Medical Examiner

We Are Completely Overreacting to Vaping

The moral panic against it is an irrational response fueled by anti-smoker bias.

A hand holding a vape pen.
Photo illustration by Slate. Photo by Getty Images Plus.

“There’s an epidemic spreading,” warns a dramatic new video from the Food and Drug Administration. “Scientists say it can change your brain,” the voice-over continues as the camera zooms into a teenager’s cranium to show grotesque wormlike creatures tunneling into gray matter. The camera pans to other high school students’ veins visibly swelling with contagion as additional dangers are listed. What is this disgusting new threat? “It’s not a parasite, not a virus, not an infection. It’s vaping.”

Teenagers are the intended audience for the video, but its portrayal of vaping is so repulsive that the federal agency that created it actually wants to minimize the number of adults who watch it. “Adults should not be seeing these ads,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products, introducing the campaign at a recent forum hosted by New York University. The reason for this unusual statement? The FDA is wary of discouraging adult smokers from switching to e-cigarettes, which many scientists estimate to be 95 percent safer for them. Ads like this one contribute to an alarmist political climate that has put e-cigarettes under attack, with bills at all levels of government threatening to tax vapor products, ban flavors, restrict their use in public, and raise the minimum age of purchase from 18 to 21.

The current wave of legislation is a predictably panicked response to a rise in teen vaping—a rise that the FDA has portrayed in inflammatory terms as an “epidemic” while obscuring the fact that much of the increase is in experimental rather than frequent use. FDA Commissioner Scott Gottlieb recently took to Twitter to lament that use among young people “puts the entire opportunity [for tobacco harm reduction] at risk for adult smokers.” If the trends don’t reverse, he warned, “I fear the consensus supporting these products for adults will disappear.”

That consensus—that e-cigarette use should be actively encouraged for adult smokers—is based on a growing body of evidence that e-cigarettes will benefit public health by becoming a substitute for combustible tobacco, helping people to quit smoking, smoke less often, or never take up smoking in the first place. The concept of population-level harm reduction tends to frame the entire debate, and Gottlieb is, nominally at least, a harm reduction advocate who believes in the potential of e-cigarettes to save smokers’ lives. Yet he also seems persistently incapable of advocating forcefully on behalf of adult vapers, to the point that the disjointed communications strategy of the agency he leads is doing far more to stoke fear about vaping than it is to promote the benefits of switching.

To understand the reasons for this institutional failure, it’s necessary to look more deeply into what motivates the hostility to vaping among health officials and anti-smoking advocates. It’s not just a disagreement over empirical evidence. Increasingly widespread panic about vaping also reflects long-standing bias against the use of nicotine, thanks to the incredibly successful public health campaign against smoking.

E-cigarettes are a complicated product. To look exclusively at observational studies and population health effects is to treat them as if they are just another pharmaceutical device, but that’s not the way that vapers themselves view them. Sarah Jakes of the New Nicotine Alliance eloquently explained the disparity in her keynote remarks at an e-cigarette conference in 2017:

One of the biggest challenges for consumers is in getting regulators, and those who advise them, to understand that for a great many people, vaping is not a medicine, or simply a smoking cessation intervention. It works precisely because it isn’t those things. It works because they enjoy it. They love the personalization that’s made possible by the diversity of the market in devices, and the thousands of flavors available. They enjoy the identity of being a vaper and the sense of community that that entails. They love that vaping is similar to smoking, but at the same time a million miles away from it.

More than anything else, what distinguishes e-cigarettes from other nicotine replacement therapies is that vaping can be pleasurable and fun. Patches and gums are boring, officially approved, handed down from the sterile hallways of GlaxoSmithKline and the Food and Drug Administration to fix something that’s wrong with people. E-cigarettes give them something to enjoy. This is also exactly what makes anti-smoking activists so uncomfortable.

I understand the reasoning behind their discomfort. When scientists convincingly exposed the dangers of cigarettes in the 1950s, it became clear that the most popular form of tobacco consumption was in fact a deadly scourge. Educational campaigns, taxes, and other measures helped lower American smoking rates from their midcentury peak, falling to around 15 percent of adults in the present day. Even so, smoking continues to be linked to hundreds of thousands of deaths each year, which means that reducing the use of combustible cigarettes is both a significant public health victory and an ongoing challenge of great importance.

But warning smokers about the harm of the products has, over the decades, morphed into a campaign to stigmatize both the act of smoking and smokers themselves, banishing them from public life entirely. The nonsmokers’ rights movement began with quite reasonable complaints that too many places were filled with cigarette smoke. But as it gained steam and cigarette smoking became concentrated among poorer and less educated Americans, smoking bans became a politically expedient means of claiming ever more spaces for nonsmokers. Their reach now goes far beyond any reasonable justification linked to secondhand smoke exposure and extends to patios, golf courses, beaches, parks, sidewalks, college campuses, even entire parts of cities. Smoking bans have always been rooted in the delegitimization of smoking: As leading activist and researcher Stanton Glantz made explicit in an editorial back in 1987, banning indoor smoking undermines “the social support network for smoking by implicitly defining smoking as an antisocial act.”

That’s exactly what’s happened. By the time e-cigarettes arrived on the scene, advocates of smoking bans no longer felt the need to pay lip service to the idea that they are justified by substantive effects on health. That vaping sort of looks like smoking has been sufficient reason to forbid it. And indeed, today, one of the most striking aspects of the various proposals to ban flavored e-cigarettes or restrict vaping in public is the complete absence of any debate over whether government ought to be interfering in the decisions of consenting adults. After decades of stigmatization, it’s become almost unthinkable to suggest that we should respect the preferences of adult nicotine users (perhaps in the same way that we respect the preferences of adult alcohol users and, increasingly, marijuana users). It’s not just that their interests lose out in a cost-benefit analysis. It’s that their interests are never taken seriously at all.

This is particularly fascinating because the innovations that make safer nicotine consumption possible arrived in a time of cultural realignment with regard to the use of various psychoactive substances. University of London historian Virginia Berridge has noted that western societies are increasingly willing to distinguish between “use” and “problem use” for cannabis and some other illegal drugs. And yet still, any use of tobacco is seen as inherently problematic. “Tobacco was changing places to become more like a drug, while drug use itself was becoming ‘normalized’ and part of a wide spectrum of substance use in society,” writes Berridge in her 2013 book Demons, which tracks attitudes toward alcohol, tobacco, and drugs from the early 19th century to the present day. “From the 1980s onward, new ideas about drug use tended to see it as more ‘normal’ while tobacco smoking became seen as pathological.”

These attitudes are so pervasive that they’ve ended up threatening the most promising product yet for tobacco harm reduction, forcing vapor advocates into a defensive posture couched in purely medical terms. And while the harm reduction case for e-cigarettes is compelling, I’d like to suggest a more radical proposal for how we should approach regulating the product: recognize adults’ ownership of their own bodies. Approach vaping not as mere medicine (it’s more than that) or just another form of smoking (it’s much safer), and treat it as one of many moderately risky activities that consenting adults should be free to engage in.

When it comes to other legal drugs, we don’t require that products intended for adults be made unpalatable to minors, even if they’re not supposed to be getting their hands on them. Teen drinking is a serious problem—the Centers for Disease Control and Prevention estimates that excessive drinking causes more than 4,300 deaths among the underaged each year, which is approximately 4,300 more deaths than can be attributed to teen vaping—but we don’t address this by banning adult beverages that young people also find appealing. In states that have legalized cannabis, a visit to any pot dispensary will dispense with the notion that unsophisticated flavors are just for kids; plenty of middle-aged adults line up for edibles in flavors like “Fruity Krispy Treat” or “Citrus Dreamsicle” caramel. Some of this stuff eventually makes its way to minors, but more than 60 percent of the U.S. agrees that it’s better to legalize it than to continue arresting nonviolent people for using it.

Yet when it comes to nicotine, policymakers seem incapable of treating anyone as a free adult. One might be tempted to dismiss objections to vaping restrictions as fodder for perpetually grumbling libertarians, but the failure to adequately defend the interests of people who use e-cigarettes puts actual lives at risk. Projections published in the journal Tobacco Control predict that a large-scale substitution of vaping for cigarettes could prevent more than 6 million premature deaths in the United States between now and 2100. For that to happen, adults need accurate information about the relative dangers of e-cigarettes, permission to use them, and access to flavors and formats that make them more appealing than real tobacco. The current restrictions contemplated by Congress, the FDA, and state or local governments—most of them a reaction to moral panic about teens vaping—would undermine those goals.

More than 35 million Americans over the age of 18 currently smoke. Around 10 million use e-cigarettes. To avoid the mistakes of previous prohibitions and drug wars, it’s necessary to recognize them not as pathological addicts but as equal citizens. As with other dangerous substances, that still allows a productive role for government. Lawmakers and regulators can ensure that nicotine products work as advertised, set limits on toxic chemicals in vapor, tax products proportionally to their harm, and promote educational campaigns about the dangers of smoking. They can work to provide accurate information about how much lower the risks of vaping are to the smokers who need to hear it most. (For a striking contrast in approach that demonstrates what’s possible, compare the FDA’s anti-vaping ad to this video from Public Health England.) And, of course, they can step up enforcement against underage sales, which the current rise in teen vaping shows is clearly needed.

But other interventions should be off-limits. The FDA’s proposal to mandate the removal of nicotine from all forms of combustible tobacco, for example, should be seen as a violation of the rights of cigarette, cigar, and pipe smokers to buy the products they enjoy. Another non-starter would be proposed bans on flavored cigars on the grounds that cigars do not benefit public health (as if a love for public health is the reason anyone chooses to smoke them). And yes, lawmakers would have to tolerate that some people will vape for pleasure, including many who were never smokers.

Nicotine and tobacco use will probably always be with us in some form, legal or not. We can, in a liberal society, take reasonable steps to discourage that use while allowing smokers and vapers the freedom to purchase the products they prefer and giving them accurate information about the risks and harms of each. But that begins with respecting the rights of consenting adults to take control of their own bodies—and not using the panic over teenage use to justify treating an entire nation like children.

Disclosure: I worked at the Cato Institute almost a decade ago when it received some tobacco company donations. I currently work in the spirits and bar industry.