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PACKET: Cancer Critics of soft-drink advertising claim "diet" soda really isn't By McClatchy Washington Bureau, adapted by Newsela staff 04.15.15 WASHINGTON — New research suggests that diet soft drinks may actually contribute to weight gain. Now, an advocacy group is charging Coca-Cola and PepsiCo with engaging in false advertising. The California-based group is known as Right to Know. It plans to file two citizen petitions Thursday. The petitions call on the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) to stop the companies from branding artificially sweetened products with the word “diet.” “Consumers are using products — Diet Coke and Diet Pepsi — that are advertised to make us think they assist in weight loss,” says the petition to the Food and Drug Administration. "In fact ample scientific evidence suggests that this is not true, and the opposite may well be true." Soda Makers Disagree With Claims The American Beverage Association speaks on behalf of Coca-Cola and PepsiCo. It strongly challenged the petitions' claims. The association pointed to numerous studies showing “that diet beverages are an effective tool as part of an overall weight management plan.” The petitions call for more questioning about the marketing of products that contain any artificial sweeteners. The most popular sugar substitute, aspartame, is used in more than 5,000 products. Both Diet Coke and Diet Pepsi contain aspartame. The artificial sweetener has been mainly sold under the brand name NutraSweet and is consumed worldwide. Last year, Diet Coke ranked third and Diet Pepsi was seventh in U.S. carbonated soft-drink sales. There have been safety controversies around the use of a number of artificial sweeteners for decades, especially NutraSweet and saccharin. However, Right to Know is the first group to call for investigations into possible deceptive marketing. Some Studies Say Diet Drinks Increase Weight Gain A number of recent studies have challenged the belief that artificial sweeteners help with weight loss. For example, a two-year study of 164 children found that overweight kids drank more diet sodas than normal-weight children. Another nationwide study looked at more than 10,000 children ages 9 to 14. It found that, for boys, drinking diet soda was “significantly associated with weight gains.” A 2010 review of previous studies concluded that "artificial sweeteners may contribute to weight gain." Another 2010 review also found "an association between artificially sweetened beverage consumption and weight gain in children." Also of particular interest is an Israeli study published last fall in the journal Nature. It found that mice given the three most popular sweeteners developed bacterial changes in their guts that caused glucose intolerance. In humans, this raises the risk of diabetes. The researchers at the Weizmann Institute of Science in Rehovot, Israel, found similar effects. Their study observed this among people who ate artificially sweetened foods for a week. Not All Scientists Agree However, not all scientists are convinced. In particular, they challenge the idea that the sweeteners can cause weight gain. One such scientist is Dr. James O. Hill, who has conducted his own study of artificial sweeteners. 1 PACKET: Cancer “I am absolutely convinced that there’s no way they are causing weight gain,” Hill said. Drinking diet sodas is "not something people should worry about,” he added. Hill's own study found that people who drank diet soda lost more weight than those who drank water. Hill acknowledged receiving hundreds of thousands of dollars from the American Beverage Association to finance the study. However, he said the industry group had no role in designing the study. Right to Know acknowledges the conflicting research results in its petition. However, it points to evidence that “industry-funded studies" are "less trustworthy than those funded independently.” Petition Could Revive Old Controversy Neither the Food and Drug Administration nor the Trade Commission would comment on the petitions. The Food and Drug Administration regulates food labeling, while the Trade Commission polices advertising claims. Trade commission spokesman Peter Kaplan said the agency is dedicated to "combating deceptive advertising." "Deceptive health claims in particular are a priority of the agency,” Kaplan said. The petition to the FDA could bring the agency back to the days of bigger controversies: its decisions in the early 1980s to approve the use of aspartame, first as an added ingredient in food and then in diet soft drinks. There have been several research studies and books that link aspartame to health problems. These problems range from cancers to neurological ailments. Yet the FDA has stood by its position that the sweetener is safe, except for people who suffer from a rare disease known as phenylketonuria, a developmental illness. 2 PACKET: Cancer Should e-cigs be regulated just like cigarettes? 03.30.15 By Tribune News Service, adapted by Newsela staff PRO: E-cigarettes abound in unproven health claims In 2014, the Oxford English Dictionary’s (OED) word of the year was “vape.” The Food and Drug Administration (FDA) should take a hint from the OED and write its own definition of e-cigarettes — a definition that will treat them as a tobacco product. Congress created the FDA in 1906. It was a time of concern over the quality and purity of America’s food and drug supply, which was awash in toxic dyes and preservatives, and shaped by the outrageous claims of “patent medicines,” fake miracle cures also known as "snake oil." The agency’s creation reflected a belief that consumers could not, on their own, always make decisions about whether a product was safe, reliable and healthy. In short, the FDA was made to regulate products just like e-cigarettes. A Booming Industry E-cigarettes have created an industry that abounds in unproven health claims; an industry in which more than 16 million children can legally buy e-cigs and administer unspecified amounts of nicotine to themselves; an industry in which the accidental ingestion of liquid nicotine has caused a huge uptick in the number of cases reported to local poison control centers — including the death of a toddler in upstate New York two months ago. And it is an industry that is booming. Last year, analysts at Wells Fargo bank estimated the overall value of the e-cigarette market at $2.5 billion and predicted that it will grow to $10 billion annually by 2017. The product's growth can be attributed in part to aggressive marketing. Yet, the other part of that growth is the high adoption rates among high school students attracted to the variety of e-cig flavors, including cotton candy, gummy bear and root beer float. This nicotine-fueled movement should be regulated, not banned. The FDA is the only agency that can do that. The FDA should prohibit sales and marketing to kids and make sure that health claims made by e-cig companies are true. It should also require companies to add ingredient lists to e-cig juice. Flavored Nicotine Solution “Juice” is a misleadingly harmless euphemism for a flavored nicotine solution. The liquid nicotine is heated through a battery-powered cylinder, which can look like a cigarette, a pen or a kazoo. The devices vaporize a flavored nicotine solution that users then inhale and exhale. Users inhale this flavored vapor and not burning tobacco, which means e-cigs are safer compared to cigarettes. But, then again, cigarettes kill 6 million people per year. In the words of historian Robert Proctor, they are the deadliest invention in human history. And herein lies the potential virtue of the e-cigarette: it could be a powerful tool for saving millions of lives if smokers switched from puffing to vaping to, ideally, nothing. The problem is that the safety and health claims of e-cigarettes have not been proven. Particularly in the online vaping community, anecdotes abound testifying to the e-cig’s usefulness in helping folks kick the habit. But in the words of Mitch Zeller, head of the FDA’s Tobacco Products Division, “FDA can’t make regulatory policy on the basis of anecdotal evidence.” Initial evidence from a major new study should give regulators pause. Initial findings from the Population Assessment of Tobacco and Health indicate high levels of “dual use” of tobacco products, meaning that smokers frequently use both e-cigarettes and regular cigarettes. 3 PACKET: Cancer False Advertising? These findings are consistent with other studies that have found that rather than helping people quit smoking, e-cigarettes may actually make it harder for smokers to quit. Nevertheless, e-cigarettes are frequently advertised as proven tools of public health. Researchers at the University of California-San Francisco found that 95 percent of e-cig websites either made outright claims that they had health benefits, or implied there were some. Sixty-four percent made claims directly related to helping users quit smoking. This is false advertising. Nicotine is addictive and it is a poison — two facts that the FDA should make clear by requiring warning labels on e-cigarette devices and vials of e-juices. Skin contact with even small quantities of liquid nicotine can cause dizziness, vomiting and seizures. Ingestion can be deadly. A world in which a dangerous product is marketed and sold as a healthy one is exactly what the FDA exists to prevent. E-cigarettes are not snake oil. But gummy bear, cotton candy and sour apple shouldn’t make them any easier to swallow. ABOUT THE WRITER: Sarah Milov is an assistant professor of history at the University of Virginia. She currently is writing a book about tobacco in the 20th century. Readers may write her at 435 Nau Hall South Lawn, Charlottesville, VA 22904. This essay is available to Tribune News Service subscribers. Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of Tribune or Newsela. 4 PACKET: Cancer Should e-cigs be regulated just like cigarettes? 03.30.15 By Tribune News Service, adapted by Newsela staff CON: Vaping is not as bad as smoking In 1964, the Surgeon General’s Advisory Committee on Smoking and Health released its very first report on tobacco smoking. It analyzed scientific evidence consisting of over 7,000 articles relating to smoking and disease. Based on those studies, the report cited tobacco smoking as a major cause of lung and throat cancer and chronic bronchitis. The report launched a “war on smoking” that soon required health warnings on cigarette packages and bans on cigarette commercials on radio and television. In recent years, it has led to bans on smoking in certain areas, like restaurants and other public places. Over this half-century of cigarette regulation, two facts have been impressed upon the nation: 1) smoking tobacco kills people; 2) once a person is addicted to smoking cigarettes, or, rather, to the nicotine one ingests by smoking cigarettes, it is very hard for a person to quit. Beating Cigarette Addiction Then an invention came along — e-cigarettes. They supply nicotine in much the same way as a tobacco cigarette, but without any apparent link to cancer or lung disease. Many people cheered the innovation. Finally there was a product that could help those who were addicted to cigarettes and for whom the available anti-smoking gum and patches had not been helpful. Lives could be saved. People could replace their tobacco cigarettes with e-cigarettes; switch out smoke and carcinogens with water vapor and the horrible smell with no smell at all — or the light scent of a chosen flavor, such as mint or strawberry. Lives could be saved. One would expect the response of the public health community to be a near-universal “hurrah” — and in some quarters, it has been. Asking "What If?" But for those who appear to be addicted to regulation, and not to public health, e-cigarettes provide an unwelcome challenge. How do they go about banning access to a product that saves lives? And what do they say when people, quite reasonably, ask, “Why do you want to?” For many of these regulators, the answer is as “what if.” “What if” vaping turns out to be harmful? “What if” people who vape decide to start smoking? These “what ifs” are quite unlikely. However, it is on the basis of them that some people support bans. Some want bans on the sale of e-cigarettes, or grossly high taxes on e-cigarettes, or even outright bans on the use of e-cigarettes in public. But such policies mean nicotine addicts will be less likely to use e-cigarettes. Instead they may be more likely to keep smoking tobacco. The obvious and predictable result is relatively more tobacco smoking and thus, more illness and death. 5 PACKET: Cancer "Dying From The Tar" The director of the Food and Drug Administration’s Center for Tobacco Products, Mitch Zeller, J.D., made the key point clear in an interview with the Robert Wood Johnson Foundation’s New Public Health: “People are smoking for the nicotine, but dying from the tar.” He says e-cigarette regulation should take into account the “continuum of risk: that there are different nicotine-containing and nicotine-delivering products that pose different levels of risk to the individual,” and regulate accordingly. Which means America should not treat e-cigarettes and vaping just like tobacco smoking and smoking. Smoking is clearly far more dangerous than vaping. In fact, because vaping can cause people to voluntarily stop smoking, a carefully crafted regulatory policy that steers Americans from smoking toward vaping as a replacement provides “an extraordinary public health opportunity.” Zeller makes a lot of sense. By contrast, there are the regulation zealots who are the enemy of public health. Smoking kills. Vaping is a safer alternative, and our nation’s regulatory policy will save lives if it reflects this fact. ABOUT THE WRITER: Amy Ridenour is chairman of the National Center for Public Policy Research in Washington, DC. (www.nationalcenter.org), a conservative think-tank on Capitol Hill. She can be reached at 501 Capitol Court NE, Washington, DC 20002 or by email at [email protected]., a conservative think tank on Capitol Hill. She can be reached at 501 Capitol Court NE, Washington, DC 20002 or by email at [email protected]. This essay is available to Tribune News Service subscribers. Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of Tribune or Newsela. 6 PACKET: Cancer Some people are worried about crumb rubber in artificial turf fields By The Record, adapted by Newsela staff 03.08.1 HACKENSACK, N.J. — Athletes who play sports on synthetic fields are all too familiar with the tiny specks of black rubber that litter the turf. The shredded bits of used car and truck tires — called crumb rubber — can embed themselves in carpets, in car mats and in homes after practice. They are used to fill almost every synthetic field in the country. And now, some people are wondering how safe the little pellets actually are. Most studies on crumb rubber have found minimal to no health risks from the pellets. A number of organizations have conducted analyses on the turf fields, including the New Jersey Department of Environmental Protection, the New York State Department of Environmental Conservation and the University of California (UC), Berkeley. But despite this research, some communities and school districts are still concerned about the safety of the fields. As towns consider upgrading their facilities to synthetic turf, the topic comes up for debate. More Studies Are Needed A growing number of parents, athletes and groups are questioning the safety of crumb rubber's ingredients. They claim that the pellets contain dangerous materials, such as carcinogens and toxic chemicals, which are used in tire manufacturing. They argue the chemicals can be swallowed, inhaled or absorbed through the pellets. Some studies have detected toxins such as benzene and carbon tetrachloride at turf fields. The studies found such minor amounts of these chemicals in the pellets that they were deemed safe. There is no concrete evidence that crumb rubber poses a health risk. But many scientists think there hasn't been enough research into the turf fields. They think that before the pellets are declared safe, researchers need to examine the fields over time and under varying temperatures and weather. Turf companies maintain that crumb rubber is safe. They say that it doesn't contain dangerous ingredients from the tire manufacturing process. FieldTurf, a turf company, has asked that the U.S. Environmental Protection Agency (EPA) research the products further. Last year, NBC News raised the public's safety concerns with an investigation into turf's health risks. “We’re certainly confident in the safety of the product, and we have absolutely no problem with more study being done,” said Darren Gill, a FieldTurf spokesman. “I think once people do the research and get past the glitzy, glamorous headlines from NBC, I think they look at the science and realize that there’s 10,000 fields in America and really no real information to the contrary that these fields are anything but safe.” EPA's Research "Very Limited" The EPA and the Consumer Product Safety Commission have published studies in the past declaring the rubber fields safe. They have since backed away from these claims, stating that their own research is "very limited." The EPA admits that it is “not possible to extend the results beyond the four study sites or to reach any more comprehensive conclusions without the consideration of additional data.” The Consumer Product Safety Commission added a large, red banner at the top of its website above the evaluation. The disclaimer cautions that the “staff’s assessment was subject to specified limitations 7 PACKET: Cancer including sample size. The exposure assessment did not include chemicals or other toxic metals, beyond lead.” The crumb rubber issue has gained national attention because the material covers fields, parks and playgrounds where both kids and professional athletes play. MetLife Stadium, home to the NFL Giants and Jets, has a turf field. Ninety-eight percent of the 11,000 synthetic turf athletic fields in the United States use crumb rubber, according to the Synthetic Turf Council. Turf fields are popular across the nation because they are weather-resistant, easier to maintain than grass and usable year-round. They last 10 to 15 years. Considered Recycled Material Crumb rubber is also the cheapest choice compared to other alternatives, like organic fill and sneaker rubber. Crumb rubber is considered recycled material. The federal Resource Conservation and Recovery Act, a piece of legislation, states that the rubber is not considered tire waste. The law is supposed to protect the public and environment from hazardous waste. Because of the recycled material's classification, crumb rubber is no longer held to the same scrutiny as tires. This has been a point of major dispute for critics. Turf manufacturers advertise recycling as part of the benefits of their fields. Research largely supports turf companies' claims that crumb rubber is safe. The New York State Department of Environmental Conservation conducted a study and declared that crumb rubber fields pose “no significant environmental threat to air or water quality and poses no significant health concerns.” UC Berkeley has also examined the material. It concluded in a research review that “the materials are both cost-effective and safe.” Turf might also have another benefit: greater safety than grass fields. Studies conducted by Montana State University and West Texas A&M University found fewer concussions, severe injuries and ligament tears among high school athletes playing on turf. Unwilling To Risk It Not everyone is convinced that crumb rubber fields are safe. The New York City Department of Parks and Recreation and the Los Angeles Unified School District no longer install crumb rubber fields. In December, a state senator from California proposed a bill that would prevent cities and school districts from installing them for three years. Keith Verkem's 13-year-old son plays soccer on a turf field. Verkem is concerned about the crumb rubber. The material “that we make tires out of is not healthy,” Verkem said. “Do we want to find out years later that there is a link?” Most researchers don’t think there is a link. But the researchers cannot say for sure and parents like Verkem don't want to take that risk. 8 PACKET: Cancer Through a water bowl, darkly: Hookah smoking catching on despite risks By Dallas Morning News, adapted by Newsela staff 09.18.14 DALLAS — Clouds of smoke are billowing out of Isaac Doss’ mouth. He inhales smoke from the hookah in front of him and passes it to Kara Brick. The two are sitting on the patio of a hookah bar on a muggy Thursday night in Dallas. They are celebrating the return of Brick’s sister from Europe. Hookah bars are a popular trend for young adults. Nearly 1 in 5 U.S. students smoked hookah in the last year, according to a study published in the journal Pediatrics. There are 10 businesses that offer hookah smoking within five miles of the University of Texas at Dallas. While the dangers of cigarette smoking are well known, doctors warn that smoking tobacco from a hookah, or water pipe, can be even more dangerous. More Dangerous Than A Cigarette? When smoking a cigarette, the user lights the tobacco with a fire and inhales the smoke. With a hookah, a charcoal brick burns flavored tobacco and the smoke is drawn through a water bowl and into a hose to be inhaled. Smoking hookah one time can deliver 1.7 times the nicotine, 6.5 times the carbon monoxide, and 46 times the tar of a single cigarette, according to the National Institutes of Health. Nicotine is the addictive chemical in tobacco that makes people want to keep smoking. Carbon monoxide can cause brain damage and even death. Tar contains carcinogens, which cause cancer. “There is no reason to believe that a water pipe is less dangerous than a cigarette,” says Dr. Thomas Eissenberg, a Virginia Commonwealth University professor who has done studies on water pipe smoking. “In fact, depending on some of the toxins, there is reason to believe it is more dangerous.” Doss, 25, smoked hookah regularly at the University of the Ozarks in Arkansas without realizing the health risks. “I was 18 the first time I smoked,” he says. “I smoked every weekend. I never considered how bad it would be for me.” Now, Doss says he is more aware of the health risks of hookah. Hookah Has No Warning Label According to a University of Michigan study, more high school seniors are smoking hookah than ever. Eissenberg says many young people do not realize they are inhaling tobacco, charcoal smoke and other carcinogens with each breath. While packs of cigarettes now carry labels like “SMOKING KILLS” and “SMOKING CAUSES LUNG CANCER,” there are no labels or health warnings at hookah bars. “The problem is, if you go into a water pipe bar and look at the pipe you are being served, there is nothing on that pipe or on the tobacco or in that charcoal that tells you it’s dangerous,” Eissenberg says. Some young people seem to think “It doesn’t say it’s dangerous, so it must be safe,” he adds. But smoking hookah is most definitely not safe, the latest science is showing. Hookah smoke contains higher levels of lead, nickel and arsenic, 36 times more tar and 15 times more carbon monoxide than cigarettes, research in the Journal of Cancer Epidemiology, Biomarkers & Prevention shows. Smoking hookah requires users to inhale harder and longer than when smoking cigarettes. This increases the amount of carcinogens and nicotine in the lungs. Hookah smokers "take about an entire cigarette’s worth of smoke in a single puff,” Eissenberg says. 9 PACKET: Cancer At The Kush Hookah Lounge The longer a person smokes hookah, the more nicotine and toxins he or she takes in. Smoking hookah for 45 minutes to an hour can expose users to about the same amount of nicotine and tar as one pack of cigarettes, according to Eissenberg. There are 20 cigarettes in a pack. “If you aren’t a cigarette smoker because you know cigarettes are dangerous and lethal, then there is absolutely no reason to be smoking a water pipe and every reason to avoid it for the same reason,” he says. “Water pipe smoking will kill you also.” Farhad Ata is the owner of Kush Hookah Lounge, where Doss and Brick were smoking. He opened the business five years ago. Ata has smoked hookah his entire life and knows smoking hookah is not healthy. “It is still tobacco, no matter what, even if it is flavored,” Ata said. “Your lungs are meant for air. Any type of smoke is not good for you, whether it’s cigarettes or hookah.” Dr. Mark Millard, a medical director at a lung-care center, has practiced medicine in the Middle East. Water pipe smoking has been widespread in the Middle East for more than 400 years. On one trip, he treated a woman from Saudi Arabia who had a hacking cough. “She was smoking every night for an hour,” he says. “That is quite a lot. I told her to get rid of her hubbly bubbly (hookah). It’s nicotine that is the addictive factor. It makes people want to come back for more. People can get addicted to hookahs, and it does affect your health.” 10 PACKET: Cancer Surviving a rare cancer, a teen helps study it By Associated Press, adapted by Newsela staff 03.17.14 WASHINGTON — First the teenager survived a rare cancer. Then she wanted to study it, spurring research that helped scientists find a weird gene flaw that might play a role in how the tumor strikes. Age 18 is pretty young to be listed as an author of a study in the prestigious journal Science. But the industrious high school student's efforts are bringing new attention to this mysterious disease. "It's crazy that I've been able to do this," said Elana Simon of New York City, describing her idea to study the extremely rare form of liver cancer. The cancer mostly hits teenagers and young adults. Making that idea work required a lot of help from scientists, including her father, who runs a cellular biophysics lab at Rockefeller University, and her doctor at Memorial Sloan-Kettering Cancer Center. Gene experts at the New York Genome Center also helped. A second person who survived the cancer, who didn't want to be identified, co-authored the study. Finding A Gene Flaw Together, the team reported Thursday that they uncovered an oddity: A break in genetic material would leave the "head" of one gene fused to the "body" of another, resulting in an unusual protein. It doesn't form in normal liver tissue but it does in tumors, so it might fuel cancer growth, the researchers wrote. They've found the evidence in all 15 of the tumors tested so far. Yet, it was a small study and more research is needed to see what this gene flaw really does, cautioned Dr. Sanford Simon, the teen's father and the study's senior author. Scientists at the government's National Institutes of Health (NIH) are advising the Simons on how to set up a patient registry, which will give them a collection of information about people with the disease. NIH's Office of Rare Diseases Research has posted a YouTube video on its website. Elana Simon and another patient who survived the disease explain why teen patients should get involved in the tests. "Fibrolamellar Hepatocellular Carcinoma. Not easy to pronounce. Not easily understood," the video says about her disease. Simon was diagnosed at age 12. Getting an operation is the only effective treatment, but her tumor was caught in enough time that it worked. There are few options if the cancer spreads, and Simon knows other patients who weren't so lucky to have caught the disease early. During her second year in high school, she had an internship at a laboratory studying another type of cancer. She helped researchers sort information about genes that had changed, or mutated, using her computer skills. Getting Tumors To Test Simon wondered, why not try the same approach with the liver cancer she'd survived? A hurdle was finding enough tumors to test. Only about 200 people a year worldwide are diagnosed, according to the Fibrolamellar Cancer Foundation, which helped fund the new study. There was no registry that kept tissue samples for testing after an operation. But Sloan-Kettering's Dr. Michael LaQuaglia, who does operations on children and was Simon's doctor, agreed to help. Simon spread the word to patient groups, and finally, samples trickled in. Sanford Simon said his daughter helped examine what was different in the tumor cells with a computer. The New York Genome Center mapped the samples and zeroed in on the weird change in the gene, coauthor Nicolas Robine said. Sanford Simon said other researchers showed the unusual protein really is active inside tumor cells. 11 PACKET: Cancer He calls it "an exciting time for kids to go into science," because there's so much they can research via computer. As for Elana Simon, she plans to study computer science at Harvard next fall. 12
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