War on Vaping Threatens Public Health
Will the government hamstring what is potentially the most important public health innovation of the 21st century?
Last week, the Food and Drug Administration announced “historic action” against e-cigarette manufacturers for what it sees as an “epidemic” of vaping among teenagers. E-cigarette makers have 60 days to come up with plans to mitigate teenage use of their products or face civil or criminal prosecution as well as new regulations such as sales bans on some of their products.
Such a move could reverse recent stop-smoking achievements. While smoking rates have been declining steadily over the last half century, the pace has dramatically picked up in recent years as e-cigarettes have gained popularity.
If regulators don’t get in the way, e-cigarettes can continue to chip away at the one-in-six Americans who still smoke. This would be a major victory for public health. Smoking is still responsible for one in every five deaths. That is nearly three times more than the combined number of suicide, overdose, and alcohol-related deaths, whose rise has been attributed to the decline in U.S. life expectancy.
E-cigarettes are a comparably safe alternative that help people quit smoking because they deliver nicotine through water vapor — without the tar, smoke, carbon monoxide, and countless carcinogens in cigarettes.
Public Health England has concluded that “vaping is at least 95 percent less harmful than smoking.” The Royal College of Physicians finds that “large-scale substitution of e-cigarettes … has the potential to prevent almost all the harm from smoking in society.” Last month, a comprehensive U.K. Parliament report concluded that e-cigarettes can significantly accelerate the decline of smoking rates and called on policymakers to lessen regulatory and tax burdens holding back their use.
Stop-smoking aids that deliver nicotine without the filth are not new. Nicotine gum and patches have been on the market for decades. But they have had limited success, with just 7 percent of users stopping smoking as a result.
Compare that to the use of e-cigarettes. A recently released Center for Substance Use Research survey of roughly 19,000 e-cigarette users found that nearly two-thirds of respondents were able to quit cigarette smoking as a result. Most of those respondents who continued to smoke cigarettes cut their intake by more than half.
Don’t trust survey data? A study published in the journal “Addiction” measured the carbon monoxide exhaled by e-cigarette users’ and found that two-thirds of participants had quit smoking. Center for Disease Control data suggest that well over 2.5 million American e-cigarette users have quit traditional cigarettes.
It’s true that teenagers, like adults, have transitioned from smoking to vaping. So much so that e-cigarette use now outpaces cigarette use: 11.7 percent of high-schoolers vaped over the past month while only 7.6 percent smoked cigarettes. Yet the CDC data also show that e-cigarette use has actually fallen among American high-schoolers since 2014. Don’t expect to hear this statistic amid the activist and editorial-board handwringing over vaping.
It is possible that vaping could still be a net negative if people who otherwise would never have smoked cigarettes were to start vaping in large numbers. Or even worse, if vaping were to serve as a gateway to smoking. Yet the evidence suggests these fears are misplaced. According to the large-scale survey of vapers, just 2 percent of respondents transitioned to smoking traditional cigarettes. University of Michigan researchers Kenneth Warner and David Mendez found that even with additional vaping-induced young smokers, e-cigarettes would save 3.3 million life-years because of the number of people giving up smoking.
The FDA claims the vaping epidemic gives it the right to take dramatic regulatory action. This includes forcing certain e-cigarette products off the market and subjecting others to so many compliance hoops that brands may not be able to keep them on the market. But forcing some or all e-cigarettes off the market means users could turn to far more dangerous nicotine sources.
Rather than threaten e-cigarette companies with extinction, the FDA should work with them to develop strategies and interventions that target the kids most likely to become vapers or smokers.
Anti-smoking extremists who want a total ban on vaping are salivating at the chance to sue e-cigarette makers out of existence. If the FDA aligns itself with this radical strategy it could endanger the public health. To be sure, vaping companies and the FDA must monitor its long-term effects. But right now, as Dr. Warner notes, “we have a crisis on our hands: Five hundred thousand people are dying each year because of smoking.” If the FDA engages in regulatory overreach, that number could grow.
Robert Goldberg is the vice-president of the Center for Medicine in the Public Interest.