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Addiction, In the News, Public Health

Stanford experts skeptical about motives behind e-cigarette health warnings

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Quotes can sometimes make or break a news article. I was skimming a New York Times article on new, harsh health warnings from tobacco companies when a quote from Stanford otolaryngologist Robert Jackler, MD, stopped me in my tracks.

“When I saw it, I nearly fell off my chair,” Jackler told the Times. What made a renowned expert in tobacco advertising fall off his chair? I was hooked (and not on cigarettes, thankfully) and had to keep reading.

It turns out that Jackler had spotted the warning on MarkTen e-cigarette packs, which details many of the deleterious effects of nicotine, calling it “very toxic by inhalation, in contact with the skin, or if swallowed.” The product is not to be used by children, women who are pregnant or breast-feeding, anyone with heart disease or high blood pressure, or those taking medication for depression or asthma. The list goes on.

These warnings are voluntary, explained the Times‘ Matt Richtel, who also wrote:

Experts with years studying tobacco company behavior say they strongly suspect several motives, but, chiefly, that the e-cigarette warnings are a very low-risk way for the companies to insulate themselves from future lawsuits and, even more broadly, to appear responsible, open and frank. By doing so, the experts said, big tobacco curries favor with consumers and regulators, earning a kind of legitimacy that they crave and have sought for decades. Plus, they get to appear more responsible than the smaller e-cigarette companies that seek to unseat them.

The tobacco companies say they are striving to be honest and open. With another choice quote, Stephanie Cordisco, president of the R. J. Reynolds Vapor Company, told the Times: “We’re here to make sure we can put this industry on the right side of history.”

Not so, Stanford science historian Robert Proctor, PhD, responded. He called the voluntary warnings “totally Orwellian.”

“They do everything for legal reasons, otherwise they’d stop making the world’s deadliest consumer products,” Proctor said.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She is an intern in the Office of Communications and Public Affairs. 

Previously: How e-cigarettes are sparking a new wave of tobacco marketing, E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher and What the experience of Swedish snuff can teach us about e-cigarettes
Photo by Lindsay Fox

Addiction, In the News, Pain, Public Health

Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse

Here are some frightening facts you might not know: Drug overdose death rates in the United States have more than tripled since 1990, with the majority of drug-related deaths caused by prescription drugs. And as of 2010, about 18 women in the U.S. die every day of a prescription painkiller overdose. Prescription-drug abuse, which we’ve written about extensively here on Scope, is a very real and pressing issue – and it was the focus of a recent Forum on KQED-FM.

Among the panelists on Friday’s show was Stanford addiction psychiatrist Anna Lembke, MD, who made the important point that most people who end up addicted to prescription painkillers didn’t start out “looking for a buzz” and that most doctors who prescribe the drugs are merely trying to help their patients. As she explained to listeners:

The problem with… prescription opioids is that they actually do work for pain initially… But for most people, after you take them every day for let’s say a month or more, [you] build up tolerance where they stop working so then you need more of the same drug to get the same effect and it escalates on like that. I really think the process is insidious, both for the patients who become addicted and the doctors who prescribe them. It happens in a subtle journey – when all of the sudden [patients are] using them not just for pain but also maybe to relax themselves, to lift their mood, to be able to go out to a party if they’re feeling anxious, and the doctors continue to prescribe them because they started out working, the patients were happy [and] their function improved. The dose is escalating, but they want to keep the patient happy for all kinds of reasons.

The entire conversation is worth a listen.

Previously: Why doctors prescribe opioids to patients they know are abusing them, Patients’ genetics may play a role in determining side effects of commonly prescribed painkillers, Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds and Study shows prescribing higher doses of pain meds may increase risk of overdose and Prescription drug addiction: How the epidemic is shaking up the policy world

Addiction, In the News, Public Health, Public Safety

Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?

beer_london_pubIn an article published yesterday in the Telegraph, Stanford addiction expert Keith Humphreys, PhD, discusses how public officials in London are turning to the United States’ “24/7 sobriety” model in an effort to reduce repeat offenders convicted of alcohol-related crimes. The program, which combines mandatory sobriety and daily breathalyser tests, was created under Humphreys’ guidance. He writes:

Research by the RAND Corporation – a US-based non-profit global policy think tank – found that 24/7 sobriety dropped repeat drink driving arrests by 12 per cent. The same study also yielded a pleasant surprise: domestic violence arrests dropped by 9 per cent, despite not being a focus of the programme. Removing alcohol from the lives of criminals can apparently have radiating benefits beyond those directly related to their most recent offence.

In light of its positive results, judges across the U.S. have been adopting the 24/7 sobriety approach. This week, under the leadership of Mayor Johnson and his team, a pilot of the programme will be launched in South London. Leaping the pond will come with some challenges, particularly around delivering sanctions swiftly within the constraints of British law, but local tailoring of innovations is always an essential part of making them spread.

In any event, with over one million alcohol-related assaults occurring nationally each year and many London boroughs being regularly marred by violence and disorder on weekend evenings, the time for new approaches to binge drinking criminal offenders has clearly arrived. The judges and probation officers who are undertaking this pilot should be applauded for refusing to accept the status quo.

Previously: Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent, Study shows legal drinking age of 21 saves lives and reduces health risks for young adults, Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by Paul Downey

Addiction, Emergency Medicine, Public Health, Research, Technology

Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent

Text messages after ER visit could reduce young adults' binge drinking by more than 50 percent

Bar_texting_0701414Researchers have demonstrated that text message programs can, among other things, help diabetes patients better manage their condition, assist smokers in kicking their nicotine habit, and encourage expecting mothers to get flu shots.

Now new findings published in the Annals of Emergency Medicine show that text messages can also be an effective tool for reducing binge drinking among young adults whose hazardous alcohol use has resulted in an emergency room visit. During a 12-week study, 765 patients who were treated in the emergency room and screened positive for a history of hazardous drinking were divided into three groups. The first group received text messages prompting them to respond to drinking-related queries and received text messages in return offering feedback aimed at either strengthening their low-risk drinking plan or promoting reflection on their drinking plan or decision not to set a low-risk goal. Another group received only text queries about their drinking, and the remaining individuals received no text messages.

A story published today on PsychCentral reports on the researchers’ results:

The group receiving both text message queries and feedback decreased their self-reported binge drinking days by 51 percent and decreased the number of self-reported drinks per day by 31 percent.

The groups that received only text messages or no text messages increased the number of binge drinking days.

“Illicit drugs and opiates grab all the headlines, but alcohol remains the fourth leading cause of preventable death in the U.S.,” said [Brian Suffoletto, MD, assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine].

“If we can intervene in a meaningful way in the health and habits of people when they are young, we could make a real dent in that tragic statistic. Alcohol may bring them to the ER, but we can do our part to keep them from becoming repeat visitors,” [he added].

Previously: CDC explores potential of using smartphones to collect public health data, Could better alcohol screening during doctor visits reduce underage drinking?, Personality-based approach can reduce teen drinking and The costs of college binge drinking
Photo by Anders Adermark

Addiction, FDA, Health Policy, otolaryngology, Public Health

How e-cigarettes are sparking a new wave of tobacco marketing

e-cig tip - smallFollowing the FDA’s announcement earlier this spring that it would regulate the sale – but not marketing – of electronic cigarettes, debate has continued on the safety of using e-cigarettes and the ethics of advertising them.

In case you missed it, today’s New York Times delves into the issue and highlights how Big Tobacco is now rolling into the world of e-cigarettes, which writer Matt Richtel calls an “overnight sensation.” A subsidiary of Reynolds American plans to begin distributing its Vuse e-cigarette line nationwide on June 23 with a campaign that includes television ads (forbidden for cigarettes) in major markets, and other tobacco companies have similar entries in the works. Questions about the potentially far-reaching effects advertising of e-cigarettes, including promoting smoking tobacco and reaching child audiences, concern public-health advocates and other critics – and a U.S. Senate hearing is planned for Wednesday.

From the article:

Matthew L. Myers, [JD,] president of the Campaign for Tobacco-Free Kids, who is scheduled to testify at the Senate hearing, said the fact that the F.D.A. did not limit marketing allowed tobacco companies to return to the airwaves with ads that make e-cigarettes sexy, rebellious, glamorous — “exactly the same themes we saw work with kids in the U.S. for decades with cigarettes.”

In the absence of marketing regulation, “they will set the agenda,” Mr. Myers said of the tobacco companies. “They will drive the evolution of the product in a way that serves their interests and not public health, and that’s exactly what’s happening.”

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, is an expert on tobacco marketing who studies it through his center, the Stanford Research Into the Impact of Tobacco Advertising. Like Myers, he has vocalized his concerns about e-cigarettes and tobacco companies’ aggressive marketing tactics – especially those targeted toward teens – and you can hear more about his views and research in this recent podcast.

Previously: E-cigarettes and the FDA: A conversation with a tobacco-marketing researcherE-Cigarettes: The explosion of vaping is about to be regulatedStanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labels and What’s being done about the way tobacco companies market and manufacture products
Photo by Li Tsin Soon

Addiction, In the News, Medicine and Society, Research, Stanford News

As AA approaches 79, a look at its effectiveness for sobriety

As AA approaches 79, a look at its effectiveness for sobriety

stairsAlcoholics Anonymous, a nonprofessional, international fellowship for people who have had a drinking problem, is approaching 79 years of existence. This morning, Keith Humphreys, PhD, a Stanford addiction expert, writes in Washington Post‘s Wonkblog about how medical experts have viewed the organization during its tenure and what can be made of results from studies measuring AA’s effectiveness.

From the piece:

For most of the 12-step fellowship’s existence, professionals in the addiction field held widely varying opinions of its value. Some praised AA as an extremely valuable resource for people seeking recovery, but others viewed it as unsophisticated folk medicine and even a bit cultish. Other tensions emerged from turf issues: Medical professionals can be dismissive of – at times even hostile to – those they consider well-intentioned amateurs. Just as some obstetricians resent midwives, some addiction treatment professionals looked down on the non-professional AA members in their midst.

Humphreys notes that results from Project MATCH, the largest study of alcohol-dependence treatment, and a subsequent randomized clinical trial have changed some skeptics’ minds. More from the piece:

Studies such as these dramatically reduced the ranks of AA critics among scientists. AA’s value is still questioned in a few quarters, but as Harvard Professor of Psychiatry John Kelly [PhD] notes, this is becoming less true as the years go by: “The stronger scientific evidence supporting the effectiveness of AA is relatively new. It takes time for evidence to disseminate into clinical practice as well as into broader society.”

Previously: What’s the best way to handle the chronically intoxicated?, Examining how addiction in the U.S. has changed over the last decade and A discussion of the history and effectiveness of Alcoholics Anonymous
Photo by Kristin Charles-Scaringi

Addiction, Public Health, Research

Text message program helps smokers “stay focused on quitting”

text_to_quit_3A growing body of scientific evidence shows that text-messaging programs are an effective and affordable way to provide motivation and support for smokers to kick their nicotine habit. Now new research shows that one such mobile health program doubles the chances that smokers will quit.

The study involved more than 500 smokers recruited via the web. Researchers randomized the participants to either receive a text-messaging program called Text2Quit or self-help material. The interactive text messages offered advice and allowed individuals to request more help, reset their quit date or play a game to help distract them until a craving subsided. After six months, individuals completed a survey to determine how many in each group had successfully quit smoking. According to a release:

More than 11 percent of smokers who used a text- messaging program to help them quit did so and remained smoke free at the end of a six- month study as compared to just 5 percent of controls, according to a new report by researchers at Milken Institute School of Public Health at the George Washington University (Milken Institute SPH.)

“Text messages seem to give smokers the constant reminders they need to stay focused on quitting,” says Lorien C. Abroms, ScD, MA, an associate professor of prevention and community health at Milken Institute SPH and the lead author of the study. “However, additional studies must be done to confirm this result and to look at how these programs work when coupled with other established anti-smoking therapies.”

In their conclusion, researchers noted that future studies should look at less-Internet-savvy populations as well as compare Text2Quit with similar programs.

Previously: Craving a cigarette but trying to quit? A supportive text message might help, National Cancer Institute introduces free text message cessation service for teens and Can daily texts help smokers kick their nicotine addiction?
Photo by William Atkins/George Washington University

Addiction, Health Policy, In the News

Increasing access to an anti-overdose drug

In the past decade, the U.S. has experienced a surge of fatal opioid overdoses, driven partly by increased heroin use but mostly by the greatly expanded availability of prescription medications (e.g. Oxycontin). One important tool in combating this epidemic is naloxone, a drug that rapidly reverses the respiration-suppressing effects of opioids.  Expanding its use has been a goal of President Obama’s drug policy from the first days of the administration, and an increasing number of community members, health and social care workers and police have been trained how to administer it.  Some New York police officers give a powerful account of their experiences with the rescue drug in the video above.

However, with the increased demand for naloxone has come an increase in its price. It’s an off-patient medication, so in absolute terms costs are low (up to $40 for the nasal administered naloxone kits that police tend to carry and much less for the injected version distributed by many non-profit service organizations). But even low costs can be a barrier particularly if a drug is provided to cover an entire population (most of whom will never need it) rather than employed to treat an identified individual in need.

That’s why it’s encouraging that The Clinton Foundation has announced that it will attempt to lower the cost and increase the accessibility of naloxone, presumably using the same strategies that were employed successfully to achieve the same goals with HIV-related medications. Another potentially important effort, under consideration in the California legislature, is to allow naloxone to be distributed by pharmacists rather than requiring an individual prescription for everyone to whom it is provided.  Although the impact of this policy on public health can’t be known in advance, naloxone does not appear to have serious or common side-effects to weigh against it potentially life-saving benefits, which makes it more reasonable to have it be available over the counter.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and Prescription drug addiction: How the epidemic is shaking up the policy world

Addiction, FDA, Health Policy, In the News, Podcasts

E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher

E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher

The FDA announced today its plans to regulate e-cigarettes. The news comes as little surprise to many, including Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, who studies the effects of tobacco advertising, marketing, and promotion through his center, the Stanford Research Into the Impact of Tobacco Advertising. I asked Jackler this morning what he thought of the FDA’s plan, and he had this to say:

While I welcome the FDA proposal to deem electronic cigarettes as tobacco products under their regulatory authority, I’m disappointed with the narrow scope of their proposal and the snail’s pace of the process. Given its importance, I’m particularly troubled by the FDA’s failure to address the the widespread mixing of nicotine with youth-oriented flavorings (e.g. gummy bears, cotton candy, chocolate, honey, peach schnapps) in electronic cigarettes products.  Overwhelming evidence implicates such flavors as a gateway to teen nicotine addiction [which] led the FDA to ban flavors (except for menthol – which is presently under review) for cigarettes in 2009.  Give the lethargic pace of adopting new regulations, a generation of American teens is being placed at risk of suffering the ravages of nicotine addiction.

In a podcast last month, Jackler spoke in-depth about the rise of, and problems with, e-cigarettes. If you haven’t yet listened, now is a great time to.

Previously: E-Cigarettes: The explosion of vaping is about to be regulated, Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labels and What’s being done about the way tobacco companies market and manufacture products

Addiction, Behavioral Science, In the News, Mental Health, Research

Knitting as ritual – with potential health benefits?

Knitting as ritual - with potential health benefits?

knittingDuring finals, one of my college roommates would ritualistically sit in silence and knit an entire hat before she could begin studying. The steady, repetitive action calmed her down and cleared her mind. (Before less stressful exams, she baked.)

I thought of her when coming across a recent post on The Checkup that points to evidence, including previous research in seniors with mild cognitive impairment, that the health benefits experienced by people who engage in activities such as knitting and crocheting might be more than anecdotal. More from the piece:

In one study, 38 women hospitalized for anorexia were given a questionnaire about their psychological state after being taught to knit.

After an average of one hour and 20 minutes of knitting a day for an average of three weeks, 74 percent of them reported less fear and preoccupation with their eating disorder, the same percentage reported that knitting had a calming effect, and just over half said knitting gave them a sense of pride, satisfaction and accomplishment.

The rhythmic movements of knitting offer many of the same kinds of benefits as meditation, says Carrie Barron, [MD,] an assistant clinical professor of psychiatry at Columbia University in New York and co-author of the book “The Creativity Cure: How to Build Happiness With Your Own Two Hands.” In addition, she says, seeing a project take shape provides a deep sense of satisfaction.

That might have been why Pee-wee Herman found the unsolved mystery of his stolen bike so unnerving: “It’s like you’re unraveling a big cable-knit sweater that someone keeps knitting and knitting and knitting…” he said in the 1985 film Pee Wee’s Big Adventure.

Previously: Image of the Week: Personalized brain activity scarves, Image of the Week: aKNITomy, Study shows meditation may alter areas of the brain associated with psychiatric disorders and Ommmmm… Mindfulness therapy appears to help prevent depression relapse
Photo by Merete Veian

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