Regulatory Science to Policy: Update on e-cigarettes. David B. Abrams The Schroeder Institute For Tobacco Research And Policy Studies at Legacy. The Johns Hopkins Bloomberg School of Public Health Georgetown University Medical Center / Lombardi Comprehensive Cancer Center. CWAG Presentation
Regulatory Science to Policy: Update on e-cigarettes.David B. AbramsThe Schroeder Institute For Tobacco Research And Policy Studies at Legacy.The Johns Hopkins Bloomberg School of Public HealthGeorgetown University Medical Center / Lombardi Comprehensive Cancer Center
Park City. Utah. 21st July 2014
20 million deaths: more than in all the American wars since founding our nation
will die prematurely
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
Despite 50 years progress, reduction in combustible cigarettes has slowed ...
As articulated in the 2014 Surgeon General’s 50th anniversary Report. Executive Summary (pages 15-17):
“Death... is overwhelmingly caused by cigarettes and other combustibles...
promotion of e-cigarettes and other innovative products is...
likely to be beneficial where
the appeal, accessibility and use of cigarettes are rapidly reduced.” ….and their cost is increased
Are e-cigs essentially unregulated NRT ?
Non-Combusted Tobacco and Nicotine Products:
Abuse Liability “Appeal”
NRT OTC: Nicotine replacement therapy bought over the counter; Med Rx: Prescription medication; NHS: NHS Stop Smoking Service; E-cig: Electronic cigarette
Conclusions and Relevance Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents
Rath J, Villanti A, Abrams D, Vallone D. Patterns of Tobacco Use and Dual Use in U.S. Young Adults: The missing link between youth prevention and adult cessation. Journal of Environmental and Public Health. 2012.
Robust ongoing surveillance of NCP advertising is critical to inform the FDA and protect public health.
Tobacco companies have long tried to discourage smokers from quitting
by marketing cigarette changes as reducing health risk.
Some e-cigarette ads carry a similar message.
Communicate intelligently about harm reduction
Policy and Practice Proportional to HARM
FDA-approved medicines, e-cigarettes, or smokeless (least harm is Swedish Snus).
"New approaches must be adopted if we are to dramatically reduce the harms over the next decade. Goal requires that we recognize the unequal dangers resulting from combustible tobacco use.”
CAN E-cigarettes make lethal combustibles obsolete?
Excerpts from: Endingtobacco smoking in Britain; Radicalstrategies for prevention and harm reduction in nicotineaddiction
Royal College ofPhysiciansof London, 2008.
People smoke because they are addicted to nicotine, but nicotine itself is not especially hazardous; it is the other constituents of tobacco smoke that cause most of the harm.
Use of smoke-free nicotine would benefit smokers directly by reducing the personal harm caused by nicotine addiction.
“In Sweden, the availability and use by men of an oral tobacco product called snus, one of the less hazardous smokeless tobacco products, is widely recognised to have contributed to the low prevalence of smoking in Swedish men and consequent low rates of lung cancer.”