Food and Drug Administration Commissioner Scott Gottlieb thinks there is a new epidemic plaguing the country. No, it is not opioids, or drinking and driving — it's electronic cigarette use among teens. The commissioner’s solution? Altogether removing “flavored e-cig products from the market,” per a comment he made to the press on Sept. 12. The FDA argues that certain flavors of e-cigarettes lure teens into smoking, and maintain that this is damaging for their health. In reality, banning these flavors won’t reduce tobacco addiction — it will only make it worse.
The idea that e-cigarettes are as harmful as regular cigarettes is simply misinformed. A 2018 National Academies of Sciences study found that e-cigarettes are significantly less dangerous than traditional cigarettes, cigars, and other tobacco products. A University of Catania studywent even further, concluding that human health is essentially unaffected by e-cigarette use. E-cigarettes are less harmful because regular cigarettes burn materials that release numerous negative chemicals like tar, while e-cigarettes do not.
Of course, there is some negative health impact behind e-cigarette use, but the FDA is wrong when it insists that e-cigarette use in teens is associated with the use of other tobacco products. In fact, according to the Centers for Disease and Control, since 2011, e-cigarettes have replaced more harmful tobacco products among high school students. More importantly, the use of any tobacco product, including e-cigarettes, has decreased from more than one-in-four high school students to less than one-in-five.
This means the glory days of cigarette smoking have actually been ushered out the door by e-cigarettes. Yes, a ban on flavored e-cigarettes could reduce their use among teens — but, likely, it would also increase their use of old products that have been consistently proven to harm them much more. How is that a victory for the FDA — or more importantly, the public?
Moreover, the FDA will not solve the problem of tobacco use in schools simply by banning one product. For instance, marijuana, a drug that is illegal for all minors and only legal for adults in select states, is still used by almost 40 percent of 12th graders every year — near an all-time high. A ban on e-cigarette flavors would be no different than this. And, for students already inclined to break the rules, a flavor ban will only inspire them to put other flavors in their e-cigarettes that could easily hurt them. In an age when teenagers eat Tide pods, lack of legal safe flavoring options could lead teens to flavor e-cigarettes in dangerous ways. Will they start injecting flavored chemicals into their e-cigarette liquid? It's even possible that a black market for illegal and dangerous flavored chemicals could emerge.
The FDA also argues that e-cigarettes, especially those with flavors, serve as a way to start a smoking habit. Even though this might be true in some cases, it leaves aside the many adults who stop smoking due to e-cigarettes. A 2018 study by the Center for Substance Use Research in the United Kingdom concluded that 137 adults stopped smoking for each one who started smoking due to e-cigarette use. Additionally, nearly two-thirds of adult smokers in the study who started using e-cigarettes are no longer smoking.
Without a plethora of e-cigarette flavors, the craving for traditional smoking among adult vapers would substantially increase. A study published in the International Journal of Environmental Research and Public Health polled approximately 4,500 former smokers who transitioned to e-cigarettes, and found that among former smokers categorized switching flavors and having many options as “very important” in helping them quit. The study also found that half of vapers said fewer options would increase their craving for cigarettes — in addition to the 40 percent who said that it would have been less likely for them to reduce or quit smoking if fewer flavors were available. There were 10.8 million adult vapers in 2016. Nine million of them were former smokers or current smokers of regular cigarettes — therefore, it is clear that a ban on e-cigarette flavors could stop millions of smokers from quitting, or even push them to relapse.
Gottlieb is right when he says that minors should not use e-cigarettes. But neither should they smoke marijuana, drink, or do many other things they often do. If the agency got its way, everything that is bad for minors would be outright banned for everyone. The FDA might want to stop teenagers from making poor decisions, but if it bans flavored e-cigarettes for everyone, it will only make matters worse.