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Smoking is up for the first time in a generation. The public health lobby is to blame

By Yaël Ossowski

It often takes a long time for health policy influencers, advocates, and proponents to admit fault. 

When it is about topics such as diet fads, saturated fats, food pyramids, and sugar consumption, long-held consensus beliefs and government actions later proved erroneous have had a lasting negative impact.

But nothing has been more egregious and harmful in our current age than the public health lobby’s persistent denialism of the harm reduction value of nicotine vaping products and other alternatives to cigarettes.

That denialism has come in many forms: public information campaigns demonizing vaping devices, misinformation on lung illnesses caused by tainted cannabis cartridges, bans, restrictions, and taxes on flavored nicotine products (especially those without tobacco), Kafkaesque market authorization applications handled by the drug regulators, and a never-ending crusade to deny adult consumers from having access to life-saving products because of illicit and risky behavior by teens.

These public health bodies, anti-smoking groups, and allied journalists, whatever their intent, have sought to convince the public that not only is smoking bad and dangerous — an easy admission — but also that alternative nicotine devices like vaping products, nicotine pouches, and heated tobacco are just as or even riskier than a pack of smokes.

Those conclusions are easily debunked by the millions of passionate vapers who have long since put down cigarettes and taken up customized tanks, vaporizers, and flavored liquids that give them a familiar nicotine sensation without the tar and combustible byproducts of tobacco.

David Butow for Rolling Stone

The public health mission to muddy the popular perception of nicotine alternatives such as vaping — even though it is scientifically proven to be 95% less harmful than cigarettes — is causing actual damage to American public health. And now we have the proof.

That proof is found both in the increased sales of cigarettes nationwide and also in a highly concentrated study on teen smoking in a jurisdiction where flavored nicotine vaping was outlawed.

According to the sales figures collected by the Federal Trade Commission for its 2020 Cigarette Report, Americans bought more cigarettes in 2020 than they have in more than a generation.

“The total number of cigarettes reported sold by the major manufacturers, 203.7 billion units in 2020, increased by 0.8 billion units (0.4 percent) from 2019, the first increase in cigarettes sold in twenty years,” cites the report.

Americans could be buying more cigarettes for a multitude of reasons: lockdowns, stress from both the pandemic and the government responses to the pandemic, job losses, closed schools, and more. Or perhaps because they’ve been told repeatedly by trusted public health sources and news outlets that vaping, an alternative that millions of adult consumers are now using to quit smoking, is just as dangerous.

Whatever your conclusion, the trend that lowered the percentage of US smokers down to 14 percent in 2019 (when the last complete nationwide survey was completed) is halting. And that should concern us all.

We see anecdotal echoes of this in a recent style piece in the New York Times, highlighting the “comeback” of cigarettes among the bourgeois hipster crowd in Brooklyn, New York. 

“I switched back to cigarettes because I thought it would be healthier than Juuling,” claimed one woman. It seems the public health lobbies have done their job.

On the more evidentiary side, an extensive May 2021 article published in JAMA Pediatrics found that after San Francisco’s ban on flavored vaping and tobacco products, more teens took up smoking.

“San Francisco’s ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts,” concludes the paper.

As tobacco harm reduction advocates have claimed for several years, the persistent public health campaigns, echoed by headline-grabbing media outlets, to demonize and restrict access to vaping has led to a predictable rise in smoking rates, both among adults and teens.

Whatever your view on whether vaping devices, heated tobacco, snus, or nicotine pouches are the most attractive and effective gateway away from smoking, this recent uptick in smoking demonstrates actual harms result when politically-charged health lobbies seek to extinguish market alternatives. And we must ask why they persist.

The opposition of these groups, along with affiliated journalists and researchers, to the rise of nicotine alternatives may have less to do with quantitative questions of science and health and more to do with how these products were created and are delivered: by entrepreneurs providing solutions in the market.

These entrepreneurs are vape shop owners, makers of vape liquids, gas station owners, vaping technology firms, tobacco firms pivoting to alternative products, and an entire creative class of vaping influencers both on and offline who are trying to give smokers a second chance at a long life. These are the true heroes of harm reduction in the 21st century.

The fact that spontaneous markets can deliver helpful and healthier solutions because of consumer demand, rather than by edicts, funding, and programs directly controlled by public health bureaucracies and agencies, runs counter to much of the ideology in the tobacco control space. 

It is the former, therefore, that is the true American innovative spirit that has helped make this country so prosperous and competitive, while the latter has failed us again and again.

If we want to reclaim a true public health victory and help smokers quit to give them long and fruitful lives, it is time to cast aside this aversion to the innovations of the market. The future health of our nation depends on it.

Yaël Ossowski is deputy director at the Consumer Choice Center

The Myth of the Vaping Crisis is Sparking a New War on Flavored Nicotine Products – And That Harms Consumers

In the backdrop of a very busy Congress, members of the U.S. House are pushing a bill that would eradicate entire categories of flavored nicotine products.

This sweeping ban would directly harm consumers who use menthol tobacco, flavored cigars, snus, and vaping products by outlawing the products they use and pushing them to the black market.

The proposed law comes in the wake of the much-hyped “vaping crisis” that transpired over the summer, in which thousands of individuals suffered lung damage from inhaling vapor products, also called e-cigarette, or vaping, product use-associated lung injury (EVALI).

In the end, the culprit was revealed to be illegal cannabis vaping cartridges loaded with Vitamin E acetate and not nicotine vaping products, according to the Centers for Disease Control.

Read the Consumer Choice Center Policy Primer: Myths and Facts on Vaping: What Policymakers Should Know

Though scientific experts correctly identified the cause of the injuries – black market THC cannabis vape cartridges – that hasn’t stopped legislators from using that pretext to introduce new prohibitions on flavored tobacco products used responsibly by adult consumers.

H.R. 2339, named the Reversing the Youth Tobacco Epidemic Act of 2019, proposes several sweeping changes to flavored consumer products and is expected to soon hit the House floor for a vote.

The bill would outlaw the following:

  • Menthol products
  • Flavored cigars and cigarillos
  • Flavored smokeless tobacco, known as snus or dip.
  • Some flavored vaping products

The goal is to significantly reduce or eliminate youth use of these products, which is a noble pursuit.

But youth smoking is at an all-time low

Fewer young people than ever are using traditional tobacco products – less than 2.3%. That’s a significant decline since the year 2000, where nearly 15% of minors smoked cigarettes, according to the CDC.

  • This represents a public health victory, and one that has been achieved with sensible education, regulation, and innovation. The same is true for adult smokers. Just 13.7% of adults currently smoke, the lowest number ever recorded.
  • The latest CDC figures show that 20.8 percent of high schoolers have vaped at least once in the last 30 days. But 7 to 8% of those were vaping cannabis rather than nicotine.
  • A total flavor ban on all tobacco products and vaping products for adults would do little to curb use among youth.
  • It may even exacerbate the problem and only punish lawful adult consumers and deprive them of their choice, not to mention devastate the communities that rely on tobacco taxes to fund important social programs.

What’s more, by categorizing non-tobacco vapor products as tobacco products, House members are attacking the very innovation that has led to the lowest-ever figure of recorded tobacco use.

Prohibition Hasn’t Worked

The 100-year anniversary of the passage of Prohibition of alcohol took place last month.

  • All these years later, we know that outlawing certain consumer products does not eradicate their existence. Rather, it moves them from the legal, regulated market to the illicit and unregulated black market.
  • This makes the products themselves less safe, and the trade around those products even more dangerous.

After an entire nation had awoken to the disaster of Prohibition, it was successfully repealed in 1933.

Minorities are more likely to use menthol products

According to the CDC, African-Americans who use tobacco are 90% more likely to favor menthol products and represent the vast majority of consumers in the flavored tobacco market.

  • A ban would create an illicit market without regulations or ID checks
  • Such bans would then force police officers to crack down on illicit menthol cigarette trade, further straining relations between the African-American community
  • As seen in the case of Eric Garner, who was choked out by a police officer and later died in New York City for selling loose cigarettes on the street, bans and restrictions that create illegal markets can lead to devastating consequences.
  • If a law bans menthol and flavored tobacco products, the demand wouldn’t disappear.

Rather, it would be pushed into the unregulated market, siphoning away tobacco taxes and incenting police officers to use their power to enforce laws in minority communities.

Age-restriction by law is a powerful means of dissuading youth use

By penalizing convenience retailers that sell to minors, regulators have already created a significant barrier to youth access.

  • This allows law enforcement to prosecute bad actors and focus their efforts on illicit markets where dealers don’t ask for ID.
  • Recently, Congress’ raising of the age to purchase tobacco and vaping products to 21 years old also dissuades youth use, ensuring no high schooler will be able to legally purchase these products.
  • Nearly half of tobacco and vape shops don’t ID young customers.

Enforcing existing laws on youth access, including prosecuting shops that don’t check ID, are a powerful means of keeping youth away from tobacco products.

Bans Deny the Science on Harm Reduction by Vaping and Smokeless Products

For many adult smokers looking to quit, vaping products have been proven key to harm reduction.

  • About 4.4% of adults, nearly 11 million, are now using vaping devices
  • National health bodies around the world, including Public Health England, the New Zealand Ministry of Health, and Health Canada have endorsed vaping as a smoking cessation method.
  • The U.K.’s top health body has repeatedly said that vaping and e-cigarettes are 95 percent less harmful than smoking.
  • Bans that include flavored vaping products would deprive adult smokers of a less harmful method of consuming nicotine

We all have an interest in eliminating the number of young people who take up smoking. But counterintuitive bans would make that goal harder, not easier to achieve.

And depriving adult consumers of harm reducing technologies like flavored vaping products will reserve the decades of public health successes.

Let’s hope our members of Congress consider these facts before they vote on H.R. 2339.

Download the full policy note here.

Vaping is a more effective smoke reduction tool than government policies

Middle schoolers, high schoolers, and university students have increased their use of e-cigarettes, despite rising public concern. While underage nicotine consumption and smoking-related lung disease deaths are a real problem, legal vaping products, and accurate consumer information can combat instead of worsen these effects. We should welcome the presence of alternatives to tobacco, and endorse safe, and legal options.

At the beginning, there were the strange cigarette look-alikes that light up as you took a drag. Now, the e-cigarette market has expanded to include safer alternatives, ranging from popular Juul products to vapes the size of a pistol grip. In Europe, the so-called “heat-not-burn” also constitutes a new type of vape, by heating up the tobacco instead of burning it, thus avoiding the more unhealthy effects of tobacco combustion. The idea that these alternatives are a good thing will raise eyebrows for many, and rightfully so. If you’ve followed the health scare surrounding vaping, you’d think that the mere thought of encouraging e-cigarettes is problematic.

While no potentially harmful product should ever be encouraged, we should recognize its harm-reducing effects. The UK’s Department of Health and Social Care, Public Health England, assessed in 2015–confirmed since then–that vaping is at least 95% less harmful than smoking conventional cigarettes. Between 2011 and 2017, the number of smokers in the UK fell from 19.8% to 14.9%. At the same time, the number of e-cigarette users rose: almost half of these consumers use e-cigarettes as a means of quitting smoking. The UK is an example that shows how a permissive vaping policy is better at helping those who want to quit smoking.

On the other hand, the US Food and Drug Administration, as well as most European nations, have released serious public health warnings regarding vaping. A recent spike in vaping-related lung illnesses has made officials afraid of the rise of e-cigarettes. Symptoms of those affected by recent illnesses include trouble breathing, chest pain, fatigue, and vomiting. About half the patients are teenagers or young adults.

Here is where giving the full picture is important.

The two main ingredients used in vape liquids, propylene glycol (PG) and vegetable glycerin (VG), are used to form their vapor and add flavor. Added to these two ingredients is a third, usually a common food flavoring found in cakes, oils, and other food items. All of these compounds are common food ingredients that are deemed healthy and safe by regulatory bodies including the FDA. Other variable ingredients include the stimulant alkaloid nicotine. Although not all vape liquids contain nicotine, the addictive chemical is the main draw for smokers that want to quit smoking. Compared to other alternatives, like the Nicotine Replacement Therapy patches and drugs, vaping has been found to be more effective.

On Dec. 6, the Center for Disease Control (CDC) released a report which uncovered that none of the patients affected in recent cases had used conventional nicotine vapes. Most of the affected consumers had used black-market THC products—many in states that have not legalized marijuana. In most of these terrible cases of vaping-related lung disease, Vitamin E has been found in these moonshine liquids. Vitamin E is very harmful when inhaled.

In Europe, more countries are approaching the issue from a different direction. Portugal’s Directorate-General for Health released a statement saying users should refrain from modifying their e-cigarette liquids or add any substances that aren’t legally marketed and labeled. That is certainly a more consumer information-based approach than the state of Michigan, which decided to ban flavored vaping outright (at least as a temporary measure).

If we want to combat deaths arising from black market products, we have to embrace safe legal products. A legal and regulated market is the best method for rooting out bad products and actors. A ban on flavored liquids will only drive those who wish to use flavored vaping products to the black market, or back to cigarettes. Recent studies have shown that if vaping products are outlawed, current vapors are more likely to return to smoking. That would be very consequential for public health.

A lot of myth-busting needs to be done on the issue of e-cigarettes. More than that, however, let’s just consider what harm-reducing products have actually done. The government has tried for decades to get people to stop smoking. In order to do that, it has utilized paternalistic policies, like taxation, restrictions on packaging and sales, which have all been shown to be ineffective. All reduction in cigarette sales has been offset by a spike in black market sales. In this shadow economy, consumers are being misled, and people get hurt.

We need to encourage the marketing and branding of safe and legal vaping products. Consumer information is necessary in order to crowd out dangerous black market products.

Vaping has achieved what decades of government policies couldn’t–gave consumers a viable alternative. This type of innovation should be celebrated, not reprimanded.

Originally published here.

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Trump’s Medicare executive order

CONSERVATIVE GROUPS SEND LETTER ON VAPING — A coalition of 25 conservative groups is urging Trump to keep flavored e-cigarettes on the market, arguing the products are “essential to the success of vaping as an alternative to cigarette use long-term.”

Groups such as Americans for Tax Reform, Consumer Choice Center and FreedomWorks argued the administration’s envisioned flavored vape ban would go against the White House’s deregulatory agenda and “destroy thousands of small businesses.” This comes as the White House abruptly organized, and then canceled, a meeting with conservative groups over vaping, which it said at the time would be rescheduled.

Read the article from POLITICO here.

For more facts on vaping, read our research on the Myths and Facts on Vaping: What Policymakers Should Know

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

The EU’s war on harm reduction is in full swing

In 2020, the Netherlands will host the ninth conference of parties of the so-called WHO-FCTC treaty. During this conference, world leaders and public health advocates discuss the ways in which smoking prevalence can be curbed.

However, these same advocates haven’t just made their policies about actual tobacco, but also about vapour: innovative e-cigarette products come under fire, even though they are provenly less harmful and help those smokers who desire to quit. EU health commissioner Vytenis Andriukaitis and the anti-tobacco European Network for Smoking and Tobacco Prevention (ENSP) are leading the charge in this fight.

In 2015, Public Health England reported that an independent review found that vaping is at least 95 per cent safer than conventional smoking. PHE confirmed this assessment in December last year.

As a result, the UK has made tobacco harm reduction a centrepiece of its policies to reduce the smoking rate, as opposed to calls for direct cessation, which are less effective.

This is also backed by current evidence: a study funded by the National Institute for Health Research UK, titled “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy” in the New England Journal of Medicine, analysed the behaviour of almost 900 randomised smokers. The conclusion: e-cigarettes were more effective for smoking cessation than nicotine replacement therapy.

A public consultation by the Health Information and Quality Authority in Ireland found that e-cigarettes are used by a third of smokers as cessation tools, and are twice as effective as a placebo.

In an interview with Euractiv, EU health commissioner Vytenis Andriukaitis said the exact opposite, claiming that nicotine replacement therapy was the better alternative. Andriukaitis also defended his head of cabinet, who had come under fire for calling e-cigarettes poison. The most telling quote from the Lithuanian commissioner is this one: “My question to the industry is the following: is it harmful or not to smoke? Does it cause cancer or not? Harm is harm. No matter if it’s less or more.”

That statement should make one think: here’s a European commissioner who does not believe in different degrees of harm. By that standard, we could also equate the harmfulness of eating red meat with smoking cigarettes. Both can cause cancer – and who really cares about the degree of harm caused by one or the other?

This lobby against harm reduction is coordinated by organisations such as the ENSP, which is funded by the Health and Consumer Programmes 2014-2020 of the European Union. This means that the European commissioner funds an NGO that invites the commissioner to events and features him in news articles funded by the same NGO.

It looks as if the European commission has broad support for their positions, but in reality, they are using claqueurs, which is nothing short of deception.

Andriukaitis and the ENSP are trying to change the narrative on anti-tobacco policy by framing it as a human right, and by making false statements about the science surrounding harm reduction.

In fact, their approach to anti-tobacco policy is an almost religious “if there is smoke, there must be harm”. They push policies that restrict not only consumer choice but also access to products that help those who choose to quit with innovate new solutions.

As the scientific evidence in favour of harm reduction is growing by the day, the European commission is stubbornly defending its anti-scientific approach to smoking cessation.

Yes, consumers should be able to quit smoking in a way they see fit, and that suits their needs. Restricting innovation for the sake of increasing your bucket list of “things to ban next” is not only nonsensical, it’s bad for people’s health.

The European commission should instead follow the British National Health Service’s approach to smoking cessation.

Read more here

כך נפחית את המחלות מעישון – בלי להיגמל מניקוטין

CALCALIST: CCC Senior Fellow Jeff Stier comments on Israeli media about the potentials for harm reduction.

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