“Those who ignore history are doomed to repeat it.” That quotation is often attributed to the British leader Winston Churchill, but scholars are generally in agreement that he adapted it from a similar saying by Spanish author George Santayana: “Those who cannot remember the past are condemned to repeat it.”  Whatever the origins of the statement, and whatever phrasing one chooses, the wisdom is timeless. What could this quotation tell us about the issue of Nevada vaping injuries?
The problems of today often have parallels – sometimes stunningly similar ones – to other challenges in past times. The way we dealt with those challenges often offer us lessons no matter how things ultimately played out. When we can identify past successes, we can sometimes uncover roadmaps to today’s solutions. And when we look back on crises mishandled, challenges not adequately met, we can sift through the wreckage to find clues to how we might do things better this time around.
The Crisis of Yesteryear: Big Tobacco
By the early 1950s, researchers in the United States and the United Kingdom were in agreement that smoking tobacco was linked to lung cancer and heart disease.  Although the public was subjected to increased warnings about these hazards, consumer behavior and public policy were slow to react. Smoking continued to be depicted favorably in popular culture and permitted in restaurants, on airplanes, and generally in public life. It took another 40 years – until the mid-1990s – before a wave of litigation began to transform the role tobacco played in American life.
In the 1990s the attorneys general of each U.S. state pursued litigation against the major tobacco producers, seeking compensation of public coffers for increased healthcare expenditures and an end to what were perceived as the worst marketing practices.  In 1998 most of these state attorneys general – 46 of them in total, including Nevada’s – reached a master settlement with the major producers that bound the producers to pay out more than $200 billion over the next 25 years.
Nevada lawmakers decided to invest the state’s share of the settlement money in a combination of public health and education. Three-fifths of the money was set aside for healthcare programs, and the remaining 40 percent of the funds created the state’s Millennium Scholarship program.  While the program has gone through changes over the years since its creation, the Millennium Scholarship is available to Nevada high school graduates who achieve a given grade-point average and testing requirements and then enroll at a Nevada college or university. A graduate can receive up to $10,000 in total funding, provided through a fixed level of assistance per credit hour that is indexed to the type of school.  For example, a student at Western Nevada College – a community college in Carson City  – or at Great Basin College in Elko  can receive $40 in Millennium Scholarship funds per credit hour, while a student enrolled at the University of Nevada, Las Vegas can consume $80 of scholarship per credit hour. (Nevada State College, a Henderson institution which is in a college category of its own , affords students $60 per credit hour.)
While these investments provide crucial support for Nevada’s young people, it is easy to forget that this money is compensation for decades of harm. At least in theory, the state would not choose to trade morbidity for money if it had the choice again. And recent events suggest that state officials are trying to prevent another public health crisis.
The Surge of Vaping Injuries
Across the nation and mostly occurring this calendar year, there have been more than 2,500 reported instances of vaping injuries that took users of vape devices to hospitals. More than 50 of these vaping injuries have resulted in deaths, but Nevada has yet to experience its first report of a fatal vaping injury. Nevada health officials are aware of six Las Vegas vaping injuries and a potential fifth in the Reno-Sparks area, but despite this relatively small number of incidents officials have been aggressive in their responses. 
Nevada Attorney General Aaron Ford, who previously represented a Las Vegas district in the state legislature, has allocated $1.7 million to collecting data on these vaping injuries. Meanwhile top health officials are warning consumers to steer clear of vaping periods entirely. This is a less extreme approach than the handful of cities and states that have acted to try and ban vape devices in a blanket fashion. 
This is an emerging issue with many unknowns. Researchers have a top suspect behind the problem: an additive known as vitamin E acetate oil that is common in black-market vape products designed to allow users to inhale THC products.  (THC is the psychoactive ingredient in marijuana, which has been decriminalized for recreational use in Nevada and several other states.) While the victims of the nation’s 2,500 vaping injuries report using a variety of kinds of vaping products, those who suspect vitamin E acetate oil is to blame theorize that the affected users who report exclusively using nicotine vaping products are not being forthright.  This leads to a question of whether vaping deaths are as a result of some product defect or mismanufactured product.
As this crisis unfolds, it seems clear that policymakers are more likely to overreact than to be caught flat-footed. But one must hold out hope that the public health consequences are contained and that those responsible for Nevada vaping injuries are held accountable.