The Ethics of Diversion - Tobacco Example

What are the ethics of diverting people from smoking to vaping?

On the one hand, we have the following argument.

• E-cigarettes ("vaping") offer a plausible substitute for smoking cigarettes.
• Smoking is dangerous, and vaping is probably much less dangerous.
• Many smokers find it difficult to give up, even if they are motivated to do so. So vaping provides a plausible exit route.
• Observed reductions in the level of smoking can be partially attributed to the availability of alternatives such as vaping. (This is known as the diversion hypothesis.)
• It is therefore justifiable to encourage smokers to switch from cigarettes to e-cigarettes.

Critics of this argument make the following points.

• While the dangers of smoking are now well-known, some evidence is now emerging to suggest that vaping may also be dangerous. In the USA, a handful of people have died and hundreds have been hospitalized.
• While some smokers may be diverted to vaping, there are also concerns that vaping may provide an entry path to smoking, especially for young people. This is known as the gateway or catalyst hypothesis.

Some defenders of vaping blame the potential health risks and the gateway effect not on vaping itself but on the wide range of flavours that are available. While these may increase the attraction of vaping to children, the flavour ingredients are chemically unstable and may produce toxic compounds. For this reason, President Trump has recently proposed a ban on flavoured e-cigarettes.

Juul, which dominates the e-cigarette market in the US, is currently being investigated by the FDA and federal prosecutors for its marketing, and the inappropriately named Mr Burns has just stepped down as CEO.

And elsewhere in the world, significant differences in regulation are emerging between countries. While some countries are looking to ban e-cigarettes altogether, the UK position (as presented by Public Health England and the MHRA) is to encourage e-cigarettes as a safe alternative to smoking. At some point in the future presumably, UK data can be compared with data from other countries to provide evidence for or against the UK position. Professor Simon Capewell of Liverpool University (quoted in the Observer) calls this a "bizarre national experiment".

While we await convincing data about outcomes, ethical reasoning may appeal to several different principles.

Firstly, the minimum interference principle. In this case, this means not restricting people's informed choice without good reason.

Secondly, the utilitarian principle. The benefit of helping a large number of people to reduce a known harm outweighs the possibility of causing a lesser but unknown harm to a smaller number of people.

Thirdly, the cautionary principle. Even if vaping appears to be safer than traditional smoking, Professor Capewell reminds us of other things that were assumed to be safe - until we discovered that they weren't safe at all.

And finally, the conflict of interest principle. Elliott Reichardt, a researcher at the University of Calvary and a campaigner against vaping, argues that any study, report or campaign funded by the tobacco industry should be regarded with some suspicion.

I wouldn't be rushing to defend the vaping industry right now. Caution may well prove to be unfounded, but highly profitable products have a habit of turning out to be unsavoury as events unfold. This would not be a good one to be on the wrong side of history for, either way. https://t.co/vNeYX9u8Uz

— Jon Ayre (@Jon_Ayre) September 16, 2019

Meanwhile, the traditional tobacco industry is hedging its bets - investing in e-cigarettes but doing well when vaping falters.

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US Food and Drug Administration, Warning Letter to Juul Labs (FDA, 9 September 2019) via BBC News

Allan M. Brandt, Inventing Conflicts of Interest: A History of Tobacco Industry Tactics (Am J Public Health 102(1) January 2012) 63–71

Tom Chivers, Stop Hating on Vaping (Unherd, 13 September 2019) via @IanDunt

Jamie Doward, After six deaths in the US and bans around the world – is vaping safe? (Observer, 15 September 2019)

David Heath, Contesting the Science of Smoking (Atlantic, 4 May 2016)

Angelica Lavito, Juul built an e-cigarette empire. Its popularity with teens threatens its future (CNBC 4 August 2018)

Levy DT, Warner KE, Cummings KM, et al, Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check (Tobacco Control 20 November 2018)

Jennifer Maloney, Federal Prosecutors Conducting Criminal Probe of Juul (Wall Street Journal, 23 September 2019)

Elliott Reichardt and Juliet Guichon, Vaping is an urgent threat to public health (The Conversation, 13 March 2019)