Tuesday, 9 August, 2022
HomeTalking PointsSeparating the benefits of nicotine from the harms of smoking

Separating the benefits of nicotine from the harms of smoking

Smoking causes cancer and nicotine improves mood. So guess which the US Food and Drug Administration (FDA) will seek to ban under a sweeping new initiative?

An ambitious decision recently announced – aimed at reduced the nicotine in cigarettes – is probably causing smokers, at least in the beginning, to light up more often and puff harder to get their nicotine hit, notes the Wall Street Journal.

If this werenʼt weird enough, in the same week, based on the inability of its manufacturer to prove a negative (an absence of any harm), the FDA made the decision to ban from the market the most popular consumer product that allows people to consume nicotine without the side effects of smoking: Juul brand electronic cigarettes.

Nicotine doesnʼt cause cancer, it pays to remember as the agency sets out on what may prove a colossal policy error. Officially regarded as a drug, nicotine may be addictive like cocaine or heroin, and produce withdrawal symptoms in many who try to quit. But unlike other controlled substances, itʼs anodyne in its effects.

Nicotine doesnʼt intoxicate. It doesnʼt addle judgment. Itʼs mildly stimulating and calming at the same time, relieves anxiety and sadness, improves memory and motor performance in the short term, and may have benefits for Alzheimerʼs, Parkinsonʼs, Touretteʼs and ulcerative colitis.

Partly, the problem is the law under which the FDA operates. The 2009 Family Smoking Prevention and Tobacco Control Act expressly prohibits the agency from eliminating tobacco products from the market, but may or may not authorise its nicotine-removing initiative.

Partly, the problem is an ideological unwillingness to distinguish the benefits of nicotine from the harms of smoking. Decades have made a cliché out of the specialist observation that people “smoke for the nicotine and die from the tar”.

In 2015, Scientific American quoted one of the worldʼs leading smoking-cessation researchers pleading for the need to “de-demonise nicotine”.

The FDA is headed in the opposite direction. Maybe, after thousands of years of people seeking out and consuming nicotine, they will stop because the agency says so. In public policy, examining costs and benefits fully and frankly is usually advisable to avoid unpleasant surprises. Left out of the FDAʼs assessment are the benefits people get from using nicotine. Left out is the possible gift to organised crime of trying to ban it.

A different approach is imaginable, one that would meet a reasonable definition of sanity, i.e., acceptance of reality. Outlaw the unreasonably dangerous nicotine delivery device known as cigarettes. Tolerate those that supply the demanded nicotine without gratuitously harmful side effects.

Thereʼs also a third viewpoint. The federal and state governments and politically connected trial lawyers have become the primary beneficiaries of smoking ever since the 1998 master settlement agreement drawn up by the tobacco industry and 46 states seeking damages for the health-related costs of smoking.

In the years since, these beneficiaries have not managed to suck e-cigarettes and vaping under the rubric of their cartel, eroding their financial take. The FDA considers itself uninfluenced by these incentives, but the 2009 law it follows was lobbied through Congress by interests with a stake in continued smoking. The larger political context in which the agency operates also continues to be shaped by their influence.

Its plan to ban nicotine, as every commentator has noted, will mobilise opposition and take a decade or more to fight through the courts, with no guarantee of success or that future administrations will be as keen to prioritise nicotine prohibition.

Its attack on Juul, on the other hand, might not even be all that upsetting to the brandʼs 35% owner, the cigarette giant Altria, since deprived Juul users may just reach for Altriaʼs market-leading Marlboro brand to maintain their habit.

The National Association of Attorneys-General has itself been receiving upward of $150m a year to administer the settlement; as the group stresses, these funds will continue “in perpetuity, so long as cigarettes are sold in the United States”. A spreadsheet on the groupʼs website tracks how much each state has garnered through April 2022, for a grand total of $152,856,477,210.76.

There is nothing wrong with the FDAʼs theory, backed by experimental evidence, that people will eventually stop smoking cigarettes if the cigarettes contain no nicotine. Contrary to some reporting, this conclusion is not undercut by the admission of some study participants that they broke discipline and occasionally snuck a full-strength cigarette.

Quite the opposite, their cheating underlines the flaw in the governmentʼs plan: people may stop wanting cigarette brands from which the FDA has removed the nicotine. That doesnʼt mean they will stop wanting or finding ways to get nicotine.

 

Wall Street Journal article – The FDA’s Anti-Nicotine Myopia (Restricted access)

 

See more from MedicalBrief archives:

 

US moves to reduce cigarette nicotine levels

 

E-cigarette Summit – Unlocking the harm reduction potential of e-cigarettes

 

US study finds many physicians have misconceptions about e-cigarettes

 

E-cigarettes not a substantial gateway to smoking for young people – UK study

 

Don’t offer e-cigarettes as an ‘official’ alternative to smoking, French doctors advised

 

 

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