Evidence, alarm, and the debate over e-cigarettes. That is the title of a new analysis published in the journal Science. The analysis was a collaboration of five prominent scientists from a range of disciplines and universities. Experts focused on the potential harm of the anti-vaping hysteria that has gripped the discussion in the latter half of 2019. As a result of the hysteria, several states have enacted vaping and flavor bans. The fear is that sweeping bans could prove detrimental to public health.
The Science vaping analysis concluded that if a significant number of Americans switched from smoking cigarettes to vaping nicotine, 1.6 million lives could be saved. Smoking still kills 480,000 Americans every year. This century, smoking will claim one billion lives around the world. The horrific death toll caused by smoking needs to be factored into any proposed vaping legislation.
“Restricting access and appeal among less harmful vaping products out of an abundance of caution while leaving deadly combustible products on the market does not protect public health. It threatens to derail a trend that could hasten the demise of cigarettes, poised to take a billion lives this century.” – From Evidence, Alarm, and the Debate Over E-cigarettes.
The analysis was published in response to the alarm raised over an outbreak of a mysterious lung illness that was attributed to vaping and to a dramatic increase in underage experimentation with vaping. The lung illness outbreak has since been traced to black-market THC products. The CDC has positively identified vitamin E acetate as the additive to THC oil that caused the outbreak of illnesses. Vitamin E acetate is not used in e-cigarettes or nicotine vape liquids.
However, the increase in underage vaping remains a serious concern. Underage past-30 day e-cigarette use rates among teens increased from 11% in 2017 to 28% in 2019. The analysis suggests that “threading the needle” between prevention and access is the key. The UK model is cited because while e-cigs are available to adult smokers, underage experimentation rates are stable. But, thus far in the United States the proposed solutions may do more harm than good.
On September 11, the President and Health and Human Services Secretary Alex Azar announced a ban on all flavored electronic cigarettes except for tobacco flavors. While the White House has since pulled back on a flavor ban, the ultimate outcome of national e-cigarette regulation is unknown. Despite a lack of final FDA guidance, many states enacted their own flavor bans. New York, Michigan Wisconsin, and others announced a ban on all vape flavors. Massachusetts Governor Charlie Baker enacted a complete ban on all vapor products. However, Governor Baker’s ban left cigarettes untouched. In New York, Governor Cuomo’s ban outlawed menthol-flavored e-cigs but left menthol cigarettes on the shelves. These are exactly the type of bans that are cause for concern according to the Science analysis.
“We share strong concern about the large surge in youth vaping (some call it an epidemic and point to studies of a possible but unproven causal gateway into smoking) and we promote harm minimization and management. Yet we suggest that careful analysis of all the data in context indicates that the net benefits of vaped nicotine products outweigh the feared harms to youth” From Science Evidence, Alarm, and the Debate Over E-cigarettes
The analysis revealed that while flavors may play a role in attracting underage experimentation, flavors are also vital to assist smokers to switch to vaping. While tobacco flavors are the usual starting point for a smoker switching to e-cigs, it is pointed out in the research that adult smokers generally transition to menthol and then to other flavors to help refrain from smoking cigarettes.
The Path Forward For Vaping
The researchers involved in the analysis derived a number of policy prescriptions designed to ensure access for adults while preventing underage use. The implementation and enforcement of a national 21 age limit for both nicotine and THC products. In addition, the analysis recommends the use of taxation on e-cigarettes but at a lower rate than tobacco cigarettes. In other words, e-cigarettes should not be cheap, but they should cost less than cigarettes.
Here is the list of recommendations proposed by researchers in Science:
No youth under 21 should use any form of nicotine
No youth under 21 should use any current form of THC
Taxation on vapor products but a lower rate than cigarettes
Communicate that vaping reduces risk compared to smoking
No predatory marketing to youth
Implement product quality standards