Will Martin Makary’s FDA listen to the evidence on e-cigarettes?

President Donald Trump’s nominee to head the Food and Drug Administration (FDA), Martin Makary, is still waiting for his nomination hearing. However, with new leadership on the horizon, the agency has a rare chance to break free from outdated, prohibitionist policies. 

The latest findings of the Cochrane Review—a gold-standard library of evidence to inform healthcare decision-making—could help steer the agency toward a smoking cessation approach that prioritizes equipping individuals with evidence-based solutions. Measures like capping nicotine in cigarettes, proposed by the Biden administration, create more problems than they solve, while harm-reduction tools like vaping are already proving effective in helping people quit smoking at higher rates.

For millions of Americans, vaping has succeeded where traditional smoking cessation methods have failed—offering an accessible, satisfying alternative that works. The Cochrane Review finds that nicotine e-cigarettes increase quit rates by 59% compared to nicotine replacement therapy (NRT) and 96% compared to behavioral support alone. Yet, instead of embracing this public health victory, e-cigarettes have been vilified, overtaxed, and regulated. By prioritizing abstinence-only messaging and waging war on vaping, we ignore real-world benefits and push people toward a far worse alternative—cigarettes.

Analysis from the National Health Interview Survey (NIHS), including data from 1990 to 2022, reveals that as e-cigarette use increased, smoking rates declined faster than expected—especially among younger adults. The groups most likely to vape—ages 18 to 34—saw the steepest drops in cigarette smoking, while those who didn’t take up vaping saw no significant acceleration towards quitting. This means that e-cigarettes are not keeping people hooked on smoking; they’re replacing it. 

Other countries are leveraging vaping and seeing its positive effects firsthand. The U.K.’s National Health Service (NHS) Better Health Report acknowledges vaping as “one of the most effective tools for quitting smoking.” They have the numbers to support their claims—with nearly three million people having quit smoking with a vape in the last five years. 

Why does vaping work so well as a cessation tool? It mimics the smoking experience, maintaining the hand-to-mouth motion and inhalation experience—unlike traditional patches and gums. Vaping also provides flexible nicotine control, allowing smokers to start at a higher nicotine concentration and gradually reduce their intake over time—tailoring the quitting process to their individual needs. It also reduces exposure to toxic chemicals. Regular tobacco smoke contains 7,000 chemicals, including tar and carbon monoxide, which cause cancer, lung disease, and heart disease. 

Despite the compelling data, the United States takes an extremely aggressive stance against e-cigarettes. The FDA has rejected countless vaping products and failed to adequately inform the public that vaping is a safer alternative to smoking. These actions give people zero incentive to switch, leaving many using traditional cigarettes or turning to unregulated black-market vape products. History has shown that these prohibitive effects are disastrous. 

With a new FDA head soon to take the helm, the agency has the chance to rethink its approach and offer a method to bridge the gap between traditional cessation aids and total abstinence. Instead of demonizing e-cigarettes, we should recognize them as a resource for public health. Not all nicotine products are created equal, so we shouldn’t regulate them like they are. 

As the Cochrane Review has demonstrated, nicotine e-cigarettes offer a significant advantage over traditional NRT, and public messaging must be clear and evidence-based: Vaping is significantly less harmful than smoking and is a viable smoking cessation tool. Will the FDA course correct? One can hope this new administration will bring policy decisions that reflect the best available evidence—rather than outdated fears.

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