Tobacco policy endangers health

David Bahr

The anti-tobacco crusade has hit a wall. Though great strides have been made in reducing the rate of cigarette smoking, about 15 percent of U.S. adults continue to smoke, and smoking-related illnesses cause nearly 500,000 deaths a year and $300 billion in medical costs annually. That’s separate and apart from the $156 billion hit businesses take each year in lost productivity.

But President Donald Trump, Congress and the Food and Drug Administration have an opportunity to make breakthroughs in reducing the rate of smoking and vastly reducing the associated ills by reversing a number of perhaps well-intentioned but misguided Obama era policies. The key is to embrace a “harm reduction” approach to public health policy.

Tobacco harm reduction recognizes that some folks find quitting their addiction to nicotine nearly impossible. But the emergence in recent years of e-cigarettes offers a popular, safer alternative to traditional combustible cigarettes.

What renders e-cigarettes a safer option lies in the physical process. The negative health impacts from traditional cigarettes arise from burning and inhaling smoke into the lungs. Smokeless tobacco or “heat not burn” tobacco products don’t combust, and thus sidestep nearly all of the health risks posed by traditional cigarettes.

You would think American public health officials would see the same benefits their British cousins do, but the Obama administration instead clamped down on e-cigarettes, with agencies crafting policies to kill an industry largely composed of thousands of small and medium-sized American businesses.

Trump has shown a tendency to bring out-of-the-box solutions to tired policy fights. To help the new administration analyze this issue, the R Street Institute has published a white paper detailing eight tobacco harm-reduction policies for the federal government.

First, seize the huge opportunity presented by low-risk nicotine products. Practically, this means making appointments and providing direction and funding to shepherd the tobacco harm reduction approach through a host of federal agencies. Just as importantly, the report recommends canceling the FDA’s “deeming rule” before it destroys the U.S. vaping market. Instead, change the Tobacco Control Act predicate date to Aug. 8, 2016 for nicotine products that do not contain tobacco, and replace the product-by-product authorization regime with a standards-based regime for low-risk nicotine products.

The report also calls for creating new labels that better inform consumers about relative risk. If e-cigarettes are described and categorized as posing the same harm as traditional cigarettes, consumers won’t understand the opportunity to switch to a much safer alternative.

The 2009 Tobacco Control Act mandated new tobacco and consumer-nicotine products pass a “public health test” demonstrating that their presence on the market would not hinder public health. But the burden of proof is set so high that it acts as a largely insurmountable barrier to products much safer than cigarettes, while safeguarding the thousands of cigarette products already on market. The report urges federal regulators to stop using the public health test.

If only a few of these recommendations are successfully taken up by Congress and the Trump administration, it will constitute a major improvement over the public health policy practiced over the past eight years.

David Bahr is a policy analyst with the R Street Institute. He wrote this for InsideSources.com.