Last week Scott Gottlieb announced his resignation as commissioner of the Food and Drug Administration. Unfortunately and unexpectedly, Gottlieb’s reign was a departure from lessening of government regulations so prevalent in other areas of the Trump Administration. His tenure culminated in siding with so-called and self-appointed public health experts who have ginned up hysteria about e-cigarettes and vaping. As a result, just yesterday the FDA moved to effectively ban flavored e-cigarettes from being sold in gas station and convenience stores, a policy that could actually harm public health. Go figure.
Vaping — smoking e-cigarettes — allows users to inhale nicotine without all of the carcinogens in cigarettes. Vaping is not harmless, of course. E-cigarettes also contain hazardous chemicals, but nowhere near as many as traditional cigarettes. Research shows that smokers who switch from cigarettes to e-cigarettes dramatically reduce the risks to their health.
E-cigarettes come in a variety of different flavors, and critics contend that the flavoring makes the product more attractive to teenagers. As proof, they cite a survey from the National Institute on Drug Abuse that found a sudden spike in teen usage of e-cigarettes last year. However, from 2014-2017, when flavored e-cigarettes were just as available as they were in 2018, data from the Centers for Disease Control showed a drop in teen vaping.
It is already illegal to sell e-cigarettes to those under age 18, but that isn’t enough for those addicted to hysteria. In a recent editorial in the New England Journal of Medicine, Drs. Jeffrey Danzen and Edward Campion and Professor Stephen Morrissey said they “fear that the creation of generation of nicotine-addicted teenagers will lead to resurgence of in the use of [cigarettes] in the decades to come.” Even if vaping does not lead to an increase in cigarette use, they worry that “[s]ince nicotine is gateway drug that lowers the threshold for addiction to other agents, the use of e-cigarette could help spawn even more opioid addiction.” They conclude that “the FDA should simply ban the sale of flavored nicotine for use in e-cigarettes.”
Gottlieb gave in to this hysteria, and Wednesday the FDA proposed a rule that would have the effect of banning gas stations and convenience stores from selling most flavored e-cigarettes. For stores to continue selling flavors other than tobacco, mint or menthol, they will either have to prevent minors from entering the store or create a separate section of the store that bars access to minors.
The flavoring is what makes e-cigarettes attractive to cigarette smokers. A recent survey found that mint was the most popular flavor among those trying to quit, but it was followed closely by mango, cucumber, and those trying multiple flavors. The least popular were menthol and tobacco flavor. Thus, an FDA ban of most flavored e-cigarettes has the potential to greatly reduce the number of smokers who quit regular cigarettes.
That would be myopic at best.
A randomized-controlled study — the gold standard of research — published in the New England Journal of Medicine in January found that e-cigarettes are twice as effective at helping cigarette smokers quit than those using replacement products like nicotine gum or patches. A 2018 study in the British Medical Journal concluded that 6.6 million lives could be saved over ten years if most cigarettes smokers switched to vaping. The authors of that study note that even “if the risk of harm to some youth would not have smoked is marginally increased, such risks must be weighed again the substantial and immediate benefits of displacing smoking with safer nicotine products among bout youth and adults.”
Even if the spike in teen vaping of 2018 sustains itself, the potential benefits of vaping outweigh the risks. A meta-analysis from 2017 found a 23% probability that an e-cigarette user would take up regular cigarettes. At that rate, it would take over ten years, based on current high-school enrollment trends, before the number of high-school seniors taking up cigarettes due to vaping reached even half the number of people who would be saved by e-cigarettes.
The next FDA commissioner needs to make policy based on the actual evidence, not on hysteria generated by nanny-staters. The potential upside of e-cigarettes to reducing cancer and other smoking-related illnesses far outweighs the risk to teenagers. FDA policy should reflect that.
David Hogberg is a writer living in Maryland who does not smoke.