and it is quite likely that if he thought about switching at all, the lack of good information and the active dissemination of misleading information coming from health groups would probably have dissuaded him from ever considering the alternatives.
(Curiously enough, the veteran’s lung cancer was discovered while screening for a kidney transplant. To be eligible, the VA requires that the recipient be tobacco free three months prior to the procedure. There is no mention of eliminating caffeine and since it and nicotine are quite similar in effect, because this requirement does not distinguish between forms of tobacco use, it appears not to be an entirely health related requirement. If the patient had been able to quit smoking but continued some relatively safe form of nicotine use, but had then and therefore been considered ineligible, and then died from kidney failure, where then would the blame be laid?)
Though some counsel patience with a new department in an agency which has little expertise with tobacco, all indications to date lead only to pessimism about where this group will take us. In his defense, it has been reported that Deyton had this advisory panel (now coming under challenge for conflicts of interest, though they really ought to be challenged on grounds of established opposition to harm reduction) foisted upon him (rather like making a fire chief work with arsonists for a crew, with the possibility that the chief is an arsonist as well).
The general tone of his address to the TMA was that despite his agreeing that dialogue with the industry was necessary, his approach would be hard line and traditional, and more in the nature of demands based in standard anti-tobacco philosophy than pooling resources to attain the common goal of safer tobacco use. In other words we were facing a new tool to advance the old tried and failed methods and not any attempt at looking for real solutions. It is telling that in Deyton’s address amidst the professed desire to reduce tobacco related disease runs the lack of distinguishing between different tobacco products which is the very essence of harm reduction; if you do not make product distinctions, you are either not familiar with the evidence or your priorities are political rather than health based.
At this time, the new Tobacco Center at the FDA seems to be little more than a means to constrain new safer products, to further complicate the lives of tobacco users of all kinds, and to keep policy on the quit or die trail.
Overall, the TMA conference was enlightening. Once again you had the strange realization that the accursed capitalists (the producers and sellers of tobacco) actually showed more interest in the health of their clients than the representatives of the government. The tobacco growers and sellers were more receptive to harm reduction than those whose job description included serving (and preserving) the public.
-Paul L. Bergen