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FDA issues warning letters to 3 tobacco companies over "additive-free" claims

Associated Press
NEW YORK (AP) — The Food and Drug Administration issued warning letters to the makers of Winston, Natural Spirit and Nat Sherman cigarettes over their “additive-free” and “natural” label claims.
The agency issued the warnings to ITG Brands LLC, Santa Fe Natural Tobacco Company Inc. and Sherman’s 1400 Broadway N.Y.C. Ltd. The issue over the claims is that they may lead consumers to believe the products pose a lower risk. That claim has to be scientifically proven.
In a statement, the FDA said it has determined that the products under the warning letter need what is called a “modified risk tobacco product order” before they can be marketed in that way. It has not issued any orders for modified-risk products to the market and this is the first time it is using its authority to take action against “natural” or “additive-free” claims.
The companies have 15 days to respond with a plan or dispute the warnings.
There was no immediate response from the companies.
Imperial Tobacco Group Plc. owns ITG Brands, which also makes Kool cigarettes and USA Gold. Reynolds American Inc. owns Santa Fe Natural Tobacco.
The warning comes several days after a large group of anti-tobacco organizations sent the FDA a letter urging the agency to enforce regulations against Santa Fe Natural Tobacco over marketing claims. That letter, sent on Monday, was signed by 29 groups including the American Heart Association, American Legacy Foundation and Campaign for Tobacco-Free Kids.
The anti-tobacco group’s letter alleged that Natural American Spirit’s advertising in magazines such as Sports Illustrated and Vanity Fair violated the Smoking Prevention and Tobacco Control Act.
“The potential for irreparable damage to public health from the marketing of tobacco products with modified risk claims is well illustrated by the industry’s years of deceptive advertising of ‘light’ and ‘low-tar’ cigarettes,” the letter stated.
http://www.usnews.com/news/business/articles/2015/08/27/fda-issues-warning-letters-to-natural-tobacco-makers

NY Times Opinion: Clashing Views on E-Cigarettes

By

A British government agency has issued a bullish assessment of the value of electronic cigarettes in helping people to quit smoking. It found that e-cigarettes can reduce the health risks of smoking by 95 percent because they deliver nicotine to satisfy an addiction, but far fewer harmful chemicals than regular cigarettes. It also found little evidence that large numbers of consumers who had never smoked were taking up e-cigarettes. That seemed to challenge the notion that e-cigarettes would be a gateway to more dangerous products.

But the study is hardly definitive; experts in America have drawn different conclusions on usage and on the gateway issue.

The British assessment, commissioned by Public Health England and conducted by academic experts, was cautious in its claims. It noted that the best results are obtained when e-cigarettes are used in combination with professional counseling and smoking-cessation medication.

In the United States, according to the Campaign for Tobacco-Free Kids, e-cigarette use by young people has grown more rapidly than in Britain. The user population includes many children who have never smoked and thus may be vulnerable to being hooked by nicotine and later moving to traditional cigarettes.

By coincidence, a day before the British study was issued, a study tracking more than 2,500 students at 10 Los Angeles schools who had never smoked tobacco, published in the Journal of the American Medical Association, came to the opposite conclusion. It said ninth graders who had tried e-cigarettes were far more likely than other students to start smoking “combustible tobacco” (cigarettes, cigars, hookahs) within a year.

Strong regulation is needed in Europe and the United States to protect young people from advertising and promotions designed to lure them into trying e-cigarettes and perhaps getting hooked on them. America’s Food and Drug Administration needs to issue rules it proposed last year and make them even stronger by banning flavors that appeal to youngsters.

http://www.nytimes.com/2015/08/24/opinion/clashing-views-on-e-cigarettes.html?_r=0

Reuters: States target e-cigarette sales to minors amid slow federal action

NEW YORK – Frustrated by the slow pace of federal action, state attorneys general are waging their own campaigns against the sale and advertising of e-cigarettes to minors.

More than a dozen AGs, including those in New York, California, Indiana and Ohio, are using new state and local laws – some of which they helped craft – to put pressure on the industry at all levels, from neighborhood vape shops to big tobacco companies like Altria Group and Reynolds American Inc.

Much of the campaign so far has involved threats to sue violators or appeals to a company’s sense of responsibility, though some lawsuits have been filed, too.

State actions have accelerated in the wake of government data released in April, which showed that teen use of e-cigarettes tripled in 2014 alone, making them more common for youngsters than tobacco.

North Dakota passed its own bill to combat e-cigarettes this legislative session. House Bill 1186, which was signed by Gov. Jack Dalrymple on April 9, outlaws the sale of e-cigarettes to minors in the state. Minors are not allowed to buy, possess or use electronic smoking devices, and those who sell or give e-cigarettes to anyone under 18 is guilty of an infraction.

“The key is to avoid another generation being addicted to nicotine,” Indiana Attorney General Greg Zoeller said in an interview.

State attorneys general played a pivotal role during the 1990s in battling tobacco companies over conventional cigarettes.

The Master Settlement Agreement (MSA), an accord reached in November 1998 between the state attorneys general of 46 states, five U.S. territories, the District of Columbia and the five largest tobacco companies, resulted in significant changes to cigarette marketing and required the tobacco industry to pay the states about $10 billion annually for the indefinite future.

Nearly a year ago, a group of AGs asked the U.S. Food and Drug Administration to take a tougher line on e-cigarettes, the risks and benefits of which are still being studied.

In April of 2014, the agency proposed banning the sale of e-cigarettes to people under the age of 18, but did not recommend prohibiting advertising, flavored products or online sales – all of which help make the devices attractive to youngsters, according to public health advocates.

The FDA proposal has been under review ever since, which has meant that vaping remains legal for youths in states that haven’t passed laws banning it. The agency is likely to finalize its new e-cigarette regulations later this summer, though it could be several years before the federal rules go into effect.

Federal regulations and the 1998 Master Settlement prohibit makers of conventional cigarettes from targeting youth and from advertising on television, billboards and mass transit, but the rules don’t apply to e-cigarettes.

So far, however, 46 states have passed laws banning their sale to minors. Twelve of those states have also passed laws requiring child-proof packaging for e-liquids and e-cigarettes, according to the Campaign for Tobacco-Free Kids.

AGs are using these laws, as well as others not directly tied to e-cigarettes, to force companies to drop ads appealing to teens, switch to child-proof packaging and spend thousands of dollars on more vigilant age verification systems for their websites and online deliveries.

In June, New York Attorney General Eric Schneiderman announced settlements with four companies that were not complying with the state’s rule about child resistant packaging for nicotine liquids.

Reuters spoke with more than 10 e-cigarette and vaping companies – including Reynolds American, which sells Vuse, and Altria Group, which sells MarkTen and Green Smoke – that acknowledged they have been contacted by state law enforcers or by the National Associations of Attorneys General. Reynolds and Altria say their brands were not in violation of local laws.

Some of the AGs have coordinated their efforts. One group is pressuring certain e-cigarette manufacturers and vendors to limit ads that appeal to teens, especially on company websites and places like YouTube.

Ohio Attorney General Mike DeWine, along with colleagues from several other states, sent a letter in April to privately-held manufacturer NJOY, asking it to “immediately instruct YouTube to restrict” access to its advertisements to adults.

NJOY said in an April letter to DeWine that more than 90 percent of the U.S. viewers who have watched its hosted YouTube videos are at least 18, and the company said it would suspend videos if that figure fell to 85 percent or less.

NJOY, which previously settled a case with California over allegations of targeting minors and deceptive marketing, would not comment further.

California has sent letters to more than 150 e-cigarette and vaping companies in recent years “to encourage voluntary compliance with applicable state and federal laws,” including a ban on sales to youth, according to documents reviewed by Reuters.

The state is also pursuing companies that sell fruit-flavored vaping liquids that appeal to teens and those that make false or misleading statements in their advertisements. One letter sent by the state asked a manufacturer to quit claiming that “electronic cigarettes are one of the safest forms of nicotine available” and that “when you exhale, you are exhaling harmless water vapor.”

“Many companies have taken some or all of our recommended steps,” said Kristin Ford, a spokeswoman for Attorney General Kamala Harris.

AGs are paying particular attention to sales on websites, a popular source of vaping materials for teens, who trade information about which ones require little proof of age.

Jan Verleur, CEO and co-founder of electronic cigarette company VMR Products, said his company changed its age verification system in some states after being contacted by a state AG. He estimated the cost per order would increase by about 50 cents, but would not say if VMR would absorb any of that. The company makes about half its sales online.

“This is bad news for the smaller players and good news for the tobacco companies, whose business model relied on mass manufacturing, not personalized products,” said Philip Gorham, an equity analyst at Morningstar who covers consumer products.

http://www.grandforksherald.com/news/business/3783488-states-target-e-cigarette-sales-minors-amid-slow-federal-action

AP: House bill aims for less e-cigarette regulation

WASHINGTON — House Republicans are pushing to ease proposed government regulations for companies that sell e-cigarettes and other new tobacco products, a move that Democrats charge could lead to unsafe products on the market.

A spending bill approved by a House subcommittee Thursday would prevent the Food and Drug Administration from requiring pre-market reviews of e-cigarettes that already are on the market.

As part of a broader rule regulating e-cigarettes for the first time, the agency has proposed that e-cigarette brands marketed since February 2007 undergo those pre-market reviews retroactively once the final rule is approved. Companies would have to submit the applications within two years of the final rule, and then the FDA would ensure that the product is “appropriate for the protection of the public health.” If not, the agency could take it off the market.

In addition to e-cigarettes, the FDA rules and the House legislation would apply to other unregulated tobacco products such as cigars, hookahs, nicotine gels, waterpipe tobacco and dissolvable tobacco products. The FDA already regulates cigarettes, smokeless tobacco and roll-your-own tobacco products.

Republicans said the pre-market review would be a lengthy and expensive process that could drive companies out of business. Alabama Republican Rep. Robert Aderholt, who sponsored the bill, said the provision is just a technical change that would keep the newer products under FDA oversight but allow them to be regulated in the same way as older tobacco products. The legislation would not affect the FDA’s proposal to ban the sales of the products to minors and would still allow certain product standards.

Public health groups said the legislation would hamper the FDA’s ability to prevent tobacco companies from marketing the new products to kids, and Democrats said before the panel’s vote that the change would reduce regulation on the industry at the same time that e-cigarette use is skyrocketing.

The bill “is nothing short of a giveaway to the tobacco industry,” said New York Rep. Nita Lowey, the top Democrat on the Appropriations Committee.

FDA’s proposed rules, expected to be finalized in the coming months, are aimed at eventually taming the fast-growing e-cigarette industry.

E-cigarettes are plastic or metal tubes, usually the size of a cigarette, that heat a liquid nicotine solution instead of burning tobacco. That creates vapor the user inhales.

The nicotine-infused vapor of e-cigarettes looks like smoke but doesn’t contain all of the chemicals, tar or odor of regular cigarettes. Some smokers use e-cigarettes as a way to quit smoking tobacco, or to cut down. However, there’s not much scientific evidence showing e-cigarettes help smokers quit or smoke less, and it’s unclear how safe they are.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the House language could keep products on the market that appear to be targeted to children, like cigars and e-cigarettes in a variety of candy and fruit flavors.

Gregory Conley, president of the American Vaping Association, said the FDA regulations could hurt small businesses.

“This proposal does not remove the FDA’s ability to regulate vapor products,” Conley said. “The FDA will still have the full authority to make science-based regulatory decisions on the manufacturing, marketing and sale of these products.”

The FDA would not comment on the legislation, but FDA spokesman Michael Felberbaum said the rules are important consumer protections.

“When finalized, the rule will represent a significant first step in the agency’s ability to effectively regulate tobacco products and, as we learn more about these products, the agency will have additional opportunities over the long term to make a positive difference in the public health burden of tobacco use in this country,” Felberbaum said.

http://www.cbsnews.com/news/house-bill-aims-for-less-e-cigarette-regulation/

MINNPOST: Proposed Minneapolis tobacco licensing changes will help curb youth smoking

By Jan Malcolm | 06/19/15

Imagine a future when tobacco is no longer the leading cause of preventable death and disease. To make this vision a reality, we must prevent more young people from getting hooked by deadly tobacco products. The Minneapolis City Council is poised to do just that by considering changes to the licensing ordinance to restrict the sale of all flavored tobacco (other than menthol) to adult-only tobacco stores and set minimum price limits for cigars. These measures strike at the heart of the tobacco industry’s strategy to sell their products to kids: flavoring and price.

While Big Tobacco is supposed to be prohibited from marketing to kids, it finds many ways around that ban. Tobacco executives know that unless they get to kids before they reach their 20s they’ve lost a customer. Documents released during the tobacco trials of the 1990s reveal how deliberately tobacco companies target young people. On the witness stand, the chairman of the Liggett & Myers Tobacco Co. said, “If you are really and truly not going to sell to children, you are going to be out of business in 30 years.” A Lorillard executive wrote that he wanted to exchange research data with Life Savers to figure out what tastes kids want. And a marketing plan from U.S. Smokeless Tobacco showed a deliberate strategy to start users on sweet flavors, then “graduate” them to plain tobacco.

Candy and fruit flavors

The appeal of flavoring to young people is the reason the FDA banned cigarettes in flavors other than menthol in 2009. Unfortunately, products such as little cigars, cigarillos, chew, e-cigarettes and others are still widely available in candy and fruit flavors such as bubble gum, grape and gummy bear – flavors that clearly appeal to youth. These flavored products are for sale in more than 250 stores throughout Minneapolis alone, and they are easy for children to purchase. One-third of Minneapolis boys under 18 report buying tobacco from a convenience store or gas station.

Research shows that young people mistakenly believe that flavored tobacco products are less dangerous than other tobacco products. In fact, they are just as dangerous, with the same health risks of cancer, heart disease and chronic obstructive pulmonary disease. Candy and fruit flavored tobacco products just mask the harsh taste and feel of tobacco.

Nearly 20 percent of Minnesota high school students have tried a water pipe or hookah, and almost all shisha (hookah tobacco) is flavored. More than 25 percent of Minnesota high school students have used an e-cigarette, and most e-cigarette liquid is flavored. More than 35 percent of Minnesota high school students report that they have tried flavored cigars, cigarillos or little cigars at some point in their lives. In fact, kids are now twice as likely as older people to be cigar smokers. Almost 20 percent of Minneapolis 12th-graders say they smoke cigar products like cigarillos regularly.

Young people known to be price sensitive

Nearly 75 percent of Minneapolis tobacco retailers currently sell cigars and cigarillos, many for less than a dollar. The proposed changes to our city’s tobacco licensing ordinance would set a minimum price of $2.60 for each cigar. Research shows that young people are very sensitive to price increases and are more likely to just quit using a product they can’t afford than adults are.

Flavored tobacco restrictions and price minimum requirements have been successfully implemented in other communities around the country – and right here in Minnesota. No one wants our young people to face a lifetime of addiction and other health problems. We know that policies that restrict access to flavored tobacco and raise tobacco prices keep kids from starting to smoke and help them to quit.

Support the proposed changes to the Minneapolis tobacco licensing ordinance. Stand up for our kids against Big Tobacco.

Jan Malcolm is the vice president of public affairs for Allina Health. She served as Minnesota state health commissioner from 1999 to 2003. Malcolm lives in Minneapolis.

https://www.minnpost.com/community-voices/2015/06/proposed-minneapolis-tobacco-licensing-changes-will-help-curb-youth-smoking

Reuters: US tobacco companies drop lawsuit vs FDA over labeling

The three largest U.S. tobacco companies on Tuesday dropped their lawsuit accusing the U.S. Food and Drug Administration of exceeding its authority by closely monitoring the content of their product labels after the agency said it would reconsider its rules.

Altria Group Inc, Reynolds American Inc and Lorillard Inc dismissed their case after the FDA on May 29 said it would review whether to mandate advance approval for label alterations such as changes to logos and background colors, or the use of descriptors such as “premium tobacco.”

In their April lawsuit filed in federal court in Washington, D.C., the companies said the 2009 Tobacco Control Act limited FDA authority to pre-approve label changes to two “narrow” circumstances: products claiming to lower tobacco-related risks, or when prior approval is required by regulation.

By expanding its oversight to cover how labels look, the FDA violated the tobacco companies’ commercial speech rights under the First Amendment, the complaint said.

The plaintiffs included Altria’s Philip Morris USA, Reynolds American’s RJ Reynolds and Lorillard Tobacco, whose respective cigarette brands include Marlboro, Camel and Newport, and some of their smokeless tobacco units.

In its May 29 statement, the FDA said it would not act against tobacco companies that do not seek pre-approval for label changes that create “distinct” products otherwise identical to those being sold, or where the only change is the quantity in each package.

The FDA said the interim policy would remain in place while the agency decides whether to adopt new label approval procedures.

Altria spokesman Brian May said there was no need to pursue the lawsuit in light of the FDA’s announcement. Reynolds American spokesman David Howard declined to comment. Lorillard did not respond to a request for comment.

FDA spokesman Michael Felberbaum declined to comment.

On May 26, Reynolds American won U.S. antitrust approval to buy Lorillard, combining the second- and third-largest U.S. cigarette companies.

The case is Philip Morris USA Inc et al v. FDA et al, U.S. District Court, District of Columbia, No. 15-00544.

http://www.foxnews.com/health/2015/06/03/us-tobacco-companies-drop-lawsuit-vs-fda-over-labeling/

Reuters: California Senate votes to raise smoking age to 21 from 18

LOS ANGELES | BY ALEX DOBUZINSKIS
The California Senate voted on Tuesday to raise the legal smoking age in the most populous U.S. state to 21 from 18, in a move that could make California one of the states with the highest smoking age.
The measure was approved by the Senate 26-8 and must now be approved by the state Assembly.
“We will not sit on the sidelines while big tobacco markets to our kids and gets another generation of young people hooked on a product that will ultimately kill them,” Senator Ed Hernandez, a Democrat and the bill’s author, said.
“Tobacco companies know that people are more likely to become addicted to smoking if they start at a young age,” Hernandez added in a statement.
The Institute of Medicine, the health arm of the National Academy of Sciences, has said that increasing the smoking age to 21 would result in more than 200,000 fewer premature deaths nationally for those born between 2000 and 2019.
The Cigar Association of America opposed the bill, contending that 18-year-olds can serve in the military, vote and sign contracts and should thus enjoy the right to smoke, according to the Los Angeles Times.
David Sutton, a spokesman for Altria Group Inc, the parent of Philip Morris USA, said in an emailed statement that Altria believed states should defer to the federal government and “allow FDA and Congress the opportunity to think through this issue further before enacting different minimum age laws.”
Representatives for R.J. Reynolds Tobacco Company, a unit of Reynolds American Inc, did not return calls seeking comment.
Hawaii lawmakers approved a measure in April to raise the smoking age to 21, and that is awaiting the state governor’s signature. Democratic Governor David Ige has not indicated whether he will sign the measure, and has until June 29 to decide whether to veto it, a spokeswoman for his office said.
Since 2013, New York City has required tobacco purchasers to be 21 or older, according to the National Conference of State Legislatures. No state has a smoking age that high, but Alabama, Alaska, Utah and New Jersey set it at 19.
(Reporting by Alex Dobuzinskis and Cynthia Johnston; Editing by Sandra Maler)
http://www.reuters.com/article/2015/06/02/us-usa-smoking-california-idUSKBN0OI2EI20150602

CBS MoneyWatch: As e-cigarette sales soar, critics eye regulations

By JONATHAN BERR | MONEYWATCH
The Food and Drug Administration expects to publish its much-anticipated regulations for e-cigarettes in June, as the products are surging in popularity. In fact, sales are expanding so rapidly that some experts predict e-cigs will overtake sales of conventional smokes within the next decade.
“From our perspective, the rules are long overdue,” said Erika Sward, assistant vice president of national advocacy at the American Lung Association, who noted the regulations have been in the works for about a year.
The FDA already regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco. Under the 2009 Family Smoking and Tobacco Control Act, the FDA can “deem” additional tobacco products to be subject to the Federal Food, Drug, and Cosmetic Act. Among other things, firms would be required to register with the FDA and submit product and ingredient listings, and include health warnings and take steps to prevent sales to underage consumers.
“To date, FDA has not been able to fully assess the public health impacts of unregulated tobacco products,” the FDA said in a statement sent to CBS MoneyWatch. “For example, some testing of e-cigarette cartridges has revealed significant variability in nicotine content and the presence of chemical constituents that raise concerns of toxicity.”
Altria Group (MO) and Reynolds American (RAI), two of the biggest tobacco companies, are welcoming the FDA’s efforts, arguing that the patchwork of existing state regulations fails to protect consumers against defective products, some of which have even exploded. The companies are lobbying the FDA to treat e-cigarettes differently than conventional smokes.
Some proponents of e-cigaretttes have claimed that they can be an effective smoking cessation tool. A study published last year found that people who wanted to quit smoking were about 60 percent more likely to be successful if they used e-cigarettes as opposed to other products such as nicotine patches or gum.
Industry critics, including the American Lung Association, counter that the evidence to back up these claims is inconclusive. A study released last month by the Johns Hopkins Bloomberg School of Public Health found that e-cigarettes generate some of the same dangerous chemicals found in traditional smokes.
“There is absolutely no federal oversight of e-cigarettes in terms of what is in them, how they are being marketed,” said Sward of the American Lung Association, adding that e-cigarette makers are “following the Big Tobacco playbook” by offering flavored e-cigarettes that would appeal to underage smokers. “Really, what we are seeing are the same tactics that we saw 30, 40 years ago.”
Altria, which is based in Richmond, Virginia, has put a 116-word warning on packs of its MarkTen e-cigarettes even though it wasn’t legally obligated to do so. AsReuters noted, it said nicotine is “addictive and habit-forming” and that MarkTen isn’t intended for women who are pregnant or breast-feeding or people being treated for depression or asthma. Spokesman Steve Callahan said the wording on the company’s label was based the “available science.”
In a statement to CBS MoneyWatch, Reynolds argued that the FDA needed to regulate e-cigarettes fairly.
“We believe if (the) FDA is going to regulate vapor products, then it should regulate all vapor products — including open systems and the vape shops in which the liquid nicotine used in open systems is mixed or compounded — to create a level playing field where all manufacturers are subject to equal treatment, including FDA inspection/registration/regulation, manufacturing standards and product clearance requirements,” writes Richard J. Smith, a spokesman, in an email.
Whenever the regulations are issued, it will open another front in the decades-long battle that pits people trying to protect the public health against the rights of an industry selling an otherwise lawful product.

Surgeon general says e-cigarette safety needs "clarity"

TIM IRELAND/PA WIRE, CBS/AP

The U.S. surgeon general says officials are “in desperate need of clarity” on electronic cigarettes to help guide public health policies.
Dr. Vivek Murthy, the country’s senior public health official, addressed the battery-powered devices that heat liquid nicotine during a stop Tuesday in Richmond. The U.S. Senate confirmed the 37-year-old physician and Harvard Medical School instructor’s nomination in December. The surgeon general’s office has previously been instrumental in guiding tobacco control.
The newly-appointed Murthy says the technology should be embraced if evidence shows e-cigarettes are able to help those who otherwise have trouble quitting smoking. However, research has found that e-cigarettes won’t necessarily help smokers quit. Last year, researchers surveyed nearly 1,000 smokers and found that while 13.5 percent of the total study pool quit smoking, only nine of the 88 e-cigarette smokers quit.
As is the case with all health officials, Murthy also expressed concern about the safety of the product. E-cigarette companies have used social media to market their product and appeal to young people, who are picking up vaping in surprising numbers. Companies claim they safer to use than standard tobacco. However, a study published last week found e-cigarette smokers are five to 15 times more likely to get formaldehyde-related cancers.
Last year, the FDA drafted recommendations to regulate marketing and sales of electronic cigarettes, though the laws have yet to be passed.
http://www.cbsnews.com/news/surgeon-general-dr-vivek-murthy-says-e-cigarette-safety-needs-clarity/

What to Know About the Science of E-Cigarettes

 
Eliza Gray & Alexandra Sifferlin | TIME Magazine

A guide to understanding conflicting and ongoing research

Two Columbia University professors warned in a new study Thursday that the health fears over electronic cigarettes are hindering research. The very same day, another new study showed that smoking e-cigs, or “vaping,” can produce cancer-causing formaldehyde.
Clearly there’s some disagreement among scientists about the risks and benefits of a product that’s growing in popularity. Here’s what you need to know about the latest science.
What’s with the latest disagreement?
Columbia public health professors Amy Fairchild and Ronald Bayer argue in Science magazine that the staunchest opponents of electronic cigarettes are so concerned about the potential downsides that they advocate for an anti-e-cigarette regulatory and research approach that may be bad for public health. This approach of “deep precaution,” they argue, “has served as a kind of trump argument, hostile to the notion of trade-offs, seeing in them perilous compromise. Such a posture does not serve either science or policy well.”
It “may be years before the disagreements over the evidence” about the effects of electronic cigarettes can be resolved, Fairchild and Bayer wrote. On the one hand, electronic cigarettes may serve as gateway drugs for young people to start smoking cigarettes, and “dual” use of electronic cigarettes with tobacco cigarettes may stop some smokers from quitting. Electronic cigarettes may also carry unknown health consequences of their own. On the other hand, they may provide harm reduction for people who have been unable to quit any other way.
Given these two competing possibilities, the authors argued that the best formula for public health is to acknowledge the possibility for costs and benefits and to push for a regulatory scheme that is flexible enough to account for both outcomes. It is better to make public policy and execute scientific research under the assumption that e-cigarettes could bring good as well as bad.
But also on Thursday, the New England Journal of Medicine published a new study reporting that chemicals inside e-cigarettes—like propylene glycol and glycerol—can produce a type of the cancer-causing chemical called formaldehyde when heated during the vaping process. The researchers report that when testing samples of the aerosol from vaped e-cigs, they found that the e-cigs can contain formaldehyde-releasing agents slightly different from regular formaldehyde, and that the levels are especially high when a user vapes at high voltages. Scientists don’t yet know if formaldehyde-releasing agents carry the same risk as pure formaldehyde, but the researchers said in their report that if they assume the substances do carry the same risks, then long-term vaping could be associated with a significantly higher risk for cancer compared to long-term smoking. The researchers said formaldehyde-releasing agents may actually burrow into the respiratory tract more efficiently than regular formaldehyde, though the observation wasn’t confirmed.
Are there other reasons experts are concerned?

There’s also debate over the safety of the liquid nicotine inside e-cigarettes. In April 2014, the Centers for Disease Control and Prevention (CDC) released a report showing what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. Calls went from one a month in September 2010 to 215 calls a month in February 2014, and more than half of the calls involved children age five and under. Forty-two percent involved people age 20 and older. Symptoms of liquid nicotine ingestion are known to be vomiting, nausea and eye irritation.

Researchers are also wary of the long term effects of inhaling propylene glycol, one of the main ingredients in e-cigarettes. The jury is still out, but some physicians are concerned. “As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Thomas Glynn, the director of science and trends at the American Cancer Society, told ABC News. “No one knows the answer to that.”

Are they really attracting young people?

Several recent—but fairly small—studies say yes. A December 2o14 study in the journal Pediatrics surveyed 1,941 Hawaii high school students and found that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, and only 3% smoked conventional cigarettes. The findings suggested that kids who smoked e-cigarettes scored lower on outside risk factors to pick up a conventional smoking habit. “The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors wrote. Numbers released in 2013 from the National Youth Tobacco Survey showedthat the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

What’s the argument in favor of e-cigarettes?

Some smokers use e-cigarettes to help them curb their traditional cigarette habit, or even quit. An August 2014 study that surveyed over 20,000 Americans showed that among adults who used a product to help them quit smoking, 57% chose e-cigarettes. That’s compared to the 39% who used prescription drugs like Chantix and the 39% who used other over-the-counter methods like patches or nicotine gum. Another study from July 2014, which reviewed 80 studies on e-cigarettes’ safety and their effects on users, revealed that not only can e-cigarettes help smokers quit, but they are less harmful to smokers and bystanders’ health compared to regular cigarettes.

What’s the FDA doing about it?

The U.S. Food and Drug Administration (FDA) only regulates e-cigarettes that are marketed for therapeutic purposes, though the agency has proposed a rule that would give it more regulatory power over e-cigarettes but that has not yet been implemented. The FDA has suggested a ban on sale of e-cigarettes to minors, and admits that there is a lot consumers don’t know about the product like whether they attract kids and teens or just how much nicotine is inhaled when a person vapes.

http://time.com/3678402/electronic-cigarettes-ecigs-health-science-research/