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FDA acknowledges “continuum of harm”

Mitch Zeller, who heads the Center for Tobacco Products for the US Food and Drug Administration, acknowledged last week, in a lecture in the Legacy Foundation Warner series, that there is a "continuum of harm" in the administration of nicotine, leaving the door open to the slight possibility that vaping might just be a teeny bit less dangerous than smoking 2 packs of cigarettes a day. Summaries of Zeller's comments are available at Reuters and the convenience store publication CSPnet. At the FDA website, you may register for updates and direct access to Zeller's lecture, or if you are already registered, you may go go directly to the webcast of the lecture.

Zeller averred that the concept has been current at the agency for a long time. If so, it must have been whispered in back hallways, because it certainly sounds like a novelty in the FDA's public discourse on vaping products. The director waltzed gingerly around the term "harm reduction", calling it "a loaded phrase within the field." Then he went on to talk about "relative risk and relative toxicity", promising to weigh those concepts "when we're actually regulating this broader spectrum of nicotine delivery systems that meet the statutory definition of tobacco product." Sure sounds like harm reduction to these ears.

Calling nicotine "a safe and effective medication" that has had the agency's approval for more than 3 decades, Zeller asked "Can we start to take a different look at this?" By all means, Mr. Chairman! Elsewhere he called for honesty in looking at the role of nicotine. The rumor that Center for Disease Control head Tim McAfee was seen swabbing out his ears with a q-tip, to make sure he'd heard correctly, is almost certain to be false.

In another neck of the Yankee woods, the Atlantic Monthly came out with an article quoting yet another researcher from the University of California at San Francisco, Professor Stacey Anderson, as follows: "to say that [vaping is] less harmful [than smoking] is like saying it's better to jump out of the 40th floor than the 100th floor of a building." This comment displays the kind of contorted logic and sloppy data presentation that has recently come to characterize the once highly respected UCSF research facility on Tobacco Control, in the effort to discredit vaping at all costs. The reason the analogy is nonsensical is precisely because there is no "continuum of harm" between 40 storeys and 100 storeys as a lift-off site for a jumper. Since either would certainly be fatal, it is invalid as an analogy for relative risk.

The Atlantic article also treats "the industry" as though it were the equivalent of Big Tobacco, interviewing only e-cig manufacturers who are now owned by cigarette-producing firms, and barely mentioning that there are vaping-supplies manufacturers who market no poisons. This is also typical of UCSF pronouncements on vaping, despite the fact Big Tobacco only got into the industry two years ago, after independents had been selling e-cigs for more than half a decade, and upon entry it simply purchased its market dominance with its huge bankrolls. UCSF theorists claim to believe that vaping is a plot by the latecomer Big Tobacco to "hook kids on nicotine" with no mention of other players in the industry who preceded Big Tobaccco's involvement. The Atlantic plays along with this UCSF fantasy.. 

Anderson decries the re-appearance of advertisements for "cigarettes" [sic] on television "just because they're heated by a battery," ignoring other differences like the absence of smoke from burning tobacco. She claims quite incorrectly that we simply don't know whether that makes them safer, refusing to acknowledge that the only unknown is how much safer, very much, or overwhelmingly much. In fact the failure to mention levels, degrees, and amounts of toxicity, danger, and risk has been a consistent feature of work coming out of UCSF since their e-cig witch hunt began. UCSF statements on the presence of toxic substances typically make no distinction between trace levels and dangerous ones. One would think these scientists were unaware of such distinctions. The same tendency has been noted in studies coming out of the Centers for Disease Control, another participant in the e-cig witch hunt. It would seem that we now must add The Atlantic to that list of witch hunters.

By contrast, it is certainly welcome to hear the FDA talking about a "continuum of harm".