Links - 11th May 2020 (3) (Vaping in the US)

Why People Are Dying from Vaping in the U.S. and Not the U.K. - "Although experts canvassed by VICE acknowledged the U.K. is in no way immune to nicotine-related health problems, the American vaping crisis that has produced at least 1,000 cases of illness and roughly two-dozen deaths is pretty much nonexistent over there. There also appears to be far less official concern that vaping is a gateway drug sucking otherwise uninterested teens into a lifetime of nicotine use. Without lobbyists killing oversight and 1990s-style drug war hysteria hamstringing policy, U.K. officials have produced a piecemeal regulatory system that carefully monitors nicotine levels in vape products. The stark contrast has American harm-reduction advocates and their counterparts across the pond touting the U.K.'s measured approach to vaping as more logical than the full-throttle panic in Washington and state capitals across the country. The only problem is American institutions seem ill-equipped to emulate it. "I think the difference between the U.K. and the U.S. are due to the American propensity to turn health issues into moral crusades," said Brad Rodu, a professor of medicine at the University of Louisville and an expert in tobacco-addiction harm-reduction, who also noted that another big issue is the bureaucratic mess in obtaining funding for research in the States. "It appears that policymakers in the U.S. are either completely ignorant of the history of tobacco, or completely ignore it."... American regulators have been roundly criticized for moving too slowly to get a handle on vape products, only to embrace prohibitionary tactics, which could drive vapers back to cigarettes, or additional users to a black market that may very well be what's causing many of the illnesses in the first place. (Many of the cases so far seem to have been linked to THC products, which are often purchased on the black market, and vaping advocates have insisted flavor bans would only encourage people to experiment with mixing e-juices, even if they don't know what they're doing.)... "It's basically reefer madness revisited in the U.S.," said Harry Shapiro, the director of DrugWise, a U.K.-based drug-education website, and the author of the Global State of Tobacco Harm Reduction report. "In the United States, you can go around firing guns, but they don't want you to vape. Which is to say, certainly, that there's a real disconnect between what counts as public safety and what people are actually, or should be, scared of."... Since 2016, the U.K. has been following the European Union's Tobacco Products Directive, which puts barriers on what advertising can be done and limits the nicotine strength in the liquids found in e-cigarettes. As CNN noted, that's capped off at 20 mg/ml, a restriction that's perhaps best understood by how it compares to what's common in JUUL pods—sometimes as much as 59 mg/ml. "Where we differ most strongly is that we have some excellent politicians and people at Public Health England, or PHE, who are all committed to evidence-based decision-making and legislation"... PHE, a government agency whose closest U.S. equivalent is the Centers for Disease Control (CDC), has repeated its claim over and over again that "vaping is 95 percent less harmful than smoking." "The U.K. has a long history of adopting a harm-reduction approach for changing behavior and improving health," said Deborah Robson, a senior postdoctoral researcher in tobacco addiction at King's College London. "We have recognized, based on empirical research for several decades, that nicotine is not the harmful substance in tobacco. It's inhaling thousands of other toxic gases and particles of tar the come from setting fire to tobacco that harms and kills smokers.""

The Truth About the Vaping Crisis (Ep. 398) - Freakonomics Freakonomics - "SIEGEL: I don’t know of any cases of respiratory failure that have been reported in the U.K...
Before there were e-cigarettes, there were cigarettes. Just how popular were cigarettes? In the 1950s, 45 percent of adult Americans said they smoked — and that’s a self-reported number, so the actual number may have been even higher... In many countries, smoking is still incredibly common. According to the World Health Organization, 76 percent of adult men in Indonesia still smoke cigarettes; in Russia, it’s 59 percent; in China, 47 percent. But in other countries, the smoking rate has fallen steeply and continues to fall. In the U.S. and the U.K., for instance, only about 20 percent of adult males now smoke...
SIEGEL: I think more than anything, what vaping offers to smokers is an identity. You don’t have an identity as a nicotine-patch-user. Nicotine-patch-users don’t get together in groups and have forums and conventions for the weekend, but vapers do... the U.K. has regulated these products. And most importantly, there is a limit on the amount of nicotine that’s allowable. You can only have up to 20 milligrams per milliliter of nicotine in your e-liquids. In the U.S., there’s no limit at all. So Juul comes along, they put 54 milligrams per milliliter in their product, and it’s no surprise that kids are getting addicted. People may not realize this, but there is Juul in the U.K., but they don’t have a youth Juuling problem. And the reason for that is you don’t have Juul at 54 milligrams per milliliter, you have Juul at 17. In this country, these products have not been embraced for harm reduction, but they’ve actually embraced electronic cigarettes as a harm reduction strategy. And as a result, the health care costs in the U.K. are going down... The U.K. has not had as much of a problem with youth vaping as we have. There are youth who vape, but the rates are not nearly as high and they don’t have a lot of youth who are addicted...
SIEGEL: The CDC has reported that approximately 89 percent of the cases are attributable to THC or black-market vaping oils, whereas 11 percent of the cases did not admit to using THC. Now that doesn’t mean that those cases were necessarily attributable to nicotine e-liquids, for a number of reasons. The most important of which is that people tend to underreport their marijuana use, especially youth...
E-cigarettes use liquids that are typically water or alcohol-based, while THC vaping liquids are oils... So when the FDA was considering a ban on these flavors — and that ban may still happen, it’s hard to say — what was the idea behind that?
SIEGEL: The idea behind that, presumably, is that youth are more likely to use the non-tobacco flavors than the tobacco flavor. The problem with that is that so are adults. Adult smokers who have quit successfully using these products have predominantly used flavored products, and they specifically don’t like the tobacco product because it reminds them of cigarettes. The whole point of switching to vaping is to get away from the tobacco experience, and so many vapers actually shun the idea of using a tobacco e-liquid. So to take these flavors off the market and to tell smokers, “Okay, well, just go back to the tobacco” — that’s just not going to happen. What are the smokers going to do? They’re basically going to have two choices. Either they just go back to smoking or they try to obtain these products off the black market...
It appears that most, if not all, of the deaths and illnesses were caused not by e-cigarettes but rather by sketchy black-market THC products. But in the public interest — and in the pursuit of a policy that seems to be driven more abstinence than harm reduction — state and city governments and some state health departments have already taken steps to curtail the availability of e-cigarettes...
SIEGEL: What’s very interesting is that these same politicians who want to ban flavored e-liquids don’t want to touch cigarettes... [they’re] basically just finding some way that they can, without having to actually take any kind of politically courageous action, make it look like they’re really taking a strong stance.
I wonder how libertarians will explain the US's problems with vaping because of less regulation than the UK by blaming regulation

Vaping-Related Lung Injuries Declining, As CDC Confirms Vitamin E Acetate As Main Culprit - "Dr. Anne Schuchat, the CDC's principal deputy director, says this sharp spike strongly points to a single culprit for most of these cases: vitamin E acetate, an additive found in illicit cannabis-containing vapes."