Harm Reduction

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

Nicole Saphier seems determined to obscure the health advantages of a much less hazardous alternative to cigarettes.

Jacob Sullum | 5.4.2026 2:20 PM

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Surgeon General nominee Nicole Saphier (Illustration: Lex Villena; MSK, Midjourney)

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........

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