A couple of Stanford engineers who had been cursed with smoking habits invented what is now the most popular smoking-cessation tool on the market — and the FDA has just declared war on it, because it looks trashy.
The FDA has ordered five big players in the vaping business — JUUL, Vuse, MarkTen, blu, and Logic — to submit plans for keeping their products out of the hands of minors, giving them 60 days to do so — and threatening to take their products off the market if Washington is not satisfied.
This calls to mind the predictably lazy federal approach to firearms regulation: Rather than do the hard work of running down street dealers and straw buyers, the ATF and the anti-gun lobby concentrate their efforts on firearms makers and licensed gun dealers, because it is easier to police the law-abiding than it is to police criminals. As with firearms, there are straw buyers of vaping products; and as with firearms, there is practically no serious law-enforcement effort to do anything about that. And as with firearms, there is a laborious but straightforward way to go about dealing with those who sell vaping products to minors and minors who buy them: investigate, arrest, charge, fine, repeat — and, if necessary, jail major offenders and revoke the business licenses of outlaw retailers.
You know: police work.
That’s what you’d do if this were a law-enforcement issue, or a regulatory issue. But the jihad against vaping products is not a regulatory issue, or a law-enforcement issue, or a public-health issue: It is a class issue.
JUUL, as the most successful company in the market, is the most attractive target.
JUUL is a smoking-cessation tool that vaporizes flavored pods containing nicotine salts, delivering a brief sharp jolt of nicotine that by design resembles the effect of smoking a cigarette. Unlike cigarettes, JUUL and other vaping products do not rely on the combustion of tobacco — or on tobacco, period — which eliminates about 90 percent of the negative health effects associated with smoking cigarettes. Switching from cigarettes to vaping has been shown to have substantial health benefits. As a paper published in Addiction Medicine: Clinical & Ethical Perspectives put it:
Many studies have found significant health improvement when smokers switch to vaping, including improved asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and reduced pneumonia risk.
The same paper makes an excellent point, one that the powers that be at the FDA should meditate on:
Medical practitioners have a duty of care to provide the best possible management at each patient encounter. Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation.
If we had an affordable, easy-to-use device that eliminated 90 percent of the health problems associated with HIV or cervical cancer in exchange for relatively minor risks and side effects, we would consider it monstrous to withhold that product from the market. If we take seriously the idea that cigarette addiction is a disease, one that should be combatted with public-health measures, then we should consider withholding effective assistance fundamentally unethical — even if it is not effective for everyone, and even if there are some undesirable associated effects.
As a public-health tradeoff, vaping is a good deal. It is an obviously good deal.
Ah, but a good deal for whom?
Smoking correlates very strongly with poverty and low educational achievement. People below the poverty line are about 60 percent more likely to smoke than people above the poverty line. Marginalized minorities such as Native Americans smoke at much higher rates than do nice white liberals in the suburbs, and people with GEDs smoke at nine times the rate of people with graduate degrees. People in rural areas and small towns in the South smoke at much higher rates than do people in Santa Monica.
Think of it this way: Smoking is a problem for people who shop at Walmart, but our public policies are made by the people who shop at Whole Foods. (Or who have their servants shop at Whole Foods.) And those people do not want to see young people in their communities doing something that even looks like smoking.
Of course people vape recreationally, and minors who are not legally able to buy vaping products get their hands on them and use them, albeit at relatively low frequency: Teenage marijuana use, for example, is about 35 percent more frequent than teenage vaping. And marijuana is of course much more heavily regulated than vaping.
And both pot-smoking and vaping are far more popular than cigarette smoking among teenagers. In fact, teen smoking rates are at historic lows — which is excellent news, and news that ought to make us at least a little suspicious of claims that vaping is going to lead to a new epidemic of cigarette smoking among young people.
Illegal, underage vaping is most visible — to the people who set the policy agenda — in areas where the parents generally don’t smoke and where the kids have discretionary money to spend on vices. Not surprisingly, those are the places where the most active and vocal political opponents of vaping tend to come from: Chuck Schumer of Park Slope, Richard Blumenthal of Greenwich, etc. Our policymaking conversation inevitably is dominated by those with higher incomes and more education — the dreaded “elites” of contemporary American English usage. And elite conversations tend to focus on elite interests: what’s going on in Greenwich, Conn., not what’s going on in Camden, Ark.
“Vaping is as white trash as having a couch in your front yard,” tweets filmmaker Dan Bell, a sentiment echoed all over the Internet. The rise of the same attitude regarding cigarettes accompanied a sharp turn in public perceptions of smoking from the 1960s forward. Shifting public attitudes, as the authors of The Changing Public Image of Smoking in the United States: 1964–2014 put it, served to “stigmatize” tobacco use, and, as one might expect, there is a class aspect to that: “A major defining characteristic of smoking prevalence today is socio-economic status, with higher smoking rates found among the poor and less educated and also among individuals with mental health and substance abuse diagnoses.” Things associated with poor people generally are not popular, and, when they are taken up by the well-to-do, they usually are taken up as a transgressive gesture, which vaping among upper-class suburban kids unquestionably is.
The risks associated with vaping are trivial compared with the risks associated with smoking cigarettes. And vaping is an effective tool for weaning smokers off of cigarettes. And here we must consider a fact of critical importance: Cigarette addiction is not the same thing as nicotine addiction — nicotine is not what kills smokers. But the FDA nonetheless intends to stand in the way of JUUL and other products that could help millions of Americans, disproportionately poor, take an important step toward improving their health. Why? Because elite squeamishness about Greenwich kids aping low-rent habits has more weight in the policymaking mind than does reducing asthma and cancer in poor people in the downscale places where cigarette smoking is most prevalent.
The FDA crackdown is generally out of character for the Trump administration, which has so far maintained a largely deregulatory stance. FDA Commissioner Scott Gottlieb apparently has decided to be the Marlboro Man’s best friend: Shares in tobacco titan Altria jumped almost 7 percent on yesterday’s FDA news. If the FDA doesn’t want to listen to what the research is telling them, then maybe they’ll listen to the market.