The U.K. Parliament’s Science and Technology Committee recently released its latest report on e-cigarettes. The advice could not have been more clear.
Vaping is significantly safer than smoking, and smokers who are thinking about switching to e-cigarettes should do so without hesitation. The report argued for lower taxes on e-cigarettes, a debate on vaping in public spaces, and greater freedom to advertise. Britain’s National Health Service encourages smokers to switch to vaping.
On the other side of the pond, the attitude is towards vaping is precisely the opposite. Sens. Dick Durbin, D-Ill., Elizabeth Warren, D-Mass., and Chuck Schumer, D-N.Y., are demanding stricter regulations on e-cigarettes. Cities and states are enacting higher taxes, raising the age of purchase, including vaping in smoke-free laws, and banning e-cigarette flavors.
A new Rasmussen poll shows just 20 percent of American adults think vaping is safer than smoking, with 13 percent saying e-cigarettes are less safe than traditional cigarettes, while 50 percent believe the health risk is about the same from both.
It’s widely known among health professionals that it’s the smoke from cigarettes, not the nicotine, which leads to the deaths of more than 480,000 Americans every year. Yet, more than half of adults think nicotine is responsible for cancers caused by smoking. The American Cancer Society, National Academies of Sciences, Engineering, and Medicine, the Royal College of Physicians, and Public Health England all agree that switching to vaping is better than continued smoking.
So, what explains this chasm between U.K. and U.S. policymakers on a seemingly anodyne issue of public health and consumer choice? Both have access to the same data but have come to radically different conclusions.
The divergence boils down to a fundamental difference when it comes to weighing the risks and rewards presented by e-cigarettes. The U.K. views e-cigarettes as a tobacco harm reduction tool where smokers can access the nicotine they desire without the smoke that may kill them. U.S. politicians see a wolf in sheep’s clothing, viewing e-cigarettes as Big Tobacco 2.0, with the potential to a hook a new generation on nicotine, acting as a gateway to future smoking. If adults are encouraged to switch to e-cigarettes, so the theory goes, it could entice teenagers to pick up vaping, seeing e-cigarettes as a relatively harmless way to signal rebellion or fit in with their peers.
FDA Commissioner Scott Gottlieb recently put a figure on this trade-off, telling USA Today that one adult smoker switching to e-cigarettes for five children taking up vaping wouldn’t be acceptable. But is this a trade-off FDA has to make? The answer is undoubtedly no.
Despite waves of hysterical media coverage verging on moral panic, there is precious little evidence to suggest an “epidemic” of teen vaping is sweeping high schools. E-cigarette use among high school students was 11.7 percent in 2017, substantially down from its high point of 16 percent in 2015. E-cigarettes are still less popular with high schoolers than either alcohol or marijuana.
As for fear of vaping being a “gateway” to smoking, the data show not a resurgence of teen smoking but a historic decline over the same period when vaping became mainstream. According to the Centers for Disease Control and Prevention, high school smoking fell to a record low of 7.6 percent in 2017, compared to 8 percent the previous year and 15.8 percent in 2011. Between 2011 and 2017, adult smoking rates also fell from 19 percent to 13.9 percent, with many public health experts attributing this success, in part, to the widespread availability of e-cigarettes.
Yet, anti-smoking groups continue to urge politicians and the FDA to act pre-emptively to head off the alleged risk of youth nicotine addiction. These actions would include flavor bans, severe marketing restrictions, higher taxes, and extending all smoke-free legislation to e-cigarettes.
In doing so, tobacco control advocates are calling in aid of the so-called precautionary principle. One of the most famous definitions of the precautionary principle comes from the 1998 Wingspread Statement, which summarizes the principle thus: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.”
While this may appear reasonable, it is precisely the opposite. In the case of e-cigarettes, harms to human health remain hypothetical. There is, in fact, no established cause and effect relationship between vaping and harms to human health though it cannot be ruled out entirely. What is known, however, is the harms of smoking and that switching to vaping is a massive improvement.
According to modeling conducted by David Levy and colleagues at Georgetown University Medical Center, replacement of cigarette use by e-cigarette use over a 10-year period would yield 6.6 million fewer premature deaths with 86.7 million fewer life years lost. A study published in February found that a ban on TV e-cigarette advertising would have reduced the number of smokers who quit in the recent past by approximately 3 percent, resulting in roughly 105,000 fewer quitters.
To pre-emptively act against e-cigarettes is to regulate on the grounds of a theoretical danger while disregarding known benefits. In this case, the precautionary principle is not an agent of protection but a catalyst for harm.
Legal scholar and former Obama regulatory czar Cass Sunstein explained the risks of such an approach in an article for the Boston Globe in 2008: “It is, of course, true that we should take precautions against some speculative dangers. But there are always risks on both sides of a decision; inaction can bring danger, but so can action. Precautions, in other words, themselves create risks — and hence the principle bans what it simultaneously requires.”
Reasonable measures can and are being taken to prevent kids from vaping. Age of purchase laws and FDA crackdowns on retailers selling e-cigarettes to minors are welcome. But hobbling an industry which is saving lives and creating jobs at zero taxpayer expense on the grounds of theoretical harms is not a service to public health but an irrational spasm which could prove lethal to millions of smokers trying to quit.
This column originally appeared in the Washington Examiner.