The FDA is worried about misperceptions – but what’s it doing to combat them?

The US Food and Drug Administration (FDA) seems to be looking for the right words to educate smokers about the reduced risks associated with vaping.

At least, this is what the agency’s Center for Tobacco Products (CTP) director Brian King implied in a commentary on an article published in the scientific journal Addiction.

His statements drew conclusions from a survey on misperceptions of tobacco product harmfulness. The survey found that only around 20% of US adult cigarette smokers believed e-cigarettes contained fewer harmful chemicals than cigarettes and, among them, only half considered vaping less harmful than smoking.

“There are no safe tobacco products,” King wrote. “However, tobacco products exist on a continuum of risk, with smoked products, such as cigarettes, having the greatest risk.”

The second part of that statement, at least, is very much one that the advocates of reduced-risk products would agree with.

King referred to existing opportunities to “educate adult smokers about the relative risks of tobacco products, including e-cigarettes, using evidence-based approaches” and said both government and non-governmental stakeholders should participate in these efforts.

But the CTP’s director seems to assume that the FDA is already doing its part by funding research in public health communication and carrying out initiatives such as The Real Cost education campaign, which King cited as an example of communication aimed at preventing initiation to tobacco products among young people.

Yet there is a fundamental contradiction in the FDA’s communication policy on the risks associated with tobacco products.


The FDA is sending the public ‘mixed signals’


Among the reactions to King’s commentary, which was highlighted by the FDA on its social media, vaping advocates nailed the issue.

“It’s puzzling how the FDA expects the public to navigate these mixed signals,” said harm-reduction activist Dale Staten. “How will you simultaneously warn youth of exaggerated harms while telling adults that e-cigarettes are a much safer alternative?”

King has been highlighting the need to fight misinformation over the different risks related to smoking and less harmful tobacco products since he took up his job, but this hasn’t led to any significant change in the FDA’s tobacco policies, especially as far as communication is concerned.

“The agency does a piss-poor job at relating the relative risks that exist among the differing tobacco and vapour products,” said Lindsey Stroud, founder of Tobacco Harm Reduction 101 and director of the Taxpayers Protection Alliance. Stroud thinks King has merely been “acknowledging what we’ve been saying all along”.

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    The vaping industry also reacted with scepticism to the director’s words, calling him out for his inaction.

    The American Vapor Manufacturers (AVM) industry association expressed doubts that King was “sincere in lamenting that 80+ percent of Americans wrongly believe vaping is more dangerous than smoking”.

    And it added that King had expressed these same concerns over the misperception of risk on other occasions over the past year. “Yes, that’s a huge and life-threatening problem,” the AVM said, “but it’s hard to tell he’s done much of anything about it since then.”


    E-cigs as a cessation tool: is the evidence in plain sight?


    There may also been contradictions in King’s reference to a lack of evidence for vaping as a cessation tool.

    While acknowledging the continuum of risk, King also said that efforts to educate adult tobacco users on the health risks associated with different products should take into account the need to prevent youth use of tobacco products and to encourage the “first-line use” of cessation therapies that are FDA-approved.

    However, the CTP’s director added in his commentary, “no e-cigarette is currently approved by FDA for smoking cessation, which would require documentation of both safety and efficacy”.

    Yet plenty of relevant studies, including some the CTP’s director could not have missed, seem to be pointing in that direction.

    For example, King’s commentary was co-authored by Benjamin Toll, director of the Medical University of South Carolina (MUSC)’s tobacco treatment and lung cancer screening programmes.

    Only days after King and Toll released their commentary, researchers from MUSC’s Hollings Cancer Center announced they had published the results of a trial the university presented as “the largest US study of e-cigarettes”, which “shows their value as [a] smoking cessation aid”.

    The study, published in online scientific journal eClinical Medicine, showed how vaping can push people towards quitting smoking, including those who said they had no intention of quitting as they entered the trial.

    It remains to be seen whether the FDA will consider these findings as “evidence” for its policies on reduced-risk tobacco products and what messages it will draw from them in its next education campaign.

    – Tiziana Cauli ECigIntelligence staff

    Photo: David Travis

    Tiziana Cauli

    Senior reporter/health & science editor
    Tiziana is an Italian journalist from Sardinia. She has worked for both international and local media in Italy, South Africa, France, Spain, the UK, Lebanon and Belgium. She also worked as a communications manager for several international NGOs in the humanitarian sector. Tiziana holds a degree in Political Science and a PhD in African Studies from the University of Cagliari and she’s a graduate of the Carlo De Martino school of journalism in Milan.