At this point, the best information suggests that a recent spate of deaths from a vaping-related lung disease — six at last report — had little or nothing to do with legal e-cigarettes. Rather, the deaths, and more than 300 confirmed cases of the disease in dozens of states, seem to be linked to illegal cartridges, mostly using marijuana derivatives that had been emulsified with vitamin E acetate, according to Food and Drug Administration investigators. The FDA has warned against using it for inhalation, and it isn’t used in legally manufactured e-cigarettes.
Naturally, the government wants to ban legally manufactured e-cigarettes.
President Trump is proposing to ban flavored cartridges, apparently endorsing the theory — common among people who neither smoke nor vape — that these products appeal only to children. In fact, the majority of adult vapers select flavors other than tobacco because — and I speak as a former smoker — tobacco tastes kind of gross. Most smokers merely endured it for that divine rush of nicotine.
The Michigan Department of Health and Human Services is way ahead of Trump; the state has already issued an emergency directive banning flavored vapes. New York moved on Sunday to follow suit. And a New Jersey state legislator is one-upping them both, proposing to ban vaping entirely.
These officials are right that the country faces a public-health crisis that could kill huge numbers of people, and that something should be done. In fact, they are that crisis, a crisis of hysteria masquerading as prudence.
Most of what is known about vaping suggests it’s saving lives. A randomized controlled trial in Britain’s National Health Service found that people offered vaping as a replacement for smoking were twice as likely to quit successfully as those given traditional nicotine-replacement therapy. I myself know at least a half-dozen heavy smokers who have kicked the habit thanks to vaping.
Collectively, my friends have probably added at least a couple of decades of human life by switching to vaping, which Public Health England estimates to be 95 percent less harmful than breathing cigarette smoke. Given the approximately 10 million Americans who use e-cigarettes — most whom seem to be current or former smokers — and you’re talking about life-centuries, life-millennia, life-eons saved by the very products that federal government is now proposing to ban.
But what about the children, some will cry. I have some good news: While youth vaping has risen dramatically since 2011 (unsurprising, since that’s about when the products hit the mass market), the rise has coincided with a sharp decline in their smoking rates.
In 2018, roughly 20 percent of high school students said they had used e-cigarettes within the past 30 days, compared with 1.5 percent in 2011. But only 8.1 percent of high school students reported using the combustible kind of cigarette, compared with 15.8 percent in 2011. And there is evidence that these two things are causally related: Youth smoking rates have been falling for quite some time, but the trend appears to have accelerated since vaping products came on the scene.
Given the evidence about e-cigarettes and tobacco use, why is the U.S. public-health community seemingly so bent on taking the most irresponsible route possible?
One possible explanation seems valid enough: Researchers don’t have decades of epidemiological data on vaping, as they do for smoking. Heroin was originally conceived of and marketed as a safe alternative to morphine; public-health officials are leery of making a similar mistake with “safer” alternatives to tobacco. The caution is admirable, but remember what is known: the absolutely enormous risks of smoking cigarettes. The Centers for Disease Control and Prevention estimates that 480,000 Americans die from smoking-related illnesses annually.
An equally likely explanation lies in the broad Puritan streak that still runs through American culture — especially the U.S. public-health community, which often epitomizes the aphorism that drinking would be seen as a virtue, rather than a vice, if only the hangover preceded the intoxication.
One gets the sense that many public health experts think that ex-smokers should atone with ascetic self-denial, rather than a pleasurable substitute. One also senses that their long tussle with the tobacco industry has created a Pavlovian aversion to anything that even resembles smoking. So instead of harm reduction — which they might be quick to suggest for opioid addicts — they advise politicians to restrict vaping as much as possible, even if that means more deaths from cancer, stroke and lung disease.
And that trade-off even sounds semi-reasonable, in the abstract. Until you meet real people suffering the agonies of cancer or the slow strangulation of emphysema. The people rushing to protect children from e-cigarettes should remember that every one of those patients was somebody’s kid. So are a lot of current teens who might be taking up cigarette smoking if a much pleasanter, and by all evidence safer, alternative weren’t available.
One of those kids might be yours; not one of them deserves to die.