FDA Has Declared An Epidemic of Ecigarette Use By Adolescents
http://www.ecigarette-research.org/research/index.php/whats-new/2018-2/267-fda2By Dr Farsalinos
There have been some outstanding developments in the US in the past 2 days concerning e-cigarettes and flavors. The FDA has declared an epidemic of e-cigarette use by adolescents. Therefore, the FDA Commissioner announced that it requires “dramatic action to try to curtail this”. What they are looking for right now is to “remove the characterizing flavors from e-cigarette products”. According to information from the Chicago Tribune, the FDA has unpublished data showing a 75% increase in e-cigarette use among high school kids compared to 2017.
This is a very important development with multiple serious potential implications. For start, the duty of public health officials is to weigh the benefits and adverse effects of any intervention and check were the balance lies. If the adverse effects outweigh the benefits, of course aggressive action is needed. But if the opposite is true, then you cannot simply ignore the benefits and take action only based on the adverse effects. This is public health harm. The FDA officials certainly know that.
Interestingly, the main purpose of this action is to avoid adolescents being addicted to nicotine through e-cigarettes, with some of them transitioning to smoking (based on some studies showing that ever e-cigarette use at baseline is associated with ever smoking at follow up). At the same time, the FDA has acknowledged that this action could hurt some of adult smokers who may need flavors in order to quit and stay away from smoking. Where is the balance between the harm from nicotine addiction and the benefit of a smoker quitting? To answer, I will simply mention the findings of a systematic review paper about the relationship between snus use and cancer. Of note, snus users obtain similar or higher amounts of nicotine daily compared to smokers. The authors reported that in the US in 2005 among men aged 35 years or over, there were a total of 104,737 deaths from seven cancers were attributed to smoking. If none of the smoked but the whole population (including never smokers) were using snus, there would have been 2,081 deaths (instead of 104,737 deaths). To make it more clear, if the whole population was addicted to nicotine through snus, there would be 2,081 cancer deaths attributed to it instead of the 104,737 deaths attributed to smoking. For cardiovascular disease, several studies of snus have shown no elevated risk (examples here, here and here). I will not suggest that there is no risk, but the risk (if any) is minimal. In fact, in two of the studies the authors clearly mentioned that “Nicotine is probably not an important contributor to ischemic heart disease in smokers” and “… nicotine is unlikely to contribute importantly to the pathophysiology of stroke”. This evidence has never been refuted but is simply ignored and hidden from the public. But it is important to think whether the public health community should worry about a dependence associated with very low health risk or an addiction with substantial disease and death burden.
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