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.

A Foundational Call to Action

 

Now is the time for all good men and women to come to the aid of the Foundation for a Smoke-Free World (FSFW).

The organization was founded in 2017 through a charitable gift from PMI Global Services.  Its mission is simple: “to end smoking in this generation.”  Its founders envision “a world in which combustible tobacco, other toxic forms of tobacco, and smoking-related death and disease are eliminated.”  Contrast that with the U.S. government’s vision of “a world free of tobacco use,” an incorrectly broader behavior blamed by the government for “cancer and suffering.”  

The FSFW not only has a firm grasp on the merits of tobacco harm reduction (THR); it also offers the only substantial funding (currently about $150 million) for legitimate, unbiased THR research. 

The Foundation recently named a new president and CEO, Clifford E. Douglas, whose anti-tobacco credentials are impressive.  He worked to eliminate smoking on airlines and college campuses, and he held high offices in the Coalition on Smoking and Health, the American Lung Association, and the American Cancer Society.  He most recently served as director of the University of Michigan Tobacco Research Network. 

As the FSFW board chair noted, “For decades Cliff Douglas has been a strong and influential voice in the work to eliminate smoking in America and globally.”  What is most remarkable is that Douglas differentiated and focused on the devastating toll of smoking, rather than the broader universe of tobacco use, the term used by prohibitionists to impugn all things tobacco- or nicotine-related.  In short, he came to recognize “emerging efforts around the world related to alternative nicotine products as a complement to traditional tobacco control measures.”

Since its creation, the FSFW has been dogged by claims that it is influenced by its founding sponsor, Philip Morris International.  Mr. Douglas has countered by terminating the receipt of PMI funds, pledging that the Foundation will no longer accept any support from the tobacco or non-medical nicotine industries.  “Any skepticism around our independence can be laid to rest,” he said.

Of course, prohibitionists never rest.  Deborah Arnott, CEO of UK Action on Smoking and Health, said, "Whether it's true or not, [Douglas] will be seen as pursuing PMI's agenda, not that of public health."  Yolonda Richardson, president of the Campaign for Tobacco Free Kids, termed Douglas’s claim “ludicrous”. 

What’s truly ludicrous is that prohibitionists, wearing the sheep’s clothing of “public health”, oppose all funding of THR, no matter its source.  Since 1999, the universities employing me have administered small grants from tobacco companies to conduct THR research.  While this work would not have been possible without such support, attacks from within and outside these institutions have been never-ending.  To quote Carl Sandburg, “If the law and the facts are against you, pound the table and yell like hell” -- about the funding.

I sincerely hope that THR researchers and supporters will stand with Mr. Douglas to make the Foundation a beacon of honesty and accomplishment in the world of public health.

 

Note: For the past year, I have served as an outside grant reviewer for the FSFW.

 

A World-Class Case of Corporate Self-Cannibalization May Save Millions of Lives

 

Heat-not-burn (HNB) tobacco products – mainly IQOS from Philip Morris (PMI) – are eroding cigarette sales in Japan, as I recently noted.  Prevalence estimates from the Japanese Health and Nutrition Survey confirm the consumption numbers. 

Because the Japanese survey only began tracking new products in 2018, no trend can yet be discerned, but HNB product use is impressive, as shown in the chart at left.  Depending on how dual users are counted, HNB accounted for 20 to 27 percent of all tobacco use in 2019.   

The highly credible Japanese Health and Nutrition Survey is the world’s oldest nutrition survey, implemented by Allied Forces after World War II.  Participants include adults age 20+ years; questions on smoking and HNB use are included in the lifestyle section. 

The HNB-driven Japanese harm reduction miracle has been ignored by most of the world, but Motley Fool just published an intriguing article, “Is It Time to Stop Thinking of Philip Morris International as a Cigarette Company?”

The answer is a resounding “Yes!”

There are two standout quotes in the article.

“Philip Morris' annual report shows that cigarette shipment volumes last year tumbled over 11%, with its most important brand Marlboro, which accounts for 37% of all cigarette shipments, down by a like amount.”

PMI risked its core cigarette business when the company launched the multi-year, multi-billion-dollar IQOS research and development effort.  Five years ago, it rolled the dice again when it marketed the products in Japan.  Leadership had no guarantee that IQOS would preferentially erode only other companies’ cigarette sales.  This may end up as a world-class example of self-cannibalization that ultimately saves millions of lives that would otherwise be cut short by smoking.  

“Philip Morris generated $6.8 billion in revenue last year from IQOS, or almost 25% of its total $28.7 billion in net revenue. [PMI CEO Andre] Calantzopoulos says if you just look at the three regions where IQOS is most prevalent -- Asia, Eastern Europe, and the European Union -- it represents 35% of the total.”

Naysayers have dismissed the Japanese miracle because there is no e-cigarette/vapor market there.  However, there is no doubt about the success of IQOS across 67 countries around the world.  IQOS might now find similar public health success in the U.S.  As Altria broadens distribution here, tobacco prohibitionists should give smoke-free tobacco products the opportunity to cancel smoking and advance public health.