President Joe Biden was set to announce in his February 7 State of the Union (SOTU) address how he’d lead the charge to reduce the number of cancer deaths in the United States once and for all: by eliminating combustible cigarette use.
News reports and a press call from the White House suggested that he’d make this statement as part of the administration’s Cancer Moonshot initiative, but it was left, it appears, on the cutting room floor. Biden himself did not bring it up.
Pledging to reduce smoking and supporting the best-evidenced ways to do so are two different things.
“We’re committed to continuing to use authorities and programs to keep making progress and especially with a focus on helping individuals avoid smoking in the first place and supporting Americans who want to quit,” Danielle Carnival, the White House’s Cancer Moonshot coordinator, said on a February 7 press call before the SOTU. “So, getting support services out for as many people, reaching as many people as possible so that we can prevent the cancer impact and we know the broader health impact that smoking has.”
But pledging to reduce smoking and supporting the best-evidenced ways to do so are two different things.
Prior to the speech, observers were already beginning to note that it would be a missed opportunity to support tobacco harm reduction (THR)—or, at the very least, clear up some rampant misconceptions among the public. To the extent the issue even has Biden’s attention, he, like the Food and Drug Administration (FDA), appears almost exclusively centered on nicotine cessation and preventing smoking initiation, which has reached record lows in the past few years.
Yet close to half a million Americans continue to die of smoking-related causes each year, a toll higher than that of the overdose crisis—which did make the speech, albeit through troubling plans. The economy, health care generally and sparring with Republicans were the dominant themes of the 73-minute address.
Like some predecessors, the Biden administration has been trying to push forward a long-awaited federal ban on menthol cigarettes—a move that has been applauded by mainstream tobacco control as a way to reduce cancer rates and youth experimentation, and criticized for its racial-justice implications by drug policy and civil rights groups like the American Civil Liberties Union (ACLU).
Despite Biden’s omission, tobacco control policy has started to become even more of a partisan issue—in ways that are uncomfortable to many.
But neither the speech nor the preceding White House messaging remotely hinted to the fact that the FDA has authorized some vaping products through its premarket tobacco product application (PMTA) process, a belabored and much-criticized pathway in which vapor manufacturers have to show that their products are “appropriate for the protection of public health” (APPH)—that is, more likely to help adults transition to a safer alternative than introduce a new generation to nicotine. Biden would not have had to look far, either, for this sort of recent news: For example, the FDA authorized three more heated tobacco products (HTPs) less than two weeks ago.
Despite Biden’s omission, tobacco control policy has started to become even more of a partisan issue—in ways that are uncomfortable, to many, even beyond the basic problem of science and public health interests being overruled. Much of the Democratic establishment continues to obsess over youth vaping rates, while some on the right champion adult use as an issue of individual liberty.
For one thing, Michael Bloomberg, an influential and wealthy Democrat, keeps doubling down on his ill-conceived mission to destroy safer nicotine alternatives: On February 2, Bloomberg Philanthropies announced an additional $420 million “to reduce tobacco use globally,” bringing the organization’s financial commitment—by its own admission—to $1.58 billion since 2005. Around the world, particularly in low- and middle-income countries where 80 percent of the planet’s tobacco users live, THR advocates have accused Michael Bloomberg and the groups he funds, like the Campaign for Tobacco-Free Kids (CTFK), as promoting nothing more than a “quit or die” mentality.
Meanwhile, as Business Insider pointed out, right-wing media pundits like Tucker Carlson—who reportedly chews nicotine gum so much that he stops “only to be filmed or to eat”—have recently argued that encroaching tobacco control policies are, essentially, infringing on individuals’ liberties: At the end of January, he spoke out against the always-forthcoming federal menthol ban, and just a few weeks earlier, had invited Troy Nehls, a congressman from Texas, to discuss lifting an indoor smoking ban in the Capitol.
Neither view, however, touches on the complicated realities of safer nicotine use. With smoking rates highest among marginalized populations, health equity is as unlikely as science to be mentioned.
Image of 2023 State of the Union via the White House