Evidence-based policymaking is dying in nanny-state America

The surgeon general’s recent report on health disparities related to tobacco use highlights how ideology can overshadow evidence in public health policy.

Despite its stated goal of reducing disparities and combating disease, the report neglects one of the most effective tools for saving lives: harm reduction. Instead, it falsely equates the risks of all nicotine-containing products, a stance that undermines efforts to reduce smoking-related mortality.

Decades of research demonstrates that harm-reduction strategies, including access to flavored vaping products, significantly lower smoking rates.

The problem extends beyond tobacco policy. Dr. Vivek Murthy, the outgoing surgeon general, recently released an advisory on alcohol use, disregarding a comprehensive review from the National Academies of Sciences, Engineering, and Medicine. The NASEM report, a 230-page analysis prepared to inform the 2025 Dietary Guidelines for Americans, concluded with moderate certainty that moderate alcohol consumption is associated with lower all-cause mortality compared to abstinence. This "J-curve" relationship, supported by decades of research, shows moderate drinkers tend to live longer and experience fewer cardiovascular events than both non-drinkers and heavy drinkers.

Rather than addressing these findings, Murthy’s advisory embraced prohibitionist rhetoric, disregarding the nuanced relationship between alcohol consumption and health. Such selective use of evidence highlights a growing trend where moralistic agendas take precedence over scientific rigor.

The disregard for taxpayer-funded evidence in favor of personal biases is becoming increasingly common. A prime example lies in the ongoing debate over flavored vaping products. Recent studies, including a comprehensive analysis in December led by Abigail Friedman of Yale University, reveal the unintended consequences of flavor bans. Using data from the Behavioral Risk Factor Surveillance System surveys, Friedman found that state restrictions on flavored electronic nicotine delivery systems reduced daily vaping but caused a 2.2-percentage-point increase in daily smoking. These findings indicate that while vaping decreases, smoking — a much greater health risk — rises.

This substitution effect, where reduced vaping leads to increased smoking, is supported by numerous economic analyses and sales data. For every 0.7 milliliters of e-liquid not sold due to flavor restrictions, 15 additional cigarettes are sold, according to Yale researchers. Studies from the National Bureau of Economic Research and the Society for Research on Nicotine and Tobacco confirm similar patterns. These findings emphasize a critical truth: Vaping and smoking are substitutes, and policies restricting flavored vaping products inadvertently push individuals back to harmful combustible cigarettes.

Despite overwhelming evidence of these unintended consequences, policymakers continue to advocate for flavor bans. Democrats in Washington State, for example, have introduced legislation to outlaw flavored electronic cigarettes, menthol cigarettes, and nicotine pouches by 2026. Supporters of the ban argue that flavored products entice young people into risky behaviors, framing the issue as a matter of moral responsibility rather than evidence-based policy.

This moralistic approach obscures the real public health impact. Decades of research demonstrates that harm-reduction strategies, including access to flavored vaping products, significantly lower smoking rates and associated mortality. By dismissing this evidence, lawmakers not only forgo a critical opportunity to save lives but also actively pursue policies detrimental to public health.

The same pattern applies to the alcohol debate. Thousands of studies have established the health benefits of moderate alcohol consumption, particularly its cardiovascular advantages. A 2021 study of European populations, published in Addiction, confirmed the J-curve relationship, showing that moderate drinkers live longer and face no heightened cancer risk from light drinking. Yet, prohibitionist rhetoric continues to overshadow this evidence, sidelining research designed explicitly to inform effective public health policy.

The rise of the “nanny state” mentality reflects a troubling shift away from evidence-based policymaking, where ideological imperatives outweigh scientific evidence. This approach erodes public trust in health authorities and leads to policies that worsen the very issues they aim to address. By treating all nicotine products as equally harmful, disregarding the health benefits of moderate alcohol consumption, and implementing flavor bans that drive people back to smoking, policymakers prioritize moralistic dogma over saving lives.

A course correction is long overdue. Public health policy must follow evidence, not ideology. The stakes are too high to allow moral biases to dictate decisions that affect millions of lives. Policymakers should adopt harm reduction as a key strategy in tobacco control, recognize the nuanced relationship between alcohol and health, and avoid blanket bans that create more harm than good.

The scientific evidence is unequivocal: Harm reduction saves lives. Moderate alcohol consumption can complement a healthy lifestyle. Flavored vaping products help smokers quit. Public health officials and lawmakers have a duty to act on this evidence. Suppressing it does a grave disservice to the people they are sworn to protect.