STIER: House lights up FDA regulation

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By Jeff Stier

Congress is now considering two rival approaches to altering tobacco regulations. One, favored by the leading cigarette manufacturer, would lock in the market shares of existing tobacco products and make things difficult for newcomers. The other, far better from a public-health perspective, would allow new, safer forms of tobacco - such as snus - to compete more easily with cigarettes.

Snus is smokeless tobacco already popular in Sweden that delivers the nicotine users crave without the dangerous, cancer-causing combustion associated with cigarettes. Sweden has seen huge reductions in lung cancer due to its populace's shift toward snus use instead of cigarettes.

Now, it's true that in an ideal world people would kick their nicotine addiction altogether. But in reality, where so few people succeed in doing so, snus makes sense as a means of “harm reduction.” Snus eliminates the risk of heart disease, lung cancer and the other systemic diseases related to smoking. Of course, there's no secondhand smoke from snus.

There is a small risk of oral cancer with snus, but even this risk is smaller than the oral cancer risk from cigarettes - and is not accompanied by numerous other risks to nearly every other system of the body. On balance, we would likely reduce tobacco-related deaths to something like a fiftieth of their current frequency if the populace switched to snus.

The top cigarette manufacturer and some ostensibly public-health-oriented activist organizations - who have worked with cigarette makers on the less snus-friendly bill - tend to downplay the huge difference in risk between snus and cigarettes. Snus contains nicotine, but nicotine in itself - absent burning - is not harmful, something that health groups like Campaign for Tobacco Free Kids and cigarette-makers like Altria Group Inc. (formerly known as Philip Morris Cos. Inc.) ought to know.

The snus-unfriendly bill, known as the Kennedy-Waxman bill (after sponsors Sen. Edward M. Kennedy, Massachusetts Democrat, and Rep. Henry A. Waxman, California Democrat), would give the Food and Drug Administration (FDA) authority to regulate tobacco. This sounds like a neat idea, but the bill has numerous provisions that would harm rather than enhance health.

The key is that it would greatly restrict the advertising of new forms of tobacco, effectively shutting products such as snus out of the game and leaving the nicotine-addicted portion of the public thinking that deadly cigarettes remain their only option.

People's rate of quitting cigarettes with non-nicotine methods is dismal. Even with the gum, the patch, pharmaceuticals, counseling, public pressure, smoking bans and everything else, quit rates fail to exceed 15 percent. It would be compassionate to give smokers more tools to help them reduce their risk and quit cigarettes.

Nearly as insane as shutting out the snus option, the Kennedy-Waxman bill would authorize the FDA to require cigarette-makers to lower the level of nicotine in cigarettes. But then smokers would likely smoke more cigarettes in order to get the nicotine they crave. Great for Altria, not a boon to anyone's health - the more puffs people take to get their hit, the more damage they do to themselves.

Finally, by appearing to give cigarettes the FDA's regulatory blessing and approval, this bill may simply make more people think cigarettes are relatively safe - but they will remain the leading preventable cause of death.

Even the FDA's most recent commissioner, Andrew von Eschenbach, was opposed to FDA taking on oversight of cigarettes for that reason.

Luckily, Rep. Steve Buyer, Indiana Republican, and Mike McIntyre, North Carolina Democrat, are introducing a bipartisan bill, with a companion bill introduced in the Senate by Sen. Richard Burr, North Carolina Republican, that is more sensible from a scientific perspective. It calls for creating a Tobacco Harm Reduction Center based out of the Department of Health and Human Services - rather than involving the FDA - and suggests a regulatory framework that would not favor cigarettes over safer alternatives.

Naturally, Altria prefers the Kennedy-Waxman bill. Maybe it's time for citizens to let their representatives know they feel differently.

Jeff Stier is an associate director of the American Council on Science and Health (ACSH.org).