鈥淭he overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes 鈥� the only legal consumer product that, when used as intended, will kill half of all long-term users.鈥�
Those are the words of Scott Gottlieb, commissioner of the US Food and Drug Administration, unveiling a .
These long-awaited plans have international significance, suggesting that the US may be the first country in the world to do this. The FDA is also providing a reprieve for e-cigarette manufacturers, giving them more time to submit documents to get current and future products approved. Many manufacturers were worried they would not meet FDA demands in time and be forced to stop selling e-cigarette products.
Advertisement
The first of these developments is bold but faces some major hurdles to make it effective, while the second is welcome, given evidence that e-cigarettes can help smokers quit tobacco.
A have examined reducing nicotine in cigarettes, with promising results. Doing this would make smoking less appealing and addictive: in carefully controlled trials, there is . However, there will be big challenges implementing this in the real world.
Why? Cigarettes are available globally, and selling less-addictive versions in the US could result in a black market in imported or counterfeit products. Reducing the nicotine might also mean smokers take in more toxicants such as tar by puffing harder and for longer on their cigarettes 鈥� something the FDA plans to test in a consultation period.
It is important to remember that nicotine is not the harmful constituent in cigarettes, but the many nasties present in the tar. It remains to be seen how viable this move is.
Eased timeline
Encouragingly, the FDA has recognised the huge burden placed on e-cigarette manufacturers, including small companies, by its current approval timelines for permission to sell their products. So the agency has extended the deadline for approval until 2022. In the meantime, existing products can continue to be sold.
This is good news, particularly given that suggests quit rates for smoking in the US have increased since e-cigarettes became available and overall smoking rates have declined more quickly too. This is a temporary reprieve, however, and the US still needs to find the right system to ensure product standards while still making e-cigarettes available.
There is also a glaring omission in the US health strategy. Unfortunately, the announcements don鈥檛 include details of progress on some of the key measures needed to reduce smoking further, including banning tobacco advertising and making tobacco less available. These kinds of policy, which are largely outside the FDA鈥檚 remit, would accelerate the current declines in smoking that e-cigarettes and other developments have achieved in the US in recent years.
Gottlieb鈥檚 announcement is to be applauded, but whether it works as hoped remains to be seen.
