Readers should note that a 4.5% decline in cigarette consumption is a substantial public health accomplishment. Here is a question for my readers: Which of the following was given as the leading explanation for the public health advances of early 2013?
a. A massive anti-smoking advertising campaign by the FDA which penetrated deeply into all major national media;
b. A national effort to promote smoke-free workplaces in all states and cities that have not yet enacted such laws;
c. A national effort to urge states to increase their cigarette taxes and allocate the revenue to anti-smoking programs; or
d. The tremendous growth of electronic cigarettes.
The answer - according to the Morgan Stanley tobacco team - is D: The tremendous growth of electronic cigarettes.
The Rest of the Story
The rest of the story is that the greatest public health accomplishment of 2013 in terms of saving lives from smoking-related diseases has come not from any action of the FDA or national anti-smoking groups, but from the natural growth of a product which all of these groups wanted banned from the market. In other words, major public health advances in tobacco control have come not because of the FDA and national anti-smoking agenda, but in spite of it.
So here is another question for my readers:
Which of the following represents the greatest threat to saving lives from smoking-related disease by drastically reducing cigarette consumption?
a. the failure of electronic cigarettes to continually improve their performance and distribution;
b. the general lack of content of electronic cigarette customers with these products;
c. increasing evidence of the health hazards of electronic cigarettes;
d. increasing evidence that e-cigs have dismal effectiveness in smoking reduction;
e. the efforts of the FDA and national anti-smoking groups to get e-cigs off the market or make it virtually impossible to market them effectively.
The answer is: E: the efforts of the FDA and national anti-smoking groups to get e-cigs off the market or make it virtually impossible to market them effectively.
It is ironic that the FDA is seen as the main obstacle to the massive decline in cigarette consumption that is predicted to occur due to electronic cigarettes. If the FDA and anti-smoking groups were interfering with any other intervention that showed as great promise in reducing cigarette consumption, you can imagine that the public would be outraged.
Well, perhaps the public should be outraged because this is precisely what is happening. While there still is an escape hatch for the FDA (carving out a separate regulatory framework for electronic cigarettes that enhances the ability of companies to make reduced exposure, reduced risk, and smoking cessation or reduction claims), I have heard no discussion to indicate that this is the direction that the agency is likely to go.
My five key points related to potential FDA reglation of tobacco products are included in a special Tobacco Journal International feature on electronic cigarettes.
NOTE: Thanks to David Sweanor, who provided ideas for much of the intellectual content of this commentary.