Tag: tobacco control

  • Durbin, No. 2 Senate Democrat and Anti-Tobacco Crusader, to Retire

    Durbin, No. 2 Senate Democrat and Anti-Tobacco Crusader, to Retire

    Senator Richard J. Durbin of Illinois, the No. 2 Senate Democrat for two decades and a leading liberal voice on Capitol Hill, announced today (April 23) that he would not seek re-election next year, closing out a 44-year congressional career focused on immigration, the federal justice system, and anti-smoking initiatives. According to the New York Times, the decision was widely expected and will immediately touch off a crowded competition for a rare Senate vacancy in his solidly blue state.

    Durbin entered Congress in 1983, and as a junior member of that chamber, led the drive to ban smoking on airplanes, helping to usher in the smoke-free movement with legislation signed by President Ronald Reagan in 1988.

    “That has to be the most significant thing I’ve done in terms of changing America,” Durbin said. “I was trying to get away from a health hazard, and I ended up reaching a tipping point on tobacco in America. I didn’t see that coming.”

    After winning a Senate seat in 1996, Durbin famously kept the tobacco and nicotine industry in his crosshairs. Motivated by the death of his father due to smoking, Durbin was a leading advocate for the Tobacco Control Act that gave the FDA authority over tobacco products and championed the federal lawsuit that resulted in a historic verdict that painted the major tobacco companies as racketeers who lied to the public for decades. In recent years, he turned his attention to e-cigarettes and flavored tobacco products.

    In 2022, the American Vapor Manufacturers Association (AVM) requested that the Senate Ethics Committee investigate Durbin for allegedly violating Senate rules by attempting to improperly influence the FDA’s scientific decisions about vaping products. The organization alleged Durbin pressured the FDA to ban all vaping products despite the agency’s premarket tobacco product application (PMTA) review process.

    At the time, Tobacco Reporter wrote, “Citing Durbin’s track record (urging the FDA to ban vapor products via letters, Senate floor speeches, press releases and private meetings) the AVM says it believes Durbin attempted ‘to interfere with and influence the outcome of an ongoing executive branch agency review process in violation of Senate Ethics rules.’”

    The AVM did not hold back with Durbin’s retirement news, saying today on X, “Durbin exits, leaving a trail of ash and arrogance. His intransigent, science-denying vendetta against vaping doomed countless smokers to misery. May his name be etched in infamy: the public health saboteur who’d rather outlaw hope than face facts.”

    Several Illinois Democrats have indicated an interest in running if the seat opened up and have been readying for a potential candidacy. It is likely to be one of several highly competitive primaries in both parties over the next 18 months, as Democrats embark on an uphill slog to reclaim the Senate majority and Republicans grasp to hold on to it.

  • China Tightens Smoking Restrictions

    China Tightens Smoking Restrictions

    Photo: Taco Tuinstra

    China is ramping up its efforts to control smoking. In 2023, 44 cities introduced or revised regulations, bringing the total number of cities with relevant regulations to 254 nationwide, according to national health authorities.

    According to the Xinhua News Agency, 24 regions at the provincial level in China have rolled out smoking regulations, and the proportion of the population protected by comprehensive smoke-free regulations is continuing to increase.

    Experts from the National Health Commission (NHC) released the data on Saturday ahead of World No Tobacco Day on May 31.

    Meanwhile, as China pledges to protect 80 percent of its population with smoke-free laws by 2030, experts on tobacco control on Sunday called for the country to introduce a national smoking control regulation as soon as possible.

    Smoking control, including preventing smoking and encouraging smokers to quit, is a viable approach for both population-wide disease prevention and individual healthcare, according to Wang Lu, a health expert from the NHC.

    Curbing smoking doesn’t aim to deprive people of their right to smoke, but to free people from being hurt by secondhand fumes, Zhang Jianshu, a senior expert at the Chinese Association of Tobacco Control, told the Global Times on Sunday.

  • Tobacco Control’s Nervous Breakdown

    Tobacco Control’s Nervous Breakdown

    Photo: Xalanx

    Innovation in the recreational nicotine market is revolutionizing the tobacco industry and disrupting tobacco control.

    By Clive Bates

    In his groundbreaking 1997 book, The Innovator’s Dilemma, Clayton Christensen defined the concept of “disruptive innovation.” The term is often used carelessly, but disruptive innovation has several characteristics that apply in today’s tobacco and nicotine market. In essence, it is a theory of how entrants to a market can challenge incumbents by focusing on unmet needs using novel business models exploiting simple enabling technologies.

    In the nicotine market, the lithium-ion battery provided a critical enabling technology with sufficient power and energy density to replace combustion with electrical heating to create an inhalable aerosol in a compact and convenient form. Once the concept took off in the early 2010s, the technology rapidly evolved through at least four major generations during the decade. The disruption has never stopped, and the emerging incumbents in the vape industry now face disruption from disposable single-use vape products. It isn’t just technology; the business model has changed and adapted over time, embracing user-driven innovation, new retailing models such as specialized vape shops and international e-commerce, and a pro-health marketing proposition spread through social media.  

    A new wave of innovation is now breaking with the rapid rise of oral nicotine pouches. This newer trend may prove even more disruptive—a low-tech, low-cost nicotine delivery with negligible health consequences, no intrusion on others and none of the stigma attached to tobacco. Through vaping, consumers have deconflated tobacco and nicotine use and are now primed to adopt this technology.

    The regulatory environment also played a critical role, but more for what it didn’t do than what it did. In the United States in 2009, the U.K. in 2010 and the European Union in 2013, there were failed attempts to classify and regulate vaping products as medicines. Several core pharmaceutical regulation concepts are hostile to vaping. Vaping products are not smoking cessation therapies but pleasurable consumer alternatives to smoking that require nicotine delivery equivalent to cigarettes. Medicine regulators are not at ease with pleasure, or what they would call “abuse liability,” yet pleasure is integral to their success as consumer products.

    Let’s delve deeper and ask who is disrupted and how.

    First, the incumbent tobacco companies. In the standard model of disruptive innovation, these giants would be caught off guard by fast-moving entrants bringing new technology to a vanguard of early adopting consumers, rapidly changing the market dynamics. This would be felt most keenly as a loss of “pricing power” (the ability to raise prices to compensate for declining cigarette volumes) and a squeeze on margins and revenue in the profitable incumbent cigarette business. This should happen as the existing customer base of people who smoke is exposed to a wide range of low-cost alternatives without many downsides. So far, I don’t think this squeeze on the cigarette business has happened to anything to the extent it might have and still could, even though the companies have entered these markets and developed heated-tobacco products. The reason is that regulators are slamming on the brakes in response to activist and political pressure—disrupting the disruption. Regulatory excess has combined with activists and academics working tirelessly to nurture false risk perceptions and reinforce doubt about the wisdom of stopping smoking by switching to a reduced-risk product. The tobacco industry has been protected from the most severe disruption with the unintentional help of the tobacco control mainstream.

    Second, disruption has wrong-footed regulators and legislators. In response to rapid changes in the market, regulators and legislators have blundered in without first understanding (or perhaps without caring about) the complex adaptive system in which their rules would be applied. Because the new products function as economic substitutes for cigarettes, we expect three primary responses to excessive regulation: more smoking than there otherwise would be, more illicit trade in the new products, and consumers adopting risky workarounds, such as mixing their own flavored e-liquids. For example, limiting nicotine strength in the European Union made it harder to bring to market the pod devices that have been successful in reducing smoking in the United States. Flavor bans in the United States made vapes less appealing and caused more people to smoke, in some cases including young people. The prescription-only availability of vapes in Australia has led to a chaotic, lawless mess, with more than 90 percent supplied via informal, illegal channels. With their mission to protect the young from vaping, regulators forgot that in a world without vaping, many young people would smoke and, therefore, are benefiting from vaping.

    Third, the rise of the confident consumer. Consumers are the primary beneficiaries of the radical reduction in health and welfare detriments of smoke-free products. We are used to smokers burdened with regret, challenged with stigma and punished by anti-smoking policies. But all of that is driven by the health implications of smoking and the policy response that started in the early 1960s. How does the recreational nicotine consumer change if they are no longer troubled by the health and welfare implications of nicotine use and related policies? Simple economic theory suggests that if the costs and nonmonetary detriments of nicotine use fall, then demand will rise. It is likely, in my view, that there will be new users of nicotine who would never have become smokers in the absence of much safer products. For some, that is profoundly disturbing. For me, it is almost an inevitable consequence of having far lower risks and there being a latent demand for the real or perceived hedonistic, functional and therapeutic benefits of nicotine. Public morality may be shocked, but more people (of any age) using much safer products should not cause a public health crisis—we would be moving to substance use more like drinking coffee.

    Fourth, the existential threat to the tobacco control complex. The public discussion of the emerging landscape of low-risk consumer products seldom focuses on the interest group that is most vulnerable to disruption: the mainstream of tobacco control. It is a complex of interests comprising nonprofit activists, academics, medical and health societies, major institutions (such as the World Health Organization or the U.S. Food and Drug Administration), philanthropists and research-funding bodies. The problem for the mainstream of tobacco control is that without serious harm, the whole movement loses its purpose and its reason to exist. When it comes to low-risk alternatives to smoking, this complex is profoundly confronted by the threat of having nothing to control, no case for intervention and no reason to be. It is a powerful incumbent interest group challenged by new technology, new suppliers and new consumer confidence.

    As a result, the mainstream of this interest group has rejected tobacco harm reduction as a strategy for addressing its own notional goals of reducing death and disease from tobacco use. Instead, it has mounted a rear-guard defense based on a range of strategies, including the following:

    • Falsely implying that noncombustible products are no less risky than cigarettes, that data is too uncertain or short-term, or asserting that reduced risk is no more than a marketing claim of tobacco companies.
    • Asserting that harm reduction is merely a commercial strategy of tobacco companies. The aim here is to attach the reputational baggage of “Big Tobacco” to these new developments. Yet, many independent experts support tobacco harm reduction, and it is good if tobacco companies adopt a business model aligned with reducing health impacts.
    • Excluding or stigmatizing contrarian opinions and creating sealed bubbles open to groupthink. The WHO Framework Convention on Tobacco Control has taken this to new extremes.
    • Shifting emphasis to problematize nicotine rather than the “tar” of cigarette smoke that is the cause of nearly all tobacco-related disease. We are hearing more about “addiction” and less about cancer. Yet, a dependence only meets the definition of addiction if there is serious net harm to the user.
    • A relentless focus on the supposed interests of children without recognizing that would-be smokers among adolescents also benefit from low-risk products and that the demand for nicotine has persisted across generations for hundreds of years. Young people have an interest in the health of the significant adults in their lives as carers, breadwinners and role models.
    • Pressing for prohibitions or equivalent regulation to cigarettes, often with manipulation of language to imply equivalent risk, for example, by stating that heated-tobacco products produce “smoke” or that all tobacco products should be treated the same even though they have very different risks.
    • A blunt refusal to face trade-offs (for example, between the interests of youth and adults) or unintended consequences (for example, increases in smoking) arising from favored policy positions.

    I have watched on in horror as the leadership in tobacco control, albeit with many honorable exceptions, has dogmatically denied and suppressed the opportunity to radically reshape the recreational nicotine market to cause vastly reduced harm and avoid hundreds of millions of premature deaths. It looks like a nervous breakdown is developing in tobacco control in response to profound disruptive innovation. I doubt they will survive it.

  • Ghana’s Tobacco Control Strategy

    Ghana’s Tobacco Control Strategy

    Image: Asada

    Ghana’s government has developed a five-year National Tobacco Control Strategy (NTCS) with a goal of decreasing the consumption rate of tobacco in the country, reports The Ghanaian Times. The end goal of the NTCS is to eradicate all tobacco usage.

    The Ministry of Health, the Food and Drugs Authority (FDA), the World Health Organization and the United Nations Development Program put the strategy plan together along with advocate policymakers on tobacco control.

    According to Baffour Awuah, acting director of the Technical Coordination Directorate of the Ministry of Health, cardiovascular disease rates due to increased smoking are rising.

    “The strategy we are launching today is the climax of extensive collaboration, research and commitment by various stakeholders, experts and civil society,” Awuah said. “Its purpose is to guide us in combatting the devastating effects of tobacco use, both in terms of health and the economy.

    “It aims to ensure effective coordination among agencies involved in tobacco control, setting clear goals and adopting strategic timelines.”

    Awuah encouraged stakeholders to actively engage in discussions to help transform the document into tangible action.

    Olivia Boateng, director in charge of tobacco and substance abuse at the FDA, stated that illicit trade in tobacco products has made them more accessible at lower prices. The country has made progress in tobacco control policies, but the illicit trade has “amplified the tobacco epidemic,” according to Boateng.

    Stakeholders will be trained on the protocol to eliminate illicit trade in tobacco products in the country once the NTCS is implemented, according to Boateng.