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.

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. 1. Combustible or not?
2
1. Combustible or not?

3. 2. Chemical, flavor or descriptor?
3
1. Combustible or not?
2. Chemical, flavor or descriptor?

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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?