True Crime: Illegal markets have great variety (PNAS)

 The forthcoming issue of PNAS (August 18, 2026 | vol. 123 | no. 33) has a big set of papers on illegal markets, with the goal of searching for common features, which turn out to be somewhat elusive.

Research ArticleAugust 10, 2026

A budding science of illegal markets

Illegal markets create untold societal and environmental harm, but they have attracted surprisingly little scholarly attention. This paper explores illegal markets as a class of objects. It considers similarities and differences across markets, with ...

• Jonathan P. Caulkins

"The raw material for these comparisons mostly comes from the February 2025 Policy and Research on Illegal Markets (PRIM) workshop held at RAND in Santa Monica. The workshop convened 17 experts on nine specific markets, or types of markets. They wrote the market-specific papers contained within this volume."  

Research ArticleAugust 10, 2026

Stability and turbulence in illegal drug markets

This article provides a primer on illegal drug markets, with a focus on the structure and nature of these markets and the enterprises involved. The markets for illegal drugs are large, with annual retail expenditures likely exceeding $100 billion in the ...

• Beau Kilmer
• 
  

IntroductionAugust 10, 2026

Illegal markets: An important domain for applied science

• Jonathan P. Caulkins,
• Beau Kilmer and
• Peter Reuter

"One premise of this special issue is that illegal markets and the supply chains that support them are a worthy topic of scientific inquiry. That turns out to be a novel claim. Illegal markets have simply not been a major topic of interest to economists, the discipline that would most plausibly study them. For example, Nobel laureate Alvin Roth, in his magisterial review of markets and market design, describes illegal markets but offers no specific analytic insights about them (2[A. E. Roth, Marketplaces, markets, and market design. Am. Econ. Rev. 108, 1609–1658 (2018).]). Gary Becker, one of the giants of microeconomics, wrote occasionally about drug markets but forced on them the presumption that they were analytically no different than legal markets (e.g., ref. 3). 

Research ArticleAugust 10, 2026

How illegal wildlife trade adheres to and defies conventional market behavior

Illegal wildlife markets comprise a complex global economy generating criminal profits while harming biodiversity and livelihoods. The negative externalities from biodiversity loss, ecosystem destabilization, and zoonotic disease risk may be orders of ...

• Greg Midgette and
• Meredith L. Gore

"At least since the third century BCE, when the Edicts of Ashoka prohibited the killing of animals with aesthetic value on the Indian subcontinent, wildlife has been trapped, harvested, and sold in contravention of laws (1). " 

PerspectiveAugust 10, 2026

Illegal firearms markets: Transaction patterns, evolving sources, and importance in criminal misuse

In the United States, the legal status of the 30 to 40 million annual firearms transactions is defined by state and federal regulations. These regulations primarily aim to reduce criminal misuse while preserving access for the large majority of adults who ...

• Philip J. Cook and
• Rosanna Smart

"Illegal transactions in firearms are often embedded in the much larger formal and informal markets, simply because sellers cannot easily distinguish between legal and illegal buyers even if they are motivated to do so. As one analogy, illegal firearms transactions look less like the market for heroin, where everyone involved knows the illegality of their transaction, than that for diverted pharmaceuticals." 

PerspectiveAugust 10, 2026

The market for human smuggling: Structure, mechanisms, and paradoxes

Human smuggling is the facilitation of unlawful cross-border movement. It is primarily a commercial activity, offered as a service to willing, paying customers, and a large-scale market catering to millions seeking to circumvent mobility restrictions. ...

• Paolo Campana

"The terms human smuggling and human trafficking are often confused, but they represent two very different phenomena, albeit potentially occurring in the same places and populations. While a victim of trafficking and a genuine client of a smuggler might find themselves shoulder-to-shoulder in the same inflatable boat, thus sharing the same means to cross the same border, smuggling and trafficking remain distinct—both analytically and legally. In the case of smuggling, the service provided is the illegal entry into a country—and a migrant enters into the transaction with a smuggler voluntarily (1). Some may have few options other than to migrate, and in that sense be forced to migrate, but they are not forced into that action by an individual or organization selling them the smuggling service. The relationship between a migrant and a smuggler terminates when the former has reached the agreed destination and paid the latter the agreed sum. On the other hand, the purpose of trafficking is obtaining control over a person for exploitation, including sexual exploitation, labor exploitation, or domestic servitude (2).† Victims of human trafficking may enter a country through legal channels, and in some cases, trafficking takes place wholly within national borders." 

PerspectiveAugust 10, 2026

The money laundering market: An economic analysis

Criminals launder their proceeds from crime, either themselves or by paying a professional, to disguise the link between the criminal, the crime, and the proceeds. This allows the criminal to spend the proceeds more freely and lowers the chance of ...

• Joras Ferwerda

"Since the goal of money laundering is to go unnoticed or to be seen as some other form of legitimate transaction, it is, by nature, difficult to provide credible estimates of how big the problem is. Moreover, the purchase of laundering services is generally a consensual crime: Both parties voluntarily enter into the transaction. Consensual crimes lack a direct victim to report the crime, which means the crime is revealed only when it is actively investigated.
There are a number of estimates of the volume of money laundering. These range in credibility; some lack empirical backup altogether [e.g., the widely quoted International Monetary Fund estimate of 2 to 5% of global GDP (3)]..." 

PerspectiveAugust 10, 2026

Casting light on the workings of illegal fishing markets

About 3.5 million fishing vessels ply the world’s oceans, providing livelihoods and food for millions of people. Sound management is key to fisheries’ sustainability, but illegal fishing, along with fishing overcapacity generally and environmental change, ...

• Philippe Le Billon,
• Zelda Ladefoged and
• U. Rashid Sumaila

 

PerspectiveAugust 10, 2026

Illegal markets for cigarettes and e-cigarettes

This paper discusses the long-standing illegal markets for cigarettes and the more recently emerged illegal markets for e-cigarettes. We identify three distinctive market fundamentals that help explain many features of the illegal markets. First, in ...

• Donald Kenkel and
• Grace Phillips

"In 2024, tobacco products generated almost $1 trillion in revenues, mainly from cigarette sales; e-cigarettes generated $26 billion dollars (1–3). While the share of the illegal markets varies by country, it is estimated that illegal markets account for about 10 percent of global cigarette consumption (4). Second, the illegal markets have arisen to evade high excise taxes that increase prices and regulations that restrict the availability of desirable features of legal products.  "

PerspectiveAugust 10, 2026

The illegal market for sex in the United States: Insights from economic research

The illegal market for sex in the United States generates significant economic activity yet remains understudied due to its illegality and clandestine nature. This paper synthesizes existing empirical evidence documenting aspects of market structure, ...

• Manisha Shah

"Although sex work is often perceived as predominantly occurring in marginalized urban areas or among underprivileged cultural groups, sex work is pervasive at all echelons of society. Media portrayals often emphasize street-based sex work, presenting it as the predominant form of prostitution; however, street-based sex work has been estimated to account for approximately 10 to 15% of total sex work participation (2). In the United States and in many other countries, the majority of the sex market has moved “indoors,” whether that be through massage parlors or brothels and/or online encounters." 

PerspectiveAugust 10, 2026

The policy construction of illegal markets: Exploring variation, success, failure, and unintended consequences

Illegal markets, broadly defined to include markets where only specific transactions are illegal, are the consequence of policy, either a prohibition or highly restrictive regulation. They are generated by a variety of concerns, some moral, some ...

• Letizia Paoli and
• Peter Reuter

"Drugs that are now prohibited were perfectly legal in most countries until the early 20th century. Famously, the British fought two “Opium Wars” with China (1839–1842 and 1856–1858) to open up that nation to opium exports from India (8). Cannabis, the most popular plant-based illegal drug, was cultivated—and also grew wildly—in at least four continents and until the 1920s “the large majority of countries did not have any controls at all” (9). However, the 1961 UN Single Convention on Narcotics Drugs virtually prohibited all production and distribution of many prominent psychoactive substances, including heroin, cocaine, and cannabis; it also prohibited possession. Since then, drug transactions have grown to form what is generally believed to be the largest illegal market globally. For the United States (US), an estimate for 2016, the latest available, was over $150 billion (10)." 

PerspectiveAugust 10, 2026

A descriptive analysis for the markets for counterfeit products

Product counterfeiting is a pervasive crime that involves the unauthorized use of a legitimate trademark, a violation of intellectual property rights. Counterfeiting is also one of many forms of global illicit trade, mirroring legitimate markets in ...

• Jay P. Kennedy

"US Customs and Border Protection reports (2) regarding intellectual property rights violations state that the most commonly seized counterfeit products at US ports of entry in 2024 were handbags/wallets (36% of all seizures), pharmaceuticals (27%), and apparel (7.4%). Other products seized included footwear, automotive parts, health and beauty products, and electronics like cell phones, computers, microprocessors, and circuit boards. While Customs seizure reports give an indication of the types of products identified and interdicted by law enforcement agencies, many more counterfeit products slip past customs agents and enter the market, including items like counterfeit aircraft parts, military equipment, weapons systems components, and even parts for nuclear reactors. "

##########

Some of these markets are also discussed in my recent book, 

Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work  

 

 

China is smoking

 The NYT has the story:

Xi Jinping Quit Smoking. China Still Cannot.
China’s tobacco monopoly has become so financially vital to the government that even its powerful leader has failed to curb the country’s smoking habit. By Joy Dong

"While cigarette sales have fallen across much of the world, China has moved in the opposite direction.

"Cigarette consumption in China rose 39 percent from 2003 to 2023, even as it fell 26 percent in the rest of the world. The 2.4 trillion cigarettes sold in China each year account for nearly half the global total, according to a report by a nongovernmental organization founded by former officials from the Chinese Center for Disease Control and Prevention.
...

"The failure to slow cigarette sales is a measure of the clout wielded by China’s State Tobacco Monopoly Administration, which both regulates the industry and operates the country’s dominant cigarette maker, the China National Tobacco Corporation.

"The company generated roughly $244 billion in profit and tax revenue in 2025, about 7 percent of national government revenue and nearly what China says it spends on defense."
 

French nicotine pouch ban is ‘attack on Swedish way of life’

 Is Swedish nicotine like French wine?

The FT has the story:

"French nicotine pouch ban is ‘attack on Swedish way of life’, minister says. Stockholm smoulders over France’s ‘absurd’ penalties of up to five years in prison for cigarette alternatives, by Mari Novik in Strasbourg and Sarah White in Paris

 "A Swedish minister has accused France of mounting “an attack on the Swedish way of living” with its ban on nicotine pouches, setting aflame a single market fight over how governments should regulate smoke-free alternatives to tobacco.

"France last month implemented one of Europe’s strictest bans on the pouches, a flavoured sachet that users tuck under their lip to release nicotine.

"France’s decree goes beyond other EU countries’ prohibitions by banning not just sales but import, possession and use of the pouches. A Swede carrying a tin of pouches legally bought at home could face French penalties of up to five years in prison and a €375,000 fine.
 

“It is as if we would prohibit French baguettes or French wine in Sweden,” Swedish trade minister Benjamin Dousa told the FT. “It is absurd.”

#########

Earlier:

Tuesday, May 19, 2026  WHO reports on the global growth of nicotine pouches

WHO reports on the global growth of nicotine pouches

 The World Health Organization (WHO) has released a report written by Robert K. Jackler, Divya Ramamurthi and Cindy Chau (Stanford Research into the Impact of Tobacco Advertising), and Ranti Fayokun (Tobacco Free Initiative, Department of Health Determinants, Promotion and Prevention, WHO).

Exposing marketing tactics and strategies driving the global growth of nicotine pouches 

 

"Key messages of the report are:
• The global market for nicotine pouches is growing rapidly.
• Nicotine pouches can be highly addictive; furthermore, some have high concentrations of nicotine, and some increase the speed and intensity of nicotine delivery (e.g. “pearls technology”).
• Labelling of nicotine content is not standardized and can be confusing and misleading.
• Some nicotine pouch packaging mimics popular candy products and contain high nicotine levels. If they are ingested by children, they can pose a lethal risk.
• Nicotine pouches often contain various youth-appealing flavours (e.g. sweet, fruity, mint/menthol), such as Cherry Punch and Frosted Apple, and candy-like flavours (e.g. “bubble gum” and “gummy bears”), which are particularly attractive to children.
The flavours of numerous alcoholic drinks are also used, marketed as “After dark”.
• Nicotine pouches often promote high-intensity nicotine and flavours with slogans such as “nicotine like never before” and visual depictions of the user experiencing a cooling effect.

• Nicotine pouches are aggressively marketed and promoted to young people.
– They are heavily advertised on youth-frequented social and digital media platforms, including through influencers.
– They are frequently promoted with youthful themes, including fun times with friends, romance and sports.
– They are often promoted for “discreet” or stealthy use, making it difficult to detect by parents or teachers, and as a way of breaking the rules.
– Manufacturers of nicotine pouches commonly sponsor youth-oriented events, where nicotine pouches and branded merchandise are distributed by attractive, young “brand ambassadors”.
• Nicotine pouch advertisements often use the tobacco industry’s “playbook” for marketing conventional tobacco products, such as cigarettes, including:
– “lifestyle marketing” and “identity marketing”, the message sometimes portraying how a consumer wishes to be perceived by others;
– depictions of nicotine pouches as “modern” and “high-tech”; and
– portrayal of nicotine pouches as boosting energy when the user is tired and helping the user to relax when stressed. Marketers call this “elasticity of meaning”, depicting the product as something that works for everyone in any situation.
• Nicotine pouch manufacturers market and associate their brands with holidays (e.g. Christmas) and cultural symbols (e.g. patriotism) to evoke happy times and celebrations.
• Messaging in nicotine pouch advertisements can appear contradictory, expressing opposing views; however, this is carefully crafted and tailored to different target groups, such as:
– co-marketing of a nicotine pouch brand with promotion of a flagship cigarette (or other tobacco) brand, while also marketing of nicotine pouches and conveying anti-cigarette messaging (e.g. “goodbye smoke smell”).
• Nicotine pouches are marketed with unsubstantiated claims that they aid smoking cessation and/or in ways that undermine quit attempts.
• Nicotine pouches are often promoted as a product for “Anytime, Anywhere”, with images of places in which smoking is not allowed. This marketing tactic can encourage dual use, hinder cessation attempts and undermine regulations prohibiting smoking or use of other tobacco and related products in public places.
• There is insufficient national action, whereby nicotine pouches commonly fall through regulatory gaps and thus either un- or lightly regulated.
• WHO calls for a comprehensive approach to tobacco control, covering the full spectrum of tobacco and related products, including nicotine pouches, and closing regulatory loopholes. "

Tobacco banned in Indian state of Odisha

 Here's the story from the Times of India, Govt notifies ban on all chewable tobacco, nicotine products | Bhubaneswar News - The Times of India.  It remains to be seen how enforceable a statewide ban will be. (Local bans on something as addictive as nicotine are likely to face black markets sourced from neighboring jurisdictions without a ban.)

 

  

 

Alcohol is being out-competed by nicotine (and maybe by pretty good non-alcoholic beer)

 The WSJ has the story:

Nicotine Is Hot, Beer Is Not. What Vice Stocks Say About America’s Guilty Pleasures.
People are smoking less, but tobacco stocks are soaring while brewers struggle to sell beer in the U.S.
By  Laura Cooper

"Want to know what guilty pleasures are gaining and losing popularity in America? Take a look at the stock prices of Molson Coors and Altria .

Marlboro cigarette-maker Altria, which also owns the growing on! nicotine pouch, is up more than 21% so far this year. Shares of Molson Coors, the brewer behind beer brands such as Miller Lite and Blue Moon, are down more than 13%.

Companies that traditionally sold cigarettes are seeing new engines of growth, no tobacco or smoking required. Nicotine pouches like on! and British American Tobacco’s BATS 0.93%increase; green up pointing triangle Velo look like tiny tea bags that sit between the gum and the cheek and are often filled with wood pulp along with nicotine salts and flavorings. The nicotine is absorbed into the bloodstream through the mouth’s lining.

Zyn, which is produced by Swedish Match North America, an affiliate of Philip Morris International PM 1.30%increase; green up pointing triangle, is the most popular nicotine pouch. It gained popularity due in part to a devoted following of unaffiliated “Zynfluencers” who tout their love of the brand.

Earlier this year, U.S. health officials authorized Zyn to stay on the market after finding that it has benefits as an alternative for adult smokers that outweigh its potential risk to young people."

Brain drugs, a review (performance enhancement, side effects, and addiction)

 From the Free Press,  tasting notes on a variety of performance enhancing drugs for concentration, finally converging on what sounds like nicotine addiction.

I Tried Wall Street’s Famous Brain Drugs
My experimental high and crash through the not-quite-legal, sort of effective, occasionally heart-pounding medicine cabinet of Wall Street and Silicon Valley’s productivity optimizers.  by  Park MacDougald

"Vyvanse:
The brand name for lisdexamfetamine, a prodrug that, once ingested, slowly converts to dextroamphetamine, one of the active ingredients in Adderall. Originally developed as a longer acting and less easily abused alternative to dextroamphetamine, lisdexamfetamine is now the third most commonly prescribed stimulant in the United States, according to the Drug Enforcement Agency (DEA), with around 15 million prescriptions dispensed in 2023. With insurance, a 30-day supply of Vyvanse can run around $60.

...

" Strattera:  Generic name atomoxetine, Strattera is a selective norepinephrine reuptake inhibitor initially developed by Eli Lilly to treat depression, but later approved by the Food and Drug Administration (FDA) as an ADHD treatment when it was found to be ineffective for its intended use. Strattera is far less commonly prescribed than Adderall, Vyvanse, or Ritalin—4.3 million prescriptions were dispensed in 2023, per the DEA—but may be favored for patients with a history of addiction, due to its low potential for abuse. It’s also cheap; with my insurance, a month’s supply of Strattera cost less than $10.

...

"Dextroamphetamine: Basically like Adderall but without levoamphetamine, a less potent amphetamine isomer that helps to smooth the overall effects of the drug. Dextroamphetamine, or “dexy,” has been available since the 1930s, and was issued to U.S. bomber pilots in World War II to help keep them awake on nighttime missions. It’s still around today, but far less common than Adderall or Ritalin (methylphenidate). Around 915,000 dextroamphetamine prescriptions were dispensed in the United States in 2023, according to the DEA.

...

"Modafinil: Unlike the other drugs on this list, Modafinil is not primarily an ADHD treatment. It’s a non-amphetamine stimulant and “wakefulness-promoting agent” developed in France during the 1970s and 1980s as a treatment for narcolepsy, but its current claim to fame is for its use by the U.S. Air Force to manage pilot fatigue on long missions (it’s also frequently prescribed for night-shift workers). Prescription modafinil is generally cheap with insurance, but the variant I bought—a supplement containing adrafinil, a closely related substance—cost $40 for a jar of 30 pills.

...

 "Zyn: Zyn is the original brand of smokeless tobacco pouches, introduced by a Swedish company, Swedish Match, as a tobacco-free alternative to Snus in 2014 (its major competitor, Velo, is also Swedish, though both companies are now owned by international tobacco conglomerates). In the United States, Zyn is sold in tins of 3 mg or 6 mg pouches, though the European version of the product—which I purchase from my local Yemeni-owned bodega in New York City—also comes in 9 mg, 11 mg, and 13.5 mg varieties. Retail, in New York, a tin costs around $9—up from $5–$6 only a few years ago.

...

"For me, however, 6 mg of Zyn—rising to 9 mg in times of crisis—has become a necessity akin to drinking water. I no longer know what Zyn “feels like,” per se, since I only feel its absence, in the form of scattered attention, forgetfulness, and low-level irritability. When I am on deadline or otherwise swamped with work, I rarely go 10 minutes without a pouch in my mouth."

 

Nicotine news--unintended consequences

 Nicotine remains a big source of addiction, and (especially in connection with cigarette smoking) a major cause of premature death.  Here's a brief report on the Whac-A-Mole nature of efforts to limit addiction, particularly by minors.

Vaping Declined in States With Flavor Bans -- But It's Not All Good News— Restrictions were also tied to increased cigarette use in youths and young adults
by Shannon Firth, MedPage Today  July 31, 2025

• "To date, seven states and Washington, D.C. have enacted flavor restriction policies for e-cigarettes.
• These state policies were associated with reduced e-cigarette use among adults in recent years.
• However, relative to states without these policies, the restrictions were also tied to increased cigarette use among high school-age youths and young adults."

The science and politics of vaping in the U.S

 The Washington Post has the story:

FDA lets Juul market vapes in the U.S. three years after trying to ban them
Federal regulators first announced a ban of Juul products in 2022, although a court order allowed them to stay on store shelves while the company filed an appeal.  By David Ovalle and Shannon Najmabadi
 

"The Food and Drug Administration has authorized Juul Labs to market its electronic cigarettes, years after the agency tried to ban the company’s products amid outcry over its role in fueling the popularity of vapes among young people.

"The agency, after reviewing scientific data provided by the company, concluded that Juul’s electronic cigarette device and refillable cartridges in tobacco and menthol flavors can help adult cigarette users reduce smoking or switch to less harmful products, outweighing the risk to youth.

...

"The news comes a few days after the Vapor Technology Association, an industry group, said it launched a seven-figure ad campaign urging President Donald Trump to draw a distinction between vape products targeting youths and “safer, adult-focused alternatives” touted as smoking-cessation tools. Trump previously offered enthusiastic support for vaping and promised to protect the industry while campaigning in 2024.

...

"A 2024 Centers for Disease Control and Prevention survey found vapes were the most common tobacco product used by middle- and high-schoolers. About 1.6 million students use electronic cigarettes, according to the survey — and nearly 90 percent of those who vape prefer the flavored liquids, the survey reported.

Thursday’s Juul decision drew immediate outcry from public health groups that assert vapes are addictive and can harm the development of maturing brains."

Nicotine underlip: Zyn, snu to manage (and start) nicotine addiction

Move over vapes: more ways to access nicotine without starting a fire: (I understand these are quite popular among our MBA students...)

  The New Yorker has the story:

Zyn and the New Nicotine Gold Rush. White snus pouches were designed to help Swedish women quit cigarettes. They’ve become a staple for American dudes. By Carrie Battan  March 10, 2025 

"In November, 2024, Sweden was declared “smoke-free” because its adult smoking rate had dipped below five per cent. As smoking has declined, so have related illnesses, such as emphysema; Sweden has one of the lowest rates of lung cancer in the E.U. This shift is broadly described in academic papers as “the Swedish Experience.”

"And yet the Swedes have an immense appetite for nicotine, the addictive chemical found in tobacco. About a third of Swedish people consume nicotine, and they mostly get their fix from snus—small, gossamer pouches that look like dollhouse pillows, which users nestle in their gums. Snus pouches deliver nicotine to the bloodstream through sensitive oral membranes; Swedes refer to the resulting buzz as the nicokick.

...

"Scandinavians have a proud history of snus usage. During the mid-seventeenth century, ground-up sniffing tobacco became popular in the French royal court and made its way to Sweden. Later, working-class Swedes started adding liquid to the powder and placing it against their gums, as a claylike paste. The preportioned pouches that are common today were introduced in the nineteen-seventies, as more people turned to snus in order to stop smoking. In the early nineteen-nineties, when Sweden held a referendum on whether to join the E.U., which had a bloc-wide snus ban, voters adorned their cars with bumper stickers that read, “E.U.? Not without my snus.” Ultimately, Sweden was granted an exemption from the ban in exchange for stricter warning labels.

...

"Until recently, the word “snus” referred solely to a pungent product made of tobacco leaves. But, over the past decade, the earthy brown substance has been joined by white snus, a new product with a characteristically Swedish design elegance. White snus, which consists of pure nicotine mixed with filling agents, has little natural odor and does not stain the teeth the way that the traditional kind can. It was developed by Swedish scientists to appeal to women, a constituency that hadn’t historically taken to brown snus. The creators also had ambitions to eventually reach Americans.

...

"In 2019, after five years of selling in select shops, mostly in the Southwest and Pacific Northwest, Swedish Match took Zyn national. Three years later, sales of nicotine pouches had increased by six hundred and forty-one per cent, and Philip Morris acquired the company for sixteen billion dollars. By this point, Zyn was a mainstay for a growing variety of users: purple-state early adopters, hockey and baseball players, Wall Street guys, medical students, truck drivers, and anyone who could use a quick jolt.

...

"Nicotine can have cardiovascular effects, including heightened blood pressure, heart rate, and cholesterol. Some pouch users complain of mouth lesions from long-term use. Yet more figures in addiction research are acknowledging the importance of smokeless tobacco products in the fight against cigarettes. In a recent interview, Ann McNeill, a pioneering scholar of tobacco addiction, said she’d started to see the benefit of adopting a harm-reduction approach—getting people to trade one dangerous habit for another, significantly less dangerous one. 

...

"Today’s nicotine entrepreneurs cite Juul as both an inspiration and a cautionary tale; the product’s appeal was so broad that teen-agers flocked to it. When the 2024 National Youth Tobacco Survey was published, Coogan and others in the industry were relieved: the rate of underage pouch usage had remained relatively low, at 1.8 per cent. Because of the Juul debacle, Zyn flavors in the U.S. are restricted to mint, coffee, cinnamon, and citrus varieties. "

FDA Proposes Reducing Nicotine to Nonaddictive Level in Cigarettes: I see 5 possible futures

 Here's the FDA press release:

FDA Proposes Significant Step Toward Reducing Nicotine to Minimally or Nonaddictive Level in Cigarettes and Certain Other Combusted Tobacco Products
Agency Encourages Public Input on Proposal That Aims to Prevent Millions of Premature Deaths 

 " the U.S. Food and Drug Administration issued a proposed rule that, if finalized, would make cigarettes and certain other combusted tobacco products minimally or nonaddictive by limiting the level of nicotine in those products. If finalized, the United States would be the first country globally to take such a bold, life-saving action to prevent and reduce smoking-related disease and death. The FDA first announced its intent to propose such a ruleExternal Link Disclaimer in 2018, and today’s announcement is an important next step in the rulemaking processExternal Link Disclaimer. The agency intends to seek input on the proposal, including through public comment and the FDA’s Tobacco Products Scientific Advisory Committee"

#########

Here are some predictions of possible outcomes of this proposal.

1. (p>.5) No new regulation: We soon see Trump-branded, musk-flavored high-nicotine cigarettes.  (no lives saved)

Conditional on the proposals being enacted (i.e. p<.5)

2.  Cigarette makers find workarounds (nicotine supplements you can add to your smokes, new organic chemicals functionally equivalent to nicotine, etc. (few lives saved)

3. Black markets emerge: get your full-nicotine cigarettes at the same time you get your Mexican coca cola made with sugar instead of corn syrup. (some lives saved)

4. Smokers switch to non-combustables: Big Tobacco becomes Big vaping, chewing, and under-lip snus, snuff, and oral nicotine pouches. (maybe significant lives saved, but no decrease in nicotine addiction, and maybe substantial increase. Lung cancer down, oral cancers up.)

5. (low probability but we can hope): Smokers quit, and few young people start to smoke: tobacco use drops so low that deaths attributable to smoking drop below those attributable to alcohol or opioids.

Should big Tobacco fund (and program) continuing medical education?

 Should physicians learn about tobacco from the source?

The Tobacco Industry Has No Business Funding Continuing Medical Education, by Robert K. Jackler, MD1,2; Pamela M. Ling, MD, MPH3,4, JAMA. 2024; doi:10.1001/jama.2024.9241 

"Recently, the for-profit medical media company Medscape promoted a series of continuing medical education (CME) courses (see the Supplement) funded by a grant from tobacco company Philip Morris International (PMI).1 These activities were certified (see the Supplement) by the Accreditation Council for Continuing Medical Education (ACCME) along with other health care professional education organizations (American Nurses Credentialing Center, Interprofessional Continuing Education, Accreditation Council for Pharmacy Education, American Board of Internal Medicine). As cigarette sales decline, PMI is promoting “harm reduction” nicotine products. This superficially appealing slogan thinly disguises PMI’s campaign to promote company brands designed to sustain nicotine addiction among people who smoke and entice youth who do not smoke to adopt new nicotine products.

...

"The tobacco industry has a long history of undermining science to promote its products, the leading cause of preventable disease and premature death in the US, indicating inherently unresolvable conflicts incompatible with education of clinicians or sponsorship of certified CME. PMI’s hypocrisy in promoting a harm reduction agenda is highlighted by its aggressive marketing of Marlboro, the world’s leading cigarette brand, including campaigns manifestly targeting youth."

...