Appreciate this thoughtful coverage by @2FirstsNews of my talk at #NewApproaches2026. My central proposition: “The continuum of risk should not simply describe the marketplace. It should play a central role in organizing it.” The overriding public health goal: reduce exposure to combustion as rapidly as we can. And “authorization alone is not a public health strategy.” We need a broader ecosystem of science, regulation, enforcement, accurate risk communication, youth protection, and responsible innovation—capable of accelerating the displacement of combustible cigarettes. Thank you to New Approaches and 2Firsts for capturing the argument so thoroughly. 2firsts.com/news/nas-2026--c… #TobaccoHarmReduction #TobaccoControl #PublicHealth #NicotinePolicy

Very encouraging talk today by @FDATobacco’s Center for Tobacco Products Director Dr. Bret Koplow at #NewApproaches2026. Former Iowa Attorney General Tom Miller told him (and the entire audience) that “It’s a breath of fresh air.” I agree. Director Koplow emphasized that tobacco harm reduction should not be controversial. It is an essential approach to helping more adults stop smoking. It is, in fact, what the PMTA process is all about. In essence, he confirmed that this is exactly what Congress had in mind when it passed the Tobacco Control Act in 2009. He also noted his and FDA’s understanding that adults prefer non-tobacco and non-menthol flavors. This is and will be taken into account in reviewing product applications. Critically, he confirmed that public misunderstanding is widespread, and to stay tuned for FDA *action* focused on better educating adults who smoke, medical associations, and others who need to be accurately informed about the continuum of risk and nicotine. Again, a breath of fresh air.

Great quote about older adults who smoke from Dr. Annie Kleykamp (@akleykamp) today at the #NewApproaches2026 Summit at the Harvard Club of New York City: “Older adults do not have less to gain. They do have less time to wait.” As a co-author of the recent landmark paper in @JAMA_current on Nicotine E-Cigarettes for Cigarette Smoking Cessation, she made crystal clear that “Vapes help more people quit smoking than other methods.” jamanetwork.com/journals/jam… And she noted that “Prioritizing younger populations introduces bias that has driven tobacco research and policy — at a steep cost.” @FDATobacco @TobaccoFreeKids @AmericanCancer @LungAssociation @American_Heart @MikeBloomberg

I agree. Now what? We are here to help.

"Nicotine" and "tobacco" and "smoking" are three different words with three different meanings. But for decades now, Tobacco Control researcher publications and public messaging has used them as synonyms. @cdoug cliffdoug.substack.com/p/whe…

This is a very important message — heartfelt, evidence-based, and obviously relevant to all of us (especially older) guys.

My latest Substack contribution examines how too many scientific papers use “nicotine,” “tobacco,” “vaping,” and “smoking” essentially as interchangeable proxies for the harms caused by combustible tobacco use. The distinction is not semantic—and getting it wrong distorts public understanding, research, policy, clinical guidance, and smoking cessation. substack.com/home/post/p-214…

Here comes another media report amplifying an overhyped study that deserves little oxygen—but illustrates, yet again, how advocacy dressed as science communication produces absurd extrapolation, exaggerated claims, and fearmongering. The unfortunate “news” story comes from @Forbes: “Vaping As A Teenager Could Drive Nicotine Seeking Later In Life, Study Finds”: forbes.com/sites/zacharyfolk… The study is promoted—of course—in a press release: eurekalert.org/news-releases… The teenagers studied? Rats. Male rats, to be precise. The premise: “The ongoing epidemic of nicotine vaping use in adolescents and young adults presents a significant health concern, yet the long-term effects of nicotine vaping remain largely unknown.” The conclusion, according to the lead author: “Even after an extended period with no nicotine whatsoever … early exposure was still shaping behavior later in life. That matters enormously for the millions of young people who began vaping as teenagers and are now carrying the habit into adulthood.” That is quite a leap—from nicotine-vapor-seeking behavior in male rats to sweeping implications for millions of human beings. The press release refers just once, obliquely and in its third paragraph, to the research as “using an animal model of e-cigarette use.” Elsewhere, it refers four times to the study’s “subjects.” Only at the very bottom, in smaller type, does the actual title appear: “Early Life Nicotine Vapor Exposure Increases Nicotine Vapor Seeking in Adult Male Rats.” But be afraid: “‘Our faculty and students are confronting a public health crisis that reaches into many households,’ said José O. Rivera, Pharm.D., founding dean and professor at UTEP’s School of Pharmacy. ‘And they are doing it with the rigor and creativity that define this University.’” Creativity, to be sure.

GRANTED. VACATED. REMANDED. Fifth Circuit court delivers blow to FDA’s mass-denial of flavored nicotine vape applications. @ECIGattorney @cdoug @ChaunceyGardner @alli_vapes @VaporTechAssoc @INNCOorg @GFNicotine @vapelawguy @NannyFreeState @GrimmGreen

Very important new evidence from @cochranecollab: Its updated living review—now encompassing 80 randomized controlled trials and nearly 30,000 participants—provides ever-stronger evidence that #nicotine #vapes help more adults quit #smoking than traditional nicotine-replacement therapies such as patches and gum. For every 100 adults using nicotine vapes in a quit attempt, approximately four more successfully quit smoking for at least six months than among 100 using nicotine-replacement therapy. That is a major difference when translated across the millions of people who smoke—many of whom are unable or unwilling to quit using other available approaches. Nicotine vaping is not risk-free, and strong protections for young people remain essential. But neither concern justifies withholding accurate information from adults who smoke: Regulated nicotine vapes are proven to be substantially less harmful than #cigarettes and a more effective smoking #cessation option for many. Public-health policy, clinical guidance, and clinical practice should follow the evidence—and help more people move away from combustible tobacco products, which cause the overwhelming burden of tobacco-related disease and death. Congratulations to Jamie Hartmann-Boyce, Nicola Lindson, and their colleagues for continuing this rigorous, living review. Cochrane report: cochrane.org/about-us/news/v…

There is something amiss on Capitol Hill. Senator Richard Blumenthal and Rep. Debbie Wasserman Schultz have introduced the "Preventing Opportunities for Teen E-Cigarette and Tobacco Addiction (PROTECT) Act" to address what they call an "alarming rise in e-cigarette use among youth." It proposes spending $500 million on a CDC initiative "to address this alarming trend" through research, grants, "the development of evidence-based policies," and other activities "to combat the rise in e-cigarette use among youth." The acronym may be impressive, but the premise is false. The latest federal data say exactly the opposite. Youth vaping has fallen dramatically—nearly 70% from 5.38 million users in 2019 to 1.63 million in 2024—and declined further to about 1.44 million in 2025. And some context for that 1.44 million figure matters: "current use" in the federal survey means having used an e-cigarette on at least one day in the past 30 days—not necessarily regular use. While 5.2% of all middle and high school students reported any e-cigarette use in the past 30 days, about 2.1% of all students used e-cigarettes on 20 or more of those 30 days, and only 1.4% used them daily. Youth vaping remains an important public health concern, and continued efforts to prevent youth use are important. But describing a steep, sustained decline as an "alarming rise" or "alarming trend" misrepresents the reality. It also obscures the extraordinary public health progress we have made in reducing youth vaping while youth cigarette smoking has fallen to historically low levels. So why portray a dramatic decline as an alarming rise? Sound public health policy—and the messaging around it—should be driven by accurate public health evidence.

Note that an 11mg pouch with "Smooth" flavor (i.e. not much of a flavor at all) snuck in there!

"The parallel here is that objective scientific understanding is being sidelined in ways that will harm people. Policies that treat vaping and pouch use as equivalent to smoking will harm people. Ideology must never supersede scientific and medical truth." Please continue ⬇️

Sharing a quote from Annie Andrews, MD, MS on MedPage Today (medpagetoday.com/opinion/sec…): “We are living in truly unprecedented times. On August 10, President Trump signed an executive order aimed at reshaping the nation's childhood immunization schedule, including directing HHS to pursue separate measles, mumps, and rubella (MMR) vaccines and to administer childhood immunizations at separate appointments whenever possible. The order also directs HHS to conduct further research on vaccines, despite decades of high-quality evidence demonstrating that vaccines are safe and effective. “Let's be clear about what is driving this policy. Throughout the second Trump administration, the president has repeatedly suggested a link between childhood vaccines and autism. The science, however, is unambiguous: decades of research involving millions of children have found no credible association between the MMR vaccine, or childhood vaccines more broadly, and autism. “The disinformation coming from the Trump administration amounts to a dangerous experiment on our children. …” And so, back on my usual subject: tobacco harm reduction. The parallel here is that clear, objective scientific understanding is being sidelined in ways that will harm people. Policies that treat vaping and pouch use as essentially equivalent to smoking, disregarding the irrefutable truth that there is a continuum of risk among different tobacco and nicotine products, will harm people. Indeed, they already are harming people. The bottom line: Ideology must never supersede scientific and medical truth. Every one of us deserves better.

A "small" change with potentially a large, counter-productive impact on public health. Feckless regulation and education regarding reduced-risk nicotine products *increases* the risk to real people.👇

There is something amiss on Capitol Hill. Senator Richard Blumenthal (@SenBlumenthal) and Rep. Debbie Wasserman Schultz (@DWStweets) have introduced the "Preventing Opportunities for Teen E-Cigarette and Tobacco Addiction (PROTECT) Act" to address what they say is "the alarming rise in e-cigarette use among youth." It proposes spending $500 million on a @CDCgov initiative "to address this alarming trend" through research, grants, "the development of evidence-based policies," and other activities "to combat the rise in e-cigarette use among youth." blumenthal.senate.gov/newsro… The acronym may be impressive, but the premise is false. The PROTECT Act is promoted as a response to an “alarming rise” and “alarming trend” in youth vaping. But the latest federal data say exactly the opposite. Youth #vaping has fallen dramatically—nearly 70% from 5.38 million users in 2019 to 1.63 million in 2024—and declined further to about 1.44 million in 2025. fda.gov/news-events/press-an… fda.gov/tobacco-products/you… And some context for that 1.44 million figure matters: “current use” in the federal survey means having used an e-cigarette on at least one day in the past 30 days—not necessarily regular use. While 5.2% of all middle and high school students reported any e-cigarette use in the past 30 days, only about 2.1% of all students used e-cigarettes on 20 or more of those 30 days, and only about 1.4% used them daily. Youth vaping remains an important public health concern, and continued efforts to prevent youth use are important. But describing a steep, sustained decline as an “alarming rise” or “alarming trend” misrepresents the reality. It also obscures the extraordinary public health progress we have made in reducing youth vaping while youth cigarette smoking has fallen to historically low levels. So why portray a dramatic decline as an alarming rise? Sound public health policy—and the messaging around it—should be driven by accurate public health evidence.

The deadliest nicotine products in America remain easiest to buy, while lower-risk alternatives like nicotine pouches face a tough fight for approval and acceptance. @HayppGroup @cdoug @ChaunceyGardner @alli_vapes @VaporTechAssoc @INNCOorg @GFNicotine @GrimmGreen @LegionVaping regwat.ch/r74z8U

This is a very thoughtful comment from President Trump‘s U.S. first surgeon general, Dr., Jerome Adams. No politicization here — just a realistic and insightful perspective shared by someone who understands.