Tobacco Harm Reduction Reflections, as My Years of Reporting End

February 14, 2023

Many people who vape, or are otherwise involved in tobacco harm reduction, will remember the summer of 2019. That was when Juul faced endless criticism from Congress—by October, the company had voluntarily stopped selling most of its flavored e-cigarettes even online—and the media became transfixed on a string of vaping-related illnesses throughout the United States. The Centers for Disease Control and Prevention (CDC) named this phenomenon “e-cigarette, or vaping product, use-associated lung injury,” or “EVALI.” In a matter of weeks, it seemed, two separate narratives had been conflated: Vaping—with which Juul, at that point, was basically synonymous—was rampant among teenagers, and now it was killing them.

Except that wasn’t true. By November, the CDC had identified what it called “a very strong culprit” for EVALI’s cause: vitamin E acetate, an adulterant and cutting agent that had been discovered in illicit THC cartridges. The damage, though, was done: Recent studies have shown that misinformation around the misnamed condition has increased cigarette sales, and the public remains generally unaware about the relative risks of safer nicotine products like vapes.

I wish I could say that I recognized, instantly, the extent to which a new moral panic was developing, but that wouldn’t be true.

This happened when I was still a staff writer at VICE, and right as we had been given a directive by management to establish “nicher” beats: Cover subjects and stories that the more mainstream press wasn’t covering. I wish I could say that I recognized, instantly, the extent to which a new moral panic was developing, but that wouldn’t be true. It took me some time—learning about a pretty unfamiliar field, and talking to consumers and other experts and sources—to realize that we were seeing the early stages of another drug war.

That impression has only strengthened since, as—initially at VICE and then for two years on Filter’s staff—I’ve reported and written close to 200 articles on tobacco harm reduction (THR). In that period, we’ve seen ever-increasing controversy and polarization around THR, and growing coverage—rarely fair—from mainstream media.

Today, I’m departing from Filter—and from journalism, though I will remain involved in THR. So I have to say goodbye, in some respects, and many thanks to the readers who have trusted me and stuck along all these years. I hope my love for the topic has always been clear. Before I started covering THR, I had little sense of an insular, passionate world. Since then, I’ve met many inspiring and brilliant individuals who devote their careers and lives to fighting for people’s right to accurate health information and access to safer options. I’m glad I was able to give a platform to voices and issues that weren’t being heard.

It leaves me with a sense of just how fast the news has moved. But it can get, unfortunately, repetitive.

It’s been instructive, at the end of my time with Filter, to have the chance to zoom out. Reflecting on the events I’ve reported for the better part of four years leaves me with a sense of just how fast the news moves.

But it can get, unfortunately, repetitive. In one of the first articles I wrote for Filter, I interviewed nearly a dozen people in New York, New Jersey and Massachusetts who had started operating in illicit markets after their states prohibited the sale of flavored vaping products. As I write today, residents of California are faced with similar choices a few months after the state voted to ban the sale of basically all flavored nicotine products.

Similar examples are not hard to find. In the fall of 2020, before I joined Filters staff, I reported how millions of Michael Bloomberg’s dollars had been funneled through so-called public health organizations and helped lead to outright vape prohibition in India. I’m leaving just weeks after Bloomberg Philanthropies announced that it would be pledging another $420 million “to reduce tobacco use globally.” And the World Health Organization (WHO), where Bloomberg has been a global ambassador, has not budged on demonizing vapor products—time and time again.

The stakes of the worldwide THR battle have not budged, either. Close to half a million people still die of smoking-related causes in the US every year. Globally, the total is more than 8 million. Such staggering tolls, the needless individual tragedies behind these numbers, are hard to process. Small wonder that THR advocacy, faced with indifference or worse, implacable opposition to measures and products that we know save lives, frequently spills into anger.

There has been some cause for optimism. But none of that has been without the obvious, gigantic caveats.

There has been some cause for optimism: Smoking in the US has hit record lows, while youth vaping rates—a source of worry, above all, for their role as a pretext for bad policies—are now nowhere near their peak. Some estimates suggest that 82 million adults now vape worldwide. Colorado activists managed to avoid a statewide flavor ban. And the FDA has authorized a handful of e-cigarettes through its premarket tobacco product application (PMTA) process—a completely unprecedented development.

But none of that has been without the obvious, gigantic caveats: The agency has, basically, wiped away the entire independent vapor market, and the PMTAs it has authorized have exclusively favored the companies with the finances and resources to meet the “appropriate for the protection of public health” (APPH) threshold—that is, a product’s likelihood in helping adults transition from cigarettes to the safer alternative instead of introducing a new generation to nicotine. Vape shops have since shuttered, and enforcement has come, albeit inconsistently, with the force of the Department of Justice. Juul, and others, are still in limbo, or have filed lawsuits fighting their marketing denial orders (MDOs).

It might be even more complicated on the international front. Despite the Japanese government’s hostility toward e-cigarettes, its lukewarm acceptance of heat-not-burn products (HTPs) has brought about a 43 percent decline in cigarette sales in half a decade. Meanwhile, in Sweden, snus—a moist oral tobacco product that’s placed inside the upper lip—has largely been responsible for the country nearing “smoke free” status.

I’m indebted, of course, to my sources for the coverage I’ve been able to produce. Thanks to a great tip, Filter managed to publish a feature on synthetic nicotine before it became the new obsession in Congress—and long before it fell under the regulatory purview of the FDA. Through court documents and internal Freedom of Information Act (FOIA) requests, we obtained one of my first scoops on the subject: the revelation that the FDA, likely under a time crunch to review millions of PMTAs, had adopted a checklist-like “Fatal Flaw” standard to evaluate whether applications had certain long-term studies, and summarily deny them if not. In appeals courts throughout the country, countless manufacturers who received MDOs on this basis have argued that the agency never previously made clear that randomized control trials (RCTs) and longitudinal cohort studies were required.

Numerous follow-ups included our reporting on how leadership at the Center for Tobacco Products (CTP) seemingly overruled the recommendation of its own Office of Science to authorize some menthol e-cigarettes.

Now, like everybody else, I’ll be waiting to see. I don’t know the answers to these questions.

I had my own favorite moments as well: I went to Triton, where I watched a company self-regulating as it petitioned the government for a fair shake. I attended the Global Forum on Nicotine in Warsaw. And I watched as leadership changed at the FDA and then at the agency’s CTP, as its longtime director Mitch Zeller retired and was replaced by Brian King, who had come from the CDC with a reputation for having spread misinformation about EVALI. (Soon, Matthew Holman, the center’s top scientist, would resign and take a job in the industry.)

Now, like everybody else, I’ll be waiting to see if the FDA bans menthol combustibles or lowers the nicotine levels in cigarettes or ever authorizes a flavored nicotine vaping product (even menthol). Or whether, on the world stage, more countries will follow pathways like the United Kingdom, Sweden or Japan—or, conversely, prohibition-oriented responses like India, Taiwan and Mexico.

I don’t know the answers to these questions. Like other observers in this rapidly evolving field, I’ve never been able to predict the future. But I’ll still be doing what I can to address the present.



Photograph by Vaping360 via Flickr/Creative Commons

The Influence Foundation, which operates Filter, has received grants from Juul and from Knowledge-Action-Change, which organizes GFN. Filters Editorial Independence Policy applies.

Alex Norcia

Alex was formerly Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in the New York Times Magazine, the Columbia Journalism Review, the Los Angeles Times and the New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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