Vaping: Perfect case for evidence-based policy-making

Congress heads out of town for the next two weeks, leaving a lot of issues to marinate. There’s the I-word, of course. Also dealing with what happens after the seven-week continuing resolution runs out. And, perhaps unexpectedly, the mounting cases of sickness and death from vaping.

Vaping has become a popular phenomenon. And now it has the government in knots, as cases of pneumonia-like lung disease and deaths mount. If you accept that vaping is a public health menace, and that the federal government has the authority, responsibility and apparatus to deal with it, then it needs careful consideration.

Congress and the last three administrations have worked toward establishing data-driven and evidence-based decision-making. If ever a situation called for this approach, vaping is it. Some of the anecdotes are bad, for sure. And many people have an intuition that inhaling these substances can’t possibly be good. But anecdotes and intuition often make for bad policy.

Members of Congress have criticized the FDA for not somehow regulating or proposing to ban the products sooner. The agency is under a May 12, court-imposed deadline to impose vaping regulations.

The situation calls for less shouting and more analysis. Especially on the immediate concern, people dying, in all cases after having vaped. Yet vaping is a complicated question. One reason is that “plug compatible” pods for Juul devices have come onto the market from gray market sources. Some don’t mimic tobacco but rather marijuana. Like dollar-store toothpaste from Lord-knows-where, no one knows what’s in them. FDA Acting Commissioner Norman Sharpless says some some contain vitamin E acetate. He described that as an oily goo meant for external skin care, not for vaporizing and breathing in — and for which there is no pulmonary use data.

Not one to avoid hyberbole, Massachusetts Congressman Joe Kennedy nevertheless correctly pointed out the fogginess of the vaping health situation. At a hearing of the investigations subcommittee of the House Committee on Energy & Commerce, Kennedy said, referring to the health problems, “We don’t know concretely why. We don’t know if it’s the nicotine products, or the THC products. We don’t know if there’s additives that are responsible, or if it’s part of the device that are causing the illness. We don’t know if the products can be traced back to the black market sales or over-the-counter purchases.”

Kennedy asked Sharpless, “How is it we don’t know and how come we don’t know more?”

On the larger question of vaping — whether it is bad for public health in a statistically meaningful way that demands some government action — the government  appears a little flat-footed. Juul, a fast-growing startup company, is somehow at the center of the debate. Its stated mission is helping people quit cigarettes by offering a safer way to get nicotine. Its marketing has appeared aimed more at hooking teenagers on nicotine. The anti-smoking industry believes this will lead to an eventual uptick in cigarette smoking.

Juul wasn’t the first with an electronic cigarette, but it’s the first viral producer. Its sleek, flat devices are to e-cigarettes what the iPhone was to cell phones.

The government has a hierarchy of issues here. Looking at them from a data analysis standpoint, some of what it needs to know:

• More about the small sample of — now, nine — deaths and the more than 530 cases of lung injury. What the people consumed, where it came from, the ingredients in their refill pods. The Centers for Disease Control and Prevention has been developing something of a profile showing that the injured vapers skew young , male, and using THC — the pot ingredient. But, as Joe Kennedy pointed out, no one knows the specific cause of the lung problems. CDC says there’s no single common denominator in all the cases, except for vaping itself.
• Which numbers are larger — cigarette smokers going over to vaping, or vapers graduating to cigarettes? Anecdotal evidence shows it runs both ways.
• How many people vape, and what the ratio of vapers to those falling sick? How does that ratio compare to other medical device or substances occurrences?

Still unanswered is what is the objective of a vaping policy?

Why anyone would inhale vaporized oil laced with nicotine and creme flavoring escapes me, personally. The networks have been running B-roll footage, showing close-ups of noses and mouths pulling on e-cigs and blowing out whatever it is — vape? steam” smoke? Echhh! But when the government acts to ban or limit vaping, it should move on solid, evidence-based ground.

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