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Center for Policy Studies
Public Affairs Discussion Group |
| The Public Health Dilemma of E-Cigarettes |
Jacob James Rich - Ph.D. Candidate, Epidemiology and Biostatistics, Department of Population and Quantitative Health Sciences |
Friday November 13, 2026
12:30-1:30 p.m.
Meeting Both In-Person and by Zoom
Dampeer Room, Second Floor of Kelvin Smith Library
Case Western Reserve University
For those interested in participating by Zoom please e-mail padg@case.edu for more information.
Dear Colleagues:
This week’s discussion will focus on something that is ever-more-visible but not so well understood: vaping, and in particular vaping of nicotine products.
It is an issue I have taught about in my SAGES course on tobacco (2016 and 2018) and made a paper topic in my Public Policy course (2024). So I was intrigued when I learned that one of our gathering’s participants, Jacob James Rich, has been doing a lot of work on it, with much of that work in collaboration with a good friend of the Friday Lunch, former CWRU law professor Jonathan Adler.
The “dilemma” is that as far as anyone can tell, use of e-cigarettes should be a LOT safer than what are now called “combustible cigarettes.” At the same time, they cannot possibly be safe in a way that would, for example, make FDA approval as a drug obvious.
Electronic cigarettes provide the nicotine drug experience that is the point of traditional smoking, in a form that delivers the dose in a similar way (unlike, say, a nicotine patch) and even allow a version of the rituals that become part of the smoking experience. And they do this without consumption of the known carcinogens in cigarette tar, as well as without one of the main causes of cardiac events from traditional cigarettes, carbon monoxide. (We should remember that probably at least a third of the excess deaths associated with smoking are from cardiovascular causes).
From one perspective, therefore, use of e-cigarettes should be promoted as an alternative to traditional cigarettes, because the damage done would be much less: in short, for harm reduction. And as e-cigarettes rose in prominence, some public health specialists, more in the U.K. than in the United States, saw them more as a benefit than a danger.
But that has not, in general, been the reaction of the U.S. public health community. One reason is that e-cigarettes must not be harm-free. At a minimum, it seems widely agreed that nicotine itself, however it is ingested, creates some cardiac risk. On another, very little is known about the chemicals that are in vape fluid – the fact that they are not the usual carcinogens is no guarantee that they are not carcinogens. A recent systematic review finds that e-cigarettes do not yet seem associated with increased cancer incidence, but use is associated with increase in biomarkers that seem to be associated with cancer. What would one do about that, given that they still seem likely to be much safer than regular cigarettes? Some oppose use of e-cigarettes on the grounds that they could be a gateway to use of regular cigarettes. Some emphasize that flavored vapes are likely to be (and likely designed to be) particularly attractive to kids, who then would get addicted to nicotine with lord knows what consequences down the line.
So, to my mind, there are actually two key dilemmas. The first was articulated nicely in a talk I invited tobacco control scholar Lynn T. Kozlowski to come to our School of Law and deliver in 2018. In general, the “precautionary principle” would suggest that absent proof it is safe, policy-makers should try to discourage vaping. But as Dr. Kozlowski argued, in this case for many people, the alternative to vaping sure seems to be much worse. So is the precautionary principle really appropriate?
The second dilemma only exists if you believe, as I do, in imperfect policies that reduce harm. Then the dilemma is how to regulate e-cigarettes. There are lots of ideas and emphases, as summarized in this CRS Report. As happened with regular cigarettes, many of these ideas focus on “kids,” with the definition of “kids” maybe not fitting how people would define themselves. Among other things they could focus on the contents of vape fluids, on the retailers, or on the users.
And the dilemma is made more difficult by something I have always told my students: nicotine is a really, really attractive drug. Not just addictive but, from some perspectives, useful. There was reason that General Pershing, asked what more he needed for the American expeditionary force in World War I, said “tobacco as much as bullets.” At least according to many smokers, tobacco makes them both more alert and more relaxed. Not a bad thing in a trench.
Too bad it also hastens the deaths of about a third of its users… Maybe a good tradeoff if you are in a trench with a bunch of machine guns facing you, but not so good if you’re just worried about a test.
Mr. Rich should have a bunch of interesting things to say, and give us lots to discuss!
Best wishes for safety and security for you and yours,
Joe White
Luxenberg Family Professor of Public Policy and Director, Center for Policy Studies
About Our Guest
Jacob James Rich is a Ph.D. candidate in the Department of Population & Quantitative Health Sciences at the CWRU School of Medicine. He is also a managing director for consumer freedom issues at the Reason Foundation, a free-market think tank based in Los Angeles. His work at Reason specializes in prescription and illegal drug regulations. His CWRU work focuses on causal inference and administrative law, typically focusing on the consequences of public health interventions. He was the winner of the best student abstract award at the American Public Health Association’s Annual Meeting. Before joining CWRU and Reason, Mr. Rich earned masters degrees in mathematics and economics from Eastern Michigan University, and conducted research for the Cato Institute.
Schedule of Friday Lunch Upcoming Topics and Speakers:
November 20: Rare Earths. With Rohan Akolkar, Ph.D., Milton and Tamar Maltz Professor of Energy Innovation, Department of Chemical and Biomolecular Engineering; Faculty Director, Great Lakes Energy Institute; Director, Electrochemical Design Center and EMF Lab.
November 27: Thanksgiving Break
December 4: Are We There Yet? Self-Driving Autonomous Vehicles and the Law. With Cassandra Burke Robertson, JD, John Deaver Drinko – BakerHostetler Professor of Law. Alternate Room, Mather House 100 | |
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