Tuesday, September 17, 2019

A Bad Case of the Vapors

By John Tierney
September 16, 2019

Image result for vaping

The war on nicotine vaping has reached a new level of absurdity. It was bad enough when public health officials, politicians, and the press reacted to the recent outbreak of respiratory illness among vapers of marijuana by failing to warn the public in a clear manner. Instead of explaining the specific danger from vaping a certain kind of THC-infused oil, officials at the Centers for Disease Control and politicians like New York Governor Andrew Cuomo told the public to stop using any kind of electronic cigarette—which is like responding to an outbreak of food poisoning by telling people to stop eating.

But now officials are using the panic they sowed to justify policies that could shorten the lives of millions of Americans. The governors of New York and Michigan have moved immediately to ban the most popular flavors of nicotine e-cigarettes used by adult smokers to quit, and the Trump administration plans to ban them nationwide. “People are dying from vaping,” Trump said, justifying the Food and Drug Administration’s plan, but there is scant evidence that nicotine vaping has contributed to any of the recent deaths or illnesses. The evidence so far clearly points to a problem with marijuana vaping, in particular to an oil derived from Vitamin E that has been added to THC in vaping cartridges sold mainly on the black market.

So why go after nicotine e-cigarettes? It’s true that a small minority of the stricken vapers said they had used nicotine, not THC, but researchers say they may have been loath to admit to illegal activity. Their symptoms don’t seem plausibly related to ordinary nicotine vaping. Nicotine, unlike THC, is water-soluble and can be vaped without the additives used to vaporize THC—like the oil blamed for the recent epidemic. It’s conceivable that some people were harmed by dangerous ingredients that were added to nicotine in liquids that were home-made or purchased on the black market, but that’s no reason to ban commercial e-cigarettes like Juul, which have been used by millions of people without causing respiratory problems. In an article published last month in Expert Review of Respiratory Medicine, a team of Italian, Canadian, and American scientists surveyed the clinical research into e-cigarettes and reported that “no studies reported serious adverse events” or “significant changes in pulmonary functions.”

Their findings jibed with the conclusions by British medical authorities that nicotine itself is no more harmful than caffeine, and that e-cigarettes are at least 95 percent safer than tobacco cigarettes. While the U.S. public-health establishment has been misleading the public—so that a majority of Americans now mistakenly believe that e-cigarettes are as harmful or even more harmful than cigarettes—the Royal Society for Public Health has been urging smokers to switch to vaping, and British hospitals have been promoting e-cigarettes by allowing vape shops to operate on their premises.

The FDA is doing just the opposite with its new policies, which it tried to justify last week by releasing the latest results of the National Youth Tobacco Survey. The survey showed that 27.5 percent of high school students in 2019 had vaped at least once in the previous month, an increase from the previous year’s figure of 20.8 percent. No one wants teenagers to develop a nicotine habit, but vaping it is far safer than smoking, and in any case much of the increase in vaping has nothing to do with nicotine. Many of the students are vaping non-nicotine liquids, notably THC, which has surged in popularity among teenage vapers, especially in states that have legalized marijuana.

Meanwhile, the FDA (and most of the press) ignored the most important result from the new survey: the sharpest one-year decline in teenage smoking ever recorded. The fraction of high school students who’d smoked in the previous month declined by 28 percent, from 8.1 percent of students in 2018 to 5.8 percent in 2019—a historic low reached thanks to the availability of cigarette alternatives. Since e-cigarettes first appeared in 2010, smoking rates among teenagers, young adults, and older adults have fallen much faster than during the pre-vaping years. 

But this remarkable progress against the leading preventable cause of death is now jeopardized by the FDA’s proposal to ban Juul and other companies from selling anything except tobacco-flavored e-cigarettes. Anti-smoking activists claim that flavors like mango and mint are being used to entice teenagers, but it’s already illegal for teenagers to buy any kind of e-cigarette, and these non-tobacco flavors are favored by more than three-quarters of the adult smokers who switch to vaping. In fact, one of the benefits of e-cigarettes is that once smokers become accustomed to getting nicotine from something that tastes better than tobacco, they can become repulsed by the taste of regular cigarettes.

What happens if those other flavors get banned? One consequence would be a black market in flavored liquids—and more risk of unsafe ingredients being added. Another consequence would be an increase in smoking, as Laura Pacek of the Duke School of Medicine and colleagues reported this summer in the journal Substance Use & Misusebased on a study of 240 young adults who use e-cigarettes as well as tobacco cigarettes. When asked how they would respond to a ban on flavored nicotine e-cigarettes, the young adults said that they would smoke more tobacco cigarettes.

That’s the same conclusion reached by Wall Street, which reacted to the FDA’s new plan by sending tobacco stocks higher. Michael Siegel, a professor at the Boston University School of Public Health who studies tobacco-control policies,says that Wall Street’s reaction “may be the best evidence yet that the FDA’s flavored e-cigarette ban will result in a substantial increase in smoking-related morbidity and mortality.” He calls it a “public-health disaster,” and the numbers back him up. By exploiting the panic they created over a few hundred cases of respiratory illness almost certainly unrelated to nicotine e-cigarettes, the federal government is in effect encouraging smokers to maintain a habit that is responsible for the deaths of 1,300 Americans per day. The U.S. public health establishment remains, more than ever, a hazard to public health.

John Tierney is a contributing editor of City Journal and a contributing science columnist for the New York Times.

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