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President Trump announced in September that he would issue a strict executive order banning the candy flavored e-cigarettes that have triggered an alarming teenage vaping epidemic.
He was responding to intense public health pressures. Federal surveys showed that 27.5% of teens had vaped in the past month. This constitutes an enormous and risky public health experiment. We don’t know the impact of high doses of nicotine on teenage brains or the downstream dangers when these kids switch to vaping unsafe street pot or hard drugs. And by the summer of 2019, a more urgent danger presented itself. The gateway to vaping street pot had swung open widely and quickly enough to cause thousands of serious lung diseases and dozens of well publicized deaths.
Vaping of flavored e-cigarettes in youngsters often begins for the taste, but quickly promotes nicotine addiction and the vaping of street drugs. The outcry against seducing kids with candy favored e-cigarettes came from parents, doctors, school officials, addiction experts, and the American Medical Association, which called for a ban on all vaping products. This opposition is paradoxically led by Scott Gottlieb MD, former FDA head, who seems now to be doing a mea culpa to undo the grave harm done by the previous FDA’s lax regulation of the vaping industry.
Juul, the main culprit, saw how the winds were blowing and the lawsuits were brewing. It started to issue warnings about teen vaping, offered to stop using flavors, and posed as a responsible company (which it isn’t).
In announcing plans for his executive ban on flavored e-cigs, President Trump was responding to the public outcry and also to pressures from within the health branches of his administration. Banning flavors seemed like a common sense political winner and a health no-brainer. On the face of it, there is no justification for seducing a generation of kids to become addicted to nicotine and every reason to fear they would later apply their vaping skills to much more dangerous substances.
It turned out that Trump was completely right on the policy, but wrong on the politics. His advisors quickly became alarmed about the impact of any vaping ban on the millions of Trump voters who have become dependent on e-cigarettes. They feared that voters’ opposition to federal vaping regulation might be a deciding issue in tight swing states during the 2020 election.
These fears were stoked and reinforced by a vigorous political and legal campaign initiated by the threatened vaping industry. Their arguments against any regulation ranged from the practical (jobs would be lost), to the clinical (vapers would revert to more dangerous smoking), to the ideological (libertarian objections to infringement on personal freedom). The vaping industry is also challenging the legality of state and municipal prohibitions on flavored e-cigarettes.
All of this is nothing more than a transparent smokescreen that fails to disguise political and commercial cynicism. Appropriate use of e-cigarettes to reduce smoking in adults who are already dependent on nicotine doesn’t require candy flavored e-cigarettes designed specifically to seduce youngsters into becoming newly dependent. There is no reasonable libertarian argument that prevents government protection of kids from the wiles of drug pushers, be they cartels or vaping companies. And we don’t as a country need a vaping jobs program that will employ only very few, but create a public health crises for the very many.
But Trump folded quickly under the political pressure. On the night before he was scheduled to announce his long planned executive order, he abruptly changed his mind and cancelled it. In the weird politics of our day, Trump calculated that protecting vaping companies would be a safer bet on election day than protecting our kids.
A bizarre footnote to this bizarre episode occurred at the Senate confirmation hearings of Stephen Hahn MD, the Trump appointee as new head of the FDA. Dr Hahn has a long and distinguished career as cancer researcher and currently directs one of America’s greatest cancer hospitals. He knows better than anyone the risks of addicting a whole new generation to nicotine. But Hahn refused to comment at all on the need to regulate vaping- hiding behind the lame excuse that the decision had already been made by the president. Hahn’s cowardice now proves he will follow in a long tradition of weak leaders leading an impotent FDA. Public health advocacy dies where political interest lies.
If the past is prologue to the future, our kids are in trouble. Politicians dithered for decades while 400,000 Americans died each year from smoking. Politicians dithered for decades while 40,000 Americans died each year in the opioid epidemic. And now, politicians are dithering as millions of teens are becoming addicted to nicotine and becoming adept at the vaping skills that will soon be applied to more dangerous drugs.
It is sad that our politicians place higher priority on protecting corporations than protecting the public. But given this reality, the most effective remaining tool in reducing the risks of vaping will likely be lawsuits against the vaping companies. Many are in progress- from victims, school systems, municipalities, and states. And more will surely follow. Ironically, Juul is 25% owned by a major tobacco company that has been to this rodeo before.
It is also some comfort to know that Juul is in a free-market free fall. The terrible publicity has forced it to abandon previous promises of rapid growth; to cut spending by $1 billion; to lay off 650 workers (16% of its employees); and to sell a San Francisco office tower it bought for $400 million just a few months ago that was meant to be its headquarters. As the lawsuits pile up, and schools and parents wise up, it seems likely Juul may go bankrupt. This would be the fitting retribution that it so justly deserves.