Robert Kennedy’s Nicotine Pouch Can Make America Healthy Again

 

The level of misunderstanding among American doctors about vastly safer cigarette substitutes is stunning.  Last week I critiqued the president of the American Medical Association (here), and this week it’s Dr. Nicole Saphier, a breast cancer imaging specialist at the Memorial Sloan Kettering Cancer Center.  In her January 30 New York Post column she called Robert Kennedy a “hypocrite” because he appeared to use a nicotine pouch during his Senate confirmation hearing.

Here are excerpts from Dr. Saphier’s screed, followed by my comments.

“After decades of relentless public health campaigns and advocacy against cigarette smoking, we are witnessing the tangible benefits, with declining smoking rates and the illnesses associated with it.”

She is only half correct, as smoking rates have declined, but mainly among children and young adults (here).  Too few older smokers at highest risk have quit, which is why nearly a half-million of them die prematurely every year.

“These small, flavored packets — filled with nicotine and other additives and tucked between the user’s gum and lip — are surging in popularity, mainly under the pretext that they are a safer alternative to traditional cigarettes.”

“The FDA has authorized Zyn and other pouches as a smoking reduction aid, giving them a reputation as a less harmful alternative.”

Nicotine pouches – in fact, any products delivering smoke-free nicotine – are vastly safer than smoking.  That is why the FDA authorized Zyn sales.  Also, the agency did not designate Zyn as a “smoking reduction aid.”  

“Yet this authorization does not equate to a declaration of safety.”

The FDA authorized Zyn as “appropriate for protection of public health.” 

“And these pouches come in varying strengths — with some providing far more nicotine than cigarettes or vapes.”

Saphier repeats a common, inaccurate claim comparing cigarettes, that deliver about 1 mg. of nicotine deep into the lungs, with a wide range of smoke-free products that deliver vastly different amounts of nicotine to the mouth and upper airway.  

“This is particularly dangerous to adolescents and young adults. Given their still-developing brains, nicotine can impair cognitive function, alter brain development…” 

The “brain development” claim has been fully debunked here.

“It’s alarming to see a new generation hooked on nicotine, reversing years of progress made in reducing smoking rates among young people.”

This is 180 degrees wrong, as the decline in smoking among young people has accelerated during the rise in use of alternative nicotine products (here).

“As he championed the Make America Healthy Again movement before the Senate committee, he was positioning himself as a warrior against chronic illness and discussing how he plans to combat diseases including food and drug addiction. Here is a figure publicly advocating for health, yet engaging in the use of a highly addictive product while doing so. In its most charitable interpretation, the incident shows how even those championing health can be ensnared by the allure of nicotine’s addictive nature.”

If Kennedy used a nicotine pouch during the hearing, it was entirely consistent with making America healthy again, and combatting the diseases and the consequences of smoking, America’s most dangerous drug addiction. 

 

 

 

E-Cigarette Falsehoods from the President of the American Medical Association

 

American Medical Association President Bruce A. Scott, M.D., authored an article, posted on the AMA website today, “Flavored e-cigarettes pose dire threat to youth and public health,” that includes the following: “Tobacco products cause cancer. Overwhelming evidence demonstrates that multiple types of cancer are linked to tobacco products, including e-cigarettes”

This is grossly incorrect, as Dr. Scott intentionally conflates the risks of tobacco use with those of smoking. He provides links to another AMA article that discusses youth and E-cigarette and vaping associated lung injuries (EVALI), but cancer is not mentioned there.

In today’s piece, Dr. Scott writes, “The use of tobacco in various forms remains the nation’s leading cause of preventable death.  According to the Centers for Disease Control and Prevention (CDC), it claims the lives of 1,300 Americans every day, or about one in every five deaths annually. As an ear, nose and throat surgeon in Louisville for more than 30 years, I’ve seen up close the devastating damage that cigarettes and e-cigarettes cause—mouth and throat cancers that too often change lives forever or end lives prematurely.” (emphasis added) The article linked here by Dr. Scott discusses smoking only.

Conflation of tobacco and smoking is a common practice among prohibitionists, as I have noted before (here, here, here), but it is beyond the pale for the president of the AMA to treat “tobacco use” as a synonym for “smoking”, and worse, to unequivocally claim that he has “seen up close” that e-cigarettes cause mouth and throat cancer.

 

Federal Surveys Demonstrate E-Cigarettes Have Been Successful Quit-Smoking Aids For a Decade

 

New research based on U.S. government survey data shows, “The most popular methods used to stop smoking were nicotine products (53.9%; 1.5 million adults), especially e-cigarettes in combination with other methods (40.8%; 1.2 million) and e-cigarettes alone (26.0%; 0.7 million)” [confidence intervals removed by me]. Additionally, “Prescription drug products (8.1%; 0.2 million) and non-nicotine, non-prescription drug methods (6.3%; 0.2 million) were less popular.”

Tobacco researchers Floe Foxon (Pinney Associates) and Ray Niaura (New York University) made those observations in their new report, “Use of nicotine products, prescription drug products, and other methods to stop smoking by US adults in the 2022 National Health Interview Survey,” appearing in the journal Internal and Emergency Medicine (abstract here).

Foxon and Niaura analyzed “U.S. adults who self-reported having stopped smoking cigarettes for 6 months or longer in the last year and the methods they used, or who did not stop smoking but tried in the last year.”  The survey that supplied the raw data is the standard instrument used by the Centers for Disease Control and Prevention to count 29 million adult current and 56 million former U.S. smokers each year. 

The researchers note that their results are similar to those in an earlier analysis of adult smokers in the FDA’s Population Assessment of Tobacco and Health (PATH) Survey.  I conducted that study along with Nantaporn Plurphanswat and noted in a blog post, “e-cigarettes were one of the most commonly used quit aids by American smokers in 2013-2014, and that they were the only aid more likely to make one a former smoker (i.e., a successful quitter) than quitting cold-turkey.”

Now we have definitive population-level evidence, provided by the federal government, that e-cigarettes have been the most popular and among the most successful quit-smoking aids for almost a decade.  It is long past time for government officials to acknowledge these facts.