Dr. Brian King is a man some tobacco harm reduction (THR) advocates love to hate. They felt no sorrow when, on April 1, he was notified of his removal as the director of the United States Food and Drug Administration’s Center for Tobacco Products (CTP).
One of thousands of casualties of the Trump administration’s Department of Health and Human Services cuts, King had widely been seen by THR proponents as obstructing the authorization of products that help people quit smoking, and communicating negatively about vapes.
On May 1, the Campaign for Tobacco-Free Kids (CTFK) announced that King had joined the nonprofit as executive vice president for US programs. Shockwaves of indignation reverberated among tobacco harm reduction advocates.
The Michael Bloomberg-funded organization has long been instrumental in spreading disinformation about safer nicotine products, focusing heavily on their perceived threat to youth and ignoring their critical role for people who smoke. To many THR advocates, King’s move was confirmation that he had always been an enemy of tobacco harm reduction.
Conspiracy theories began to spread online minutes after the announcement, none of which I believe. Some think King planned to secure a position at CTFK, and that some of his actions at the CTP were taken to that end.
It’s undoubtedly true that King was unapologetic, even defiant, about prioritizing youth prevention during his CTP tenure. This emphasis aligns closely with CTFK’s, and worries THR advocates.
The different directions former CTP officials have taken provide intriguing clues to their prior thought processes about nicotine products.
At times, the FDA seems like a giant revolving door, where people switch roles between being a regulator, working for nonprofits or consulting firms, or accepting positions with the industry they were once responsible for regulating. Advocates are often leery of these changes, wondering if back-door deals were involved in the transition.
While laws prohibit these former employees from lobbying, some workarounds allow them to use their influence with FDA staffers still at the agency. Over the past few years, several key CTP staffers have voluntarily left for outside roles.
Kathy Crosby, for instance, worked for the CTP for 12 years and was the first director of its Office of Health Communication and Education. She is now the CEO and president of the Truth Initiative, a nonprofit that sees the eradication of commercial, non-medical nicotine as its long-term goal. Crosby worked with King at the FDA and issued a congratulatory statement about his new role “during a period of significant transition for public health infrastructure.”
The different directions former CTP officials have taken provide intriguing clues to their prior thought processes about nicotine products. Dr. Matthew Holman worked at the FDA for over 20 years, including his last position as director of the Office of Science for the CTP. He is now vice president and chief scientific and regulatory strategy officer for Philip Morris International (PMI) in the US.
Mitch Zeller is a former director of the CTP. His long career has included several years in other positions with the FDA and spells at the American Legacy Foundation (now the Truth Initiative) and the pro-THR consulting firm Pinney Associates, before serving as CTP director. Zeller is currently a policy and regulatory strategy advisor to Qnovia, a pharmaceutical company working on a prescription nicotine inhalation device for smoking cessation.
Meanwhile, former FDA Commissioner Dr. Scott Gottlieb is on the board of Pfizer, a senior fellow at the American Enterprise Institute and a partner at the venture capital firm New Enterprise Associates.
Little improvement occurred during King’s CTP tenure, and frustrated THR advocates directed their anger at him, at influential politicians and at groups such as CTFK.
When FDA conversations about the continuum of risk and a comprehensive plan for nicotine products began in 2017, THR advocates felt there might be hope for a more balanced regulatory pathway. One that would allow reduced-risk products that appeal to people who smoke to be authorized and widely available.
Eight years later, advocates are still waiting to see that balance, and the debate is still weighted to the side of youth prevention while conversations about adults who smoke are given short shrift. The US has reached a record low in youth smoking since vapes have been available, but few public officials are celebrating that victory.
Little improvement occurred during King’s CTP tenure, and frustrated THR advocates directed their anger at him, at influential politicians and at groups such as CTFK. I share those frustrations, even if my interactions with King were more positive than I expected.
But King’s time at the FDA will also be known for the first authorizations of vaping products in a non-tobacco flavor, belated though this was. And one of the last things King’s office did under the Biden administration was to grant marketing orders for several flavors and two strengths of nicotine pouches.
It was like a breath of fresh air, a glimmer of hope that the THR needle was finally moving in the right direction.
Some of King’s positions sit uneasily with the track record of his new employer. It will be interesting to see how those differences are reconciled.
Could the influential public health groups that have opposed THR move a little toward accepting that evolution? Kathy Crosby’s Truth Initiative statement about the pouches’ authorization contained much that THR advocates would object to, but perhaps, with its title “Need for Balancing Youth Protection and Adult Access,” it represented a slight softening.
Like Crosby, King was exposed to reams of data about THR while at the CTP. He has overseen the authorization of THR products for adult use, if not enough. And he is on the record as acknowledging the health benefits of switching from cigarettes to safer nicotine products.
Despite the role of his own agency in perpetuating misinformation, King coauthored a 2023 commentary, which held that “efforts to prevent initiation among young people need not preclude efforts among adult smokers to promote cessation and educate about the relative risks of tobacco products.”
Some of those positions sit uneasily with the track record of his new employer. It will be interesting to see how those differences are reconciled. At the very least, I don’t think hiring King will worsen the Campaign for Tobacco-Free Kids’ message. But I choose to be hopeful for something better.
Photograph (cropped) by Dan4th Nicholas via Wikimedia Commons/Creative Commons 2.0
The Influence Foundation, which operates Filter, has receieved unrestricted grants from PMI, as well as personal donations from Joe Gitchell, the CEO of Pinney Associates. Filter‘s Editorial Independence Policy applies.
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