Smoke-free alternatives have lower risks than cigarettes – US FDA official

Dr. Lorenzo Mata, a tobacco harm reduction advocate and president of Quit for Good.

MANILA, Philippines – Smoke-free products have lower health risks than cigarettes, according to an official of the U.S. Food and Drug Administration Center for Tobacco Products (FDA-CTP).

Consumer advocacy groups in the Philippines said the statement by no less than FDA-CTP Director Brian King in a commentary published in a peer-reviewed medical journal confirms long-held beliefs that smoke-free products such as vapes, heated tobacco, and nicotine pouches carry far less harm than traditional cigarettes.

“We all know that nicotine is not the problem, but the way it is delivered through combustion and smoke.  With smoke-free products, smokers could significantly reduce their exposure to toxic chemicals,” Anton Israel, president of the Nicotine Consumers Union of the Philippines (NCUP), said in a statement.

Israel said these smoke-free alternatives do not generate smoke containing thousands of harmful and potentially harmful chemicals that cause smoking-related diseases.

The FDA-CTP commentary, “Nicotine e-cigarettes: Considerations for healthcare providers,” said that “non-combustible tobacco products, such as e-cigarettes, generally have lower health risks to the user than combusted tobacco products.” 

It noted that the U.S. National Academies of Sciences, Engineering, and Medicine (NASEM) found conclusive evidence that switching completely from cigarettes to e-cigarettes reduces a person’s exposure to many toxins and carcinogens present in combusted tobacco cigarettes.

Co-authored by Dr. King, the commentary was published by Nature Medicine, a peer-reviewed medical journal.

It discusses the considerations healthcare providers should take when talking to adults about the relative risks of different tobacco products. 

The other co-authors are Dr. Benjamin A. Toll of the Medical University of South Carolina’s Department of Public Health Sciences and Dr. Tracy T. Smith of the university’s Department of Psychiatry and Behavioral Sciences.

The commentary also noted that “misperceptions among physicians and other healthcare professionals may lead to patient counseling that is not consistent with existing scientific evidence.” It said these misperceptions are associated with lower odds of smokers completely transitioning to e-cigarettes.

For adult smokers who have unsuccessfully tried proven cessation methods, medical providers may consider educating patients about the relative risks of tobacco products and the potential health benefits of switching completely to a lower-risk product, the commentary said.

Joey Dulay, president of the Philippine E-Cigarette Industry Association (PECIA), said tobacco harm reduction (THR) products could help millions of Filipino adult smokers abandon cigarettes.

“Nearly a million former smokers in the Philippines have already switched away from smoking, and with the recent FDA-CTC commentary, we expect more smokers to understand the huge difference and transition to less harmful alternatives,” Dulay said.

“The Philippine Congress also acknowledges the role of these smoke-free products in providing Filipino smokers with alternatives when they enacted the Vape Law in 2022 to regulate vapes and novel tobacco products,” he said.

These smoke-free products emit aerosols or vapors that contain 95 percent less harmful chemicals than tobacco smoke produced by combustion. Aerosols are formed through heating at a much lower temperature than the burning process, resulting in a much smaller number of constituents compared to smoke.

Dr. Lorenzo Mata Jr., a Filipino THR advocate and occupational medicine physician, asked fellow medical professionals to consider the weight of the latest FDA-CTC commentary.

“We should look at scientific facts about THR and study how it can help millions of Filipinos quit smoking through less harmful nicotine alternatives,” said Mata, president of Quit for Good, a non-profit organization promoting harm reduction.

The commentary noted that youth should not use any form of tobacco products. Among adults who smoke, it noted the importance of using evidence-based cessation methods, including FDA-approved pharmacotherapies, as a first-line treatment.