November 25, 2019

Calls for e-cigarette regulations intensify as vaping illness cases reach nearly 2,300

Daily Briefing

    President Trump on Friday met with tobacco and vaping industry stakeholders to discuss ways to combat the growing number of vaping-linked illness cases, as calls for an e-cigarette flavor ban mount from public health experts and medical groups, Politico reports.

    Cases of a vaping-linked illness surpass 2.2 K

    CDC data updated Thursday shows the number of reported cases of a lung illness officials believe is linked to e-cigarette use and vaping, dubbed EVALI, reached 2,290 as of Nov. 20, up 118 cases from the previous week's update.

    There have been 47 confirmed deaths related to the vaping-illness, according to CDC. Cases of the illness have been reported in 49 states, Washington, D.C., and two U.S. territories, with deaths confirmed in 25 states and the District of Columbia. Alaska is the only state with no reported cases of the illness.

    CDC officials in a report released Tuesday said 95% of vaping-linked illness cases have required patients to be hospitalized. Doctors report that patients' recoveries have varied, with some patients appearing to make full recoveries and others continuing to have trouble breathing. CDC last month reported that some patients have relapsed and had to be hospitalized a second time, with readmissions occurring from as few as five days to as many as 55 days after initial discharge.

    CDC said it is unclear why those patients relapsed. However, Anne Schuchat—CDC's principal deputy director, who is overseeing the agency's investigation into the matter—said it is possible that the lung illness made the patients more susceptible to other conditions. In addition, she said steroids used to treat the lung illness could "set [patients] up for increased infection risk."

    CDC on Tuesday also updated its guidance for providers on how to diagnose and treat patients experiencing lung injuries associated with e-cigarettes, vaping, or other products. CDC in the guidance noted that EVALI shares similar symptoms with influenza, and recommended that providers ask patients with respiratory conditions whether they recently have vaped or used e-cigarettes.

    CDC also recommended that providers consider treating EVALI patients with antimicrobials and antivirals, and cautioned that treating patients with corticosteroids in an outpatient setting could be risky, as corticosteroids could worsen respiratory infections. CDC said providers should evaluate all EVALI patients to determine whether they should be admitted to a hospital.

    Calls for flavored e-cigarette ban intensify

    Amid reports of rising cases of the vaping-linked illness more public health experts and groups have called on the Trump administration to regulate flavored e-cigarettes.

    In September, the Trump administration announced that FDA intended to finalize a compliance policy that would clear the market of unauthorized, non-tobacco-flavored e-cigarettes, including mint and menthol flavors. However, FDA has yet to unveil a final plan to do so.

    Former FDA Commissioner Scott Gottlieb on Sunday in a tweet wrote, "The longer that the youth use continues—and grows in scope and severity as it is—the more draconian the regulatory action that'll be required to reverse these trends when those decisive steps are eventually implemented." He added, "Delays on regulatory steps to combat youth vaping may be a Pyrrhic victory for outside vaping groups fighting reasonable action to stop kid use of the products; putting the entire opportunity at risk and making bipartisan legislation to impose restrictions increasingly inevitable."

    In addition, the CEOs and presidents of six major public health groups—including the American Heart Association, the American Academy of Pediatrics, and the Campaign for Tobacco-Free Kids (CTFK)—in an op-ed published Monday in STAT News urged Trump to move forward with the policy. "We are deeply troubled by signals that the administration will fall well short of taking the bold action necessary to end this nationwide epidemic," the groups wrote. They continued, "There is no public health justification to allow any flavor to be exempt from a policy to remove flavored e-cigarettes from the market. In fact, evidence is clear that [youth] will turn to any e-cigarette flavor that is left."

    The American Medical Association (AMA) on Tuesday went a step further, calling on federal regulators and legislators to ban the distribution and sale of all e-cigarette and vaping products without FDA approval as a smoking cessation tool. AMA President Patrice Harris said, "It's simple—we must keep nicotine products out of the hands of young people."

    Admin resumes talks on e-cigarette policy

    On Friday, Trump hosted a meeting with advocacy groups, industry groups, nonprofits, medical associations, and state officials to discuss e-cigarette regulations in which he appeared to question the wisdom of a flavored e-cigarette ban, Politico reports.

    According to Politico, Trump during the meeting said his administration would raise the legal age to purchase tobacco from 18 to 21—a proposal backed by anti-tobacco, tobacco, and vaping industry groups. However, Trump did not indicate whether he would move forward with the plan announced in September to ban all unauthorized flavored e-cigarettes.

    Instead, Trump during the meeting asked stakeholders whether a ban on flavored e-cigarettes would result in young people purchasing less safe, counterfeit products from street vendors. Trump said, "You watch prohibition. If you don't give it to them, it is going to come here illegally. ... They could be selling something on a street corner that could be horrible. ... They are going to have a flavor that is poison."

    Trump also asked if it should be left to states to regulate the sales of e-cigarettes—an action several states have begun to take.

    Industry groups during the meeting said flavored e-cigarettes are not the issue at the center of the increase in youth vaping, arguing instead that more restrictions need to be enforced on the marketing and sales of e-cigarettes, including age verification. They also said banning flavored e-cigarettes would close small businesses and cause people to lose their jobs.

    For example, Ryan Nivakoff, NJOY CEO, said, "It's not necessarily a flavor problem," noting NJOY's youth use rate is 1.2%, while Juul's youth use rate is 60%. He added, "The youth problem is a huge problem, and flavors definitively contribute to it. But … if you ban flavors, which there is some public health redeeming virtue to doing so, 100,000 Americans are going to lose their jobs."

    Similarly, Tony Abboud, executive director of the Vapor Technology Association, said an analysis by John Dunham & Associates found a ban on flavored e-cigarettes would result in more than 150,000 job losses and more than 13,000 small business closures.

    However, Sen. Mitt Romney (R-Utah) disputed the validity of those claims, saying, "Those numbers aren't right. I'm sorry, that's just not right." He added some business might close, but "I put the kids first."

    Trump meanwhile asked the industry groups why Juul's decision to eliminate the sales of flavored e-cigarettes has not led the company to go out of business. One industry representative said "investment capital" allows a larger company like Juul to "wait it out" and file an application with the FDA to market and sell e-cigarettes again.

    Matt Myers, president of Campaign for Tobacco-Free Kids, said public health groups are not asking the administration to permanently ban flavored e-cigarettes. Instead, the groups are calling on the administration to require companies to study their products, share their data with FDA, and allow FDA to make a science-based decision on whether the products should be on the market, Inside Health Policy reports. Myers said, "That's what we're really talking about, and what do you do in the interim? If we do nothing in the interim, we're going to wake up in six months and another million-and-a-half kids are going to be addicted and they're not going to be able to quit."

    Myers added that Trump's concerns about the effect of a ban didn't necessarily suggest he was changing his mind about enacting such a plan, Politico reports. "It would be a mistake to prejudge an outcome based upon the questions," Myers said to Politico, noting that the meeting had "a very free-flowing conversation" (Maddipatla/Sibi Joseph, Reuters, 11/21; Bean, Becker's Clinical Leadership & Infection Control, 11/20; Steenhuysen, Reuters, 10/19; O'Donnell/Jackson, USA Today, 11/20; Wang, Inside Health Policy, 11/19 [subscription required]; McGinley, Washington Post, 11/19; Hellmann, The Hill, 11/20; Owermohle, Politico, 11/19; Brown et al., "First Opinion," STAT News, 11/18; Wang, Inside Health Policy, 11/22 [subscription required]; Owermohle, Politico, 11/22; McGinley/Wan, Washington Post, 11/22; Maloney/Leary, Wall Street Journal, 11/22).

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