New E-Cigarette Restrictions Could Be Lethal

FDA regulations aimed at discouraging underage vaping may also deter smokers from switching.

Scott Gottlieb, the head of the Food and Drug Administration, says he still believes in the harm-reducing potential of e-cigarettes, which are far less hazardous than their combustible competitors. But by threatening to restrict e-cigarettes in the name of preventing underage vaping, he is knowingly setting a course that leads to more smoking-related deaths than would occur if the government let the market thrive.

"In closing the on-ramp to kids," Gottlieb said in a speech last week, "we're going to have to narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs." That "unfortunate tradeoff," as he calls it, is not necessary, scientifically sensible, or morally justifiable.

Gottlieb is responding to "an epidemic of e-cigarette use among teenagers," which he erroneously equates with an "epidemic of addiction" and even "a whole generation of young people becoming addicted to nicotine." According to the National Youth Tobacco Survey (NYTS), the share of high school students who reported vaping during the previous month peaked at 16 percent in 2015, fell to about 11 percent in 2016 and remained roughly the same last year.

The percentage of teenagers who vape often enough to become addicted to nicotine is much smaller. In the 2015 NYTS, for example, just 2.5 percent of high school students (16 percent of "current" users) reported vaping on 20 or more days in the previous month, and almost all of them were current or former smokers.

To the extent that teenagers who otherwise would be smoking are vaping instead, that is an unambiguous gain in public health terms, since the latter habit is much less risky. And despite warnings that increased experimentation with e-cigarettes would lead to more smoking, consumption of conventional cigarettes by teenagers continues to decline, reaching a record low last year.

Gottlieb says the FDA has "preliminary data" indicating that, contrary to the latest NYTS results, "youth use of e-cigs is rising very sharply." That would be troubling, but it still would not justify regulations that discourage adult smokers from making a switch that could save their lives.

In addition to enforcing the ban on selling e-cigarettes to minors, the FDA is considering restrictions aimed at making the products less attractive to adolescents. "We know that the flavors play an important role in driving the youth appeal," Gottlieb says, so "we may take steps to curtail the marketing and selling of flavored products."

The problem is that supposedly kid-friendly e-liquids are also popular with adults, many of whom report that flavor variety was an important factor in switching from smoking to vaping. A recent survey reported in Harm Reduction Journal found that "adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time."

The authors of that study (which was funded by a grant from an e-cigarette company) warned that "restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes." The FDA itself recognized that danger last year, when it noted "the role that flavors…may play in helping some smokers switch to potentially less harmful forms of nicotine delivery."

More generally, the FDA can force manufacturers to make e-cigarettes less appealing to teenagers, but only at the cost of making them less appealing to adults, which is inconsistent with the agency's avowed commitment to harm reduction. The public health impact of encouraging smokers to get their nicotine from less dangerous sources, Gottlieb says, "can dwarf anything else we're able to accomplish in any reasonable stretch of time" by "avoiding a lot of the death and disease that's going to be caused by cigarettes."

If the FDA impedes the transition to safer nicotine habits through misguided regulations, the result will be "a lot of death and disease" that could have been avoided.

© Copyright 2018 by Creators Syndicate Inc.

Comments

[loveconstitution1789]

There is nothing the US or state Constitutions that authorize banning products or services.

Regulation does not mean banning.

So, there is no constitutional authority to ban vaping or vape products. Leave people alone.

[sarcasmic]

"Congress shall do everything necessary and proper to regulate commerce and promote the general welfare."
-Constitutional CliffsNotes

Let's see. Buying and selling stuff is commerce. Banning bad stuff promotes the general welfare. Looks good to me.

[VinniUSMC]

Woah, did sarcasmic actually use sarcasm?

[TJJ2000]

LMAO.......... "Constitutional Cliffs Notes" -- Don't you mean "Your Cliff Notes" which carry a few cherry-picked phrases and words paraphrases from the Constitution all eclipsed, cut and pasted back together for the communists manifesto?

"To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;"
THUS; the only time the constitution allows federal to intervene is when that vape product crosses state lines.

"To make all Laws which shall be necessary and proper for carrying into Execution the !!!---foregoing Powers---!!!"
The Necessary and Proper Clause ISN'T A DO ANYTHING VOID THE CONSTITUTION phrase. As clearly stated it just grants the power of law in [carrying into Execution] WHAT POWER WAS GRANTED!

I get so sick of people corrupting our Constitution.

[VinniUSMC]

butbutbut...

We've got to DO something!!!! Think of the children!!!!!11!!1!

[JWatts]

This is a horrible Click Bait headline. Come on Reason, stick with a rational carefully thought out argument. Not an appeal to emotion.

[JesseAz]

Do you have a recent example of a well reasoned article?

[aajax]

The headline is quite accurate.

[Jerryskids]

Everybody knows tobacco is the Devil's weed and therefore nicotine is evil and nicotine users are sinners. It is God's will that nicotine users be punished so that they may see the error of their ways, but in these fast-paced modern times we cannot wait for an angry and vengeful God to strike down these sinners so it is incumbent on our government to do the work of the Lord in punishing the wicked for Him. Praise the Lord for the good works of His ministers in afflicting the ungodly!

[DiegoF]

Please do read the full text. This is one of the most statist, authoritarian statements ever put out by an FDA chief or antismoking warrior zealot bureaucrat.

This is one of the few times the Reason editors and the HnR commentariat seems to have been in agreement. My (admittedly alarmist) ass has been freaking out about "libertarian" Gottlieb from square one; and each time I've been told by people here to calm down and wait for "actual evidence that he is actually doing something." Then the kratom krackdown, the labeling, the salt threats--all not to mention that he is planning to do something not even the most fanatical antitobacco bureaucrat in the nanniest state on Earth (to say nothing of leftists here at home) have even proposed: ban the nicotine from cigarettes. He says this, and proudly trumpets it over and over and over again. But he doesn't mean it; it will never happen; wait for it to actually happen before you freak out, everyone says here. And Reason, for its part, seemed mysteriously content to treat this extremist prohibitionism as a mere asterisk to the hosannas they lay upon him for his pro-vaping policy. (This despite the fact that he said little about vaping but loved bragging about.nicotine abolition. 3D chess to fool the swamp creatures, insisted you all with a straight face.) Hey, at least that means his overall regulatory strategy is smart, they said, like a parody of Catotarianism.

[DiegoF]

Now it turns out he is not even pro-vaping, and will proudly impede adults' access to it for the children, actual science be damned. More chess, I guess, the clever guy! How much do you want to bet that the "ban nicotine" part of his delightful "smartarian" plan will go ahead as planned, despite the fact that it makes even less sense without its other half? Hmm, I wonder... Naah, gotta have faith! MAGA!

[DiegoF]

P.S. this will of course only give him more excuse to crack down on cigarettes (and cigars, hookah, etc. which are set for some industry-destroying regs), as he like a good incrementalist statist cites the precedent he himself created and notes that if it was warranted to do all those things to harmless old vaping for the children, surely it will be warranted to do them to actual deadly tobacco! First up: Banning flavors from cigars, and menthol from cigarettes. These regulations are already actively in formation as we speak, and can readily be justified as child protection--and again, it will look ridiculous to not ban them if you have banned flavored vaping.

[NoVaNick]

We all know that they won't stop until tobacco and nicotine are banned in every way, shape, or form, and the FDA will one day transfer its duties to the DEA. This is all part of the WHOs tobacco-free framework which the US signed under GW Bush's administration, though has not ratified.

[Stephen Lathrop]

DiegoF, I suggest there may be a limit to the number of times you can satirize arguments in favor of child protection, before folks will reasonably begin to conclude you are okay with child abuse.

[Cynical Asshole]

wait for it to actually happen before you freak out

I've never understood that argument. If you wait until the government does something before speaking up or taking action opposing whatever it is - whether it's banning nicotine, cracking down on prescription opioids, or raising tariffs through the roof - it will be too late. Better to at least get your opinion out there ahead of time. Of course, the vast majority of the time it won't do any good. The government does what they want, our opinions don't matter to them. Especially when what they're doing is "for our own good."

[Gilbert Martin]

This is yet another tiresome example of the "we must do it for the children" excuse for an expansion of government force on the private sector.

[Rockabilly]

Everyone knows the booze is bad. People drink it and fight and some even get addicted to the demon drink

The problem with the prohibition of alcohol was that the the 18th Amendment was repealed. See, it takes time for the people to realize government knows what's best for them.

That's why there is a 'general welfare.' clause. Anything that is bad must be make illegal through this clause. Also, it gives the poor the welfare they need to live.

[Contactforinfo]

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[Cynical Asshole]

"In closing the on-ramp to kids," Gottlieb said in a speech last week, "we're going to have to narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs." That "unfortunate tradeoff," as he calls it, is not necessary, scientifically sensible, or morally justifiable.

I'm pretty sure the FDA doesn't consider smokers to be people, so they really don't care what happens to them. In fact, from a purely cost benefit perspective, letting them die may be cheaper because then they won't be sucking as much money out of Medicare when they get older.

[DiegoF]

Smokers most certainly are cheaper--as are people who don't wear their motorbike helmets, who are even kind enough to be one of our most important source of organs. Yet another reason we should treat them like grown-ups and leave them the fuck alone.

[NoVaNick]

Gottleib has at least acknowledged the e-cigs are safer, but this seems like the kind of BS I would have expected to hear from a prog admin. Wonder if all those suburban soccer mom voters have something to do with it?

[NoVaNick]

I was actually concerned that I was vaping too much recently (going through one Juul cartridge of plain tobacco flavor a day). Then the store ran out of them, so I bought the mint flavor and am actually vaping about half as much-go figure...

[Curt]

VA Tobacco or Classic Tobacco? I like VA; haven't tried Classic.

Mentally, I previously dismissed vaping as the province of douchebags. But, after enough of these articles, I decided to give it a try. I haven't had a cigarette in four months. I'm pretty happy with that result. And, pretty pissed at these nanny fucks who can't understand relative risk/harm.

[Mark22]

FDA regulations aimed at discouraging underage vaping may also deter smokers from switching.

Yeah, because in the New Libertarianism, it's all about the nanny state encouraging proper behavior! /sarc

Harm reduction isn't a libertarian principle, liberty is. The legality of vaping shouldn't depend on what it discourages or encourages.

Once you start making arguments about harm reduction, you've gone over to the dark (progressive) side.

[Stephen Lathrop]

But by threatening to restrict e-cigarettes in the name of preventing underage vaping, he is knowingly setting a course that leads to more smoking-related deaths than would occur if the government let the market thrive.

In what time frame? Seems like that involves a policy judgment about fundamentally unknowable future occurrences. What is really in controversy in this instance is the answer to that guess about the future. The argument to the contrary, which is the argument of the OP, pretends nobody needs to guess about the future. Doing it that way begs the question, making the OP pointless in its own terms.

But a glance at the comments shows why libertarians turn this stuff out?it gives them a chance to parade as anti-statists, and get a lot of approval from pro-libertarian bystanders for doing it.

It's also another instance where libertarians show themselves willing to risk avoidable public harm to prevent government being seen as delivering any outcome which most people would approve.That is a perverse way to promote libertarianism, but it comes up all the time anyway.

[NoVaNick]

It's also another instance where libertarians show themselves willing to risk avoidable public harm to prevent government being seen as delivering any outcome which most people would approve.That is a perverse way to promote libertarianism, but it comes up all the time anyway.

Not sure I see your point, Steve. Nobody is disagreeing that smoking is bad for health, or that teenagers shouldn't be vaping. While it is not yet possible to know what the long term (20 - 30 years) effects of vaping on health are, the preponderance of evidence strongly suggests that they are safer than conventional cigarettes. Now, along comes the FDA and says they might yank flavored e-cigs from the market because teens might be tempted to try them, even though the FDA forbids the sale to anyone under 18, and some states its 21. Yet, there are many flavored alcohol drinks that appeal to teens and nobody has said anything about banning those, and alcohol is much more dangerous in the short term, and probably long term too, for them to consume. You can't buy alcohol anywhere in the US if you are under 21, yet plenty of teens get access to it. So should the government just go ahead and ban Kahlua, peach schnapps, flavored vodka, and wine coolers, because teens like them?

[Stephen Lathrop]

My notion of avoidable public harm is not limited to health effects. It may be that libertarians don't think it is legitimate from a public policy standpoint to focus on addiction and impoverishment as harms in themselves. I do.

I suggest that the health benefits of helping current cigarette smokers quit are real, but demonstrably limited. Limited in 3 ways, actually. There are only so many current cigarette smokers, for one thing. For another, a great many of those can quit without vaping. And for a third, of those who try vaping, only some will make the switch permanently. Add that together, and vaping might not turn out to be the cigarette smoking panacea described in the OP. Maybe a help, but notably less than impressive.

Compare the costs, including addiction and its attendant useless expense to the addicted. Those harms are unlimited. Make customary a new addiction-based business model, and it will likely grow to afflict considerable percentages of the population, as cigarette smoking did, and afflict uncountable generations.

Compare the number of present beneficiaries of a pro-vaping policy with the likely much larger number of victims, and you get a result which ought to give anyone pause, even if the effects on each group are dissimilar. Then note that the effects may not turn out dissimilar. Only long years of experience to come can deliver reliable estimates of presently unsuspected harms to health which vaping may inflict.

[NoVaNick]

So when you talk about the social costs of addiction, I suppose you mean to include caffeine, gambling/lotteries, and of course alcohol. Most, if not all, vices are habit forming and are certainly not necessary, although they are enjoyable. Do you think all the 30-40 million nicotine addicts will start sending the money they spent on vaping or smoking to support orphans in Somalia instead? If prohibition is your solution, what do you make of the societal costs of the drug war, which has torn families apart and costs society to keep the violators imprisoned?

[Stephen Lathrop]

Of course every mode of addiction, once entrenched as a profitable industry (legal or illegal), and socially customary, creates not only great harm, but also a devilish policy problem. All your points strike me as arguments in favor of nipping in the bud this new addiction-reliant business model?before those problems become uncontrollable in this case. The tenor of comments responding to this OP suggests that almost everyone agrees that limiting vaping is doable?it's mostly just arguments against doing it.

As for what the would-be-addicts will do with the money saved, I expect nearly all of them will do with it whatever they do with their other money?and in almost every instance, they will get a comparative boost in their welfare and happiness as a result.

Of course I expect from you a tiresome reply suggesting I leave the question of personal happiness to the addicted to answer on their own. To anticipate, please go find yourself a nice sample of cigarette addicts, and ask them if they agree with your view, or mine, about whether they are better off addicted, or would be better off not addicted.

Just in passing, I wish there were some way to get it into the heads of commenters who like to pile up analogies, that arguing that way is mostly just subject changing and question dodging. Analogies have their uses, but if you can't make your entire point without them, then you probably don't have much of a point to make.

[vek]

I'm a former smoker that quit using vaping. I had never tried to quit before, but found it INCREDIBLY EASY... Not what I expected, having heard it was a bitch and a half my whole life from basically every smoker that ever tried to quit. I think the reason it was easy is because I used vaping. It gives you the keeping the hands busy thing, the inhaling thing, and the nicotine. My father, who had failed at quitting several other times, but was able to do it easily with vaping, agrees.

Since it is almost guaranteed to be safer than real smoking, as per almost all evidence to date, this is a good thing. It may be next to harmless. Even if it somehow is somewhat dangerous, it is probably not a big deal. How do I know this? Because even real smoking harms are overblown.

If you're a couple dozen pounds overweight, you're more likely to die young than a pack a day smoker. Ditto for a lot of other bad habits tons of people have.

[vek]

So the whole "nip it in the bud" thing is nonsense. Even if it is substantially bad for people, but less than smoking, so what?

It's no worse than sucking down several Cokes a day, or eating too many hamburgers, or drinking, or not exercising, or or or... Should we ban ALL soda? Alcohol? Force exercise? Etc.

If people enjoy something, like eating too much sugar, it's really not the governments place to intervene. Tell people it's bad, and let them make the call. Thinking you can just ban vaping and it will save the day is a flawed idea anyway, but it's not the governments place even if it worked. But it won't work.

The road you're going down is the road to no soda in the world, forcing people to do jumping jacks, banning alcohol etc. It's a HORRIBLE idea, anti freedom, AND will simply never work. People like pleasant things, and will do them even if illegal. Therefore the easiest, and best thing for freedom, thing to do is simply not fuck with them. Inform of negative effects if they exist, but don't try to control their behavior through regulation.

[MichaelL]

What do we expect when ignorant doctors and regulators are controlling the process?! I just can't imagine a physician thinking that vaping has the same potential as cigarettes, at harming kids or adults. It makes no scientific sense. And, common sense is out of the question!

[Stephen Lathrop]

It makes perfect scientific sense?so long as your notion of science includes a need for empirical evidence to prove theory. The evidence on cigarettes took many decades of observational diligence to compile. Prior to that, cigarettes were widely supposed to be aids to good health, and sold on that basis. That's where vaping is now. When there is a large population who have vaped heavily for the better part of a lifetime, then a scientific basis for your optimism may be proved, or science may disprove your optimism.

If your notion of science does not include a need for empirical evidence to prove theory, you shouldn't be calling ignorant the people who do rely on science.

[NoVaNick]

Science suggests that vaping is safer in that there are not nearly as many chemicals as there are in tobacco smoke. Addiction to nicotine is not the same as cocaine or opioids since it is very hard to overdose on it. However, if the trend continues to regulate it out of existence, we certainly could start seeing that once addicts have to turn to the black market.

[vek]

The reality is that one can get a tip off a LOT faster than over a lifetime. One can also use logic.

The fact that basically none of the actually harmful chemicals are found in it is tip off number one it is almost certainly a lot safer. Nicotine itself is NOT really harmful in itself, if you were unaware. The other ingredients are mostly ones that have been studied for years in other applications, and are mostly known to be quite safe. If using them in vaping somehow makes them dangerous, it is likely they are still not THAT dangerous.

Also, the fact that people who switched to vaping, such as myself, instantly feel better and can TELL the difference is another big tip off.

If I had to guess I would say vaping is probably not better for you than not smoking or vaping... But it is almost certainly better than smoking. Drinking too many Cokes a week, or spending too much time in a chair is also bad for you... Sooo perfection is not what anybody except lunatics is after.

We'll get the full science eventually, and I'm quite confident it will be minimally harmful.

[Stephen Lathrop]

Science suggests a geocentric universe. Science suggests phlogiston. Evidence disposes of the suggestions, one way or the other.

Reliable evidence for the long-term safety of vaping can only be had at the cost of taking on risks which can't be undone if the experiment creates harm. That's pretty much the universal definition of an experiment which is unethical to conduct on humans.

Time and again with libertarians, and across subject matters, the same thing happens. You get endless theories, no evidence, and a suggestion that you can reason backward from axioms to prove facts by deduction. What accounts for that?

[Stephen Lathrop]

Oh yeah, and the axioms aren't subject-specific. They are magical, universal axioms, mostly about rights and government. Usually, when you look at those arguments, you discover that the purported facts aren't even the point of the argument. The point is to tailor the facts to validate the axioms?which is easy to do, because none of the "facts" is ever tested empirically.

[NoVaNick]

Your arguments seem to be very circular Stephen, and you don't really make your point. Nipping a "problem" in the bud means you have to be able to anticipate said problem. E-cigarettes have been on the market for over a decade now, with perhaps over 10 million users and few problems, other than addiction, if you want to call that a problem. An ideal human would not be addicted to anything and would spend all their free time in selfless service to others, right? I have yet to meet one. Nicotine addicts certainly serve others as first responders, military, ER nurses, and their addiction may even help them do their job better.

[vek]

Jesus dude.

Look, people do all kinds of things that aren't "perfect" for their health outcomes, or other life outcomes. If you're so nuts you want to have mandatory exercise, ban all sugar products, require everybody to eat X amount of broccoli every week, etc... Then you're insane. And can also fuck off.

Vaping, or even smoking real cigs, is not the worst thing ever. Being a fat fuck will kill you faster than smoking a pack a day. People aren't perfect, and people enjoy some things that aren't good for them. That's just life. You can't ban every thing that can be abused by a small subset of people.

I'd be willing to bet I could look at your life and find 1000 things you do "wrong" according to the way conventional wisdom, or some expert, says you should do it. Probably your eating habits, your bad financial habits, etc. You can either believe in a total nanny state, or not.

If you want to make a few exemptions for EXTREMELY harmful things, you can try to argue that on utilitarian grounds vs principled arguments... But vaping, or even real smoking, are NOT that harmful. They're not worse for you than being moderately chubby, watching too much TV, etc. So unless you're prepared to ban allowing people to be moderately chubby, you're just being irrational and emotional about it.

[librich]

A friend of my daughter's in middle school is vaping like crazy. It's cool, she thinks. She's becoming a nicotine addict. At the same time, the wife of a close friend, who will probably be addicted to nicotine for life, has radically reduced her health risk by vaping. Her rights are being undermined by the kid's behavior.

The problem is stupid people. That's why we have the nanny state. That's why we have tags on electric appliances. That's why we have laws about seat belt use. That's why we have drug laws.

Other than the spooks and the military, stupid people are the gravest threat to our freedoms.

[vek]

Well, that's the rationale behind all the laws... But the simple truth is you don't HAVE to have the laws. Just let stupid people be stupid. Let society shame them when it's sufficiently bad behavior, or simply give them some mild side eye when it's not so bad. That's all there used to be for 95% of the nonsense laws we have now, and it worked fine then.

As I said above, in this instance there is little proof it is all that harmful anyway. I'd bet my life that vaping is less bad for you than being 20-30 pounds overweight. It's not like we're talking about being hooked on heroin here.

[loki]

Sucking on douche flutes can cause cronic hipstertitis.
Side effects are:
Fedora wearing
Silly beards (possibly with flowers)
Corduroy jackets with faggy patches on the elbows
Stupid socialist politics
Extreme pretintion, etc. etc.

[loki]

Sucking on douche flutes can cause cronic hipstertitis.
Side effects are:
Fedora wearing
Silly beards (possibly with flowers)
Corduroy jackets with faggy patches on the elbows
Stupid socialist politics
Extreme pretintion, etc. etc.

[loki]

Sucking on douche flutes can cause cronic hipstertitis.
Side effects are:
Fedora wearing
Silly beards (possibly with flowers)
Corduroy jackets with faggy patches on the elbows
Stupid socialist politics
Extreme pretintion, etc. etc.

[gordo53]

Prohibition = Stupidity
Any questions?

[Vaporleaf]

Restrictions and regulations should most definitely be (and are) set in place to prevent underage kids from purchasing equipment. Unfortunately, the methods the FDA is using is more so trying to push vaping out of the tobacco industry as a whole. Millions have been able to quit smoking using this technology, why ruin it for the people trying to quit their unhealthy habits? We as a community need to come together for the FDA to see the benefits electronic cigarettes can have.