The following editorial published on June 21 in the Washington Post:
The Food and Drug Administration on Tuesday made a decision of rare importance, concerning not a pandemic illness but the country’s leading cause of preventable death: smoking. It is crucial the White House stick up for what would be the FDA’s most assertive antismoking policy ever — one that will inevitably meet severe resistance.
The agency is preparing a rule that would mandate that tobacco companies dramatically cut the amount of nicotine in cigarettes sold in the United States, rendering their deadly products minimally or not-at-all addictive. This move has long been anticipated: Congress in 2009 gave the FDA broad powers to regulate tobacco products. The agency started exploring this policy in 2017, and it should have used its authorities fully before now. It must move quickly. About half a million Americans a year die of smoking-related illnesses; any further delay would mean more unnecessary suffering and death.
The idea is to make cigarettes unattractive to people addicted to nicotine and to encourage them to get their fix in less dangerous ways — or simply to quit. While highly addictive, nicotine does not damage people’s bodies the way other chemicals in cigarette smoke do. If smokers could not extract large amounts of nicotine from cigarettes, they would turn to vaping or smoking-cessation products such as nicotine gum or patches. Some questions remain about vaping’s effects on health, but there is little serious doubt that it is a far less deadly alternative for chronic cigarette smokers. Meantime, anything that gets substantial numbers of people to quit tobacco entirely should be embraced.
Critics object that smokers would simply smoke a lot more cigarettes or inhale more deeply. But an FDA study published in the New England Journal of Medicine rebutted that concern, estimating that the smoking rate would plummet from 12.8% to 1.4 % by 2060. Some of this would come from product switching, some from people quitting and some from people not starting at all. By the end of the century, the number of new smokers would be reduced by 33.1 million, 8.5 million tobacco-related deaths would be averted, and 134.4 million life years would be gained.
Such an aggressive regulation might also create a black market for full-nicotine cigarettes, leading some to compare the policy to alcohol prohibition in the early 20th century. This is nonsense. Alternative nicotine delivery vehicles are pervasive. The FDA is not proposing to ban all nicotine products, just to discourage use of the deadliest. A massive, coordinated black market would have to form to put a substantial dent in the huge shifts in behavior the FDA projects. It would be of such a size and scope that federal authorities would easily be able to disrupt it.
To be sure, the FDA will have to write its regulations carefully so smokers do not move en masse to other dangerous combustible tobacco products, such as cigars and pipe tobacco. Another danger is that smokers might add nicotine liquids to their cigarettes manually.
But the greatest risk is that resistance from industry and its ideological allies will derail the long rulemaking process to come. The agency should proceed with all possible speed, and the White House should stand by the rule as it works its way toward finalization.