The Tricky Matter of Nicotine

Nicotine and tobacco policy is often cited for similar issues confronted in nutrition and obesity. In this guest post, our good friend Joe Gitchell shares his perspective based on decades of experience in tobacco control, bumping into disconnects between science, bias, and policy. Sound familiar?

Mitch Zeller, Director of FDA’s Center for Tobacco Products, has one of the hardest jobs out there. His center is the newest one at FDA and it’s still staffing up. He has stakeholders that range from scientists to public health advocates, policymakers, and influencers, to various components of the regulated industry, including law firms and consulting firms. (I work for a firm that provides consulting services on tobacco harm reduction and smoking cessation to Reynolds American, Inc.)

Plus, among the products his center regulates, combustible cigarettes have very large negative health consequences and are inherently risky.

He has one advantage: only a single active ingredient to regulate, nicotine. But nicotine is a tricky drug. The increasing popularity of novel ways to consume nicotine (including products like hookah and electronic cigarettes) has captured substantial public attention — particularly around youth use, flavors, and marketing approaches.

At a recent tobacco-focused meeting of the Food and Drug Law Institute, in his remarks and in the following Q&A session, Mr. Zeller called upon all interested parties to challenge their thinking about nicotine. He echoed points he had made in an interview with the New York Times’ Joe Nocera from earlier this year.

The core challenge is with e-cigarettes and other nicotine products that do not burn. Those products make it possible to largely break the link between addiction and medical harm that has driven the public health calamity from cigarettes. But experts in this field — health organizations and the government itself — have not yet come to a resolution of these issues.

Vexing issues swirl around nicotine: the huge disconnect between the public’s fears about nicotine safety and its actual toxicity profile in the absence of smoke; the potential continued use of an addictive substance, youth initiation, and even children becoming accidentally exposed to nicotine. It will not be easy to find common ground and build from there. These challenges seem similar to some of the issues derived from society’s interactions around food, nutrition, and weight where science, public policy, and society’s norms and mores stand in the way of effective consensus.

Vapour, photograph © Mathanki Kodavasal / flickr

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October 31, 2015