Author: Staff Writer

  • The Watchful Eye

    The Watchful Eye

    Credit: Sergey Nivens

    Tobacco companies should be allowed to transition to harm reduction products, but under history’s watchful eye.

    By George Gay

    I don’t go along with the oft-repeated idea that, if we don’t remember the past, we are condemned to repeat it. This is not to say that particular versions of the past, whether real or invented, are not repeated, just that mostly it is impossible to know whether an event is an original or a repeat. For one thing, memories of the past are mostly not the result of direct experiences and so are not fixed and generally agreed. History, into which the past is roughly sieved, is never objective. It is most often weighted, open to interpretation and subject to disagreements.

    I would be happy to consign all versions of history to oblivion, but then, as somebody famously said, there would be no point. In saying that we consign something to oblivion, we suggest that it is simultaneously forgotten and preserved. We are incapable, it seems, of letting go of favorite versions of the past, which get stuck to our shoes like carelessly discarded chewing gum.

    Specifically, it concerns me that history, or versions of it, are being allowed to act as a drag on advances that could be being made in reducing the health consequences of cigarette smoking. I recently attended a nicotine conference and, as part of one generally good presentation, a still of a video was shown in which CEOs from U.S. tobacco companies told a Congressional oversight committee sitting a quarter of a century ago that they did not believe nicotine was addictive. I have seen this still, or similar ones, on more occasions than I care to remember, often presented as shorthand for how heinous the tobacco industry was or even is.

    But one problem in my view is that what is presented here is a version of history directed by the enemies of the tobacco industry who feel they won the moral war. In other words, a history presented by the victors. It implies that those CEOs were willing to lie about something that everyone knew to be true—that nicotine was and is addictive. There is no time for nuance in a single still. There is no room for other interpretations.

    Credit: Sky Next

    For instance, were all the CEOs referencing the same, agreed version of addiction? And if, as generally supposed, they were all referencing the same definition of addiction, were they acting in bad faith, or were they, or at least some of them, not informed or badly informed by the scientists working in their companies who did believe that nicotine was addictive? Is it possible the CEOs were right and everybody else was wrong? Was one or more of them delusional and in need of help?

    I ask above whether all of the CEOs were referencing the same definition of addiction and, frankly, I have no idea what the answer to that question is. I tend to the view, however, that they were, because I find it difficult to believe their legal teams would have allowed them to give the answers they did without knowing exactly what they were signing up for.

    But I have one troublesome doubt in this regard. As far as I am aware, five of the seven CEOs who testified in 1994 said they believed that nicotine was not addictive; one said he believed that neither nicotine nor his company’s products were addictive while another said he believed cigarettes and nicotine clearly did not meet the classic definition of addiction because there was no intoxication.

    The reference to “the classical definition” surely suggests that it was admitted there was more than one definition, which possibly means the answers need to be interpreted individually. Additionally, it cannot be ruled out that even if a CEO knew that his company’s scientists believed nicotine to be addictive, his personal view might have been different. We all become fed up with experts at one time or another.

    The oversight committee’s hearings later revealed that all sorts of skulduggery had gone on; for instance, at least some of the people within these companies knew or believed that nicotine was addictive and that some had manipulated their products to try to make them more addictive, whatever that means in the context of whatever definition you are using.

    But where did this information come from? It came in part from documents voluntarily handed over to the committee at the behest of the CEOs. This seems to suggest that the CEOs were either not aware of what was in those documents or that they were not aware of all that was in them.

    But let’s say for the sake of argument that the CEOs, or at least some of them, told the committee they believed nicotine was not addictive, knowing that all this skulduggery had been going on—would they not have been acting in exactly the way they would have been expected to act—perfectly in line with business and societal norms? After all, they were CEOs charged with maximizing company profits at a time when greed was good, so there was some collateral damage. But then, starting only with the “A’s,” look at the alcohol, arms and automobile industries.

    I don’t want to defend what the CEOs said during that committee hearing or what the tobacco industry got up to because I don’t know enough about this stuff. But it seems a little odd to me that, at a time when the U.S. was deep in the grip of neoliberal dogma, these men (they were all men) were condemned for following the logic of the market and maximizing profits.

    But the committee seemed to want to set itself above all of this tacky business stuff, somewhere on the moral high ground. This is, in part, what the chairman on April 14, 1994, said in opening the hearing: “For decades, the tobacco companies have been exempt from the standards of responsibility and accountability that apply to all other American corporations. … This hearing marks the beginning of a new relationship between Congress and the tobacco companies. The old rules are out; the standards that apply to every other company are in.”

    I would imagine that what a lot of people took away from this, whether it was meant or not, is that there goes the wicked tobacco industry again, avoiding its responsibilities for decades. But, if the finger is to be pointed anywhere, it should surely be pointed at Congress, which, as is more or less admitted by the chairman, allowed this situation to exist and to continue. It cannot be expected that businesses will, in the normal course of things, lobby Congress to saddle themselves with additional regulations.

    I thought the opening remarks strange in another way also. The chairman at one point says: “Nearly a half million Americans die every year as a result of tobacco. This is an astounding, almost incomprehensible statistic. Imagine our nation’s outrage if two fully loaded jumbo jets crashed each day, killing all aboard. Yet that is the same number of Americans that cigarettes kill every 24 hours.”

    As I see it, the chairman is making a comparison as part of what I suppose was meant to be a moral argument, but that comparison does not stand up to even basic scrutiny. As human beings, we take risks every day, balancing those risks, either consciously or unconsciously, against perceived benefits. Smoking and drinking alcohol are two obvious everyday examples of this. And so, too, for a lot of people (though perhaps not recently) is getting on an airplane. As things stand, people get on airplanes because they are overwhelmingly safe to use, so the benefit-to-risk ratio is hugely positive.

    But it is inconceivable that if two jumbo jets crashed each day in the U.S. alone, people would still board them. The chairman was ignoring the fact that people make risk assessments so as to conjure up a situation that would never occur. People understand that smoking might cause them to die in 40 years to 50 years, and they understand that falling from 30,000 feet brings on death a lot quicker.

    The idea of risk can be manipulated, and often is, as in the story about the therapist with a patient who is still nervous of flying even after being told that the chances of a bomb being on board a plane is a billion to one; the therapist advises her to take her own bomb on board next time she flies because the chances of there being two bombs on board are a trillion to one.

    I need to emphasize that I am not trying to defend the past behavior of the tobacco industry or the CEOs in question. What concerns me here is that a single picture is being regularly presented as telling a story that is far simpler than it really is. What has passed into history—what I would imagine most people would “remember” from the picture of the subcommittee hearing—was that all of the CEOs lied in saying that nicotine was not addictive. I doubt that many people would realize that what they said was they believed nicotine was not addictive, let alone the back story to this event.

    This is the problem with the versions of history we drag around with us. In the end, what did the hearings bring about? Reputational damage to tobacco companies for sure. But they are still operating in one form or another, and part of their business is largely unchanged. It is said that the number of smokers fell after the hearings, but who knows whether the hearings were a causal factor in this.

    It is more interesting to examine what continued: taxes. Local, state and federal agencies continued to benefit from people smoking through the taxes they paid, and later was added the proceeds of the Master Settlement Agreement, very little of which is ever spent on ameliorating the toll of tobacco smoking; so who gets to stand on the moral high ground?

    Credit: Gawriloff

    Well, the answer to that question might seem strange. I say above that it is not usual for businesses to lobby Congress to try to saddle themselves with additional regulations. But, in fact, odd as it might seem, this is exactly what many nicotine and tobacco companies have been doing in recent times.

    I’m not saying they are perfect and that part of this new way of thinking hasn’t to do with competition, but in part it is a genuine attempt to ensure that the new generation products that are being developed and offered to help people transition to safer forms of nicotine consumption are not causing, and can be seen not to be causing, unintended consequences.

    And for those people who tend still to be wedded to the idea portrayed by the still of the tobacco CEOs, it is worth noting that, importantly, in the recent past the major tobacco companies have found a way of offering reduced-risk products while roughly maintaining the sorts of business models that were so successful for them in the past. Does this put them on the moral high ground? Of course not, but it has mapped out a route to that ground.

    Times are changing, and we desperately need to stop slowing the transition into a new world of nicotine consumption by constantly dragging behind us a little-examined history of what went on 20 years to 30 years ago—a time that few working in the nicotine and tobacco industries could probably remember.

    There was a furor just after I started to write this piece about a proposed takeover by Philip Morris International of the pharmaceutical company Vectura, which in news reports was said to be developing inhaled treatments for respiratory diseases. Why the furor? Well, it’s all about history, of course. PMI has in the past sold traditional cigarettes and still does; so, the detractors claimed, we cannot let it near a pharmaceutical company.

    There seems to be no way such people can accept that, in order to move ahead with the transition from smoking to other forms of nicotine consumption, we have to look at innovative, even daring ways of doing things.

    I have no insights into what PMI is up to beyond what has been reported in the general press, but it doesn’t take a genius to figure out that it might be looking, in part, to benefit from some cross fertilization of ideas in respect of inhalation technologies—ideas that just might allow it to make a breakthrough in respect of reduced-risk, next-generation nicotine products.

    At least we should allow companies to try such things—while keeping an eye on them, of course. We should not let history stand in the way.

  • Video: Vaping’s Harm Reduction Potential

    Video: Vaping’s Harm Reduction Potential

    Considerable evidence suggests that e-cigarettes are an effective smoking cessation tool for adults in the United States, where hundreds of thousands of people die of smoking-related illness each year.

    Kenneth Warner, dean emeritus and the Avedis Donabedian Distinguished University Professor Emeritus at the University of Michigan’s School of Public Health, says, however, that the potential of vaping to increase smoking cessation has been largely overshadowed by media coverage and policies that focus on the potential risk vaping represents for teens.

    Warner and 14 other past presidents of the Society for Research on Nicotine and Tobacco co-authored an article that argues that the media, legislators and the general public have developed a negative view of e-cigarettes because of the heavy emphasis public health organizations have placed on protecting kids from vaping while ignoring the potentially substantial benefits of e-cigarettes in helping adults quit smoking. The article is published online in the American Journal of Public Health.

    In an interview with Michigan News of the University of Michigan, Warner discusses why the group, all of whom have presided over the top tobacco research society in the world, decided to take on this issue.

    What prompted this group to write this article?

    In my 45 years in the field of tobacco control research, I’ve never seen an issue that is as divisive as this one, and maybe none that is as important to public health. We have a large group within public health who are very much opposed to vaping because they see it as imposing huge risks on kids. On the other end of the spectrum, we see a number of researchers and members of the vaping community who believe that vaping is a great tool for helping people to quit smoking and that it is far less hazardous than smoking. These polar opposite views have created much of the contention within the tobacco control community.  

    Our goal in this paper is to try to inject some sense of balance, to get public health organizations, the media and legislators to recognize that their appropriate but singular desire to keep e-cigarettes out of the hands of kids may actually be harming public health. Policies oriented exclusively toward protecting kids may be responsible for more adults smoking than would be if we had policies that also emphasized helping adults to quit with vaping, and frankly, if we had honest characterizations of the risks of vaping.

    Exaggerations of the risk have led a majority of Americans, including a majority of smokers, to the erroneous belief that vaping is as dangerous as, or more dangerous than, smoking. The National Academies of Science, Engineering and Medicine has determined that vaping is likely substantially less dangerous.

    What do you want people to take away from the AJPH article?

    We call for a rebalancing of society’s consideration of vaping and specifically for more attention being paid to its potential to increase smoking cessation. We should continue working to decrease young people’s use of e-cigarettes—of all nicotine products, for that matter—but we must increase our focus on adult smokers.

    In the article, my colleagues and I express concern that we have forgotten about the adults who are going to die as a consequence of smoking. We lose 480,000 Americans every year as a result of smoking. Understandably and justifiably, all Americans were enormously concerned by the toll of Covid-19 this past year. Consider that we have a Covid-level disaster created by smoking every year, year after year after year.

    How would you characterize the risks associated with e-cigarettes? What are the potential benefits of vaping for adult smokers?

    Vaping is clearly not risk-free, but it is also substantially less dangerous than cigarette smoking. Inhaling combusted tobacco smoke, which includes over 7,000 chemicals, is what causes the disease and death associated with tobacco use.

    Multiple types of evidence, identified in our article, demonstrate that vaping can increase smoking cessation. The highly respected Cochrane Review has concluded that it is likely that vaping is more effective than FDA-approved nicotine-replacement products like gum and patches. The CDC has also found that more smokers use e-cigarettes than other aids in attempts to quit smoking—and with a higher self-reported success rate.

    Still, the public is largely unaware of the potential vaping has to aid in smoking cessation. As I mentioned previously, a majority of adults, including a majority of smokers, believe that vaping is as dangerous as, or more dangerous than, cigarette smoking. This misunderstanding has actually worsened over time. That reflects, in part, the media’s coverage of vaping.

    A recent study cited in our article found that 70 percent of U.S. news coverage on vaping mentioned vaping’s risks to kids while only 37 percent noted the potential benefits for adult smokers. As such, it’s likely that fewer smokers are trying e-cigarettes as a method of quitting smoking than would be the case if they were accurately informed about its potential to help them quit and its smaller health risk compared to smoking. That means fewer people are quitting smoking.

    Put simply, research shows that the potential benefits of vaping for adult smokers are substantial. Those benefits are not being fully realized in today’s environment of misinformation and a singular focus on the welfare of kids, to the detriment of the health of adults who smoke. 

    What is known about the risks of youth e-cigarette use?

    Vaping does have risks for kids, including the potential of addicting some to nicotine. But in our article, we point to evidence that the percentage of kids being addicted to nicotine by vaping is much smaller than popularly believed.

    We also note that while prospective studies have found that vaping by kids who had never smoked increases their risk of trying cigarettes 6–24 months later, much of this may be explained by what is called “common liability,” meaning that kids who try e-cigarettes are more prone to risk-taking than are kids who don’t vape, so the former may be more likely to try cigarettes anyway, even if e-cigarettes had never existed.

    Further—and very importantly—even if there is an increased risk, doing the math indicates that this factor would increase overall smoking initiation by kids by only a very small amount. However, even that seems unlikely since we’ve seen smoking rates fall among young people (both adolescents and young adults) at unprecedented rates precisely during the period of vaping’s ascendancy. That certainly is not consistent with the idea that vaping increases smoking.

    Why has e-cigarette use in adults not been a focus in policy or the media?

    First, the concern for young people’s welfare is a compelling one, and the rapid increase in youth vaping in 2018 and 2019 understandably created a great deal of anxiety. The focus on youth drowned out attention to the welfare of adults who smoke. Youth vaping decreased significantly in 2020. We will have to monitor future years’ trends closely.

    Second, I think a lot of people may believe that the problem of smoking is pretty much resolved. I’m referring mainly to the higher education, upper socioeconomic status population. They don’t smoke, their friends and colleagues don’t smoke, there’s no smoking in their workplaces, and there’s no smoking in the restaurants and bars that they frequent. They don’t see smoking and thus may believe the problem has largely been solved.

    And yet one out of seven adult Americans is a smoker today. When we take a look at who’s smoking, it’s the underprivileged members of our society, those who don’t have a voice in politics. African Americans as a group, although they don’t smoke more, have higher rates of smoking-produced disease and death than do [white individuals]. There are groups like low socioeconomic populations, people with mental health problems and the LGBTQ community that all have higher than average smoking rates.

    My fear, frankly, is that many nonsmokers are ignoring smokers because they may not care that much about them. There is a very large life expectancy differential between the rich and the poor in the United States, and perhaps the single most important behavior-related variable is differences in smoking. The data show that low-income, low-education populations smoke at much higher rates than the high-income population, and they die at much younger ages. If we could reduce smoking among these often marginalized populations, we might be able to reduce the gap in life expectancy. This is fundamentally a matter of social justice.

    What are some policy changes that might help achieve a more balanced approach to e-cigarettes?

    Currently, we have very unbalanced policies that are directed exclusively at trying to reduce youth vaping. Two of the most prominent are eliminating or seriously restricting flavors in e-cigarettes and trying to equalize the taxation of e-cigarettes and cigarettes. Both of these policies can have adverse consequences for adult smokers. Adult smokers like flavors just like kids do, and in fact, they tend to like the same flavors.

    Banning flavors would eliminate adult smokers’ access to the flavored e-cigarettes that they prefer in attempts to quit smoking. So that’s a real concern. We propose restricting the sale of e-cigarettes to adult-only establishments, such as vape shops. This is a compromise—flavors are a significant attraction to vaping for kids, and our recommended policy would not eliminate flavors; at the same time, the policy would restrict access for adults, thereby creating an inconvenience for them. But this policy would strongly limit youth access to flavored e-cigarettes while allowing adults to get the flavored e-cigarettes they want to aid in their attempts to quit smoking.

    We also suggest a substantial increase in excise taxes on cigarettes and other combusted tobacco products, and a much more modest tax on e-cigarettes. This is the opposite of what is happening now, with states imposing “equalizing” taxes on e-cigarettes without raising taxes on cigarettes. Significantly raising the tax on cigarettes will discourage both adults and kids from smoking. A big differential in price between very expensive cigarettes and less expensive e-cigarettes creates an incentive for adults who don’t quit smoking to switch to e-cigarettes. For kids, a modest tax on e-cigarettes will discourage them from vaping because they’re the most price-sensitive group when it comes to nicotine and tobacco products.

  • Study Debunks Link Between Heart Attacks and Vaping

    Study Debunks Link Between Heart Attacks and Vaping

    Vaping products are not associated with increased heart attack incidence among people without a history of smoking combustible cigarettes, according to a new study. Published in the American Journal of Preventive Medicine, researchers also concluded that three previous studies claiming a link between e-cigarettes and heart disease wrongly included those who previously smoked cigarettes or were using both vaping and combustible products. One paper even included participants who had heart attacks before they had ever vaped.

    “Previous researchers confused their own models’ assumptions that these risks were independent with the idea that their analyses validated the presence of independent risks,” the researchers wrote. “There is no reliable evidence that e-cigarette use is associated with ever having had a myocardial infarction among never smokers.”

    Authored by Michael Siegel, a community health sciences professor at Boston University, and University of California, Berkeley, business professor Clayton Critcher, analyzed data from 175,546 respondents to the annual National Health Interview Survey from 2014 to 2019. They found that daily e-cigarette use was only associated with higher heart attack incidence among people who were also currently smoking combustible cigarettes (duel users)—and that there was no evidence at all for increased risk among vapers who had never smoked combustible cigarettes.

    Credit: NDABCREATIVITY

    The researchers state that the initial study had drawn its conclusions about a perceived cause (vaping) and effect (heart attack) without factoring in a key variable (smoking). Critcher and Siegel acknowledge that a more thorough analysis of previous research would have noted that e-cigarettes are relatively new, limiting the ability to assess long-term health effects and make comparisons with combustible tobacco smoking, in an article with Filter. However, the findings of previous research that e-cigarette use in of itself causes heart attacks is fundamentally flawed.

    A 2018 study, also published in the American Journal of Preventive Medicine, claimed that daily vapers increased their odds of heart attack. However, the study only included participants who used both e-cigarettes and combustible cigarettes—none who used e-cigarettes alone. Suspicious of that methodology, a different group of researchers published a reply, arguing the importance of examining the purported link among people who had never smoked combustible cigarettes. Authors of the original study then published a reply to that reply, arguing that such a distinction wasn’t necessary.

    In the meantime, two (one, two) other papers were published based on the original paper’s claims, lending further harmful legitimacy to the idea of a link between e-cigs and heart attacks, according to Kevin Garcia writing for Filter.

    The second of those two papers was coauthored by the former prominent tobacco harm reduction opponent Stanton Glantz. It was retracted in 2020 for basing its claim that vaping caused heart attacks on evidence that included heart attacks from before the participants had even started vaping. Three weeks after the American Heart Association’s journal retracted the vaping study, academics and health experts began pushing for another influential peer-reviewed medical journal to retract another Glantz study.

  • Abdicating Responsibility

    Abdicating Responsibility

    Credit: Lisa F. Young

    Divisive WHO report encourages countries to adopt harsh anti-vaping and anti-harm reduction positions.

    VV Staff Report

    By making demands for prohibitive curbs on the sale and use of electronic nicotine-delivery systems (ENDS), experts say the World Health Organization has declared war on tobacco harm reduction and the vaping industry. In its latest biannual report, WHO Report on the Global Tobacco Epidemic, 2021: Addressing New and Emerging Products, the global health agency’s director-general, Tedros Adhanom Ghebreyesus, stated that countries must remain vigilant to the risks presented by e-cigarettes and heated-tobacco products.

    “While framing these products as a contribution to global tobacco control, the tobacco and related industries employ the same old marketing tactics to promote new tools to hook children on nicotine and circumvent tobacco legislation,” he writes. “At the same time, they continue to fight measures and legislation designed to protect people from the many harms of tobacco across the globe.”

    In response to the report, Jamie Hartmann-Boyce, senior research fellow in health behaviors at the University of Oxford, said the WHO report’s view that vaping is “harmful” will wrongly concern vapers who have switched over from combustibles and dissuade smokers considering making the switch. He states that, while e-cigarettes are not risk free and people who do not smoke should not start vaping.

    “Nicotine is addictive, but it’s not what causes the harm from smoking. Evidence shows e-cigarettes with nicotine can help people quit smoking and that they are considerably less harmful than smoking,” he states. “The latest report from the WHO should not discourage people who smoke from switching to an alternative product—one which evidence shows is less harmful to them and those around them.”

    While the report found that more than four times as many people are covered under WHO-recommended tobacco control measures than in 2007, it expressed concern that children who use ENDS products are up to three times more likely to use tobacco products in the future. “Nicotine is highly addictive. Electronic nicotine-delivery systems are harmful and must be better regulated,” Ghebreyesus said.

    Writing for InsideSources, Lindsey Stroud, a policy analyst with the Taxpayers Protection Alliance, states that the recently released WHO report is full of both alarmism and misleading information. Just six pages into the report, for example, the WHO asserts that youth who use e-cigarettes can double their risk of smoking combustible cigarettes.

    “There is zero evidence to support this. According to data from the Centers for Disease Control and Prevention, in the United States, smoking rates among young adults are at their lowest levels with 11.9 percent of American adult smokers being between 18 to 24 years old in 2019. Conversely, in 2009, 22.5 percent of smokers were young adults,” she writes. “The report also fails to acknowledge harm reduction. In 212 pages, ‘harm reduction’ is mentioned a total of four times, and when mentioned, the WHO paints a picture that tobacco companies are using the concept to promote the use of their products and such marketing is ‘undermining successful tobacco control initiatives.’ If tobacco control measures were effective, smokers would not have developed the modern electronic cigarette.”

    This is the first time that this WHO report has included data on ENDS. It states that a total of 111 countries regulate ENDS in some way. The report found that 32 countries (covering 2.4 billion people) have banned the sale of ENDS and an additional 79 have adopted at least one partial measure to prohibit the use of ENDS products in public places, prohibit their advertising, promotion and sponsorship, or require the display of health warnings on packaging. “This still leaves 84 countries where they are not regulated or restricted in any way,” according to the WHO.

    In the report, Ghebreyesus states that in places where e-cigarettes are not banned, “governments should adopt appropriate policies to protect their populations from the harms of electronic nicotine-delivery systems and to prevent their uptake by children, adolescents and other vulnerable groups.”

    The European Tobacco Harm Reduction Advocates (ETHRA), a group that advises on harm reduction policies, stated that while previous WHO reports were hostile toward ENDS products, the latest report “ramps up the rhetoric” and has transformed into an “all-out attack” on nicotine.

    “The report states that progress has been made in the fight against tobacco but adds that there is a need to ‘tackle threats posed by new nicotine and tobacco products,’” the group wrote. “In an attempt to justify their calls for prohibitionist measures such as flavor bans and all out bans, the report makes unfounded claims that safer nicotine products are a gateway to smoking for youth and that their purpose is to ‘hook another generation on nicotine.’ The WHO’s dangerous position on tobacco harm reduction must be resisted in the strongest possible manner.”

    Credit: Oleg Kachura

    John Britton, emeritus professor of Epidemiology at the University of Nottingham and chair of the group that released the landmark 2016 Public Health England report that found e-cigarettes to be 95 percent safer than combustibles, said that the WHO does not comprehend the fundamental difference between addiction to tobacco smoking, which kills millions of people every year, and addiction to nicotine, which does not.

    “The WHO is also evidently still content with the hypocrisy of adopting a position which recommends the use of medicinal nicotine products to treat addiction to smoking but advocates prohibition of consumer nicotine products, which do the same thing, but better,” said Britton. “The WHO is right that nonsmokers, especially children, should be discouraged from using any nicotine product. But for the more than 1 billion tobacco smokers in the world, electronic nicotine-delivery systems are part of the solution, not the problem.”

    Rudiger Krech, the WHO’s director of health promotion, said that the challenges associated with ENDS regulation are hugely diverse and are evolving rapidly. Some devices are modifiable by the user, making nicotine concentration and risk levels difficult to regulate. Products have also been found to be marketed as nicotine-free but, when tested, are found to contain nicotine.

    “Distinguishing the nicotine-containing products from the non-nicotine, or even from some tobacco-containing products, can be almost impossible,” he stated. “This is just one way the industry subverts and undermines tobacco control measures.”

    One of the major controversies surrounding the report is that it was funded by Bloomberg Philanthropies, a foundation created by American billionaire and former New York City mayor Michael Bloomberg. Not coincidentally, Bloomberg was appointed the WHO global ambassador for noncommunicable diseases and injuries, a largely honorary title granted in recognition of the dollars his foundation spends on fighting nicotine policy from small cities to large countries.

    “More than 1 billion people around the world still smoke,” Bloomberg stated in a release. “And as cigarette sales have fallen, tobacco companies have been aggressively marketing new products—like e-cigarettes and heated-tobacco products—and lobbied governments to limit their regulation. Their goal is simple: to hook another generation on nicotine. We can’t let that happen.”

    Stroud stated that while the report was supported by Bloomberg Philanthropies, the report also strangely states that the report “should not be regarded as reflecting the position” of Bloomberg Philanthropies. “Yet, the report reads like a Christmas in July wish list for a Bloomberg-created anti-tobacco regime, she writes. “[While mayor of New York City] … in late 2019, on top of the $1 billion Bloomberg had already donated to anti-tobacco groups and efforts, the former mayor announced a $160 million campaign to ‘fight flavored e-cigarettes.’”

    Knowledge-Action-Change (KAC), a private sector public health agency, condemned the WHO and “its single most significant funder for anti-smoking efforts, U.S. billionaire Michael Bloomberg,” for using the report to distract from “years of failure” in the fight against combustible tobacco.

    “Unable to demonstrate that its tobacco control strategy has resulted in meaningful outcomes—the most important of which would be substantial declines in smoking—the WHO focuses instead on how many countries implement its ‘MPOWER’ measures,” according to a press release. “On closer inspection, even progress on the MPOWER measures is underwhelming. The WHO reports that 104 countries have introduced ‘one or more MPOWER measures at the highest level of achievement’ since 2007 but also states that 41 of the 49 countries that have not implemented a single measure are [low- and middle-income countries].”

    MPOWER stands for: Monitoring tobacco use and preventive measures; Protecting people from tobacco smoke; Offering help to quit; Warning about the dangers of tobacco; Enforcing bans on advertising, promotion and sponsorship; and Raising taxes on tobacco. More than half of all countries and half the world’s population are now covered by at least two MPOWER measures at the highest level of achievement. This reflects an increase of 14 countries and almost one billion more people since the last report in 2019.

    In the U.K., a group of lawmakers expressed concern over the influence exerted by Bloomberg Philanthropies on tobacco regulation policies, especially in low- and middle-income countries (LMICs). In a separate report, the U.K.’s All-Party Parliamentary Group for Vaping Inquiry (APPG) stated that The Union, another group funded by Bloomberg Philanthropies, as well as other anti-vaping nongovernmental organizations (NGOs) should not be permitted as “civil society observers” to the Framework Convention on Tobacco Control Conference of the Parties 9 (FCTC COP 9) meeting, which will dictate tobacco policies in LMICs are “hostile to the concept of tobacco harm reduction and thus the U.K.’s policy approach.”

    The report has already begun to impact tobacco policy in LMICs. Shortly after its publication, Ukrainian lawmakers passed a new law after the WHO released its report that prohibits the use of ENDS in public places as well as advertising, sponsorship and promotion of e-cigarettes in the country. The law also bans the sale of flavored e-liquids other than tobacco flavors.

    The parliamentarians said that justification for the regulations was based on the WHO’s new report that “suggests e-cigarettes are a gateway to smoking and that they are as harmful as conventional cigarettes,” according to the Independent Women’s Forum. Lawmakers also claimed the flavor ban would reduce underage vaping in Ukraine, while data from the U.S. concerning flavor bans has showed banning flavors actually increases youth use of combustible products.

    Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) stated that the WHO’s latest attack on safer nicotine products deserves the global ridicule it has attracted. She says that the organization charged with looking after public health continues to ramp up its efforts to deny smokers access to products that can help them quit.

    “Consumer advocates are increasingly angry that the WHO continues to promote its baseless and incredibly destructive view on vaping,” she said. “It comes despite leading scientific evidence confirming vaping is at least 95 percent less harmful than smoking and is the world’s most effective smoking cessation tool.”

  • Industry Experts Look Back on the PMTA Process

    Industry Experts Look Back on the PMTA Process

    Credit: Pressmaster

    As the FDA’s deadline to approve marketing applications nears, industry experts look back on the submission process.

    By Chris Howard and Rich Hill

    It’s been nearly a year since many of us filed premarket tobacco product applications (PMTAs) to the U.S. Food and Drug Administration for new tobacco products, so now seems like a perfect time to reflect on what we took away from the experience. Below you will find a Top-10 list of learnings from the front line.

    1. Everyone (and no one) is an expert.

    From day one, we worked with dozens of consultants, researchers, similarly situated companies, regulators, outside counsel and other stakeholders. Which groups provided the most insight?

    Answer: It certainly wasn’t the ones who claimed to definitively know everything about a particular facet of the PMTA. Rather, we felt most confident when working with those who acknowledged the inherent uncertainty in the process. The ability to speak candidly with these individuals enabled us to collaborate to best achieve our goals of meeting FDA expectations. We learned the least from those who “guaranteed” us security or made promises about what the FDA needs/wants.

    2. The FDA is not the enemy.

    Believe it or not, the agency isn’t out to get you. The Center for Tobacco Products (CTP) is not maliciously trying to ensure that all applications for new tobacco products are denied. Despite what you read from frustrated vapers on Twitter, the team at the CTP is doing what they are required to do—assessing whether new tobacco products are appropriate for the protection of public health.

    Yes, it is expensive and requires a lot of work to meet this standard, but collaborating with the FDA is a much better approach to achieving this goal compared to taking an adversarial posture. If a combustible cigarette can receive a market order, then there is clearly a path for modern oral products and electronic cigarettes to do the same.

    3. Money talks. 

    Unfortunately, not too many shortcuts are acceptable when it comes to a PMTA, so as a result, the entire process is expensive. While you can reduce your spend by seeking discounts, collaborating with others, etc., the fact remains that you will need to make a substantial investment in this work.

    Throughout the process, we sought the best deals without sacrificing quality and looked for ways to reduce costs wherever we could, but we still spent a significant sum for our product applications. The greatest potential PMTA cost savings really begins with what products you intend to put through the process. Doing a full, scientifically sound PMTA for 1,000 stockkeeping units (SKUs) is not realistic. Make hard choices about your products in the beginning and pare your list down—this will generate your greatest cost savings.

    4. Not all labs are created equal. 

    This may seem obvious, but just because a lab is certified, has a slick website and talks a good game doesn’t mean they have the scientific rigor or physical capacity to complete your project. Many labs jumped into the “PMTA testing game”—but the solid labs delivered on time and provided scientifically sound methods and results. How do you choose a solid partner?

    Answer: Seek out laboratories that have a reputation working with your products. They don’t have to be the biggest, but they need to be experienced with the testing you are seeking. Audit them with external consultants. Do they have sufficient equipment and personnel to handle the throughput you need to finish on time (especially with competing client demands)? Ultimately, you get what you pay for. You can go to the cheapest labs, but there is no guarantee that you will get results on time or on target.

    5. No kids allowed.

    This goes without saying, but vapor products are obviously for adults only. We are all aware of the concerns regarding youth usage of vapor products, and you can be sure that the FDA places a priority on this topic. Take the time to describe the practices you employ to deter youth usage of your products.

    Don’t try to guess the minimum you need to do to achieve the goal. Rather, show the FDA that you are willing to spare no expense when it comes to this issue. We drafted company marketing standards and have shared them industrywide to encourage others to adopt the same.

    6. The perfect is the enemy of the good.

    A premarket tobacco application for a handful of SKUs can consist of tens of thousands of pages. Given this, we can confidently say that forgetting to indent a paragraph is not going to be determinative in whether the FDA ultimately decides to grant you a market order.

    Details obviously matter, but prioritize conveying your message(s) clearly by prioritizing substance over form. A misplaced semicolon isn’t going; to make the difference.

    7. Tell your story.

    Which story matters the most? Is it what you read this morning online about Juul and kids?

    Answer: No, the FDA isn’t evaluating your application based on what others in the industry are doing. Your application is the opportunity to tell the story of why your products are appropriate for the protection of public health. Don’t be consumed by details about what is going on with other products.

    8. From here to there 

    Finding a publishing partner that can handle your application is critical. Not all electronic publishers do large-scale projects. Many publishers want more time for loading and checking your application than you realistically can afford. Some publishers work with 20–30K pages exclusively (which doesn’t work as most PMTAs far exceed that page count).

    Clearly communicate your timelines and ensure that your publisher’s project management teams can meet expectations. Because it’s the final step in the submission process, publication is naturally a bit of a scramble—which makes it prone to errors. Develop a dedicated quality control process so that you can confirm that your publisher submitted your complete application.

    9. It’s not over until it’s over.

    You will undoubtedly feel a sense of relief following the submission of your application, but we caution you to keep your eye on the prize. The FDA will inevitably have questions about your products in the form of a deficiency letter, so you need to stay focused on responding with the detail required.

    These questions will come with deadlines, so do not wait until the last minute to prepare your response. Nothing would be worse than fumbling the ball at the goal line.

    10. Uncertainty is the only certainty.

    Anyone working in the vapor industry during the past five years knows exactly what I am talking about. The PMTA process is effectively in its infancy and, as such, several variables are subject to change. Is this a reason to give up on harm reduction and your individual goal of securing a market order?

    Answer: No. Embrace the changes as they arrive and do your part to help the FDA develop a clear path forward for your future applications. This evolving regulatory environment provides an opportunity for you to help shape changes. Those who back away won’t have this luxury.

    Chris Howard is the vice president, general counsel and chief compliance officer of E-Alternative Solutions, an independent, family-owned innovator of consumer-centric brands. Rich Hill serves as regulatory compliance director for E-Alternative Solutions.

  • An Error in Judgment

    An Error in Judgment

    A new Yale University study shows that flavor bans cause an increase in underage smoking.

    By Maria Verven

    A new study by the Yale School of Public Health suggests that San Francisco’s ban on sales of flavored tobacco products may have substantially increased smoking among minors. When San Francisco voters approved a ban on the sale of flavored tobacco products, including menthol cigarettes and flavored e-liquids in 2018, public health groups prematurely celebrated another “win” in their battle to reduce teenage vaping.

    Now advocates of the ban must come to terms with the fact that the flavor ban, and most likely similar flavor bans around the world, are inextricably tied to significant increases in teenage smoking rates. According to the study, the odds that high school students would start smoking conventional cigarettes doubled in San Francisco’s school district after the ban was put into effect when compared to districts that didn’t implement a flavor ban, even when adjusting for individual demographics and other tobacco policies.

    A Threat to Public Health

    Published in JAMA Pediatrics in May 2021, the sole author of the study, Abigail Friedman, associate professor in the Department of Health Policy and Management at the Yale School of Public Health, said the study is the first to assess how complete flavor bans affect youth smoking habits. “These findings suggest a need for caution,” she said. “Even if it is well-intentioned, a law that increases youth smoking poses a threat to public health.”

    Before the ban was implemented, smoking rates in school districts in and around San Francisco were on the decline. Using data on over 95,000 youth from the Youth Risk Behavior Surveillance System’s 2011–2019 school district surveys, Friedman compared trends in smoking rates in San Francisco versus other districts. The findings revealed a glaringly large discrepancy after the flavor ban went into effect. In 2019, San Francisco’s smoking rates rose to more than twice the average of school districts without a flavor ban. In those districts, smoking rates among youth continued to fall.

    E-cigarettes—and particularly those with flavors—have been the most popular tobacco product among U.S. youth since at least 2014. “Some kids who vape choose e-cigarettes over combustible tobacco products because of the flavors,” Friedman said. “For these individuals, banning flavors may remove their primary motivation for choosing vaping over smoking, pushing some of them back toward conventional cigarettes.”

    Michael Siegel, professor in the Department of Community Health Sciences at Boston University School of Public Health, said society is at a critical juncture with regard to youth smoking. “It has plummeted to record lows and on top of that, a culture of vaping has completely replaced the culture of smoking,” he said. “The policies enacted in the next year could likely decide what happens next.”

    Huge Policy Implications

    Credit: JAMA Pediatrics

    The results of the Yale study should have huge implications for other states and even other countries when deciding to ban flavored vapes. According to the National Conference of State Legislatures, five states—California, Massachusetts, New Jersey, New York and Rhode Island—have implemented laws banning flavored electronic nicotine-delivery systems (ENDS), and at least 310 localities have passed restrictions on menthol cigarettes and/or flavored tobacco products (including e-liquids), although these laws vary widely.

    The U.S. Food and Drug Administration implemented a partial ban on the sale of flavored closed-system e-cigarette products in January 2020. The FDA ban exempts menthol and tobacco flavor as well as open tank vaping systems, which tend to be sold in vape shops where age restrictions are more often enforced.

    Members of Congress have been pressuring acting FDA Commissioner Janet Woodcock to ban all flavored e-cigarettes, maintaining that flavors are attracting youth to ENDS products. Woodcock has not indicated whether the agency has plans to ban or otherwise limit the sale of flavored vapes, but a decision could be made this fall.

    When asked to comment on the trend that youth use of cigarettes was declining while their use of ENDS products was on the rise, former FDA Commissioner Scott Gottlieb said the trends are not acceptable, even if they are moving in a more positive direction of reduced overall use of tobacco products. “Even if kids are using ENDS [products] instead of cigarettes—and that migration in part accounts for the decline in youth [combustible] cigarette use—that’s still not an acceptable trade,” he said.

    Clive Bates, a tobacco harm reduction expert and former director of Action on Smoking and Health U.K., called this argument outrageous, adding that just because a regulatory agency believes young people should not smoke or vape does not mean that is how it plays out in the real world. “Public health is about dealing with the world as you find it—not giving instructions to people who are not listening, uninterested in your views and unimpressed by your authority,” said Bates. “But that doesn’t mean a regulator is absolved of responsibility for the consequences (good or bad) of its actions.”

    Since Gottlieb essentially said that the FDA doesn’t care if vaping is helping to reduce smoking, Bates says the FDA is ignoring a big public health benefit that has been a goal of U.S. policy for decades. “The dangerous corollary is [that] the FDA doesn’t care if their anti-vaping measures increase smoking among adolescents. That’s what is so despicable about this lofty attitude—it’s an indifference to the group most at risk,” Bates said. “Yet the FDA doesn’t care if vaping works as an alternative to smoking for adolescents—and this is deeply unethical.”

    Generally, regulators do not allow adolescent experimentation to bend adult society and legitimate choices out of shape, especially if these are beneficial to adults, according to Bates. “It should not be taken as a given that adult products that appeal to adolescents should be banned. For many, it is part of being a teenager to sample the forbidden fruits of adulthood,” Bates explains. “We don’t respond to youth experimentation by banning other potentially harmful adult products like alcohol or cannabis just because adolescents use them,” Bates said. “Though it has risen sharply, vaping is not out of the ordinary compared to the prevalence of other risk behaviors. But crucially, it does not actually pose much risk.”

    Decisions That Kill

    In June, Health Canada admitted in a regulatory impact statement that its intended flavor ban could lead to an increase in the smoking rate. David Sweanor, an industry expert and chair of the advisory board for the Centre for Health, Law, Policy and Ethics at the University of Ottawa, said that the Health Canada statement is basically saying Canadian regulators know they are going to do something that kills Canadians.

    “Countries that simply allow alternatives, even without actively facilitating substitution, are seeing dramatic declines in cigarette sales,” Sweanor said, citing Japan, where cigarette sales over the past five years declined at a very rapid pace—far greater than declines in other countries, including the U.S. “I think the biggest constraint on progress is a lack of understanding of the magnitude of substitution effects. To dramatically reduce the use of lethal cigarettes, we need products that are less hazardous and evidence that consumers will switch to them in sufficient numbers to justify substitution as a policy intervention.”

    Sweanor said efforts that show the extent of substitution effects are blocked by the absence of funding for such research, obstruction from the anti-vaping moralists and those pursuing a “tobacco-free world” agenda. He also believes that tobacco companies may be reluctant to release sales and consumer research data that would bolster policies designed to undermine their lucrative cigarette business. “Jurisdictions that allow viable alternatives to cigarettes, where such products are as accessible as cigarettes and consumers aren’t given misleading information on relative risks, will see far more rapid declines in smoking,” Sweanor said.

    Friedman said the findings from her study strongly suggest that policymakers should be careful not to inadvertently push minors into using the more harmful product. When asked to suggest an alternative policy, she suggested that states consider restricting all tobacco product sales to adult-only (21-plus) retailers. “This would substantively reduce adolescents’ access to tobacco products at convenience stores and gas stations without increasing incentives to choose more lethal combustible products over noncombustible options like e-cigarettes,” she said. 

    Sweanor added that good policies are contagious and would be replicated. “I am confident that science and rationality combined with consumer advocacy will ultimately win,” he said. “Unfortunately, those opposing such policies can cause lengthy delays, which can result in a tragic and avoidable loss of life.”

    Science, Reason and Humanism

    Abigail Friedman, PhD

    Seigel says that there is hope that the Yale study impacts future decisions regarding flavor bans; however, the mainstream anti-tobacco groups are not going to publicize the study because it goes against their preordained conclusions. “If flavor bans are widely adopted, I suspect that many youth who are experimenting with vaping will switch over to cigarette smoking and some will use THC vapes off the black market,” he said. “In contrast, with sensible policies that restrict e-cigarette availability to youth while allowing adult smokers to continue to access them, I think we could drive youth smoking pretty much into the ground—perhaps to a level from which it could never recover.”

    Bates questioned how regulators and lawmakers alike could continue with confidence in implementing flavor bans after seeing the results of the Yale study. He added that he seriously questions whether legislators will admit that the ban was a bad idea and reverse course.

    “It may put the brakes on some of the worst policy mistakes,” he said. “It’s what many of us have been saying should be expected from a flavor ban. But legislators hate to admit they were wrong, so it will probably lead to calls for tougher enforcement and anti-smoking campaigns rather than realizing that the whole idea is wrong.”

    In jurisdictions where viable alternatives to combustible cigarettes are made available, data has shown that the rates of combustible cigarette smoking among youth and young adults is plummeting, according to Sweanor. “More importantly, we are seeing longer term cigarette smokers whose lives are truly on the line, substituting low-risk alternatives,” he said. “People’s response to research depends on motivations. There is a very long and frustrating history of reduced-risk alternatives to cigarettes being attacked by those on a moralist quest to rid the world of nicotine.”

    Vaping products are attacked based on accusations about formaldehyde, popcorn lung, e-cigarette or vaping use-associated lung injury (EVALI), cognitive impairments and a seemingly endless list of other supposed hazards, Sweanor explained, adding that these arguments are ultimately shown to be meritless, but vaping opponents never admit to being wrong.

    “Such behaviors are hallmarks of conspiracy theorists and those seeking to use the power of the state to impose their moral views on the behavior of others. But where lawmakers are open to science, reason and humanism, studies such as this … [Yale study] are very important,” said Sweanor. “Public health breakthroughs are possible when rational lawmakers get past the panics caused by the moralists. We are staring an historically significant public health breakthrough in the face. The sooner lawmakers recognize this, the sooner we can relegate cigarettes to history’s ashtray.”

    The original “Vaping Vamp,” Maria Verven owns Verve Communications, a PR and marketing firm specializing in the vapor industry.

  • Smok Parent, IVP Technology, Considering Hong Kong IPO

    Smok Parent, IVP Technology, Considering Hong Kong IPO

    Smok is one the most well-known and respected hardware manufacturers in the vaping industry. Now, Shenzhen IVPS Technology, the firm behind the brand Smok, is considering an initial public offering to raise at least $500 million in Hong Kong as soon as next year, people with knowledge of the matter said.

    According to a Bloomberg report, the company is working with a consultant in preparation for a potential share sale, said sources who asked not to be identified as the information is private. The offering could raise between $500 million and $1 billion. Deliberations are at an early stage and details of the potential offering such as timing and size may change, the people said. IVPS didn’t immediately respond to requests for comment.

    Smoore International Holding’s stock (HK: 6969), parent to the Vaporesso, FEELM and CCELL brands, grew by nearly 150 percent on its opening day of trading on the Hong Kong Exchange. However, after China’s Ministry of Industry and Information Technology proposed a draft regulation in March that would apply the same rules for the conventional tobacco industry to the e-cigarette sector, shares of several Chinese e-cigarette companies plunged and Smoore shares are down about 40 percent this year.

    While rising regulatory scrutiny of the vaping industry could impact investor appetite for listings in the sector, according to the article. IVPS could be less affected because it makes the device rather than the e-cigarette liquid, one of the sources said. However, Smoore also produces hardware and shares still fell after the Chinese government’s regulatory announcement.

  • RLX Revenue Growth Slows Amid Regulatory Uncertainty

    RLX Revenue Growth Slows Amid Regulatory Uncertainty

    Photo: RLX Technology

    RLX Technology revenue slowed in the second quarter of 2020 amid uncertainty about the regulatory environment in China.

    Net revenues were RMB2.54 billion ($393.6 million), representing an increase of 6 percent from RMB2.4 billion in the first quarter of 2021. The improvement was due primarily to an increase in net revenues from sales to offline distributors, which was mainly attributable to the expansion of the company’s distribution and retail network.

    The company believes that the slowdown in quarterly sequential revenue growth was due primarily to external factors, including negative publicity on the vapor industry in the latter half of the second quarter, coupled with the fact that the draft new rules for vapor products announced by China on March 22, 2021, have not been formally confirmed and no new implementation details had been revealed, which had an adverse impact on sales.

    The company is also target of a lawsuit by investors who claim RLX Technology overstated its financials and misrepresented potential regulatory risks when it filed the paperwork for its initial public offering in the U.S.

    Gross margin was 45.1 percent compared to 46 percent in the first quarter of 2021.

    “In the second quarter of 2021, our business continued to develop as we increased our efforts to further improve underage protection and product safety,” said Ying (Kate) Wang, co-founder, chairperson of the board of directors and CEO of RLX Technology, in a statement. “With our strategic focus on technology investment and brand building, we strive to make RELX a trusted brand for adult smokers with state-of-the-art products, industry-leading technologies and scientific advances. Going forward, we will further enhance investments in scientific research, strengthen our distribution and retail network, and improve our supply chain and production capabilities to create more value for our users and shareholders alike.”

    RLX hosted an earnings conference call on Aug. 20, 2021. A live and archived webcast of the conference call is available on the company’s investor relations website. A replay of the conference call will be accessible until Aug. 27, 2021.

  • VPR Brands Reports ‘Turnaround’ in Second Quarter

    VPR Brands Reports ‘Turnaround’ in Second Quarter

    Photo: snowing12

    VPR Brands, a supplier of vaporizers, reported revenues of $1.7 million for the second quarter of 2021, up from $1.2 million in the comparable 2020 quarter.

    The increase was a result of the Covid-19 pandemic, which hampered sales significantly in 2020 and increased direct on-line sales in 2021.

    Operating expenses for the three months ended June 30, 2021, were $457,895, compared to $372,652 for the three months ended June 30, 2020. The increase in expenses is primarily due to increased sales activity in 2021.

    Revenue for the six months ended June 30, 2021, was $2.96 million, compared with $1.8 million in the second quarter of 2020.

    Operating expenses for the six months ended June 30, 2021, were $995,798, compared to $849,476 for the six months ended June 30, 2020. The increase in expenses is primarily due to increased sales activity in 2021.

    Net income for the six months ended June 30, 2021, was $163,135 compared to a net loss of $471,944 for the six months ended June 30, 2020.

    Net income for the three months ended June 30, 2021, was $264,786 compared to a net loss of $50,354 for the three months ended June 30, 2020.

    “The company has finally put the pandemic and other extenuating circumstances behind us and is back on track,” said Kevin Frija, CEO of VPR Brands, in a statement. “The numbers, which show a tremendous turnaround from last year, speak for themselves as our team is focused on maintaining not only steady growth but most importantly profitability.”

  • U.S. Tobacco Control Experts Support ENDS as Quit Aid

    U.S. Tobacco Control Experts Support ENDS as Quit Aid

    A new paper co-authored by a majority of recognized tobacco control experts in the United Sates endorses the harm reduction benefits of vaping for adult smokers trying to quit combustible cigarettes. The group of experts state that the public image of vaping products must be improved and electronic nicotine-delivery systems (ENDS) should be promoted as a safer alternative to combustible cigarettes.

    “Opponents focus on e-cigarettes’ risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths,” the report states. “Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e-cigarettes in quit attempts.”

    The paper, published August 19 in The American Journal of Public Health, was led by Kenneth Warner, a professor emeritus of health management and policy at the University of Michigan and a distinguished tobacco control expert. Fifteen former presidents of the Society for Research on Nicotine and Tobacco (SRNT), the leading scientific professional society focused on nicotine and tobacco, co-authored the paper.

    The authors present four categories of evidence supporting vaping as a quit aid for combustible tobacco use: the results of randomized trials, which show e-cigarettes outperform other cessation methods like nicotine patches; population studies, the findings of which “are consistent with a near doubling of quit attempt success”; cigarette sales, which decrease rapidly as vaping sales increase; and the unintended consequences of policies restricting vaping, such as bans that unintentionally shot up cigarette smoking.

    “The major elements of the public health community that are concerned with tobacco have been singularly focused on the risk to kids,” Warner told Alex Norcia of Filter. “They seem to truly have no interest whatsoever in adult smokers. The other piece is that you’re seeing lots of allegedly scientific papers that are raising health concerns that are unwarranted.” One such paper, which claimed that vaping increased the likelihood of having a heart attack, was later retracted.

    The paper also presents “a sensible mix of policies” to boost ENDS use, including taxing traditional cigarettes higher than e-cigarettes to encourage adult smokers to switch, allowing flavored vaping products available only at vape shops, restricting advertising to limit youth initiation and reducing the nicotine levels in cigarettes while ensuring the availability of “consumer-acceptable” reduced-risk nicotine products.

    “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,” the paper states.