Ever since the abominable Family Smoking Prevention and Tobacco Control Act, giving oversight over tobacco to the FDA, was passed in 2009, I and many of my colleagues in public health have watched in disbelief and horror as the crusade against e-cigarettes swung into high gear. It seemed for a moment as though the Golden Age had come to pass regarding smoking: the twin goals of FDA regulation and a truly low-risk method of delivering nicotine to addicted smokers without the lethal tar was at hand, at last.
Then the prize slipped through our fingers like sand: the FDA and all of the other federal health agencies (especially the CDC) led a crusade against these disruptive devices, initially trying to simply ban them as drug delivery devices (alongside a propaganda campaign alluding to various toxins in their vapor, all imaginary). When the federal courts blocked that path, the drug agency decided to enforce the Tobacco Control Act in the most stringent manner by promulgating a regulatory schema deeming e-cigs and vapor products as candidates for regulation as tobacco — despite their total lack of that substance. Such over-regulation would effectively ban these products, despite their proven and accelerating popularity among smokers trying to quit. The anti-vaping crusade has since been eagerly joined by most of the academic centers, “public health” nonprofits, and politicians far and wide, ostensibly to “protect our children from Big Tobacco.”
Of course, as soon as your hear a politician chant the “for the children” mantra, get ready to have your pocket picked. And, no surprise, the real motivation behind these campaigns became clear: follow the money. Once that realization came, the whole issue became clear, depressingly so.
This fear-mongering mythology against the illusory harms of e-cigs has zero — nothing — to do with public health. It’s an economic battle, and the forces arrayed against true public health devotees make this an uphill battle, to say the least. Because while the tobacco companies do indeed make billions globally from selling toxic, lethal, addictive cigarettes, close behind in raking in the cigarette-revenue lucre are governments: local, state, and federal. Cigarette excise taxes keep the wheels of Big Government in motion, not to mention those yummy Master Settlement Agreement transfer payments — all strictly dependent on cigarette sales.
Then, there’s Big Pharma. Their direct interests lie in selling ineffective cessation aids: patches, gum, and drugs. But while many millions are spent by desperate smokers on these products — way more expensive than e-cigs and vapors — they also make a lot of hay from the drugs used to treat smoking-related diseases, of which there are many. Cancer treatments probably lead the way, but other chronic conditions yield profits as well.
To promote this agenda, pharmaceutical companies donate millions to numerous academic centers (“supporting educational programs” is a common euphemism) and the big “health” nonprofits (American Lung Association, American Cancer Society, etc.). And if you were to open any respected medical journal, you would find their pages clogged with Big Pharma ads. All of these have nearly unanimously opposed truthful communication to smokers about the relative risks (minimal) vs. the benefits (quitting!) of reduced-harm products — and they never disclose the clear conflicts of interest inherent in their funding sources. Instead, they all stick to the party line: “We don’t know what’s in them. We don’t know what the long-term effects might be. Stick to the FDA-approved products.”
Sadly, these “effective” products fail ninety percent of the time. The FDA, CDC, NGOs and academics know this very well, yet will not change their tune and advise smokers who have failed ten or more times, why not give e-cigarettes a try? Never happened.
The FDA’s tobacco chief, Mitch Zeller, mouths the “continuum of risk” occasionally as though he believes it: meaning, regulation should be commensurate with risk. If he went that route, e-cig regulation would be light, as if they were consumer products, not tobacco. But until he took over at FDA, he was a salesman for Pinney Associates, an arm of Glaxo, the world’s second largest pharm company and a big seller of nicotine patches. This was not exactly an unimpeachable choice, and he has spoken many times of his devotion to regulating vapor products tightly. The CDC’s head, Tom Frieden, has been disingenuous in the extreme (some call it lying) about e-cigs. He has gone so far as to ignore the wonderful decline in teen smoking his own agency discovered, choosing instead to conflate cigarette smoking and e-cig vaping to confuse the public, while financing a national disinformation campaign replete with lies about imaginary risks of these products. While declaiming his concern about the children, he seems to be ignoring those kids whose parents will be taken from them by smoking-related diseases, unable to quit with his precious “approved” methods.
Depressing as it seems, there may be some light in the tunnel: two separate measures proposed recently in the U.S. House of Representatives may amend the worst aspects of the tobacco law, and prevent the FDA from regulating them right off the market — at least temporarily. All true aficionados of America’s public health, smokers, and those who love them should hope that these measures come to pass.
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