The E-Cigarette Summit marked the 60th anniversary of the publication of U.S. Surgeon General Luther Terry’s landmark report on smoking and health – a consensus document that clearly established the link between smoking and serious disease. The 1964 report is considered the catalyst for the modern tobacco control movement and is a historic example of the importance of science-based public health measures.
Smokers know the problem – countless attempts are made to kick the habit. Everything from hypnosis to “cold turkey”. As a rule, however, these efforts are unfortunately not crowned with success. The role of non-combustible alternatives to cigarettes is a variable that Surgeon General Terry and his committee have not yet had to address. Deciding whether and how such products should be included in the fight against smoking-related death and disease is the task of today’s experts. The goal of the E-Cigarette Summit is to facilitate respectful dialog and careful analysis of the independent scientific evidence to inform policy and regulatory decisions.
Many smoking cessation programs have been initiated to support health and counteract the smoking trend. In recent years, alternative nicotine products have become increasingly popular. As a result, many studies have looked at the effectiveness of e-cigarettes for smoking cessation. A recently updated Cochrane Review concludes that there is high-certainty evidence that e-cigarettes increase cessation rates compared to nicotine replacement therapy, Dr. Ruoyan Sun, Birmingham (USA), pointed out. However, most studies on smoking cessation have focused on cessation. The question of maintaining smoking cessation or relapse has not been considered. There is also no standardized definition of relapse. Existing long-term studies vary in their definitions of relapse. These range from “any smoking in the past 12 months” to “smoking ≥1 cigarette a day”.
| The E-Cigarette Summit at a glance |
| With almost 1 billion smokers worldwide, smoking is the leading cause of preventable death in industrialized countries.
The devastating effects of long-term smoking should not be underestimated: About half of all lifetime smokers die from smoking-related diseases, and many more suffer from a reduced quality of life.
Despite decades of successful tobacco control efforts, we are still a long way from ending the smoking epidemic.
The advent of e-cigarettes has led to one of the most controversial and contentious public health issues in a generation, with divisions within long-standing professional alliances in both tobacco control and public health, although the common goal of protecting public health and ending the smoking epidemic remains. The E-Cigarette Summit provides a neutral platform to explore the available peer-reviewed evidence and discuss the issues that divide scientists, health experts and policy makers alike. So are e-cigarettes a valuable harm reduction strategy or a tacit abandonment of decades of effective tobacco control efforts? Regardless of which side of the debate you are on, this is likely to be one of the most important public health issues for a generation. Over the past 18 months, significant changes have once again taken place in the US tobacco control and legal landscape. The tragic EVALI outbreak, which many still mistakenly associate with nicotine-containing e-cigarettes, sparked a wave of hostile government action and tobacco control activism targeting the e-cigarette industry. The EVALI crisis unfolded at the same time as the release of the 2019 NYTS data, which showed another dramatic increase in e-cigarette use in the past 30 days among both high school and middle school youth. Both events appeared to play a role in the decision announced by former President Trump in September 2019 to remove all flavored e-cigarette products from the market. Although this announcement was partially mitigated in the FDA guidance issued in early 2020, which only mandated the removal of flavored “cartridge-based” products, there is increased uncertainty about the future of flavored e-cigarettes in the U.S. This process could result in a significant number of current products being removed from the market while answering critical questions about product safety and the role of flavors for those products that successfully obtain a PMTA. Looking ahead to the next 12 months, it remains to be seen how the long-awaited PMTA deadline will impact the potential for tobacco harm reduction. Critical questions include whether the FDA’s product review will provide a measure of stability for this brand new category and whether it will improve the tenor of the tobacco control conversation in the US. As always, the E-Cigarette Summit is designed to provide an evidence-based environment that fosters open and respectful dialog on the most important scientific and current public health issues, with the sole goal of reducing smoking-related death and disease. |
A recent data review therefore addressed the question of whether smokers who stop smoking cigarettes and switch to alternative nicotine products are at an increased risk of relapse. In addition, it was analyzed whether the definition of relapse influences the relationship between switching to other tobacco products and relapse from cigarette smoking. For this purpose, relapse was divided into three stages: Stage I was any cigarette use within the past 12 months, Stage II was cigarette smoking within the past 30 days, and Stage III was cigarette smoking on ≥3 days in the past 30 days. It was found that the relapse rate of people who used e-cigarettes did not differ from those with normal nicotine consumption in all three stages. According to the expert, stage I showed the highest overall risk of relapse.
5-year plan for the regulation of nicotine products
The Director of the FDA Center for Tobacco Products. Dr. Brian King, then presented the already ongoing 5-year plan for the regulation of nicotine products (Tab. 1). In April 2022, menthol was banned as a characterizing flavor in cigarettes and all characterizing flavors – except tobacco – in cigars. In addition, the FDA plans to develop a proposed product standard to establish a maximum nicotine content to reduce the addictive potential of cigarettes and certain other combusted tobacco products.
One ally is the industry, which is held accountable through training, investigations and enforcement actions. As of March 2024, the FDA has sent more than 1,300 warning letters to both companies and retailers issued as part of online investigations into various tobacco product violations. Even closer cooperation is expected. To protect public health, out of 26 million applications submitted for market approval, only 23 e-cigarettes were actually approved, King said. These include IQOS, for example, which was already classified as a “modified risk tobacco product” (MRTP) by the FDA in 2020.
Congress: E-Cigarette Summit
Source: The E-Cigarette Summit, 14.05.2024, Georgetown, USA. “Cigarette smoking relapse among recent former smokers who switched to e-cigarettes or other tobacco products” and “The Center for Tobacco Products’comprehensive 5-year strategic plan”.
HAUSARZT PRAXIS 2024; 19(8): 30-31 (published on 22.8.24, ahead of print)
