In a significant move in 2009, the US Congress granted the Food and Drug Administration (FDA) the power to regulate tobacco products. In addition to controlling cigarettes, the FDA is now also responsible for categorising and regulating newer tobacco products, many of which are less harmful than cigarettes. This makes the FDA, potentially, a role model for other countries with outdated regulatory schemes.
Compared to cigarettes, most newer tobacco products – including smokeless tobacco (or snus), dissolvable tobacco, and e-cigarettes – are less harmful for the user. In a 2008 report, the World Health Organisation's (WHO) study group on tobacco product regulation (pdf) stated, "There is little question that, in general, smokeless tobacco products are less harmful than combusted tobacco products such as cigarettes." This is because nicotine, while highly addictive, is not particularly bad for you. This is similar to caffeine in sugary soda: it's the excess sugar, not the caffeine, that does the real damage by causing obesity.
As yet, it's unclear how widely available these new products will be, how they will be marketed or how their reduced risks will be communicated. Will companies be allowed, for instance, to make truthful claims about their products' risk profiles? Or will newer, lower-risk products be regulated as harshly as cigarettes, as some are advocating?
Before making these decisions, US regulators must first answer a more fundamental question: will these new tobacco products help smokers reduce their tobacco-related disease risks? This approach – known as "harm reduction" – is generally accepted in public health circles. It underpins, for instance, methadone clinics for heroin addiction and condom use to reduce sexually transmitted diseases.
Yet the "harm reduction" principle may not prevail in the case of tobacco. Many prohibitionists dream of a world without tobacco – smoking is so reviled among public health campaigners that they have a hard time acknowledging that some tobacco products are far less dangerous than others. But the FDA, to its credit, has engaged two separate panels, an internal one and an external one at the Institute of Medicine, to evaluate the science behind new tobacco products. The rosters are fairly one-sided and the questions are somewhat biased, but at least there is a process where science is at the forefront.
Other countries can learn from the United States, which has a transparent decision-making process, fixed timetables and puts the science first on public health issues. By contrast, the European Union does not have such a process in place. Updates to the EU's tobacco directive have fallen behind, and revision is sorely needed. According to the EU's obsolete regulatory scheme, all tobacco products are banned with the exception of those meant to be smoked or chewed. So while cigarettes and chewing tobacco are legal and widely available, products likes snus and dissolvables are either banned or in an undefined regulatory netherworld. A friend of mine in London who has been struggling to quit smoking is forced to buy his snus when he comes to New York on business. This is no way for governments to help people give up smoking.
When the EU finally gets around to updating their rules over the next two years, let's hope they follow the US FDA's lead. Then, instead of counter-productive bans, the EU could embrace the harm reduction approach. If tobacco policies – both in the US and the EU – are based on science, rather than ideology, we'll all be better off.