How well does Scott Gottlieb, the former federal Food and Drug Commissioner, sleep at night? Or does he even pause to think much about his role in opening the door to what has become a widening and lethal health menace: vaping and e-cigarettes?
The federal Centers for Disease Control and Prevention has joined with respected specialists in public health and lung disorders to urge the public, most especially young Americans, to stop vaping and using e-cigarettes at least until authorities can sort out an outbreak of serious problems connected with the trendy practices involving inhaling of substances catalyzed by electric devices.
Vaping suddenly has been implicated in 450 cases in 33 states and it has been tied to at least five deaths. Dozens of young people have been hospitalized, some with significant and sustained lung damage requiring extensive medical treatment.
Doctors have published in the New England Journal of Medicine (NEJM) a grim and detailed description of the harms suffered by young vapers: weakened condition, poor breathing, and need for intubation or mechanical ventilation. Doctors also reported finding clusters of cases in Illinois, Wisconsin, and Utah.
“Although more investigation is needed to determine the vaping agent or agents responsible [for the outbreak of injuries and deaths], there is clearly an epidemic that begs for an urgent response,” Dr. David C. Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published in NEJM.
Dr. Dana Meaney-Delman, the CDC’s leading investigator into the current vaping problems, offered this warning in the New York Times: “While this investigation is ongoing, people should consider not using e-cigarette products.”
Officials have emphasized that they believe the vaping nightmares are recent in origin, though they have not yet pinpointed a definitive cause or causes, as the Washington Post reported:
“The Centers for Disease Control and Prevention warned that no consistent e-cigarette products have been linked to the disorder, and that while some victims used marijuana-based products, some reported using marijuana and nicotine products, and a smaller group reported using nicotine only … No specific device or substance has been linked to all the cases, officials said. The Food and Drug Administration is analyzing samples collected from patients across the country who have fallen ill and is testing them for a broad range of chemicals, including nicotine, THC — the active ingredient in marijuana that produces the high — and ‘cutting agents’ to dilute solutions and other substances.”
New York state health investigators have focused on a vitamin E acetate, a common nutritional supplement, as a potential culprit in the vaping illnesses and deaths. Officials say it has been detected in samples it tested of potentially problematic vaping liquids. It may be an additive or an adulterant. Axios, a news and information site, said experts told its reporters the substance would cause lung injuries because it, essentially, would be like inhaling “grease.”
E-cigarettes and vaping had not become a nationwide youth phenomenon until Gottlieb became the FDA chief, appointed by President Trump. The agency, instead, had fought hard under the Obama Administration for rigorous oversight.
As part of the Republican administration’s favor for big business, Gottlieb suspended plans for tough FDA regulation of vaping and e-cigarettes. That was part of a reconsideration of nicotine and cigarette smoking. Gottlieb and allies argued that by cracking down on highly addictive nicotine, adult smokers might be freed of tobacco cigarettes that have been shown to cause cancer, heart disease, and other huge health harms. He said more research was needed to show if vaping and e-cigarettes might cause lesser injury, since they did not involve inhaling burning substances and the toxins that causes.
But while the FDA fiddled, a San Francisco company that considered itself a technology innovator set ablaze among the young the e-cigarette market and the practice of vaping with the Juul device.
Parents and educators howled at the FDA that “Juuling” had taken over young Americans’ lives, taking off as a fad that fast became an entrenched addiction. Officials later would see how the company had pumped up the nicotine that the device could deliver — more than a pack of cigarettes in a vaping cartridge. Juul also exploited social media and youthful desires, pitching its product relentlessly in ways that many adults never saw.
Gottlieb and the FDA cracked down on Juul. It was too late. He, of course, asserts that the company and other device sellers are to blame and should be held to account. In a Washington Post Op-Ed rife with chutzpah, he tries to distinguish between “legitimate” e-cigarette makers and vaping vendors and those, like Juul, which he says deserve tough regulation and maybe even punishment.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be wreaked on them by dangerous and defective products, like e-cigarettes are proving to be. As I’ve said before, if nicotine posed such risks to the public health — and indeed it does, especially in how it can harm young, developing minds — why did Gottlieb and the FDA so readily turn away from seeing and putting down the substance’s harm when delivered in e-cigarettes and vaping? Is there validity in the Gottlieb view, still held on to by many, that vaping is OK because it is a form of harm reduction for smoking? Is it better to put a hand on the table and slam it several times a day with a baseball bat, rather than regularly dropping a 50-pound weight on it?
Michigan has joined San Francisco in cracking down on e-cigarettes and vaping, with the state becoming the first to bar sales of flavored e-cigarettes, including those that use liquids to give their “smoke” sweet tastes like those of bubble gum or candy cereals. It does not affect tobacco, mint, or menthol flavors.
The New York Times Editorial Board, among others, has taken the position that bans and draconian crackdowns may not be the best way to deal with vaping and e-cigarettes, because these approaches may create a greater underground demand for products. An Opinion writer for the newspaper has penned a piece asking if the nation has “hit peak vape panic.”
With a generation at heightened risk — with hospitalizations, lung damage, and deaths, not to mention nicotine addiction and a gateway opening to tobacco abuse — actions and not theories and platitudes should prevail. E-cigarettes and vaping aren’t good for Americans’ health. No one is arguing they are. So, what will we do about them?