Category: Regulation

  • Cambodia Wants Crackdown on Online Vape Promos

    Cambodia Wants Crackdown on Online Vape Promos

    Credit: Luzitanija

    Cambodian Movement for Health operations director Mom Kong has called on the authorities to pursue legal action against people who promote the sale of e-cigarettes on social media despite several recent high profile raids.

    Kong said that the confiscation and incineration of e-cigarettes, or vapes, contributes to a reduction in their use among young people, according to Asia News.

    “I applaud the authorities’ willingness to destroy confiscated stock, as it demonstrates the strength of their commitment to the fight against these devices,” he added.

    He issued his statement just days after the Consumer Protection, Competition and Fraud Repression Directorate-General of the Ministry of Commerce – in cooperation with the National Authority for Combating Drugs and the Phnom Penh Municipal Police Commission – destroyed 7,200 boxes, or 288 cartons of confiscated vapes and related products in a Dec. 30 bonfire.

    The products that were incinerated were confiscated during an early November raid on a Phnom Penh warehouse.

  • CTP Director Pens Op-Ed, Fails to Mention Recent Reviews

    CTP Director Pens Op-Ed, Fails to Mention Recent Reviews

    Brian King / Credit: FDA

    In a new op-ed published in the HPHR Journal, The U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) Director Brian King writes about what the FDA is calling “health equity.” However, missing from the editorial is any response to either the recent Reagan-Udall Review or the findings of a recent investigation into the CTP by the U.S. Office of Special Counsel (OSC).

    In the editorial, King writes that “there is no safe tobacco product; however, products do exist on a continuum of risk, with combustible products being responsible for the overwhelming burden of disease and death from tobacco use.”

    He also states that “science is central to informing tobacco regulatory decision making,” noting that he is “a scientist by training” and is “particularly attuned to the vital importance of ensuring we gather and use the best scientific evidence available.”

    In writing about his “vision” for the CTP, King does not address memos recently submitted to the U.S. Court of Appeals for the Third Circuit that show King reversed a recommended marketing approval of Logic Technology’s menthol vaping products, ignoring the advice of FDA scientists, according to Logic’s lawyers. 

    King also failed to address the conclusion a recent investigation conducted by the OSC that found the CTP had relaxed its standards of review for certain tobacco products and stifled attempts by its scientists to raise concerns. The OSC sent a letter to the U.S. President and Congress outlining the findings.

    In the op-ed, King claims that the CTP “strive[s] to engage with a wide array of stakeholders, including those that work with and represent individuals and communities who are disproportionately impacted by tobacco use, to facilitate an open exchange of opinion from diverse groups.”

    However, when the Reagan-Udall Foundation submitted its recommendations to Robert Califf , commissioner of the FDA, in December, the report concluded that vaping industry stakeholders observed a lack of “consistent implementation” of what the industry understood to be the policies of the CTP, particularly with respect to tobacco harm reduction and the requirements needed to navigate the premarket tobacco product application (PMTA) process.

    King then goes on to state that in the 13 years since the landmark Tobacco Control Act (TCA) was signed into law, CTP has done “significant work to effectively research, regulate, and educate in a complex and rapidly changing tobacco product landscape.”

    However, the Reagan-Udall report stated that the CTP needs to make “process improvements and identify and address the policy and scientific questions” that underpin its regulatory framework. The review concluded that CTP’s implementation of its PMTA program also has been affected by “changes in leadership and administrations.”

    Since the implementation of the TCA, CTP has operated under seven different commissioners in three different administrations, and recently hired its third CTP director, King. In October, numerous comments from staffers of the CTP for the Reagan-Udall assessment of the performance of the FDA’s tobacco center claimed the regulatory agency is in a state of disarray and being influenced by outside forces, not scientific research.

    One comment stated that reviewers of PMTAs in the CTP’s Office of Science (OS) lack the autonomy to exercise “best scientific practices” in their reviews of PMTAs.

    “Scientific disagreement is frowned upon, if not entirely suppressed, and punished through various backhanded methods (e.g., lack of assignments, projects, and other opportunities that are needed for career development/promotion),” the comment states. “In some divisions (e.g., Division of Nonclinical Science [DNCS]), leadership pushes a ‘gotta get em’ mentality onto staff, which is unsupportive of a reviewer’s fundamental duty to provide an unbiased review using the best available science.”

  • Holland Flavor Ban Begins, Belgium to Tighten Rules

    Holland Flavor Ban Begins, Belgium to Tighten Rules

    Image: Tobacco Reporter archive

    The Netherlands banned flavored e-cigarettes effective Jan. 1, reports The Brussels Times. Companies have until Oct. 1 to remove the flavored products from shelves; retailers can sell their current stock until that date, but new flavors may not be marketed.

    Belgium plans to tighten vaping regulation as well, according to Federal Health Minister Frank Vandenbroucke.

    “E-cigarettes contain some 1,800 different products of which we are far from knowing all the health consequences,” he said. “Maybe some people will switch from regular cigarettes to e-cigarettes, but maybe by using e-cigarettes, people will just end up smoking regular cigarettes.”

    A ban on flavors is not currently planned in Belgium, but a royal decree will soon be published imposing more restrictions on the sale of flavored e-cigarettes. “No more trendy names will be allowed to be given to those flavors, and lights will no longer be allowed on e-cigarettes either,” said Vandenbroucke.

    There will be a six-month transition period for the industry to adapt to the new rules and another six-month period to sell current stock.

  • FDA Accepts Bantam Vape Non-Tobacco PMTAs

    FDA Accepts Bantam Vape Non-Tobacco PMTAs

    Bantam Vape received acceptance of its premarket tobacco product application (PMTA) submission from the U.S. Food and Drug Administration for its non-tobacco nicotine e-liquids, according to a press release. Bantam’s application now moves to the next step in the PMTA process—a preliminary scientific review to confirm the application contains all required items to permit a substantive review by the FDA.

    Bantam submitted its application for its non-tobacco nicotine e-liquids to the FDA on May 13, 2022, and is seeking marketing orders from the agency.

    “The receipt of this acceptance letter reflects Bantam’s efforts to provide adult consumers with high-quality, science-based e-liquids while upholding our responsibility to restrict youth access and use of these products,” said Bantam spokesperson Anthony Dillon. “Bantam remains supportive of the need for science-based regulation in the e-liquids industry and is proud of the progress of our various PMTAs. We remain confident in the quality and consistency of our products and the science behind them.”

    Prior to its non-tobacco nicotine-focused submission, Bantam submitted a PMTA to the FDA in September 2020 for its tobacco-derived e-liquids. The application entered scientific review in August 2021, and, to date, remains under FDA review.

    Earlier this year, the -liquid manufacturer received an exemption from the United States Postal Service (USPS) that allows the company to ship its e-liquid products to select vape retailers and distributors throughout the United States.

  • OSC Sends Letter to Biden for FDA’s ‘Public Failure’

    OSC Sends Letter to Biden for FDA’s ‘Public Failure’

    Credit: Tada Images

    The U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products (CTP) had relaxed its standards of review for certain tobacco products and stifled attempts by its scientists to raise concerns, according to an investigation conducted by the U.S. Office of Special Counsel (OSC). The OSC sent a letter to the President and Congress outlining the findings.

    The investigation began after a leading CTP toxicologist-turned-whistleblower disclosed to OSC that a 2019 memorandum issued to CTP’s scientists revised the process for evaluating potentially harmful ingredients in substantial equivalence applications used for certain tobacco products. According to the whistleblower, the memo directed scientists to stop using objective, quantitative data to evaluate applications and to instead use an approach which was more akin to “eyeballing it,” resulting in unclear review standards and less reliable decisions, according to the CTP.

    The whistleblower also alleged that flaws in CTP’s internal scientific dispute resolution process effectively prevented the whistleblower and several other concerned scientists from raising these issues within the agency. “This internal dispute process is intended to safeguard the integrity of CTP’s scientific evaluations, including consideration of certain tobacco products to ensure those authorized for market meet the applicable health and safety standards,” CTP stated.   

    OSC referred the whistleblower’s allegations for investigation. In response, the FDA convened an independent panel of scientific experts to evaluate allegations concerning the allegedly flawed tobacco application review process. The panel largely agreed with the whistleblower’s concerns, finding that the process lacked “quantifiable standards or criteria.” The expert panel made six recommendations, including a new process for resolving scientific discrepancies, which the agency largely adopted.

    In response, the whistleblower acknowledged CTP’s progress in giving scientists discretion to consider quantitative data in reviewing potentially harmful chemical compounds in substantial equivalence applications for new tobacco products. CTP also revamped its scientific dispute procedures and created a mandatory training program for all CTP staff involved in scientific decision-making. While supportive of these steps, the whistleblower stated that FDA scientists will still need courage to challenge a system that “discourages dissenting voices.”

    “The public depends on the FDA to vigorously implement and enforce our nation’s health and safety laws, especially when new tobacco products are being brought to market,” said Special Counsel Henry J. Kerner. “I am deeply troubled that FDA’s own scientific dispute process failed our whistleblower and fellow concerned scientists, and as a result failed the public. I commend the whistleblower for persevering in the face of these unnecessary obstacles. I also thank the FDA for taking the allegations seriously by convening an independent expert panel, and for taking positive steps to repair its review process.”

  • Nothing to See: Reagan-Udall Submits CTP Review

    Nothing to See: Reagan-Udall Submits CTP Review

    Credit: Postmodern Studio

    The Reagan-Udall Foundation today submitted its recommendations to Robert Califf , commissioner of the U.S. Food and Drug Administration. The findings are what many in the industry are calling “meaningless” and “less than compelling.”

    The report concludes that vaping industry stakeholders observed a lack of “consistent implementation” of what the industry understood to be the policies of the Center for Tobacco Products (CTP), particularly with respect to tobacco harm reduction and the requirements needed to navigate the premarket tobacco product application (PMTA) process.

    The “Operational Evaluation of FDA’s Tobacco Program” was facilitated at Califf’s request. The announcement came as Califf attempted to push past several controversies that dominated his second stint running the agency, including his issuing of a marketing denial order (MDO) to e-cigarette maker Juul Labs and later having to rescind that order.

    The report did highlight several wide-ranging problems that the report states hinder its ability to regulate the industry and reduce tobacco-related disease and death. The report stated that the CTP should make “process improvements and identify and address the policy and scientific questions” that underpin its regulatory framework. The review concluded that CTP’s implementation of its program also has been affected by “changes in leadership and administrations.” In its first 13 years, CTP has operated under seven different commissioners in three different administrations, and recently hired a third CTP director, Brian King.

    “From the stakeholders’ perspective, policy shifts with broad impact on the industry occurred without notice. The Center has faced significant challenges in clearing its policies through the career and political infrastructure. It took years to establish requirements and standards governing application reviews, frustrating industry and creating problems for the Center itself when it received deficient applications,” the report states. “Issues in application reviews resulted in litigation necessitating re-review of some applications. The current environment reflects an unintended shift from what was structured by law as a pre-market authorization framework to the reality of a post-market regulatory environment, which is much more difficult to deal with given that there are few incentives for industry to come into compliance and many incentives for industry to delay the process.”

    The evaluation and resulting recommendations focused on four program areas: regulations and guidance, application review, compliance and enforcement, and communication with the public and other stakeholders, according to the review. The review and recommendations are meant to assist the agency in making changes to better carry out its regulatory responsibilities; to strengthen its relationships with stakeholders

    The report identified several fundamental issues that the center needs to address and it states that the report offers “cross-cutting as well as program-specific recommendations to help CTP operate more effectively,” according to the authors of the review.

    The key points from the report can be summarized as follows:

    • The panel observes that CTP has been forced to operate primarily in a reactive mode, moving
      from one challenge to the next, mainly provoked by the outside forces. The Center should transition to becoming a more proactive and strategic program. With more substantial engagement with stakeholders and the public, CTP should take the time now to think strategically about where it is today and where it needs to go in the next several years.
    • Although CTP has a critical mission to protect the public health from tobacco-related disease and death and is regulating products that have no inherent benefit and huge societal costs, it is a government regulatory program with a duty to run efficiently, fairly, and transparently. This responsibility to function as an effective product regulator should be captured in the Center’s mission, vision, and goals and carried out to the best of the Center’s ability.
    • The panel recognizes that to improve the effectiveness of its application review, the Center should make process improvements and identify and address the policy and scientific questions that underpin its regulatory framework.
    • CTP needs to work with other entities on strategies to clear the market of illegal tobacco products more rapidly and provide more transparency to the public on its efforts to do so. This work is challenging but essential as CTP adopts a more strategic approach. While there is much the Center can do on its own, the panel notes that enforcement of the premarket requirements in the tobacco laws, particularly to help prevent youth use of tobacco products, requires the involvement and support of agencies other than FDA. The authors encourage the agency to elevate this issue and pursue a more comprehensive approach that leverages the resources of other agencies with a declared role in tobacco control.

    “Overall, the panel is confident that many of the concerns raised in this report can be addressed by CTP’s
    talented and dedicated staff, with the support of FDA leadership,” the report states.

    Numerous comments from purported staffers of the FDA for the Reagan Udall assessment claimed the regulatory agency is in a state of disarray and being influenced by outside forces, not scientific research. One comment stated that reviewers of premarket tobacco product applications (PMTAs) in the CTP Office of Science (OS) lack the autonomy to exercise “best scientific practices” in their reviews of PMTAs. The report fails to address these issues.

    The panel was comprised of former federal public health leaders, regulatory strategists, and process improvement specialists. Lauren Silvis, served as chair of the group, which included Jane Axelrad, Keith Flanagan, Charlene Frizzera, and Alberto Gutierrez.

    “The panel provided recommendations to help the Agency’s tobacco program strengthen its operations as it works to reduce the harm associated with tobacco use,” said Lauren Silvis. “The Center for Tobacco Products has made significant progress in establishing a regulatory program for tobacco products and our recommendations are intended to help the Center develop additional tools for achieving its public health objectives.”

    Through multiple listening sessions, interviews, and an online portal, the group received and carefully reviewed input from a range of stakeholders, including FDA staff and the public, according to the report. The author’s claim the report offers “cross-cutting and program-specific recommendations” for the FDA to consider, “focusing on regulations and guidance, application review, compliance and enforcement, and communication with the public and other stakeholders.”

    The report did not address tobacco policy issues, which are outside the scope of the evaluation, according to a Reagan-Udall Foundation.

    One industry stakeholder, who asked not to be named for fear of retribution from the FDA for its brands under PMTA review by the agency, said the report’s findings were “a joke” and “completely ignorant of the real problems at the CTP.”

    Califf said Monday he will review the recommendations with the aim of outlining the agency’s next steps by February.

    Earlier this month, Reagan-Udall delivered its food report that was commissioned at the same time as the tobacco report. The food response suggests the agency’s leadership be restructured to improve its response to emergencies, including the recent shortage of baby formula

    Reagan-Udall was created by Congress to help further FDA’s mission. The non-profit receives funding from both the FDA and the industries it regulates, including drugmakers.

    The report can be found at reaganudall.org.

  • CTP Director Ignored Science in Logic Menthol Decision

    CTP Director Ignored Science in Logic Menthol Decision

    Brian King / Credit: FDA

    Memos recently submitted to the U.S. Court of Appeals for the Third Circuit show that the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) allowed its director, Brian King, to reverse a recommended marketing approval of Logic Technology’s menthol vaping products, ignoring the advice of FDA scientists, according to Logic’s lawyers. The new documents were made available to Logic after it had filed its motion for a stay of its marketing denial order (MDO) for its menthol vaping products.

    Attorneys for Logic, which is represented by Troutman Pepper, stated that the new documents, that Vapor Voice is reviewing, reveal the “extraordinary fact that CTP’s Office of Science (OS) reversed its science-based recommendation to issue marketing granted orders for Logic’s premarket tobacco product applications (PMTAs) for its menthol-flavored electronic nicotine delivery systems (ENDS) after receiving pressure from the new CTP director and his office, the Office of Center Director (OCD).”

    Logic attorneys claim the company is entitled to a stay of the agency’s MDO for the Logic menthol products because the OCD overruled OS’s initial recommendations to approve Logic’s products based upon its “science-based evaluation” of Logic’s submission. However, because the OCD said in the memos that menthol as a category would be “treated disfavorably,” Logic is asking the court to recognize that the agency’s actions of “basing product-specific decisions” on “unpromulgated, across-the-board policies” that were never subject to notice-and-comment rulemaking is “arbitrary and capricious.”

    In the first memorandum (dated Oct. 25), the OS explains that it evaluated Logic’s PMTAs, including its product-specific evidence, and concluded that authorization of the marketing of Logic’s menthol-flavored ENDS was appropriate for the protection of public health (APPH). However, the memo shows that the OS changed course only after the new CTP director and OCD, to whom OS reports, concluded that menthol-flavored ENDS should be treated as a “disfavored” product category, despite the evidence to the contrary.

    “From a policy perspective, OS believed at the time that as long as menthol-flavored cigarettes remain on the market, menthol-flavored ENDS could be a direct substitute for them, providing a less harmful alternative for menthol-flavored cigarette smokers who are less likely to successfully quit smoking than smokers of non-menthol-flavored cigarettes,” the OS memo reads. “OS considered that this suggested potential benefit in the form of increased opportunity for use and transition coupled with product-specific evidence of some benefits to smokers even if not greater than that of tobacco-flavored ENDS products amounted to a likelihood of greater cessation or significant reduction in smoking that would outweigh the known risks to youth from the marketing of the products sufficient to meet the legal standards for authorization.”

    OCD then raised questions about OS’s recommendation including questions about “the role and sufficiency of the general scientific literature on adult menthol smokers’ differential preference for menthol ends in demonstrating likely behavioral change” and underscored its concerns about the substantial appeal of menthol to youth. A decision was still pending for the Logic PMTA in July 2022, when CTP transitioned to a new center director, Brian King.

    “OS shared its views with the new center director and engaged in an open discussion on topics including the general body of literature, Logic’s clinical studies, risk to use, and potential postmarketing requirements,” the memo states. “After that meeting, the OCD senior science advisor shared OCD’s views with OS, articulating that in light of the substantial risk to youth and the lack of robust evidence of actual differential use to quit or significantly reduce cigarettes per day, the approach to menthol flavored ends should be the same as for other flavored ends, i.e., the products could be found to be APPH only if the evidence showed that the benefits of the menthol flavored ends were greater than tobacco flavored ends, which pose lower risk to youth.” The OS subsequently changed course and its opinion about Logic’s marketing approval.

    The second memorandum reiterates the same policy shift and suggests that meetings were held to address the concerns of OS staff regarding the appropriateness of the decision-making process behind the denial of Logic’s menthol PMTAs. The OS also had concerns that the new OCD approach would eliminate all non-tobacco-flavored ENDS products.

    “During deliberations, it became clear that there was not agreement with CTP on the approach for evaluating menthol-flavored ends. OCD took steps to consider and address staff use and to ensure that the process for decisions on PMTAs was driven by the science. In July 2022, shortly after becoming CTP center director, Brian King, a doctoral-level scientist, conferred with OS and members of OCD about menthol-flavored ends and the Logic menthol-flavored ends PMTA,” the second memo states. “After that meeting, the OCD senior science advisor conveyed that Dr. King’s position was the same as the previously held OCD position. Articulating in particular that in light of the risk to youth and the lack of robust evidence of actual differential use of menthol-flavored ends to quit or significantly reduced cigarettes per day, the approach to menthol-flavored ends should be the same as with other flavored ends with respect to the evidence of adult benefit. Subsequently, and upon its own initiative, OS reassessed OCD’s approach … .”

    In October, numerous comments from staffers of the CTP for the Reagan Udall assessment of the performance of the FDA’s tobacco center claimed the regulatory agency is in a state of disarray and being influenced by outside forces, not scientific research. One comment stated that reviewers of PMTAs in the OS lack the autonomy to exercise “best scientific practices” in their reviews of PMTAs.

    “Scientific disagreement is frowned upon, if not entirely suppressed, and punished through various backhanded methods (e.g., lack of assignments, projects, and other opportunities that are needed for career development/promotion),” the comment states. “In some divisions (e.g., Division of Nonclinical Science [DNCS]), leadership pushes a ‘gotta get em’ mentality onto staff, which is unsupportive of a reviewer’s fundamental duty to provide an unbiased review using the best available science.”

    Earlier this week, a unanimous panel of the United States Court of Appeals for the Fourth Circuit denied Avail Vapor’s petition to have its MDO invalidated. Avail also argued that the FDAs review process for PMTAs, although not specifically menthol, were arbitrary and capricious.

    The U.S. Court of Appeals for the Eleventh Circuit stayed an MDO issued by the FDA to Bidi Vapor earlier this year, which also argued the agency’s rulemaking was arbitrary and capricious.

    These two rulings were all made before the release of the Logic documents. Several industry experts have told Vapor Voice that this revelation of FDA memos could be “game changing” for industry lawsuits. Avail is rumored to be taking its case to the Supreme Court of the United States. The FDA does not comment on pending litigation.

  • New Report Finds FDA Fails in Enforcing MDOs

    New Report Finds FDA Fails in Enforcing MDOs

    Photo: Postmodern Studio

    The U.S. Food and Drug Administration has failed to follow through after issuing warning letters to online tobacco products and vapor product sellers, according to a report by the Health and Human Services Office of the Inspector General (OIG).

    Between 2010 and 2020, the FDA issued warning letters to 899 online retailers but “took no enforcement actions,” according to the report.

    The FDA enforcement schedule, as of March 2022, calls for the following actions: first violation—warning letter; second violation within a 12-month period—fine of up to $320; third violation within a 24-month period—fine of up to $638; fourth violation within a 24-month period—fine of up to $2,559; fifth violation within a 36-month period—fine of up to $6,398; sixth violation within a 48-month period—fine of up to $12,794; and five or more repeated violations within 36 months—no-tobacco-sale order of 30 calendar days or six months or permanent.

    The OIG report criticizes the FDA’s lack of transparency, which it says makes it hard to track the FDA’s performance. The report suggests that the FDA collaborate with the Bureau of Alcohol, Tobacco, Firearms and Explosives on oversight of online tobacco retailers; complete its rulemaking on non-face-to-face sales of tobacco products as required by the Tobacco Control Act; collect data to support process and outcome measures for its oversight of online tobacco retailers; and publish information and performance data on its oversight of online tobacco retailers.

    In a response, the FDA did not dispute a lack of enforcement actions and agreed with the first and fourth suggestions, stating it is in the process of making those changes. The organization was noncommittal regarding the other two suggestions.

    The OIG report is separate from the Reagan-Udall Foundation review of the FDA’s Center for Tobacco Products.

  • New Zealand Passes Combustible Tobacco Endgame

    New Zealand Passes Combustible Tobacco Endgame

    Credit: ViDi Studio

    The New Zealand Parliament today adopted the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill, which is expected to phase out combustible tobacco product use in the country.

    “Today, history was made for public health and for the generations of families who have lost loved ones to the preventable diseases caused by ordinary tobacco use,” said Action on Smoking and Health (ASH) Executive Director Laurent Huber. “New Zealand has single-handedly changed the course of what is possible in tobacco regulations and we stand ready to help other jurisdictions follow their groundbreaking lead.”

    The concept, called “Smoke-Free Generation” (SFG), can also be characterized as a sales ban with a grandfather clause for existing adults who smoke, according to a press release.

    New Zealand will be only the third government to pass such a law, following Balanga City in the Philippines – which has been unable to implement the law due to litigation – and Brookline, Massachusetts, which implemented a similar law (tobacco-free generation) in January 2021 and successfully defended an industry lawsuit in October 2022.

    Unlike New Zealand, Balanga City and Brookline banned sales to anyone born this century, and included all tobacco products (including e-cigarettes and snus), rather than a focus on combustibles.

    “It’s important to stress that the Smoke-Free Generation law applies only to sales of combustible tobacco,” stressed Huber from ASH, which has endorsed SFG for years. “The law does not outlaw individual purchase, possession or use – or the act of smoking. The problem here is the tobacco industry, not their victims.”

    The second leg of the law is a drastic reduction in the number of retailers – researchers estimate that the final reduction may be as much as 95 percent. Finally, the new law includes reducing nicotine content in cigarettes to below-addictive levels, according to the release.

    Hong Kong Health Minister Lo Chung-mau confirmed that banning tobacco sales for future generations will be on the table as a tool to further reduce youth smoking, according to the South China Morning Post. The Malaysian government is also pushing forward a bill that seeks to ban vaping and smoking for those born from 2007, after making amendments following resistance from some lawmakers.

  • Officials Urged to Fight Vaping Misinformation

    Officials Urged to Fight Vaping Misinformation

    Photo: Yeti Studio

    A group of public health experts along with the attorney general of Iowa have asked the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Surgeon General to correct misinformation overstating the dangers of e-cigarettes.

    In an editorial published Dec. 12 in Addiction, the authors cite the 2019 outbreak of EVALI and the Surgeon General’s 2016 youth vaping report, which claims that nicotine vaping is a gateway to smoking.

    The authors take issue with the CDC’s failure to amend the name EVALI (e-cigarette or vaping product use-associated lung injury) even after it became clear that the health problems were brought about by vitamin E acetate (mixed with cannabis oil by black market sellers) rather than nicotine vapes.

    “Smokers are still twice as likely to incorrectly identify e-cigarettes as the cause of a serious lung disease outbreak in 2019 than to correctly identify marijuana vape products contaminated by vitamin E acetate as the cause,” said lead author Michael Pesko of Georgia State University in a press note. “Because many smokers then falsely believe e-cigarettes to be as or more dangerous than cigarettes, the misinformation reduces smoking cessation that would otherwise occur. Population health suffers as a result.”

    The Surgeon General’s gateway claim, meanwhile, is simply untrue, according to the authors. “Significant evidence now exists that this association between vaping and smoking is not causal, which is a source of confusion for the lay public and healthcare professionals,” wrote Georgia State University health economist Pesko.

    “The lack of causation is underlined by real-life data collected since the SG report’s publication. Even as youth vaping hit its peak in 2019, youth smoking was sinking rapidly, and that decline has continued.”