FDA and Juul E-Cig Regs Should Keep Anti-Smoking Zealots at Bay

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This week FDA Commissioner Scott Gottlieb announced a plan to close the on-ramp to kids using e-cigarettes while preserving adult use of “potentially less harmful forms of nicotine delivery.” The plan's centerpiece curbs the sale of flavored e-cigarettes, which regulators claim entice youth (logic that apparently doesn't extend to Absolut Peach vodka or Jack Daniel's cinnamon whiskey), but which also help smokers quit because they don't remind them of traditional cigarettes.

The problem is that anti-smoking zealots want to go further and remove e-cigarettes from the market altogether while leaving most tobacco products untouched. That would snuff out the most impactful public health development in decades. The FDA’s action is designed to reduce e-cigarette use among high school and middle school students “because there is also evidence that a large percentage of these children will become addicted to nicotine and ultimately take up smoking." Yet plummeting and all-time low smoking rates – especially among young adults – would suggest otherwise. In contrast, the FDA recognizes that use of e-cigarettes can help adults stop smoking.

Days before the FDA's announcement, e-cigarette manufacturer Juul, which commands about 75 percent of the e-cigarette market share, self-imposed regulations to curb teen use of its products. Juul's "Youth Prevention Plan" will eliminate pod flavors, such as cucumber and mango, from the 90,000 or so retail outlets across the country.

Flavored pods will still be available online, but Juul is ratcheting up its age verification tools to ensure that purchasers are 21 years of age or older. These include demanding permanent addresses, the last four digits of social security numbers, pictures of government issued ID, and real-time photos.

To prevent bulk purchases that feed black markets that target minors, Juul introduced new purchase limits and product serialization. It is also quadrupling its secret shopper program to ferret out rogue retailers.

And finally, for good measure, Juul is spiking its social media pages, which teens are more likely to visit.

To be sure, faced with an existential threat of lawsuits and an outright ban from regulators and anti-e-cigarette zealots on a warpath, the e-cigarette industry needed to respond. Yet in doing so it means e-cigarette manufacturers will save fewer lives. Juul’s actions, lauded by the FDA, will improve the public risk vs. benefit tradeoff of e-cigarettes in the short term by possibly increasing tobacco use in the future. Gottlieb has acknowledged that the speed bumps Juul has put in place will make it harder for consumers over the age of 21 to buy e-cigarettes. For instance, those reliant on flavored e-cigarettes to quit will be out of luck next time they go to the store for their nicotine fix. Yet if these consumers understandably don't want to go through the rigamarole and privacy invasion of online purchases, they may simply pick up a pack of cigarettes instead.

Similarly, while some limit on bulk purchases is probably smart, Juul's new limit of ten per year seems low for former smokers who want to gift e-cigarettes to friends and family trying to quit smoking.

E-cigarettes have helped millions of Americans quit smoking. And they have helped millions more reduce their consumption. According to one independent study, 70% of U.S. users who had been smokers reported quitting following their e-cigarette use. And an incredible 96% of the former smoking e-cigarette users reported being less interested in smoking. According to randomized trials, quit rates are directly correlated with e-cigarette use. And the frequency of e-cigarette use increases quit success.

With smoking still responsible for one in every five deaths, Boston University preventive-medicine physician Michael Siegel believes e-cigarettes are the singular technology that could put an end to smoking. Yet the anti e-cigarette zealots want to ban e-cigarette sales altogether.

Ironically, it's young adults who have the most to lose. Centers for Disease Control data show that the 18 to 24 year old demographic has seen by far the largest decline in smoking in recent years. This is partially thanks to increased e-cigarette use among kids under 18. Barring people from buying e-cigarettes for their first three years of adulthood (18-20 years old) will likely increase both the number of cigarette consumers, while reducing the number who are able to quit.

Public health advocates concerned about rising use of e-cigarettes among those under the age of 18 should recognize that e-cigarette use is often a symptom of a deeper emotional turmoil like anxiety or depression, which are skyrocketing among youth. While self-medication with e-cigarettes isn't ideal, it is better than doing so with marijuana, alcohol, or traditional cigarettes.

Juul’s actions and the FDA initiative are a historic attempt to harness the public health benefits of e-cigarettes by maximizing the number of people who use them to stop smoking and limiting the number of people who use them to take up tobacco. This laudable effort is not perfect and, as we note, must be monitored to ensure it doesn’t make smoking more likely.

Yet judging by their dismissive response to Juul’s actions, anti-smoking zealots don't seem to really care about those dying from cigarettes. If they did, they would champion e-cigarettes for the public health phenomenon that they are. Perhaps they're worried that if Big Tobacco goes out of business because smokers turn to e-cigarettes instead, so will they. 

Peter Pitts is the President and co-founder and Robert Goldberg is the Vice-President and co-founder of the Center for Medicine in the Public Interest. 

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