The Food and Drug Administration (FDA) just made a huge announcement this morning:
I returned to the U.S. Food and Drug Administration last year, it was immediately clear that tackling tobacco use – and cigarette smoking in particular – would be one of the most important actions I could take to advance public health. With that in mind, we’re taking a pivotal step today that could ultimately bring us closer to our vision of a world where combustible cigarettes would no longer create or sustain addiction – making it harder for future generations to become addicted in the first place and allowing more currently addicted smokers to quit or switch to potentially less harmful products. As part of our comprehensive plan on tobacco and nicotine regulation announced last summer, we’re issuing an advance notice of proposed rulemaking (ANPRM) to explore a product standard to lower nicotine in cigarettes to minimally or non-addictive levels. This new regulatory step advances a comprehensive policy framework that we believe could help avoid millions of tobacco-related deaths across the country.
I am not a federal rule making lawyer, I am not a lawyer at all, but I expect that this rule will take several years to operationalize after working its way through the courts. But if the final implemented rule looks anything like the ANPRM, this is a huge deal. It effectively would lead to a glide path towards the extinction of the tobacco industry with associated massive public health gains.
I would have a few policy questions.
1) What do current smokers substitute towards for a legal or illegal small upper during the day? What are the costs of the alternatives?
2) What do states that rely on significant cigarette tax revenue to fund current public health programs do instead?
But wow, this is a big deal and if it works, it will be a huge advancement for public health.
Hm–if they lower the nicotine they may increase the consumption, increasing taxes paid per unit, costing the working class addicts who self medicate through cigarettes more, and increasing the amount of inhaled other carcinogens. I mean I hate to rain on the parade but I kind of wonder about those unintended consequences?
Might i suggest tobacco farmers begin to fight for hemp, which could save their farms without all the harmful side effects of harvesting tobacco. There are many uses and one of the side benefits of hemp as fiber is it’s more economical to manufacture it locally.
The Moar You Know
@aimai: Not hypothetical. That’s exactly what happens.
Also pretty sure there’s no such thing as a “non-addictive” level of nicotine. The amount that gets the smoker’s brain goin’ is in the micrograms if I recall correctly.
Thankfully, when I decided to quit my use levels had always been minimal: pack a week. I know people who used to smoke four packs a day. That guy quit only when he went blind from it. I have a lot of respect for nicotine, in the same way I have a lot of respect for rattlesnakes. It will fuck you up.
Also, for reference: nicotine itself is not a carcinogen.
With each incremental statutory restriction on smoking in my corner of the liberal hellscape that is California, dire predictions of lost business, lost productivity, cruel repression of the poors, etc. have been claimed and then proved false. Beginning with requiring “smoke free” seating in restaurants and bars, then on to elimination of smoking in same, elimination of smoking in the workplace, elimination of smoking in public spaces, raising tobacco taxes, we were told Bad Outcomes would Prevail only to find…nope. What we did find: the lowest smoking rates in the nation.
Tobacco took my dad at 65. My response: eye for an eye–if the tobacco industry can kill my father, I can assist in killing the tobacco industry. Let’s do it for the kids.
Vastly outweighed by the reduction in how addicted they are reducing their need to self-medicate. I’m going to go for ‘They may briefly smoke more, but after a few months tops will smoke much less.’
Major Major Major Major
@Mike Noordijk: and iirc they’ve already made some pro-vaping changes.
@aimai: I thought about that too, but I figure that it would 1) help prevent future addictions, and 2) make it enough of a pain in the ass to push some people to quit.
The Moar You Know
@Frankensteinbeck: I hate to tell you this, but that is not how it works.
Wow. If this were any other administration, I would be celebrating.
But given the Trumpists ability to f*ck up everything they touch, I have to assume that the FDA will soon announce an exemption for Trump-branded high-nicotine cigarettes.
It reads to me like someone has made a large financial investment in vape technology.
I do not understand why people think vaping is safer than smoking. You’re still inhaling foreign substances into your lungs, except instead of KNOWING what those substances are (for the most part) you have absolutely no idea. The only advantage to vaping is it reduces secondhand exposure, presumably, but I’m not totally convinced of that either, because people who vape still exhale excess quantities of whatever unknown substances it is that they’re inhaling.
@The Moar You Know: No, I know nicotine is not a carcinogen (though it is toxic) but the smoke itself may be carcinogenic.
Villago Delenda Est
Donald will fuck this up.
Gin & Tonic
Even though my kids are grown, when I tell them that when I started my career and traveled, airplanes had smoking sections and every hotel room was a smoking room, they look at me as if I were talking about riding my horse to work. They know literally nobody who smokes tobacco.
The Moar You Know
@karen marie: This may just be a CA thing, but every vape cartridge I’ve seen here (two, lol) have a full ingredients list on them. I would have no problem in asserting that vaping is safer than smoking. But vaping is not safe. I stay clear of all that shit these days. The air is hard enough on your lungs as it is.
@The Moar You Know:
I am all for ‘that is not how it works’ as an explanation. Do we have any examples of this situation beyond the short term to use as a reference?
I smoked cigs for 25 years, and have switched to vaping. I feel better, can control the amount of nicotine in the juice, and have my sense of taste back. Plus it is costs about 80% less than cigs do. Now if I can just quit the fucking vaping…
I noticed the specification of “combustible cigarettes” too. This is a glide path for the tobacco industry to transition to nicotine-based vaping cartridges as their primary product.
It may still be better for public health, if vaping is less carcinogenic than smoking, and it may well be. But it’s not going to ruin Philip Morris.
@trollhattan: In 2002 we learned that there were smoking areas in Disneyland and DCA. My husband had an older cousin who decided to visit us. Think of Forrest Gump without the charm. When he arrived he wanted to go to Disneyland. Before then I never noticed anyone smoking in the parks but there were designated places to light up and it was all we could do to keep this idiot from lighting up elsewhere.
In answer to question #1, my dad turned to Lifesavers candies when he gave up smoking. He’d always been thin before that but he got a tiny pot belly that he attributed to the using the candy as a substitute. He gave up smoking cold turkey in 1970 when he saw the report that the lungs could return to a healthy status in less than a year. We lost him in 2012, age 94.
The Moar You Know
@Gin & Tonic: Ashtray in every armrest. I remember that. I was a kid.
So, my dad is a retired airline pilot. He started when you could smoke on planes. And he told me the following: As you all know, airlines account for every ounce of weight, because every ounce costs them money. The reason the airlines jumped all over no-smoking laws promptly is because at every service interval (the airplane in question was the 727, an average-sized airliner even by today’s standards) the maintenance guys pulled about two hundred pounds of tar out of the A/C ducting.
We were all breathing that shit.
@Villago Delenda Est: You would think so, but IIRC DFT really hates smoking, so at least the commish won’t catch his ire.
Dr. Ronnie James, D.O.
@karen marie: It is almost certainly safer than smoking tobacco, for two reasons:
1) the level of carcinogens is lower
2) because vapor is generated at a much lower temperature, there is vastly less carbon monoxide which is also bad for cardiopulmonary health
This is not to say vaping is harmless (nicotine is not good for your blood vessels, and when you inhale it, the highest concentrations go to your coronary arteries and brain, respectively). But as a healthier alternative to cigarettes, especially if used as a quit aid, vaping is pretty hard to argue. The British Medical Society endorsed vaping for that use, as do the two chiefs of Pulmonology at two hospitals I have worked at.
@Gin & Tonic:
Ashtrays in plane seat armrests. When I was a kid they were something to play with in addition to the swiveling air vent.
Agreed. It has changed my life. And since I’ve tried every single trick to stop smoking, this is the best option for me so far. Plus, I find I actually do use it less as time goes by. I certainly don’t vape as often or as long as I did when I smoked cigarettes.
The Moar You Know
@Frankensteinbeck: Sure. Both tobacco users and any other user of any addictive substance (opioids are a useful example). They use to the point of overdose or running out of substance and that’s where the usage stays until they stop using.
Dr. Ronnie James, D.O.
Call me crazy, but this seems like something that could actually lose Trump a lot of WWC votes. There is that joke about ATF being the redneck trinity, and this is taking one pillar out at the knees. Cigarettes have become somewhat fetishized in RWNJ circles as Things That Really P.O.’s Liberals (like rolling coal).
@trollhattan: Have you noticed the recent RW refrain that California is a hellhole and bankrupt? Mostly I see it repeated on Twitter whenever a CA politician like Ted Lieu or Jerry Brown tweet something. This must be a talking point on Faux.
@The Moar You Know:
No, that’s still theory. It doesn’t test a situation where their only supply has been limited to a much weaker dose, left long term, with added financial restraints. In fact, isn’t that kind of limit specifically used to reduce people’s level of addiction? And society-wide, they can’t break free and get stronger doses.
@Dr. Ronnie James, D.O.:
Vaping, sadly, is preponderantly done by the young and IIUC early data show a significant fraction of vapers who have never smoked “graduate” to cigarettes, explaining big tobacco’s vaping interest and investments. I don’t doubt it represents a less-toxic substitute for smoking itself.
Having never had the habit I’ve not experienced nicotine’s grip, but it appears very strong indeed.
I’m also curious how vape lounges skirt OSHA and CalOSHA rules as safe workplaces. Do they have giant ventilation hoods?
@aimai: and that is the reason for this
@trollhattan: In old buildings you still occasionally see built in ashtrays by elevators or in restrooms if they haven’t remodeled them. It seems so odd now but it’s a reminder of how ubiquitous smoking used to be.
Yup. So help me I had to listen to Trump’s remarks on his trip here and got a LOL from “And the taxes are so high here, three times what they should be” from a guy with a NYC address and thus, federal, state and city income tax.
Also heard this week we have the nation’s highest venture capital rates per capita. Sounds like fail to me.
Downtown sidewalks and gutters carpeted with butts. Drivers popping flaming butts from the window, something else to dodge when motorcycling.
@Gin & Tonic: If you really want to blow their minds, tell them there used to be ashtrays in elevators.
This is great news. We all remember how low tar and nicotine cigarettes caused tobacco consumption to plummet in the 1960s.
@hellslittlestangel: For me it’s the ashtrays in bathroom stalls that are the hardest to understand . People couldn’t stop even to do their business. It’s not like they had to hide their smoking since smoking was allowed everywhere.
@trollhattan: Grocery stores had ashtrays filled with clay kitty litter every 2 or 3 endcaps. They also usually had 2 or 3 cuds in the litter from the tobacco chewers.
Bring in a cup of coffee and you have the perfect breaktime trifecta! :-)
Thinking back, while I’ve never smoked I really did from the time I was born. Two smoking parents and smokers everywhere except at school (but, the blue cloud that rolled out of the teachers’ lounge) and the park. I’ve put away a lot of cartons.
O/T nice family you got there.
@opiejeanne: When I was a kid, I remember seeing an American Heart Association PSA with a childlike animation and a child’s voice talking about her parents, saying “of course they don’t smoke cigarettes”. It made a strong impression on me because I assumed that all adults smoked cigarettes. My parents did; nearly every grownup I knew did.
One day in the late 1970s or early 80s, I forget exactly when, my dad caught a really bad cold and went to the doctor, and the doctor said “to recover faster, you should probably stop smoking until it’s over… aaaand, in fact, this would be an excellent opportunity for you to just quit.” And he did! He seemed to have an anomalously easy time of it.
Some time after that, my mother stopped smoking in the house, and her consumption went way down. I don’t actually know whether she smokes at all any more, haven’t seen her do it in a very long time. For a while it seemed as if she’d only go out and have a cigarette if she was being visited by a smoker.
They’re both in their 70s and doing fine.
I sell tobacco in a warehouse-type store, I’ve been doing it about 4-5 years now. My single-carton customers are, for the most part, around 60 or older. We carry some vaping products but older customers don’t find them very attractive; anecdotally, I know a few younger people who’ve been able to reduce or even quit their consumption by vaping. Chewing tobacco is what most of my younger customers buy and I think there’s not enough attention paid to that side of addiction.
The buying patterns of both personal-use and reseller customers really shows marked class divisions. Tobacco is an unspoken class signifier here and I imagine it’s even more so in states that conscientiously discourage use through taxation. My state has some of the lowest taxes in the nation, less from industry lobbying (I think) than a refusal to raise revenue through taxing anything – might get people to thinking that government has positive outcomes.
@Yarrow: Well, nowadays I can’t go into a public john without hearing a phone conversation, so…
Gin & Tonic
@brettvk: I tried chewing tobacco once. Once. That was enough to prevent me from ever going near it again.
@brettvk: Chewing tobacco and snuff were omnipresent in my high school in the 1980s. Kids would spit gross puddles of spit in the hallways or leave paper cups full of spit somewhere. Probably could have been a tuberculosis epidemic from all the spitting.
I never developed an interest in tobacco because I grew up with a heavy smoker in a 1-bathroom household. Nothing like getting ready for school after your nicotine-addicted parent has spent 20-30 minutes in there prepping for the day.
I quit several years ago after smoking for 20+ years. In my experience, it wasn’t the nicotine that was so hard to quit; it was the ritual of it, the habit of using a cigarette to punctuate events throughout the day. Inside a week after I quit, I wasn’t feeling jangled and antsy from the chemical withdrawal, but for weeks, months and YEARS afterward, I missed the ritual of it. Still do, sometimes.
Not unless the rest of the world follows suit.
@Betty Cracker: I think everything about it is addictive. I felt dizzy for weeks after I quit, I think because I was getting oxygen into my blood instead of sweet sweet carbon monoxide
The Dark Avenger
@The Moar You Know: @Betty Cracker: My mother went through the same thing. Sometimes she’d be crying with a drinking straw in her hand to mimic the feel of holding a cig.
From the CDC Fact Sheet:
Anti-smoking efforts have already had a huge impact on public health. This latest effort, while welcome, is good, but not an earth-shaking development.
I guess we might see more vaping, more energy drinks. At the edges, more meth.
This would probably be good for the cannabis market, even though we are talking about a different kind of buzz.
This seems to be a spotty revenue stream. The case of New York is illustrative:
If all domestic cigarettes are low nicotine, this would have a temporary impact on cigarette smuggling. The question then becomes how profitable it would be to smuggle in cigarettes from other countries. Also, the number of cigarette smokers may continue to decline, reducing the total market.
@Matt McIrvin: I can really understand how chewing tobacco can be almost instantly addicting to a adolescent brain still under formation. But it seems like such an objectively disgusting habit! And taking it up at a life stage when you’re so anxious about your personal appearance anyway. So many of my chew customers are wives buying for their husbands, telling me how much they wish he’d quit. I’ve never had the face to ask them how they were attracted to the guy in the first place.
The AIDS ward that I was hospitalized in a few times had a smoking section.
Steve in the ATL
@trollhattan: one big reason I never smoked was having family members who did. Breathing in smoke first thing in the morning on the way to school was absolutely disgusting. And after a meal while I was still trying to enjoy the taste of the food. [shudders]
ETA: I see brettvk beat me to it at #44!
Gin & Tonic
Why? The I-95 smuggling of cigs is purely tax arbitrage. As long as NYC taxes are 2-3x VA taxes, it’ll go on.
I can’t remember where I read it, but years ago I came across the notion that caffeine and nicotine are the drugs we take to feel normal (instead of high). I know there’s an initial nicotine buzz on first use, but after that you need the dose to feel “right,” not buzzed.
Steve in the ATL
Also, note for the record my objection to the alleged word “operationalize” in the original post.
Further bulletins as events warrant.
So…being an actual nicotine addiction scientist whose work was a (small) part of the large body of work that has been part of this long rule making process (started in the late 80’s), yes reducing nicotine in tobacco cigarettes will reduce use. People will compensate initially but that only lasts for a few days – eventually they give up. There have been both “true” and supposed low nicotine cigarettes on the market. The latter were only low nicotine when smoked by machines (which is how the the yield numbers were determined for tar and nicotine); smokers soon learned that they could get the regular amount of nicotine by various manipulations of the filter – and so they did so also getting more tar as well. True low nicotine cigarettes where there is simply physically little nicotine were always commercial failures. Will some people still smoke such cigarettes? Sure but far, far fewer than currently smoke (I would estimate less than 10%, probably less than 5% of the current smoking population, especially given modern alternatives).
Is vaping safer than tobacco smoking? Overall yes, but there is a wide range of products and the safety largely remains unclear. States are still responding to how to regulate vaping and there has been very little time so far for independent research. It is not even clear yet whether vaping might encourage tobacco smoking or might decrease tobacco smoking – I’ve seen data showing both.
As to whether nicotine is a carcinogen the answer is no BUT there is evidence that nicotine does facilitate the growth of certain existing tumors, especially in the lung. So it won’t give you cancer but… And moreover, it should be remembered that while tobacco smoking is most associated with lung cancer, it actually kills many people via cardio-vascular disease. That will not change with vaping.
In associated news, Australia may end up killing tobacco cigarette smoking via a different regulatory path: requiring cigarettes to meet standards that won’t cause accidental fires. So far tobacco companies are having great difficulty in meeting the new standards (not easy to keep cigarette lit enough to be easy to smoke but not so long that leaving it unattended is a problem). For example, Phillip Morris has indicated they may simply give up that market.
Switched from smoking to nicotine gum about a dozen years ago. BOOM got very fat.
Just quit the gum 3 days ago.
When smoking rates went down, diagnoses of adult ADHD went up. Turns out that people were self-medicating for ADHD using nicotine, which is a powerful stimulant. I’m pretty sure that’s why people in my family used it, including my dad.
@Gin & Tonic:
I don’t know whether low nicotine cigarettes would have the same appeal as regular cigarettes.
Rob in CT
They’d have to crack down on mail-ordering cigs from eastern Europe. Friend of mine gets all his smokes from Moldova (theyre Marlboros, made in Moldova) to evade taxes.
The UK satire show with Stephen Fry noted why snuff handkerchiefs were not white. Stephen Fry’s guests take snuff.
@brettvk: Chewing definitely seemed to be a boy thing, unlike smoking, which both boys and girls did. I don’t know how the girls felt about it, but I remember the boys in my neighborhood making a great show of spitting in public even when they were pretty little, before they were likely to be chewing. They thought it was cool.
@TaMara (HFG): The drug warriors would be promoting hemp if they understood how industrial hemp pollen would hose any nearby outdoor growers of high potency smokable weed.
But her emails!!!
The weirdest thing about smokers is that they seem to think that everyone’s sense of smell is as impaired as theirs. As a lifelong nonsmoker, I can tell if someone lit up a cigarette in a rental car within the last year even if they smoked with their head hanging out the window and doused the interior with lysol before returning the car.
The data marking vaping as a “gateway” to cigarette smoking is very weak, so far, and California stupidly taxes vaping devices as though.they were the same as cigarettes.
Meanwhile, communities want to establish cannabis lounges.
A seriously addicted smoker could not get enough nicotine from a low nicotine cigarette. They’d have to smoke 10+ packs a day. They will shift to vaping/gum/chewing, which is the point because all are much less dangerous.
My aunt and great-aunt could not quit even when emphysema from smoking forced them to use oxygen. Pity such policies weren’t followed when they were young.
I am surprised at the number of young people I see smoking here in Austria.
I started soon after the surgeon general’s report sometime in the 60’s, smoked until I was in the hospital in the early 80s with some sort of stomach ache. Got a shot of demerol. At that time it was still allowed to smoke in the room around the corner and whenever I smelled that smoke I threw up. Three days later I was over the physical withdrawal.
Still went through the “always had a cig after breakfast….” etc, but thank goodness for that shot of demerol.
Less a matter of evidence being weak than a the lack of consistent results among multiple studies in part due to many of them being industry-funded. The number from the National Academies’ report that should catch everyone’s attention: …more than 11 percent of all high school students — nearly 1.7 million youths — reported using e-cigarettes within the past month.
Maybe not. There used to be the bullshit that cannabis was a gateway drug to cigarettes, cocaine, whatever. A Keck USC study noted the following:
I suppose that e-cigarette use is not wonderful, but human beings seem to like some degree of recreational drugs (including alcohol).
@Mike Noordijk: This. I’m a high-school teacher, I haven’t seen a cigarette for at least five or six years. This a rural-chucklehead community in many ways and they all have vape pens now… even the “how-the-hell-is-this-legal” ones that look like USB drives. *deep sigh* There will be no shortage of this in the future. Now… that said, If vaping carries fewer health risks than smoking, so be it. High Schools students today are no more or less dumb on average than I was, just a different risk landscape in many ways.
I was in the Army in the 60’s, during Basic Training I had pneumonia, in the pneumonia ward, every night stand had an ashtray and the Red Cross passed out free cigarettes. All through training, there was a smoke break every hour, the barracks had butt cans hanging on the beams. Now Army training is damn near smoke free, However ,Iraq and Afghan vets tell me that once again almost everybody in the Army smokes.
Yes to all of this.
This is not unknown territory. Big Tobacco did their own research into this and worked out what they refer to as the weaning point. It’s very simple to both breed low nicotine tobacco leaf and to reduce the content of it without altering the overall taste of the product. The industry knows it’s commercial suicide. For an example, check out Next.
All of which means the industry is going to push hard against this. Congress and the Senate will reek of tar money being handed out to stop this. Even if the FDA prevails they’ll hunker down globally to prevent this from expanding to other countries. 40% of cigarettes produced around the world come from state-owned (pdf) companies.
So while it is definitely a worthy goal I expect it to be a bigger fight than what the FDA can handle on its own.
Ah yes. I only know this because of a book I read.
@aimai: research sez they’ll smoke more. It’s an addiction.
J.A.F. Rusty Shackleford
Back when I was smoking, my Doctor told me that if I couldn’t quit, at least switch to a low-tar and nicotine cigarette. I went from smoking about 1 1/2 to 2 packs a day to over 4 packs a day. My lungs rebelled at that amount of gunk, so I went back to my old brand and was back down to only a little over 1 pack a day for a while, then built back up to the not quite 2 I had been doing for years.
Low nicotine will help people to not become addicted to cigarettes in the first place, but someone who needs nicotine will either have to smoke a lot, or turn to vaping. Presumably the vaping is safer than cigarettes, but we didn’t know about the real danger of tobacco for years, and we weren’t told about it for years after that.
@aimai: That matches my experience exactly. Of course back then they didn’t have a vaping alternative.
Never smoked regularly, but found that I LURVE nicotine. Started using the nicotine gum (and now the mints instead) about twelve years ago.
As “users” know, nicotine is both a stimulant and a relaxer. Studies I’ve seen about nicotine itself show improved mental acuity and slight physical performance gains. Easy to see why it’s popular and addictive, even absent the glamour advertising of smoking in pop culture (of yesteryear?).
The delivery method of nicotine is often the problem, not nicotine itself. I’m surprised that the gum/mints aren’t more popular because of its seemingly benign nature. The part that boggles the mind (and wallet) is the exhorbitant cost of this “smoking cessation” product. At its cheapest, it’s about equal in cost to major brand cigarettes (about 25¢ per dose) and prices vary significantly between vendors, with WalMart being as much as 35% less expensive than major drugstores, such as CVS, RiteAid, etc.—where cigarettes are actually CHEAPER.
With costs to manufacture nicotine-only products probably not being much more than making regular gum or breath mints, the manufacturers are making a LOT of money off this stuff.
Alain the site fixer
@VeniceRiley: I quit smoking after a major surgery and subsequent infection and second surgery, but kept using the patch for 5 years until one day I realized I’d not had it on for three days. I threw the rest away. I had no problems doing it slowly, though I’m glad i no longer have that vice.
There was one group that loved Next cigarettes: nicotine addiction researchers. As you might imagine, making cigarettes for research purposes is neither easy or inexpensive and the tobacco companies were not inclined to help research showing nicotine in cigarettes was the addictive component. The University of Kentucky was tasked by NIH to produce research cigarettes of various nicotine levels but since they didn’t have any of the other additives, smokers tended to hate them. So when Next came along, there was great rejoicing which soon turned to hording when the brand quickly folded. I still have packs of Next in refrigerated storage.