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The Desperate Search for a Health Threat From Nicotine Pouches

Earlier this month, the Centers for Disease Control and Prevention (CDC) tweeted about the dangers of nicotine pouches, a fairly new reduced-risk nicotine product.

The pouches are small bags of food-grade powder infused with nicotine. They’re placed under the lip, where the nicotine is absorbed into the user’s gum. Even though they have only been on the US market for about two or three years, public health groups seem to be developing a growing distaste for them.

The CDC tweeted—along with a fancy graphic—that the pouches “deliver high levels of nicotine, which is addictive and can harm the developing brain.” The graphic warned that they contained “flavors that are banned in cigarettes and cartridge-based e-cigarettes.” Presumably, the CDC considers itself a science-based organization. Yet there is little scientific merit to the tweet. It links to a highly partial study, authored by CDC employees—which in turn cites studies that make claims of nicotine harms recently described as “speculative” by 15 former presidents of  the prestigious Society for Research on Nicotine and Tobacco (SRNT).

It is undeniable that combustible tobacco as a means of delivering nicotine can be very harmful. But many safer alternatives have been condemned by ideological public health groups for entirely spurious reasons.

They work in the same way as nicotine patches and gum, which are endorsed by governments all over the world.

Most prominently, there is a fierce and often splenetic debate around vaping—in the US and worldwide, though not so much where I live, in the UK. Its alleged problems include being a so-called “gateway” into youth smoking, supposed harms to the lungs and cardiovascular system caused by inhalation, and the perpetuation of addiction, among others.

None of these arguments stand up. Youth smoking is at historic low levels in jurisdictions where vaping is widespread. And, where e-cigarettes or flavors are banned, smoking rates tend to rise. There is little or no sign of death and disease from legal nicotine vaping since devices entered the market over a decade ago. And while addiction can be problematic, many definitions of addiction—including the American Psychiatric Association’s diagnostic criteria for substance use disorders—contend that serious harms are a necessary component of the condition. Substances from caffeine to sugar to alcohol all receive incomparably lower scrutiny.

But nicotine pouches are far removed from even vaping. They work in the same way as nicotine replacement therapy patches and gum, which are endorsed by governments all over the world. The CDC warns that flavors are banned in cigarettes and vape products. But what does that have to do with nicotine pouches? The agency is comparing apples with oranges.

The justification put forward by the public health community for cigarette flavor bans is that flavors make smoked tobacco more appealing. With vaping, they claim that flavors entice youth, and that we do not know the effects of inhalation. But, with pouches the flavors are not inhaled; they are ingested into the gum or swallowed, which food regulators consider to be quite safe with equivalent products that don’t contain nicotine.

The CDC declares that nicotine can harm the developing brain. But, as a scientific institution, it is well aware that this claim results from a few studies in mice—which are highly unreliable, for the obvious reason that mouse brains are not a good proxy for human ones. Consider, in contrast, a vast natural experiment with human subjects: Smoking rates were once sky-high, and millions of adolescents have used combustible tobacco over hundreds of years. If nicotine caused widespread harm to cognitive function, we would know about it by now. Perhaps the CDC believes that Einstein would have been even more brilliant if he hadn’t been a regular smoker.

It suggests that they dislike the behavior of nicotine use, rather than the health harms associated with some ways of consuming it.

The CDC is not alone in this twisting of science, logic and fact. Many other groups are desperately seeking some kind of health threat to enable the demonization of a safer alternative to smoking with huge public health potential.

Sweden boasts the lowest smoking prevalence among wealthy nations along with the lowest smoking-related disease figures—thanks largely to a tobacco-containing product called snus. Also placed under the lip, snus works in the same way as nicotine pouches, and its availability over the past few decades has seen Swedes switch from combustible cigarettes in droves. Snus is considered roughly on a par with vaping on the nicotine risk continuum. Modern oral pouches don’t even contain tobacco, so could be lower still!

It is sad that renowned public health institutions are so concerned with deterring nicotine use that they reject innovations to tempt smokers away from the most dangerous nicotine delivery device: the cigarette. It suggests that they dislike the behavior of nicotine use, rather than the health harms associated with some ways of consuming it.

An ugly stigma around nicotine is leading academics to abandon scientific rigor and let their prejudices overwhelm their principles. Policymakers are only too happy to follow, and we are seeing this now with the irrational reaction to the potential that nicotine pouches surely offer.  Alarmism should never trump science, especially when it comes to saving lives.