Surgeon General Declares War on E-Cigarettes But Not Marijuana, Hookah

One of my extended family members is a former smoker. Nagging him to stop did little good. Warning him against its health dangers produced similarly poor results. He was addicted, and he appeared to like smoking, anyway. 

Then e-cigarettes came along. After giving them a try, he quit cigarettes for good. No nagging was necessary. He received the same kick from vaping minus all the nasty smoke that makes cigarettes so dangerous. His blunted sense of smell and taste returned to normal and breathing became easier. 

His story is not unique. Many former smokers credit e-cigarettes with changing their lives for the better. A study in the journal Tobacco Control concluded that smokers who used e-cigarettes for two years were four times likelier to quit than people who did not. Another study suggested that vaping could help combat obesity (since nicotine suppresses appetite).

That is what makes the current debate surrounding e-cigarettes so odd. One could be forgiven for having the impression that they're every bit as bad as regular cigarettes.

E-Cigarettes: Not Great, But Not Terrible

Surgeon General Vivek Murthy recently announced that e-cigarettes pose a "major public health concern," particularly for young people. He added, "The key bottom line here is that the science tells us the use of nicotine-containing products by youth, including e-cigarettes, is unsafe."

But that's not true. When it comes to the safety of e-cigarettes, the jury is still out, though there is some early evidence that suggests they are not harmless. One paper, for instance, concluded that e-cigarette vapor induces mutations in cells that can lead to cancer. Because e-cigarettes are new, few if any long-term health studies in actual humans exist.

Thus, from a public health perspective, it would be far better for the Surgeon General to say that people who do not currently vape should not take up the habit, but that e-cigarettes are likely to prove much safer than regular cigarettes. 

Such nuance is lost in popular media coverage of the topic. For instance, a Washington Post article referred to e-cigarettes as a "form of tobacco." That is misleading. Yes, nicotine is isolated from tobacco, but the alkaloid can be found in any number of nightshade plants, such as potatoes and tomatoes. Nicotine can also be synthesized in the laboratory. Nicotine itself is not particularly dangerous, which is why the term "tobacco product" (which is meant to elicit images of smoking) is disingenuous.

It went on to say: 

[W]hile Tuesday's [sic] report stops short of saying e-cigarettes are a gateway to smoking, it found that vaping “is strongly associated with the use of other tobacco products among youth and young adults, particularly the use of combustible tobacco products.”

Well, yes, that's to be expected. Out of curiosity and convenience, people who smoke cigarettes sometimes try e-cigarettes. But the converse is not true. There is no evidence that people who start vaping move on to take up smoking.

(To its credit, the article does quote an expert who says just that, but it's buried ten paragraphs deep. He also went on to say, "[I]t is important that people understand the actual public health implications of the emergence of vaping... and it is nothing close to what the surgeon general has suggested.")

What About Marijuana and Hookah?

What is particularly befuddling is why so much attention has been paid to e-cigarettes when far bigger threats to public health are emerging.

More states are legalizing marijuana. Because people who use marijuana inhale smoke into their lungs, they are likely to suffer similar health problems as cigarette smokers. One night of smoking hookah, which is becoming more popular among young people, is like smoking 10-40 cigarettes in a single sitting.

Public Health Policy Should Aim for Harm Reduction

Humans have smoked for a very long time. Big Tobacco didn't invent it; they simply harnessed (and profited handsomely) from a habit that has been around since perhaps 5,000 BC. For whatever reason, lighting something on fire and sticking it in our mouths is something humans like to do. 

In a perfect world, nobody smokes anything. But we don't live in a perfect world. Given the many choices that exist to tempt young people -- from pot to hookah to cigarettes to e-cigarettes -- clearly vaping is the "best" option. In other words, if people are going to rebel or indulge in bad habits, they should do so in the least harmful way possible. 

As the popular aphorism goes, let's not allow the perfect to become the enemy of the good.