Commissioner Makary on High Schoolers Vaping: Half or Half a Percent?

 

In his Congressional testimony on May 22, FDA Commissioner Dr. Martin Makary said, “There are high schools in America now where kids are saying half of the kids are addicted to these vaping products.”

During the 2024 campaign, President Trump promised to save vaping.  Now that job falls to Dr. Makary, whose agency “oversees the safety of more than $3.9 trillion worth of food, tobacco, and medical products produced in the U.S. and abroad.”  With so much on his plate, he can be forgiven for not having all the facts yet on youth vaping.

Last December, I took a deep dive into vaping among American high schoolers, using the CDC’s 2023 National Youth Tobacco Survey (here), the latest available dataset.

My analysis demonstrated that some 73,092 of the nation’s 15.8 million high schoolers vaped frequently enough (20-30 days in past month) to be at risk for being addicted.  That represents only 0.5%, not 50%.

No one is comfortable with youth vaping, but Dr. Makary and his team should understand that vaping has contributed to the disappearance of smoking among American high schoolers, and the rate among young adults is similarly minimal.  This means that in 25 to 30 years, smoking-related diseases will nearly disappear, too.  It’s time for the FDA to focus on adult smokers over age 40, whose risk grows with each cigarette.  Going smoke-free will give them the chance for longer and healthier lives. 

 

 

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. 

 

 

 

Tobacco Prohibitionists Kill Safer Cigarette Substitutes… and Smokers

 

Dr. Michael Siegel has published a blog entry criticizing a “new article in American Journal of Medicine claim[ing] that youths who use e-cigarettes are 5 times more likely to become cigarette smokers.”  The commentary was authored by tobacco and nicotine opponents Pamela Ling and Edward Goetzl.

Dr. Siegel correctly notes, “the article in question fails to provide any citation or source for its preposterous claim… Apparently, we are supposed to just take it on faith that this is true.”

Reviewing the Ling-Goetzl screed, I found that the authors specified that the five-fold claim was for “tobacco-naive adolescents.”  While that claim was not attributed, the commentary’s authors did include in their reference list one possible source: another commentary, authored by fellow prohibitionist Jonathan Winickoff and coworkers in September’s JAMA. 

Winikoff did not provide a source for his claim either, but he hinted at it with a reference to a 2019 article by Kaitlyn Berry, et al., in JAMA Network Open.

Further complicating the matter, I, along with David Abrams and Ray Niaura, had published a critical comment in that journal, documenting how Berry, et al., engineered their study to make e-cigarettes seem to increase smoking rates by 4 times (in their abstract), not 5.  I also wrote a blog entry on the subject in February 2019 that contained this highlight:

“While Berry, et al., and [then FDA] Commissioner Gottlieb, emphasized the 4.0% probability of current smoking among e-cigarette first users, we found a reverse result buried in a supplemental table: The probability of current e-cigarette use at follow up among cigarette first users was 8.3%.  This means that twice as many first-smoking teens currently used e-cigarettes at follow-up than first-vaping teens who currently used cigarettes.”

The critical lesson here is not about the transgressions of Ling-Goetzl, or Winikoff, or Berry.  It is how the incessant repetition of exaggerated, distorted and sometimes falsified research dangerously distorts public perceptions about vastly safer cigarette substitutes.  It happened with smokeless tobacco; it is happening today with vapor and nicotine pouches.  Millions of smokers will die, and prohibitionists will never be held accountable.