On Wednesday, Donald Trump floated a policy that he framed as a response to the growing number of lung illnesses and deaths that appear to be related to vaping: He’d like to ban flavored e-cigarettes. He announced this during a press conference in the Oval Office in which he acknowledged that one of his reasons was first lady Melania Trump’s concern for their son, Barron, and other teens like him.
Here is the problem: It’s not the flavors that appear to be responsible for the outbreak of vaping-associated lung injury that has so far sickened hundreds and killed at least six people. So far, the main culprit appears to be vitamin E acetate, a derivative in THC-contaning e-cigarettes, as well as other contaminants found in black market products. Banning flavored e-cigarettes as a way of combating the outbreak of vaping-associated lung illness is like banning all cheeseburgers because of an E. coli outbreak on two lettuce farms. It’s the wrong solution to the wrong problem. It makes us feel like we are doing something, but it won’t actually help.
And yet, after the announcement, my social media feed lit up with doctors and public health officials celebrating the proposed ban. Many of my professional colleagues are generally against flavored e-cigarettes because they appear to be a lure for teens, which is a reasonable long-term concern.
Like many of my colleagues, I also think vaping is a nuisance and that no good ever comes from inhaling an array of non-medical chemicals into your lungs (even people who vape admit this freely, but I am a doctor and am professionally obligated to remind you of it). Minors in particular shouldn’t vape because e-cigarettes contain nicotine, which may have an effect on the developing brain. That’s why companies that make these products should be aggressively penalized for marketing to kids who otherwise wouldn’t smoke.
But I still feel obligated to defend the practice in part, because for at least some adults who smoke, including those who have failed other methods of quitting, vaping is a far safer alternative than relapsing back to cancer-causing cigarettes or chewing tobacco. The evidence that vaping helps people quit smoking is admittedly weak, but it’s there. Sure, inhaling nothing at all would be best, but for those who can’t maintain abstinence, vaping is the best approach.
But banning flavored e-cigarettes in response to this unfolding crisis might make things worse for minors. For one thing, there are already bans on selling e-cigarettes to people either under 18 or 21 (it depends on where you live), and there are laws restricting access to them and/or unsupervised use in almost every state. Banning commercial companies from selling flavors may turn out to decrease some use overall, which in the long term would be good. But it will also likely push others to the black market now, which in this case matters a lot, because that is where the real risks of immediately life-threatening contaminants mainly appear to be.
As a society, we have confronted the issue of marketing dangerous products that adults may use but kids may not before. We banned advertising campaigns of cigarettes that clearly appealed to minors. That worked. Additionally, underage drinking has steadily declined in the past decade (amazingly, the alcohol industry has largely self-regulated), and we didn’t even have to ban Mike’s Hard Lemonade (or White Claw Hard Seltzer).
Cigarette smoking still kills approximately 480,000 Americans per year. So far vaping-associated lung injury has killed exactly six people. Granted, if in the long run vaping turns out to be more on-ramp than off-ramp for cigarette smoking, we would have to reconsider these figures—especially if flavors themselves were determined to be a crucial factor. But for now the proposed ban on flavored e-cigarettes, but not actual cigarettes, appears to be yet another example of a policy that is no more than a futile gesture pointing away from one real problem at hand and toward another: We are all very bad at assessing health risks.
The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.
