As a senior at Brown University back in 1986, Michael Siegel wrote a thesis on the health effects of second-hand cigarette smoke, drafted a bill to ban smoking in workplaces and lobbied for it at the Rhode Island state legislature.
The bill passed—a nifty graduation present for Siegel, who has been an anti-smoking advocate ever since.
“We won, kicked Big Tobacco’s butts…and the legislature was on its way to becoming a national leader in the effort to make smoking history,” he says.
Needless to say, Siegel didn’t get the law passed on his own: He worked with allies like the American Cancer Society and the American Lung Association as a national anti-smoking movement began to gather steam. These were early days; not until 1988 did Congress ban smoking on airline flights, and then only on flights of two hours or less.
Siegel went on to earn an M.D. from Yale and an MPH from Berkeley. A professor of public health at Tufts, he has published nearly 70 tobacco-related papers. He testified against the cigarette makers in the landmark Engle lawsuit that resulted in a $145 billion judgement against Big Tobacco.
His credentials as an anti-smoking warrior are unimpeachable.
Déjà vu all over again
So it tells you something that Siegel has become a sharp and frustrated critic of his erstwhile allies in the tobacco-control movement—the cancer society, the lung association, the American Heart Association and the Campaign for Tobacco-Free Kids.
They distort science, he says.
They lack integrity, he believes.
Worst of all, they have become unwitting allies of the cigarette companies, by trying to prevent people who want to quit smoking from obtaining flavored e-cigarettes.
“These groups are apparently OK with using misinformation and deception to promote their position,” Siegel recently wrote, more in sorrow than in anger, on his blog, The Rest of the Story.
Here’s what provoked Siegel’s latest diatribe against the groups: In March—40 years after he first testified before the Rhode Island legislature—the 62-year-old Siegel returned to Providence, this time trying to persuade the lawmakers to support a bill to permit the sale of flavored e-cigarettes, albeit under limited circumstances. Under the bill, e-cigarettes would be sold solely in vape shops that are open to adults over 21 and that employ age-verification technology beyond checking IDs.
This is classic harm reduction. Vaping is not risk-free but it much safer than smoking combustible cigarettes. E-cigarettes are more effective than nicotine patches or gums at helping smokers to quit. People who smoke deserve access to what, in their hands, becomes a life-saving technology.
Of this, Siegel has no doubt. “The evidence that has continued to mount has been incredible,” he says.
Yet the prohibitionist wing of the anti-smoking movement wants to keep flavored vapes off the market.
Lies and damned lies
A bit of history: Rhode Island banned flavored e-cigarettes in 2019 when then-Gov. Gina Raimondo signed an executive order prompted by the misnamed EVALI scare, which wrongly blamed e-cigarettes for death and disease caused by tainted marijuana vapes. She extended the order in 2020, an action that, predictably, was applauded by Tobacco-Free Kids, as “a tremendous victory for Rhode Island’s kids and exactly what’s needed to reverse the youth e-cigarette epidemic that is addicting a new generation of young people.” The legislature codified the ban in 2024.
Testifying in March, the groups—heart and lung associations, cancer society and Tobacco-Free Kids—urged the legislature to extend the ban. They oppose even the modest changes proposed in this year’s bill, which would leave e-cigarettes at a big competitive disadvantage against lethal, combustible cigarettes that are sold everywhere.
Their letter warns that “flavored tobacco products are reversing decades of progress in reducing tobacco use among youth.”
“This is untrue,” Siegel says.
He’s right, pointing out:
Tobacco use among youth is the lowest it has been in decades and has declined even more rapidly since e-cigarettes have been on the market. In the 2026 National Youth Tobacco Survey, the prevalence of youth smoking was only 1.4%.
The other big lie — sorry, there’s no other word for it — told by the groups is that e-cigarettes are a gateway to smoking. To the contrary, the evidence overwhelmingly tells us that vaping is an off ramp for people who want to quit.
If vaping were part of a tobacco-industry scheme to hook kids, as the groups claim, it’s failing badly. Youth vaping peaked in 2019, when 27.5% of high school students and 10.5% of middle school students reported using e-cigarettes in the past 30 days. (This was the so-called epidemic of vaping, which proved to be more like a fad.) Today, youth vaping and smoking are at record lows. Vaping is not “reversing decades of progress in reducing tobacco use.” It is accelerating it!
So why do the prohibitionists cling so tightly to their story, evidence be damned?
Who knows. Perhaps it’s confirmation bias, the psychological tendency to seek out and absorb information that confirms one’s priors and ignore contradictory findings. Or maybe it’s the malign influence of billionaire donor Michael Bloomberg, who funds the prohibitionists.
“I'm not sure any amount of evidence would make a difference,” Siegel tells me.
How to change your mind
Interestingly, Siegel opposed e-cigarettes when they were introduced to the US in 2007. He suspected that they were a tobacco-industry ploy to keep people smoking. But he dug deeper and realized that Big Tobacco was not behind the e-cigarettes of the early 2010s. He also saw study after study showing the vapes were safer than cigarettes, and read randomized controlled trials showing that they help people quit.
Most importantly, Siegel did what few academics do: He talked to people who use e-cigarettes. Visiting a vaping convention at the Foxwoods Resort Casino in southeastern Connecticut, he heard the same story again and again. He recalls hearing:
The story was, I couldn't quit. I was heavily addicted. I tried everything. I tried the patch. I tried nicotine gum, I tried all kinds of stuff. Nothing worked. And then all of a sudden, I tried e-cigarettes, and it was like a miracle, and I haven't smoked in two years or whatever. I heard that 600 times. It completely changed my view.
This Substack is, in part, about humility, as regular readers know. Siegel admitted his mistake about e-cigs. The groups have not. Of course, it’s never too late.
Let me conclude with some good news. Last week, the FDA, which had until then declined to permit the sale of flavored e-cigarettes, except for menthol or tobacco flavors, authorized a small company called Glas to sell vapes in mango and blueberry flavors. To discourage underage use, Glas vapes are equipped with technology that requires users to verify their age with a government-issued ID and pair the device with a smartphone via Bluetooth. Clunky, perhaps, but it should satisfy those who worry about kids.
But no. The Campaign for Tobacco-Free Kids called the FDA’s action “a big step backwards.” In truth, it’s a small step forward for anyone who cares about saving the lives of adult smokers.