Latest data from the Centers for Disease Control and Prevention (CDC) show an alarming increase in unexplained vaping-related respiratory illnesses. Dr. Anne Schuchat, a public health official from the CDC, testified at a September 24th congressional hearing that the number of confirmed cases was now 530, including nine deaths, and that ‘hundreds more’ cases were expected soon. Public concern about this mysterious illness has grown quickly and there are now actions/proposals by several state and federal agencies to address the problem, including proposals to halt the sale of e-cigarettes altogether. Tuesday’s congressional hearing was contentious, with one side of the argument best summed up by the mother of a teenage girl recently hospitalized in the ICU by a vaping-related illness “If E-Cigs were romaine lettuce – they’d be off the shelf”, and the other side of the argument reflected in comments by a 51-year old former smoker and current vaper who strongly argued that vaping was the only thing that allowed her to break a 23-year cigarette smoking habit.
The debate that took place at this congressional hearing is a reminder about what we can learn from behavioral economics about changing public policy and human behavior. Behavioral economics applies principles from psychology to understand the not-so rational decisions about healthcare that are frequently made by patients, doctors and institutions. It provides important lessons for how public health officials can best structure and frame health information campaigns and policy recommendations to spur a willingness among stakeholders to take prompt action to address public health emergencies, like vaping-related illness. For instance, the tendency for ‘hyperbolic discounting’, in which people place a higher premium on current, rather than future (even relatively short term) rewards, seems to be at the very heart of decisions by young people to take up vaping, or purchase a vaping product from an ‘off the street’ source, despite the uncertainty about the product they are consuming and the long terms effects on their health. Public health notices and advertising campaigns should provide people with all of the latest factual information they can, emphasize the risks that people are taking and the potential consequences. Resistance to proposals to restrict the marketing or sale of flavored (and unflavored) e-cigarettes, until the causes of the current epidemic in vaping-related illness are better known, seem to be underpinned by the tendency for ‘loss aversion’ and the ‘endowment effect’. In loss aversion, people consider losses as much more powerful psychologically than gains. A related tendency is the endowment effect, in which people show a tendency to value something they currently have much more than something they do not. Public health officials should consider how those arguing against action to regulate e-cigarettes are employing ‘framing’ (negative advertising) to take advantage of peoples’ sense of loss aversion, and work to counter these messages with facts, so that people know the risks and consequences of their decision to vape.
Peter Erwin, Ph.D.
Vice President Federal Health Transformation Services