Washington Post Attack on E-Cigarettes Deserves Emergency Room Treatment

 

Dr. Leana Wen, an emergency physician and Washington Post columnist, attacked tobacco harm reduction in a Post column last week, “The New Nicotine Product Replacing e‑Cigarettes to Addict Teens” (paywalled).  It dealt mainly with Zyn nicotine pouches, but it touched on the gamut of safer cigarette substitutes. 

Matt Holman, Ph.D., Chief Scientific and Regulatory Strategy Officer at U.S. Philip Morris International, has responded (here) with an accurate point-by-point rebuttal of Dr. Wen’s numerous misstatements. 

I’d like to focus on one especially egregious statement in Wen’s article: “Mitch Zeller, former director of the FDA’s Center for Tobacco Products, explained that as much as 70 percent of people who vape continue to smoke. He showed me industry data from two years ago that showed 84 percent of adult pouch users kept up cigarette use.”

I was astonished that Zeller would cite 70 percent, when he can readily access updated information from the gold standard CDC National Health Interview Survey (NHIS). In this chart of the smoking status of 17.8 million vapers estimated from the 2024 NHIS, the highest percentage were former smokers, while only 26 percent were current smokers.

While dual use is a transition period for many smokers, dual use has another, more ominous driver: misinformation from federal agencies and major medical organizations.  For example, Matt Holman noted: “under the helm of Mr. Zeller, [the FDA Center for Tobacco Products] authorized more than 2,800 cigarette products to be marketed while only authorizing 30 novel smoke-free products (heated tobacco products, Swedish snus, and vapes). These actions resulting in 100 times more authorizations for combusted tobacco than novel smoke-free products are in direct opposition of CTP’s stated mission ‘To protect the public health of the U.S. population from tobacco-related death and disease...’”

Additionally, in 2018, CTP director Zeller launched the FDA Real Cost E-Cigarette Campaign, which is a misinformation circus.  It ostensibly targets kids, but I calculated – using the FDA’s formula – that this campaign also dissuaded hundreds of thousands of smokers from switching to safer vape products (here).

The Washington Post should run a major correction for Dr. Wen’s article.

Not-So Fine Whine, From the Society for Research on Nicotine and Tobacco

 

The Society for Research on Nicotine and Tobacco (SRNT) bills itself as “the only professional association dedicated exclusively to the support of researchers, academics, treatment professionals, government employees, and the many others working across disciplines in the field of nicotine and tobacco research.” 

The organization claims that it advances the field of nicotine and tobacco research by working with groups including the FDA’s Center for Tobacco Control and Center for Drug Evaluation and Research, the National Cancer Institute (NCI), and the National Institute on Drug Abuse.  While those relationships are appropriate, SRNT’s bragging about its “close relationships” with the Truth Initiative, the Campaign for Tobacco Free Kids (CTFK), the Association for the Treatment of Tobacco Use Dependence, and the American Cancer Society is unseemly, given those groups’ open hostility to any research or data supportive of nicotine, tobacco or tobacco harm reduction.

Responding to the CDC losing $310 million for its Office on Smoking and Health (OSH), SRNT published a “Nicotine & Tobacco Research Community Call to Action.”

The call to action links to a CTFK letter, dated April 30, that argues for continued CDC OSH funding: “The elimination of CDC’s Office on Smoking and Health would have a profoundly negative impact on our nation’s efforts to reduce the death and disease caused by tobacco…OSH has provided grants to all 50 states and territories to support tobacco prevention and cessation programs. Comprehensive state and local tobacco control programs…OSH has provided funding to state quitlines…With $310 million, CDC will be able to address the challenges posed by e-cigarettes…”

Stated more accurately, if the CDC loses this funding, it will no longer be able to pursue its stated goal of achieving nationwide tobacco prohibition.

SRNT emphasizes the prime reason they support continued funding for their CDC piggybank: “More than ever, we need to explain how tobacco impairs health, why people continue to use tobacco, and what can be done to reduce tobacco-related deaths.”  

In reality

 The only tobacco use that impairs health is smoking;

2.  People use tobacco because it is pleasant and satisfying; and,

3   We can reduce tobacco-related deaths by reducing smoking. 

This bit of federal spending reduction may actually promote public health, “more than ever.”

 

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.