“The FDA’s new plans could just switch one form of nicotine addiction with another,” was the title a letter Dr. Enid Neptune from the American Thoracic Society (ATS), sent to the editor of the Washington Post. Dr. Neptune was referring to the recent FDA announcement, in which it disclosed its new tobacco plan.
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In his letter, the vice chair of the ATS insisted that the FDA should not differentiate between high risk and low risk nicotine products. “As a physician who treats patients devastated by tobacco-caused lung disease, I was concerned by the Aug. 5 editorial “Breaking nicotine’s grip,” which embraced Food and Drug Administration Commissioner Scott Gottlieb’s plan for regulating tobacco products. The commissioner seems unconcerned about switching one form of nicotine addiction with another. Nicotine in any form is bad for your health, adversely affecting neurological and cardiovascular systems and reproductive health. Evidence shows that nicotine can be a gateway drug. … The FDA’s job is to protect youths from all types of tobacco and nicotine addiction, not to negotiate which types of nicotine addiction it will allow.”
The ATS’s radical ideology
Dr. Siegel pointed out, that should one adopt this ideology, then similarly methadone or buprenorphine should also not be administered to heroin addicts, as that could also be considered as a case of substituting one addiction for another. However he added, “I, and fortunately the new FDA Commissioner, strongly reject this radical ideology. Risk does matter. Addiction is a public health problem not because the concept of someone being addicted to a substance is severely damaging, but because the addictive substance carries severe health risks.”
“Switching from a high-risk addictive substance to a low-risk addictive substance is not a zero-sum game. It is a critical and life-saving intervention. Just as methadone maintenance programs have saved thousands of lives from heroin-associated morbidity and mortality, electronic cigarettes are saving thousands of lives from smoking-associated disease and death,” added Siegel.
Harm reduction not prohibition, is the way forward
The public health expert pointed out that unfortunately this kind of ideology is the “underlying philosophy” of all the major health organizations and anti-tobacco groups in the US, including the Centers for Disease Control(CDC). He added that luckily the new FDA Commissioner seems more open to the idea of harm reduction, as to the contrary of prohibition, this is a strategy that is proven to work, and these major organizations should instead focus on promoting sensible regulations for these low risk products, and on educating the public about the relative risks of all nicotine products.
“Public health is about saving lives, not fighting for some ideological principle of no addiction to any substance, regardless of how low-risk the product might be or how the product might be saving a life by switching someone to a much safer form of drug delivery,” concluded Professor Siegel.