Have you ever written something and sent it off, only to encounter a perfect example of what you wanted to say? That happened to me.

I had just finished a new book on addiction when the vaping crisis erupted. The gist of the book is that that globalization, industrialization, mass marketing, digitization, and social media have turned the ancient human preoccupation with disreputable, potentially addictive pleasures into lucrative, commercially normal enterprises. Bad habits have been McDonaldized.

Vaping couldn’t have been a more perfect example of this.

advertisement

I call those who help make bad habits routine “limbic capitalists,” a reference to their products’ neural common denominator. Whether they sell junk food, porn, slots, computer games, alcohol, or drugs, they target the limbic system, the brain networks responsible for pleasure, motivation, long-term memory, and other survival functions linked to emotions.

Biological evolution shaped the limbic system, which is indispensable for life and reproduction. But cultural evolution and technological change created a trapdoor. The same neural pathways can be exploited — lethally — by entrepreneurs of brain-rewarding products that foster excessive consumption and addictive behavior.

I analyzed several categories of mortality data from the World Health Organization and found that, for every premature death from homicide or war-related violence, there were 30 premature deaths from unhealthful practices such as smoking, overeating, or distracted driving. Bad habits may be big business, but they are also big killers.

The surest way to recruit the heavy, regular users who provide the bulk of limbic capitalists’ profits is to entice them at an early age. With e-cigarettes, the incentive to do so was especially strong. Reducing harms by substituting nicotine vapor for tobacco smoke, though a promising idea, had an obvious economic downside. Adult vapers would eventually die or wean themselves away from nicotine. They could be replaced but, beginning in the late 1990s, smoking among U.S. teens began a sustained decline.

Given that the U.S. was easily the world’s largest e-cigarette market, and given that the odds of smoking diminish rapidly as nonsmokers mature through their 20s, the future looked like it would be filled with millennials with no need of e-cigarettes and no association of “pods” with anything other than sci-fi movies.

Unless, of course, vaping became the new original source of nicotine dependency.

In hindsight, the temptation for e-cigarette pioneers resembled the one that faced opioid manufacturers and distributors. Before the 1990s, when physicians prescribed narcotics for cancer, surgery, and trauma, the licit market for these painkillers was ethical and self-limiting. Patients died or recovered.

But then the industry’s patiently orchestrated campaign to liberalize opioid prescribing for chronic non-cancer pain, and the ensuing overpromotion and oversupply of drugs like OxyContin and Roxicodone, greatly expanded the market and triggered the entwined epidemics of iatrogenic and diversion-based opioid addiction. The latter disproportionately involved young males, the same demographic most prone to vaping-based nicotine addiction.

The limbic-capitalist moment for e-cigarettes arrived in 2015, just as the prescription opioid addiction crisis was transitioning to its heroin-and-fentanyl phase. In June of that year, Pax Labs launched Juul, a compact, concealable, and customizable e-cigarette ideally suited to an adolescent marketing campaign.

Some early Juul promotions were conventional: samples doled out at movies and concerts, glam ads featuring the ripped-jean young. But the startup’s biggest marketing assets were the internet and social media. Juul, whose vaporizer resembles a USB drive, took advantage with a barrage of tweets, Instagram posts, YouTube videos, and paid media influencers like Christina Zayas. “They really wanted to appeal to the younger market,” Zayas said. “And they did.”

Juul had another hook for youths: fruity flavors. These reflect an older tactic I call blending. Economists tend to miss its significance because they slot limbic capitalists into categories like Big Tobacco. But their actual products involve artful hedonic manipulation. Think of menthol, aromatics, and nicotine-enhancing ammonia in cigarettes. Some additives, such as sugar in cereals and sodas, have the further benefit of enticing young consumers. Juul worked the trick with mango and cool mint. Recording vaping tricks and uploading them for fun, instruction, and likes provided a juvenile sweetener of another variety.

Then Juul ran into two problems inherent to commercialized vice. One hitch was that other limbic capitalists, including counterfeiters and black marketeers, could also play the additives game. Skip the nicotine, advised a 2018 High Times article, and fill your Juul pods with THC oil (assuming it really was THC oil). Any enhancement or substitution increases the risk of toxic adulteration, suspected as a contributor to the 2019 outbreak of acute lung injuries among those who make or buy customized cartridges with alternative flavors and drugs. As with prescription opioids, many of the knockoffs could be traced back to Chinese manufacturers and internet vendors.

That so many hospitalized vapers — current median age of 24 years — were young aggravated a second threat facing the industry. In December 2018, news broke that rates of self-reported vaping had jumped from 11% to 21% among high school seniors, the biggest one-year increase in drug use ever recorded in the Monitoring the Future survey.

An estimated 1.3 million more high school students were vaping in 2018 than in 2017. By mid-2019, parents had begun filing lawsuits on behalf of their addicted minor children, while federal regulators proposed banning e-cigarettes of the flavored variety. In September, Massachusetts Gov. Charlie Baker went further, imposing a four-month ban on sales of all vaping products.

The legal blowback is consistent with the history of limbic capitalism. Societies reserve their strongest condemnations for addictive products that target the young, on whose health the future depends. Nothing scandalizes the public like hooked teenagers on respirators or morgue slabs.

Knowing how sensitive this nerve is, limbic capitalists have often countered with strategic walk backs and PR buys. This year, Juul ran a series of full-page ads in the Wall Street Journal advocating raising the age of legal purchase and tougher ID checks for vaping products. Attentive readers could not help but notice how closely the newly vigilant tone of the Juul ads echoed those that Purdue Pharma — “We Make Prescription Opioids. And We Want to Limit Their Use” — ran in the Journal in late 2018.

If the ads were too late for Purdue, they were nonetheless instructive for historians looking for patterns in the distant and more recent past. The pattern for the vaping scandal, and for the opioid crisis, and for proliferating addictions generally, is that of limbic capitalism. Step away from the headlines, take a closer look at vaping, and you will see but the latest blossom on the prettified thorn bush of commercialized vice.

David T. Courtwright, Ph.D., is professor emeritus at the University of North Florida who has written several books on the history of addictive substances. His latest is “The Age of Addiction: How Bad Habits Became Big Business” (Harvard University Press, May 2019). He has testified as an expert witness for plaintiffs in litigation against prescription opioid manufacturers.

Leave a Comment

Please enter your name.
Please enter a comment.

    • Load of BS. They don’t even specify what the “contaminant” is. It sounds like the “contamination” is that they sold product NEARING its “best by” date.

      Don’t you think a professor should be curious about things and try to figure out what happened before gossiping about them online?

  • “Limbic capitalism” is a perfect term for the utter, unscrupulous escalation of greed by profiteering entities that are devoid of any ethics, and whose moral base-line is zero. This term applies to any company, politician, group or gang involved with willingly and knowingly causing and increasing addiction to killer substances. Thank you Mr. Courtwright, for also cleary exposing that our “society” is suffering from its own weak backbones, meakly or obliviously tolerating the disgusting promotion of horribly addictive substances. Let’s hope the rude awakening leads to re-building guts to stop this horrible trend.

  • I started smoking when I was 12 years old and honestly thought I’d never be able to quit. I tried so many times in different ways, but nothing worked. I was able to drastically cut back, but not completely stop. But then a friend of mine had been vaping for a while and I had never even heard of it before. He told me he was using it to quit smoking and it worked, but I didn’t believe him. A couple months later, he still wasn’t smoking, so I decided to give it a try. Within 2 weeks, I didn’t even want cigarettes anymore. It’s been over 5 years now that I haven’t smoked a cigarette. I am so thankful to vaping, because I thought I’d never be able to quit. I still vape, but I’ve weaned myself down off the nicotine to almost none.
    I’m am really mad at all the bad press vaping has received recently. I’m a grown adult using products responsibly, but now it’s hard for me to buy what I want. It’s not my fault that a bunch of idiots decided to buy knock off products or misuse vaping by trying to get high with this THC crap! And as far as the problems using Juul…why should the whole market be punished when the company we’re all hearing about is Juul? As far as I’m concerned, Juul pods and E-cigarettes have nothing to do with vaping e-juice from your local vape shops–it’s completely different! Juul pods have WAAAY more nicotine and other additives that regular vape products do not have. And the majority of deaths or illnesses are being caused by adding THC, which is NOT what normal vapers do.
    Also, I’d really like to see parents take some responsibility for their kids’ underage use of products they aren’t even old enough to buy. And when people see that others are dieing from using these THC products, but they still decide to use them anyway, are we supposed to feel bad for them when they end up in the hospital? Because I don’t bad. Sorry if that sounds cold-hearted, but it’s their own stupidity. No one made them do it. Geeze, whatever happened to just smoking some weed?
    There’s always going to be some kind of crisis going on and teenagers are always going to make stupid decisions, because that’s what they do. But it’s the parents’ jobs and moral responsibility to guide their kids and protect them. It seems like this generation is a free for all with little guidance and no discipline. This would’ve never been a problem decades ago, because our parents would’ve whooped our butts for being stupid and irresponsible enough to use dangerous things. They wouldn’t have filed lawsuits on our behalf after we got sick, they would’ve laid the smack down before it ever got to that point.
    What it all really comes down to is that people are getting sick or even dieing from unregulated/black market products or product misuse, but no one is going after these producers/distributers. Instead, vaping is paying the price and all the responsible adults who vape are thrown into the same category. But it’s not the same thing!
    VAPING IS NOT KILLING PEOPLE.

  • I thought the same way until it hit home. Marketing is big business..food addiction.sugar addiction. Gambling shopping porn sex work.self rightousness
    Etc.
    As humans constantly bombarded by marketing ads. we all want that quick fix in this society. And yes AA works as long as we dont judge the newcomer and stay away from substituting the addiction
    Let’s focus on our humility and remember everyone has their own circumstances. I pray alot for the younger generation. Thank u for the opportunity to Express my feelings.
    I dont usually respond.
    Btw lets not fool ourselves . Somebody is making big $$ at the expense of losing our children

  • No one can cause anyone elses addiction. We are responsible for our own addictions. What I’ve been seeing thru this opioid hysteria and now this proposed proposed prohibition of flavored vapeing, vice in general is total lack of personal responal responsibility. I find it weak and dangerous considering the mortality rate. No substance can harm an individual unless they make the choose to use it. With holding medications from valid medications and reducing production of necessary production of necessary supply already in desperate demand causing horrific suffering to millions in our country isn’t reducing the mortality rate from illicite Fentanyl, Heroin and Carfentanil coming from China and Mexico while rogue DEA is raiding the few Physicians that still mercifully relieve tortous painful chronic and terminal conditions. Suicides are soaring in the pain community. 400,000 people die every year from smoking related illnesses. Vaping is saving lives. Government over reach has killed billions of us. Innocent Americans since this war on drugs started. Look at Portugal. The dacrimalized. It’s a success.

  • What is your clinical experience with addiction?

    What research have you conducted or read that confirms your “altered neurons” statement?

    What is your expertise in this area? I see that you are a historian, weall-respected, but many of your statements seem far afield from your expertise. Am I mistaken?

    • @Andrea
      I share your skepticism of Mr. Cartwright’s arguments, though not of his authority to make them. We don’t need medical degrees to read and discuss data.

      But to your point- merely reading this sentence and remembering it will alter your neurons forever! You can find many studies exploring correlations between nicotine use and cardiovascular disease online, but the correlation is weak and confounded by the fact that most nicotine consumption is tobacco consumption, which has independent risks. The risk of addiction to non-tobacco nicotine is well-validated, though its impact on health may be no worse than an addiction to Starbucks. It appears harmless in animal models, though we don’t have enough epidemiological data to be sure.

  • Opioid use in chronic illness has allowed millions to survive and thrive. Your Only two acceptable options, recover or die, are stunning in their obliviousness.

  • All limbic products should be legal.
    Freedom is a misleading thought, globally. Freedom of speech, right to bear arms, but no right to consume what we want. Products don’t kill. The black market kills.

    • It isn’t bad, when used as a harm-reduction measure for confirmed smokers. It is bad when it is used to addict people, especially young people, to nicotine.

      As with all toxic, habituating drugs, the basic problem with vaping is how to maximize medical benefits while minimizing profit-motivated exploitation that leads to addiction.

    • But why is recreational use bad? Nicotine has no known negative effects on health, yet it enhances recall, attention, fine motor skills, and aerobic endurance. Why is it worse than a tea habit?

    • Recreational use is risky because nicotine is highly addictive. Casual use often leads to regular use, which alters neurons, increases tolerance, and triggers withdrawal symptoms when people try to quit. Once hooked they are at a higher long-term risk for cardiovascular and other diseases, not to say steady customers for those who got them addicted to nicotine.

Your daily dose of news in health and medicine

Privacy Policy