As the federal government has backed away from a ban on flavored e-cigarettes, opponents of the products are shifting their attention to state and local levels. It’s easy to understand the reasons for concern: Vaping is novel, we’re protective of the youth, the wave of lung illness is frightening, and the carnage caused by cigarettes has made us wary of nicotine in any form. But getting risk right requires taking a step back, calmly evaluating the evidence, and not giving in to panic.
First, let’s put the alleged danger of e-cigarettes into perspective. Fifty-two people have died from the so-called “vaping lung illness” nationwide. In comparison, the Centers for Disease Control and Prevention attribute 480,000 deaths to smoking in the United States each year. That means that around 25 times more people die from smoking every day than have died from the entirety of the current outbreak. From a public health perspective, providing smokers with every opportunity to quit, including the use of flavored e-cigarettes that many adult smokers find most appealing, should be our greatest priority.
Second, let’s be clear about the cause of this lung illness. In the CDC’s latest testing, 100% of patients’ lung fluids came back positive for vitamin E acetate, an adulterant used to dilute cannabis oils without visibly thinning them. The vast majority of patients report vaporizing THC, and we know that even this is likely underreported because patients are reluctant to admit to using cannabis or may have done so unknowingly. Opponents of vaping are cynically sowing confusion about the outbreak to demonize e-cigarettes and vape shops. Don’t let them fool you.
The other justification for these bans is the use of e-cigarettes by youth, which is a legitimate worry. But here, too, some perspective is in order. Scary statistics in the news generally reference experimental or occasional use by teens. The percentage of teens who vape habitually is much lower, and the percentage who do so without having previously smoked is lower still. Most importantly, and in clear contradiction to the “gateway effect” that vaping opponents have warned about for years, teen use of cigarettes is falling dramatically — by almost two-thirds over the past decade and by 28% in just the past year. This is a remarkable achievement that is almost completely ignored in debates about vaping.
For adult smokers, there is compelling evidence that e-cigarettes carry a lower risk and can be an aid to quitting. A randomized control trial with nearly 900 participants found e-cigarettes to be twice as effective as conventional nicotine replacement therapies such as gums or patches. The population-level quit rate in the U.S. increased as vaping became popular, with smokers trying e-cigarettes among the most successful at giving up smoking. Modeling by public health researchers suggests that widespread switching from smoking to vaping could prevent more than six million premature deaths in the U.S. through the end of the century.
Ideological opponents of nicotine use insist on an abstinence-only approach, but we know from the experience of other countries that tobacco harm reduction can change behavior and save lives. In Sweden and Norway, a low-risk form of oral tobacco called snus has played a similar role to e-cigarettes in the U.S. Swedish men gave up smoking for snus, and the country now boasts Europe’s lowest rates of tobacco-related mortality. In Norway, the adoption of snus has helped halve the smoking rate in just one decade. Among young Norwegians, smoking is vanishing. This success was achieved not by demanding abstinence or implementing coercive bans but by allowing adults access to a much safer alternative — one that, incidentally, comes in a wide variety of flavors.
Could cigarette smoking vanish in the U.S. too? Yes, if we allow vaping to compete with it. Banning flavors and exaggerating dangers will create black markets and perpetuate smoking. Instead, we should strike the same bargain we do for alcohol and, increasingly, marijuana: strong enforcement of rules against underage sales tempered by respect for free adults to make their own choices about what they put into their bodies.
Americans learned the folly of prohibiting alcohol in just 13 years. We are learning still the folly of the war on drugs. Vaping’s opponents seek to drag us down the same wretched path once more. To save lives and preserve liberties, there is a simple response to their call for moral panic: Just say no.
Jacob Grier is the author of The Rediscovery of Tobacco: Smoking, Vaping, and the Creative Destruction of the Cigarette.
