Would RFK Jr. buck or bow to Big Tobacco?

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Robert F. Kennedy Jr. is expected take on Big Pharma, Big Food and Big Science if he’s confirmed as the next U.S. Secretary of Health and Human Services.

Two critical questions for his upcoming Senate confirmation hearing:

A welcome though last-minute move by the Biden administration to prevent young people from getting hooked on smoked tobacco adds urgency to pressing Kennedy about this particular public health issue. The Senate hearing is expected later this month.

On Wednesday, the U.S. Food and Drug Administration (FDA) announced a historic step, one that could prevent millions of premature deaths in years to come by drastically limiting nicotine levels in cigarettes and most other smoked tobacco products.

As the FDA noted, “nicotine is the primary addictive chemical in tobacco products that keeps people using the products.” The proposed rule announced Wednesday, if finalized, would cap nicotine at a very low level. In turn, that could make cigarettes and other products such as cigarillos minimally or even nonaddictive.

To be clear, the move would not ban any tobacco products. But setting the nicotine ceiling so low — at 0.7 milligrams per gram of tobacco when the industry has averaged around 17.2 mg/g — means little to no pleasurable rush from lighting up.

New smokers may not get addicted, preventing the long list of health risks that accompany cigarette use. Longtime smokers may also benefit, such as by quitting when there’s no longer an upside to tobacco use. Or, they might also move to less harmful though still risky e-cigarettes (which would not be affected by the proposed nicotine cap).

Some might wonder whether longtime smokers would simply smoke more to compensate. The FDA addressed this concern, saying “a large body of research also shows that reduced nicotine content cigarettes do not lead smokers to compensate for lower nicotine by smoking more.”

Smoking more to get the same nicotine hit also isn’t likely realistic if the nicotine level is at 0.7 mg/g vs. the 17.2 mg/g average.

Smoking cessation experts like Richard Hurt, a retired Mayo Clinic physician, understandably praised the FDA proposal as “huge step forward.” In an interview on Thursday, Hurt noted how much of a disrupter this could be for the tobacco industry.

Young people experimenting with cigarettes “never become addicted to begin with. Therefore, over time, you wouldn’t have the replenishment of the ranks of smokers with young people, or as the industry calls them ‘replacement smokers,’ ” Hurt said.

Sadly, replacement smokers are needed because those using these products tend to die off prematurely. Smoking is a “major driver of chronic disease” and smokers have a mortality rate two to three times higher than those who have never smoked, the FDA reports.

“Cigarettes are responsible for the majority of tobacco-related death and disease in the United States. Each year, 480,000 people die prematurely from a smoking-attributable disease, putting a substantial burden on the U.S. healthcare system and causing massive economic losses to society.”

To sum up, the FDA move if finalized would save smokers’ lives and could significantly reduce the nation’s health care spending without limiting patient access to quality care or new treatments.

That ought to be right in the wheelhouse of Kennedy, who has vowed to “Make America Healthy Again" by concentrating on chronic diseases. By teeing up the nicotine cap, the exiting Biden administration has provided a golden opportunity for Kennedy to make good on that promise.

The FDA action on Wednesday involved issuing a proposed rule to restrict nicotine levels. The public comment period ends Sept. 15, the announcement said, after which the “agency will review it as it considers future action.”

That means the responsibility for finalizing the nicotine cap rule will fall to the Trump administration and Kennedy if he’s confirmed.

Kennedy ought to enthusiastically embrace the proposed nicotine limits. And he should be quizzed about his position on this during the hearing. Hopefully, Minnesota’s two U.S. senators, Amy Klobuchar and Tina Smith, will help ensure this happens.

But as Mayo’s Hurt noted, nicotine limits will face fierce political opposition. The tobacco industry’s profits depend on hooking young people. The industry “will fight this tooth and nail,” he said.

The nicotine cap has been under consideration for years, Hurt noted. If it were easy, it would be in place already. The industry has long had a successful playbook of “delay, delay, delay and delay,” Hurt said.

Hurt has tangled with the industry before and knows how hard it is to mount a challenge. In the 1990s, the Minnesota attorney general and a state health insurer filed a historic lawsuit against tobacco companies. Hurt served as the state’s lead witness when the case went to trial, yielding a $6.6 billion settlement that made public damning industry documents.

Kennedy, or anyone else leading HHS, will need to be the same type of fearless crusader to make nicotine caps a reality. Just as important: Trump’s backing.

Does Kennedy have the fortitude to take on this worthy cause? His answers at the upcoming hearing will indicate if he and his boss will buck or bow to tobacco and other powerful special interests standing in the way of meaningful public health advances.