Vaping on Trial: How U.S. Policy Drives an Increase in Smoking

 Smoking contributes to more preventable death than any other cause. Nicotine in cigarettes is addictive, but it is the burning of tobacco that releases chemicals that worsen health. To wean smokers off cigarettes, all nicotine substitutes should be welcomed, even if they pose some risk. But many US organizations, public and private, discourage vaping because they’re concerned children might try it and it might have cardiovascular risks.

But many studies show that vaping and other products are more effective at lowering smoking rates than gums and patches. Smoking is a ritual, and alternative vaping and heat-not-burn products simulate the act of smoking, without the burning of tobacco. 

Yet many U.S. health groups, like the American Cancer Society, will only tolerate abstinence and medically provided nicotine patches and gums, viewing vaping skeptically with a zero-tolerance or ultra-precautionary approach. Official U.S. health policy does not actively encourage these products. The Food and Drug Administration has approved very few vaping products, denying hundreds of applications. The Centers for Disease Control is equivocal about the role of vaping in smoking cessation.

Britain, on the other hand, has adopted a more holistic approach to risk by acknowledging the possible risks of vaping and clearly explaining that smoking is 95% more dangerous than vaping. Indeed, government bodies such as Public Health England and the National Health Service (NHS) encourage the use of vaping in smoking cessation, even providing vaping to the poor to stop them smoking. The UK bans vaping for kids but wants new products that can help current smokers quit. 

The difference in the policy approach of U.S. and UK governments is followed by the physicians in those nations. I undertook a survey of British and American physicians. Only 1 out of 23 U.S. physicians (4%) thought vaping was a legitimate part of smoking cessation policy, whereas nearly half (44%) of the 25 British physicians surveyed thought vaping could be part of smoking cessation policy.

This difference in policy advice and physician opinion matters. Some cities in the U.S. have banned vaping products because they think they’re associated with youth vaping. While it is true that young people do try vaping products, those that vape often do so instead of smoking. One of the few academic studies of these recent policy changes found that in San Francisco, smoking rates had risen following the vaping ban. This is simply the worst possible outcome from a public health standpoint.

The great social anthropologist and risk expert Aaron Wildavsky understood the fear of new products. As he explained, experimentation generally produces better and often safer products. Cars produced in 2022 are safer than those produced 20 years ago, which were safer than those produced in the 1980s. Per mile traveled driving has never been safer. That doesn't mean new cars are safe. As Wildavsky famously wrote, it is better to have “trial and error,” allowing new and potentially risky but often safer products to come on the market, than “trial without error,” denying the new because it might carry risk. In many ways, vaping is on trial in the U.S. Most new products are not being allowed on the market, and existing ones are being restricted and even banned.

But it is smoking that is the real danger, and vaping is far safer than smoking and therefore should be encouraged. Under 18s should not smoke or vape, but many will nevertheless find ways to try alcohol, smoking, or illicit drugs. Seasoned anti-smoking advocates have explained that, when looking for the lesser of two evils, it is better for kids to vape than smoke. While children shouldn’t do either, to ignore the lure of forbidden fruit drives naive public policy.

Unfortunately, very well financed anti-vaping groups seem to dominate advice and influence public policy. Bloomberg Philanthropies is spending $160 million to push for vaping flavor bans, and it considers the San Francisco ban a success. While it and other groups are obviously well intentioned, current and future smokers are at risk because safer alternatives to cigarettes are not available.

Roger Bate is a Senior Fellow at the Pacific Research Institute and author of the paper 'Vaping on Trial', published this week by PRI.

https://www.realclearhealth.com/articles/2022/06/22/vaping_on_trial_how_us_policy_drives_an_increase_in_smoking_111354.html