Are we seeing the first signs of common ground in tobacco control in the United States?
On January 27, a group of tobacco control experts published a letter in the American Journal of Public Health (AJPH), urging the public health community to move away from categorizing scientists as “opponents” or “supporters” of e-cigarettes.
The co-authors, including Micah Berman, associate professor of public health and law at Ohio State; Pamela Ling, professor of medicine at the University of California, San Francisco; and Joanna Cohen, Bloomberg Professor of Disease Prevention at Johns Hopkins University, write that the terminology “highlights division rather than the many areas in which there is agreement.” This means, they continue, that most scientists would agree both that e-cigarettes have a place for adult smokers looking for a change and that young people should not experiment with nicotine.
The authors of the letter were responding to a AJPH article from last August, when some of the most esteemed and influential tobacco control experts endorsed the harm reduction benefits of vaping and lamented that media coverage was overwhelmingly geared towards the risks For the young. They agree, they write, “much more needs to be done in the United States and countries around the world to quickly and decisively reduce the burden of combustible products and to help smokers quit.”
Still, the letter is a relatively balanced response and can be read as a rare olive branch.
“However,” they continue, “emphasizing e-cigarettes and harm reduction as the only solution ignores the critical utility of proven, established, and science-backed interventions. We strongly encourage the community scientist to consider how e-cigarettes (in all their heterogeneity of design and usage patterns) perform in the real world when drawing conclusions about their effects and to move away from the false opponent/supporter dichotomy.
As proponents of tobacco harm reduction have pointed out before, no serious advocate has attempted to argue that vaping is “the alone solution” – just that, as a consumer product, it’s an option with unique capabilities, like replicating the hand-to-mouth action of smoking and help smokers who never even wanted to quit switch to a safer alternative.
Still, the letter is a relatively balanced response and can be read as a rare olive branch in an ongoing exchange where common ground remains fragile at best.
While there are shades of gray in any perceived dichotomy, tobacco control in recent years has been dominated by two vocal factions: abstinence-based public health organizations, such as the Campaign for Tobacco-Free Kids (CTFK ) funded by Michael Bloomberg, this center young people demand bans and restrictions; and former smokers, manufacturers and harm reduction specialists who make evidence-based arguments that draconian legislation on safer alternatives to nicotine, like banning flavors, is only contributing to the death of the smoking. (Tobacco use, of course, is the number one preventable cause of death on the planet.)
The nuance here could represent a harbinger of what the future might look like.
The letter’s authors also insist that e-cigarettes must “work at the individual level and at the population level in practice” to reduce “tobacco-related disparities” – which depend “largely on how whose products are regulated and traded” – and that e-cigarettes “comprise a heterogeneous class of products,” so their short-term and long-term effects vary depending on a certain vape’s design, composition e-liquid and how a respective company advertises it.
The nuance here could represent a harbinger of what the future might look like, where vaping’s biggest antagonists and skeptics will have to accept that we will never be a nicotine-free society, even if the restrictions, exceptions and Quarrels remain commonplace. The stark reality, with innovation and adoption accelerating, is that e-cigarettes aren’t going anywhere.
This is true despite the regulatory mess in the United States: The Food and Drug Administration (FDA) dithered over numerous premarket tobacco product applications (PMTAs) that vaping companies had to file last September to stay on the market. In short, companies had to prove that each individual product would be “appropriate for the protection of public health”– a norm that is now understood as the likelihood that a given product will help adult smokers make the transition without introducing nicotine to a new generation of users. So far, the agency authorized a single vaping product, while exceeding a time limit imposed by the court, refusing thousands of applications small businesses, and hit the biggest players. Some denied manufacturers, such as Triton, sued the FDA, alleging that he acted “arbitrarily” and “capriciously” in requiring in-depth studies which he had specified would be necessary.
Industry and consumer advocates have long expected the federal government to prioritize the largest producers, those with the capital and resources to invest in the bureaucracy of the agency. It is easier, according to logic, to regulate an essential oligopoly than a multitude of small and medium-sized manufacturers.
“I see this as proof that authorized products subject to marketing restrictions should be able to win the support of all tobacco control advocates.”
“I see this as proof that authorized products with marketing restrictions are the ones that really should be able to win the support of the tobacco control advocate community,” a vaping industry insider said, who requested anonymity so as not to affect the PMTA process, Told Filtered. “What you can begin to see is something like what we observe in New Zealand– an embrace of vapor (PMTA-licensed vapor in particular) from former skeptics, as well as a plea for ever tougher measures against combustible cigarettes.
As part of its overall tobacco control program, the FDA has also signaled that it will move towards banning menthol cigarettes and reducing nicotine levels in fuels to near zero in an effort to eliminate addiction – coercive and punitive strategies that some critics of the war on drugs say would. only fuel the illicit market in the United States while increasing criminalization. But these processes could take years.
This is not the end of the battle, nor even the beginning of the end. Tobacco control will enter uncharted territory, where many experts in the field will have to answer questions they have not yet had to face, sometimes ill-equipped to do so.
To what extent can an illicit market develop? How far will consumers go to vape their favorite flavors, which may no longer be legally available? What if, decades later, it turns out that the long-term effects of vaping nicotine are even less of a concern than scientists’ conservative estimates — in fact, no different from, say, drinking a cup of coffee?
The authors titled their letter “Balancing the Risks and Benefits of E-Cigarettes in the Real World.” But with nicotine, the future “real world” is hard to imagine for any of us.
Photograph by Peter Franz via Flickr/Creative Commons 2.0