Vaping Turns Deadly

At this writing, three people have died and hundreds more have become ill from a mysterious lung ailment that is connected with certain types of e-cigarettes.  The victims typically have nausea or vomiting at first, then difficulty breathing.  Many end up in emergency rooms and hospitals because of lung damage.

Most of the sufferers are young people in their teens and twenties, and all were found to have been  using vaping products in the previous three months.  Many but not all were using e-cigarettes laced with THC, the active ingredient in marijuana.  Others were vaping only nicotine, but some early analysis indicates that a substance called vitamin-E acetate was found in many of the users' devices.  It's possible that this oily compound is at fault, but investigators at the U. S. Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) have not reached any conclusions yet. 

In fact, the two agencies have released different recommendations in response to the crisis.  The CDC is warning consumers to stay away from all e-cigarettes, but the FDA is limiting its cautions to those containing THC.  Regardless, it looks like the vaping party has received a damper that may change a lot of things.

So far, vaping and the e-cigarette industry is largely unregulated, unlike the tobacco industry.  It found its first mass market in China in the early 2000s.  The technology was made possible by the development of high-energy-density lithium batteries, among other things.  While vaporizers for medical use have been around since at least the 1920s, it wasn't possible to squeeze everything needed into a cigarette-size package until about fifteen years ago. 

Since then, vaping has taken off among young people.  A recent survey of  U. S. 12th-graders shows that about 20% of them have vaped in the last 30 days, and this is up from only about 11% in 2017, the sharpest two-year increase in the use of any drug that the National Institutes of Health has measured in its forty-some-odd year history of doing such surveys.

The ethical question of the hour is this:  has vaping become popular enough, mature enough, and dangerous enough, that some kind of regulation (either industrial self-policing or governmental oversight) is needed?  The answer doesn't hinge only on technical questions, but on one's political philosophy as well.

Take the extreme libertarian position, for example.  Libertarians start out by opposing all government activity of any kind, and then grudgingly allow certain unavoidable activities that are needed for a nation to be regarded as a nation:  national defense, for instance.  It's not reasonable to expect every household to defend itself against foreign aggression, so most libertarians admit the necessity of maintaining national defense in a collective way. 

           

But on an issue such as a consumer product, the libertarian view is "caveat emptor"—let the buyer beware.  If you choose to buy an off-brand e-cigarette because it promises to have more THC in it than the next guy's does, that's your business.  And if there's risk involved, well, people do all sorts of risky things that the government pays no attention to:  telling your wife "that dress makes you look fat" is one example that comes to mind. 

On the opposite extreme is the nanny-state model, favored generally by left-of-center partisans who see most private enterprises, especially large ones, as the enemy, and feel that government's responsibility is to even out the unfair advantage that huge companies have over the individual consumer.  These folks would regulate almost anything you buy, and have government-paid inspectors constantly checking for quality and value and so on. 

It's impractical to run your own bacteriological lab to inspect your own hamburgers and skim milk, so the government is supposed to do that for you.  Arguably, it's also impractical for vapers to take samples of their e-cigarette's goop and send it to a chemical lab for testing, and then decide on the basis of the results whether it's safe to use that particular product. 

My guess at this point is that sooner or later, probably sooner, the e-cigarette industry is going to find itself subject to government standards for something.  Exactly what isn't clear yet, because we do not yet know what exactly is causing the mysterious vaping illnesses and deaths.  But when we do, you can bet there will be lawsuits, at a minimum, and at least calls for regulation of the industry. 

Whether or not those calls are heeded will depend partly on the way the industry reacts.  Juul, currently the largest maker of vaping products, is one-third owned by the corporate entity formerly known as Philip Morris Companies.  In other words, the tobacco makers have seen the vaping handwriting on the wall, and are moving into the new business as their conventional tobacco product sales flatten or decline. 

The tobacco companies gained a prominent place in the Unethical Hall of Fame when they engaged in a decades-long campaign of disinformation to combat the idea that smoking could hurt or kill you, despite having inside information that it very well could.  In the face of an ongoing disaster such as the vaping illness, this ploy doesn't work so well.  But they could claim that only disreputable firms would sell vaping products that cause immediate harm, and pay for studies that show it's better than smoking and harmless for the vast majority of users.

Sometimes the hardest thing to do is be patient, and that's what we need to do right now, rather than rushing to conclusions that aren't supported by clinical evidence.  Investigators should eventually figure out what exactly is going on with the sick and dying vapers, and once we know that, we'll at least have something to act on.  Until then, if by chance anyone under 30 is reading this blog, take my advice:  leave those e-cigarettes alone. 

Sources: I referred to articles at CNBC.com (https://www.cnbc.com/2019/09/07/cdc-fda-clash-on-warning-consumers-during-lung-disease-outbreak.html) and vox.com (https://www.vox.com/science-and-health/2019/9/3/20847219/vaping-health-risks-2019-lung-damage-death) as well as the Wikipedia article on Juul.

To Vape or Not to Vape?

A year or two ago, the administration at Texas State University, where I teach, passed a regulation that abolished smoking everywhere on campus, inside and out.  I have mixed feelings about this.  Personally, I have never smoked.  Both my parents were moderate to heavy smokers, and my father died of lung cancer at the age of 57.  So I am familiar with the harm smoking can do.  On the other hand,  some see widespread bans on personal habits that have at least some redeeming features as abuse of governmental authority.  Overall, I was mildly pleased by the ban, and so when I walked by a student lounge area in our building the other day and saw what I thought was a puff of cigarette smoke, I was surprised.

But on closer inspection, the student turned out to be "vaping":  smoking (or whatever the appropriate verb is here) an electronic cigarette.  Was that violating the smoking ban or not?  So far, the university hasn't ruled on whether vaping counts as smoking.  Since electronic cigarettes are unquestionably an engineered product, their production, sale, and use fall within the purview of engineering ethics. 

A visit to the website HowStuffWorks.com informed me that a Chinese pharmacist invented e-cigarettes a decade ago.  They depend on small lithium batteries for their energy source, and rechargeable lithium batteries themselves haven't been around for much longer than that.  The power goes through a voltage regulator to a small heating element, where a solution of nicotine in propylene glycol is vaporized and inhaled by the user.  The stuff becomes a finely dispersed mist upon exhaling and looks different than true cigarette smoke, probably because the particles are larger and evaporate rather than dispersing.  The current form of the device was originally marketed as an aid to help people quit smoking, but as with many such aids for addiction, the cure may not be much of an improvement over the disease.

Who is affected by vaping?  Well, there are the manufacturers of the product and its auxiliary apparatus and supplies:  chargers, the nicotine solution, the e-cigarettes themselves.  There are users, many but not all of whom are former smokers of real cigarettes.  There are the makers of conventional tobacco products, who may either feel threatened by the new development or may co-opt it once the market gets large enough, and start selling similar products themselves.  There are various organizational entities ranging from private companies up to things like the European Union, which are now tasked with deciding what if anything to do about vaping.  And last, but hopefully not least, there is the general non-smoking public for whom second-hand-smoke bans were enacted.  But partly because e-cigarettes are so new, nobody has a lot of solid data on their health hazards and whether second-hand nicotine-tinged propylene glycol is something to worry about. 

Hong Kong and Singapore, among other countries, have imposed flat-out bans on e-cigarettes, but most nations either have no laws about them or impose only mild regulation.  Their status in the U. S. has been the subject of numerous court cases, and attempts to get them classified as drug delivery devices have been unsuccessful.  The latest court ruling, which is more definite than logical, says they can be regulated only as tobacco products, which is a little like classifying tires as agricultural products because rubber comes from trees.  But the effect is that governments can't do anything to e-cigarettes that they can't do to regular cigarettes.  Consequently, some state governments have banned sales to minors, but that is about the extent of U. S. regulation so far.

It seems to me that e-cigarettes are all about the nicotine, which has been proved time and again to be addictive.  But so has alcohol, and we all know what a flop Prohibition was.  I confess that I don't relish the idea of attending a party at which I discover several of my friends or students sucking on phony cigarettes, but then again, I don't go to a lot of parties anyway.  In the last couple of decades, the latent puritanical streak in American culture has fastened onto cigarettes, with the result that most people who smoke, as well as most non-smokers, regard the cigarette habit as a disreputable vice.  And this attitude itself will probably keep e-cigarettes from becoming as common as cellphones, for example.

The medical and health evidence on vaping is still largely lacking, so the precautionary principle says to leave it alone until it's been proven to be safe, whatever "safe" means in this context.  The main ingredients of the vapor—nicotine and propylene glycol—are well-understood compounds.  Nicotine use in any form is psychologically addictive, but doesn't itself cause cancer.  Propylene glycol, if pure, is approved for use in foods.  So it's unlikely that their combination in e-cigarettes poses a sinister unknown risk, although one can't be sure without the appropriate long-term studies.

The thing I dislike the most about e-cigarettes is that they present one more opportunity for people, especially young people, to become dependent on a costly habit that otherwise doesn't make the world a better place.  I say that in full knowledge that some of the historical figures I most admire, including G. K. Chesterton and C. S. Lewis, were smokers, not of e-cigarettes but of the original old smelly tobacco products themselves.  E-cigarettes are an addition to a spectrum of products that are potentially habit-forming, products that lie on a spectrum whose mildest end includes coffee and tea, and whose opposite malignant end winds up with heroin and crystal meth.  Some people can choose to stay in one place on the harmless end of that spectrum, while others find that they are drawn through the milder products to take dangerous and illegal risks at the other end.  This is not to say that everyone who tries e-cigarettes will end up hooked on them, or will start smoking real ones.  But some will.  And is the pleasure, or whatever satisfaction that people get from them, worth the risk to those who may find that they are being controlled by their habit, rather than the other way around?  We don't know, but it is a risk both governments and individuals should consider seriously. 

Sources:  HowStuffWorks.com has a good description of e-cigarettes I referred to at http://science.howstuffworks.com/innovation/everyday-innovations/electronic-cigarette1.htm, and I also referred to Wikipedia's articles on electronic cigarettes, nicotine, and propylene glycol.