Condemning Nicotine Pouches, Trump’s Surgeon General Nominee Reveals Her Hostility to Harm Reduction

During his Senate confirmation hearing in January 2025, Secretary of Health and Human Services Robert F. Kennedy Jr. slipped what seemed to be a nicotine pouch into his mouth, replacing a spent one that had been lodged between his lower lip and gums. Nicole Saphier, the radiologist and Fox News contributor whose nomination as surgeon general President Donald Trump announced last Thursday, was appalled. Her reaction, which she expressed in a New York Post op-ed piece published after Kennedy’s hearing, does not bode well for her attitude toward tobacco harm reduction or her ability to accurately discuss health topics as surgeon general.

“After decades of relentless public health campaigns and advocacy against cigarette smoking, we are witnessing the tangible benefits, with [declines in] smoking rates and the illnesses associated with [smoking],” Saphier wrote. “But as we relish this good news, the rise of nicotine pouches could upend this great advancement in public health.”

By preposterously suggesting that rising use of nicotine pouches might cancel out the health gains from reduced cigarette smoking, Saphier misled her readers in two important ways. First, she glided over the huge difference in the health risks posed by these two forms of nicotine consumption. Second, she ignored the role that nicotine pouches can play in “this great advancement” by offering smokers a much less hazardous alternative to cigarettes.

The Food and Drug Administration (FDA) recognized the harm-reducing potential of nicotine pouches in the waning days of the Biden administration, when it authorized the marketing of Zyn nicotine pouches in two doses and 10 flavors. That decision was based on the FDA’s determination that “the new products offer greater benefits to population health than risks.” The data, said Matthew Farrelly, director of the Office of Science at the FDA’s Center for Tobacco Products, “show that these nicotine pouch products meet that bar by benefiting adults who use cigarettes and/or smokeless tobacco products and completely switch to these products.”

Nicotine pouches contain “substantially lower amounts of harmful constituents than cigarettes,” the FDA noted. They therefore offer “a lower-risk alternative for adults who smoke cigarettes.”

Saphier not only ignored the scientific evidence underlying that analysis. She cast doubt on the health advantages of nicotine pouches, saying they are sold “under the pretext that they are a safer alternative to traditional cigarettes.” Social media influencers “promote these products as tobacco-free, smoke-free and odorless, undoubtedly more appealing than the carcinogen-laden smoke of cigarettes and tobacco,” she complained. “These marketing strategies seem cleverly designed to appeal to younger Americans.”

The thing is, nicotine pouches are “a safer alternative to traditional cigarettes,” as the FDA recognized. They are also indisputably “tobacco-free” and “smoke-free,” meaning their use does not entail exposure to the myriad toxins and carcinogens generated by tobacco combustion. But Saphier made it sound as if these advantages are illusory, a mere “pretext” or marketing gimmick.

“The FDA has authorized Zyn and other pouches as a smoking reduction aid, giving them a reputation as a less harmful alternative,” Saphier wrote. “Yet this authorization does not equate to a declaration of safety.”

By saying that nicotine pouches have “a reputation as a less harmful alternative,” Saphier again implied that the basis for that reputation is dubious. And by noting that the FDA’s decision does not amount to “a declaration of safety,” she obscured the whole point of harm reduction, which is not and never has been aimed at eliminating all risk.

Like pretty much everything that humans do, drug use carries some level of risk. But when one form of drug use is much less likely than another to make you sick or kill you, it is obviously preferable if the aim is reducing morbidity and mortality, the avowed goal of public health officials such as the surgeon general.

Saphier seems determined to obfuscate that point. Without ever conceding that nicotine pouches are safer than cigarettes, she warned that they “still deliver nicotine” (duh), which is “an addictive chemical known for its impact on cardiovascular health and brain development and its high potential to foster dependency.” As a physician and “a mom of three impressionable kids,” she said, “I’m deeply concerned about how the media are targeting nicotine pouches directly at teens and young adults, helping to normalize nicotine use at an age when the brain is still developing—and most vulnerable.”

Nicotine pouches are “particularly dangerous to adolescents and young adults,” Saphier wrote. “Given their still-developing brains, nicotine can impair cognitive function, alter brain development, affect concentration and self-control and potentially derail educational and social development. Regular use of nicotine can also lead to appetite suppression [and] weight loss and possibly fuel body-image disorders that run rampant among youth.”

Whatever you make of those warnings, they have nothing to do with the question of whether adults should be allowed to purchase these products. Saphier takes it for granted that concerns about underage consumption should trump the rights of adult smokers who might be interested in switching to nicotine pouches—a change that could literally save their lives by enabling them to avoid smoking-related diseases.

That assumption is morally dubious on its face, and it is especially questionable in light of data on adolescent use of nicotine pouches. According to the National Youth Tobacco Survey, just 1.6 percent of middle and high school students reported past-month use of nicotine pouches last year, down from 1.8 percent in 2024.

Saphier nevertheless castigated Kennedy, who will be her boss if she is confirmed as surgeon general, for “platforming this product on Capitol Hill.” Kennedy “was positioning himself as a warrior against chronic illness and discussing how he plans to combat diseases including food and drug addiction,” she said. “Here is a figure publicly advocating for health, yet engaging in the use of a highly addictive product while doing so.”

Leaving aside the question of whether it makes sense to view habits as diseases, Saphier’s reference to food “addiction” raises some interesting questions. Is overeating or a nutritionally deficient diet the sort of problem that can be addressed only by complete abstinence, which is the solution that Saphier favors for nicotine? Obviously not: When it comes to the food we eat, abstinence is not an option, and even incremental improvements can make a difference. The same goes for nicotine consumption. And when we are talking about a change that entails a dramatic reduction in disease risks, the public health calculation should be a no-brainer.

A November 2025 profile of Kennedy in The Atlantic noted that “he regularly pulls Zyn nicotine pouches from his shirt pocket or desk drawers to tuck between his lower lip and gum.” Although the author of that piece, Michael Scherer, thought Kennedy’s nicotine habit was inconsistent with “federal health advisories,” Kennedy was unapologetic. “I’m not telling people that they should do anything that I do,” he said. “I just say ‘get in shape.'”

Whatever you think of that explanation, Kennedy’s take on nicotine pouches as a harm-reduction tool is much more empirically grounded than Saphier’s. “Nicotine itself does not cause cancer,” he noted in a 2025 interview with Brazilian journalists. “Nicotine is of course clearly addictive, but it is not carcinogenic.” He added that “nicotine pouches are probably the safest way to consume nicotine, with vapes being second,” but “the thing we really want to get away from [is] cigarettes.”

Although Kennedy’s views on subjects such as vaccines and food dyes might make you question his scientific expertise, his assessment in this case was accurate and sensible. By contrast, Saphier can’t even bring herself to acknowledge the harm-reducing promise of nicotine pouches. Her highly misleading treatment of the subject would be medical malpractice if she were offering advice to a patient who smoked and was thinking about switching to the product that Kennedy uses. But soon, if the Senate is willing, she will be charged with advising Americans about such matters.

“When [Saphier] attacked RFK Jr. last year, she casually conflated nicotine pouches, one of the safest ways to use nicotine, with cigarettes and promoted panic over youth nicotine use, which is at a 25-year low,” notes Guy Bentley, director of consumer freedom at Reason Foundation (which publishes this website). “How can she be trusted to promote accurate information on safer nicotine alternatives to America’s smokers?”