5 September 2019
With dozens of people becoming sick from a vaping-related illness, it’s time to get more information about the risks of e-cigarettes.
This editorial has been updated to reflect news developments.
Health officials have identified one potential cause of the mysterious vaping-related illness that has sickened more than 450 people and claimed at least three lives: vitamin E acetate, an oil found in some marijuana-based vaping products. But there’s still a lot they don’t know. Are other adulterants also involved? Does a combination of vaping ingredients, or the use of a certain vaping device, increase the likelihood of falling ill?
Parents have been anxious, as many patients so far have been teenagers and young adults. Health officials are scrambling — the Centers for Disease Control and Prevention have advised those who are concerned to not use e-cigarette devices. And, as uncertainty persists, states and cities are taking matters into their own hands. On Wednesday, Michigan became the first state to ban flavored e-cigarettes. San Francisco has issued an even more comprehensive ban — of all e-cigarettes — and other communities have similar measures in the works.
Outright product bans are risky. If they give rise to a more dangerous black market, or drive vapers back to traditional cigarettes, the effects could be disastrously counterproductive. But the confusion and worry behind such actions are understandable, given how popular e-cigarettes have become and how little is known about their risks.
The first e-cigarettes entered the market more than a decade ago, with the promise that they would be less harmful than traditional cigarettes and could even help people quit smoking. But the Food and Drug Administration has yet to review any of these products to determine whether they offer a net benefit for public health. While e-cigarettes don’t contain the combustible tobacco that makes regular cigarettes so carcinogenic, they do contain several other chemicals whose long-term health effects are largely unknown.
Based on existing evidence, most doctors and scientists think that e-cigarettes are probably safer than regular cigarettes. But exactly how much safer is still anybody’s guess. The only way to know for certain is with a thorough and impartial vetting of these products.
Companies are supposed to submit their data to the Food and Drug Administration for review by next May, but the Vapor Technology Association, an e-cigarette industry group, has sued the federal government in an effort to delay that reckoning. The association says that the 2020 deadline does not give companies nearly enough time to produce the data that regulators are requesting. Smaller companies will be wiped out by the expense of securing regulatory approval, and adult smokers who use e-cigarettes to quit smoking will suffer as a result, the association argues.
There is some truth to these arguments. But it’s been three years since the F.D.A. gained jurisdiction over e-cigarettes. It’s past time for consumers to know whether these products will truly help them quit tobacco and whether such benefits outweigh the potential risks.
In the meantime, youth vaping rates have surged, and e-cigarette makers are at least partly to blame: A congressional investigation has found that Juul, the nation’s leading e-cigarette maker, used social media and “educational” and “antismoking” campaigns to plug its products to minors. In at least one instance, the company targeted children as young as 8. In another, it told students that e-cigarettes were “totally safe.” The company’s lobbyists have fought to block or weaken state bills that would curb access to its products. And according to The San Francisco Chronicle, the company has spent millions of dollars on a ballot initiative that would overturn the city’s e-cigarette ban.
In response to growing criticism, Juul has ended its youth education programs, closed social media accounts and has begun to introduce stringent age-verification measures to prevent minors from buying its products. A Juul spokesman says the company does not support the Vapor Technology Association’s lawsuit against the F.D.A. and plans to comply with the regulatory deadline.
Those are welcome course corrections. But the relationship between e-cigarette makers and the tobacco industry is concerning. Juul sold a 35 percent stake of its company to the tobacco giant Altria, and the broader e-cigarette industry appears to have borrowed from the Big Tobacco playbook. Cigarette makers used cartoons and cowboys to market their products, directly and deliberately, to young children. They knew for decades that those products were highly addictive and potentially deadly, and they lied to the public and to Congress about those risks. They also lobbied aggressively to stave off regulatory oversight and tobacco control legislation.
Those deceptions took decades to uncover. They also led to widespread nicotine addiction and millions of smoking-related deaths — a public health disaster that the nation is still grappling with today. The best way to avoid repeating those mistakes with e-cigarettes is through strong, transparent regulation, put into place as quickly as possible.
