San Francisco • A 29-story office building at 123 Mission St. illustrates the policy puzzles that fester because of these facts: For centuries, tobacco has been a widely used legal consumer good that does serious and often lethal harm when used as it is intended to be used. And its harmfulness has been a well-established and widely publicized scientific proposition for generations.
The building is the headquarters of Juul, a large company that markets vaping products — electronic cigarettes — that has been running full-page ads in major newspapers ostensibly attempting to limit sales of its product: "Youth vaping is a serious problem" that justifies "cracking down on underage sales at retail stores" and removing from stores "flavored products." Juul's flavors include mint, mango, fruit and cucumber. Other companies' flavors have included "Unicorn Puke" and "Zombie Juice." The target audience is not mature.
This city, Juul's host, recently banned such products from being sold in stores or online and delivered to city addresses. Its purpose is to limit cigarette smoking, the nation's foremost cause of preventable death. Well.
In 2016, cigarette companies spent $8.7 billion advertising and otherwise promoting their products, 34% more than the total 2016 spending by all presidential and congressional campaigns ($6.5 billion). The companies claim that their primary aim is to enlarge market share, not enlarge the market by creating new smokers, and especially not young ones. However, the companies know that few people begin smoking after 21, so if there is to be a future market for the companies’ products … . Altria, maker of Marlboro and other brands, has invested $12.8 billion in Juul.
Some smokers who cannot quit can transition to e-cigarettes, which deliver large doses of nicotine but are less harmful than inhaling smoke from burning tobacco. More people under 18 vape than smoke. For some, e-cigarettes will be a gateway to real ones: Data show that vapers are more likely than non-vapers to become smokers, but that although teen smoking has stopped declining, it remains at a historic low. More than three million high school pupils (one in five) and half a million middle school pupils vape. America is in a rapidly expanding mass experiment with a new product, and it will be a while before there is sufficient data to estimate whether it will be a net public health benefit.
In 1906 — 302 years after King James I called smoking “harmful to the brain, dangerous to the lungs,” and 299 years after he planted Jamestown in Virginia, whose tobacco enhanced his treasury — a character in an O. Henry short story said, “Say, sport, have you got a coffin nail on you?” This was long before the surgeon general declared tobacco carcinogenic (1964) and addictive (1988). Today, cigarettes are stigmatized by common sense, social disparagement and government, whose best cost-benefit ratio involves the dissemination of public health warnings.
When vaping among high schoolers increases 78% in one year (from 2017 to 2018), it has become a fashion fad that is flourishing in the absence of credible frightening information. But, then, after more than half a century of the aggressive dissemination of such information, 16% of American adults still smoke.
In "The Emperor of All Maladies: A Biography of Cancer," Siddhartha Mukherjee, an oncologist, writes, "In the turbulent century between 1850 and 1950, the world offered conflict, atomization, and disorientation. The cigarette offered its equal and opposite salve: camaraderie, a sense of belonging, and the familiarity of habits. If cancer is the quintessential product of modernity, then so, too, is its principal preventable cause: tobacco."
So, perhaps some causes of increased vaping resemble those of the current opioid epidemic, which echoes the alcohol crisis that accompanied the mass movement of Americans from farms to cities early in the 20th century. But while San Francisco anathematizes vaping, what Mukherjee says remains true: "One of the most potent and common carcinogens known to humans can be freely bought and sold at every corner store for a few dollars."
More cigarettes might be sold because of bans on vaping products — because smokers cannot use e-cigarettes to stop smoking, or because teenaged vapers will move on to readily available cigarettes. Perhaps instead of bans California should revive the anti-smoking ads that three decades ago reduced the number of smokers 17% in three years: "I tried it once and I, ah, got all red in the face and I couldn't inhale and I felt like a jerk and, ah, never tried it again which is the same as what happened to me with sex."
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