Commissioner Makary on High Schoolers Vaping: Half or Half a Percent?

 

In his Congressional testimony on May 22, FDA Commissioner Dr. Martin Makary said, “There are high schools in America now where kids are saying half of the kids are addicted to these vaping products.”

During the 2024 campaign, President Trump promised to save vaping.  Now that job falls to Dr. Makary, whose agency “oversees the safety of more than $3.9 trillion worth of food, tobacco, and medical products produced in the U.S. and abroad.”  With so much on his plate, he can be forgiven for not having all the facts yet on youth vaping.

Last December, I took a deep dive into vaping among American high schoolers, using the CDC’s 2023 National Youth Tobacco Survey (here), the latest available dataset.

My analysis demonstrated that some 73,092 of the nation’s 15.8 million high schoolers vaped frequently enough (20-30 days in past month) to be at risk for being addicted.  That represents only 0.5%, not 50%.

No one is comfortable with youth vaping, but Dr. Makary and his team should understand that vaping has contributed to the disappearance of smoking among American high schoolers, and the rate among young adults is similarly minimal.  This means that in 25 to 30 years, smoking-related diseases will nearly disappear, too.  It’s time for the FDA to focus on adult smokers over age 40, whose risk grows with each cigarette.  Going smoke-free will give them the chance for longer and healthier lives. 

 

 

Tobacco Prohibitionists Kill Safer Cigarette Substitutes… and Smokers

 

Dr. Michael Siegel has published a blog entry criticizing a “new article in American Journal of Medicine claim[ing] that youths who use e-cigarettes are 5 times more likely to become cigarette smokers.”  The commentary was authored by tobacco and nicotine opponents Pamela Ling and Edward Goetzl.

Dr. Siegel correctly notes, “the article in question fails to provide any citation or source for its preposterous claim… Apparently, we are supposed to just take it on faith that this is true.”

Reviewing the Ling-Goetzl screed, I found that the authors specified that the five-fold claim was for “tobacco-naive adolescents.”  While that claim was not attributed, the commentary’s authors did include in their reference list one possible source: another commentary, authored by fellow prohibitionist Jonathan Winickoff and coworkers in September’s JAMA. 

Winikoff did not provide a source for his claim either, but he hinted at it with a reference to a 2019 article by Kaitlyn Berry, et al., in JAMA Network Open.

Further complicating the matter, I, along with David Abrams and Ray Niaura, had published a critical comment in that journal, documenting how Berry, et al., engineered their study to make e-cigarettes seem to increase smoking rates by 4 times (in their abstract), not 5.  I also wrote a blog entry on the subject in February 2019 that contained this highlight:

“While Berry, et al., and [then FDA] Commissioner Gottlieb, emphasized the 4.0% probability of current smoking among e-cigarette first users, we found a reverse result buried in a supplemental table: The probability of current e-cigarette use at follow up among cigarette first users was 8.3%.  This means that twice as many first-smoking teens currently used e-cigarettes at follow-up than first-vaping teens who currently used cigarettes.”

The critical lesson here is not about the transgressions of Ling-Goetzl, or Winikoff, or Berry.  It is how the incessant repetition of exaggerated, distorted and sometimes falsified research dangerously distorts public perceptions about vastly safer cigarette substitutes.  It happened with smokeless tobacco; it is happening today with vapor and nicotine pouches.  Millions of smokers will die, and prohibitionists will never be held accountable.

 

2023 High School Seniors Preferred Alcohol and Marijuana, But Almost Abandoned Cigarettes

 

My readers know that I have followed the results of the annual Monitoring the Future Survey (MTF) for many years, focusing on alcohol, marijuana and tobacco use among high school seniors.  The 2023 MTF results, released in December (here), indicate that past 30-day (i.e., current) use of all products declined from the previous year (as seen in chart at left).    

Despite its illegality, drinking alcohol retained its decades-long top-substance status among seniors at 23%, down significantly from 28% in 2022.  Marijuana was second at 18%, one point higher than the 17% of seniors vaping nicotine in the past 30 days, which was a significant 4 percentage point decline from the year before.  Happily, current smoking remained at the bottom of the chart, at a new low of 2.9%.    

Another fascinating MTF finding (not on my chart) is that 18% of seniors currently consumed flavored alcohol, one point higher than those who vaped nicotine.  Protecting teens from flavors has driven the FDA’s attempts to ban vape flavoring and these products are being prohibited outright in jurisdictions across the country.  Flavored alcohol is far more dangerous for teens, but those products are apparently beyond the FDA’s reach, and no one has yet established a Campaign for Alcohol Free Kids.