New York Gov. Andrew Cuomo announced yesterday that he plans to impose an "emergency" ban on the sale of flavored e-cigarettes. Cuomo's ban, like Michigan Gov. Gretchen Whitmer's and the Trump administration's, is officially a response to "the increasing number of youth using vape products." Yet his press release also says "these efforts follow a series of actions taken by the Governor aimed at addressing the growing use of vaping products, which have come under national scrutiny following a rising number of cases of vaping-associated respiratory illnesses."
The implication is that legal e-cigarettes have something to do with those "vaping-associated respiratory illnesses." But as far as we know, that isn't true. Data from California, Illinois, New Mexico, and Wisconsin indicate that the vast majority of these patients had vaped black-market THC products. The leading theory among state and federal investigators is that the illnesses are caused by additives or contaminants in those products, and possibly also black-market nicotine e-liquid. One possible culprit is vitamin E acetate, which was detected in most samples of THC fluid tested by New York's state lab and by the federal Food and Drug Administration (FDA).
Notwithstanding the evidence from his own investigators, Cuomo seems to be deliberately muddling the issue. "Vaping is dangerous, period," the governor said at a press conference yesterday. "No one can say long-term use of vaping—where you're inhaling steam and chemicals deep into your lungs—is healthy."
While it's true that we do not have long-term data on the health effects of vaping, we know enough to conclude that the habit is far less dangerous than smoking, which produces many more hazardous substances at far higher levels. For smokers considering a switch to vaping, the relevant question is not whether e-cigarettes are "healthy" but whether they are less deadly that the conventional, combustible kind. And on that point there is no serious scientific dispute.
The insinuation that legal e-cigarettes, which have been in wide use for years, are to blame for these recent lung disease cases is apt to drive vapers back to smoking and discourage current smokers from making a switch that could save their lives. That is unambiguously bad for public health. Likewise the plans to ban the vaping products that former smokers overwhelmingly prefer, a policy that poses the additional hazard of driving both adult and teenaged vapers toward black-market nicotine concoctions that may pose special dangers.
"The e-cigarettes and the vaping devices are often used to vape other substances," such as "THC" and "vitamin E acetate," Cuomo noted during his press conference. "And many of these other products have no controls on them whatsoever, the so-called counterfeit products. They're not cleared by the FDA. There's been no analysis of them at all. So vaping is dangerous." Under the cover of "vaping is dangerous," Cuomo is imposing a ban that will lead to greater use of the "counterfeit products" that are "not cleared by the FDA," have not been analyzed, and "have no controls on them whatsoever." How does that make sense?
Press reports continue to amplify this misleading message, warning about the dangers of "e-cigarettes" and "vaping" in general instead of focusing on the specific hazards of black-market products. "Amid a surge of vaping-related illnesses and deaths," The New York Times says at the beginning of its story, "Gov. Andrew M. Cuomo of New York announced on Sunday that he would pursue emergency regulations this week to quickly ban the sale of flavored e-cigarettes." In the sixth paragraph, the Times says that "health officials around the country continue to grapple with an outbreak of a severe lung disease linked to vaping that causes severe shortness of breath and days of vomiting, fever and fatigue." It notes that "at least six deaths and hundreds of hospitalizations have been reported." Several paragraphs later, the Times says "Mr. Cuomo's action came less than a week after the state announced a series of other measures meant to address both the surge of vaping illnesses and the expanding use of e-cigarettes."
In the 14th paragraph, the Times finally offers this clarification: "Though the specific substance or product causing the vaping illnesses remains unclear, the New York State Department of Health has linked many cases of the illness to cannabis products that contain high levels of vitamin E acetate, a thickening agent for vaping liquid. Vitamin E acetate is now a key focus of the department's inquiry." (Emphasis added.) What does banning flavored e-cigarettes have to do with symptoms that seem to be caused by additives in black-market cannabis products? Absolutely nothing, but that is not the impression readers will get from this story.
Cuomo says he will continue to allow the sale of tobacco- and menthol-flavored e-cigarettes, because (as the Times puts it) "some data suggests that those menthol products could assist in helping people to stop smoking traditional cigarettes." The data actually indicate that e-cigarettes are nearly twice as effective in smoking cessation as alternatives such as nicotine gum and patches. The data also show that the flavors Cuomo plans to ban, which he portrays as part of an insidious plot to hook "children and underage youth" on nicotine, are the ones favored by the vast majority of adults who used to smoke and are now vaping instead.
The FDA, the agency that is now planning to ban the vast majority of nicotine vaping products, has itself acknowledged the enormous harm-reducing potential of e-cigarettes. Former FDA chief Scott Gottlieb, whose concerns about underage vaping led the agency down this road, described e-cigarettes as a "tremendous public health opportunity." In its haste to deter teenagers from using e-cigarettes, the government is on the verge of squandering that opportunity.