Truth Initiative, a leading anti-smoking nonprofit, has released a report laying out its “strategy to move toward the end of commercial tobacco and nicotine use.”
You read that right.
Truth Initiative, according to its July 12 report, ultimately wants governments to ban not just combustible cigarettes but all commercial nicotine products.
Gone would be nicotine vapes, which have helped millions of people in the United States quit smoking.
Gone would be snus, oral tobacco pouches that have helped to drive the smoking rate in Sweden to the lowest in Europe.
Gone would be devices known, inelegantly, as “heat not burn” products. These heat tobacco to produce vapor, and have reduced cigarette sales at an unprecedented rate in Japan.
Not just kids, but adults would eventually be prohibited from using nicotine.
Critics fear Truth’s focus on nicotine prevention could keep deadly cigarettes around longer by exaggerating the dangers of lower-risk substitutes.
“A tobacco-free future is possible,” declared Robin Koval, the president and CEO of Truth Initiative, during an online panel discussion about the plan.
But is it desirable?
Experts who favor tobacco harm reduction—the idea that people who are unable or unwilling to quit nicotine should be encouraged to switch from cigarettes to far safer products—say it is neither.
“The end game should be reducing premature deaths from tobacco, not the eradication of nicotine, which is not going to happen and is misguided policy,” K. Michael Cummings, a veteran tobacco-control expert and professor at the Medical University of South Carolina, told Filter.
“Changing the objective from reducing smoking-related deaths and disease to destroying the tobacco industry and eliminating nicotine use is completely misguided,” said Alex Wodak, a physician and the director of the Australian Tobacco Harm Reduction Association.
Critics fear that Truth Initiative’s new focus on nicotine prevention could keep deadly cigarettes around longer by exaggerating the dangers of lower-risk substitutes. Combustible cigarettes are estimated to cause 480,000 deaths annually in the United States. If people who can’t otherwise quit are discouraged from seeking safer ways to obtain nicotine, more deaths and disease will result.
Truth Initiative’s 18-page report, “Gamechanger: Shifting from tobacco control to ending the industry’s influence for good,” is, in fact, a game-changer. It outlines an ambitious set of policies intended to decrease “the access, appeal and addictiveness” of nicotine products and to “denormalize all tobacco use, ultimately relegating it to a behavior of the past.” The only exception to the ban would be medications approved by the US FDA.
In the near term, Truth wants to see a national ban on menthol cigarettes and cigars; a ban on the flavored vaping products that people who switch find most helpful; sales of nicotine products restricted to adults-only stores; a dramatic reduction in the number of outlets selling tobacco; reduced nicotine levels in cigarettes; and improved access to pharmaceutical smoking-cessation drugs.
In the medium and longer term, Truth wants to develop new quitting options; cap nicotine levels in all nicotine products; and, eventually, prohibit the sales of tobacco and nicotine products, as two California cities, Beverly Hills and Manhattan Beach, have done.
“Today it’s disposable e-cigarettes. Tomorrow, it’ll be oral nicotine pouches. We don’t need these products. We don’t want to use these products.”
To move towards a nicotine-free world, Truth endorses laws that are designed to create either a “Tobacco-Free Generation” or a “Nicotine-Free Generation.” Under these laws, no one born after a specified date can legally be sold tobacco or nicotine.
New Zealand has enacted legislation that prevents those born after 2008 from ever being able to buy cigarettes, while the city of Brookline, Massachusetts, passed a local ordinance saying that no one born after January 1, 2000, can ever buy cigarettes or vaping products.
State and local tobacco control programs are the incubators that lead to federal action in the US, said Stacy Gogosian of Truth Initiative during the panel discussion. She made clear that Truth is targeting next-generation nicotine products as well as cigarettes.
“The industry’s going to fight all of these policies tooth and nail and they’re just going to keep introducing the next thing,” Gogosian said. “Today it’s disposable e-cigarettes. Tomorrow, it’ll be oral nicotine pouches. The next day, it’ll be something we don’t even know yet.”
“We don’t need these products,” she said. “We don’t want to use these products.”
Who Gogosian is referring to when she says “we” is unclear, but it’s surely not the estimated 17 million or so Americans who use nicotine vapes, most of whom previously smoked.
Truth Initiative and its allies say that curbs on the sales of tobacco and nicotine are politically popular, citing a CDC-sponsored survey that found that 57 percent of adults support prohibiting the sales of all “tobacco products.”
“We have to convince decision makers that this is not just the right thing for them to do, it’s the popular thing to do,” said Chris Bostic, policy director of anti-smoking group Action on Smoking and Health. “Nobody wants their kids to smoke.”
“Can anyone name any psychoactive substance enjoyed by many which has been more-or-less eradicated from planet earth in the last few thousand years?”
In the report, Truth Initiative takes pains to differentiate its approach from prohibition.
“Endgame policies are not prohibition policies, as they do not call for immediate or near-term prohibition of all commercial tobacco product sales,” the report says.
It’s wrong to describe Truth’s approach as prohibition, Koval said during the panel discussion. “It’s another scare tactic of the industry,” she alleged, adding: “Not all these policies will go into effect on the same date at the same time.”
The argument from Truth appears to be that phasing in anti-smoking and anti-nicotine laws, along with improved smoking-cessation programs, will over time reduce or even eliminate demand.
“Done properly, a comprehensive collection of endgame policies will instead make tobacco something that people simply do not want,” the report says.
This is magical thinking, critics say.
About 1.3 billion people in the world use tobacco, according to the World Health Organization. Global prohibition of other drugs has failed to end their availability while creating many harms.
“Can anyone name any psychoactive substance enjoyed by many which has been more-or-less eradicated from planet earth in the last few thousand years?” Wodak asked.
“No group has pushed harder or yelled louder for FDA and DOJ to outlaw vaping and kick in the doors of anyone perceived as disobedient.”
Truth, which did not respond to Filter’s request for comment by publication time, also says that its endgame policies are not aimed at consumers, but at manufacturers and retailers.
That claim, too, is disputed.
Alli Boughner, vice president of American Vapor Manufacturers, an industry group, says it’s absurd for Truth Initiative to claim that its proposals don’t target or criminalize users.
“No group has pushed harder or yelled louder for FDA and DOJ to outlaw vaping and kick in the doors of anyone perceived as disobedient,” Boughner told Filter, describing the endgame plan as “totally dislocated from the real world or even basic human decency.”
Harm reduction advocates especially object to the way that Truth fails to distinguish between the harms caused by smoking and those attributed to nicotine. The Truth report says nicotine can damage adolescent brain development and “increase risk of cardiovascular, respiratory, and gastrointestinal disorders.” Some of these claims are disputed. But nowhere does Truth reckon with the fact that people derive benefits from nicotine.
Some people report that nicotine lifts their mood, eases stress and helps them to focus. Decoupling nicotine from cigarettes should change the way we think about nicotine, says Clive Bates, a British harm reduction advocate.
“Nicotine should join the list of socially acceptable psychoactive substances like caffeine, like the moderate consumption of alcohol and, increasingly, like cannabinoids,” he said. We don’t lose our minds when young people have a drink or take coffee.”
Founded in 2000 and formerly known as the American Legacy Foundation, Truth Initiative remains the largest anti-tobacco nonprofit in the US. It reported net assets of $726 million and spending of $118 million in its 2021 fiscal year, according to its most recent federal tax return. As president and CEO, Koval was paid about $932,000 in salary and benefits.
Photograph by Tony Webster via Wikimedia Commons/Creative Commons 2.0
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