Vaping is risky. Why does the FDA allow electronic cigarettes?


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When they first First introduced in the United States in the mid-2000s, “electronic nicotine delivery systems” – electronic cigarettes, vapes, e-liquids, and other products containing the stimulant found in tobacco – were subject to little federal oversight. Their manufacturers could incorporate countless other ingredients and flavors. Like cigarettes before them, the devices have proven to be extremely appealing to young people; in 2018, the surgeon general declared youth vaping an “epidemic” and noted that one in five high school students and one in 20 middle school students used e-cigarettes. Nicotine can interfere with brain development, and electronic cigarettes contain potentially harmful toxins such as heavy metals; the long-term effects of vaping – the heating of nicotine to create an inhaled aerosol – are uncertain.

Despite these concerns, state health officials killed up to 24 million Americans over the past six decades. Since electronic cigarettes generally contain fewer toxic chemicals than tobacco smoke, they are thought to be less damaging than cigarettes. If a significant number of one in seven adults in the United States who smoke switched to e-cigarettes, the theory is that far fewer people could suffer from cancer and cardiovascular and respiratory disease.

In 2016, in an effort to mitigate the potential harms of electronic cigarettes, the Food and Drug Administration began to regulate them as “new tobacco products”. It has become illegal to sell e-cigarettes to anyone under the age of 18 (a threshold that rose to 21 nationwide in late 2019), and the agency was empowered to require warning labels. The FDA has also been given the authority to keep products off the market unless it can be shown that their public health benefits outweigh their risks. (Due to legislation passed in 2009, this condition applies to new tobacco products in general; cigarettes themselves and other tobacco products on the market before February 15, 2007 do not have to meet the same standard.) last month, the agency had turned down nearly a million requests. But one vaporizer and two liquids, with regular tobacco and menthol flavors, were allowed, after the FDA said data submitted by their manufacturer showed they were indeed less toxic than cigarettes and could, according to the terms. the agency’s press release, “Benefit addicted adult smokers who switch to these products.” This would “outweigh the risk to young people” and lead to “comprehensive protection of public health”.

The decision was controversial. Part of the reason is that research into whether electronic products can help adult smokers stay smoke-free is showing mixed results at best. For example, in October, the same month as the FDA decision, JAMA Network Open published a study that “Found no evidence that switching to e-cigarettes prevented cigarette smoking relapse”, says senior author John P. Pierce, Professor Emeritus at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego. He and his colleagues analyzed data from the Population Assessment of Tobacco and Health Study, a longitudinal study of tobacco use in the United States started in 2013 by the National Institutes of Health and the FDA. Based on responses up to 2017, researchers identified 13,604 participants who were cigarette smokers. When these same participants were interviewed a year later, 9.4% said they had quit smoking.

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