Brownstone Institute
Lead Author of Cochrane Mask Review Responds to Fauci’s Dismissal of Evidence
From the Brownstone Institute
BY
Former chief medical advisor to the US President Anthony Fauci was questioned over the weekend by CNN reporter Michael Smerconish, about face masks being able to curb the spread of covid-19.
“There’s no doubt that masks work,” said Fauci.
“Different studies give different percentages of advantage of wearing it, but there’s no doubt that the weight of the studies … indicate the benefit of wearing masks,” he added.
Smerconish brought up the 2023 Cochrane review which found no evidence that physical interventions like face masks could stop viral transmission in the community and cited my interview with lead author of the study Tom Jefferson who confirmed, “There is just no evidence that they [masks] make any difference. Full stop.”
Fauci replied, “Yeah but there are other studies,” stressing that masks work on an individual basis.
“When you’re talking about the effect on the epidemic or the pandemic as a whole, the data are less strong…but when you talk about an individual basis of someone protecting themselves or protecting themselves from spreading it to others, there’s no doubt that there are many studies that show there is an advantage,” said Fauci.
Professor Tom Jefferson, who says he is committed to updating the Cochrane review as new evidence emerges, has responded to Fauci’s comments.
“So, Fauci is saying that masks work for individuals but not at a population level? That simply doesn’t make sense,” said Jefferson.
“And he says there are ‘other studies’…but what studies? He doesn’t name them so I cannot interpret his remarks without knowing what he is referring to,” he added.
Jefferson explains that the entire point of the Cochrane review was to systematically sift through all the available randomized data on physical interventions such as masks and determine what was useful and what was not.
Since 2011, the Cochrane review only included randomized trials to minimise bias from confounders.
“It might be that Fauci is relying on trash studies,” said Jefferson. “Many of them are observational, some are cross-sectional, and some actually use modelling. That is not strong evidence.”
“Once we excluded such low-quality studies from the review, we concluded there was no evidence that masks reduced transmission,” he added.
The problem with Fauci is that his story has changed.
Initially, Fauci said that masks were ineffective and unnecessary. In March 2020, Fauci told 60 Minutes, “Right now in the United States, people should not be walking around with masks.”
But only a few weeks later, he did a U-turn and began recommending widespread use of face masks.
Fauci defended his U-turn saying, “When the facts change, I change my mind.”
Jefferson retorted, “What facts changed? There were no randomized studies, no new evidence to justify his flip-flop. That’s simply not true.”
Since then, Fauci has remained adamant that face masks not only stop people from infecting others, but they also protect the wearer.
Fauci advocated for the use of cloth masks, and even encouraged double-masking in the absence of evidence.
“You put another layer on, it just makes common sense that it would be more effective,” Fauci told NBC News.
“What Fauci doesn’t understand is that cloth and surgical masks cannot stop viruses because viruses are too small and they still get through,” said Jefferson.
He laments that public figures have tried to undermine the Cochrane review, despite it representing the gold standard of evidence.
Columnist Zeynep Tufekci wrote an article in the New York Times titled, “Here’s Why the Science Is Clear That Masks Work,” claiming that Cochrane’s mask study had misled the public.
Cochrane’s editor-in-chief, Karla Soares-Weiser capitulated to pressure and “apologized” for the wording in the plain language summary of the review because it “was open to misinterpretation” and may have led to “inaccurate and misleading” claims.
And former CDC director Rochelle Walensky misled Congress after claiming the Cochrane review had been “retracted” which was patently false.
As it stands, the Cochrane review will continue to be the subject of attacks because it presents a major roadblock for implementing masking policies. Jefferson says he doesn’t know what motivates people to ignore the facts.
“Could it be part of this whole agenda to control people’s behaviour? Perhaps,” he speculated.
“What I do know,” said Jefferson, “is that Fauci was in a position to run a trial, he could have randomized two regions to wear masks or not. But he didn’t and that’s unforgivable.”
Fauci, who served as the federal government’s top infectious disease specialist for nearly 40 years, stepped down in Dec 2022 and is now a professor at Georgetown University’s Department of Medicine, in the Division of Infectious Diseases.
Reposted from the author’s Substack
Author
Brownstone Institute
Bizarre Decisions about Nicotine Pouches Lead to the Wrong Products on Shelves
From the Brownstone Institute
A walk through a dozen convenience stores in Montgomery County, Pennsylvania, says a lot about how US nicotine policy actually works. Only about one in eight nicotine-pouch products for sale is legal. The rest are unauthorized—but they’re not all the same. Some are brightly branded, with uncertain ingredients, not approved by any Western regulator, and clearly aimed at impulse buyers. Others—like Sweden’s NOAT—are the opposite: muted, well-made, adult-oriented, and already approved for sale in Europe.
Yet in the United States, NOAT has been told to stop selling. In September 2025, the Food and Drug Administration (FDA) issued the company a warning letter for offering nicotine pouches without marketing authorization. That might make sense if the products were dangerous, but they appear to be among the safest on the market: mild flavors, low nicotine levels, and recyclable paper packaging. In Europe, regulators consider them acceptable. In America, they’re banned. The decision looks, at best, strange—and possibly arbitrary.
What the Market Shows
My October 2025 audit was straightforward. I visited twelve stores and recorded every distinct pouch product visible for sale at the counter. If the item matched one of the twenty ZYN products that the FDA authorized in January, it was counted as legal. Everything else was counted as illegal.
Two of the stores told me they had recently received FDA letters and had already removed most illegal stock. The other ten stores were still dominated by unauthorized products—more than 93 percent of what was on display. Across all twelve locations, about 12 percent of products were legal ZYN, and about 88 percent were not.
The illegal share wasn’t uniform. Many of the unauthorized products were clearly high-nicotine imports with flashy names like Loop, Velo, and Zimo. These products may be fine, but some are probably high in contaminants, and a few often with very high nicotine levels. Others were subdued, plainly meant for adult users. NOAT was a good example of that second group: simple packaging, oat-based filler, restrained flavoring, and branding that makes no effort to look “cool.” It’s the kind of product any regulator serious about harm reduction would welcome.
Enforcement Works
To the FDA’s credit, enforcement does make a difference. The two stores that received official letters quickly pulled their illegal stock. That mirrors the agency’s broader efforts this year: new import alerts to detain unauthorized tobacco products at the border (see also Import Alert 98-06), and hundreds of warning letters to retailers, importers, and distributors.
But effective enforcement can’t solve a supply problem. The list of legal nicotine-pouch products is still extremely short—only a narrow range of ZYN items. Adults who want more variety, or stores that want to meet that demand, inevitably turn to gray-market suppliers. The more limited the legal catalog, the more the illegal market thrives.
Why the NOAT Decision Appears Bizarre
The FDA’s own actions make the situation hard to explain. In January 2025, it authorized twenty ZYN products after finding that they contained far fewer harmful chemicals than cigarettes and could help adult smokers switch. That was progress. But nine months later, the FDA has approved nothing else—while sending a warning letter to NOAT, arguably the least youth-oriented pouch line in the world.
The outcome is bad for legal sellers and public health. ZYN is legal; a handful of clearly risky, high-nicotine imports continue to circulate; and a mild, adult-market brand that meets European safety and labeling rules is banned. Officially, NOAT’s problem is procedural—it lacks a marketing order. But in practical terms, the FDA is punishing the very design choices it claims to value: simplicity, low appeal to minors, and clean ingredients.
This approach also ignores the differences in actual risk. Studies consistently show that nicotine pouches have far fewer toxins than cigarettes and far less variability than many vapes. The biggest pouch concerns are uneven nicotine levels and occasional traces of tobacco-specific nitrosamines, depending on manufacturing quality. The serious contamination issues—heavy metals and inconsistent dosage—belong mostly to disposable vapes, particularly the flood of unregulated imports from China. Treating all “unauthorized” products as equally bad blurs those distinctions and undermines proportional enforcement.
A Better Balance: Enforce Upstream, Widen the Legal Path
My small Montgomery County survey suggests a simple formula for improvement.
First, keep enforcement targeted and focused on suppliers, not just clerks. Warning letters clearly change behavior at the store level, but the biggest impact will come from auditing distributors and importers, and stopping bad shipments before they reach retail shelves.
Second, make compliance easy. A single-page list of authorized nicotine-pouch products—currently the twenty approved ZYN items—should be posted in every store and attached to distributor invoices. Point-of-sale systems can block barcodes for anything not on the list, and retailers could affirm, once a year, that they stock only approved items.
Third, widen the legal lane. The FDA launched a pilot program in September 2025 to speed review of new pouch applications. That program should spell out exactly what evidence is needed—chemical data, toxicology, nicotine release rates, and behavioral studies—and make timely decisions. If products like NOAT meet those standards, they should be authorized quickly. Legal competition among adult-oriented brands will crowd out the sketchy imports far faster than enforcement alone.
The Bottom Line
Enforcement matters, and the data show it works—where it happens. But the legal market is too narrow to protect consumers or encourage innovation. The current regime leaves a few ZYN products as lonely legal islands in a sea of gray-market pouches that range from sensible to reckless.
The FDA’s treatment of NOAT stands out as a case study in inconsistency: a quiet, adult-focused brand approved in Europe yet effectively banned in the US, while flashier and riskier options continue to slip through. That’s not a public-health victory; it’s a missed opportunity.
If the goal is to help adult smokers move to lower-risk products while keeping youth use low, the path forward is clear: enforce smartly, make compliance easy, and give good products a fair shot. Right now, we’re doing the first part well—but failing at the second and third. It’s time to fix that.
Addictions
The War on Commonsense Nicotine Regulation
From the Brownstone Institute
Cigarettes kill nearly half a million Americans each year. Everyone knows it, including the Food and Drug Administration. Yet while the most lethal nicotine product remains on sale in every gas station, the FDA continues to block or delay far safer alternatives.
Nicotine pouches—small, smokeless packets tucked under the lip—deliver nicotine without burning tobacco. They eliminate the tar, carbon monoxide, and carcinogens that make cigarettes so deadly. The logic of harm reduction couldn’t be clearer: if smokers can get nicotine without smoke, millions of lives could be saved.
Sweden has already proven the point. Through widespread use of snus and nicotine pouches, the country has cut daily smoking to about 5 percent, the lowest rate in Europe. Lung-cancer deaths are less than half the continental average. This “Swedish Experience” shows that when adults are given safer options, they switch voluntarily—no prohibition required.
In the United States, however, the FDA’s tobacco division has turned this logic on its head. Since Congress gave it sweeping authority in 2009, the agency has demanded that every new product undergo a Premarket Tobacco Product Application, or PMTA, proving it is “appropriate for the protection of public health.” That sounds reasonable until you see how the process works.
Manufacturers must spend millions on speculative modeling about how their products might affect every segment of society—smokers, nonsmokers, youth, and future generations—before they can even reach the market. Unsurprisingly, almost all PMTAs have been denied or shelved. Reduced-risk products sit in limbo while Marlboros and Newports remain untouched.
Only this January did the agency relent slightly, authorizing 20 ZYN nicotine-pouch products made by Swedish Match, now owned by Philip Morris. The FDA admitted the obvious: “The data show that these specific products are appropriate for the protection of public health.” The toxic-chemical levels were far lower than in cigarettes, and adult smokers were more likely to switch than teens were to start.
The decision should have been a turning point. Instead, it exposed the double standard. Other pouch makers—especially smaller firms from Sweden and the US, such as NOAT—remain locked out of the legal market even when their products meet the same technical standards.
The FDA’s inaction has created a black market dominated by unregulated imports, many from China. According to my own research, roughly 85 percent of pouches now sold in convenience stores are technically illegal.
The agency claims that this heavy-handed approach protects kids. But youth pouch use in the US remains very low—about 1.5 percent of high-school students according to the latest National Youth Tobacco Survey—while nearly 30 million American adults still smoke. Denying safer products to millions of addicted adults because a tiny fraction of teens might experiment is the opposite of public-health logic.
There’s a better path. The FDA should base its decisions on science, not fear. If a product dramatically reduces exposure to harmful chemicals, meets strict packaging and marketing standards, and enforces Tobacco 21 age verification, it should be allowed on the market. Population-level effects can be monitored afterward through real-world data on switching and youth use. That’s how drug and vaccine regulation already works.
Sweden’s evidence shows the results of a pragmatic approach: a near-smoke-free society achieved through consumer choice, not coercion. The FDA’s own approval of ZYN proves that such products can meet its legal standard for protecting public health. The next step is consistency—apply the same rules to everyone.
Combustion, not nicotine, is the killer. Until the FDA acts on that simple truth, it will keep protecting the cigarette industry it was supposed to regulate.
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