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NEW ORLEANS – Is FDA support for low-nicotine cigarettes a step forward or a step backward for public health?
Members of the American Academy of Family Physicians (AAFP) discussed this issue, along with others, at their delegates' convention meeting Tuesday.
The AAFP's Illinois section presented a resolution calling on the Academy to withdraw support for the FDA's decision to force cigarette manufacturers to keep nicotine levels under a certain threshold, arguing that it's not a good idea. there is no safe level of nicotine.
In March, the FDA issued a notice of regulatory proposal to explore ways to develop a requirement to reduce nicotine levels in combustible cigarettes and to review scientific evidence regarding the role of nicotine in addiction to cigarettes.
FDA Commissioner Scott Gottlieb said the new policy framework could "help prevent millions of tobacco-related deaths across the country," citing a recent study by New England Journal of Medicine.
In the article, researchers who simulated the impact of the hypothetical policy – reducing nicotine to "a minimum level of dependence" – estimated that 5 million smokers would quit smoking one year after its implementation. and more than 33 million more people would avoid becoming smokers. from here to the year 2100.
On March 20, AAFP President Michael Munger issued a statement applauding the FDA's decision, calling it "an important step in reducing the addictive power of cigarettes" and "likely to" help smokers quit. "
Some delegates now believe that the Academy acted prematurely and sent the wrong message by endorsing the FDA's new approach.
At first glance, this seems like a good thing, said Asim Jaffer, MD, an Illinois delegate, "but what worries us is the unexpected consequences."
Jaffer presented a resolution calling on the Academy to reverse its support for FDA-proposed action to limit nicotine to "minimally or non-addictive levels," while reviewing the literature on the effects on the drug. health of low-nicotine products in adolescents and adults.
In committee discussions held on Monday, Jaffer argued that the agency's recommendations do not make it clear that reducing nicotine levels is safe and that this harm reduction strategy is at odds with AAFP's current policy of "working towards the elimination of all tobacco products".
"There is no safe use of nicotine," Jaffer said. He worries, as well as others, that cigarette manufacturers "are spinning" will put on the letter of the AAFP.
"We do not want to be seen as being in bed with the tobacco industry," he added. "Soon, there could be a tobacco product that could be labeled as" recommended by a family doctor [group]& # 39; and we do not want that. "
Tom Houston, MD, former president of the Ohio section of the AAFP and co-author of a report on reducing cigarette addiction (originally presented at a meeting from the House of Delegates of the American Medical Association in 1998), opposed the idea of a reversal of the academy. his position; However, he supported the idea of writing a report after reviewing and reviewing studies on the impact of low-nicotine products on the health of adolescents and adults.
Everyone is worried about the increasing use of products such as Juul, he said, "requiring all tobacco products to reach the very low threshold of nicotine release has the potential to reduce Nicotine consumption among current smokers and young smokers ".
Studies currently available suggest that "very low-nicotine cigarettes" can limit nicotine exposure, reduce dependence, and reduce the number of cigarettes smoked each day, Houston said.
As a result of these proposed changes, new smokers "may be less likely to become addicted smokers," he said.
Under current legislation, the FDA can not reduce nicotine levels to zero and the current support of the AAFP, alongside other organizations specializing in the medical field, should be maintained, a said Houston.
The board of directors recommended that the resolution be referred to the board, stating that the FDA's actions seemed appropriate pending further evidence-based research.
However, after discussions with the entire congress on Tuesday – during which several delegates repeatedly pointed out that there was "no safe level of nicotine" and put it in place. focus on the optics of a medical group seemingly approve of any type of cigarette – the resolution to reverse the previous position of the agency had been approved (61-50) by electronic vote.
2018-10-11T18: 00: 00-0400
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