Monday, January 24, 2022

Facts About Safer Smoke-Free Products Are “Somewhere,” But Not at the FDA

 

I recently came upon the FDA website “Nicotine is Why Tobacco Products Are Addictive.”  The section “What Makes Tobacco Use Harmful” starts with partially truthful information: “Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly.” [emphasis in original].

That’s not too bad, although agency officials know that the thousands of deadly chemicals are present only in smoke, not tobacco.  Then they get more specific. 

“Combustible products, or products that burn tobacco, are the most harmful. An example of a combustible product is cigarettes, which deliver more than 7,000 chemicals along with nicotine that makes it hard to quit.

“FDA-approved nicotine replacement therapies (NRTs), such as gums and lozenges, are the least harmful.”

Then it gets awful, as the guidance turns to noncombustible, or smoke-free tobacco products.

“Noncombustible products, such as heat-not-burn tobacco products, smokeless tobacco, and e-cigarettes, fall somewhere in between combustible products and NRTs.”

Somewhere?

The FDA has hundreds of scientists on staff and has funded research by thousands more at universities across America.  This federal agency is responsible for regulating the entire tobacco industry, and it sets precedents for tobacco regulation worldwide.  It claims to act only on the basis of hard science, yet it feigns ignorance about where the risks fall for smoke-free products.

This farcical position is undermined elsewhere on the webpage where the agency acknowledges that “many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes.” 

Those studies do more than suggest.  Britain’s Royal College of Physicians has stated for years that smoke-free products are at least 95% less hazardous than cigarettes – a fact that anti-tobacco zealots consistently ignore.  The FDA’s response is always “more research is needed,” though for this agency, there will never be enough.  Regulators know the facts, but they refuse to share them with smokers and their loved ones as smoker deaths continue to mount.

 

 

Thursday, January 13, 2022

FDA Sets a “Very Low” Bar for Favored Tobacco Products

 

The U.S. Food and Drug Administration on December 23 announced it had “authorized the marketing of 22nd Century Group Inc.’s ‘VLN [Very Low Nicotine] King’ and ‘VLN Menthol King’ combusted, filtered cigarettes as modified risk tobacco products (MRTPs), which help reduce exposure to, and consumption of, nicotine for smokers who use them.  These are the first combusted cigarettes to be authorized as MRTPs…”

I do not understand how these VLN cigarettes will meet the agency’s tough MRTP standard, which requires that products “significantly reduce harm and the risk of tobacco-related disease to individual tobacco users and benefit the health of the population as a whole taking into account both users of tobacco products and persons who do not currently use tobacco products.”

Reducing nicotine will not reduce risk, as nicotine is not the cause of any smoking-related disease.  These products may reduce nicotine to trace levels, but their smoke will still contain thousands of toxins.  Where is the “benefit” to smokers, or to population health?

Mitch Zeller, director of FDA’s Center for Tobacco Products, supported the MRTP certification with unverified cessation claims for the products in the agency’s press release.  Here is what he said (bolding is mine): “data on these products show they can help addicted adult smokers transition away from highly addictive combusted cigarettes…these products authorized today, which contain less nicotine and are reasonably likely to reduce nicotine dependence, may help adult smokers. If adult smokers were less addicted to combusted cigarettes, they would likely smoke less and may be exposed to fewer harmful chemicals that cause tobacco-related disease and death.”

Clive Bates raises another major concern, which I share:

“One of the quite insidious aspects of FDA granting an MRTP order to the 22nd Century very low-nicotine cigarette (VLNC) is the extent to which FDA/NIH has financially supported the company’s application by buying its cigarettes and using independent research organisations and investigators in the United States to provide the evidence to support its case.”

After a search of the NIH funding database with the term “low nicotine cigarette” in the title or abstract, I found 698 projects totaling $286 million.  This does not mean that all of that money was invested in VLNCs, but at the very least it shows that the subject was a buzzword used by researchers to attract considerable federal financial support.

Clive Bates also notes:

“Any other tobacco or vape company would need to present extensive trials that it conducted itself and at its own expense, something that would be prohibitively expensive for most companies.  But not so for 22nd Century.

“FDA and NIH have been extraordinarily generous to [22nd Century]. These public bodies account for almost all of 22nd Century’s reduced-nicotine cigarette sales (there is no significant market for these products other than for research purposes). Not only that, through extensive funding of VLNC research, FDA and NIH have paid for the research base for 22nd Century to make a commercial application, via bridging, for a modified risk claim that is specific to the company and its products (it is not a general claim for the VLNC category). This MRTP order allows it to make actual and implied reduced risk claims for ongoing use of this product.”

The bottom line:  The FDA and NIH are advancing the government’s objective of “create[ing] a world free of tobacco [and nicotine] use” by using hundreds of millions of taxpayer dollars to fund research so that a private company’s cigarettes can be said to satisfy an FDA regulation requiring a benefit to smokers and the general population.

The VLNC MRTP was authorized by the FDA after 31 months of review, while the agency continues to crawl through MRTP reviews for Camel snus (58 months and counting) and Copenhagen moist snuff (46 months and counting).  Research dating back 28 years demonstrates that smokeless products are 98 percent less hazardous than cigarettes.

The FDA's decision to remove nicotine but keep the smoke is not only backwards, the regulator has doubled down on the smoke by failing to authorize the sale of thousands of vapor products already being used by millions of former smokers.  The result is regulatory purgatory at its deadliest.

 

Wednesday, December 1, 2021

The American Medical Association Only Promotes and Protects Doctors, Not Public Health

 

Dr. Gerald E. Harmon, president of the American Medical Association (AMA), authored a commentary November 19 claiming that the “FDA made the wrong choice in allowing Vuse marketing.”

Dr. Harmon said that the FDA’s decision “is wrong on many levels,” but I will show that his commentary better fits that description.

Harmon says that the FDA’s “gravest error is to frame its action as ‘appropriate for the protection of the public health.’”  Gravest error?  Harmon tells his readers in the next paragraph that the FDA had no choice: Congress dictated that precise standard in legislation giving FDA regulatory authority over tobacco in 2009 (here).

Next, Harmon claims that “the role that e-cigarettes may play in smoking cessation strategies is unclear.”  That may be true – for someone who has never looked at federal surveys (here, here and here), never read the scientific literature (here, here and here) and/or never met a former smoker (also called an “anecdote”) (here).    

Incredibly, Harmon cites a recent study from the University of California San Diego involving “smokers who turned to e-cigarettes as a cessation device.”  No.  They.  Didn’t.  As I recently explained in a critique on that study (here and here). 

Then he gets to the core of his commentary: “The AMA has specifically recognized the use of e-cigarettes and vaping as an urgent public health epidemic and has called for a total ban on all e-cigarette and vaping products that do not meet FDA approval standards as cessation tools.” (emphasis added)  In other words, the AMA wants prohibition if the FDA doesn’t regulate e-cigarettes as harshly as it regulates cancer chemotherapy.

Harmon comes up with a claim that will make ever smokers laugh out loud: “Data has shown that using FDA-approved cessation medicine can double a persons [sic] chance of quitting smoking successfully.” 

Double what?  Every year only 5% of smokers quit, so doubling that number makes 10%.  Does Harmon care about the other 90% of smokers who couldn’t quit the AMA way?  I don’t think so.

A lot of Harmon’s rant about Vuse was devoted to “fruit- and candy-flavored” products.  This is strange.  The only Vuse products the FDA authorized are tobacco-flavored.

Why does the AMA, one of the most influential organizations in American medicine, take such a prohibitionist position when 480,000 American smokers are dying prematurely every year?  Well, its influence derives not from its commitment to public health, but from its power as a trade organization.  And trade organizations’ first and foremost goals are to advance the interests of its members.  According to blogger Matthew Yglesias, the AMA actively makes the number of doctors in the U.S. scarce, by blocking increased scope of practice for nurses, making it hard for foreign-trained doctors to practice in the United States, and historically pushing to train too few doctors here at home.  This results in big salaries for doctors and dismal, expensive access to medical care for Americans compared to many other developed countries (see chart below). 

The AMA protects and promotes doctors, it doesn’t care about American smokers.