Institute of Medicine committee report on Modified Risk Tobacco Products to be released today

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Bill Godshall

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Today, December 14th at 11 AM EST (about ten minutes from the time I'm posting this), the FDA contracted Institute of Medicine committee will release its report recommending Scientific Standards for Studies on Modified Risk tobacco Products (MRTP) for tobacco manufacturers to conduct before they can truthfully inform smokers that smokeless tobacco products are significantly less hazardous alternatives to cigarettes (and other reduced risk claims for tobacco products regulated by Chapter IX of the FSPTCA).

If the FDA proposes/approves a "deeming" regulation (as the agency has stated its intent to do) to apply Chapter IX provisions to cigars, pipe tobacco, hookah/shisha tobacco, e-cigarettes, certain dissolvables and other currently unregulated tobacco products, Section 911's MRTP provisions also would apply to those manufacturers.

More information and access to the IOM committee report can be found at www.iom.edu/modifiedrisktobacco

Also there will be a briefing of the report at 12:00 Noon EST today.
Those wishing to dial into the IOM to receive a briefing of the report can do so by calling:

866 528-2256
Access code: 3343154

The following link contains some limited information about the report.

Scientific Standards for Studies on Modified Risk Tobacco Products - Institute of Medicine
http://www.iom.edu:80/Activities/PublicHealth/ModifiedRiskTobacco.aspx

Below is my statement to the IOM committee at its first meeting on February 3, 2011.

Bill Godshall
Executive Director
Smokefree Pennsylvania
1926 Monongahela Avenue
Pittsburgh, PA 15218
412-351-5880
smokefree@compuserve.com


IOM Committee on Scientific Standards for Studies on Reduced Risk Tobacco Products
February 3, 2011

Hello,

I’m Bill Godshall, founder and executive director of Smokefree Pennsylvania, a nonprofit organization that since 1990 has been advocating local, state and federal policies to reduce indoor tobacco smoke pollution, reduce tobacco marketing to youth, hold cigarette companies accountable for past misdeeds, increase cigarette tax rates, fund tobacco education and smoking cessation services, and inform smokers that all smokefree tobacco/nicotine products are far less hazardous alternatives to cigarettes.

For disclosure, neither Smokefree Pennsylvania nor I have ever received any direct or indirect funding from any tobacco, drug or electronic cigarette company or trade association.

There appear to be three different types of modified risk or reduced exposure applications that will be submitted to the FDA via Section 911 of the FSPTCA:
- those comparing a smokefree tobacco product to cigarettes,
- those comparing a cigarette to other cigarettes, and
- those comparing a smokefree product to other smokefree products.

Existing scientific evidence indicates that all cigarettes pose similar morbidity and mortality risks, and that all smokeless tobacco products marketed in the US pose similar morbidity and mortality risks. So additional evidence is needed before one cigarette can be determined to be less hazardous than another, and more evidence is needed before one smokeless tobacco product can be determined to be less hazardous than another.

In sharp contrast, many decades of scientific evidence confirms that daily use of smokefree tobacco products marketed in the US and Sweden pose about 99% fewer mortality risks than cigarette smoking, and that switching to smokefree tobacco products reduces a smoker’s mortality risks nearly as much as quitting all tobacco/nicotine. Nonsmokers are also exposed to less tobacco smoke when smokers switch to smokefree alternatives.

Since >99% of all tobacco attributable deaths in the US are caused by the repeated inhalation of tobacco smoke, while <1% are caused by the use of noncombustible tobacco products, it is vitally important for this committee to acknowledge these exponential differences of risk and encourage the FDA to incorporate this into the establishment of criteria for evaluating modified risk and reduced exposure tobacco product applications.

In the absence of reduced risk marketing claims, population surveys confirm that several million smokers have already switched to smokeless tobacco products even though the vast majority of smokers inaccurately believe that smokeless tobacco is just as hazardous as cigarettes. So smokeless tobacco products have already saved more lives (of smokers) than could be offset even if every non-tobacco user in America begins to use smokeless tobacco.



Even if many more non-tobacco users begin using smokeless tobacco products, the truthful marketing of smokefree tobacco products as lower risk or reduced exposure alternatives to cigarettes can only further reduce tobacco morbidity and mortality (to a meaningful degree).

Therefore, this committee should encourage the FDA to not require new costly studies for a smokefree tobacco product to claim it is less hazardous than cigarettes. But reasonable post-market surveillance should be required.

Requiring additional scientific studies for these types of modified risk or reduced exposure claims would be a “truth tax” for far less hazardous smokefree alternatives, would unfairly protect cigarettes from market competition by lower risk alternatives, and would threaten instead of improve public health.

Once the FDA begins approving truthful modified risk or reduced exposure claims for smokeless tobacco products compared to cigarettes, the agency also will be prompted to evaluate and eliminate the 25 year old intentionally misleading Congressionally mandated warning on smokeless tobacco products and advertisements stating: “This product is not a safe alternative to cigarettes,” which has confused most smokers to believe that smokefree products are just as hazardous as cigarettes.

Please remember that smokers have a human right to accurate and relevant health information and legal access to far less hazardous alternatives. The IOM and FDA should ensure that.

Thank You,
 

Bill Godshall

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rolygate

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Report Brief - Institute of Medicine

It looks as if the application for MRTP status will have several drawbacks:

1. There is no current concrete framework for an application.

2. There is no current cost estimate either for the FDA license or the research costs.

3. The FDA requirements are not available.

4. Research costs are likely to be substantial.

5. The report seems to indicate that independent researchers may not be suitable (and thus not approved), and existing named bodies should be used - therefore costs would be substantial.

6. Any research on e-cigarettes would be limited to vapor analysis and short-term in vivo effects. It is not clear if the FDA are now allowing human research trials with e-cigarettes, it was previously reported that they had been blocking such research.

7. A realistic trial would need some sort of elapsed time element unless exclusion of this element was specifically allowed in advance by the FDA. With Snus, the results can be clearly seen after 25 years. What timeframe would research for MRTP status with the FDA be limited to?

8. There will always be a belief that the FDA will block any application, with any results of whatever conclusion whether positive or not, after several years of expensive research (until the first such application is approved). Therefore many manufacturers will be unwilling to proceed.


The IOM report basically appears to be a step forward on the path to achieving MRTP status for products; but realistically, even an application is years away, at this rate.
 
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Placebo Effect

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Must prove the safety of e-cig sounds to me the cost of all this will shut down alot of small online retailers and the price of pv's and e-juice will sky rocket. here is a link from yahoo Electronic Cigarette Makers Must Prove Safety of Products: Report - Yahoo! News

Interpretations like this are exactly why I posted a comment to the article saying that the headline should be changed.

The true version of that headline is 'Makers of Tobacco Products Must Prove Safety of Products If They Decide to Apply for Modified Risk Tobacco Product Classification.'

E-cigarettes can continue to be sold without MRTP classification.
 

Bill Godshall

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FOR IMMEDIATE RELEASE: December 14, 2011
CONTACT: Bill Godshall
Executive Director of Smokefree Pennsylvania
412-351-5880 or smokefree@compuserve.com

Statement by Bill Godshall on the IOM committee's new report on Modified Risk Tobacco Products at:
Scientific Standards for Studies on Modified Risk Tobacco Products - Institute of Medicine

Institute of Medicine urges FDA to protect deadly cigarettes from market competition by far less hazardous smokefree tobacco alternatives.

The new IOM committee report is terrible for public health because it urges the FDA to protect deadly cigarettes from market competition by far less hazardous smokefree alternatives.

The IOM committee is basically urging the FDA to impose a several hundred million dollar tax on any tobacco company before it could truthfully inform smokers that a smokeless tobacco product is less hazardous than cigarettes.

While the report correctly points out that NRT products pose virtually no health risks, it ignores a half century a evidence documenting that smokeless tobacco products in Sweden and the US have very similar health risks/benefit profiles as NRT products.

The IOM committee report also ignores the undeniable evidence that several million smokers in the US and Sweden have already switched to smokeless tobacco products, and have significantly reduced their disease risks by doing so.

The IOM committee's recommendation would require a tobacco company to conduct far more research than FDA requires drug companies to conduct on NRT products before they can be marketed as smoking cessation aids.

Smokers have a human right to truthful health information about far less hazardous alternatives to cigarettes. But this IOM committee obviously disagrees.

In sum, the IOM committee's report protects cigarettes at the expense of public health, human rights and the truth.

Bill Godshall
Executive Director
Smokefree Pennsylvania
1926 Monongahela Avenue
Pittsburgh, PA 15218
412-351-5880
smokefree@compuserve.com
 

Bill Godshall

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Bill Godshall

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I spoke to Mike Esterl at the Wall Street Journal about the IOM committee report on MRTP, and I also communicated with Richard Craver at the Winston-Salem Journal (where RJ Reynolds is headquartered) about the IOM committee report.

I also sent my press release to several dozen other national news reporters.
 

Bill Godshall

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Bill Godshall

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The title of the article at
Electronic Cigarette Makers Must Prove Safety of Products: Report - Yahoo! News
is false, as e-cigarettes are currently NOT subject to regulatory provisions of Chapter IX of the FSPTCA, including Section 911's MRTP provisions.

Today's IOM committee report is yet another reason why the FDA should NOT propose/approve a "deeming" regulation to apply Chapter IX to e-cigarettes and other currently unregulated tobacco products.

But even if the FDA approved a "deeming" regulation to apply Chapter IX to e-cigarettes, manufacturers would only have to conduct these types of studies (recommended by the IOM cmte) if they were submitting an application to the FDA to allow the company to make an a MRTP claim.

RJ Reynolds has gotten around the MRTP requirement by simply running ads urging smokers to switch to Camel Snus (without claiming Camel Snus is less hazardous than cigarettes). But if Reynolds wants to truthfully claim that Camel Snus is less hazardous than cigarettes, the company would have to conduct whatever studies FDA requires them conduct before being legally permitted to make any MRTP claim.
 
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The FDA contracted Institute of Medicine committee will release its report recommending Scientific Standards for Studies on Modified Risk Tobacco Products (MRTP) for tobacco manufacturers to conduct before they can truthfully inform smokers that smokeless tobacco products are significantly less hazardous alternatives to cigarettes (and other reduced risk claims for tobacco products regulated by Chapter IX of the FSPTCA).

MRTP - Modified Risk Tobacco Products
are e-cigarettes MRTP ? Even though they don't contain tobacco ?
I sure hope not.

The IOM report is called: Scientific Standards for Studies on Modified Risk Tobacco Products
Surely that has *nothing* to do with e-cigarettes.
 

Bill Godshall

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Placebo Effect asked

Did you listen in on the conference call? Jeff Stier tweeted that Stanton Glantz asked three questions in a row.

I missed the first ten minutes of the conference call, and it ended just ten minutes after I got on because nobody asked any more questions. I heard Stan ask several rhetorical questions, but I didn't hear any substantive questions or answers. There were 60 people on the conference call when I joined it, and I suspect that most of them called in only because I sent them an e-mail informing them about it this morning.

Since the IOM only made the report available one hour before the conference call, nobody had adequate time to read anything more than the report's summary (and I didn't even read that much before joining the conference call). That's why nobody asked any worthwhile questions during the conference call.

Digital Doctor inquired

are e-cigarettes MRTP ?

Currently, only cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco products are subject to Chapter IX provisions of the FSPTCA, which includes Section 911's provisions for MRTP.

As long as e-cigarettes remain unregulated (i.e. not subject to Chapter IX provisions), e-cigarette manufacturers can continue to truthfully claim that they are far less hazardous alternatives to cigarettes. But if the FDA proposes/approves a "deeming" regulation to apply Chapter IX to e-cigarettes (and other currently unregulated tobacco products) as the FDA has stated its intent to do, it would then become a federal felony for any e-cigarette company to truthfully inform smokers that e-cigarettes are less hazardous than tobacco cigarettes, which is why we need to prevent the FDA from proposing/approving a "deeming" regulation.
 

Placebo Effect

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Report Advises Caution Over Smokeless Tobacco - WSJ.com

Several anti-tobacco groups praised the report. "It properly puts the burden on tobacco manufacturers to produce adequate scientific evidence before allowing them to claim that any tobacco product reduces the risk of disease,'' Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

Industry critics say smokeless products contribute to tobacco addiction and stop smokers quitting outright. Government-mandated labels currently warn such products can cause mouth cancer and gum disease.

But Bill Godshall, director of Smokefree Pennyslvania, a nonprofit group that campaigns against cigarettes, said the report ignored decades of studies by credible third parties showing smokeless products to be safer.
 

rolygate

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I believe that Bill has pointed out above that e-cigarette vendors can legally make such claims, since the statutes that specifically prevent such claims do not yet apply - but most likely will soon.

However, making such claims would be foolish unless made from a position of strength. Note that a class action has been allowed in CA against Smoking Everywhere for making similar claims.

Members of the community, though, can make whatever claims they like, since they are unlikely to be held to account for them.
 
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