Tag Archives: Bhutan

Further up the garden path

I wrote about the Population Assessment of Tobacco and Health (PATH) Study on 17 June 2017 (http://nicotinemonkey.com/?p=1605). Here is another paper about it in, where else, Tobacco Control (July 2017).

It’s written by a no less than forty-one American authors from thirteen different institutions. The conclusion of this astonishing collaborative effort confidently asserts that

…the PATH Study will contribute to…the evidence base to inform FDA’s regulatory mission…and efforts to reduce the Nation’s burden of tobacco-related death and disease.

This interesting idea set me musing why they seem only concerned to reduce tobacco-related death and disease rather than eliminate them.

The paper helpfully starts by putting the problem in perspective by commenting on the  Surgeon General’s Report on smoking and health from 1964.

It has been over 50 years since the Surgeon General of the USA first concluded that ‘cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action’.

Some kind of remedial action does seem to have happened because, we are informed, ‘Cigarette smoking prevalence has been halved since publication of 1964 Surgeon General’s Report’. This good news, however, is somewhat tempered by the shocking fact that ‘tobacco use…[still] cause[s] over 480,000 annual US deaths’. Further, we are reminded that ‘Scientific evidence [shows] that smoking causes at least 15 types of cancer, as well as numerous chronic diseases including heart disease, stroke, lung diseases and diabetes’.

In response to this dire situation the Surgeon General’s Report of 2014 merely ‘highlighted the need for continued implementation of comprehensive tobacco control programmes and policies’. Better than nothing I suppose. But fear not – we are also told that

The Food and Drugs Administration (FDA) now has regulatory authority over the manufacturing, marketing and distribution of tobacco products to protect the Nation’s health.

Considering the nearly half-million annual US tobacco related deaths, the Nation’s health is clearly in need of protection. To help it achieve this vital aim it’s a relief to know that the FDA now has within it a Center for Tobacco Products (CTP) that has been ‘charged with regulating tobacco products’. And the way it is supposed to do this is by ‘weighing potential benefits and harm to current, former and never users of tobacco products’. And what might these potential benefits be?

Now, where does the PATH Study come into all this?

The PATH Study’s research focus is most clearly illustrated in its eight overarching objectives

One of these, which are also referred to as ‘primary objectives’, is to

Characterise the natural history of tobacco dependence, cessation and relapse.

And when the characterisation is complete, then what?

We already have voluminous research on the effects of smoking. To what end is it hoped further research will lead? The paper makes repeated reference to ‘regulation’. What does this mean? That it is acceptable for some people under some circumstances to smoke? That in the unlikely events that people under the age of, say, 18 never start to smoke, that tobacco products including e-cigarettes are never sold near schools, that marketing is restricted to adults who wish to use tobacco products, that smoking and vaping in public indoor spaces nevermore occur, that cigarettes products are only sold in plain packs festooned with horrible pictures and dire health warnings, then our tobacco regulators can give themselves a pat on the back and go home?

If this imaginary scenario were by some miracle to become reality, there would still be millions of adult smokers in all countries of the world except Bhutan.

So that’s all right then.

Text © Gabriel Symonds