By Justin Leventhal, American Consumer Institute
Smoking remains one of the leading causes of preventable death in the United States, withnearly half a million Americans dying each year from smoking-related illnesses. The primary source of harm is not nicotine; it is the combustion, which contains carcinogens and toxic chemicals. Because of this, hundreds of billions of dollars are spent on smoking related healthcare annually. Reducing the harm and cost of smoking should prioritize eliminating cigarette smoking, not nicotine use itself.
Vaping and other smoke-free products significantly reduce exposure to the toxic chemicals that cause cancer, heart disease, and lung damage. Vaping carries less than five percent of the risk of smoking. Treating vaping as equivalent to smoking ignores the fundamental difference in risk between the two—a difference the Food and Drug Administration (FDA) should, but does not, adequately account for.
Not only are vapes less harmful than cigarettes, but many smokers have successfully quit smoking by switching to vaping after failing with traditional cessation tools. Numerous studies find that vaping is a highly effective smoking cessation tool. In real-world settings, e-cigarettes function as substitutes for cigarettes, not a gateway to smoking as the FDA often implies. When vaping products are available, smokers have a pathway away from combustible tobacco to a far less harmful option. Removing those alternatives risks pushing smokers back toward cigarettes.
Encouraging smokers to transition to vaping would not only improve individual health outcomes but also reduce healthcare costs. The Center for Disease Control estimates that in 2018 cigarette smoking cost $240 billion in healthcare costs and another $365 billion in lost productivity from smoking related illness and deaths. This amounts to approximately $6,000 to $7,000 per smoker each year.
Smoking-related diseases impose enormous burdens on public health programs. In 2014 more than 50 percent of healthcare spending on smoking related disease was paid by taxpayers through Medicare and Medicaid, and while smoking rates have fallen there is little reason to think the share of the burden that falls on taxpayers has. Shifting smokers toward lower-risk products could significantly reduce long-term healthcare spending without imposing the unrealistic goal of eliminating nicotine use entirely.
Unfortunately, misleading messaging from the FDA and public health authorities has led many Americans to believe vaping is as dangerous as smoking, These perceptions discourage smokers from switching to less harmful alternatives, that would also reduce their future healthcare costs and costs to taxpayers. The messaging often implies vaping is both equally harmful and a gateway to smoking—despite all the evidence against both points. Public health agencies should instead provide accurate comparisons of relative risk so adults can make choices informed about both the health and financial costs of smoking.
Despite the potential of harm reduction technologies like vaping to save both lives and money, the FDA has approved only a few dozen vaping products total—meanwhile, it approves a new cigarette product roughly every two days totaling nearly nine hundred in just a few years.
Demand for vaping has not disappeared simply because the FDA has been reluctant to approve these products. Instead, restrictions push some consumers back toward cigarettes. It is not the FDA’s role to decide what products adults should want, especially when they are transitioning to less harmful and costly habits. Its responsibility is to accurate information about product risks and the likely future costs.
Regulatory burdens should be proportional to the risk posed by the product. Vaping products should face fewer restrictions than cigarettes, not more. They have the potential to not only reduce the harm to smokers, but save Americans and federal healthcare programs billions. There is no justification for making safer products harder to buy than cigarettes themselves. Expanding consumer choice increases the likelihood that smokers will find a cessation product that works for them, improving health outcomes while reducing healthcare costs for both individuals and taxpayers. The FDA’s goal should be reducing smoking, not eliminating safer and less costly alternatives to it.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Visit www.TheAmericanConsumer.Org or follow on X @ConsumerPal.