Why are CDC and the FDA Incapable of Telling the Truth? E-Cigarettes are NOT a Form of Tobacco Use

In an article published Friday in the journal Tobacco Control, the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health and the Food and Drug Administration (FDA) indicated that electronic cigarettes are simply another form of “tobacco use.” The article noted that 68% of electronic cigarette users vape flavored e-liquids and concluded that: “It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products.”

The Rest of the Story

Vaping is not a form of tobacco use. Electronic cigarettes do not contain any tobacco. This is a tobacco-free product and to tell the public that vaping is a form of tobacco use is dishonest. What the CDC and FDA are doing here is “a form of” lying.

The interesting question is: Why are the CDC and the FDA apparently incapable of telling the public the truth? Why are they not able to be honest about the fact that electronic cigarettes do not contain tobacco?

Clearly, for some reason, the truth represents a great threat to these agencies. Perhaps they are worried that if the public understands that vaping does not involve the use of tobacco, many more young people will start vaping. But that hardly justifies lying to the public.

What is so potentially damaging about being honest and telling the public that while vaping is not a form of tobacco use and is therefore much safer than smoking, there may be some risks associated with long-term use?

And what is so damaging about being honest and recommending that in addition to being concerned about all forms of tobacco use, public health practitioners should also address the use of electronic cigarettes (among nonsmokers and particularly, youth)?

The dishonesty being displayed by health agencies like the CDC is having documented adverse consequences for the public’s appreciation of the severe hazards of smoking. According to a paper published just last week in the American Journal of Preventive Medicine, the proportion of U.S. adults who incorrectly believe that smoking is no more hazardous than vaping tripled from 2012 to 2015.

The study concluded that: “The findings underscore the urgent need to convey accurate information to the public, especially adult smokers, about the available scientific evidence of the harm of e-cigarettes compared to combustible cigarettes.” And my esteemed mentor – Dr. Michael Eriksen, dean of Georgia State’s School of Public Health stated that: “Our public health messages should accurately convey to cigarette smokers that switching completely to e-cigarettes would reduce their risks even if e-cigarettes are addictive and not risk-free.”

The CDC’s dishonesty is problematic not only because it violates ethical principles of public health practice (i.e., honesty and transparency), but because it is actually doing public health damage: it is deterring smokers who might otherwise have quit using e-cigarettes, and it is encouraging many ex-smokers who quit using e-cigarettes to return to smoking. After all, if vaping is just another form of tobacco use, then why not enjoy the full-on experience of a good smoke?

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FDA Issues New Draft Guidance on Regulation Compliance for Certain Types of E-Cigarettes; CDC Comments

The FDA took steps yesterday to clear a big point of confusion that has arisen concerning a subset of electronic cigarettes on the market. Due to novel technology that allows nicotine to be extracted in concentrated form from potatoes, a number of e-cigarette companies have switched to using potatoes as a source of nicotine for their e-liquids. Several companies have asked the FDA’s Center for Tobacco Products for guidance on whether they need to comply with the tobacco product regulations, since their products do not contain tobacco and the nicotine used is not derived from tobacco.

Here is the relevant excerpt from the FDA’s guidance document which explains how these products will be treated by the agency:

On May 10, 2016, the agency published a final rule that deems all products meeting the statutory definition of “tobacco product,” except accessories of the newly deemed tobacco products, to be subject to FDA’s tobacco product authorities under chapter IX of the FD&C Act. Section 201(rr) of the FD&C Act (21 U.S.C. 321(rr)), as amended by the Tobacco Control Act, defines the term “tobacco product,” to mean “any product made or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product (except for raw materials other than tobacco used in manufacturing a component, part, or accessory of a tobacco product)” and does not mean “an article that is a drug under subsection (g)(1), a device under subsection (b), or a combination product described in section 353(g) of this title.”

Products that contain nicotine derived from tobacco meet the definition of a tobacco product under the FD&C Act and are required to bear a health warning on packages and in advertisements stating: “WARNING: This product contains nicotine. Nicotine is an addictive chemical.” For products that are made or derived from tobacco (but do not contain nicotine), manufacturers may submit a certification to FDA and, instead, bear the statement “This product is made from tobacco.”

The definition of “tobacco product” as set forth in section 201(rr) of the FD&C Act includes all components, parts, and accessories of tobacco products (except for raw materials other than tobacco used in manufacturing a component, part, or accessory of a tobacco product). FDA interprets components and parts of a tobacco product to include any assembly of materials intended or reasonably expected: (1) To alter or affect the tobacco product’s performance, composition, constituents or characteristics; or (2) to be used with or for the human consumption of a tobacco product. E-liquids that do not contain nicotine or other substances derived from tobacco may still be components or parts and, therefore, subject to FDA’s tobacco control authorities, if they are an assembly of materials intended or reasonably expected to be used with or for the human consumption of a tobacco product and do not meet the definition of accessory.

E-liquids that contain nicotine derived from potatoes do not meet the statutory definition of “tobacco product” unless they are reasonably expected to be combined with a tobacco product. However, since e-liquids that contain nicotine derived from potatoes are “potato products,” the agency declares that such products must comply with Marketing Order No. 946, as amended (7 CFR part 946), regulating the handling of potatoes, hereinafter referred to as the “order.” The order is effective under the Agricultural Marketing Agreement Act of 1937, as amended (7 U.S.C. 601-674), hereinafter referred to as the “Act.”  

Under the order, regulated potatoes must be inspected and certified by FSIS. As authorized under the order, the Committee uses information included on FSIS inspection certificates as a basis for collecting assessments and compiling industry statistics. The order requires handlers to submit reports to provide information on the volume of red types of potatoes handled for the fresh market. The order includes handling regulations for all varieties or varietal types of potatoes grown in the production area. These regulations can include minimum grade, size, quality, maturity, and inspection requirements. They can also provide for the size, capacity, weight, dimensions, pack, marking, or labeling of containers used in the handling of such potatoes. 

Because the agency has deemed e-liquids using nicotine derived from potatoes to be “potato products,” these e-liquids and any vaping devices intended for use with these e-liquids are subject to inspection and certification by FSIS. These e-cigarette manufacturers must also submit reports to provide information on the volume of red potatoes handled for the fresh market. They must also comply with the handling regulations for all varieties or varietal types of potatoes grown in the production area.

The Rest of the Story

I have to give the FDA credit for at least following its own logic. If e-liquids that use nicotine derived from tobacco are “tobacco products,” then e-liquids using nicotine derived from potatoes are “potato products,” and their manufacturers should be subject to all regulations for potatoes, including handling, inspection, packaging, labeling, and production requirements. However, I have to question why the agency ignored the recent emergence of companies that are using nicotine derived from eggplants to prepare e-liquids. Clearly, these products should be deemed “eggplant products” and should be required to comply with all USDA regulations governing the production, inspection, and labeling of eggplants.

Understandably, many small business owners who are in the e-liquid potato nicotine extraction business were upset. The president of NicoSpud E-Liquids was quoted as saying: “These regulations are going to decimate the potato nicotine extraction business. As a small company, we cannot afford the expense of complying with the detailed reporting, inspection, packaging, and labeling requirements. The FDA has basically handed the entire market over to Big Potato.” Indeed, the two largest potato manufacturers have each put their own brand of potato-derived e-cigarettes on the market. The R.D. Offutt Company is now selling its “E-Tater” brand in major convenience stores across the country. J.R. Simplot is test-marketing its “SafeSpuds” in Colorado and Utah.

But the national anti-vaping groups defended the FDA’s action. According to the Campaign for Tobacco-Free Kids: “Following the playbook of Big Tobacco, e-cigarette companies are using sweet flavors to entice kids to what could turn into a lifetime addiction to nicotine.” The Campaign called out “Sweet Potate,” a Tampa-based company, for using the word “sweet” in the very name of the product (Sweet Potate Cigs).

The CDC also supported the new guidance, saying: “The use of nicotine in any form is hazardous and can cause impaired brain development in adolescence. The great gains we have seen over the past decades in reducing youth smoking are sadly being undermined by their increased use of potato products.”

The CDC, in classifying e-cigarettes using nicotine derived from potatoes as “potato products,” has recently documented a large increase in youth potato use. While actual youth consumption of potatoes has fallen significantly, overall potato use among high school students has increased over the past two years.

I do not understand why the FDA and CDC need to lie about these e-cigarettes. They are not potato products simply because the nicotine in their e-liquids happens to be derived from potatoes. And classifying the use of these e-cigarettes as “potato use” is disingenuous at best. Why do we need to lie in order to make our point? Wouldn’t it be enough to tell kids that these products are not made from potatoes and therefore do not carry the same safety profile as potatoes. Already, there is evidence of widespread public confusion. More than 50% of youth surveyed believe that e-cigarette use is no more hazardous than eating candied yams.

The rest of the story is that by treating e-cigarettes like NicoSpud, SafeSpud, and SweetPotate exactly like potato products and by classifying them as potato products, the FDA and CDC are essentially telling the public, including our children, that the hazards of vaping these products are virtually identical to those of consuming potatoes.

What will it take for these agencies to understand that just because the nicotine in the latest generation of e-cigarettes happens to be derived from potatoes, that does not mean they are potato products? It is misleading if not outright dishonest to talk about these e-cigarettes as “potato products,” to classify them as potato products in surveys, and to claim that youth who are using these products are engaging in potato use.

ADDENDUM: It has come to my attention that many readers did not realize that this is a parody  – my attempt at satire. It is a sad state of affairs that the FDA’s logic has been so terrible that my readers don’t know if this is true or not. That was my exact point in doing this piece. I wanted to show the absurdity of the FDA’s approach – and I think this analogy points it out in a way that many anti-vaping organizations would not understand in any other way. If there is any doubt about whether the deeming regulations are “arbitrary and capricious,” this is the proof.

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Article Defending Nicotine Replacement Therapy Fails to Disclose Author's Conflict of Interest with Big Pharma

In another example that demonstrates the hidden influence of Big Pharma on tobacco treatment policy and the extent to which many defenders of nicotine replacement therapy (NRT) are going to hide their conflicts of interest, an article (letter to the editor/reply) defending NRT from criticism that was published online ahead of print in the Journal of Clinical Epidemiology fails to disclose the serious conflicts of interest of its lead author.

The article is a response to a paper published recently in the Journal which concludes that once one accounts for publication bias, there is no significant effect of NRT on smoking cessation.

The published article (a PDF of the accepted manuscript) does not disclose any conflicts of interest that the authors may have. There is no conflict of interest statement at all.

The Rest of the Story

The rest of the story is that the lead author has a long string of financial relationships with pharmaceutical companies, including some that manufacture drugs for smoking cessation, such as NRT.

In 2016, the lead author was the recipient of a Pfizer research award for the study of nicotine dependence. That announcement reports that he “has received consulting fees, honoraria and grants from several for-profit and non-profit organizations that develop smoking-cessation devices, medications, and services, including Pfizer.”

The lead author’s online CV acknowledges that he has performed consulting services for: “Abbot Laboratories,Acrux Ltd, ALZA Corporation, American Cynamid, Anesta, Aradigm, BASF/Knoll, Begbies Traynor; Boehringer-Ingelheim Pharmaceuticals, Celtic Pharmaceuticals, Ciba-Geigy, Cygnus, DynaGen Corporation, Elan/Sano, Eli Lilly Pharmaceuticals, Glaxo Wellcome, Dupont Merck Pharmaceuticals, Hoechst Marion Rouseau/Marion Merrell Dow/Merrell Dow Lakeside, Lederle Pharmaceuticals, McNeil Pharmaceutical/McNeil Consumer, Nabi, Inc, Neuromedical Technologies, Inc., Neuroscience Ventures, Pacific Pharmaceuticals, Parke Davis Pharmaceuticals, Pfizer Pharmaceuticals, Pharmacia & Upjohn/AB Leo Pharmaceuticals/Kabi Pharmacia/Pfizer, Proctor & Gamble, Sano Pharmaceuticals, Propagate Pharmaceuticals, Sanofi/Synthelabo Pharmaceuticals, SmithKlineBeecham/Glaxo SmithKline Consumer Healthcare, Xenova Limited.”

The lead author reports (in the online CV) having received grants from Pfizer (Chantix), McNeil Pharmaceuticals (Nicotrol inhaler and nicotine nasal spray), Pharmacia & Upjohn/Smith Klein Beecham Healthcare (nicotine gum), ALZA (Nicoderm), Marion Merrell Dow (Nicorette), and DynaGen (NicErase). 

There doesn’t appear to be any question that this author’s financial conflicts of interest are hugely significant and highly relevant to the subject matter of the manuscript. Therefore, these conflicts of interest should have been disclosed in the published article so that readers can be aware of the conflicts and take that potential source of bias into consideration when evaluating the validity of the paper’s conclusions.

It is not clear whether the failed disclosure in the published article is the fault of the authors or of the journal itself (i.e., it is possible that the authors disclosed these conflicts during the submission process but that the journal failed to add these disclosures to the published article). However, it doesn’t matter because either way, readers are deprived of knowing about these important conflicts of interest. In addition, I believe it is the authors’ obligation to ensure that the conflicts of interest are disclosed in the actual published paper. The authors are able to make such a correction when reviewing the manuscript proofs.

This is not the first example I have highlighted on this blog of the hiding of financial conflicts with Big Pharma in papers defending nicotine replacement therapy or other smoking cessation drugs. This is a general pattern I have observed. To me, it suggests that many defenders of NRT really do have something to hide. The evidence supporting NRT as a population-based strategy for smoking cessation is already flimsy, and it becomes even more flimsy once one considers the severe conflicts of interest of so many investigators who are evaluating these drugs. So it makes sense that there would be an effort to hide these conflicts from the public. But it is not an ethical practice, and it does a great disservice to the public and to the public’s health.

(Thanks to John Polito for the tip.)

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Medical School Researchers Criticize Campaigns Intended to Get Smokers to Quit

In a shocking and ironic development, a group of medical school researchers has attacked efforts to promote smoking cessation among adult smokers. Previously, I have only seen such an inappropriate attack coming from the tobacco companies. That in 2016, such an attack is coming from people in medicine, and not from Big Tobacco, is a surprising and troubling irony.

In this month’s issue of Preventing Chronic Disease, researchers from the Washington University School of Medicine in St. Louis argue that: “Vaping poses a threat to smoking prevention progress, and it is important for those in tobacco control to understand and counter the tactics used by vaping companies to entice their consumers, especially on social media where young people can easily view the content.”

They also argue that “the online use of price discounts or coupons that we observed on Twitter is a concerning practice from an industry that is rapidly growing and evolving.”

Furthermore, the authors warned that: “We observed the promotion of flavored e-juices and images of colorful vape pens in our sample of tweets; these promotions and images could grab the attention of potential consumers and entice them to initiate use of these products.”

In the introduction to the paper, the authors state that their primary objective in examining tweets about e-cigarettes and vaping is to investigate the marketing of e-cigarettes to young adults. They note that 32% of users are aged 18 to 29 years. Thus, this young adult group appears to be the primary focus of the article.

The Rest of the Story

It seems quite clear that the authors are opposed to the use of effective marketing techniques to promote electronic cigarettes. They attack e-cigarette companies for using price-based marketing, for trying to make their products taste good, and for trying to make their products look attractive. In other words, they are attacking electronic cigarette companies simply for promoting their products!

The authors conclude that we must “counter the tactics used by vaping companies to entice their consumers,” implying that it is inappropriate for the vaping companies to be marketing their products.

The marketing campaigns of vaping companies, at least as they apply to adults, are aimed at achieving a single, primary objective: to get as many smokers as possible to quit smoking and switch completely to vaping. The clear financial incentive of vaping companies is to get smokers to switch completely because the fewer cigarettes smokers use, the more e-cigarettes they use. The avowed value proposition of NJOY is “to make smoking obsolete.”

Vape shops are only going to stay in business if they can convince enough smokers to switch completely, or almost completely, to e-cigarettes. There is no market for adult nonsmokers to start vaping because the small number who do this are unlikely to vape with any frequency. The money is with smokers, especially those with long smoking histories or high tobacco consumption and dependence, who will vape early and often.

Thus, the rest of the story is that by opposing the efforts of vaping companies to promote their products, these researchers are opposing a major societal effort to entice smokers to quit smoking.

Would these authors also attack the pharmaceutical companies for using price discounts to promote nicotine patches or nicotine inhalers, to market nicotine replacement products with flavors, or to make their products look attractive? Their attack on e-cigarette companies for marketing to adult smokers, even if they are young adults, is the same as criticizing the promotion of smoking cessation drugs. Except it’s probably worse because e-cigarettes are probably a little more effective than traditional nicotine replacement therapy.

The story would be different if this paper was focused exclusively on the marketing of vaping products to underage youth; that is, to minors. Everyone agrees that these companies should not be marketing to kids. But the study was not designed to examine the marketing of e-cigarettes to minors. The paper itself states that the primary audience of concerns is young “adults.” This is the precise population for which electronic cigarettes are so important. If we can get young adult smokers to quit by switching to e-cigarettes, we can protect their health and save their lives before smoking has taken its toll.

The only thing that is not surprising to me about this story is that the article was published by the Centers for Disease Control and Prevention (CDC). From the get-go, the CDC has been vigorously opposed to smoking cessation via vaping products. Thus, it makes sense that they would publish an article which argues that we must counter all efforts to promote vaping products, even if the very purpose of that marketing is to try to make smoking obsolete.

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IN MY VIEW: FDA is Partly to Blame for Explosion that Injured Teen on the Hogwarts Express

For several years, the FDA has been nagging us about how important it is that the agency claim jurisdiction over electronic cigarettes because of their safety hazards. Now that the FDA has that jurisdiction, it is the public health agency that is ultimately responsible for ensuring the safety of electronic cigarettes. And so far, it is doing a terrible job.

This past weekend, a teenager suffered burns after an e-cigarette exploded on the Hogwarts Express at the Universal Orlando theme park, sending a fireball in her direction. Since the FDA is responsible, upon its own insistence, for the safety of electronic cigarettes and this explosion occurred on its watch, the agency bears some responsibility for the girl’s injuries.

After all, the agency has failed to set any standards, or even to issue a guidance or advisory, for electronic cigarette battery safety. Moreover, the FDA’s Center for Tobacco Products has actually institutionalized the problem of exploding batteries because it promulgated regulations that prohibit e-cigarette companies from repairing the defects that are causing these explosions. Since August 8, companies have been prohibited from making any safety improvements on their products, including fixing the problem of exploding batteries. To correct such problems would amount to selling a new “tobacco product,” something that is not allowed under the FDA’s regulations.

Imagine being the president of the company that manufactured the product which injured this girl and having to explain to the girl’s family that although a safety defect has been identified in your product, the FDA has prohibited you from fixing it. The idiocy of these regulations would be comical if they weren’t causing so much human damage.

The Rest of the Story

The FDA regulations are so detrimental to the public’s health that vape shops are interpreting the rules to mean that they cannot even fix defective e-cigarette devices of their customers: “In addition to talking about health benefits, the regulations now prohibit vape shops from working on customers’ devices, which is something that shops charged money for as a service. “It’s almost like going to a mechanic and the mechanic tells you what’s wrong and how to fix it, but telling you that you have to do it yourself,” said Jonathan Golin, a manager at Gorilla Vapes in East Brunswick.”

So if a customer has a device that is overheating, leading to the release of formaldehyde, many vape shops apparently believe there is nothing they can do to fix these devices, which is going to harm the health of these customers unless they can fix the devices themselves, which is not something most people are able to do.

Suppose, for example, that a company or a vape shop discovered that it could prevent overheating, and therefore the formation of formaldehyde, by adding a second coil. Thanks to the FDA, the company or vape shop cannot do this because it would result in a “new” tobacco product, whose sale would be unlawful. While one might argue that if a customer already bought a device and then brought it back, the store could fix it; however, it would still essentially be selling a “new tobacco product.”

As the official regulator of e-cigarette devices, including batteries, the FDA should be held responsible for its failed regulatory approach. Instead of regulating the safety of these products, the agency chose instead to take a prohibition approach — wiping out 99% of the industry.

In the meantime, people riding the Hogwarts Express may want to practice their extinguishing spells, as the problem of exploding batteries is not going to be fixed any time soon, thanks to the FDA’s Center for Tobacco Products shirking its responsibility for ensuring the safety of the products under its jurisdiction.

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National Anti-Tobacco Groups File Feeble Lawsuit Against FDA While Continuing to Oppose Smoking Cessation via Vaping

Earlier this week, eight national anti-tobacco groups, headlined by the Campaign for Tobacco-Free Kids, filed a lawsuit against the FDA in an attempt to force the agency to re-issue a requirement for graphic warning labels on cigarette packs.

As the lawsuit explains, here are the key facts:

1. “The Tobacco Control Act became law on June 22, 2009. Section 201 required the FDA to  promulgate its final rule [regarding graphic warning labels] “not later than 24 months after the enactment” of the Act: June 22, 2011.”

2. “On June 22, 2011, exactly two years after the Tobacco Control Act was enacted, the FDA promulgated a final rule designating nine graphic warning labels depicting the negative health consequences of cigarette smoking as required by Section 201 and set September 22, 2012 as the time by which such warning labels would be required.”

3. “On September 2, 2011, a group of tobacco product manufacturers and sellers filed an action in the United States District Court for the District of Columbia alleging that the 2011 Rule was unconstitutional as applied because the specific required content, placement and type style of the mandated warning labels infringed their rights of free speech under the First Amendment.”

4. “On February 29, 2012, the United States District Court for the District of Columbia found that the specific warning labels required by the 2011 Rule were unconstitutional and enjoined the  enforcement of the rule. On August 24, 2012, the Court of Appeals for the District of Columbia Circuit affirmed the judgment of the District Court and vacated the 2011 Rule. The Court of Appeals remanded the rule to the FDA and vacated the District Court’s permanent injunction.”

5. “On March 15, 2013, Attorney General Eric Holder, in a letter to Congress, stated that, given the FDA’s plan to undertake research to support a new rule mandating graphic warning labels consistent with the Tobacco Control Act, the Solicitor General had determined not to seek Supreme Court review of the Court of Appeals’ ruling.”

The lawsuit’s complaint is that although “more than four years have now passed since the Court of Appeals vacated the 2011 Rule, the FDA has not even be gun rulemaking proceedings to promulgate a new graphic warnings rule as required by Section 201. No proposed rule even appears on the FDA’s Unified Regulatory Agenda for action during 2016.”

The Rest of the Story

This is a very weak lawsuit. At this point, whether or not the FDA re-issues a rule regarding graphic warning labels is entirely up to the agency’s discretion. The agency has already complied with the statute, which merely requires it to issue a graphic warning rule by June 22, 2011. The FDA did issue that rule, on June 22, 2011, as required. The rule was deemed unconstitutional by the D.C. District and Circuit courts and was vacated. Since the FDA issued the rule as required by the statute, it has fulfilled its obligation under the law and is not required to issue a subsequent rule. There is nothing in the statute indicating that if the initial rule is found to be unconstitutional, the agency must keep issuing additional rules until one finally passes Constitutional muster.

The key argument of the plaintiffs, which include the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, American Lung Association, and the American Academy of Pediatrics, is that the FDA has failed to comply with Section 201. I don’t find that argument compelling because the agency has in fact complied with Section 201 by issuing a rule on graphic warning labels, as required, by June 22, 2011. The FDA is not in violation of Section 201.

While the plaintiffs have every right to use advocacy strategies to urge the FDA to re-issue a graphic warning label requirement that does not conflict with the First Amendment rights of the cigarette companies, their attempt to use the law to force the agency to re-issue a graphic warning label rule is unsupported by the facts of the case.

While not directly relevant to the legal issues in the case, the plaintiffs repeatedly claim that the scientific evidence shows that graphic warning labels are effective in getting smokers to quit. However, I do not believe that is the case. The evidence supporting the use of graphic warning labels to promote smoking cessation is weak. Moreover, there is substantial evidence that graphic warning labels are ineffective. A body of psychology and neurophysiology research suggests that graphic warning labels on cigarette packages will have very little effect in deterring smoking among existing smokers.

The Circuit Court recognized as much: “FDA has not provided a shred of evidence – much less the ‘substantial evidence’ required by the APA – showing that the graphic warnings will ‘directly advance’ its interest in reducing the number of Americans who smoke. FDA makes much of the ‘international consensus’ surrounding the effectiveness of large graphic warnings, but offers no evidence showing that such warnings have directly caused a material decrease in smoking rates in any of the countries that now require them. … FDA’s Regulatory Impact Analysis (RIA) essentially concedes the agency lacks any evidence showing that the graphic warnings are likely to reduce smoking rates. … The Rule thus cannot pass muster under Central Hudson.”

Thus, the lawsuit’s claim that the failure of the FDA to issue a new graphic warning label rule is hindering the anti-tobacco groups’ ability to carry out their mission is unsupported.

The rest of the story is that what is really hindering the ability of these groups to carry out their mission is their continued refusal to promote smoking cessation if that cessation involves anything that resembles smoking, even if no tobacco is involved. Of course, I am talking about their continued attack on electronic cigarettes and vaping, despite the evidence that vaping has helped millions of smokers to quit or substantially cut down on the amount they smoke.

The obsession of the anti-tobacco groups with graphic warning labels coupled with their vigorous protection of cigarette consumption by discouraging smokers to switch to vaping suggests that something else is going on beyond a simple desire to promote smoking cessation. It appears that the desire is to promote smoking cessation only in the way that these groups prefer. Whether the advocated strategy is actually the most effective or most helpful to smokers is not important. What is important, apparently, is not that smokers quit, but that they quit in the “right way.”

Quitting using e-cigarettes is not the “right way” because it involves an activity that resembles the act of smoking (even though the product is tobacco-free). Quitting by being bombarded with graphic warnings is the “right way” because smokers are being punished and chided for what is viewed as an immoral or stupid decision to smoke (even though the approach has been shown not to be very effective).

These groups also continue to urge smokers to use other ineffective methods, such as nicotine replacement therapy, because they view these as a “right way” to quit. For the 90% of smokers who fail to quit using nicotine replacement therapy, and for whom e-cigarettes might be the only viable option, these groups still discourage vaping because it is just not the “right way” to quit.

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