And now for the other side of the coin … Harsh Lung Association report says FDA efforts to stop teen vaping a complete “failure”

In what NBC News is calling a “scathing” report, the American Lung Association rips the Food and Drug Administration for failing to take any action to stem the epidemic of teen vaping.

One of the proposals from the Lung Association is to raise the legal age of buying e-cig products to 21 and getting rid of fruity e-cig flavourings.

From the NBC News story:

“This year’s report finds a disturbing failure of the federal government and states to take action to prevent and reduce tobacco use in 2018, placing the health and lives of Americans at risk, including our youth,” the American Lung Association’s national president and CEO, Harold P. Wimmer, said in a statement.

Health

“The FDA’s failure to act has emboldened the tobacco industry, which has become increasingly aggressive in seeking to delay or oppose proven policies,” Wimmer said.

States need to raise their minimum age to purchase tobacco products to 21 and remove flavored e-cigarettes from the market, Erika Sward, national assistant vice president for advocacy for the American Lung Association, told NBC News.

“As a result of the failure by the federal and state governments to act, the tobacco industry is on a resurgence,” and therefore maneuvering “to addict our kids,” Sward said.

This final point is a really important to remember about the tobacco industry’s ties to e-cigs. The industry absolutely control the e-cig market, especially since Altria (formerly known as Philip Morris, makers of Marlboros) bought a stake in Juuls, the biggest e-cig brand on the market. Big Tobacco already owned Blu E-cigs, MarkTen and Vuse.

The industry sold people the disease — cigarettes. And is now selling people the cure — e-cigs. Pretty ingenious, huh?

So, cigarettes have become socially unacceptable, how is the tobacco industry recovering its costs? A wildly successful e-cig market and a 78 percent increase in teen vaping.

The report also grades states on their efforts toward tobacco control. The Lung Association doesn’t mince words. Most every state gets a failing grade. A handful get As, California gets a B.

The FDA is talking tough about e-cigs lately, but so far hasn’t taken any firm action. One proposal from the agency is to require that e-cigs be sold in areas cordoned off to teens, but no one has any idea how that could work. A proposal to restrict all sales to tobacco shops was dropped as quickly as it was raised.

It may be too little too late for the FDA to stem the epidemic of teen vaping. This epidemic grew and grew for four or five years before the FDA even acknowledged it.

Study: E-cigs more effective than patches, gum for quitting cigarettes

Three studies came out in one day about e-cigarettes, two very, very negative and the third one with positive news.

It sort of sums up the mixed bag that are e-cigs, and sums up the quandary about them.

First, the good news. A recent study by Queen Mary University in London, published by the New England Journal of Medicine shows that e-cigarettes are far more effective than nicotine gum or patches in getting people to quit cigarettes.

The study involved 886 smokers, half were given the option to quit using e-cigs and the other half were given the option to quit through patches, gum or other nicotine replacement therapies.

After one full year, 18 percent of the e-cig group was able to quit smoking, while just 9.9 percent of the patches and gum group quit.

Those percentages may not sound good, but it’s widely known that nicotine replacement treatments have a pretty high failure rate. Most smokers, it takes four or five tries or more to actually quit.

From a CNBC article:

Doctors have been wary of recommending people use e-cigarettes as a way to wean themselves off conventional cigarettes, citing both the lack of evidence showing they work and lack of data on the long-term health effects of using the products. The new study may quell some of those concerns. However, the study is also likely to receive some pushback because it was conducted in the United Kingdom, which has embraced and even encouraged e-cigarettes as an alternative for adult smokers.

Here’s another flaw with the study, I think. The point of patches and gum is to eventually wean people off of addictive nicotine. However, that’s not how very many people really use e-cigs. They remain addicted to the nicotine, and in my opinion, as long as they remain addicted, they remain at risk at falling back onto cigarettes.

From the same article:

“While e-cigarettes are ‘safer’ than traditional cigarettes, they are not without risks,” Boston University professors Belinda Borrelli and George O’Connor said in a statement.

They also pointed to the finding that at the one-year mark, 80 percent of people in the e-cigarette group were still using the devices. So while people stopped smoking cigarettes, they were still using e-cigarettes. The study’s authors also noted this finding, saying it “can be seen as problematic if e-cigarette use for a year signals ongoing long-term use, which may pose as-yet unknown health risks.”

Huge numbers of teens using the products — particularly one brand, Juul — have soured perceptions about e-cigarettes in the U.S. Even Food and Drug Administration Commissioner Scott Gottlieb, who has championed the devices as a way to help adult smokers, says the industry is at a tipping point.

That final paragraph about Juuls explains the condundrum about e-cigarettes. While they appear to have a very valid and genuine value in helping some people quit smoking, the down side is their use among teens has exploded in the past five years … and these are kids who have never smoked a cigarette in their lives. They’re not using e-cigs to get off cigarettes, they’re using them to get addicted to nicotine to begin with.

The FDA has started talking tough about e-cigs the past couple of months, even going so far as saying it might just outright ban e-cigs. If 18 percent of the people who try e-cigs to get off cigarettes are successful, I think that’d be a terrible step in the wrong direction.

But, they gotta stop the teen epidemic of vaping. If that means banning fruity e-cig flavours, so be it. I personally would like to see e-cig marketing more strictly regulated. I liked the idea the FDA came up with a few weeks ago (and quickly dropped, unfortunately), of only allowing e-cig sales in tobacco shops, where you have to show an ID just to walk into the door. The FDA came up with some odd idea of only allowing e-cig sales in adult areas … but still allowing them to be sold in convenience stores. How could that even work?

Anyway, an interesting study showing the other side of the e-cig debate and showing that it’s not a black and white issue.

FDA chief threatens to completely remove e-cigs from the market

The war between FDA chief Scott Gottlieb and the e-cig industry continues to escalate with Gottlieb last week threatening to just say “Fuck it” and completely take e-cigs off the market.

To wit, the Food and Drug Administration has come out harshly against the e-cig industry beginning about six months ago because of the skyrocketing increase in teen vaping rates.

So, the FDA came out with a series of rules regarding e-cigs, including some restrictions on fruity flavours and the requirement that e-cig products only be sold in areas open to adults. The FDA didn’t get into marketing of e-cig products.

These rules weren’t as strong as what *I* had hoped for, at the very least, I liked an idea that was floated to restrict e-cig sales strictly to tobacco shops, but that got dropped, likely because of pressure from the industry.

Anyway, Gottlieb said he has met with industry representatives and he remains unimpressed with their response so far.

This is a quote from a Gottlieb tweet:

I still believe e-cigarettes present an opportunity for adult smokers to transition off cigarettes and onto nicotine delivery products that may not have the same level of risks. However, if the youth use continues to rise, the entire category will face an existential threat

Also, from an NBC News article:


“I’ll tell you this. If the youth use continues to rise, and we see significant increases in use in 2019, on top of the dramatic rise in 2018, the entire category will face an existential threat,” Gottlieb told a meeting.
“It will be game over for these products until they can successfully traverse the regulatory process.”

Gottlieb said he has met repeatedly with the vape industry. “I find myself debating with tobacco makers and retailers the merits of selling fruity flavors in ways that remain easily accessible to kids,” he said.

Last November, Gottlieb said he was starting the process to limit sales of flavored e-cigarettes, as well as to ban menthol in combustible cigarettes.

“I have questions about whether they are living up to the very modest promises that they made,” he said. “It matters if the e-cig makers can’t honor even modest, voluntary commitments that they made to the FDA.”

I’m curious if the industry is taking these threats seriously? Juul very quickly shut down its social media presence, but it might be too little, too late to slow down teen vaping use … or to satisfy the FDA.

Gottlieb said the dramatic rise in e-cigs is sabotaging the success public health advocates have had in cutting the teen smoking rate.

From a Yahoo article:

“This progress is being undercut — even eclipsed — by the recent, dramatic rise in youth vaping. A few years ago, it would have been incredible to me that we’d be here, discussing the potential for drug therapy to help addicted youth vapers quit nicotine,” he said Friday.

Gottlieb cited statistics about the large use of e-cigarettes by young people, saying that between 2017 and 2018 there was a 78 percent increase in e-cigarette use in high school students, and a 48 percent increase among middle schoolers. That means the total number of middle- and high-school students using e-cigarettes rose to 3.6 million — 1.5 million more than used the product the previous year. He added that more than a quarter (27.7 percent) of high-school-age e-cigarette users use the product regularly, and more than two-thirds (67.8 percent) are using flavored e-cigarettes. 

“Youth use of e-cigarettes has become an epidemic,” Gottlieb said, adding, “It could be ‘game over’ for some [of] these products until they can successfully traverse the regulatory process. I think the stakes are that high.” Gottlieb also noted that e-cigarettes can be a helpful tool for adults trying to quit smoking traditional cigarettes, and said he hopes to avoid removing e-cigarettes from the market because of the good they can serve in that regard. 

Stay tuned. Gonna be a rocky year on this issue likely.