The Food and Drug Administration chairman, Dr. Scott Gottlieb, took aim at the increasing use of e-cigarettes among minors in the United states on Twitter last week. Here’s what he had to say.
The troubling reality is that e-cigarettes are the most commonly used tobacco product among youth. Preventing youth from initiating the use of any tobacco product, including e-cigs, is critical. More on FDA and @CDCgov findings: https://t.co/bFNA2mubRD
— Scott Gottlieb, M.D. (@SGottliebFDA) February 15, 2018
Protecting future generations from all nicotine-containing products remains a top priority. #FDA’s efforts seek to restrict youth access, limit youth appeal. We’ve also expanded public education efforts to include messaging re: dangers of youth use of e-cigarettes.
— Scott Gottlieb, M.D. (@SGottliebFDA) February 15, 2018
A few things stand out here. First, as many people noticed, e-cigs currently sold in the United States do not contain any tobacco. It’s possible that Gottlieb was referring to a new generation “Heat Not Burn” technology that does use actual tobacco in creating a vapor without combustion. IQOS, the world’s most popular product using this technology is currently under review by the FDA, which is considering an application from Phillip Morris International, to sell the product in the United Sates. Traditional e-cigs though, do not contain any form of tobacco.
Gottlieb seems to be suggesting the 17 percent of young people who believe e-cigs are a safer alternative to combustible cigarettes are wrong, but nothing could be further from the truth. There is no scientific doubt that e-cigs absolutely are a dramatically safer product than traditional cigarettes. It is actually quite a damning statistic for the FDA, which has fought tooth and nail to keep the truth about e-cigs from the American people.
The Science Is Clear
In a recent policy statement the American Cancer Society (hardly a bosom buddy of big tobacco) had this to say: “Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA approved cessation mediations. These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.”
As it turns out, in the last decade, millions of people around the world have been making this switch, with millions more foregoing combustible products altogether and starting with less harmful e-cigs. In 2008, Wells Fargo estimated $20 million in sales of e-cig products worldwide. By 2017, that figure was $10 billion.
Closer to home, the numbers also look very promising. In 2008, the year roughly associated with the rise of e-cigs, 11.4 percent of high school seniors smoked combustible cigarettes every day. By 2015, that number had been reduced to 5.5 percent. Importantly, from 2011 to 2015, the number of high school seniors who used e-cigs rose from 4.7 percent to 16 percent. By 2015 more students were using e-cigs than smoking cigarettes.
A deeper dive into these numbers tells us even more. About one third of all high school seniors report having ever smoked a cigarette, with about 7 percent having smoked in the month prior to reporting. What the data show is that many adolescents are now using multiple nicotine delivery products. The result of this development is fewer kids are exposed to the vastly more deadly effects of combustible cigarettes, which can only be seen as a positive.
Don’t Make The Perfect The Enemy Of The Good
In a perfect world no teenagers would use nicotine products. Also, none of them would drink beer, smoke grass, or drive too fast. But alas, we don not live in a perfect world and are not likely to any time soon. Curious teenagers will explore nicotine; it is after all one of the most popular drugs in the world.
It makes sense not to allow marketing of e-cigs directly to teens, and there are real concerns that the use of flavoring, often even candy flavors, may be an attempt to seduce young people into trying the product. But these concerns are not an excuse to keep vital information about the real safety difference between e-cigs and traditional smokes from anyone, let alone vulnerable kids. This is clearly a case where the perfect should not be the enemy of the good.
The FDA has considerable influence not only on federal policies, but also on state and local decision-making. In New York City last year a comprehensive anti-tobacco law was passed that makes it much more difficult for e-cig shops to open, limiting the total number that are allowed to operate. What this unfortunately does is make it harder for New Yorkers to access a product much safer than cigarettes and makes it more likely that many simply remain traditional smokers.
This Is A Health, Not A Moral Issue
Few topics in American life carry more condemnation and moral judgment than smoking. Disdain is heaped upon smokers regularly. Wherever one stands on that approach to a habit enjoyed by about 15 percent of the country’s population, e-cigs should not be lumped into the same deplorable basket as cigarettes. And the FDA absolutely should not be sending the dangerous message to kids that e-cigs are no different than their combustible cousins.
Experts in this field, whether independent academicians, industry scientists or regulators almost all agree that the best approach to smoking cessation is a wide range of nicotine delivery systems that make people less dependent on traditional combustible cigarettes.
Gottlieb and the FDA should take a more nuanced and honest approach to this issue. Kids who decide to try nicotine, and millions will, should have the real facts at their disposal. They should know that not all of these products are equally harmful and that they can make better choices should they decide to experiment.
Over the past several years, regulators and the nicotine industry have enjoyed a much better working relationship than ever existed in the past. It is understandable that the FDA would prefer no kids use any nicotine product, but that isn’t going to happen. In the real world, the FDA needs to do a much better job adjusting to the changes that are making nicotine use safer. The goal should be saving lives, not moral preening, and to that end, there is no better approach than simply telling kids the truth.