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E-cigarette Summit US presentation 2018

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My presentation at the E-cigarette Summit Washington DC, 30 April 2018. "The urge to ban: 10 questions to ask first" calling for calm over flavors and the latest moral panic over JUUL.

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E-cigarette Summit US presentation 2018

  1. 1. The urge to ban: 10 questions to ask first E-cigarette Summit U.S. 2018 30th April 2018 Washington DC Clive Bates Counterfactual London www.clivebates.com
  2. 2. 1. Combustible or not? 2 1. Combustible or not?
  3. 3. 2. Chemical, flavor or descriptor? 3 1. Combustible or not? 2. Chemical, flavor or descriptor?
  4. 4. 3. What are the flavors of concern? 4 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? I have real concerns about kids’ use of e-cigarettes […] especially those products marketed with obviously kid-appealing flavors. Scott Gottlieb, FDA
  5. 5. 3. What are the flavors of concers? 5 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? Shiffman S, Sembower MA, Pillitteri JL, Gerlach KK, Gitchell JG. The impact of flavor descriptors on nonsmoking teens’ and adult smokers' interest in electronic cigarettes. Nicotine Tob Res 2015 Participants indicated their interest (0-10 scale) in e-cigarettes paired with various flavor descriptors
  6. 6. 4. Is use among adolescents similar to adults? 6 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 55% share
  7. 7. 5. What is the behavior of concern? 7 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern?
  8. 8. 6. Does a flavor preference create a change in behavior? 8 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior?
  9. 9. Ambrose et al, JAMA, 2015 7. Is the behavior change harmful or beneficial? 9 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health?
  10. 10. 8. Trade-offs between harms and benefits to youth? 10 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth?
  11. 11. 9. Benefits to adults versus any net harm to youth? 11 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth? Less than a quarter use tobacco flavours
  12. 12. 9. Benefits to adults versus any net harm to youth? 12 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth? About three- quarters relied fully or partially on flavours
  13. 13. 9. Benefits to adults versus any net harm to youth? 13 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth?
  14. 14. 9. Benefits to adults versus any net harm to youth? 14 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth? But now the U.S. tobacco market is beginning to be disrupted by JUUL — U.S. cigarette volumes fell 6% in 1Q18 according to Nielsen, about 1-2% worse than historic models would suggest. This is due to the rapid growth of JUUL. Adam Spielman - Citi April 2018
  15. 15. 10. Impact of FDA rule-making and unintended consquences? 15 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth? 10. Impact of FDA rule-making and unintended consequences? Use other Mix own and sell Buy from China online Smoke cigarettes Marijuana, Meth, Fentanyl That’s a good boy FDA bans some flavors or Juul Now what? Total abstinence? N Y
  16. 16. The urge to ban: 10 questions to ask first 1. Combustible or not? 2. Chemical, flavor or descriptor? 3. What are the flavors of concern? 4. Is use among adolescents similar to adults? 5. What is the behavior of concern? 6. Does a flavor preference create a change in behavior? 7. Is the behavior change harmful or beneficial to health? 8. Trade-offs between harms and benefits to youth? 9. Benefits to adults versus any net harm youth? 10. Impact of FDA rule-making and unintended consequences?

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