E-cigarette regulation progress

Lynn Johnston’s For Better or for Worse comic strip of Friday, June 17th, 2016,  continues a smoking theme when Georgia, who marries Phil Richards, Eli Patterson’s younger brother, walks out on the deck and catches him smoking … or does she? With sleight of hand and quick reflexes the cigarette is not visible in the first three panels, only to reappear as Phil gasps for breath in the fourth.

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Phil is trying to fool Georgia, just like the E-cigarette industry is trying to fool the public about their product, claiming it’s to unhook smokers from regular cigarettes while using sex to sell them. (See, for example, 2013-07-12 P-D: New health concern about e-cigarettes?)

The recent announcement by the FDA that it would finally move to regulate E-cigarettes is welcome news. As recently noted, at present it’s more like the wild west. The E-cigarette industry, which has been growing by leaps and bounds, responded unsurprisingly by criticizing the move, vowing to fight it. After all, regulation is likely to crimp industry profitability, but public health and welfare should come first. The original rationale for E-cigarettes as helping smokers to quit is proving to be a fantasy, and regulation is definitely needed and overdue.

The FDA put out a News Release on May 5, 2016, with the following headline:

FDA takes significant steps to protect Americans from dangers of tobacco through new regulation

The move was met by opposition on-line and in the Congress. Jacob Sullum, a senior editor at Reason magazine, wrote a strong critique on reason.com titled:

The FDA’s Deadly E-Cigarette Regulations
The agency’s new rules threaten products that offer a much safer alternative to smoking.

On May 10th a lawsuit was filed by NICOPURE LABS in Florida arguing that ‘the FDA overstepped its authority under the 2009 Tobacco Control Act to include products that are “neither made nor derived from tobacco nor intended for human consumption.” ‘

There’s also reportedly push-back from Republican U.S. Senator Ron Johnson (R-WI), according to a May 19th news article by reporter Guy Bentley in the Daily Caller:

GOP Senator Challenges FDA On Crushing E-Cig Regulations

Let’s hope that cool heads prevail and the public health and not industry profits take precedence.

2016-05-11 P-D: “St. Louis County drawing fire as indoor tobacco ban extension continues to go up in smoke”

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Dan Martin’s Weatherbird says “NO SMOKING!”

[The article below by reporter Steve Giegerich was followed the day after by an editorial, Revoke St. Louis County smoking-ban exemptions, accompanied on-line by this Weatherbird cartoon.]

Here’s reporter Steve Giegerich’s opening paragraph in the story below:

“Charlie Dooley was ensconced as county executive, St. Louis fans had a rooting interest in a local NFL franchise and Ferguson was still an obscure suburb when a proposal to tighten a 2011 anti-smoking ordinance first appeared on the agenda of the St. Louis County Council.”

The headline below the fold on the front page of today’s print edition of the St. Louis Post-Dispatch was “Inaction on indoor tobacco ban exemptions draws fire,” and the story’s first paragraph provided an unusual historical introduction to Giegerich’s story. (I can vouch for Ferguson formerly being “an obscure suburb” three years ago because that’s where I live!)

When County Councilman Mike O’Mara, currently the county council chairman, introduced this measure it was hailed by smoke-free air advocates because it was at last going to address some of the most egregious remaining inequities when it comes to protection from secondhand smoke. Instead, Councilman O’Mara has regrettably sat on his hands and done nothing, apparently after getting burned in his initial attempts to move forward with his bill. A St. Louis Post-Dispatch story by reporter Paul Hampel describes a meeting between bar owners and O’Mara which apparently brought this effort to a halt. I wrote about it here:
2013-02-07 P-D: “Bar owners weigh in on move to eliminate smoking ban exemptions in St. Louis County”

Below is today’s story by reporter, Steve Giegerich. There’s an unexpected punch line at the very end.

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St. Louis County Executive, Steve Stenger (L) and County Council Chairman, Mike O’Mara, listen during public testimony at the weekly county council meeting on May 3rd, 2016.  
 Photo by Sid Hastings

CLAYTON • Charlie Dooley was ensconced as county executive, St. Louis fans had a rooting interest in a local NFL franchise and Ferguson was still an obscure suburb when a proposal to tighten a 2011 anti-smoking ordinance first appeared on the agenda of the St. Louis County Council.
That was 39 months ago.

Week in and week out, legislation to reconsider and possibly revoke exemptions granted to about 135 businesses under the original law has been set before the council.

And week in and week out since February 2013, the council has tabled the measure.

Anti-tobacco activists, their patience tested by a three-year wait, are calling on the council to act.

The time has come, they say, for an amendment to the smoking ban that will bring the county into conformance with St. Louis. Indoor use of tobacco is prohibited in the city at all but two locations — designated smoking rooms in the membership-only Missouri Athletic Club and the Lumiere Place casino.

The Trophy Room, a St. Louis watering hole near the county line, earlier this year failed to convince a judge that small business owners in the city were unfairly singled out when the 2011 exemptions expired.

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Dr. Charles Rehm

Dr. Charles Rehm, chief administrative officer with the St. Louis region’s Mercy Health and a longtime advocate for smoke-free workplaces, is frustrated by the county’s reluctance to align tobacco-free policies in the city and county.

“We’ve made such great progress,” Rehm said. “We’re kind of at the goal line. We need to push it in the end zone and be done with it.”

The County Council, however, seems content to keep playing out the clock.

Councilman Mike O’Mara, the bill sponsor, fully concurs that the county at some point needs to “level the playing field.”

But, preaching caution, O’Mara, D-Florissant, wants to gauge the effectiveness of the expanded city smoking ban before moving the county legislation toward passage.

“We need to wait,” said O’Mara, whose district includes several small, exempted bars. “We have to look at the broader picture.”

Nursing homes exempt

The county law as currently written provides waivers to establishments that collect under 25 percent of gross revenue from the sale of food.

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Martin Pion, President of Missouri GASP Inc., addressing the county council urging them to expand smoke-free air protections.  
 Photo by Sid Hastings

Private and semi-private rooms at nursing and extended-care facilities are also exempt, a provision that spurred Ferguson resident Martin Pion to address the issue at the May 3 County Council meeting.

“The idea of my ending up in a nursing home where indoor smoking is still permitted is a pretty horrifying prospect,” Pion, the co-founder of Missouri GASP — Group Against Smoking Pollution — told council members.

Establishments that serve alcohol or provide care for the infirm may constitute the bulk of the 135 smoking waivers spread across the county.

But the primary beneficiaries of the exceptions are River City Casino and Hotel in the Lemay area and Hollywood Casino in Maryland Heights.

The city and county have stipulated that Lumiere, River City and Hollywood casinos will become smoke-free only if St. Charles County — home to Ameristar Casino Resort — adopts an ordinance to block tobacco use on the other side of the Missouri River.

O’Mara says the absence of a statewide smoking ban makes it difficult to structure a comprehensive regional approach to indoor tobacco use (28 states now have partial or total no-smoking statutes on the books).

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Charles Gatton studying the agenda at the meeting.  
 Photo by Sid Hastings

Charles Gatton, chairman of Tobacco Free St. Louis, says the absence of state law makes it incumbent on the St. Louis County Council to seize the initiative.

He accuses the council of tacitly promoting a double standard by ignoring the issue for three years.

“Essentially, the (2011) bill was saying there were two classes of citizens,” Gatton told council members last month. “Those deserving of clean air where they worked and those that weren’t — the employees of casinos, taverns, nursing homes and the like.”

Pointing out that lung cancer remains the most lethal form of cancer, Rehm questions why the county continues to support the selective application of an ordinance that subjects hourly-wage earners to secondhand smoke.

“It puts a real burden on people in the service industry,” Rehm said. “It’s one thing if someone wants to smoke in their home. But the people who work in the service industry are not empowered. And in addition to not being empowered, (businesses) are also saying, ‘We are going to put you at risk.’ Why do we not have some empathy for folks that have to work in that environment?”

Rehm said the council aversion to lifting waivers that permit patrons in scores of bars to light up at will is inconsistent with the comprehensive public health model the county introduced in 2015.

“It’s almost shameful that (the county) hasn’t acted,” the physician said.

Labeling it a “political” discussion, a spokesman for County Executive Steve Stenger turned aside a request for an interview on the subject with public health department officials.

Voters approved ban

The origin of the stalled bill dates to a 2009 ballot initiative that saw county voters approve a public smoking ban by a 2-1 ratio.

In the spirit of regional cooperation, St. Louis agreed to extend the decision of county voters to businesses operating within the city limits.

The law granted certain types of businesses in both the city and county — notably the casinos — a five-year exemption from the no-smoking rules. That exemption lapsed on Jan. 1.

O’Mara believes the council needs time to address the economic impact of the no-smoking legislation before imposing a countywide ban.

Gatton rejects that premise, pointing to landmark reporting by the Centers for Disease Control and Prevention and other economic studies that debunk the notion tobacco prohibitions cut into business profits.

“The restaurants (that bar smoking) here will pretty much tell you that their sales went up,” Gatton said. “It clearly hasn’t put anyone out of business. If anything, it has increased their business.”

On the flip side, the presence of smoke at one tobacco-tolerant establishment recently became a deal-breaker for friends out for dinner and drinks.

The haze that enveloped the friends as they entered prompted the men to regroup at a venue where breathing was easy, recalled a member of the party — Mike O’Mara.

(Note: There are plenty of Comments from foes of smoke-free air posted following the on-line story.)


2016-03-18 P-D: Cig. addiction – “For Better or for Worse” & Mo Senate

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Elly Paterson is the main female character in the comic strip, For Better or For Worse by Lynn Johnston. Her chain-smoking brother, Phil, is being pressured to quit smoking but isn’t finding it easy. Finally he’s down to his last cigarette before facing a smoke-free future, as illustrated in the Friday, March 18th, comic strip. So what does he do?


Surprise! Yes, he’s weak, and as addicted to nicotine as Missouri’s state legislators are addicted to tobacco industry money. This is revealed starkly in the following table listing donations each state senator has received from Big Tobacco and their allies (cigarette retailers and convenience stores). As noted in a cover letter MoGASP recently received accompanying the following data, “the Missouri Senate is Marlboro Country.” Out of 34 senators, all but one, Sen. Jill Schupp (D-24), have accepted campaign donations from Big Tobacco and/or their allies. Not surprisingly perhaps, Republicans, who control both the Senate and the House, received over 90% of the $394,710 total, but the Democrats still didn’t fare too badly, as shown in the table and detailed information below.

I’m reminded of a leaked 1989-1990 Philip Morris* regional lobbyist report for the southwestern states [ref. 1]  boasting of their success at controlling the Missouri legislature. The lobbyist described it this way:

“MISSOURI: This is a [sic] close [to complete control] as you are going to get. We are members of everything but our contract lobbyist works very closely with the tobacco wholesalers and they do anything we ask for. Surprisingly, the Chamber of Commerce is usually very helpful statewide and on a local level. We work well with the restaurant associations. We sponsored a golf tourney for the wholesalers and a party boat cruise on Lake of the Ozarks with the restaurant folks for the Black Caucus.”

CCI16032016_2 Mo Sen $ list

Missouri State Senator and Tobacco-related donations
Detailed listing by Senate District below

CCI16032016_3 Mo Sen $ alpha
CCI16032016_4 Mo Sen $ alpha

Ref. 1: Philip Morris Southwest Regional Lobbyist Memo 1989-1990, leaked to Doctors Ought to Care (DOC), 2000.

*Philip Morris became Altria in 2003 in a move designed to shield the company from possible crippling tobacco-related lawsuits.

2016-02-24 P-D: Cornered comic strip by Mike Baldwin

I saw this in yesterday’s St. Louis Post-Dispatch and resolved to post it here. Then I forgot about it until just before biking out today for brunch and also drop off the newspaper for recycling. I searched the newspaper recycling bin but it wasn’t there! Then I checked the front room and sure enough it was where my wife had left it after partially completing yesterday’s Sudoku. Such is life these days.

So here’s the cartoon which reminded me that some of mogasp’s strongest supporters, whom I won’t name, are former smokers.

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2016-01-15 P-D: “City smoking ban remains in force, St. Louis judge rules”


For Better or For Worse, by Lynn Johnston, St. Louis Post-Dispatch 01.19.2016

Ellen Patterson’s brother, Phil, above, relapsed back to his nicotine addiction after encountering some personal pressure.

But Trophy Room owner Herbert Krischke couldn’t face going smoke-free at all, despite the St. Louis City bar exemption expiring on Jan. 1st, 2016, following a 5-year delay.  Instead, as it was about to go into effect,  Mr. Krischke sought an injunction to prevent it from happening. The aim was to permanently postpone the day of reckoning, as reported by Christine Byers in the Post-Dispatch story on Wednesday, December 30th, headlined St. Louis bar wins delay in fight against city smoking ban.

Part of the argument his attorney used is that it targets St. Louis bars while giving St. Louis casinos, such as Lumière Place, an exemption, and forced it to “unfairly compete with other smoking bars in nearby St. Louis County, where exemptions remain in place.”

However, when the judge took up the case he ruled against the Trophy Room for reasons given in the story reproduced below.

I have some sympathy for those who argue against fundamentally unfair exemptions for some and not others. Of course, that’s a problem that’s been dogging how the issue of smoke-free air was legislated from the beginning, because smoking for literally decades was treated almost as a civil right that can’t be restricted. And when smoke-free air ordinances at last became more commonplace, exemptions were sought for restaurants or other venues, usually on specious grounds like being “private businesses,” which somehow meant that on this one issue they were untouchable.

Turning to St. Louis County, it should take the next step and remove exemptions for small bars and taverns. County Executive Steve Stenger, who originally insisted on these exemptions in exchange for his support when he was still a county councilman, should take the lead now. Ideally, he and Mayor Slay should work together on really leveling the playing field, for the benefit of patrons and employees, by making all local casinos smoke-free. It’s the right thing to do and won’t lead to a loss of revenue, as opponents claim.

The St. Louis Post-Dispatch story is reproduced below, generating 38 comments:

City smoking ban remains in force, St. Louis judge rules

January 15, 2016 5:00 pm  • 

ST. LOUIS  •  A circuit judge denied a St. Louis bar’s request to temporarily block the city from enforcing its smoking ban.
St. Louis Circuit Judge David L. Dowd ordered on Friday that the Trophy Room bar did not show sufficient evidence of immediate irreparable harm.
“The balance between the harm to petitioners and injury to others does not weigh in favor of granting a preliminary injunction,” Dowd wrote. “Finally, the public interest would not be furthered by granting a preliminary injunction in this matter.”
The Trophy Room had won a ten day reprieve in order to argue its case. Now, the bar was go non-smoking.
The bar, at 5099 Arsenal, argued the city’s 2011 “Smoke Free Air Act” was unconstitutional, granted unfair exemptions, was vague, and forced the bar to unfairly compete with other smoking bars in nearby St. Louis County, where exemptions remain in place.
The law, which granted 100 bars five-year smoking exemptions in 2011, went into full force on Jan. 2.  Exemptions for casino gaming areas and tobacco stores, like Lumiere Place Casino or Stanley’s Cigar Bar in downtown, remain in place.
The Trophy Room’s suit argues that the law “grants a special or exclusive right, privilege or immunity” to casinos such as Lumière, which would keep its exemption. Bar owners say that sets a double standard.
The Trophy Room argued that it operates Missouri Lottery’s Keno game, which makes it a gaming area.
“The court does not find it is probable that petitioners’ retail license to sell Missouri Lottery products renders the subject property a ‘casino gaming area,'” Dowd wrote.
It remains unclear how vigorously the city will enforce the ordinance. Bars can be fined $500 a day for violating it, but so far no citations have been written.

2015-11-30 Dr Roach’s P-D column: “Doctors should practice what they preach”

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Kenneth Roach, MD

Kenneth Roach, MD

The St. Louis Post-Dispatch publishes a medical advice column every weekday in the  comics section. Originally written by Dr. Donahue, it’s been taken over by Dr. Kenneth Roach of the Weill Cornell  Medical College. Today he responded to a letter reproduced below concerning hospital smoking.

It’s amazing that this is still a problem, but I also recall how surprisingly difficult it has been to get hospitals to address this seriously until the relatively recent past. As I’ve noted before, instead of being in the vanguard of the smoke-free air movement, they were really slow to respond.

I recall a visit to Barnes-Jewish Hospital in downtown St. Louis to ask them about permitted smoking in the entrance foyer and in the wards. I also queried how they could square offering tobacco products in their shop with their medical mission. The reply to this was that their volunteers raised significant amounts from tobacco sales, and they also didn’t want to force their patients to have to leave the hospital for their smoking needs.

Back in those days smoking was permitted on the oncology floor with cancer patients, with visitors being allowed to smoke too. I was told of instances when nurses would respond aggressively when a by nonsmoking patient would complain. What hell that must have been.


Vivian Dietemann (Photo captured from TV)

Asthmatic Vivian Dietemann, whose son Christopher also had asthma needing many medical visits for treatment, had serious difficulty with the smoking she encountered when visiting doctor’s offices and clinics. She ended up filing multiple complaints under the Americans with Disabilities Act to try to bring about institutional change, which prompted MoGASP to follow suit over Lambert Airport’s smoking, embarking on our longest-running campaign. Starting in 1993, it didn’t end until the successful approval of Proposition-N: “Indoor Clean Air Code,” on the November 3, 2009 St. Louis County ballot. Lambert Airport finally took out it’s smoking rooms before the smokefree air ordinance went into effect on Jan. 2, 2011. 

Health professionals: Practice what you preach

Dear Dr. Roach • I retired from a large hospital after smoking was prohibited in the building. At that time, doctors still smoked in their lounge, and other employees — nurses, technicians, etc. — smoked on the adjacent strip-mall property or in their personal vehicles. I imagine that the doctors no longer smoke in their lounge and are not seen in public view, but employees still smoke in public view. It’s obvious because most of the medical staff wear scrubs. — L.

Answer • Health care professionals can make bad decisions about their health, but I agree with your implication that they have an obligation not to do so while in the role of someone concerned for health.

I certainly have seen physicians in white coats smoking outside my own (previous) hospital, and routinely see other health professionals do so. It’s hypocrisy for us to then tell others not to smoke. So, to my colleagues in medicine: Please don’t smoke when you are recognizable as a health professional. It makes it harder to get people to quit.

“Merchants of Doubt” Part 2

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[I started writing this “Merchants of Doubt” Part 2, but while doing so a flood of memories came back to me. If time permits, I’ll add some in a later blog.]

Merchants of Doubt_5031Weaving a gifted performer of card tricks into this movie was a stroke of genius.
Jay Ian Swiss earns money legitimately by demonstrating to his audience something they know is fake but cannot fathom out how.

Contrast that to the successful tobacco industry, who knew their product was both highly addictive and killing hundreds of thousands of Americans, yet denying it strenuously and successfully for decades in order to continue profiting from it.

Subsequently other industries causing harm and facing critics recognized that they could learn from Big Tobacco, employing deniers to bamboozle the public.

Below are screen shots with audio transcript captured from the opening part of the movie, starting with an animated nicotine-addicted King of Diamonds in the movie’s credits:

King of diamonds sm_5029 King of diamonds smoking_5030
First he’s smoke-free …….

Then he’s not!

(Click any image to enlarge; back arrow top left to return to this page)

Jamy Ian Swiss_5046Jay Ian Swiss, Magician:

     My expertise is in deception. The thing that sets magicians apart from con men and other kinds of thieves and liars is that we’re honest liars. It’s the moral contract.

Swiss is introduced to an intimate audience and while he’s shown performing he continues:

“I’m saying, I’m gonna fool you but it’s OK, right, that’s my job. But I’m gonna bring you back whence you began in a not severely altered condition.”

After being shown performing some amazing sleight-of-hand card tricks Swiss concludes:

“I make an honest living, right?
Therefore, it offends me when someone takes the skills of my honest living, if you will, and uses it to twist and distort and manipulate people and their sense of reality in how the world works.
I know how to fool people, and I know how to recognize when people are being fooled.”

Steve Milloy JunkScience.com_5052Short clip of Steve Milloy, who maintains a website JunkScience.com which evidently focuses on attacking and seeking to undermine good science, being interviewed and stating:

“Dioxin, pesticides, chemicals in general: there’s no evidence that these are harming us.”

Below is a clip from the movie, kindly provided by Melissa Robledo, Robert Kenner Films, after a request to Dr. Stan Glantz, and from which the still images in the previous blog were captured.

And below, in response to a TV host’s claim that his smoking harms no one at work, I’ve pasted Stan Glantz’s most memorable scientific rejoinder during the entire clip:

Glantz_No, that’s bullsh-t_5087

No, that’s bullsh-t!