E-cigarettes

Dick Durbin Argues That E-Cigarettes Will Cause an Increase in Smoking

The senator's claim is based on some highly implausible assumptions.

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Ron Sachs—CNP / MEGA / Newscom

In a recent letter to the Chicago Sun-Times, Sen. Richard Durbin (D-Ill.) takes issue with my argument that new FDA restrictions on e-cigarettes could deter smokers from switching to vaping, resulting in more tobacco-related deaths than would otherwise occur. "Mr. Sullum needs to check his facts," Durbin says, claiming that e-cigarettes, on balance, lead to more rather than less smoking. That conclusion is based on some highly implausible assumptions.

"[Sullum] claims that vaping helps people quit smoking traditional cigarettes," Durbin writes. "A recent study from Dartmouth found the exact opposite: e-cigarette use leads to 81 times more new smokers than quitters." The study to which Durbin refers, which was published in the online journal PLOS One last March, grossly underestimates the number of smokers who use e-cigarettes to quit while overestimating the number of people who would never have started smoking if e-cigarettes were not available.

To calculate the impact of e-cigarettes on smoking cessation, the researchers relied on a single 2013 study, reported in The Lancet, that compared quit rates among smokers randomly assigned to groups that received nicotine patches or e-cigarettes with or without nicotine. The six-month quit rate for e-cigarette users was 7.3 percent, compared to 5.8 percent for patch users and 4.1 percent for subjects who used nicotine-free e-cigarettes. In other words, e-cigarettes were 26 percent more effective than patches.

By contrast, a 2014 study based on British survey data, reported in the journal Addiction, found that smokers who used e-cigarettes to quit were twice as likely to be successful as smokers who used nicotine replacement therapy (NRT) such as patches. That suggests e-cigarettes are something like 100 percent more effective than NRT. Although randomized studies are usually considered to be stronger evidence of causality than surveys (which don't control for confounding variables), they may underestimate the effectiveness of e-cigarettes if vaping is more appealing to some subgroups of smokers than others. Another issue with the earlier study is that improved e-cigarette design in recent years has resulted in more satisfying nicotine delivery, which probably has increased the effectiveness of e-cigarettes as an aid to quitting.

The PLOS One study assumed that the availability of e-cigarettes increases successful quit attempts by just 2,070 per year in the United States. But as Brad Rodu points out, data from the National Health Interview Survey (NHIS) indicate that 2.6 million former smokers were vapers as of 2016, which would amount to 260,000 successful quit attempts per year, on average, in the decade since e-cigarettes were commercially introduced in the United States. It is not safe to attribute all of those successes to e-cigarettes, since some vapers might have quit smoking through other means. But the 125-fold difference between the NHIS results and the estimate used in the PLOS One analysis suggests the latter number is unrealistically low, to put it mildly.

On the other side of the ledger, the PLOS One study put the number of additional smokers attributable to e-cigarettes at 168,000 a year, or 81 times the number of quitters (hence the number cited by Durbin). The researchers arrived at that figure by comparing smoking initiation rates among people who try vaping and people who don't. But that risk ratio, although "adjusted for demographic, psychosocial, and behavioral risk factors," cannot possibly account for all the pre-existing differences between people who are attracted to vaping and people who aren't. It stands to reason that some of the same factors that predispose people to vaping also predispose them to smoking. The relevant question is how many people who start smoking after vaping would not have used tobacco if e-cigarettes had never been introduced. The answer is unclear, but the number is certainly lower than 168,000 per year.

The predicted net increase in smoking does not seem to be happening in the real world. To the contrary, smoking rates among adolescents and adults continue to fall, and a 2017 BMJ study found that "the substantial increase in e-cigarette use among US adult smokers was associated with a statistically significant increase in the smoking cessation rate at the population level." A 2018 analysis in the journal Tobacco Control projected that switching from smoking to vaping could result in as many as "6.6?million fewer premature deaths with 86.7?million fewer life years lost" over a decade in the United States.

Durbin also dismisses the point that adult vapers happen to like supposedly kid-friendly e-liquid flavors. "Mr. Sullum…claims that these candy-like flavors are aimed at adults, not kids," he writes. "Flavors like blue razz candy, gummy bear, whipped cream, and chocolate cupcake? Come on." That is the full extent of Durbin's argument. Yet it's undeniable that such sweet e-liquid flavors are highly popular among adult e-cigarette users, many of whom report that flavor variety was an important factor in switching from smoking to vaping.

If you think e-cigarettes are a public health disaster, as Durbin insists, such details may not matter to you. But if you acknowledge the harm-reducing potential of e-cigarettes, as the FDA does, you have to recognize the potentially lethal impact of attempts to reduce underage vaping by making these products less appealing.

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  1. Common sense argues that Dick Durban is a deusch.

  2. Dick Durbin is one of many progressive old farts who are long past their relevance date. Hopefully he will retire soon, I know Illinoisans will never vote him out.

  3. What would happen to the tobacco industry if many, perhaps most, smokers quit?

    Is that something Sen. Durbin is worried about? And, if so, why?

    1. The tobacco industry would move into other businesses, including weed no doubt, as they have been doing for decades while smoking has been in decline.

      What Durbin is worried about is the billions in lost cigarette tax revenue

  4. Dick Durban is a moron, and a Senator, but I repeat myself.

  5. I had managed to quit for three years or so when I was offered an e-cigarette. I figured what the heck, what’s one puff gonna do? I bought a pack of smokes later that day. Nicotine is a powerful bitch. Quit a few years later with the help of Chantix. That stuff works.

    1. I vape but haven’t smoked in nearly 5 years. It made me like cigarettes even less, so I am one of those nearly 2 million who no longer smoke because I prefer vaping.

      1. I went back and forth for a while before I quit the second time. Different flavors, different batteries, some of the things leaked juice all over the place. Batteries would die at the most inconvenient times. It was a pain in the ass. I’m glad to be done with it all.

        1. Yeah, the old e-cigs were a pain-had my share of leaks and one almost caught fire in my pocket. I know there is the moral argument that I should get over my addiction, but its fun for me.

          1. I’m a bit of a miser so I quit mostly to save money. That and I didn’t like being a slave to nicotine. When the bitch called I had to answer. On the other hand I did like always knowing what was going on outside. Knew what the weather was like, what birds were in town, where the squirrels were nesting, and stuff like that.

    2. >>>Nicotine is a powerful bitch

      word. 8 cans a week – my hypnotoad fixed me in one visit.

    3. I figured what the heck, what’s one puff gonna do? I bought a pack of smokes later that day. Nicotine is a powerful bitch.

      But I’m gonna guess that you’re in no hurry to ban vaping or otherwise control other people’s choices just because of your poor experience with it, right?

      Therein lies the difference between libertarians and people like Dick(head) Durbin.

      1. Well yeah.

        But to argue that vaping doesn’t lead to smoking is as disingenuous as saying it doesn’t help people quit.

        It goes both ways.

        1. Your personal story doesn’t really support that though. You started on cigarettes, then vaping brought you back to them. Do you think it’s likely that a person who starts out vaping will switch to cigarettes?

          1. Maybe I should just RTFA, because the study suggests that 168,000 people a year do just that. That’s difficult for me to believe, but I have no grounds on which to challenge it. Sullum does make an excellent point though, saying that it’s unclear how many of those people would not have started smoking if they hadn’t first tried vaping.

            1. Sullum does make an excellent point though, saying that it’s unclear how many of those people would not have started smoking if they hadn’t first tried vaping.

              Right. So I don’t think anyone can honestly say vaping is more of a gateway to smoking or more of a gateway to quitting because it is impossible to get enough information to be certain either way.

              1. Its hard to imagine anyone who starts vaping, but never has smoked, switching to smoking in this day and age. The smell is immediately noticeable on your clothes, hair, and breath and is off-putting, and there aren’t many places you can smoke anymore, certainly not inside.
                The one thing I do miss about smoking is the camaraderie, I made good friends and had many interesting conversations with other smokers. Vaping is kind of a solo act-note that you don’t see vapers hanging out together like you see smokers.

                1. Why? Convenience. You can buy cigarettes literally anywhere. Not so much with vape juice.

                  And what you said about hanging out with the cool kids.

    4. I figured what the heck, what’s one puff gonna do? I bought a pack of smokes later that day.

      Yeah – it also took me a couple of cycles to realize that “one puff” was never what I actually wanted, no matter what my treacherous mind tried to talk me into.

  6. >>>That conclusion is based on some highly implausible assumptions.

    it is based on the wishes of whomever paid Durbin

  7. Damn, this article just made me remember that I was sexually assaulted by Dick Durbin at a high school party 36 years ago.

    1. Too bad Dick Durbin’s not up for a SCOTUS seat, you could totally derail his nomination with a single letter to whoever the biggest Republican grand-stander in the Senate is, IOW the Republican version of Dianne Feinstein (I’m not sure who would that be since McCain’s dead).

  8. Dick Durbin’s still alive? When is that desicated old fuck gonna do the rest of us a favor and fall victim to a horrible wood chipper “accident?”

  9. Dick is definitely an aptonym for Durbin.

  10. Dick Durbin: One of the many reasons Illinois is the toilet.

  11. “Mr. Sullum needs to check his facts,” Durbin says,

    Wow, Jacob, it appears that you have arrived.

  12. E-Cigs absolutely will increase the number of smokers in the US. Once the feds place enough restrictions as to make it too expensive for enough users, they’ll switch to tobacco to get their nicotine.

    1. That’s exactly their plan I am sure.

  13. The Lancet? Isn’t that the journal that told us autism is caused by vaccines? That’s who I trust! /s

  14. The study Mr. Durbin cites was based on 2014 data and projected a 2015 increase of 168,000 never-cigarette smoking smokers. Indeed, that was a period where both youth smoking and vaping had a temporary peak. High school youth smoking went from 9.2% in 2014 to 9.3% in 2015 (barely statistically significant,) with vaping rising from 13.4% to 16% respectively. However, by 2017, vaping had declined to 11.7% and smoking was down to 7.6%.

    However, overall, high school vaping rose from 1.5% in 2011 to 11.7% in 2017, while smoking declined from 15.8% in 2011 to 7.6% in 2017. Middle school vaping rose from 1.1% in 2012 to 3.3% in 2017, while smoking declined from 3.5% in 2012 to 2.1% in 2017. If vaping was causing non-smoking youth to smoke cigarettes, shouldn’t there have been an increase in youth smokers as vaping rose?

  15. As far as adult smokers, vaping increased from 1% in 2010 to 3.2% in 2016, while smoking declined from 19.3% in 2010 to 15.5% in 2016. Again, with the increase in vaping, where is the predicted increase in smoking?

    Based on a high school population of 15 million (estimated from the 2017 NYTS, with the reported 2.95 million high school tobacco users being 19.6% of the high school population,) even with the 2014-2015 uptick from 9.2% to 9.3% smoking in high school, that was an overall increase of just 15,000 (including both youth who smoked previously and those who hadn’t previously smoked) not the predicted 168,000 for just never-smokers. And, of course, by 2017, high school smoking had declined to 7.6%, which is approximately 255,000 FEWER high school smokers than in 2014.

    The researchers’ projected 168,000 more never-cigarette smoking smokers simply never materialized, so Mr. Durbin’s claim that vaping leads to 81 times more smokers because of vaping is completely unsupported by the CDC’s own numbers.

  16. Durban is a Democrat. That means he’s got to control or restrict something – for our own good.

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