Should the Government Ban E-Cigarettes?

A version of this article first appeared in BU Today.

For the anti-regulatory Trump administration, it was an ironic full-court regulatory press: last week, the Food and Drug Administration (FDA) gave e-cigarette sellers and makers just 60 days to come up with a plan to curb youth vaping or face a possible ban on their products.

The FDA’s sweeping warning to five e-cigarette manufacturers, including Juul Labs, and to 1,100 retailers, among them 7-Eleven, Walgreens, Shell stations, and Circle K, was coupled with 131 fines to vendors who’d sold e-cigs illegally to minors. Scott Gottlieb, commissioner of the FDA, told reporters he was concerned about what he described as an “epidemic” of underage vaping, fueled by the runaway popularity of Juul, whose maker controls more than 70 percent of the market. Gottlieb noted that more than two million middle and high school students last year used e-cigs, which have higher levels of nicotine—known to be addictive—than traditional cigarettes.

As a longtime anti-smoking expert and activist, Michael Siegel hopes the FDA can avoid an outright ban, calling it “a public health disaster” that would push ex-smoking adult vapers back to dangerous, traditional cigarettes. Siegel, a School of Public Health professor of community health sciences, outlined the fine public health line regulators must walk.

Is this a smart move by the FDA?

Siegel: It is certainly a smart move for the FDA to crack down on illegal sales of electronic cigarettes, including Juul and other vaping products, to youth. The agency should take enforcement action against retailers that are selling these products to underage youth and against companies that are marketing their products to youth.

However, the FDA has also threatened to ban all flavored e-cigarettes. This would be a terrible mistake, because there are literally hundreds of thousands of ex-smokers over 21 who are currently using flavored e-cigarettes to stay off real tobacco cigarettes. If the flavored products are taken off the market, there is no question in my mind that tens of thousands of ex-smokers would return to cigarette smoking. This would have a devastating impact on the public’s health.

You’ve argued that vaping might be a way to divert youth from traditional smoking. Is the FDA jeopardizing that anti-smoking effort with this crackdown?<strong/h5>
While the emergence of a vaping culture has effectively diverted many youths from traditional smoking, it’s not clear to me that cracking down on illegal sales of these products to minors would substantially reverse the existing trends. I think smoking is becoming less and less popular and will remain that way. So it makes sense to do what we can to try to keep youth both smoke-free and vape-free if possible. The Juul is especially problematic because of its high addictive potential.

What the FDA may be jeopardizing if it follows through with its threat to ban flavored e-cigarettes is the health of adults in this country. Many adult ex-smokers are able to stay off traditional cigarettes only because of the availability of flavored e-cigarette alternatives. A ban on flavored e-cigarettes is tantamount to a ban on the sale of vaping products, because there are virtually no unflavored e-cigarette liquids on the market.

Pretty much all e-liquids contain the same ingredients: water, propylene glycol, glycerin, and nicotine. It is the flavors that differentiate between different brands and types of e-liquids. I’m not even sure that an unflavored e-liquid could survive on the market. Vapers have flavor preferences. Using a bland e-liquid with no flavorings would not be appealing to any vaper or to any smoker.

The New York Times reports that teens are getting hooked on vaping, with its heavy nicotine content. Is that a danger?

For the bulk of e-cigarettes on the market, the nicotine delivery is quite poor. These products pose very little risk of addiction. However, the Juul is different. It uses a nicotine salt that is much more rapidly absorbed into the bloodstream. The nicotine pattern in the blood mimics that of actual cigarette smoking. Juuling has a real potential for addiction.

I wouldn’t say that this is as big a danger as traditional cigarette addiction. If you become addicted to smoking, there is a 50 percent chance that you are going to die prematurely because of it. But with the Juul, we don’t know if there are any long-term health consequences. We certainly want to do what we can to prevent youth from becoming addicted to Juuling, but in no way would I compare that to the danger of youth addiction to real cigarettes.

What steps should the industry take to stop sales to minors?

The first is to increase the price of the product. State and local governments could impose taxes on these products to deter youth use. If they do this, they should increase the tax on cigarettes to an even higher level to make sure that price remains a deterrent to smoking and an additional incentive for smokers who cannot quit completely to switch to vaping.

The second effective way is aggressive media campaigns to educate youth about the harms of the product and to make it less glamorous. One way this could be funded is to require manufacturers to pay a certain percentage of their profits or sales into a fund that would be used for such a campaign.

I don’t think cracking down on a number of retailers for illegal sales to minors is going to have a huge impact on youth use of vaping products. Youths are able to obtain e-cigarettes through other channels, such as having older kids legally purchase the products and then sell them to younger kids.

Does the FDA’s move—threatening to ban devices from the market if the industry can’t stop use by minors—represent a rare regulation from the anti-regulatory Trump administration?

This is quite ironic, because if the FDA bans vaping products, or even if it merely bans flavored e-liquids, it will be one regulation that we would be better off without. What an irony it would be if the administration, which is getting rid of really important public health regulations left and right, were to impose this regulation, which would actually cause substantial harm to the public’s health by causing many ex-smokers to return to smoking. There is no action the administration could take that would be better for the profits of cigarette companies than to ban their chief competitor: flavored electronic cigarettes.

—Rich Barlow