New in Science: "Evidence, Alarm and the Debate Over E-Cigarettes"

A new review essay in Science warns of the dangers of prohibitionist thinking

A new article in Science, "Evidence, alarm, and the debate over e-cigarettes," warns that, when it comes to vaping, "prohibitionist measures threaten public health." This may not be news to those that have followed the burgeoning medical and social science literature on e-cigarettes and vaping, but it is quite notable to see this message in a journal as prestigious as Science.

Written by researchers from the schools of public health at Ohio State, Emory, New York University and Columbia, the article explains the importance adopting prudent harm reduction strategies to address the health consequences of tobacco use and the risks of adopting unnecessarily prohibitionist or restrictive policies.

The article begins:

This is a moment for legitimate alarm at the intersection of two distressing but distinct epidemiological patterns involving e-cigarettes ("vaping"): an increase in vaping among youth and a sudden outbreak of acute lung injuries and deaths in the United States, associated most strongly with vaping tetrahydrocannabinol (THC), the main psychoactive compound in cannabis. Discussions of vaping, however, often neglect distinctions between nicotine and THC; between adults and youth; and between products obtained through the retail and black markets. As we move to confront these challenges, we face the danger that justifiable alarm will turn alarmist, short-circuiting careful analysis of the full range of evidence and focusing attention on the most frightening, thus enhancing the prospect of adopting counterproductive policy. We suggest that the evidence warns against prohibitionist measures. 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.

Surveying the relevant literature, the article notes that there is widespread support for the proposition that "vaping nicotine is much safer than smoking" and that "Careful analysis of all the data in context indicates that the net benefits of vaped nicotine products outweigh the feared harms to youth." Among other things, the authors note, is that e-cigarettes have been shown to be "more effective than medicinal NRTs [nicotine replacement therapies] at helping smokers quite" and that the availability of flavors often play a key role in helping smokers quit.

They write:

The most conservative estimates suggest that were vaping nicotine to replace most smoking over the next 10 years, 1.6 million premature deaths would be avoided and 20.8 million quality adjusted years of life would be saved in the United States alone. The greatest gains would be among younger cohorts.

Despite the growing body of research supporting the role of e-cigarettes as part of a broader tobacco harm reduction strategy, regulatory measures threatening to squelch the e-cigarette market and curtail the usefulness of vaping as a smoking cessation tool proliferate at all levels of government. Perhaps this article will help turn the tide and lead to more effective—and more life-saving—approach to tobacco.