FDA misinterprets massive victory on teen smoking
As detailed this morning by the Food and Drug Administration, cigarette smoking by U.S. high school students has been cut in half since 2011—from 15.8 percent to 8.0 percent—a remarkable and previously unanticipated public health victory.
Unfortunately, it appears federal authorities may be misattributing the cause. In his announcement earlier today, FDA Commissioner Scott Gottlieb attributes most, if not all, of this reduction in smoking to a federally sponsored program that has only been in place since 2014. Despite substantial evidence in federally sponsored surveys in the United States and abroad showing that remarkable reductions in teen and adult smoking have been concurrent with the increasing popularity of e-cigarettes, the FDA announcement makes no reference to the possibility that much, if not most, of the recent reductions in teen smoking may be attributable to e-cigarettes.
In fact, Gottlieb urges continuing efforts to reduce teen use of all nonpharmaceutical nicotine delivery products, while endorsing expanded efforts at smoking cessation that rely on the pharmaceutical nicotine gums, patches and other products that have proved to be of only marginal effectiveness over the past four decades.
This public health victory is too important to leave to chance and guesswork. If Commissioner Gottlieb has evidence to support the claim that The Real Cost campaign “has already helped prevent nearly 350,000 kids from smoking cigarettes since it launched in 2014,” he should present it to the public. Regulators and public health authorities also should present and discuss the evidence for and against the possibility that the availability of e-cigarettes and related vapor products may, in fact, have played a major role in securing these reductions in smoking.
This is not an academic question. Recently promulgated regulations from the Gottlieb’s own FDA threaten to eliminate more than 99 percent of e-cig products from the marketplace before the end of 2018, including all or almost all of the vape-shop component of this industry. The limited data available strongly suggests that the vape-shop products—with their ability to customize devices, flavors and strengths of nicotine to satisfy the preferences of each smoker, and modify the flavors and strength of nicotine over time to prevent relapse to cigarettes—may be more effective than the mass-market products in achieving and maintain reductions in smoking in both youth and adults.
Image by Sabphoto
