Public-health issues can be really, really complicated. A lot of the time they involve all sorts of cost-benefit trade-offs and complicated webs of interrelation: How does a regulation or tax or recommendation implemented now affect people’s choices and options not only today, but a year or a decade from now? Which sorts of health information do people respond to, changing their behavior appropriately, and which sorts of information do they ignore?
For one of the most fascinating recent examples of this complexity, check out today’s front-page New York Times story by Sabrina Tavernise about e-cigarettes and their struggle to catch on in the United States.
As Tavernise writes, while society is lacking in long-term data about the health effects of e-cigs since they’re so new, there is solid reason to believe they are much, much safer than traditional ones, since they deliver a nicotine fix via a vapor that does not bring with it “the deadly tar found in regular cigarettes.” In fact, the U.K.’s Royal College of Physicians issued a report earlier this year stating that e-cigs are 95 percent safer than their tarry counterparts.
In the U.S., though, Tavernise writes that a decade after e-cigs were introduced, “use has flattened, sales have slowed and, this fall, NJoy, once one of the country’s biggest e-cigarette manufacturers, filed for bankruptcy.” That’s partly because American public-health authorities have been much more reluctant to tout the benefits of e-cigs relative to normal ones. Rather, their messages to the public have often focused more on the as-yet-unknown risks of e-cigs, and on the possibility of kids who haven’t smoked before taking up e-cigs and ending up with a standard cigarette addiction via the gateway. As Tavernise puts it, “the country’s top public health authorities have sent an unwavering message: Vaping is dangerous.”
In addition, Tavernise writes, companies are banned by regulations from making the claim that e-cigs are safer than cigarettes — a claim that is empirically well-supported at this point, even in the absence of long-term data — “unless they go through a long process to prove it, and so far, no e-cigarette maker has done so. More states are also passing laws that lump e-cigarettes in with traditional cigarettes, levying taxes on them and banning their use as part of local smoke-free rules.”
To the average American trying to weigh a flurry of conflicting health claims, information, and, of course, advertising from companies trying to make money, e-cigs may well seem just as dangerous as cigarettes, in part because of the perception that the government is treating them as part of the same category. “When they are regulated just like tobacco, people draw the conclusion that they are just as dangerous,” Daniel I. Wikler, a Harvard School of Public Health ethicist, told Tavernise. “You didn’t say it, but you didn’t have to. People make that assumption and you don’t try to disabuse them of it.”
Part of what makes this such a fascinating issue is that the most informed experts are trying to effect two opposite behaviors in two different populations. That is, every time a current smoker begins vaping and switches to it entirely, that’s very good — the evidence we have suggests it will likely significantly reduce their risk of smoking-related illness and death. But every time a current non-smoker begins vaping, that’s at least a little bit bad — vaping likely carries some risk, and there’s a chance that it could lead to cigarette smoking. (To make things yet more complex, it’s surely the case that some of the smokers who switched to vaping might have otherwise quit nicotine entirely, and that some of the kids who took up vaping and never “graduated” to cigarettes would have gone straight to regular cigarettes if vaping hadn’t been an option.)
Overall, though, many reasonable experts think the substitution from cigarette smoking to vaping could be a huge boon for public health. While smoking has been on the decline in the U.S. for a while, there are still 40 million smokers, reports Tavernise. That’s a lot of people who could potentially switch, which could translate to a lot of lives and health-care money saved, especially in light of the fact that the experts at the Centers for Disease Control and Prevention believe smoking kills 480,000 Americans annually.
David Sweanor, a lawyer at the Center for Health Law, Policy and Ethics at the University of Ottawa, likened the difference between cigarette smoking and vaping to “the relative risks of jumping out a fourth-story window versus taking the stairs[.]” At the moment, he told Tavernise, American health authorities are “saying: ‘Look, these stairs, people could slip, they could get mugged. We just don’t know yet.’” His implication is clear: Because they’re scared of a relatively safe trip down the stairs, a lot of people are jumping out of windows needlessly.