Early this year, I testified at FDA in support of approval for a new smoking cessation tool called iQOS. While it may have seemed odd for the president of the American Council on Science and Health, which has campaigned against smoking for 40 years, to endorse a product made by a tobacco company, the reason was simple data.

I'm not in a war on corporations or a plant, I'm in a war on smoking. Nicotine, like caffeine, is addictive, but it is not harmful the way smoking is. And in Japan, the iQOS product caused a 70 percent migration rate off cigarettes, far better than the 10 percent for pharmaceutical products endorsed by Stan Glantz at U.C. San Francisco and others. That is a win for Japan and we want that trend in the United States as well.

And we have seen the curve happening here. (1) A recent analysis of five different population-level surveys(2) from 2013 to 2017 showed that young people who would have become smokers did not, and people who were smokers quit, or at least cut back substantially. Results from 12th graders taking the Monitoring the Future survey found that a decline of last 30 day smoking prevalence of 4.6 percent with an additional 9.5 percent annual reduction from 2014-2017 vaping period, making a decline of 14.1 percent during the vaping period. This reduction was similar among regular smokers, those who smoked daily.

There are still reasons to be concerned about youths, but without smoking a billion lives will be saved. The nicotine salt product Juul, which is different from e-cigarettes, also did not yet see its boom in popularity, including among young people, and it is unclear what, if any, public health implications that product may have.


(1) Though we need to get out of our own way. While the U.S. Centers for Disease Control has sought to manufacture hype about e-cigarettes (along with prediabetes, Ebola, and too many things to count - if it will get them more money from Congress, they will scare the public about it), the U.S. Food and Drug Administration has taken a more balanced approach, chasing out the bad actors trying to create pediatric customers while conceding that they must not make the perfect the enemy of the good.

(2) The Monitoring the Future (MTF) Survey, the National Youth Tobacco Survey, the Youth Risk Behavior Survey, the National Survey of Drug Use and Health, and the National Health Interview Survey.