Should FDA Try to Move Smokers to E-Cigarettes and Other Less-Harmful Tobacco Products and, If So, How?

The emergence of e-cigarettes has produced major changes in the tobacco industry and to adult and youth tobacco use patterns. But there are sharp disagreements about the extent to which e-cigarettes might be helping or hurting efforts to reduce public health harms from smoking and other tobacco-nicotine use. There are also active disputes among tobacco control researchers and other experts about exactly how much less harmful e-cigarettes might be compared to smoking and about how e-cigarettes and their marketing might be affecting youth and adult initiation, cessation, switching, and relapse. Without trying to resolve these disputes, this article offers recommendations for specific U.S. Food and Drug Administration (FDA) actions that would produce large public health gains by shifting smokers to using less harmful e-cigarettes without creating any significant risk of delaying total cessation, increasing youth initiation, or prompting any other health-harming e-cigarette use. Based on a Food and Drug Law Journal Symposium panel that offered diverse tobacco control and tobacco industry viewpoints, this article offers recommendations designed to make sense not just for the public health but for FDA, the industry, and the White House—regardless of who is right or wrong in the ongoing debates about e-cigarette harmfulness and current impacts.

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