Don't get me wrong. As a physician who has operated on patients with the ravages of tobacco, as a son who has seen both parents have severe coronary heart disease from smoking, and as a former Congressman who wrote one of the first bipartisan bills to allow The FDA to regulate tobacco, including nicotine content, tobacco use should be curtailed. For several years, the Obama, the first Trump, and the current Biden administrations have worked on a rule to decrease nicotine in tobacco products.
The Biden administration, the FDA, has just proposed reducing the nicotine content of cigarettes by 95%. This would effectively ban cigarettes currently on the market. The proposed Tobacco Product Standard for the Nicotine Level of Certain Tobacco Products has completed a regulatory review for a product standard establishing a maximum nicotine level to reduce the addictiveness of cigarettes. The new rule has not been finalized. This rule will be further examined by the Trump administration and his appointees to the FDA. This will undoubtedly greatly affect tobacco consumption . . but maybe not in a good way. The administration thinks that lowering the addictive nicotine content will keep people from smoking, but it may, paradoxically, cause them to smoke more in order to get the nicotine dose they require. Nicotine is more addictive than heroin. But it doesn't cause cancer per se. It is the toxic tar chemicals from the smoke that cause cancer.
In the Spring of 2001, as a physician and member of the Health Subcommittee of the Energy and Commerce Committee with oversight jurisdiction of the FDA, I was approached by the chief lobbyist for Phillip Morris and the anti-tobacco lobbyist Matt Myers of Tobacco Free Kids representing the anti-tobacco NGOs to draft an FDA tobacco regulatory bill. Even though tobacco products were killing more than 400,000 Americans every year and caused one of every five deaths in the United States, oversight of tobacco by the FDA had been stymied for years by the tobacco industry. This was an opportunity for the Marlboro tobacco company and the anti-tobacco NGOs to seek a common goal. Other tobacco companies with less market share were vehemently opposed.
On the steps of the U.S. Capitol on March 15, 2001, amid graphic posters of pictures of patients with the ravages of cancers caused by tobacco, I and cosponsors Henry Waxman (D-CA) and John Dingell (D-MI) introduced the Ganske/Dingell/Waxman bill to allow the FDA to restrict tobacco marketing in order to protect public health, including those forms of marketing that had the greatest appeal to children, Tobacco would have to meet the same public health standards that applied to other products. The FDA would be allowed to require tobacco companies to reduce or eliminate harmful components in tobacco products and smoke. It required independent scientific testing of products and unsubstantiated health claims that could harm public health. It addressed concerns of tobacco farmers and convenience stores.
We were as concerned about tobacco companies adding nicotine to products to increase their addictive potential as we were about reducing nicotine, which does not cause cancer per se. Nicotine gum, for example, does not cause oral cancers. Our bill and another by Waxman, which I cosponsored, provided the basis for the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) that finally allowed the Food and Drug Administration to regulate tobacco products.
I am concerned that in the haste to implement this new rule, we are not getting proper input from both health and law enforcement experts. There should be a full examination and public discussion of its unintended results. The price of cigarettes is already very high for those who are addicted to nicotine. Will they need to smoke twice as many cigarettes to satisfy their nicotine urge? Will decreasing the nicotine to almost nothing be analogous to liquor prohibition and make worse the illicit trafficking of tobacco products into the United States by the narco gangs and cartels? Will it increase the chances of fentanyl contamination of illicit tobacco products and cause even worse drug addiction?
Our country has experienced prior banning of an addictive chemical during Prohibition. Is there a point at which such a low nicotine level in legal products causes smokers to seek illicit higher nicotine products that are cheaper? The State Department already warned in 2015 about terrorist and criminal groups using profits from tobacco smuggling to finance other crimes. Mexican cartels are already doing this. There is bipartisan Senate concern about illicit tobacco trafficking.
There should be a public discussion about how far to reduce nicotine in tobacco products. This decision involves weighing many health and law enforcement concerns.
Greg Ganske, MD, is a retired plastic surgeon who cared for tobacco-related patients, women with breast cancer, children with cleft lips, farmers with hand injuries, and burn patients. He served in Congress representing Iowa from 1995-2003.
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