Wednesday, June 23, 2021

Matt Myers in 2003 and Today: A Pertinacious Tobacco Prohibitionist


Matthew Myers is a founder of the highly influential Campaign For Tobacco-Free Kids (CTFK), where he has served as president for over 20 years (here).  He claims to have “participated in virtually every major US tobacco-related legislative effort” and to have “led the effort that resulted in 2009 in the US Food and Drug Administration being given authority … over tobacco products.”

Myers and his organization are warriors for tobacco prohibition and staunch opponents of all forms of tobacco harm reduction (THR). 

At a 2003 congressional hearing titled, “Can Tobacco Cure Smoking? A Review of Tobacco Harm Reduction,” witnesses included the U.S. Surgeon General, the chairman of the Federal Trade Commission and Myers.  David Sweanor and I testified in support of THR.

Interestingly, Myers actually endorsed THR in his testimony, with a caveat.  He insisted that Congress

“grant the Food and Drug Administration comprehensive regulatory authority over all tobacco products. If we want to do harm reduction based on science, not rhetoric; if we want to make the truism that knowledge is power, then we will insure that there is a government agency that has regulatory authority over the product so that we will know and consumers will know what is in that product; so that we will know and consumers will know truthfully not just what the manufacturers want us to know but the truth, the full truth about the relative harmful effects of those products.” 

This was not an isolated statement.  In his oral and written testimony, he repeatedly expressed support for FDA-supervised THR.  Here is another excerpt:

“A discussion about harm reduction has to begin with a discussion about providing the FDA with the kind of authority that is necessary to protect consumers, verify claims, and require that all reasonable steps are taken to reduce the harm caused to smokers. Is there a role for smokeless tobacco in a comprehensive effort to reduce the death toll from tobacco overseen by the FDA? No one has the information to make that decision today. The FDA should be open to all strategies that are scientifically based and that will save lives. The decision about what role smokeless tobacco plays in that overall scheme is a decision that can only be made by the FDA after it has all of the relevant information before it.” 

Kentucky Congressman Ed Whitfield posed this question to Myers: “So is it your position that if the U.S. had a similar regulatory system that you would have no objection to products like snus or Revel?”

Myers responded, “If the U.S. had a comprehensive regulatory system, then scientists with full knowledge about the product would be able to make appropriate comparative science claims.

Fast forward to 2019.  FDA tobacco regulation had been in effect for a decade, operating according to the legislative framework that Myers says he engineered.  This includes an onerous application pathway for manufacturers to convince the agency that their smoke-free products are safer than cigarettes.  Despite the seemingly impossible task of proving a negative, Swedish Match obtained modified risk status from the FDA for its General snus brand, allowing the company to tell smokers that “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.” Myers had testified against the application at an FDA hearing. 

In 2020, the FDA granted Philip Morris International modified risk status for its IQOS heat-not-burn tobacco, allowing the company to tell smokers that “Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals.”

Myers and other tobacco prohibitionists were apoplectic about the IQOS decision, characterizing it as “a dangerous precedent that puts kids and public health at risk”, “making [kids] guinea pigs in a Philip Morris marketing experiment,” and repeating “an egregious error the FDA has made in the past” [with General Snus].  The groups’ press release concluded that “The FDA should have denied Philip Morris’ application in its entirety.” 

Make no mistake: Myers is a tobacco prohibitionist.  He gave lip service to THR in 2003, feigning support for THR contingent upon FDA regulation, as he expected to make it nearly impossible for manufacturers to convince the FDA that they had safer smoke-free products.  When companies twice succeeded, he reneged on his Congressional testimony and trashed the FDA. 

Sadly for Myers and CTFK, more smoke-free products will be approved by the FDA.  Camel Snus and Copenhagen moist snuff are already in the review pipeline, and it’s just a matter of time before dozens or more e-cigarettes, vapor products and nicotine pouches obtain safer FDA status. 


Thursday, June 17, 2021

Man, Oh Man, That San Fran Flavor Ban!


Tobacco flavor bans are all the rage among tobacco prohibitionists.  As I noted last week, the first attack on flavored tobacco took place over a decade ago (here).  Tobacco opponents pursue flavor bans, rather than outright prohibition, as a form of Tacit Incremental Prohibition - Tobacco Elimination. 

Prohibition, when it is imposed, has consequences, as seen when San Francisco banned the sale of tobacco products containing any non-tobacco flavors in January 2019.  The San Fran ban was comprehensive, covering menthol cigarettes and almost all e-cigarette and vapor products.

Abigail Friedman, Ph.D., of the Yale School of Public Health, just published an analysis in JAMA Pediatrics (here) of smoking among underage high schoolers in San Francisco compared with seven other cities and counties, including Los Angeles, San Diego, New York City, Philadelphia, plus Florida’s Broward, Orange and Palm Beach Counties.  She used data from the CDC’s Youth Risk Behavior Surveillance System (YRBSS) every other year from 2011 to 2019. 

As the chart at left shows, Dr. Friedman found that smoking among underage high schoolers declined everywhere from 2011 to 2017, from nearly 10% to about 4%.  However, while the smoking rate continued to drop in other jurisdictions in 2019, to 2.8%, it spiked upward in San Francisco, to 6.2%.

Dr. Friedman notes that the San Francisco increase “raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution” (Friedman’s reference here).

I confirmed Dr. Friedman’s primary results using the same YRBSS data, but I also found intriguing information about underage smokers, which I illustrate in the following chart.

Note the big difference between San Francisco and other areas in the number of days smoked in the past month.  It appears that there are many more infrequent smokers in San Francisco: 60% smoked only 1-2 days, and over 80% smoked less than 10 days.  If teens were substituting cigarettes for flavored vape products in San Fran, most were doing so experimentally, with no major difference in frequent smoking.

As tobacco flavor bans become more common, research like Dr. Friedman’s will increase in importance, and will likely be ignored by tobacco prohibitionists.