Sunny Shin, who studies tobacco use at Virginia Commonwealth University, says his colleagues are seeing cases of young people switching to cigarettes because they are scared of vaping, a sort of warped perception of overall harms. “Some e-cigarette companies targeted young people [with marketing], and people in low-income communities, and many in those targeted groups started to think they should avoid smoking because it causes cancer, but they thought vaping was harmless,” Shin says. Now that trend could be reversing, and people who got addicted to nicotine because of marketing by vaping companies stand to suffer yet more if they transition to smoking or vaping homemade products.
For years, vaping products were rolled out with essentially no oversight. Not until 2016 did vaping devices come under the jurisdiction of the Food and Drug Administration. While the big vaping companies face distinct controversies over targeted marketing, flavored products, and drawing countless people into long-term nicotine addiction, mainstream products might be the least likely to be the source of recent spikes in disease.
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The most radical solution could also be the most responsible and careful. If you ban it, you can’t regulate it. At least metaphorically speaking, the juice cannot be put back into the cartridge.
“This is a good moment to establish the regulatory structure for these vaping products that should have been in place since the beginning,” Shin says. He emphasizes that ideally no one would be using nicotine regularly, and that the emotional impulsivity that underlies tobacco use is an effective target if a society truly wants to stop people from abusing substances. But short of that sort of meaningful preventive approach, substances can at least be made as safe as possible.
When nicotine is delivered to people’s brains by way of regulated and thoroughly tested products, at least the risks become more predictable. As in the food system, contaminated or especially dangerous products can be traced, and individual products recalled or manufacturing practices banned. This would mean funding the FDA and state health departments to test and ensure the purity and safety of products. It could also involve an industry-driven approach. “You want a device that’s tamper-proof,” Friedman says. “You want a device where people can’t inject vanilla extract, or whatever they have at home to make a flavor, because they can’t buy flavored products.”
As the nebulous long-term health consequences of vaping reveal themselves, it will remain the goal of public health to minimize nicotine use altogether. Doing this will involve the common public-health approach known as harm reduction: working to make a dangerous practice as safe as possible. Drawing on the failures of approaches like abstinence-only sex education and prohibition of alcohol, harm reduction is considered whenever total elimination from society does not seem to be an option. People around the world throughout history have ingested tobacco, and the capitalist American spirit of autonomy has never had the political will to ban it altogether. If the past is any indication, the last humans on Earth will be ingesting tobacco and alcohol as the waters rise around their ankles in their survival bunkers.
In the meantime, the impulse to discontinue all sales and outright ban all vaping products may be a case of applying one big hammer to a job that requires a belt full of small screwdrivers. Meanwhile, in the mission to prevent fatal lung disease, that big hammer could be squarely aimed at cigarettes and air pollution.