““It’s really a product that’s good for some people and bad for other people, which doesn’t feel like too complex of a statement, but actually feels like something that is difficult for many to grapple with,” said Hartmann-Boyce, who is an associate professor of evidence-based policy and practice at the University of Oxford.
She led a 2022 Cochrane review — considered the best type of analysis of the available evidence — which looked at studies of e-cigarettes for smoking cessation. It found the strongest evidence yet that vaping works better than traditional nicotine replacement tools such as patches or gum to help people stop smoking. For those advocating that vaping is an effective harm-reduction mechanism, it was a significant win.
But it’s also more complicated than that.
Hartmann-Boyce said that since Cochrane first started looking at the evidence nearly 10 years ago, things have changed dramatically. The devices themselves are different now and are much better at delivering nicotine. That’s good for people trying to give up smoking but creates a problem with non-smokers like kids who are trying these for the first time.
But not everyone is even convinced it’s good for most smokers in the long term.
Jørgen Vestbo, a clinician and emeritus professor of respiratory medicine at the University Hospital of South Manchester, who recently returned to his native Denmark, agrees that the randomized controlled trials show e-cigarettes can help people quit.
But he also points to data from clinical trials that show people given e-cigarettes were more likely to use them for longer than those using aids such as nicotine gum. Vestbo said population-level evidence shows that as long as you are addicted to nicotine you are more likely to start smoking again.”
“After nearly two years of review, the Food and Drug Administration (FDA) is preparing to deny Juul’s application to keep its tobacco- and menthol-flavored vaping products on the market, according to reporting from The Wall Street Journal. The news is surprising; when compared to competitors’ applications, Juul’s was one of the most detailed and data-heavy, showing just how effective it was at transitioning smokers away from cigarettes, toward a safer alternative.”
“But what appeared to be a classic Silicon Valley success story soon became a victim of an intensely ideological war on nicotine. Unfortunately, Juul also for a time became the most popular product among minors who were experimenting with vaping. Youth vaping rates rose substantially. Current e-cigarette use, defined as taking a puff or more in the past 30 days, jumped from 11.7 percent in 2017 to 27.5 percent in 2019.
Juul was squarely blamed for the rise of youth vaping, with critics pointing to its initial marketing campaigns showing people in their early twenties enjoying the product. Critics alleged that flavors like mango and cucumber were especially appealing to the younger demographic. But what they forget is that in late 2016, the company switched to exclusively using models who are 35 or older in their advertising campaigns, as well as only using real customers who have switched from smoking to vaping. What anti-vaping campaigners also ignore is that the vast majority of adult vapers quit smoking using sweet or fruity flavors; such products are not just desired by teens.
The claim that Juul’s flavors were the underlying cause for the rise in youth vaping is highly dubious, considering there were thousands of different flavors for other e-cigarettes on the market years before Juul took off. Surveys of teenagers by the Centers for Disease Control and Prevention show that just 13.2 percent of young people who use e-cigarettes say they do so for the flavors. Experimentation with e-cigarettes mimics other behaviors like alcohol and illicit drug use, often with the same populations engaging in these types of activities. But to appease critics, Juul voluntarily removed all flavors other than tobacco and menthol from the market in 2019.”
“In 2020, the Cochrane Review, widely considered the gold standard for evaluating evidence-based medicine, concluded that e-cigarettes are more effective than traditional nicotine replacement therapies for helping smokers quit. By banning the most effective and popular e-cigarette on the market, there is no doubt that the FDA’s choice will force a portion of current Juul users to go back to smoking, and an unknown number of smokers to never make the healthier switch to vaping. What economist Alex Tabarrok calls the FDA’s “invisible graveyard” just got a whole lot bigger.”
I used to support legalizing all drugs. Then the opioid epidemic happened. German Lopez. 2017 9 12. Vox. https://www.vox.com/policy-and-politics/2017/4/20/15328384/opioid-epidemic-drug-legalization Dopesick Reinforces These Pernicious Misconceptions About Opioids, Addiction, and Pain Treatment Jacob Sullum. 2021 11 17. Reason. Two Courts Debunk Widely Accepted Opioid
“A 2020 meta-analysis of 26 randomized controlled trials concluded “there is moderate-certainty evidence that [e-cigarettes] with nicotine increase quit rates compared to [e-cigarettes] without nicotine and compared to nicotine replacement therapy.” The results of population studies, Balfour et al. say, “are consistent with a near doubling of quit attempt success, found in the randomized controlled trials, and the fact that e-cigarettes are smokers’ most used aid in quit attempts.” They also note that declines in U.S. cigarette sales accelerated sharply as sales of vaping products took off, which reinforces the impression that more vaping means less smoking.”
“In newly published research, she looked at youth smoking rates in San Francisco, which banned flavored tobacco products—including flavored cigarettes and flavored vaping liquids—in June 2018. Previous research suggested the ban actually increased cigarette smoking in 18- to 24-year-olds while decreasing overall tobacco product use in 18- to 34-year-olds. Friedman wanted to measure the ban’s effect on high school students under 18.
Using data from the 2011-2019 Youth Risk Behavior Surveillance System (YRBSS), Friedman was able to look at under-18 cigarette smoking rates in Los Angeles, New York City, Philadelphia, San Diego, San Francisco, and Florida’s Broward, Palm Beach, and Orange counties. This allowed her to compare youth smoking in San Francisco with districts that did not ban flavored cigarettes and vaping products.
“Comparing recent smoking rates by wave revealed similar trends in San Francisco vs other districts prior to 2018 but subsequent divergence,” writes Friedman of her findings. “San Francisco’s flavor ban was associated with more than doubled odds of recent smoking among underage high school students relative to concurrent changes in other districts.”
“While the policy applied to all tobacco products, its outcome was likely greater for youths who vaped than those who smoked due to higher rates of flavored tobacco use among those who vaped,” she adds. “This raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution.””
“While America may have taken smoking more seriously, it continues to kill nearly half a million people every year. Alcohol-related deaths number almost 100,000 annually.”
““The number one substance that is involved in arrests and incarceration is alcohol in the United States,” Keith Humphreys, a drug policy expert and professor of psychiatry at Stanford University, told me. “In terms of the damage — people think of illegal drugs as the drivers of the criminal justice system, [but] none of them come close to alcohol.””
“the documented health benefits to smoking bans like reductions in secondhand smoke exposure largely outweigh any of the costs, like a small increase in drunk driving in some places. Additionally, there are simple ways to eliminate potential increases in drunk driving.”
“While there is still some debate around the potential increase in drunk driving, there is a vast, peer-reviewed, scientific literature around the harms of secondhand smoke inhalation, and around the massive health benefits associated with the sharp decline in smoking in part due to smoke-free policies.”