The FDA’s Runaway Trolley Problem


If you’ve ever participated in a thought experiment, you know how fun that can be. The most famous is the Trolley Problem, entertainingly portrayed by the sitcom The Good Place. It forces participants to choose to either divert a runaway trolley and intentionally kill one person or do nothing and let the trolley kill five others in its path. The experiment is fun because it allows us to consider the ethics of our choices without ever putting anyone in danger. But, the version of the Trolley Problem our government is undertaking is no experiment. The unchecked push to ban e-cigarettes puts millions of adult lives at risk in order to prevent a slight increase in potential health risks for a small number of adolescents. Unless Congress or the FDA changes the direction, people — real people — will die.

No matter how much we tax, restrict, and warn, some people will smoke. Smokers have about a 50/50 chance of dying because of their habit. In a free society, we might not be able to fully eliminate tobacco and nicotine use, and yet some countries have figured out how to shift nicotine use to safer alternatives. Sweden, for example, is now virtually smoke-free, with the lowest smoking rate of any EU nation. Swedes still consume nicotine, but they do so by using smokeless tobacco. Smokeless tobacco, particularly Swedish snus (a moist tobacco chew) is far less dangerous than smoking. As such, Swedish men have the lowest rates of lung cancer and tobacco-related cardiovascular disease in Europe.

The United States has a once-in-a-generation opportunity to replicate the Swedish experience. Like Snus, e-cigarettes or electronic nicotine delivery systems (ENDS) allow users to consume nicotine with only a fraction of the risks associated with combustible smoking.

E-cigarettes are also very popular. This is a good thing because, like Snus and unlike other traditional nicotine replacement products, it means e-cigarettes are a viable low-risk replacement for deadly cigarettes. But it is exactly the popularity of e-cigarettes that has some pushing to ban them.

Since at least 2013, anti-tobacco advocates have called on the government to put a stop to rising youth use of e-cigarettes, even as teen vaping declined after 2015. They successfully convinced health agencies, including FDA, to undertake a media blitz to advertise the dangers of e-cigarettes to teenagers, school officials, and parents. As I’ve previously written, it is highly likely that it was these attempts to persuade people of the dangers of vaping that made e-cigarettes more attractive to adolescents.

After years of declining teen vaping, once-a-month use of e-cigarettes among high schoolers increased in 2017, according to the latest National Youth Tobacco Survey. Though this uptick was likely caused by health advocates’ and agencies’ efforts to dissuade teen vaping, it has become the latest excuse to push for the restrictions anti-tobacco advocates have long desired.

In the wake of the latest survey data, the FDA threatened to ban e-cigarette flavors, certain types of devices, online sales, and take other action that would make the lower-risk products more expensive, less accessible, and less attractive for adult smokers. This week, the Chairman of the House Energy and Commerce Committee, Frank Pallone (D-NJ), introduced a bill called “Reversing the Youth Tobacco Epidemic Act of 2019.” The bill would, among other things:

· Prohibit all flavors apart from tobacco;

· Prohibit online e-cigarette sales;

· Give FDA authority to collect $100 million in fees from the industry;

· Ban sales to anyone under 21 years old; and

· Set a national minimum age for tobacco (and e-cigarette) purchasing of 21 years.

Will Pallone’s bill reduce the number of teens who experiment with e-cigarettes? Maybe. And for the 1 percent of those adolescents who never smoked and a smaller number who would have never used nicotine in the future, their abstinence from vaping might slightly reduce their risks. But, it will also likely increase youth smoking, which, concurrent with the rise of vaping, has dropped to the lowest levels ever. More importantly, in an effort to eliminate even the smallest amount of risk for a tiny portion of the population, anti-vaping advocates will be sacrificing millions of current and future smokers who, because of these restrictions, will continue their deadly habit.

Like the Trolley Problem, adult smokers and e-cigarette users are tied to the tracks, facing an oncoming train they can do little to stop. But, Congress should intervene. Unlike the Trolley Problem there is a clearly ethical course of action which would be to pull the breaks on the unscientific drive to ban e-cigarettes. If Congress does this it would preserve individuals’ right to make their own choices about whether and how they consume nicotine. And in doing so, it would also save millions of real — not hypothetical — lives.

Originally published at Medium.