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.

What Medscape Subscribers Really Thought About Its Tobacco Harm Reduction Programs

 

Earlier this year, Medscape, which describes itself as “the leading online global destination for physicians and healthcare professionals worldwide,” invited me to participate in a series of short continuing medical education (CME) programs on tobacco harm reduction (THR).  Medscape clearly disclosed that the series was sponsored by Philip Morris International, but the programs were firewalled; faculty were not in contact with or influenced by the sponsor.

Topics included, among others, an examination of nicotine, and the differential risks of combusted versus smoke-free tobacco/nicotine products.

I recorded two programs.  The first, “Nicotine Misperceptions: What Does the Evidence Say,” was published online by Medscape around March 1.  The second, in collaboration with Dr. Sally Satel, “Harm Reduction From Tobacco: An Evidence-Based Discussion,” was published April 1.  Dr. Satel also recorded a third program.

Following publication, a few anti-tobacco crusaders objected, threatening “a rapid global boycott by healthcare professionals disgusted by [Medscape’s] behaviour” in two British Medical Journal articles and one in The Examination.  I will not provide links to these, as they include ad hominem attacks on me.  Dr. Satel recounts the sorry tale in this article (here).    

As Dr. Satel notes, Medscape buckled, whining that “use of this funder was a misjudgment that was out of character for Medscape Education and that doing so may have disappointed our members.”

But were Medscape members truly offended by the PM sponsorship?  Evidence from an email I received from a Medscape manager says “NO.”  Shortly after my nicotine program aired, I received an unsolicited email from the manager titled, “One of the best CME programs I have seen in a long time…” Following is the text of that email, with some passages highlighted by me.

“We have the preliminary results from your program that was posted less than a month ago, and I am personally flabbergasted by the participation - over 6000 learners and over 2200 test takers!

“The comments from participants have been incredible as well:

• I can better educate and motivate pts on how to cut down their use of nicotine products. I am also more cognizant now that those who use cigarettes may have a more difficult time quitting. Will refer these pts to our clinical pharmacist who can also help advise and prescribe the appropriate tobacco cessation products.
  

• This was fantastic! This down to earth harm reduction approach is absolutely key to help meet people where they are, as nicotine addiction is so strong! Much better outcomes can be achieved as these presenters described, using less harmful forms of nicotine. As the doctors stated, there is a great need to educate providers, and clarify misconceptions about nicotine vs various methods of ingesting nicotine. I hope this presentation reaches a wide audience! One of the best continuing eds I have done in a while.
  

• Dispelled many myths I previously held about nicotine that I will no longer propagate.

• Thank you for bringing up such an important topic that can bring down the costs of healthcare and truly improve the public health. I am a psychiatric provider and have had a large number of patients successfully quit smoking with harm reduction measures!”

It is tragic that Medscape capitulated to rabid tobacco prohibitionists and stopped providing vital, life-saving information to health professionals.

 

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.