We all like to think that we make decisions rationally, objectively, and with an independent streak. The reality is that we all have biases that influence the choices we make. One common cognitive bias is the anchoring effect, which is the tendency to rely on an initial experience or piece of information to make subsequent judgments or decisions.
Stores use it consistently to convince us to buy. We need that anchor price of $450 for the flat-screen TV to know that we are getting a fantastic discount at $299.
We like anchors because they can simplify complex problems and help us manage risk and uncertainty. However, they can also cause us to minimize risk. For example, if your grandmother lived to be 100 despite heavy smoking, you may underestimate the objective health risks of smoking.
The vaping industry has been masterful in its use of anchoring. Its strategy has been to frame our perceptions about the risk of vaping by comparing it to the risk of smoking--a "lesser of two evils" approach. And vaping advocates took the cue: They regularly point to a 2016 report by the Royal College of Physicians stating that the health hazards from vaping are "unlikely to exceed 5 percent of the harm from smoking tobacco."
Until the recent publication of a study in the American Journal of Preventive Medicine documenting the independent health risk of vaping, the public health community has had little to displace this notion.
The industry's anchoring strategy has been so effective that Congress has enshrined it in federal law. The federal Food and Drug Administration may classify products as "modified risk" if they are "sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products." Juul's failure to obtain such a classification before making modified-risk claims recently prompted the FDA to issue a warning letter to the e-cigarette maker.
The modified-risk concept nearly made it into Arkansas law during the 2019 legislative session. Arkansas House Bill 1565, a bill to provide funding for a National Cancer Institute-designated cancer center in Arkansas, originally contained language that would have triggered an automatic 25 percent to 50 percent excise-tax reduction for products designated as modified-risk by the FDA, although that provision ultimately was removed.
And Arkansas is not alone: Similar language has popped up in bills in Georgia and Virginia.
A "lesser of two evils" approach might be appropriate if the purchase and use of vape products were limited to those with long-term tobacco use, as a path to cessation. It could also be helpful if vape products were part of a cessation strategy, overseen by a physician, for nicotine addiction.
But that's not where we are. Instead, our youth--many of whom have never smoked before--are increasingly using vape products as their first nicotine-based product.
According to the Centers for Disease Control and Prevention, 27.5 percent of U.S. high school students are current users of vape products, more than double the rate of current users just two years ago. Misperceptions about the harms of vaping are among the major factors influencing youth initiation, and the "lesser of two evils" approach only reinforces those misperceptions.
If smoking cessation among adults were the goal of vape products, then they would be considered failed products: Most adults who vape in an effort to quit smoking cigarettes instead continue to use both products, and some may actually increase their addiction.
On the contrary, vape products are highly successful and profitable, with marketing that has targeted our youth to create the next generation of nicotine-addicted consumers. That is why an anchor tied to the harms of smoking is not the right starting point.
Let's instead measure the risk of vaping by comparing it to the place where the majority of our youth are, at least for now: not vaping at all.
Craig Wilson, JD, MPA, is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock.
Editorial on 01/16/2020