After standing to one side while vaping hooked a generation of young Americans on nicotine, the Trump Administration has now abruptly decided to try to vaporize youthful vaping by banning candy-like flavorings favored by e-cigarette users.

The president and Alex Azar, the chief of the Health and Human Services agency, announced the latest e-cigarette and vaping crackdown. It still must be defined in regulations, practices, and the financial support for the federal Food and Drug Administration to enforce it. FDA Commissioner Ned Sharpless and First Lady Melania Trump also participated in the Oval Office session.

The White House announcement came as public officials add daily to the toll of a sudden outbreak of reported deaths (at least a half dozen) and serious respiratory harms (hundreds of cases in three dozen or so states) blamed on vaping. Investigations continue as to the cause of the e-cigarette-related fatalities and injuries.

They have further infuriated parents, educators, public health officials, and anti-smoking advocates. They had assailed the policy decisions of Scott Gottlieb, Trump’s former FDA commissioner and a onetime board member of an e-cigarette maker, to delay planned anti-vaping measures fought for and won by the Obama Administration. Gottlieb instead sought further study as to whether e-cigarettes could reduce the proven harm of smoking tobacco-burning cigarettes. He wanted more research on breaking nicotine addiction, which he and his allies asserted might be key to abating tobacco’s harms.

Abuse of burned tobacco, the federal Centers for Disease Control and Prevention says, kills 480,000 Americans annually, as a scientifically proven cause of cancers, heart disease, lung and respiratory disorders, and other destructive health injuries.

The Trump Administration’s legal lollygagging on vaping, however, led to the rise of Juul and other tech-minded e-cigarette makers. They not only amped up the nicotine in cartridges used in the devices — some deliver as much of the addictive substance as a pack of cigarettes — they also tapped into social media and the insecurities and aspirations of the young to make e-cigarettes and vaping a red-hot trend for the youthful.

Juul and other makers also exploited young tastes, as Azar and HHS reported. The makers promoted sweet flavorings for liquids catalyzed in e-cigarettes, also creating those distinctive vapor clouds. The liquids not only taste sweet, they also contain unknown substances and harmful substances. Besides nicotine, vaping can be used to deliver tetrahydrocannabinol or THC, the chemical that gives marijuana its high. Authorities suspect that vaping liquids, especially “street” or bootleg varieties, contain toxins that kill and cause severe damage to the lungs and other organs — notably because vaping provides such a direct and effective way to move the substances into the body and past its defenses.

The administration will target vaping flavors — those that give tastes like fruit, menthol, mint, candy, and alcoholic drinks — to try to stem a product that the federal government estimates that as many as 1 in 4 young people has dabble in. Anti-smoking advocates say that growing amounts of research shows that, rather than serving as a less harmful alternative, e-cigarettes and vaping have proven to be a gateway to burned tobacco use and abuse.

A first puff of makers’ defenses

Juul and other makers, as expected, coughed up limp initial defenses of their devices and vaping, also arguing that further restrictions on them infringe on individuals’ rights. The New York Times reported that e-cigarette makers and vendors are trying to figure how radically the flavor ban would alter their businesses and how best to react.

The vaping industry further has thrown up a counter-factual, hand-wringing contention that the flavoring ban may prove detrimental to adults who just might, maybe, possibly turn to e-cigarettes as an alternative to burning tobacco products like cigarettes and cigars. Anti-smoking advocates point out that this hasn’t this occurred already, even with the huge attention given to Juul and its ilk among the young.

Advocates of e-cigarettes as a less harmful option point to 10 million adults using the devices, half of those individuals are young — 35 or under. That, however, underscores the perils of vaping to younger users. It also undercuts arguments that older Americans, many of whom may be long-term tobacco users, see e-cigarettes as a less damaging option (just 2.8% of adults ages 45-65 have vaped). Research  shows vaping may be a nightmarish add-on, with grownups both abusing burning tobacco and vaping.

Juul and the other makers, incidentally, already are or are morphing into Big Tobacco, with legacy companies not only buying into their newer, hipper counterparts but the enterprises also heading overseas — including to already tobacco-plagued China — to flee U.S. oversight and seek big profits. This has been Big Tobacco’s killer playbook, including its endless and successful battles to preserve profitable but damaging flavored (menthol) cigarettes.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the  damage that can wreaked on them by defective and dangerous products, as e-cigarettes are proving to be. I also long have seen the benefit they get from staying healthy and far from the known and considerable risks in the current health care system. If you don’t smoke, please don’t start and consider the huge health boosts that can happen for you if you quit. If you and the young people you know don’t vape, please don’t start. It may be tough and painful to quit this nasty habit, too. The sooner the better.

Research-based policy, a First Lady’s intervention, and gun violence

Here’s something else that would be terrific if it occurred, pronto: Could the administration make a 180-degree turn and base its actions and policies on rigorous research and hard evidence, rather than Big Business-favoring or neck-snapping reactions to who-knows-what by the leader of the free world?

It took the First Lady to weigh in to get Trump officials, finally, to act to protect the health of the nation’s young, including the Trumps’ teen-aged son.

It’s also a disconcerting sign of the times that social media has been rife with a correct question, posited, perhaps, as an unacceptable either-or: Why after a half dozen deaths has the Trump Administration decided to act decisively on vaping, while gun violence — especially mass shootings killed an estimated 40,000 Americans in 2018, with zero action from Congress or the White House?

With scores of CEOs demanding common sense action on destructive weaponry and a rising backlash from businesses telling customers that they won’t stock guns and ammo, and, no, they’re not welcome to open-carry in their enterprises, wouldn’t the White House and Congress — especially Senate Majority Leader Mitch McConnell — regard the terrible toll of guns to be an urgent public health matter demanding response?

Would it be so tough to deal with both gun violence and the threat of vaping to the young? Can Congress and the White House walk and chew gum at the same time?

Taking care of Americans’ health and well-being is a big, complex, and messy matter. Voters will decide in 2020 how well they think the incumbents have managed one of their significant governmental roles. We’ve got a lot of work ahead.