As the federal government continues to tackle smoking as a public health issue, some experts argue it should be more open to allowing electronic cigarettes and smokeless tobacco as valuable tools for those trying to kick the habit.
European studies have found both far less harmful than cigarettes, they say.
And current government policy actually harms both active-duty servicemen and veterans, one expert argues.
“We’ve tried more education and more tobacco taxes and scaring them, and at the end of the day too many people aren’t able to quit smoking,” Brian Fojtik, a senior fellow with the Reason Foundation, a libertarian think tank, told The Daily Signal. “If there is a product that will reduce the risks from smoking of cancer and mortality, we should encourage it.”
Fojtik, who researches public health and tobacco-related issues, blames agencies such as the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Surgeon General’s Office for characterizing e-cigarettes and smokeless tobacco as equally harmful as smoking.
“The CDC and the FDA and the surgeon general have provided a lot of misleading information into tobacco. Misinformation costs lives,” Fojtik said.
Fojtik and other critics of government policies say they are hopeful that FDA Commissioner Scott Gottlieb, a former scholar at the American Enterprise Institute, will make positive changes.
Gottlieb announced in late July that the Food and Drug Administration would study cutting nicotine in cigarettes to nonaddictive levels and the idea of shifting smokers toward e-cigarettes.
The FDA’s current approach of opposing the alternatives harms those currently in the military as well as veterans, said Dr. Sally Satel, a practicing psychiatrist who specializes in addiction medicine and lectures at Yale University School of Medicine.
In Satel’s view, the Defense Department’s smoking-cessation hotline for active-duty military and veterans, called UCanQuit2, should not advise against using smokeless tobacco.
A Swedish product called snus has gained in popularity as a replacement for smoking. It is a small tobacco pouch that the user puts between the inner lip and gum. Research shows that Sweden—which has the highest use of smokeless tobacco in Europe—has the lowest rate of smoking deaths there, Satel said.
She called the UCanQuit2 hotline herself to ask about alternatives, Satel wrote, only to have an operator tell her she had no information on whether either vaping or using smokeless tobacco was less harmful than smoking, The operator warned only against using any tobacco product ever.
“As long as reduced-risk products are portrayed as being as dangerous as cigarettes, smokers will continue smoking,” Satel, also a resident scholar at the American Enterprise Institute, told The Daily Signal. “The Defense Department should cut ties with UCanQuit2 until the organization can provide accurate advice.”
UCanQuit2 is part of the Defense Department’s Defense Health Agency, which generally opposes tobacco products, Pentagon spokesman Kevin J. Dwyer said, adding:
The Centers for Disease Control and Prevention recommend eliminating all tobacco consumption and avoidance of nicotine, a highly addictive drug. The many tobacco cessation aids referenced through UCanQuit2, including nicotine replacement therapies, counseling, and prescription medications, are covered products and services under the Tricare health benefit that provides health care coverage to 9.4 million beneficiaries. Electronic nicotine delivery devices are not a covered Tricare health benefit.
The Defense Department has taken a responsible route, said Thomas Spoehr, director of the Center for National Defense at The Heritage Foundation.
“I completely support the idea of not suggesting either smokeless tobacco or e-cigarettes as an alternative to smoking. I think that reflects the advice and thinking of the medical community as well,” Spoehr, a retired Army lieutenant general, told The Daily Signal, adding:
I went to the program’s website for UCanQuit2, and it seemed well organized and the content was good. Smokeless tobacco is a big problem in the military due to soft-tissue cancers, and we would not want to do anything to encourage people to use those products. I believe the pharmaceutical alternatives to smoking provide much better alternatives that either of those two products.
The FDA will carry out its regulatory authority while the Centers for Disease Control and Prevention continues to provide scientific research, a CDC spokesman who didn’t want to be named told The Daily Signal.
A 2014 surgeon general’s report warned about potential problems with e-cigarettes, stating in part:
It is crucial that the progress made in reducing conventional cigarette smoking among youth and young adults not be compromised by the initiation and use of e-cigarettes. This surgeon general’s report focuses on the history, epidemiology, and health effects of e-cigarette use among youth and young adults; the companies involved with marketing and promoting these products; and existing and proposed public health policies regarding the use of these products by youth and young adults. …
E-cigarettes are now the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, including cigarettes and other burned tobacco products.
However, the Royal College of Physicians in Britain has found that vaping is unlikely to exceed 5 percent of the harm caused by smoking, though it identifies a need for regulation.
A study by The Heritage Foundation concluded that the U.S. government should allow the market to make it possible for smokers to use products that help them quit, rather than discourage their use.
Federal agencies haven’t presented a complete picture, said Daren Bakst, a research fellow in agricultural policy at Heritage, but he is hopeful the FDA will follow through in embracing alternate ways to reduce the harm done by tobacco.
“It’s not all or nothing,” Bakst told The Daily Signal. “Potentially we’re talking about saving the lives of people. The government needs to provide accurate information.”
“It doesn’t mean these products are safe, but they are far less risky as a nicotine-delivery device,” he added.
Asked whether Gottlieb would take a more lenient approach to such products, FDA spokesman Michael Felberbaum said in an email to The Daily Signal: “I have nothing additional to share with you at this time.”
The Surgeon General’s Office did not respond to inquiries from The Daily Signal for this report.
It’s not too late for U.S. agencies to change their policies, Satel said.
“The CDC should admit its errors and the FDA should make [product] approval less onerous,” Satel said. “If both do, smokers will be better educated about options and have better access to them.”