CCC Submission to the FDA: Flavor Bans on Less Harmful Products

To:       Food and Drug Administration:

Agency/Docket Number: Docket No. FDA-2017-N-6565

RIN: 0910-AH60

From:  Jeff Stier, Senior Fellow

Consumer Choice Center

Date:   July 17, 2018

This document is in response to the FDA’s request for comments, data, research results, or other information about, among other things, how flavors attract youth to initiate tobacco product use and about whether and how certain flavors may help adult cigarette smokers reduce cigarette use and switch to potentially less harmful products.

The FDA should be applauded for seeking more information about flavors in combustible tobacco products and e-cigarettes as it considers how to protect public health under the Tobacco Control Act.

Flavor Bans on Less Harmful Products:

The FDA might be seeking to use this vaguely-worded ANPR to begin the process of either directly banning certain flavors in e-cigarettes, or to deny premarket tobacco applications (PMTA) for products containing certain flavors. Doing so without conclusive and comprehensive data to prove that the benefits of such bans outweigh their costs. No such evaluation could possibly take place at this time, for the reasons described below.

The city of San Francisco has already banned the sale of all flavors in e-cigarettes, even to adults. This local ban, and others that could follow, are already undermining the FDA’s comprehensive regulatory plan to fight smoking, given the critical role flavors play in helping adult smokers both reduce their cigarette use and to quit smoking completely through the use of less harmful alternatives. As Director Zeller has stated, products that are potentially less harmful than cigarettes must also appeal to adult smokers in order for them to switch. I am aware of no evidence that if certain flavors were removed from the marketplace, adult smokers would continue to use e-cigarettes instead of tobacco cigarettes.

As other submissions to this docket illustrate, there are a wide variety of preferences among adult e-cigarette users (almost entirely former smokers, or those who have significantly reduced use, many of whom are on a path to quitting), and some cite their ability to use a variety of certain flavors to keep their interest; “anything not to go back to cigarettes,” is a common refrain.

No adult smokers should be restricted from having access to lower-risk products that can help them reduce harm from smoking.

We’ve seen cigarette use decline among adults as e-cigarettes have taken market-share from cigarettes.

But a significant number of adults still smoke, even as they say they’d like to quit.

Many of these smokers have tried NRT together with counseling, and have still been unable to quit completely and permanently. For the most inveterate smokers, e-cigarettes with a wide range of flavor choices have been their only savior.  Any intervention that makes it harder for adults to quit the use of combustible tobacco is not acceptable, even if the trends of overall smoking rates is moving in a more positive direction.

We cannot be complacent with currently available NRTs, nor can we count on NRTs developed in the future, nor should we believe that currently available e-cigarettes are enough to help every smoker.  A ban on certain flavors would harm an unknown number of adult smokers, by blocking what may be their own best cessation option.

Back to Basics: Smoking Prevention and Cessation

Preventing youth initiation of cigarette smoking — as well as helping adult smokers who want to quit smoking  — should be paramount.

Far too many kids today initiate smoking combustible cigarettes and far too many adults who want to quit have not been successful.

Youth Vaping Versus Adult Cessation, a False Dichotomy:

FDA need not try to engage in the impossible task of accurately guessing whether the benefit of preventing some youth from initiating e-cigarette use by banning certain flavors outweighs the cost of preventing adults from quitting smoking by banning certain flavors.

The FDA was correct to ban the sale of all e-cigarettes to minors. The agency should use the enforcement power granted to it by Congress to prevent all e-cigarette sales to minors. The agency should also incorporate youth prevention messages with a long overdue tobacco harm reduction educational campaign, which would inform all citizens, regardless of their age, about the unique dangers posed by cigarette smoking.

The Not Yet Knowable Promise of Harm Reduction:

Given widespread misconceptions about nicotine, no current or past analysis of the efficacy of e-cigarettes to help adult smokers quit should be considered a representation of the full potential of the public health benefits of non-combustible tobacco products. These products can only reach their potential after a number of conditions are met;

  • All smokers, including vulnerable populations, are able to differentiate between the dangers of nicotine use, including from the use of non-combustible recreational products, and the dangers of smoking.
  • The market is fully mature and able to quickly adjust to always-evolving consumer preferences and new technologies.
  • Lower-risk products are given an opportunity to compete in the marketplace with already commoditized cigarettes, where the costs of innovation, regulatory compliance, and marketing are low compared to new products

Further, because PMTA guidelines need to be more transparent and because product innovation is frozen as a result of the deeming regulation, the market for e-cigarettes and other non-combustible products is not anywhere near fully developed. Look only to the FDA’s continued failure to grant modified risk tobacco product claims on snus and heated tobacco.

Therefore, because it is impossible to fully ascertain how many smokers could quit smoking through the use of certain e-cigarette flavors, it is impossible at this time to consider the public health costs of banning the sale of certain flavors to adults, even if those flavors contribute to the appeal of e-cigarettes among youth, especially given the fact that sales of e-cigarettes are already forbidden to minors.

It is not acceptable for youth to use e-cigarettes. Period.

But this does not mean that banning certain flavors because they may appeal to youth is justified, regardless of the fact that doing so would undermine cessation either now, or when conditions for harm reduction to achieve its potential are met.

Less Intrusive and More Effective Interventions to Prevent Youth Vaping:

The FDA must also recognize the role of parents, families, school, and communities to prevent youth e-cigarette use, or far worse, youth smoking.

Product bans are the most blunt tool available to regulators. And they come with a potentially very high cost to those truly in need of better choices: adult smokers, a segment of the population that has been shunned, heavily taxed and literally forced out into the cold, but not helped by regulators.

A ban on certain flavors will prevent a currently unknowable number of adult smokers from quitting, while illicit youth vaping will continue. Harming adult smokers by preventing them from legally purchasing appealing lower-risk alternatives in the name of potentially protecting some youth is not an acceptable trade, especially when a more narrowly-tailored regulatory option is already in place, even though enforcement efforts have been insufficient to prevent all illicit sales to minors.

Marketing Restrictions, Not Flavor Bans:

This does not mean that, short of more effective enforcement and educational efforts, there are no other appropriate regulatory tools available to prevent youth use of e-cigarettes.  The agency should distinguish between regulating certain flavors and regulating the marketing of e-cigarettes to reduce the appeal to youth. For instance, even though many adults enjoy the taste of gummy bears, the FDA could consider regulating products marketed as “gummy bear” e-cigarettes, without banning the actual flavor used in those products, which appeal to adult smokers.  This is not to say that e-cigarette companies shouldn’t be allowed to market their products with fun and imaginative names to attract adult smokers. In fact. marketing is essential to appeal to smokers— and e-cigarette advertising effectively and narrowly targeting adult smokers amounts to private-sector funded smoking cessation campaigns that achieve more than scolding and fear-inducing ads ever could. However, if the FDA finds it necessary to take additional regulatory action to prevent youth e-cigarette use, it could do so in a way that advances this worthy objective in a way that limits the harm caused to adult smokers.

Menthol:

The FDA is also considering whether to regulate menthol in combustible cigarettes.

The Tobacco Products Scientific Advisory Committee report on menthol steered clear of making a policy recommendation to the FDA. The report addressed a number of unintended consequences on a ban on menthol, but the FDA has not yet produced sufficient evidence to address these concerns to consider a rule on menthol.

The FDA also issued a report, “PRELIMINARY SCIENTIFIC EVALUATION OF THE POSSIBLE PUBLIC HEALTH EFFECTS OF MENTHOL VERSUS NONMENTHOL CIGARETTES: but the report stated that it did not “constitute a decision about what regulatory action, if any, FDA might take with respect to menthol in cigarettes.” This is appropriate, since the question of menthol versus nonmenthol cigarettes is very different than the question of what impacts, including unintended ones, a ban of the sale of menthol cigarettes would have on the population.

Adding to the evidence against a ban on menthol cigarettes, in 2015, the National Academy of Sciences published a report, “UNDERSTANDING THE U.S. ILLICIT TOBACCO MARKET Characteristics, Policy Context, and Lessons from International Experiences,” which reported that:

On the question of reducing menthol in cigarettes, the research has been limited to consumer surveys and short-term laboratory studies of U.S. smokers using nonmentholated products. That research suggests most smokers would consider legal alternatives, including switching to a nonmentholated cigarette or quitting. Some may choose some kind of self-mentholation technology if the option is available. This research also indicates that highly addicted smokers and daily users would be more likely than other smokers to seek mentholated cigarettes through the illicit market. 

To date, the FDA has not addressed the points made in the NAS report with regard to the efficacy of any proposed menthol ban, or such a ban’s effect on the illicit market. Currently, the literature suggests that while a ban might curb some smoking among less addicted menthol smokers, it would also increase the size of the illicit market and come with the wide range of costs associated with that, which include an increased rate of youth initiation of cigarette smoking.

Incorporation of Earlier Comments:

The FDA received 174,466 in response to the now closed 2013 docket on menthol in cigarettes, Docket ID: FDA-2013-N-0521. Because the current docket addresses many topics, including menthol in cigarettes, the FDA should incorporate all comments from Docket ID: FDA-2013-N-0521 into the current docket in order to fully understand the issues as it considers this ANPR. Little has changed in terms of policy considerations or the science of menthol in cigarettes since the earlier docket, and those who commented at the time may no longer be available to comment in the current docket, or they may have a reasonable expectation that the prior comments are taken into to account in the current ANPR, since the same issue is under consideration. Further, since there have been personnel changes at both the FDA, and at OMB, which must evaluate the rule, it is important that those comments be incorporated into the current docket.

Jeff Stier

Senior Fellow

Consumer Choice Center

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About Jeff Stier

Jeff Stier is a Senior Fellow at the Consumer Choice Center. Mr. Stier has been a frequent guest on CNBC, and has addressed health policy on CNN, Fox News Channel, MSNBC, as well as network newscasts. He is a guest on over 100 radio shows a year, including on NPR and top-rated major market shows in cities including Boston, Philadelphia, and Sacramento, plus syndicated regional broadcasts. Jeff’s op-eds have been published in top outlets including The Wall Street Journal, The Los Angeles Times, The New York Post, Forbes, The Washington Examiner, and National Review Online.

When environmentalists oppose science

In the era of self-driving cars, big data and increasingly sophisticated bio-medical advances, the age-old question of how regulation can keep up with technology is more relevant than ever.

Scientific advances touch every aspect of our lives, often in ways we rarely think about. Today, we live longer, healthier, more productive and more enjoyable lives because of our access to products that were unimaginable for most of human history. So it’s important to get the right balance when regulating our modern world, to both keep us and our planet safe, while fostering innovation that benefits society.

The debate over regulation often devolves into a debate about “too little” versus “too much” regulation, split along the ideological divide. Too little regulation, goes the argument, and we are exposed to too much risk. Too much, and we don’t advance.

This binary approach, however, represents the dark-ages of regulatory policy. It was more frequently relevant when our tools to measure risk were primitive, but today’s technology allows much more precise ways to evaluate real-world risks. With less uncertainty, there’s less of a need to cast a broad regulatory net.

Regulation not warranted by countervailing risk just doesn’t make sense. That’s why a pseudoscientific approach, dubbed the “precautionary principle,” behind much of today’s regulation is so pernicious. This dogma dictates that it’s always better to be safe than to ever be sorry. The approach is politically effective not only because it’s something your mother says, but because it’s easier to envision potential dangers, remote as they may be, than potential benefits. Uncertainty, it turns out, is a powerful tool for those who seek to live in a world without risk.

But what happens when regulators can get a reasonably good handle on benefits and risks? Some potential risks have been eliminated simply because the basis for the concern has proven to be unwarranted. For more than two decades, the artificial sweetener, saccharin, came with a cancer warning label in the U.S.But it turned out that the animal experiment which led to the warning was later found to be irrelevant to humans, and the warning was eventually removed.

Warning about a product when risks are not well-understood is prudent. But it would be absurd to continue to warn after the science tells us there’s nothing to worry about.

Today, an analogous situation is playing out in the EU, where activists are using outmoded tests not just to place warning labels on silicones, a building block of our technological world, but to ban them outright.

The playbook is predictable: as the scientific basis for a product’s safety grows, opponents go to increasingly great lengths to manufacture uncertainty, move the goalposts and capitalize on scientific illiteracy to gain the political upper-hand.

We’ve seen these tactics employed in opposition to everything from growing human tissue in a lab, to harm-reducing alternatives to smoking, such as e-cigarettes. Now, the effort to manufacture uncertainty is playing out in the debate over the environmental impact of silicones, which are used to in a wide range of consumer, medical, and industrial products.

Fortunately, in the case of silicones, regulators in a number of countries, including Australia, have put politics aside and adhere to appropriate scientific methods to inform their decision-making.

The Health Department’s National Industrial Chemicals Notification and Assessment Scheme published an environmental assessment for certain chemicals used to make silicones, in particular, a class of chemicals called siloxanes. Silicones have unique properties which make them useful in a wide range of applications, including aviation, energy-efficient LED lighting, medical products, and personal care products. But their widespread use and unique properties have raised questions about their effect on the environment, such as whether they bioaccumulate and pose a risk to aquatic life. The report employs a risk-based approach, the very type that European-based precautionary principle advocates oppose.

Here’s where we get back the issue of uncertainty. Advocates for restricting the use of certain siloxanes rely primarily on studies done in laboratories, which don’t replicate how the chemicals respond to real-world conditions, where for instance, they quickly evaporate. (This property is what makes them particularly useful in sunscreens which spread easily and evaporate quickly.)

Laboratory studies are a valuable part of evaluating chemicals because they can identify the potential that a particular substance poses a hazard. But hazard assessments are of limited value without considering real-world circumstances. To do that, scientists do risk assessments, which takes into account factors such as the level of exposure to the hazard in conditions being evaluated.

We like to look at it this way: falling out of a boat and drowning to death is a hazard. However, the risk of drowning in a desert is so low because there’s no exposure, that it a risk not worthy of concern.

This rational approach to hazard and risk was successfully adopted in Canada. Environment and Climate Change Canada (ECCC), using real-world exposure information, decided to minimize exposure to a level that didn’t degrade the environment, requiring monitoring from certain industrial sources. In other words, the ECCC didn’t just consider the hazard, they also considered the risk. As a result, Canada did not ban consumer use, but, instead, took steps to reduce environmental exposure from only a narrow group of industrial sources that were potential problems.

With regard to one siloxane, D4, ECCC regulators found that the chemical “is entering or may be entering the environment in a quantity or concentration or under conditions that have or may have an immediate or long-term harmful effect on the environment or its biological diversity.” But instead of banning its use, consistent with their risk management approach, they required a significant reduction of “D4 releases to the aquatic environment” and encouraged the use of alternatives to reduce or minimize risks.

On D5, Canada’s regulators did something even more practical. Recognizing industry objections to the E.U.-style modeling approach, which ECCC initially used for D5, the Board of Review took real-world exposures of D5 into account. Then they did what all good scientists should be prepared to do: they reversed course after finding that new, more accurate data conflicted with their initial findings. In light of the improved information, the ECCC regulators wrote that “it is virtually impossible for Siloxane D5 to occur in any environmental matrix at concentrations sufficient to produce harm to the environment.”

Similarly, the U.S. Environmental Protection has been working in concert with manufacturers to measure the degree to which key chemicals used in the manufacture of silicones are released into the environment, as well as what happens to the chemicals in real-world circumstances, rather than through modeling or laboratory studies which don’t necessarily reflect what happens in nature.

Australia’s report is consistent with these approaches, noting that “[t]he direct risks to aquatic life from exposure to these chemicals at expected surface water concentrations are not likely to be significant.”

This is the very type of scientific analysis that European activists disdain. Because for them, environmental protection is not measured by outcomes, but by the severity of restrictions, regardless of the quality of science used to justify them.

We support tough environmental regulation when the best science supports it. But sadly, many of today’s environmentalists see science only as a tool to advance an anti-progress political agenda. When the science contradicts the agenda, the science is the first to fall by the wayside.

In legal circles, they say “If you have the facts on your side, pound the facts. If you have the law on your side, pound the law. If you have neither on your side, pound the table.” The opposition to risk-assessments is the scientific equivalent to pounding the table.

The value of the Canadian and Australian approach is that consumers will continue to benefit from improved product performance provided by silicones. The environment will benefit as well, given silicones widespread use in green energy products, from solar panels to wind turbines and even in energy efficient lighting.

Australia’s risk-based approach should be a model for other governments assessing not only silicones, but all innovative products because it ensures the protection of the environment, while at the same time, when the science justifies it, also protecting consumers’ access to incredibly useful products.

Jeff Stier is a Senior Fellow at the Consumer Choice Center.

Originally posted on Catallaxy Files.

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About Jeff Stier

Jeff Stier is a Senior Fellow at the Consumer Choice Center. Mr. Stier has been a frequent guest on CNBC, and has addressed health policy on CNN, Fox News Channel, MSNBC, as well as network newscasts. He is a guest on over 100 radio shows a year, including on NPR and top-rated major market shows in cities including Boston, Philadelphia, and Sacramento, plus syndicated regional broadcasts. Jeff’s op-eds have been published in top outlets including The Wall Street Journal, The Los Angeles Times, The New York Post, Forbes, The Washington Examiner, and National Review Online.

Ending sugar protectionism will help boost small business and benefit consumers

This week in the nation’s capital, the House Agriculture Committee will decide the fate of various agricultural subsidies and food benefits for millions of Americans.

The bill, H.R. 2, known as the Farm Bill, includes provisions on crop insurance, dairy prices, wetland conservation, Supplemental Nutrition Assistance Program (SNAP) adjustments, and dozens of other rules and regulations on commodities.

Tucked within this massive bill is a continuation of the U.S. Sugar Program, a decades-old government program that effectively sets prices for sugar, guarantees cheap loans for domestic sugar producers, and keeps out foreign competitors. It’s sugar protectionism, through and through.

As I mentioned in the Washington Examiner some months ago, this program has the unintended consequence of raising the costs of sugar for various small businesses, and passing those costs on to consumers.

The consequence of that multi-decade arrangement, however, has been higher costs for consumers and domestic businesses that rely on sugar as a base ingredient for their products.

According to the American Enterprise Institute, users and consumers of sugar lose out to the tune of $2.4 billion-$4 billion a year. That directly hurts the thousands of small businesses that rely on sugar’s low prices.

Now that the Farm Bill is set to be voted on in the committee, legislators have a chance to alter this program that has proven to be a huge burden to small businesses and consumers.

Key to this will be the Foxx Amendment, proposed by U.S. Rep. Virginia Foxx from North Carolina. This amendment would shrink the U.S. Sugar Program from its current size to a more moderate version. It wouldn’t go so far as scrapping the program, but it would make necessary changes that would better benefit consumers and American businesses that rely on affordable sugar.

In an op-ed with Americans For Tax Reform President Grover Norquist, Foxx makes the case for reforming the U.S. Sugar Program and slimming down sugar protectionism once and for all.

But the sugar program costs some Americans more than higher grocery prices: it costs them their job. As the U.S. International Trade Administration found, the program kills three manufacturing jobs for every sugar-producing job that it protects.

Let’s look at a few painful examples. The Spangler Candy Company reports, “Today, we have about 150 people making candy for us in Mexico. In 2017, Spangler had 900 people apply for jobs at our Ohio factory. I would love to offer 250 of them a job as a candy cane maker, but our government insists that sugar processing jobs are more important than manufacturing jobs. They are picking winners and losers and our town has been the loser for many years now.”

The Atkinson Candy Company moved 80 percent of its peppermint-candy production to a factory in Guatemala that opened in 2010.

And the makers of President Reagan’s favorite candy, Jelly Belly, had to build its new 50,000-square-foot plant in Thailand thanks to the high sugar price driven by U.S. policy.

The evidence is overwhelming — this is an expensive and damaging special-interest giveaway and it must be stopped.

As Foxx and Norquist demonstrate, the current sugar program forces small, family-owned food companies to pay twice as much for sugar as the rest of the world. It restricts how much domestic sugar can be sold, and how much sugar can be imported from other countries.

That’s a huge blow to consumer choice, not to mention an indirect tax to small businesses that rely on sugar for their products.

According to the U.S. Census Bureau, the sugar program killed 123,000 jobs between 1997 and 2015. The U.S. Department of Commerce reports that for every sugar-processing job subsidized through artificially high U.S. sugar prices, three American manufacturing jobs are lost.

In response, Foxx introduced her own bill to tackle the program and modernize it. The Sugar Policy Modernization Act of 2017, introduced back in November, currently has 80 co-sponsors but remains stuck in the House Agriculture and Ways and Means Committees.

The Farm Bill will take precedence, and thus focus will now be on the Foxx Amendment to make the needed changes for America’s domestic sugar policy. If legislators want to help prop up American consumers and small businesses rather than Big Sugar, they would vote to reign in the sugar protectionism in the Sugar Program.

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About Yaël Ossowski

Yaël Ossowski is a journalist and informational entrepreneur. He's currently deputy director at the Consumer Choice Center, and senior development officer for Students For Liberty. He was previously a national investigative reporter at Watchdog.org. He is currently seeking a Master’s Degree in Philosophy, Politics, Economics (PPE) at the CEVRO Institute in Prague. Born in Québec and raised in the southern United States, he currently lives in Vienna, Austria.

Will Government Allow Gene Editing for Cancer Treatment?

The idea of genome editing is no longer a theoretical concept studied only within the confines of labs and scientific research institutions. In August 2017, scientists reportedly managed to successfully use the genome-editing technique to correct a disease-causing mutation in viable human embryos. This is just one of the many applications of the technique scientists want to use to alter, and ultimately prevent, damaging mutations in plants, animals, and humans.

So how is all of this supposed to work? In essence, genome editing makes it possible to alter the DNA of an organism. By doing this, it is possible to either delete, add, or change genetic materials in certain locations of the DNA. CRISPR-Cas9 is a relatively recent genome-editing technique that holds particular promise at the moment. Compared with previous methods of genome editing, CRISPR-Cas9 has created enthusiasm in the scientific world for its comparable cost, accuracy, and speed of execution.

CRISPR-Cas9 is based on a gene-editing process that naturally occurs in bacteria. When viruses invade the organism, bacteria are able to snap parts of the virus’ DNA. They then use them to create unique DNA segments that help them “remember” the invading virus and closely related ones. These segments are referred to as CRISPR arrays. If the virus invades the organism again, the bacteria deploy the CRISPR arrays to produce RNA segments to target the DNA of the virus. Afterward, the enzyme Cas9 is used to disable the virus by cutting its DNA apart.

Scientists have adopted this mechanism, making use of the DNA’s repair and memory mechanism to add, delete, and alter genetic material.

Though the technology is still in its infancy, its potentially transformative effect is no longer confined to pure theory and speculation. Chinese scientists have already deployed CRISPR-Cas9 to genetically edit several people. Right now, the European Union and the U.S. Food and Drug Administration have begun the process of regulating and ultimately permitting the use of CRISPR-Cas9 for initial genomic editing on plants and ultimately, for humans.

CRISPR-Cas9 offers the possibility of tackling diseases that were previously thought of as incurable—in China, a significant portion of those undergoing genome editing treatment did so to combat esophageal cancer, leukemia, and HIV.

In the wake of potentially significant side-effects of the technology, some people might be inclined to reject its introduction. Enthralled by a fear of unknown consequences of using genome editing, they might reject it altogether. While it makes sense to support sensible guidelines for scientists when it comes to such transformative technologies, we should not succumb to a generalized mindset of skepticism towards innovation. Throughout history, human beings have stirred towards scientific progress by a method of continuous trial and error. This is how penicillin got discovered and similarly, how the X-Ray was accidentally discovered by Wilhelm von Roentgen in his Wuerzburg, Germany lab.

If we accept this process of trial and error, of inevitable mistakes on the path towards technological progress, it makes no sense to adopt a default attitude of skepticism. In this context, such an attitude is akin to saying that because mistakes have happened in the past and will likely continue in the future, technological change should be generally met with a dismissing response. This attitude is commonly referred to as the precautionary principle. If one is aware that technological change emerges from uncertainty and constant trials, hurdles and errors along the way should rather lead to the acknowledgment that this is simply all part of the process in the discovery of new ideas.

Instead of falling prey to a default mode of skepticism that undermines discovery and human achievement, we should strive to combine sensible regulations with an aspirational mindset that is open towards new technologies. Such an attitude of permissionless innovation creates social values that hold the constant strife for greater human achievement in high regard instead of dismissing it with a mindset of cynical skepticism. Including such values within the framework of a society is crucial in laying the groundwork on which further technological innovation can flourish.

In that same spirit, please join my Competitive Enterprise Institute colleagues and I this weekend when we celebrate Human Achievement Hour, our annual celebration of innovation and progress.

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About Nur Baysal

Nur Baysal is a Technology and Disruption Fellow at the Consumer Choice Center and Research Associate at the Competitive Enterprise Institute. A philosophy major, she is especially interested in the intersection between creativity and technological innovation.

Letter to the Utah House Revenue and Taxation Committee on HB 88

Dear Chairman Eliason and members of the House Revenue and Taxation Committee,

I received thoughtful feedback from many of you after I wrote to you last month to share my concerns that H.B. 88 (Electronic Cigarette and Other Nicotine Product Amendments) would harm Utah consumers (especially the most vulnerable), local businesses, and provide no countervailing benefit to the broader public or to the treasury.

I was pleased that some of you shared my view that this attempt to create additional tax revenue does not justify the negative ramifications it will have for your constituents. You understand that any excise tax on lower-risk alternatives to combustible cigarettes would make it harder for your constituents to quit smoking. But this 86% tax proposal is particularly unwise as it would guarantee an expansion of the black market while harming responsible businesses in your community.

Some of you also sought a better understanding about whether e-cigarettes are indeed helping adult smokers quit, and the impact of e-cigarettes on youth, who we all agree should not use any nicotine products, including e-cigarettes.

I wanted to share some recent developments that add to the substantial evidence that suggests that e-cigarettes should be regulated, but with caution, given their potential to help adult smokers quit.

Yesterday, the American Cancer Society, which had been a strident opponent of e-cigarettes, announced an important change in course.  Without dismissing concerns about youth, ACS now recommends “that clinicians support all attempts to quit the use of combustible tobacco and work with smokers to eventually stop using any tobacco product, including e-cigarettes.  Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA approved cessation medications.  These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.”

Additionally, although there are certainly differences between the populations in Utah and the U.K., this month’s Public Health England’s updated comprehensive review is instructive. In describing the analysis, their tobacco control program lead wrote, “Our report found no evidence so far to support the concern that e-cigarettes are a route into smoking among young people. UK surveys show that young people are experimenting with e-cigarettes, but regular use is rare and confined almost entirely to those who already smoke. Meanwhile, smoking rates among young people in the UK continue to decline. 

He added that, There is currently no evidence to suggest that e-cigarettes are encouraging people to continue smoking – the picture in the UK suggests the opposite. The proportion of e-cigarette users who are ex-smokers has been increasing over recent years. Of the 2.9 million adult e-cigarette users in the UK, more than half have completely stopped smoking. A further 770,000 have given up both smoking and vaping. At the same time, quit success rates have been improving and we’re seeing an accelerated drop in smoking rates, currently at a record low of 15.5% in England.

I have faith that the public health community, legislators, and responsible local businesses can work together to prevent youth use of e-cigarettes without unnecessarily harming adult smokers and Utah businesses, so many of whom are diligent in not allowing minors to even enter their premises. It is evident that youth who use e-cigarettes attain them from illicit businesses and other sources. This tax would do nothing to address that problem.

Sincerely,

Jeff Stier Senior Fellow, Consumer Choice Center

@JeffAStier

February 21, 2018

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About Jeff Stier

Jeff Stier is a Senior Fellow at the Consumer Choice Center. Mr. Stier has been a frequent guest on CNBC, and has addressed health policy on CNN, Fox News Channel, MSNBC, as well as network newscasts. He is a guest on over 100 radio shows a year, including on NPR and top-rated major market shows in cities including Boston, Philadelphia, and Sacramento, plus syndicated regional broadcasts. Jeff’s op-eds have been published in top outlets including The Wall Street Journal, The Los Angeles Times, The New York Post, Forbes, The Washington Examiner, and National Review Online.

Cryptocurrency Regulations Should Not Stifle the Innovative Potential of Blockchain Technology

By Nur Baysal | 12. February 2018

Recently, the prices of cryptocurrencies like Bitcoin and Ethereum made new headlines: After reaching a staggering all-time-high of $19,783 in December, the price of Bitcoin lost more than half of its value in January and February, dragging the price of other cryptos down alongside it.

During this time, a plethora of news stories tinted cryptocurrencies in a negative light – from Facebook banning ads for cryptocurrencies and ICOs to China restricting access to foreign crypto exchanges for its citizens and lastly, banks banning cryptocurrency purchases on their credit cards.

It is not news that volatility in the crypto markets exceeds that of traditional stock exchanges by a couple of magnitudes. From late 2013 to early 2015, cryptos underwent a draining bear market that came to an end with exponential price explosions in the following bull market.

Shortly following any crash of cryptocurrencies, some people feel validated to voice their prediction of the end of Bitcoin and cryptocurrencies and call for harsher crackdowns of the technology as a whole. In some, this volatility awakens a deeply-entrenched skepticism of a new technology that’s still in its infancy.

But this overly conservative regulatory approach is a danger to the innovative potential of blockchain technology. Instead of focusing on the volatile nature of the crypto market and equating it with manipulation or dismissing it as a sheer gamble, crypto skeptics should learn more about the transformative nature of the technology behind many cryptocurrencies.

Despite their popular label in the media, many of them are not, in fact, primarily currencies.

The use cases of distributed ledger technology span from delivering aid efficiently to refugees, using blockchain to build a digital identityenabling scientists to use your safely stored genomic data and a myriad of other fields of application.

Many crypto skeptics refuse to inform themselves on the multitude of use cases of blockchain technology across several industries. Solely focusing on the volatile price does not leave enough room to ponder upon the many ways this newly emergent technology might change our lives in the near future.

During the recent Senate hearing on cryptocurrency regulations, the chairman of the United States Commodity Futures Trading Commission (CFTC) J. Christopher Giancarlo had some encouraging words for the primarily younger generation interested in blockchain technology.

Talking about his niece’s interest in Bitcoin, Giancarlo stressed that any future regulations should not be dismissive, but rather respectful of the younger generation’s fascination with blockchain technology:

“It strikes me that we owe it to this generation to respect their enthusiasm about virtual currencies with a thoughtful and balanced response, not a dismissive one,” said Giancarlo.

Elaborating further, Giancarlo stressed that regulators should have a positive outlook on the future of this technology. While doing so, he seemed quite knowledgeable, even going as far as explaining the meaning of crypto-related terms like ‘HODL’ and ‘kimchi premium’.

For Giancarlo, regulating cryptocurrencies should have the aim of cracking down on fraudsters and fight market manipulation, not to stifle the flourishment of a new technology whose many advantages he acknowledged.

In this way, consumers should be given the opportunity to educate themselves on the different use cases of blockchain technology and have the liberty to invest in projects they deem promising.

Instead of stifling innovation and consumer choice, such a regulatory framework that provides enough space for creative exploration would ensure that future advancements in the cryptosphere are acknowledged as such and gradually find themselves changing traditional banks, corporations, and government operations.

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About Nur Baysal

Nur Baysal is a Technology and Disruption Fellow at the Consumer Choice Center and Research Associate at the Competitive Enterprise Institute. A philosophy major, she is especially interested in the intersection between creativity and technological innovation.

Dental Therapists: A new dental category may not be the answer

Because so much of the U.S. healthcare system is focused on medical expenses, benefits, and insurance programs, it’s an unfortunate fact that dental care is often neglected.

An estimated 35.6 percent of U.S. adults didn’t visit a dentist last year, along with 55.3 percent of Medicaid-eligible children.

Is it mostly because people cannot find enough dentists or because costs are too high?

For consumers, it seems the single biggest reason for not visiting a dentist is cost. Knowing these facts, what can we do in order to help reduce costs for dental patients around the country? It’s a serious question which invites a good amount of discussion and recommendations.

In Florida, legislators and dental professionals have called for the state to improve the dental workforce by establishing a special loan program for dentists who practice in high-need areas.

That would at least increase the number of dentists and ease the burden for dental students who face an average amount of $287,331 in debt once they leave school.

In states like New Mexico, Arizona, and Florida, there is a movement afoot to introduce a new professional category in the field of dental care, known as dental therapists.

Dental therapists, unlike dentists, require less training and education, and could presumably offer their services at a lower cost, albeit while not fully capable of performing more complex procedures.

Such programs have already been implemented in states such as Maine, Vermont, and Minnesota, and in countries like New Zealand and Canada, but the results haven’t been clear.

New Zealand first implemented dental therapy programs early in the 20th century, and they formalized their degree program in 1999.

In the last two decades, however, the rate of child tooth decay has increased wildly, forcing thousands of children to face hospitalization or emergy surgeries. The number of children hospitalized for dental issues has skyrocketed from 4500 to 7500 in the past 15 years. So that result doesn’t seem positive.

One researcher at the School of Public Health at the University of Minnesota studying this issue is very skeptical it will work in that state.

However, the reality is that this hasn’t truly addressed the problem of that growing disparity between rural and urban oral health. As of December 2016, there were only 63 licensed dental therapists, half of whom were practicing in the Twin Cities metropolitan area.

It seems that dental therapy school graduates, once able to practice, are flocking to major cities in order to pay off their debts as well.

Organizations such as Pew Charitable Trust have crafted multi-state campaigns in order to advocate for the midlevel dental position, advocating for legislation which would allow dental therapists to become legal professions and be eligible for accepting Medicaid funding.

And that last distinction is important to note.

If we look at the state of Arizona, for example, there are 1,921,145 Arizonians on the Medicaid program, according to the  Arizona Health Care Cost Containment System. That’s 27 percent of the population eligible to have dental treatments covered as part of their public plans paid by taxpayers.

If dental therapists become a category of dental professionals and are able to perform dental services, they will also be eligible to accept Medicaid funding.

Would consumers benefit from such a scenario? Would patients be able to afford better care and have access to higher quality dental services?

That much is unclear, but the numbers from states and countries which have implemented dental therapy programs give us pause on whether they have been effective.

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About Yaël Ossowski

Yaël Ossowski is a journalist and informational entrepreneur. He's currently deputy director at the Consumer Choice Center, and senior development officer for Students For Liberty. He was previously a national investigative reporter at Watchdog.org. He is currently seeking a Master’s Degree in Philosophy, Politics, Economics (PPE) at the CEVRO Institute in Prague. Born in Québec and raised in the southern United States, he currently lives in Vienna, Austria.