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.

CCC Comments to FDA on Tobacco Product Standard for Nicotine Level of Combusted Cigarettes

Jeff Stier

Senior Fellow

Consumer Choice Center

New York, NY

July 10, 2018

Submission to the Food & Drug Administration

Submit your own comments:  https://www.regulations.gov/document?D=FDA-2017-N-6189-0001

 

The FDA’s consideration of a product standard to set a maximum nicotine level for cigarettes is a dangerous experiment justified only by good intentions and faulty research. Further, even if the FDA’s scant research were validated with the substantial research that is necessary to implement such a risky proposal, especially at a time when smoking rates continue to decline at an an unprecedented rate, implementation would not be appropriate until a robust array of satisfying lower-risk products were available to adult smokers who understood the differences in risk.

Good intentions, Unintended Consequences:

A ban on today’s cigarettes could have significant unintended consequence, leading to compensatory smoking, where smokers inhale more dangerous chemicals in an effort to get the nicotine they crave. The agency’s only science to support this risky policy is based on unvalidated modeling.

The agency also fails to address the obvious risk that this potential change would cause an explosion in the already-significant illicit trade in cigarettes. Because nicotine is so addictive, especially in cigarettes, smokers would find a way to get the cigarettes they prefer, even if it requires going to the black market.

Although the FDA is, as required by law, seeking comments on these issues, the agency’s haste in advancing this plan before the science exists to validate it, is troubling.

The FDA was in such a rush to move forward with the announcement of this ANPR, that my meeting with the Office of Management and Budget’s Office of Information and Regulatory Affairs, which was confirmed in writing on February 21st, was cancelled just in time for the FDA’s announcement that the ANPR was moving forward.

Contrast this hastiness with the FDA’s ongoing failure to keep its promise to develop product standards for ENDS, to fully and in a timely way grant PMTA and MRTP to snus and to heated tobacco. Without transparent rules which would make it easier to bring lower-risk non-combustible nicotine products such as e-cigarettes and heat-not-burn tobacco to market, adult smokers faced with a dramatic reduction will have only the black market to turn to.

The agency must also do a better job making sure consumers are fully informed about the differing risks of an emerging and diverse range of lower-risk nicotine products. In order for that to happen, the FDA, the Centers for Disease Control, local governments and leading public health organizations will have to correct the widespread misperceptions they have created about lower-risk “tobacco” products.

Scant and Faulty Research: 

On June 18th, 2018, Commissioner Gottlieb stated, “As we evaluate the best ways to regulate tobacco products, based on scientific evidence as well as the law, we depend on rigorous science to inform our policies and save lives.”

Yet to date, the preliminary science behind a nicotine rule is anything but rigorous. It relies on assumptions plugged into simulation models that are not based on real-world evidence of how smokers would respond to dramatic reductions in cigarettes- because no such evidence exists at this point in time.

It appears that the FDA is pushing a policy agenda and looking for the science to support it. Shouldn’t it be the other way around?

Premature:

On July 28, 2017, the FDA extended timelines for premarket tobacco applications for non-combustible products, such as e-cigarettes, until August 8, 2022. The agency did so “In order to allow the FDA to encourage innovation that has the potential to make a notable public health difference—and to inform future policies and efforts that will protect kids and help smokers quit cigarettes.”

The FDA stated at the time, nearly one year ago, that it plans to issue “foundational rules to make the product review process more efficient, predictable, and transparent for manufacturers, while (emphasis added) upholding the agency’s public health mission.”

The use of the word “while” suggests that issuing those rules could somehow undermine the agency’s public health mission. Yet in fact, it is the lack of such rules that are inconsistent with the agency’s public health mission. A robust market of lower risk-recreational nicotine products that have completed the PMTA process must be in place before the FDA implements a nicotine rule for combustible cigarettes.

Furthermore, the agency must take proactive steps to increase awareness of the promise of tobacco harm reduction. Studies have found an increase in the proportion of U.S. adults who incorrectly believe e-cigarettes to be as harmful as combustible cigarettes.

The agency promise that,  “Among other things, the FDA intends to issue regulations outlining what information the agency expects to be included in Premarket Tobacco Applications (PMTAs), Modified Risk Tobacco Product (MRTP) applications and reports to demonstrate Substantial Equivalence (SE). The FDA also plans to finalize guidance on how it intends to review PMTAs for ENDS.”

But to date, it has not issued anything along these lines, while at the same time it has rushed forward the nicotine rule.

On March 15, 2018, Commissioner Gottlieb stated that “We said from the outset that ours was a comprehensive approach that requires us to pursue all of its parts in tandem.” Yet the agency’s actions belie this commitment.

The FDA is correct that in order for a nicotine rule to potentially be effective, if backed up by rigorous science, there must be a range of lower-risk nicotine products available under PMTA and MRTP. However, the reverse is not true. In order for a tobacco harm reduction strategy to advance public health, it is not necessary to reduce nicotine in combustible cigarettes. I concede, that if unintended consequences of such a rule can be eliminated, it is clear how both prongs can work together to accelerate smoking cessation, with a two-pronged approach. But if the science, when it is complete, not support the dramatic reduction of nicotine in cigarettes, tobacco harm reduction is still absolutely in the interest of public health. While an incentive (non-satisfying cigarettes) would be eliminated, the most powerful incentive for most people is the will to live and to minimize harm to their own health. In order to reduce smoking rates, it is critical that the FDA fosters innovation through the PMTA and MRTP as required by Congress.

Congress did not authorize the FDA to properly implement PMTA and MRTP only if it is able to dramatically reduce nicotine in cigarettes. In fact, Congress required FDA to implement PMTA and MRTP. It only authorized FDA to reduce nicotine in cigarettes. The idea that “you can’t have one without the other” is a gross misrepresentation of the Tobacco Control Act.

Recommendations:

The agency should prioritize the development of a product review process for lower-risk products to be more efficient, predictable, and transparent for manufacturers, in order to truly advance the agency’s public health mission.

This part of the comprehensive plan needs to be in place first, giving time for investors to invest, allowing innovators to innovate, manufacturers to comply with the regulatory process, and the agency and public health groups to undo misperceptions about nicotine, before nicotine levels in cigarettes might be lowered.  Doing so is essential in order to minimize a black market for full nicotine cigarettes. The agency should look to Public Health England for guidance on how this can be done effectively, given the UK’s recent unprecedented successes in reducing smoking rates by embracing tobacco harm reduction.

At the same time, the agency should begin to develop rigorous, comprehensive and unbiased science that either supports, or doesn’t support, the policy put forth in the ANPR. Because the agency’s apparent intent to advance the rule even before a scientific basis exists, the agency will have to take extraordinary steps to insulate the entire research effort is free of confirmation bias.

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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.

Our Comment on WHO Independent High-Level Commission Report on Non-Communicable Diseases

LINKED ON WHO WEBSITE

From:    Jeff Stier, Consumer Choice Center (NGO)

To:         WHO Independent High-level Commission

Date:   13 May, 2018

Re:      Comments on Draft Report

The Consumer Choice Center shares the sentiment of the draft report of the WHO INDEPENDENT HIGH-LEVEL COMMISSION ON NON-COMMUNICABLE DISEASES that “a fresh working relationship must be established” with a wide range of industries to promote health and behavior change.

We believe that the best way to promote health is to recognize the role of individual choices made by consumers and foster robust private sector activity that makes it easier for consumers to make better choices. Advances in public health require partnership between the private and public sector. History shows that improvements in public health are driven by innovation in a wide range of sectors. As such, while a positive and collaborative working relationship must be established with industries including food, non-alcoholic beverages and restaurants, all industries must be treated as allies, employing their knowledge and incentive for profit to promote health. 

For instance, innovation in the alcohol industry has the potential to lower mortality related to alcohol abuse. But despite scientific advances making this possible, industry has yet to embrace the approach. As Dr. David Nutt, professor of neuropsychopharmacology at Imperial College London, and the chair of DrugScience.org.uk wrote in The Guardian in 2013,  “before we can sober up in minutes, the drinks industry needs to embrace this healthier approach.” 

While abstinence is the safest approach, the public health community should also embrace lower-risk options for those who do not abstain. 

The commission is well-aware of the public health gains achieved from the application of harm-reduction in areas including clean needle exchange and condom use. 

The draft report properly points to another area where gains should and must be made given the disease and death caused by smoking. However, the report strikingly fails to distinguish between different forms of tobacco use. Indeed, the type of tobacco use responsible for the vast majority of the harm caused by tobacco is not even mentioned once in the draft report.  The report does not use the word “smoking” or “cigarettes” even once.

The draft report should be revised to recognize the difference in risk between non-combustible tobacco products and the deadly cigarette. The astounding fact that the rate of cigarette smoking in Sweden, where snus is often used instead of cigarettes, is down below 5 percent, and tobacco-related diseases are correspondingly low, should be a wakeup call to those who are resistant to recognizing the promise of tobacco harm reduction. 

Noncombustible tobacco, e-cigarettes, and other forms of nicotine delivery that can replace the combustible cigarette for those who are otherwise unable or unwilling to quit using nicotine should be seen as allies, not threats, to public health.  Consumers should understand that these products should be used exclusively by smokers, and despite their significant lower-risk profile as compared to cigarettes, are still not free of risk.

Regulations, taxes, and public awareness campaigns must all recognize the difference in risk between different products, recognizing that the most important difference between products is whether or not the product delivers nicotine through combustion.

Gains in this area will require that government agencies, public health organizations, and industry put aside their differences to focus on helping consumers reduce the harm they cause themselves and others when they smoke cigarettes.

 Finally, it is important to note that consumers, the very public that the public health community seeks to help, are often left out of policy discussions that affect them, and require their engagement.

We believe that when making lifestyle choices, consumers make decisions based on a number of individual factors, one of which includes what is best for their own health. But a wise choice for one individual may be an unrealistic choice for another. As such, we believe that consumers are best-positioned to make decisions about their own health and the choices they make.

We believe that consumers, and public health as a whole, will benefit when industry is incentivized to innovate, giving consumers more choices to make decisions that are in their best interest.

Sincerely,

Jeff Stier

Senior Fellow

Consumer Choice Center

Washington, DC

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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.

Response to DG Trade’s list of countermeasure to Trump’s Tariffs: Trade provocations do not require any response!

Your views and information regarding the EU economic interests in steel and aluminium products originating in the EU that might be affected by a tariff increase, announced by the United States of America on 8 March 2018 and applicable as from 23 March 2018:

 Potential tariffs imposed by the US government on steel and aluminium imports from the EU and other trade partners are bad news for US consumers and manufacturers abroad. Since the Consumer Choice Center represents consumers not only in Europe but also in the United States we see this build-up of trade barriers by the Trump administration with worry. While steel and aluminium are rarely directly purchased by consumers, unintended consequences in the larger value chain will lead to less choice and higher prices for consumers. Experts have already warned about the threat to canned sodas and canned beer (cans are mainly made out of aluminium). An increase of packaging prices will especially hit poorer households as they spend a higher share of their disposable income on consumer goods. We at the Consumer Choice Center firmly believe that trade barriers are bad for consumer choice and consumers’ purchase power. We still hope that these announced measures will be as ephemeral as the planned and revoked anti-dumping tariffs on the Bombardier C-Series.

6.     Your views and information regarding the EU economic interests in the products which could be subject to possible EU commercial policy measures in response to an announced U.S. tariff increase on certain steel and aluminium products originating in the EU, listed in the enclosed document ‘List of Products’:

While the current US government seems to be interested and willing to increase trade barriers, the European Union’s trade policy should follow the paradigm of consumer choice and affordability. The EU has been pushing for free trade agreements with many large trade blocks. Abandoning this policy of more openness and accepting the US’ invitation to join a trade war would be bad for European consumers.

The initial goods mentioned by Mr. Juncker in his Hamburg speech included Kentucky Bourbon, Harley Davidson motorbikes, and Levis Jeans. These are not just strong US brands but also products that are hard to substitute by EU consumers with switching to EU-produced alternatives. New tariffs on US products reduce consumer choice of EU citizens, lower their purchase power (e.g. a 25% tariff on a motorbike would make it much less affordable for future buyers and more expensive to maintain for current buyers that need to purchase spare parts from the same manufacturer), and MOST IMPORTANTLY punish EU consumers for the trade policy of the US government.

Example Bourbon: Bourbon is a drink more and more fancied by bartenders and is included in many cocktails. Adding a 25% tariff on Bourbon would force many bar-owners to either delist Bourbon, buy cheaper Bourbon of a lower quality, increase cocktail prices (an Old Fashioned with Bourbon could easily go from 8 EUR to 10 EUR), and rewrite price lists and menus. Given that trade policy is made by the Commission Eurosceptic groups would have an easy play to blame the EU for this price increase and would hit fertile grounds given that they would actually have a point.

Trade provocations do not require any response:

We recommend the European Commission and DG Trade to take the high road in this trade provocation. Instead of imposing new tariffs the EU should unilaterally drop tariffs on US products. This would increase the purchasing power of consumers in the EU, reduce manufacturing costs for EU industries with suppliers from the US, and stall a looming trade war in its infancy.

7.     Any other relevant input:

Given that we, the Consumer Choice Center, is a trans-Atlantic consumer group we are very concerned about moves on both sides of the Atlantic to impose tariffs and hurt consumers. We firmly believe in consumer choice and stand against any policy measure that increases market prices for consumers. Therefore we actively seek out the dialogue with regulators and policymakers in the EU and the US and hope that the voice of the consumer will be heard in this debate.

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About Fred Roeder

Fred Roder has been working in the field of grassroots activism for over eight years. He is a Health Economist from Germany and has worked in healthcare reform and market access in North America, Europe, and several former Soviet Republics. One of his passions is to analyze how disruptive industries and technologies allow consumers more choice at a lower cost. Fred is very interested in consumer choice and regulatory trends in the following industries: FMCG, Sharing Economy, Airlines. In 2014 he organized a protest in Berlin advocating for competition in the Taxi market. Fred has traveled to 100 countries and is looking forward to visiting the other half of the world’s countries. Among many op-eds and media appearances, he has been published in the Frankfurter Allgemeine Zeitung, Wirtschaftswoche, Die Welt, the BBC, SunTV, ABC Portland News, Montreal Gazette, Handelsblatt, Huffington Post Germany, CityAM. L’Agefi, and The Guardian. Since 2012 he serves as an Associated Researcher at the Montreal Economic Institute.

Rhode Island’s 80 percent on E-cigarettes Would Harm Consumers

Letter sent to the House Finance Committe of the State of Rhode Island General Assembly

Dear House Finance Committee Member,

I’m writing to share my concerns about the proposed 80% tax on e-cigarettes that your committee will consider on Wednesday, March 21st.

This new tax would harm Rhode Island consumers (especially the most vulnerable), local businesses, and provide no countervailing benefit to the broader public or to the treasury.

This attempt to create additional tax revenue does not justify the negative ramifications it will have for your constituents. Ay excise tax on lower-risk alternatives to combustible cigarettes would make it harder for your constituents to quit smoking. But this 80% tax proposal is particularly unwise as it would guarantee an expansion of the black market, encourage consumers to purchase e-cigarettes out of state, while harming responsible businesses in your community.

When evaluating this issue, it is important to understand first whether e-cigarettes are indeed helping adult smokers quit, as well as 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.

Last month, 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 Rhode Island and the U.K., last 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.

Public Health England also pointed out that policies should “make a clear distinction between vaping and smoking,” because “E-cigarette use does not meet the legal or clinical definitions of smoking. Furthermore, international peer-reviewed evidence suggests that e-cigarettes carry a fraction of the risk of cigarettes and have the potential to help drive down smoking rates, denormalize smoking and improve public health. So policies need to be clear on the differences between vaping and smoking.”

Similarly, New York University’s Professor David Abrams and colleagues have written that “Each tobacco control strategy (e.g., taxes, media campaigns, treatment availability, accurate consumer knowledge of relative harms, regulations) will influence the flows from one state to another,” or, simply stated, policies such as the smoke-free air act will affect the likelihood that smokers will be able to quit smoking completely by switching to far-less harmful vapor products.

By imposing a 80% tax on vapor products which are used by adult smokers to quit smoking, we reduce the chance that people will quit smoking. The tax will be a disincentive for these people to make the switch, and will not prevent minors from continuing to obtain e-cigarettes through illicit or out of state purchases.

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 Rhode Island 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

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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.