Tobacco kills half a million people a year.
Talking about the impact of smokers’ switching from cigarettes to vaping in a recent interview with Medscape, Dr. Scott Gottlieb, the head of the Food and Drug Administration (FDA) said this:
At face value, we believe that these products pose less risk than combusting tobacco. If you can fully switch every currently addicted adult smoker who is using combustible tobacco products onto e-cigarettes, you will have a profound impact on public health. And some people are able to switch completely. We think that is a public health benefit.
Back in November, he told CNBC: "If we can switch every adult smoker fully to e-cigarettes, it would have a huge public health impact." And in a Tweet on January 19, Gottlieb reaffirmed his belief that "if every currently addicted adult smoker switched completely to e-cigs it would provide a tremendous public health gain."
Well, yes. By now it is hard to ignore the studied and reported health benefits for smokers who switch to e-cigarettes. Study after study has concluded that using e-cigarettes, like Juul, is eminently safer than smoking cigarettes since they deliver nicotine — what smokers are after — while eliminating 95 percent of the harm of smoking regular cigarettes. New research also finds that "switching entirely to Juul reduced smokers' exposure to biomarkers, or signals of exposure to cigarette smoking, 99.6 percent as much as abstaining entirely from cigarettes."
Another study, reported in the New England Journal of Medicine, finds that vaping is also significantly more effective than FDA-approved nicotine medicines in helping smokers quit. And indeed, data show that many smokers are switching, and hence quitting conventional cigarettes.
Unfortunately, Gottlieb’s tweet also says: "But if youth use continues to rise, the entire category faces an existential threat."
Basically, he is saying that if youth consumption of e-cigarettes continues to increase, the FDA won’t hesitate to impose sweeping regulations that could end up killing the one innovation responsible for the biggest public health reduction ever made available to smokers.
This threat is justified, in part, by data showing that vaping among 12th, 10th, and 8th graders has almost doubled between 2017 and 2018 (from 11 to 20.9 percent for 12th graders, 8.2 to 16.1 percent for 10th graders, and 3.5 to 6.1 percent for 8th graders). Part of this impressive growth is simply the result of the fact that vaping didn’t exist just a few years ago.
As John Tierney explained last summer in City Journal:
The press has been scaring the public with tales of high schools filled with nicotine fiends desperately puffing on Juuls, but the latest federal survey, released last month, tells a different story. The vaping rate last year among high-school students, a little less than 12 percent, was actually four percentage points lower than in 2015, when Juul was a new product with miniscule sales. As Juul sales soared over the next two years, the number of high-school vapers declined by more than a quarter, and the number of middle-school vapers declined by more than a third — hardly the signs of an epidemic.
Apart from failure to understand the data, there is also the fact that vaping is reported in the press in a way that often gives the impression that teens never used illegal substances before vaping came along. From the stories my friends tell me about their teenage years, and from my own experience, I know it’s not true.
And underreported is the happy fact that minors, as well as adults, are reducing dramatically their consumption of traditional tobacco products.
Last November, a study by the Georgetown University Lombardi Comprehensive Cancer Center, in Washington, D.C., found that "smoking among teens dropped off dramatically after e-cigarette use became more widespread." According to David Levy, the lead researcher on the study, the rate of decline in cigarette use tripled.
Another beef that the FDA has with e-cigarettes is that they might not reduce smokers’ addiction to nicotine. Interestingly, the concern over nicotine isn’t shared by European, U.K., or Canadian health officials. This American exceptionalism is weird. After all, while nicotine is addictive, it isn’t what kills smokers. In play here is nothing but nanny statism.
What about the fear that because e-cigarettes deliver nicotine, they are a gateway to smoking addiction? It’s unfounded. As Tierney reports, "Studies have repeatedly shown that they’re not even a gateway to regular vaping, much less smoking. (See "The Corruption of Public Health," Summer 2017.)"
All that said, everyone supports keeping minors away from e-cigarettes. Since 2016, the FDA has included e-cigarettes in its regulation of tobacco products, and it prevents their sale to minors. In addition, Juul has come out in favor of increasing the legal age of purchase from 18 to 21 in order to avoid the risk that high school students who turn 18 before they graduate (80 percent do) will supply e-cigarettes to their younger friends. These regulations put e-cigarettes on an equal footing with cigarettes and alcohol.
Juul has even made it terribly hard for minors to buy its very popular mango-flavored e-cigarettes. It does so by selling it only on its website and by requiring that consumers first upload their IDs. Unfortunately, this move also makes it harder for adult smokers to buy the flavor, which could reduce the rate at which adults switch from smoking to vaping. However, the company felt that self-regulation was an important way to demonstrate its commitment to preventing teen consumption of Juul products.
Unfortunately, the FDA campaign against e-cigarettes in the name of any real or imaginary risks they cause to minors comes at the unambiguous expense of adult smokers. In addition, given the scare tactics, as well as the failure to adequately acknowledge that switching to e-cigarettes truly would benefit smokers, many continue smoking conventional tobacco products. National Review’s Kevin Williamson correctly labeled the FDA "the Marlboro Man’s best friend."
The contrast with other countries is striking. In the U.K., government officials and most medical societies encourage smokers to switch to e-cigarettes. They apparently understand the important role vaping plays in harm reduction. They also understand the impact this switch will have on government spending as smokers stop needing care for the diseases they contract because of their smoking habits. And as mentioned earlier, these officials abroad, unlike Americans, also aren’t concerned with nicotine addiction.
As Peter Hajek, a public health researcher at Queen Mary University of London, told the press recently, "For us the lung disease, heart disease and emphysema to which smokers are at risk are important." He continued, "We are talking about smokers who otherwise are going to get these horrible diseases and now won’t get them. For us, the fact that they are now vaping is problem solved."
U.K. officials are taking steps to keep minors away from e-cigarettes in part by highlighting that this is a device to help adult smokers switch.
The same is true elsewhere in Europe, where health officials have embraced the new technology.
And in Canada, government officials have set clear rules that e-cigarette companies must follow — rules such as banning cartoons on the boxes, and prohibition of candy flavors. In the U.S., by contrast, health officials haven’t clarified any limits on flavors, thus leaving companies unsure as to what they should do.
Meanwhile, back in 2016, the FDA froze the marketplace by saying that existing products could remain on the market pending approval (they still have not clarified how to get approval) but that no new products would be allowed to enter the market after 2016 and no changes could be made to existing products. Imagine if the government had told Apple in 2008 that it could continue selling its very first smartphone model (the iPhone 2G) but couldn’t make any changes to it.
That’s what the FDA is doing with e-cigarettes.
Rest assured, Juul and other companies won’t stay idle. They will innovate, they will improve their products, they might even figure out how to eliminate the concern with nicotine addiction. But they won’t do it in the U.S., where they are being held back by the FDA. The biggest losers will be American smokers, who will continue smoking regular cigarettes while Canadian, European, and U.K smokers will switch and enjoy significant harm reduction from the change.