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.
