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On Wednesday, the Biden administration announced a bizarre proposal to cap the amount of nicotine in cigarettes. This change could see as much as 95 percent of the total nicotine content removed, aiming to “save many lives and dramatically reduce the burden of severe illness and disability,” according to FDA Commissioner Robert Calliff.
Reducing the harms posed by cigarettes is a noble public health aim, but this particular measure is simply not based in fact.
Nicotine is the addictive component of cigarettes, but alone, it is relatively harmless. Cigarettes are harmful due to the products of combustion. Setting tobacco on fire produces carbon monoxide and tobacco tar, containing carcinogens that harm your body. According to the Royal Society for Public Health, nicotine is “no more harmful to health than caffeine.” This is generally accepted as fact.
So, what is the rationale behind Biden’s nicotine crackdown? FDA researchers reported in 2018 that by reducing the nicotine content of tobacco cigarettes by 95 percent, the percentage of adult smokers could be lowered to 1.4 percent by 2060. This research admits that “nicotine itself is not the direct cause of most smoking-related diseases,” but uses a simulation model to come to the conclusion that ordering cigarette manufacturers to reduce the level of nicotine in combustible cigarettes may reduce the number of people that smoke.
However, a randomized control study of the actual real-life efficacy of reducing the nicotine content in cigarettes found that it had no impact. The study, published in 2015, concluded that:
In smokers not interested in quitting, reducing the nicotine content in cigarettes over twelve months does not appear to result in extinction of nicotine dependence, assessed by persistently reduced nicotine intake or quitting smoking over the subsequent twelve months.
So, a simulation model came to the conclusion that reducing the level of nicotine in cigarettes had the “potential” to reduce cigarette consumption, and an actual randomized control study found that it had no impact on the amount of cigarettes consumed anyway. This is just one example of policymakers picking and choosing the “evidence” that supports their pre-decided policy aim. This phenomenon is consistently prevalent in public health policy making.
We all remember the government insistence that they were going to “follow the science” to save lives during the pandemic, despite the fact that our mortality rates were almost no different to Sweden’s, which experienced no lockdown at all. But politicians will often choose a policy pathway, especially in public health, that is politically popular. Biden ending his presidency like this makes him look good. It is a last-minute attempt at creating a “legacy,” perhaps inspired by Rishi Sunak’s equally as bizarre and illiberal generational tobacco ban.
Some research has actually suggested that reducing the nicotine content in cigarettes could result in more smoking. Research conducted by a team at the University of Pennsylvania, found that “smokers increase nicotine intake from lower yield cigarettes by compensatory behavior.” It may be the case that smokers will find ways to compensate for the lower nicotine levels in cigarettes, perhaps by smoking more cigarettes.
The entire policy also rests on the belief that mandating a lower nicotine level in cigarettes would mean that the previously enjoyed level is no longer available. The likely scenario is that it will stimulate a black market in the higher nicotine cigarettes, as has already occurred with menthol cigarettes.
Ultimately, if the aim really is to reduce smoking rates, Biden should look across the Atlantic. Sweden, the only European country to be “smoke-free” (obtain a smoking rate of less than 5 percent), has done so not by reducing accessibility to tobacco products, or indeed by reducing the nicotine content in cigarettes, but by allowing adults to choose safer and healthier forms of nicotine use. In Sweden’s case, this is snus. Because nicotine is addictive, but about as harmful as caffeine, encouraging safer ways to deliver nicotine to the body is the most effective way to get people to quit smoking.
If policymakers want more people to quit smoking, they should “follow the science,” and steer clear of draconian measures. Unfortunately, it looks as though it is too late for Biden.
