By Rory E. Riley-Topping, veterans’ advocate and TES Contributor
The sentiment “horror vaccui,” which translates to “nature abhors a vacuum,” is usually attributed to Aristotle. The phrase loosely means that if you take something away, something else will naturally end up filling that space. In terms of military and foreign policy, we most frequently hear this discussed in the context of a country’s leadership, i.e., a “power vacuum.” However, this principle is also applicable to many other areas of service members’ daily lives. To this end, service members and veterans are more likely to smoke than their civilian counterparts, especially if they have deployed overseas. And when it comes to quitting smoking, many of those trying to quit need some sort of oral stimulant to fill the void that a traditional tobacco cigarette once provided. This principle of science is exactly what Hon Lik, the Chinese pharmacist who invented the electronic cigarette, had in mind when he created the device in 2003.
Here in the United States, the vacuum left by turning our backs on the usage of traditional cigarettes (which is of course a good thing) is felt most strongly by active duty service members and military veterans.
Although many regulators are quick to note that cigarettes of any kind are bad, smoking and the military have a long and intertwined history together that is important to understanding why a more thoughtful analysis of smoking cessation via the use of e-cigarettes is required than just the typical bureaucratic mantra of “because we said so.”
As Aristotle also noted, the most important component of moral virtue is practical reason, which entails weighing all the evidence and arriving at an ethical solution. Although there is certainly merit to the various arguments raised against vaping by children and teenagers, we must consider more complex factors, i.e., use our practical reasoning, when it comes to helping service members and veterans to definitively quit smoking. And, when we do so, we arrive at e-cigarette usage as an ethical solution.
The primary factor we must consider is history. The US military saw a substantial increase in the number of smokers, both military and civilian alike, during World War I. General John Pershing, commander of the American Expeditionary Force, cabled the War Department in 1917: “You ask me what we need to win this war. I answer, tobacco as much as bullets.” And, after the war, the activity continued to be encouraged, even within VA hospitals. Offering a cigarette to a wounded soldier was often viewed as a symbol of compassion.
As the U.S. entered World War II, cigarette became an international language between allies and enemies alike. Sharing a cigarette remained synonymous with compassion, particularly when offered to a wounded enemy soldier.
The backdrop of World War II also leads to the second factor we must consider – cultural identity. Ironically, not smoking was viewed as suspicious and un-American because the world’s first major anti-smoking campaign wasconducted by Nazi Germany, due to Hitler’s personal dislike of the practice. This made smoking all the more symbolic of American freedom and therefore embraced by members of the military for decades to come.
The military’s relationship with smoking started to shift after the Vietnam War, as studies showing the harmful effects of cigarette-smoking became more widely accepted. The military stopped providing cigarettes in C-rations in 1975. However, also around this time, research into PTSD began to increase. Not only were veterans diagnosed with PTSD more likely to smoke, but most believed that it helped them to manage their stress levels.
The final factor we must consider is access. Despite the fact that it is now generally accepted and widely known that smoking cigarettes is harmful to one’s health, tobacco products continue to be sold at military bases (and, until April 2017, were sold at subsidized prices), making traditional cigarettes readily accessible to servicemembers. Although some in the anti-tobacco movement have proposed banning the sale of tobacco products on military bases altogether, tobacco is still sold in nearby pharmacies and convenience stores, making this solution sound better in theory than it would work in practice. (Also, look no further than alcohol and the prohibition movement in the 1920s to see how this type of strategy usually works out). Therefore, if we sincerely want to encourage service members to quit, we must also provide them with access to acceptable alternatives.
Although nature abhors a vacuum, the FDA, nonsensically, appears to abhor sensible alternatives to smoking that will aid in cessation. Earlier this year, the FDA proposed a rule banning e-cigarettes from pharmacies and convenience stores, citing to a rise in teenage vaping. Although the FDA nonetheless stressed the importance of keeping e-cigarettes availablefor adult smokers trying to quit, they failed to realize that severely restricting such access to adults not only sends a conflicting message, but also may cause some adults, including service members and veterans, who want to quit smoking to remain addicted to traditional cigarettes.
Although the impact on youth is a legitimate concern, the FDA’s proposed rule produces greater harm to service members than it does proactive benefits to teenagers. Rather than focusing its energy on unrealistic bans and access restrictions, the FDA and other stakeholders should be working toward more sensical solutions, such as honest advertising that portrays e-cigarettes as a cessation device for adults, not targeting youth with promises of trying something new.
When we refer to America as the “land of the free and the home of the brave,” we often say it is so because of our service members who have fought for our country. So, let’s help them to succeed in the fights they face when they return home, such as with quitting smoking. “I count him braver who overcomes his desires than him who conquers his enemies,” Aristotle also said, “for the hardest victory is over the self.”
Rory E. Riley-Topping is a consultant who has dedicated her career to advocating for our nation’s veterans. She previously served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP). She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.).