Will Califf and the Biden administration really heed the science on e-cigarettes?

In autumn 2020, with a presidential election looming, this blog asked: “If Biden wins, will a new administration be bad news for the US vapour industry?” To which the short answer was: probably.

Not long afterwards, we wrote: “Everyone from Big Tobacco to the small vape store will have a keen eye on who president-elect Joe Biden picks to be the next chief of the FDA.” It’s taken until now, almost a full year on, for that choice to settle on Robert Califf, who at 70 might have expected to be enjoying a pleasant retirement rather than taking up again a post he held for the last year of the Barack Obama presidency. In the words of at least one news report, however, Califf (pictured) has “plenty of unfinished business” at the US Food and Drug Administration.

That unfinished business would appear to include instituting a “vigorous” – one might say “aggressive” – regulatory regime for e-cigarettes.

In a blog post for the Association of American Medical Colleges two years ago, Califf wrote: “Flavors in vaping products should be banned immediately and the campaign about the dangers of unregulated vaping should be dramatically increased.”

Describing e-cigarettes as products “with no health benefit”, he called for “surveillance” to identify people selling vaping products to minors and vigorous punishment for those who were caught. He said nicotine limits should be set at “subaddictive levels”, along with support for “prescription vaping” and a ban on over-the-counter sales of e-cig products.

Granted that all this was written at the height of the lung-injury (EVALI) scare, one might still think this is not a man the vaping industry will welcome back to the head of the agency in charge of US e-cig regulation.


Biden’s ‘New Deal’


At the same time Biden’s much-trumpeted Build Back Better budget bill – what might be seen as his bid to do for the post-Covid, post-Trump US what Franklin D Roosevelt’s New Deal did post-Depression – comes with a tax proposal attached that would make vaping as costly as smoking.

North Carolina’s attorney general Josh Stein is undoubtedly grandstanding when he proclaims his various legal assaults on e-cigarette manufacturers “to protect kids” as “playing whack-a-mole with these companies” but he also seems to be tuned in to a prevailing mood among many in positions of authority across the US, particularly in the Democratic party.

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    This mood sits uncomfortably, though, alongside a couple of recent scientific studies, one analysing data from ten years of studies of US high school students, the other reporting the views and experiences of more than 500,000 British teenagers.

    The US analysis, published last month by the National Library of Medicine, drives a horse and cart through the idea that vaping leads young people on to smoking – the so-called “gateway effect”.

    It concludes: “ The decline in current smoking among 12th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking. Among nonsmoking youth, vaping is largely concentrated among those who would have likely smoked prior to the introduction of e-cigarettes.”

    In other words, vaping draws young people away from smoking, not towards it.


    The importance of ‘harmless’ flavours


    The other study, published this week by the University of East Anglia, set out to review the use of vaping flavours by young people and the associated uptake or cessation of both vaping and smoking. And lead researcher Caitlin Notley’s conclusion?

    “We found that flavoured e-liquids are an important aspect of vaping that young people enjoy,” professor Notley said. “This suggests that flavoured products may encourage young people to switch away from harmful tobacco smoking towards less harmful vaping.

    “Flavours may be an important motivator for e-cigarette uptake, but we found no evidence that using flavoured e-liquids attracted young people to go on to take up tobacco smoking. And we also found no adverse effects or harm caused by using liquid vape flavours.”

    Do Robert Califf, US legislators and state attorneys general read and pay attention to the scientific publications of the University of East Anglia? Probably not. But maybe they should.

    Aidan Semmens ECigIntelligence staff

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    Aidan Semmens