The FDA’s Inexplicable Crusade against Tobacco Smoking Harm Reduction Continues

While the press was understandably preoccupied with the White House commandeering private businesses to enforce a COVID vaccine mandate on September 9, it gave little attention to the Food and Drug Administration’s strike against an effective form of tobacco harm reduction on the same day. The FDA was under a court order to review 6.5 million applications from over 500 companies to market nicotine‐​containing e‐​cigarettes and rejected 90 percent of them, while it delayed deciding on applications from Juul, which commands an overwhelming share of the vaping market. One can be forgiven for having a cynical view of the delay.Ironically, a spokesperson for the American Lung Association, which should be promoting nicotine‐​based vaping products as a proven way to help adults quit smoking tobacco products, was “deeply disappointed” that the decision about Juul’s fate was delayed. The association is concerned about what it sees as an “epidemic” of vaping among youth. Yet it is against the law to sell vaping products to people under age 18, and one would think the American Lung Association would support tobacco harm reduction for adults.Writing in the American Journal of Public Health last month, fourteen academic public health experts point out “the National Academies of Science, Engineering, and Medicine concluded that e‐​cigarette use is likely far less hazardous than smoking,” and warned that “Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e‐​cigarettes in quit attempts.” They added:Because evidence indicates that e‐​cigarette use can increase the odds of quitting smoking, many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking‐​attributable mortality.Studies show flavored e‐​cigarettes, while popular with teens, are preferred by adults trying to quit tobacco and are not associated with an increase in youth tobacco smoking initiation. And a recent study in the Journal of the American Medical Association found that San Francisco’s ban of flavored vaping products may have unintentionally increased teen tobacco smoking.With a few exceptions, such as Boston University School of Public Health Professor Michael Siegel, most anti‐​smoking activists paint vaping with the same brush as tobacco smoking. Perhaps it is because tobacco and many vaping products contain nicotine. Yet nicotine is much less harmful than the carcinogens and other ingredients in tobacco smoke. Perhaps it is due to irrational, zero‐​tolerance of any activity that resembles smoking. Whatever the reason, it runs counter to the evidence, and counter to their stated goal of reducing tobacco smoking.