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Juul: Does new e-cigarette save or cost lives?

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Source

The rapid growth of a new brand of e-cigarette known as Juul has attracted media and public health advocates’ attention.  According to The New York Times, school officials, struggling to control an explosion of vaping among high school and middle school students across the country, fear that the devices are creating a new generation of nicotine addicts.

Since launching about two years ago, reports BuzzFeed News, Juul has become one of the hottest e-cigarettes on the market. It’s been called “the iPhone of e-cigs” and it has gained somewhat of a cult following among young adults. Shaped like a USB device and easy to conceal, Juul is made by a San Francisco-based company that has received venture capital money.

Following the playbook of cigarette and alcohol manufacturers, who long ago learned that the best way to market their products to children and young people was to claim they were only for adults, Ashley Gould, the chief administrative officer of Juul, told the Times that the company’s products are intended solely for adults who want to quit smoking. Among the flavors Juul markets are fruit medley and crème brulee.

A new study published in PLOS One assesses the net gains and losses from the spread of  vaping.  The authors calculated the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort.  Their conclusion: “e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.”

To counteract the rapid spread of e-cigarettes, seven public health and medical groups, and several individual pediatricians, filed suit in federal court in Maryland challenging a U.S. Food and Drug Administration (FDA) decision that allows electronic cigarettes and cigars – including candy-flavored products that appeal to kids – to stay on the market for years without being reviewed by the agency. According to Industrial Safety and Hygiene News,  The lawsuit was filed by the American Academy of Pediatrics and its Maryland chapter, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, Truth Initiative and five individual pediatricians.

Although the groups strongly support the FDA’s new efforts to reduce nicotine levels in cigarettes to minimally or non-addictive levels, they also believe that the FDA’s August 2017 decision to exempt e-cigarettes and cigars from agency review for years to come is unlawful and harms public health.

Alcohol, Cancer and the Right to Know

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Credit  Source  Based on UK survey

There is a “direct link between alcohol and fatal cancers” — that’s what Irish health officials want their country’s drinkers to know each time they look at a bottle of alcohol, reports the European edition of Politico.  Even as producers of wine, beers and spirits fret about any European Commission regulation that would force them to list ingredients and calories on their products, health officials in Dublin are making a big push for what the alcohol industry considers a nightmare scenario: mandatory cancer warnings on liquor. “Reducing alcohol intake is an important step in reducing the burden of cancer,” Irish Health Minister Simon Harris said in February, ahead of submitting to the parliament a bill with proposals that include some of the toughest provisions on alcohol labeling on the Continent, including a label stating the link between drinking and cancer. “This is a landmark piece of public health legislation which will make a real difference when it comes to reducing the harm caused by alcohol,” Harris added.

In this five minute video, Michael Greger summarizes the evidence on alcohol’s role in cancer.  And in a March 2018 article in Drug and Alcohol Review, the authors conclude that the alcohol industry “appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer. These activities have parallels with those of the tobacco industry. This finding is important because the industry is involved in developing alcohol policy in many countries, and in disseminating health information to the public, including school children. Policymakers, academics, public health and other practitioners should reconsider the appropriateness of their relationships to these alcohol industry bodies.”

In NAFTA Talks, U.S. Tries to Limit Junk Food Warning Labels

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Source: OECD Obesity Update 2017

Urged on by big American food and soft-drink companies, reports the New York Times,  the Trump administration is using the trade talks with Mexico and Canada to try to limit the ability of the pact’s three members — including the United States — to warn consumers about the dangers of junk food, according to confidential documents outlining the American position.

The Mexican government support for such restrictions “is one of the most invasive forms of industrial interference we have seen,” Alejandro Calvillo, the founder of El Poder del Consumidor, or Consumer Power, a health advocacy group in Mexico told the New York Times. Heading off pressure for more explicit warnings through the NAFTA negotiation is especially appealing to the food and beverage industry, writes the Times, because it could help limit domestic regulation in the United States as well as avert a broad global move to adopt mandatory health-labeling standards.  “It kind of kills a law before it can be written,” said Lora Verheecke, a researcher at the Corporate Europe Observatory, a group that tracks lobbying efforts. “And once you put it in one trade agreement, it can become the precedent for all future deals with future countries.”

Sustain, an alliance of advocates in the United Kingdom working for better food and agriculture policies and practices, summarizes some of the ‘”barriers to trade” that a 2017 report by the  US Office of the Trade Representative identified:

  • Additional nutritional labelling such as traffic light labels in the UK and Ireland. The US is arguing that these initiatives must remain voluntary.
  • South Africa’s plans to introduce a sugary drinks tax in 2016. The US raised concerns that the tax would effectively discriminate against sugary drinks. The move jeopardizes $5m of US sugary beverage exports
  • Proposals by six Gulf states to regulate energy drinks, including introducing labelling statements about recommended consumption. (One estimate puts this market at $2bn.)
  • Efforts by Chile to clearly label products high in sugar, salt and saturated fat and restrict junk food marketing on packaging to children. The US has referred the Chileans to the WTO saying delays and repackaging has cost the US firms ‘millions of dollars’ in lost sales
  • A food act in Peru introducing mandatory front of pack warnings for pre-packaged foods high in sugar, salt and fat and restrictions on junk food advertising to children and young people
  • Indonesia’s attempts to introduce nutritional labelling for pre-packaged and fast food along with and regulations to limit advertising and health claims aimed at children.

Twenty-Seven Years of Pharmaceutical Industry Criminal and Civil Penalties:1991 Through 2017

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Pharmaceutical Industry Financial Penalties, 1991-2017. Credit and source

A new report from Public Citizen concludes that the number and size of federal and state settlements against the pharmaceutical industry remained low in 2016 and 2017, with federal criminal penalties nearly disappearing. Financial penalties continued to pale in comparison to company profits, with the $38.6 billion in penalties from 1991 through 2017 amounting to only 5% of the $711 billion in net profits made by the 11 largest global drug companies during just 10 of those 27 years (2003-2012).  To our knowledge, a parent company has never been excluded from participation in Medicare and Medicaid for illegal activities, which endanger the public health and deplete taxpayer-funded programs. Criminal prosecutions of executives leading companies engaged in these illegal activities have been extremely rare. Much larger penalties and successful prosecutions of company executives that oversee systemic fraud, including jail sentences if appropriate, are necessary to deter future unlawful behavior. Otherwise, the illegal but profitable activities will continue to be part of companies’ business model.

Cutting-edge NHS drugs do more harm than good

Almost all new drugs approved for Britain’s National Health Service  do more harm than good, according to a study using  modelling adopted by the government, reports The Times (London).  Saving a life with a new drug can cost about twice as much as doing the same through more staff or equipment, according to official calculations that led to calls for reform of the way the NHS pays for medicines. The Department of Health and Social Care has implicitly conceded that the cost of most cutting-edge medicines kills more people through diverting money from other NHS services than the treatments themselves save.

FDA’s Gottlieb blames industry ‘Kabuki drug pricing’ for high costs

Reuters reports that U.S. Food and Drug Administration chief, Scott Gottlieb, criticized pharmacy benefit managers, health insurers and drug makers for “Kabuki drug-pricing constructs” that profit the industry at the expense of consumers.  The comments, made at a conference organized by a leading U.S. health insurer lobbying group, stoked speculation over what steps the administration of U.S. President Donald Trump may take to rein in lofty prescription drug costs.  “Patients shouldn’t face exorbitant out-of-pocket costs, and pay money where the primary purpose is to help subsidize rebates paid to a long list of supply chain intermediaries,” Gottlieb said at the meeting of America’s Health Insurance Plans (AHIP). “Sick people aren’t supposed to be subsidizing the healthy.”

Pension Funds Under Pressure to Sell Off Investments in Gun-Makers

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Since the mass killing at a Parkland, Fla., high school earlier this month, many teachers have called on their state pension funds to sell their stakes in gun-makers, reports National Public Radio.  Private investment firms including BlackRock and Blackstone are reviewing their firearms investments in response to clients’ demands. “I’m currently urging my colleagues to divest in retail and wholesale suppliers of weapons that are banned for possession or sale in the state of California,” says State Treasurer John Chiang, who sits on the boards of his state’s two largest pension funds — CalPERS for public employees and CalSTRS for teachers.  “We can make a clear and powerful signal that the inaction by Congress is heartless, it’s intolerable, and there are people who want to make sure that kids aren’t losing their lives,” Chiang says.