Medical Examiner

The Problem With San Francisco’s Proposal to Ban Vaping

We shouldn’t let our panic over teen Juuling overshadow e-cigarettes’ potential as a harm reduction tool.

A bearded man vaping.
Photo illustration by Slate. Photo by Getty Images Plus.

San Francisco is on a bit of a banning spree. Last year, it was electric scooters. Now, the city is considering a bill to get rid of cashless stores and legislation that could effectively ban vaping. That last bit of proposed legislation hinges on the idea that we don’t yet know enough about e-cigarettes to allow them. It’s not an outright ban; it’s a proposed ban of vapes that have not undergone review by the Food and Drug Administration. But at the moment, that’s all of them.

The vaping ban is meant to “protect youth from e-cigarettes,” according to a press release put out by City Attorney Dennis Herrera, who is proposing it along with Supervisor Shamann Walton. It’s of a piece with the recent outcry over the “epidemic” of teen vaping, as outgoing FDA Commissioner Scott Gottlieb has described it (he led his agency in restricting the sale of vaping cartridges in flavors like mango and sour gummy). Worry over e-cigs has been building since research last year showed a rise in teen vaping. Juul, the only brand named in the San Francisco press release, is a bit of a phenomenon with teens: The product’s early ads featured young people, and its Urban Dictionary definition notes that the device is “commonly mistaken for a USB stick,” making it easy to conceal at school.

Cutting down on teen vaping is a fine goal. Like all tobacco products, e-cigarettes cannot be sold to those under 18 years of age (though some states have upped that to 21). But calls like this one show how moral panic over teen e-cigarette use tends to obscure e-cigarettes’ potential as an essential harm reduction tool and a safer alternative to cigarettes, a known cancer causing agent.

The lawmakers behind the San Francisco proposal say they just want the FDA to move faster on evaluating e-cigarettes’ role in public health. It’s true that the FDA has not vetted e-cigarette products—but it has a plan to do so by 2022 (a deadline it pushed back for good reason, as Jacob Grier has argued in Slate). Requiring vaping to be regulated right now or else also stands in contrast to the comparatively lax requirements for cigarettes: As Herrera pointed out to me in an email, “there is no legal requirement for the FDA to conduct that type of review for traditional cigarettes, which were on the market before that law went into effect.”

In the meantime, the U.S. Department of Health and Human Services has already issued a nearly-300-page surgeon general report on vaping. After reading it, physician Jeremy Samuel Faust concluded that “e-cigarettes are nowhere near as harmful for most people as traditional cigarettes or chewing tobacco—both of which clearly cause cancer and a host of other long-term serious medical problems,” as he wrote in Slate. And even with the recent rise in teen vaping, it’s worth noting that use of tobacco products among teens is about where it was in 2011, according to the Centers for Disease Control and Prevention (it did dip and then rise again in that window). But the net situation has improved, because consumption has swayed toward a less harmful version of the product.

The problem with the proposed ban is that it wouldn’t just keep vapes away from teens; it would also keep them from an essential audience: adult smokers. “Smoking is uniquely deadly, and the evidence we have so far suggests electronic cigarettes (e-cigarettes) with nicotine may help you quit,” a 2018 report in the BMJ argued. The surgeon general’s 2016 report says that the evidence showing that vapes work as an overall nicotine cessation tool is “extremely weak,” though the science is still evolving. Either way, we know that using a Juul is less harmful than smoking a cigarette. Being an alternative to adult smoking is incidentally Juul’s current purported goal, and where its advertising dollars seemed to be aimed.

In the end, the proposal raises the question: Why not just add old-fashioned cancer-causing cigarettes to the list of things not allowed in San Francisco, too? I think this reveals the concept’s flaws. There are social reasons not to go the whole mile on tobacco: It’s not a zeitgeisty issue, and even though cigarettes do still affect teens, they don’t hold the same youthful connotations as Juuls. But a ban on cigarettes would also look obviously paternalistic and kind of ridiculous, standing out as a clear way to unfairly control people living with addiction, rather than offering them help and resources and the right to manage vices as they wish. A vaping ban would do the same thing; it’s just slyer about it.