Policy ForumPUBLIC HEALTH

Evidence, alarm, and the debate over e-cigarettes

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Science  13 Dec 2019:
Vol. 366, Issue 6471, pp. 1318-1320
DOI: 10.1126/science.aba0032

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Summary

This is a moment for legitimate alarm at the intersection of two distressing but distinct epidemiological patterns involving e-cigarettes (“vaping”): an increase in vaping among youth and a sudden outbreak of acute lung injuries and deaths in the United States, associated most strongly with vaping tetrahydrocannabinol (THC), the main psychoactive compound in cannabis. Discussions of vaping, however, often neglect distinctions between nicotine and THC; between adults and youth; and between products obtained through the retail and black markets. As we move to confront these challenges, we face the danger that justifiable alarm will turn alarmist, short-circuiting careful analysis of the full range of evidence and focusing attention on the most frightening, thus enhancing the prospect of adopting counterproductive policy. We suggest that the evidence warns against prohibitionist measures. Restricting access and appeal among less harmful vaping products out of an abundance of caution while leaving deadly combustible products on the market does not protect public health. It threatens to derail a trend that could hasten the demise of cigarettes, poised to take a billion lives this century.

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