On Incredibly Botched Cost-Benefit Calculations

So one morbid hobby that I have is using QALY measures to calculate roughly how many people any single policy decision would kill. Thankfully I don’t get to indulge it much since most policies that I encounter aren’t completely terrible, but today, my friends, we have truly been blessed.

So the FDA recently imposed a bunch of e-cigarette regulations, including forbidding them from advertising true claims about how they are safer than cigarettes, stopping vape shops from helping their customers assemble and fix vapes, forbidding companies from making them safer or more pleasant to use, and having such a stringent and expensive review process that it’s pretty much the equivalent of banning them completely after a 2 year grace period.

Because when doing the cost-benefit calculations, they assigned no value to smokers who will die because they reverted back from vaping to smoking cigarettes.

Alright, lets do the math. Let’s do this very, very conservatively.

So we know that 

smoking is associated with 1.9 fewer years of QALE for U.S. adults.

A reuters/ipsos poll tells us that 10% of US adults vape (

(i.e. 24.5 million of 245 million), and also provides us with this helpful graphic to work with:

image

(source)

From this we know that 30% of that 24.5 million has used it to successfully quit using conventional tobacco. That is 7.35 million people who used to smoke cigarettes, and then quit because of e-cigarettes.

Is vaping harmful? According to this post by the Scientific American, 

Given the long and sorry list of harmful and toxic chemicals in cigarettes, vaping is almost certainly less dangerous to your health.

But also (from the same article):

There is evidence that e-cigs deliver some toxic stuff of their own such as formaldehyde (a known carcinogen), nitrosamines (linked to cancer) and lead (a neurotoxin). Though the toxicant levels of e-cigs may be “9–450 times lower than in cigarette smoke,” [emphasis mine] as this study suggests, levels of formaldehyde and metals have been found to be comparable to or higher than those found in conventional cigarettes. Silicate particles, which are a cause of lung disease, have also been found in e-cigarette vapors. 

Hmm, so definitely less harmful than smoking, but by how much? Let’s lowball, like, a lot, and say that there’s only a 50% difference in harm levels between vapes and cigarettes (so that 1 vape session is as toxic as half of a cigarette). Realistically, the difference in safety between vapes and traditional cigarettes is likely much larger.

And let’s lowball a lot again, and say that only half of the 7.35 million people who used vapes to quit their smoking habit revert back to smoking cigarettes. So 3,675,000 people. And again, realistically, the number is likely larger than that.

(I’m sure that there are probably actual numbers for these, but I’m just too lazy to look them up. I may edit this later on to reflect research findings.)

Alright, it’s time for the math.

Our parameters:

  • 1.9 fewer QALYs for American adult smokers
  • 3,675,000 people reverting to smoking
  • 50% risk difference between vaping and smoking

it’s fairly simple to calculate the damage in terms of QALY:

image

Plugging in our numbers gives us a total loss of 13,965,000 QALYs.

Assuming an average lifespan of 80 years, that’s a loss of 174,562.5 lives.

Remember that we’ve been pretty conservative in estimating our variables, so the actual cost in lives is likely much more. And also, this equation only accounts for people who started smoking e-cigarettes. So future Americans who start smoking because e-cigarettes stopped being commercially available are also not represented here.

So, yeah. The sheer stupidity of this is frankly rage-inducing. Please don’t do this if you do cost-benefit analyses professionally.

I’m reminded of this pretty good quote from the Discworld series:

“I have never laid a finger on anyone in my life, Mr Pump. I may be–– all the things you know I am, but I am not a killer! I have never so much as drawn a sword!”

“No, You Have Not. But You Have Stolen, Embezzled, Defrauded And Swindled Without Discrimination, Mr Lipvig. You Have Ruined Businesses And Destroyed Jobs. When Banks Fail, It Is Seldom Bankers Who Starve. Your Actions Have Taken Money From Those Who Had Little Enough To Begin With. In A Myriad Small Ways You Have Hastened The Deaths Of Many. You Do Not Know Them. You Did Not See Them Bleed. But You Snatched Bread From Their Mouths And Tore Clothes From Their Backs. For Sport, Mr Lipvig. For Sport. For The Joy Of The Game.”

― Terry Pratchett, Going Postal

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