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Friday, April 25, 2014

E-cigarettes: What the FDA’s Rules Don’t Cover

By Arefa Cassoobhoy, MD, MPH

e cigarettes

As a doctor and as a mother, the FDA’s announcement to regulate e-cigarettes should be great news to me. The best news is that it bans sales of e-cigarettes to anyone under the age of 18. But I wish the proposal included the same bans on advertising and marketing that are in place for traditional cigarettes.

Nicotine and Tobacco

First, it’s incredible to me that e-cigarettes weren’t automatically considered a tobacco product.

Nicotine is the key ingredient in an e-cigarette. Nicotine is the key addictive chemical in tobacco.  An e-cigarette is a tobacco product. Isn’t it that simple?

E-cigarettes should be regulated just like old-school cigarettes. And I know plenty of people who are surprised when they hear the rules for cigarettes don’t apply to e-cigarettes.

But of course it’s not that easy. The FDA’s fight to control tobacco has been a slow, long process.  The Tobacco Control Act is recent – from 2009.  Only then did the FDA pass rules to limit the sales of tobacco to anyone under 18, along with advertising and marketing directed at young people.  Only then did the FDA ban tobacco companies from sponsoring sports and entertainment events. Only then did it ban flavored cigarettes because of their appeal to kids.


Since then, the tobacco industry got a boost with the invention of the e-cigarette. An e-cigarette uses a battery to heat and vaporize liquid nicotine that a user inhales, or “vapes.” It does not have the carcinogens you get from smoking traditional cigarettes. It is a better choice if you’re a smoker not ready to quit.

But it’s not a better choice if you are a teen. Public health officials worry that the marketing of e-cigarettes is targeted to teens. Between 2011 and 2012 e-cigarette use doubled among middle and high school students. That translates to 1.78 million teens who tried an e-cigarette in 2012. And the majority of teens who tried an e-cigarette also smoked a regular cigarette.

Why is this concerning? We know “virtually all new users of tobacco products are under 18.”  And we know of the 3,000 teens who try their first cigarette each day in the U.S., 700 of them will go on to become daily smokers.

We don’t need another generation of Americans sick from tobacco-related illnesses.

Today’s FDA Proposal

In addition to banning sales to minors, the FDA proposal expands the types of tobacco products that come under its regulation. This also includes cigars, pipe tobacco, and hookahs.  It also says:

  • No free samples
  • No e-cigarette vending machines in areas with young people present
  • Warning labels required

All this is great, and it’s important progress, but something major is missing.

No Ban on E-cigarette Advertising or Marketing

While e-cigarettes are now regulated as tobacco products, all the rules don’t apply. There’s no ban to limit advertising and marketing directed at teens. There’s no limit on e-cigarette company-sponsored events. Flavored e-cigarettes are not banned.

Also surprising, the tobacco industry can still advertise e-cigarettes on TV.  To put this in perspective, traditional cigarettes were banned from TV in 1970.

What Happens Now?

The FDA has made a step in the right direction, but it falls short by not including limits on advertising and marketing.  The proposed rules are open for public comments for 75 days.

Each day 700 teens become daily smokers.  We’ve established the guidelines limiting their exposure to cigarettes. Those rules should apply to all tobacco products, including e-cigarettes.

I’m planning to send my opinion to the FDA. I hope you do.

For more information on submitting your comments, visit the FDA’s web site.

Posted by: Arefa Cassoobhoy, MD, MPH at 2:31 pm


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