Eliminating nicotine from tobacco products could help up to 5 million adult smokers quit within a year.
There’s an on-the-shelf policy the Biden administration could enact unilaterally that would save millions of American lives, without costing the government a single cent on net. That policy, one pushed for but never implemented by the Trump administration, is eliminating most nicotine from tobacco products. It would not render cigarettes illegal; they would still be available to adults, and the smoking experience would remain much the same. But the product would no longer be so addictive. Researchers have estimated that this policy change would enable 5 million adult smokers to quit within a year. The share of adults who smoke regularly would drop from roughly 15 percent to just 1 percent; 33 million fewer people would become smokers by the end of the century. It would save 8.5 million lives by 2100, at little public cost. “I am always a bit suspicious of silver bullets in public health,” Michael Fiore, one of the country’s leading experts on tobacco use and smoking cessation, told me. “Things are rarely silver bullets. But reducing the nicotine in cigarettes to near-zero is as close to a silver bullet as you get.” He’s right, and there’s nothing I know of in public policy remotely like it. Changing laws, medical advances, and social mores have saved millions of lives by suppressing tobacco use. With nothing more than a few pen strokes and a standard regulatory process, Biden could save millions more. As smoking has disappeared from television screens, planes, bars and restaurants, and other public spaces, the smoking rate has dropped to a third of its peak of 45 percent in the mid-1950s. The share of high-school students who have smoked a cigarette in the past 30 days is down too, falling from 36 percent in the mid-’90s to just 6 percent today. That latter figure is considered crucial among public-health experts, as most adults who are dependent on cigarettes, and who ultimately die from the habit, start smoking as kids. Still, smoking remains the leading cause of preventable death in the United States. Thirty-four million American adults smoke. Sixteen million live with a health condition related to the habit, such as lung cancer, emphysema, or heart disease.
