Despite the growing use of safer nicotine being strongly associated with declining smoking rates, there is still systemic opposition to these products from institutions and NGOs - but why is this the case? In this episode Lindsey Stroud joins us to unpack the FDA's reluctance to approve new nicotine products, and the misinformation used to prop up the opposition to THR.
Transcription:
00:04 - 01:17
[Joanna Junak]
Hello and welcome. I'm Joanna Junak and this is GFN News on GFN.TV. Misinformation about vaping in the United States has created a significant challenge for public health officials, educators and policymakers. While there is strong evidence that vaping is a viable smoking cessation aid for adult smokers trying to quit, there are significant challenges in communicating this to the wider public. Focusing on dispelling myths and providing clear guidance on the risks of vaping is a key part of any public health strategy. Joining us today to discuss the ongoing misinformation around vaping is Lindsey Stroud. Hello Lindsey. Let's start our discussion with the most common myths and misconceptions about vaping among people in the U.S. What are they?
01:18 - 08:24
[Lindsey Stroud]
Yes, well, I imagine that they're the same common misperceptions that we're seeing globally. That kind of happens when you have a billionaire that, you know, is shaping the narrative. I mean, I guess when you're going back, I mean, you're starting... When you look at the history of the United States, it was like the CDC... Um, when I started doing the research on it, like, you know, 2013, they started looking at e-cigarettes and their big thing was also like looking at youth. Um, but you started seeing this big main misperception about nicotine is probably one of the worst, um, things that we find, um, that, you know, that nicotine is what causes the harm, despite having, you know, what, 1976 with Michael Russell, people smoke for the nicotine, but they die from the tar. And since then, um, you know, companies have been trying to figure out a way to provide these products. And it seems that this consumer driven revolution, well, now that, oh, well, now they're getting nicotine and a safer thing. Now it's this demonization of nicotine. I think one of the biggest things you hear is just as addictive as heroin. And that's patently false. If you look at the withdrawal symptoms from heroin or any opioids compared to a withdrawal symptom from nicotine, they are just completely, you know, apples and oranges is what you're comparing it to. And it's just really the false alarmism there. The other one is the, you know, the big tobacco, you know, brought up e-cigarettes to hook a new generation. Again, patently false. especially when you're looking at the states. It's 2007 is when we first had, you know, the modern e-cigarette really introduced a lot of, you know, issues with that. We can go into a whole different time, but it wasn't until like 2012 that you actually saw a larger tobacco company purchase blue e-cigarettes. Yeah, and so five years later, and then, you know, they waited until the regulatory place. And even now you can tell that our landscape isn't good, but that's a different question. We'll go and talk about that later. But no, this is really a consumer driven revolution that I mean, it's kind of amazing, actually, to sit there and see how much that it's that, you know, the people kind of, you know, force companies to change. It's one of my favorite things about it. And then the big one now, and it's been for the past couple of years, and this is kind of coming from our industry or, you know, some people who are supposed to be on our side of the industry is some of these Chinese illicit babes. And like, I remember reading something from like 2015 and they're like, you know, 90% of, you know, e-cigar products come from China. Well, welcome to America. A lot of everything comes from China. Just go walk into a Walmart store But again, I understand it, too. I mean, you have all these bad actors that didn't even file with the FDA, completely scurrying regulations. Companies that are playing by the rules are losing market share. It's just this big catch-22. And unfortunately, with these Chinese illicit vapes, so to speak, You are seeing massive declines in smoking rates, and you're also seeing this coupled with a decline in youth use as well. So it's overwhelmingly, at least with the numbers, these are adults using it, and then we have that in actual real consumer data, real actual population data, and also mostly in sales numbers. those would be the biggest like you know i mean and then there's all the other nuances depends on what state you're going into and stuff that you'll find out with the common misperceptions but yeah nicotine big tobacco and then chinese weights are the big things right now in the states so where does most of the misinformation about e-cigarettes come from oh everywhere i mean everywhere um okay obviously we could start with the easiest target um you know Michael Bloomberg for like what, 25 years has been rallying against big tobacco and tobacco companies. You know, New York was one of your first, you know, cities to start doing, you know, smoking bans and, you know, excessive taxation and, you know, his empower policies that really, you know, shape the whole framework convention on tobacco control and everything. And, you know, he set his eyes on e-cigarettes once they came out. He's won $1.5 billion, I think, or whatever. Then he launched like $500 million just to go end the sales of flavored vapes. And he's been really good at doing that grassroots local stuff where you get it started out at a local, you know, a city or a town. And then it gradually moves around the whole state. And then eventually the state gets to it. And then then at some point you're looking at the federal government. Then you got the federal government agencies that have done really, you know, again, Tom Frieden was at the CDC. And then he's a big homie. You know, he runs Vital Strategies. He was the health commissioner of New York City when Bloomberg was mayor. They're there. You know, they're homies. OK. And so. you know, he started looking at, you know, when the CDC, when these cigarettes are coming out, we're pretty much alarmist. I mean, there's a reason to have the wary, you know, the precautionary principle, which shouldn't be to this demonization. So when you're looking at the way that the CDC is, you know, fuel this misinformation, um, Look no back further than 2019 with the vaping lung injuries. We knew that overwhelmingly that these were the original illicit and the real illicit products, the THC-containing vape devices that people were making and they were selling on the street. And the CDC really kind of was not very transparent about that. And you had other agencies that were pretty much yelling at them to, hey, you need to go – they were – I guess the perfect example would be Brian King in like August of 2019 when he was interviewed by, I wanna say it was an NPR person, but don't quote me on that. But they asked about what the role of THC was and he just pivots and deflects and he's like, well, You know, there's ultrafine particulates and, you know, like aerosols not harmless and, you know, kind of just downplays this. And it's kind of a shame. So and then also when you're looking at the FDA and the lack of authorizations that, you know, they help fuel that one. And then, I mean, you just have a lot of these in these organ organizations that, you know, I mean. I sat there in Rhode Island a couple of weeks ago and one of the kind of laugh at this with the campaign. This is actually a campaign for tobacco free kids. But, you know, doing the numbers in 2023 of the Rhode Island kids who had ever used an e-cigarette, only four percent of them cited using it for flavors. So this guy comes up after me and it's like, you know, she talks about the four percent, but they're not understanding that 80% of them are using, and it's like, well, you're kind of pushing the cart before the horse, okay? I mean, if you want to address youth vaping, shouldn't you address why they're vaping, not what they're vaping? And I hate to break it to you, so we're 80% of adults using those flavors, so... Um, and unfortunately they have a big, they've been, all of those groups have been very, very good at collaborating, communicating, and getting out the same message. So when you sit there at a hearing, you sit there at anything, a lawmaker sitting there for eight hours, they keep hearing the same message over and over again, it's going to pick up and it's just really unfortunate. So there's like the whole bunch of misinformation and, you know, I would like to be positive. You know, the only way to kind of send me this misinformation is to keep, going hard and putting out the real data, putting out the real information, especially for consumer advocates. We all talk about kids vaping. We need to be talking about adults vaping or using any other of the tobacco harm reduction products.
08:26 - 08:38
[Joanna Junak]
Based on what you said, in which regions of the US is information about e-cigarettes the least accurate? And where is public knowledge, especially regarding THR, the weakest?
08:39 - 11:13
[Lindsey Stroud]
Oh, I mean, the federal government, Congress. I mean, it's funny watching Congress be so upset with the FDA when they're like, you're the ones who designed the 2009 Family Smoking Prevention and Tobacco Control Act. This is all of your fault. So, and then when the FDA is sitting there getting thrilled and being like, right to your lawmakers, they're not completely false on that one. The federal government, I mean, and, you know, I mean, well-meaning and, you know, policymakers that, you know, unfortunately, tobacco companies kind of just have like a target on their back. It doesn't matter what they do. They're always going to be bad, even though they've done their crime, they've done their time, you know, they're paying, you know, with the master settlement agreement and everything. So, you know, there's this like, you know, this... Lawmakers mean well, I mean, I understand it, but they're completely clueless. So I would say here and say that like where most of our misinformation lies is a lot with the policymakers. And a lot with like, I don't completely blame the FDA. I do feel that they're a little bit stunted, but they could be doing a lot more too in terms of some of the stuff that they have. Um, in terms of like the states that are like looking at the state level in the regions, I mean, it's places that tend to be more, um, quote unquote, liberal states, um, tend to have some of the most restrictive policies. So like Massachusetts is like the perfect example on this one. They were one of the first states to implement T21 back in 2013. So you're talking even before Juul and all of this, um, they, you know, uh, when the flavor bans were coming back down in 2019 during the lung injury stuff, it was funny. Cause it was like, you know, Michigan was like, Oh, we're going to ban flavors. And then New York is like, Oh, I see you. We're going to ban them. And we're going to ban them before you do it. And then Massachusetts was like, hold my beer. We're banning them tomorrow and everything. And they did have the first state to enact a full flavor ban on menthol cigarettes. And, um, and vapor products. And now they're still going even further. You know, they're doing NFG, nicotine free generation proposals. And it's like, so what happens after that? I mean, what are you going to keep doing at this with the tobacco control? So I think in places that were, there's more, the more money spent too on tobacco control programs, like California is a good example that you're seeing a lot of this, you know, misinformation. But I will note too, when you're looking at use around the country and everything, vaping use among both youth and adults kind of mirrors the smoking rates. So if you have higher smoking rates, combustible cigarette use, you're going to see higher rates of vaping, which kind of shows, again, this efficacy of this being a tobacco harm reduction tool and that these are being used by those people.
11:15 - 11:21
[Joanna Junak]
So are current regulations on e-cigarettes in the U.S. based on the latest scientific research?
11:22 - 15:51
[Lindsey Stroud]
No, not at all. They never have been. Okay, well, we'll just start. We'll start with the federal. The TCA has is appropriate for the protection of public health standard, the APPH standard, which is like that's what's going to determine whether they're going to get a marketing authorization. And for all intents and purposes of this conversation, if I say approval, just assume that I mean authorization because technically the FDA does not approve tobacco products. Per the TCA, because that would be misleading. Go figure. Ain't that a kick in the head? But the APPH standard, they're pretty much holding it hostage to is that the likelihood that a user will be able to quit smoking and then the likelihood of a non-user picking up this product, which is overwhelmingly looking at youth. They're not really looking at whether this product is safer than a combustible cigarette or not as far as the science as that goes. So that's what you're seeing. I mean... When you're looking at FDA orders and stuff, I mean, look at Brian King. There was about 1,500 orders during his tenure. Only 11 of them were for e-cigarettes. It's less than 1%. Like 783 were for combustible cigarettes. And I just did the math this morning. It was like for every one e-cigarette product that King approved or authorized, more than 140 cigarettes were authorized. Mind you, smoking is at its lowest rates ever, and you have an increase in adults using e-cigarettes. And they're increasingly using products that the FDA is not regulating because the FDA has denied all of them. And I understand the youth stuff, but like, I mean, in 2019, I think we'll still figure this out, that that was a blip, you know, because it's just when you look at how much, how high it went up and everything, and then it went down. I mean, it's not a long term. There was no long term trend in this increase whatsoever. And actually now you've been seeing a significant long-term trend and the decrease. So we went, yeah, it was 20% of U.S. middle and high school students vaping in 2019. That's current vape, you know, past month use. And then it's like 5.9% in 2024. It's like a 75% reduction. We went from one in five kids vaping to like one in 20, which is impressive. all the while having an increasingly unregulated marketplace and the most amount of e-cigarettes that you've ever had on it. So FDA's regulation is not even, yeah, what they're doing is not relying on science. I mean, it's also, again, it's the way the TCA is kind of set up to, you know, you can't sit here and regulate this one product this one way and then regulate this other one this other way. I mean, they could do it if they change some of the rules and regulations on it. I think that'll have to take Congress to actually enforce them. At the state level, I mean, it's all reactionary. These aren't really well thought out policies. You're seeing a lot of a push for doing tax parity. So disregarding the reduced harms, I will never advocate for a tax on tobacco harm reduction products I understand that, like, you know, you might have to kind of acquiesce and throw them a bone at some point. But if you're going to have a tax on it, then it needs to be related to its harm. So combustible cigarettes should be taxed at a greater rate than a tobacco harm reduction product. Just, you know, incentivize people to quit, you know, to switch over. and flavor bans again they disregard the data you have we have numerous years of evidence again back to Rhode Island since 2017 they have been looking at you know state specifically in their youth risk behavior survey why do you vape and you're not even back then flavors yeah they were citing them a little bit more but they still were never the number one reason it's always been a friend or family member but according to the CDC um yeah the most common reason why kids vape is to um self-medicate feelings of anxiety, depression, and or stress, um, which is kind of the same reason that adults vape and smoke. I mean, go figure that that's how we use our nicotine products. Um, so when you're looking again, when you're looking at a flavor band, you're not, you know, addressing, you know, why kids are doing this. So, um, And you're just ignoring the science of flavors and everything. And just give a shout out to the FDA when they just, they did just authorize the 20 Zen products in January and a wide variety of flavors. So they do recognize it. So there's the positive thing there. Thank you.