How vaping became a go-to public health villain

The Business of Business: Amanda, can you talk about who your organization represents? Because I think we all have an idea that vaping is like Juul [the leading manufacturer], but you have a much more diverse membership.

That's right, Christie, thanks for the question. We have over 100 members who have been involved in manufacturing and selling vapor products in the United States as far back as 2009. Long before some of those companies like Juul and the tobacco companies stepped into the space, it really was a space that was led by a wide variety of small businesses that were mostly started by former smokers who were using the products to quit smoking, and wanted to share that technology with other people in their communities. And it spawned a really vibrant, small business industry until about 2016 and 2017, when you saw some of these bigger companies stepped into the space.

And what about yourself? Are you in the vaping industry? 

Yeah, I own a small business based out of Arizona, it's called Jvapes, my husband and I started that back in 2011. Because we were both very heavy smokers. I tried everything to quit. And you know, one, one weekend, my husband picked up a vape [device], when he was buying his usual two cartons of cigarettes. And for the first time ever, he was able to quit in about two days. So we thought it was pretty miraculous. 

Not a lot of people knew about vaping. At the time, the products were pretty hard to find. And so we started our business because we just really wanted to make it available in our local community. And our business has grown from there. We're located in about three states now. We have 40 employees and 11 years later, we’re still going. 

So there's a lot of criticism of vaping, as we know, for all sorts of different reasons. But why is it a good thing in your view? And what's the harm if this industry is wiped out?

So vaping, to me, is a very important thing, because about 480,000 people a year die from diseases related to cigarette smoking, and they're totally preventable deaths. But for better or worse, cigarettes are very addictive. It’s a very, very hard habit to quit. And for a lot of people, the tools that are out there existing the nicotine gums, the patches, and the medications, those didn't work for them. And this technology is something that has worked very well, for a lot of those smokers, that were the hardest ones for tobacco control and for traditional cessation efforts to reach. Vaping was able to reach a lot of those people and help a lot of those people.

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“About 6.5 million of those people have given up cigarettes entirely through the use of vaping products. And so it's been a very powerful tool for millions of people to quit.”

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Currently, there are about 15 million adults in the United States that use vapor products. The vast majority of them are former smokers. About 6.5 million of those people have given up cigarettes entirely through the use of vaping products. And so it's been a very powerful tool for millions of people to quit.

I think it's fair to say there are some people who would love to kill off the entire vaping industry. What are the unintended consequences of that?

Oh, there are several unintended consequences of that. And you can see living examples of this that have played out in regional, state and local levels. It’s pretty easy to extrapolate what would happen if this were to be done at a national level. But you know, invariably, there are a lot of smokers that use vape products that returned to smoking. Black markets sprang up, because there's a very high demand for the products. And responsible businesses are put out of business. 

And oftentimes, when these types of bans happen, you know that the people promoting them have really good intentions. But I don't think that people really look at in practice how this harms a lot of people when they want to ban a product that so many people depend on.

Right, and I want to touch on a couple of specific criticisms to kind of get what's the other side of this. One of the things that a lot of negative headlines tend to dwell on is the connection between vaping and children. There are a lot of flavors and stuff that sound like candy. We even did a story a while back showing vape shops that sold Juul and how close they were to schools. Let’s take that criticism. Is that a thing that should concern us, in terms of the possible appeal of these sweet flavors to kids? 

Is it a concern? Absolutely. You know, I am a parent of two middle school children. So I understand the concern, and you know, all of the members of our organization, we believe very strongly that children should not be using these products, and we take a lot of measures on the business side to prevent youth from accessing the products. 

There have been companies that have engaged in marketing practices, that I think some foresight would have shown these companies were going down the wrong path. You brought up Juul. I think when they first came out, they were a very young company that didn’t really understand the seriousness of marketing toward a millennial crowd. When you’re marketing to that age group, there’s obviously going to be some spillover to younger categories. And I think that was a marketing mistake by that particular company.

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“People generally like things that have a flavor to them, and the same is true of vaping products. It’s more a question of how these flavors are marketed and where they’re marketed.”

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But flavors are a very important part of vaping to adults. And I think one thing that’s really important to know is that vaping is quite different from tobacco. Vaping liquids don't have any kind of native flavor to them. And so when people say that  they can only be sold in a tobacco flavor, you're mandating that this product that has nothing to do with the cigarette must taste like a cigarette. And to me that's a very strange thing. 

When we're telling adults that want to quit smoking, the only thing that they can use must be flavored to taste like a cigarette, and over 70% of adults who vape use flavors other than tobacco and menthol, because it's the variety of flavors that that keep the products appealing to them as adults, right? Adults like flavors and a lot of different contexts: in alcohol, in ice cream, in coffee menus at Starbucks, right? People generally like things that have a flavor to them, and the same is true of vaping products. It’s more a question of how these flavors are marketed and where they’re marketed. 

When these things are marketed in places that have a youth audience, obviously, that's a problematic situation. In our stores, for example, we don't allow any minors into our business. Nobody under 21 comes inside. We card every single purchase that's made in our store, because we take it very seriously. And, you know, we feel like there is a responsible role for flavors for adults. It's more a question of good business practices and good marketing practices. 

One other concern, actually, was something my coworkers were curious about: We have one person we work with who had an incident where he got very ill, I think in respiratory arrest, after heavy vaping. He had to go to the hospital. Do we know why this happens? What are the risks and how do you mitigate them? 

Yeah, so this, so this is an interesting thing that we first saw start to happen in 2019, what the CDC termed EVALI. These were, what they called vaping related lung injuries. And it was interesting to all of us that had been making and using these products for nearly 10 years at the time, because we had never seen or heard about anything like this before. And you know, 10 years is a long time to go with none of those kinds of stories. So it was pretty clear to us that something different was happening with the products and so we started looking into it to figure out what was going on.

What we found out is that EVALI was actually associated with a chemical called Vitamin E acetate, that was being added to a lot of marijuana and THC-style vaping cartridges. And I don't know about your colleague, I don't want to, you know, be nosy and ask him what particularly he might have been vaping. But so Vitamin E acetate is not something that anyone should put in their lungs. It's used in a lot of topical applications. Vitamin E is very good for your skin. It's not very good for your lungs. The thing about Vitamin E acetate is that it's hydrophobic, it doesn't blend with water. It only blends with oils.

And so the base of nicotine vaping liquids is very different from the base that's used in THC vaping liquids. And so in the THC world, some of the black market companies in that space, were putting these additives into the THC cartridges as sort of filler to have to use less marijuana in the cartridge. That really was a problem that we saw coming out of bootleg marijuana vaping cartridges. 

Is that being resolved in any way?

The CDC and the FDA have been investigating. The CDC has a lot of information on their website about it, as does the FDA. Certain states have enacted regulation to ban the use of certain additives in those marijuana vaping products to prevent this sort of stuff from occurring. And interestingly, with those lung injuries, if you look at where they were happening most frequently, it was in states that did not have legal recreational cannabis. And so people were turning more to street sales of those types of products. So it was quite interesting. 

That's good. One other question: The general sense that I get from the news coverage of vaping is that it is like a boogeyman. Like, there’s nothing good about this and everything is terrible. And you’re unfortunately in a very defensive position, because you’re trying to say, “hey, it’s not that bad,” which is never a great argument to have to make. Nobody wants to listen to that. But why do you think that there is such a strong outcry over vaping even though we know cigarettes are so much worse?

I appreciate that you know that. And I know that. But there's actually an incredible misperception out there. An overwhelming majority of people, something like north of 70%, actually hold the belief that vaping is as bad or worse than cigarette smoking. And it's interesting, because if you look at all the science, if you look at all of the data, a cigarette has 7,000 carcinogens that people are exposed to when they smoke. 

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“[There's] an incredible misperception...An overwhelming majority of people, something like north of 70%, actually hold the belief that vaping is as bad or worse than cigarette smoking.”

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Vapor products expose people to 95% less of those chemicals, at least 95% less. And so for someone that is smoking, and nothing else is working for them, it’s an incredible harm reduction tool. You have maybe 5% of the exposure, or risk, that you get from smoking.

But there is a lot of public misinformation. Most people don't know that to be the case. Most people think that it's as bad or worse. And so there's a huge disconnect between the reality of the situation and what public perception of the situation is. And part of that not for nothing. There are many, many groups out there that have poured hundreds of millions of dollars into advertising and public relations efforts to demonize the products because of their concern for youth that may be using the products. They've sort of thrown the baby out with the bathwater and caused a huge amount of public misperception.

Are there competitive interests behind this?

You know, there are always a lot of competitive interests, right? And the other thing I want to note as far as misinformation goes while we’re on the topic, is that youth vaping in our country has decreased. Now it’s back to the level where it was in like 2013 or 2014. And so to anybody who’s interested, I would encourage you not to take my word for it, but go look at the data from the CDC and the FDA. The data from the CDC and the FDA shows that there has been a dramatic decline.

Youth use is at the level to where actually youth drinking is higher than youth vaping. Youth marijuana use is higher than youth vaping. But the money PR messaging machine isn't put into those areas, it's really put into an anti-vaping campaign. 

And so back to your question about are there competing interests, that's a complicated topic, right? There's a big tobacco interest in the space. What you saw in 2010 to about 2015 is you saw cigarette sales in this country go like this [makes downward hand motion], right? And at the same time, you saw that sales of vapor products really dramatically go up.

And so the tobacco companies really looked at this, the products that they had on the market weren't really appealing to smokers. You saw Big Tobacco making an investment in Juul, and you saw the tobacco company RJ Reynolds come out with their own vapor product. So that's one competing interest. You've got the tobacco companies that saw their cigarette sales take a huge hit because of all of these vapor products. 

And the other is a pharmaceutical competing interest here. Because a lot of pharmaceutical companies provide products that are intended to help people quit smoking, the patches, the gums, the medications, all of that. Interestingly enough, the patches and the gums use the same nicotine source that we use in vaping products. They also have flavors in them. So that’s just kind of an interesting comparison. No one is demonizing, you know, cherry flavored Nicorette gum, even though it’s literally the same flavor and nicotine suppliers that we use.

There is a very well funded, very powerful political machine that existed in our country for decades, to specifically fight cigarette smoking, right? And so now they've turned that entire money machine, they've turned that entire focus to stomping out vaping like they used to focus on stomping out cigarette smoking. It’s more of this prohibitionist Reefer Madness, “just say no,” “quit or die,” that kind of thing. It’s just very strange to me that they’re acting like we’re still in the tobacco wars of the 90s.

So just generally speaking, would you consider vaping to be safer than alcohol and safer than smoking, and safer than marijuana?

You know, I don't know about alcohol or marijuana. I will say with cigarettes, we've done the research. There have been scientific studies on this for over 10 years. And we know without a doubt it’s vastly safer than smoking.

CORRECTION: Because of a transcription error, this story previously misstated a comment Wheeler made on Vitamin E acetate. She said it blends with oils, but she did not say it blends with nicotine.