The results of President Obama's latest trip to the doctor revealed last week that he has been unable to completely kick his smoking habit. But if he relies on the advice of his doctors, as well as his own Food and Drug Administration (FDA), he's likely to remain frustrated and vulnerable to illness.
The FDA's current recommendations for helping smokers quit are woefully ineffective. Cigarettes are uniquely addictive, and Obama is hardly the only one finding that conventional quitting methods don't work well.
Reports indicate that the president's doctors told him to continue using nicotine gum to quit smoking. Nicotine gum and patches are nicotine replacement therapies (NRTs) that are relatively safe and FDA-approved. After all, it is the burning and inhaling of tobacco that makes smoking so deadly, not the nicotine. But for the president, the gum isn't doing the trick. And the longer he continues to smoke, the more he piles on the irreversible damage he has already done to himself.
The president is not alone. Even with NRT, fewer than 15% of people trying to quit manage to remain off cigarettes for so long as six months. If the president, with the help of the best medical care on Earth, can't quit using the tools currently available, imagine how hard it is for everyone else. Yet his own FDA is actively blocking two cessation methods that might help the president and addicted smokers everywhere.
The first is Swedish-style smokeless tobacco called snus, a small pouch of tobacco that goes between cheek and gum, delivering the nicotine that smokers crave without the harm that comes from burning and inhaling tobacco. Surprisingly, the risk of oral cancer from smokeless tobacco is low--far lower than the oral cancer risk from smoking cigarettes. And switching from cigarettes to snus eliminates the risk of heart disease, lung cancer and the other systemic diseases related to smoking--not to mention secondhand smoke.
Still, the legislation the president signed last June giving the FDA authority to regulate tobacco makes it nearly impossible for smokeless tobacco manufacturers to state the simple truth about their product: It is far less harmful than cigarettes.
Penalizing smokeless tobacco sends the implicit--and dangerous--message that it won't do people any good to switch, so they may as well keep lighting up. But the evidence from Sweden, at least, suggests that snus helps smokers quit. True, smokeless tobacco is not 100% safe (what is?), but it makes no sense for regulators and antitobacco activists to rob current smokers of this less-harmful option. The regulators' approach suggests that "quit or die" is the only acceptable choice to offer people.
Similarly, late last year the FDA warned about the safety of e-cigarettes, a product that supplies vaporized nicotine--something used by many smokers to quit smoking real cigarettes. The FDA, which found very tiny levels of carcinogens in some e-cigarettes, is attempting an outright ban, while some states and municipalities seek to ban "vaping" everywhere that regular smoking is already prohibited.
E-cigarettes not only supply "clean" nicotine, but also look like cigarettes--many even having an LED light at the tip. These products, which contain no tobacco, are noncombustible. While we'd certainly benefit from a review of their safety as well as their efficacy as cessation devices, you don't need to be a heart surgeon to know they aren't as dangerous as the real thing.
A panel to advise the FDA on tobacco issues has just been named, and unfortunately it will comprise people who will advise against the use of smokeless tobacco and e-cigarettes. One of the twelve chairs is occupied by a pharmaceutical industry consultant whose NRT products stand to lose a slice of the market if smokeless tobacco or e-cigarettes are approved. As Boston University School of Public Health professor Dr. Michael Siegel put it, giving a pharma advisor "a seat (along with a tobacco rep) at a supposedly 'scientific advisory' table undermines the entire point of the panel and turns the whole thing into a joke, rather than a serious scientific and policy undertaking for the benefit of the public's health."
As long as the FDA isn't willing to offer smokers more options, smokers will be left--like the president--to choose between the same old NRT products with miserably low success rates and the cigarettes that kill nearly half a million Americans each year. Perhaps the FDA should take some of those e-cigarettes they want to confiscate and share them with the president.