Iowa AG to FDA: Flavor ban of e-cigs is ‘overly simplistic’ reasoning

The Attorney General of Iowa in accordance with four public health experts have written a letter to FDA Commissioner Scott Gottlieb expressing concern over a potential flavor ban on e-cigs.  The movement to ban “kid appealing” vaping flavors is largely being led by anti-vaping activist groups like the Campaign for Tobacco Free Kids.  After Gottlieb signaled that the FDA is considering new rules regarding flavors of both tobacco and nicotine products in a July 28th announcement, Iowa AG Thomas J. Miller decided to offer his opinions on the subject.

Together with Dr. David Sweanor of the Centre for Health Law, Policy & Ethics in Canada, the UK’s Clive Bates of the Action on Smoking and Health, and Dr. David Abrams and Dr. Raymond Niaura of the NYU College of Global Public Health, the Iowa Attorney General spearheaded the letter writing campaign urging a deeper analysis of the facts.

“We are concerned that some prominent commentary about flavors in low-risk tobacco and nicotine products, including that provided in the Surgeon General’s 2016 report, is overly simplistic in presuming that the primary purpose and consequence of offering flavors is to recruit current non-users, especially youth, to nicotine use. A proper assessment requires a deeper analysis, and must at least consider the possibility that these low-risk products can function as alternatives to combustibles, not only for adults, but also as a diversion from youth smoking uptake and as support for youth smoking cessation. In that case, the attractiveness and appeal of such non-combustibles may be a positive factor in reducing the use of the far more harmful products, such as cigarettes. This harm-reduction benefit may apply for both adult and adolescent users.”

According to the five co-authors, the proposed flavor ban asks more questions than it answers.  For example, if the FDA is targeting only “kid appealing” flavors, then what protocols will be used to make these distinctions?  Is the FDA taking into consideration the possible negative effects to adult vapers trying to quit smoking?  And what are the possible consequences to teen smoking rates if even some vape flavors are forever banned by the FDA?  In short, has the FDA really thought this through? 

Is e-cig flavors the real issue?  Or is it their marketing?

The FDA announcement by Gottlieb is rather unclear as to the true cause of concern which has led to a possible flavor ban.  According to Clive Bates, there are three potential pathways for a possible FDA flavor ban.

  1. The FDA might argue that all flavored e-liquids are harmful to public health in some way.
  2. The FDA might argue that certain flavors have characteristics that make them more palatable and/or attractive to younger vapers and should therefore be prohibited.
  3. The FDA might restrict the use of certain “descriptors” in the marketing and advertising of e-liquids, including terms and trademarks like gummy bears or cotton candy.

In the FDA letter submitted by Iowa Attorney General, the co-authors also warn FDA Chief Gottlieb to carefully weigh the pros and cons before taking any decisive action.   

“Any justification for an intervention must show that a rule is appropriate for the protection of public health and that it is reasonable to conclude that harms will outweigh benefits. To show this is likely would require a long chain of reasoning, supported by credible data. Is a flavor attractive? Is it differentially attractive to youth, versus adults? If it is differentially attractive, does it change behavior? If it changes behavior, is the change harmful or beneficial? How would an intervention affect behavior? Would an intervention reduce harm or reduce benefits in youth and adult populations? What are the potential mechanisms for unintended consequences?”

While the letter focusses on the FDA’s intended protocols for establishing one kid appealing e-juice from another, it could also be viewed by anti-vaping organizations as further reason to ban them all.  If the FDA must be required to spend perhaps billion of dollars of taxpayers’ money to continuously police the American vaping industry for kid appealing e-liquids, then why not just ban them entirely?

However, as the Iowa AG and his co-authors also note, is an uptick in teen vaping really all that harmful in the first place?  Smoking rates among teens is plummeting in recent years. By implementing a flavor ban on e-cigs, the FDA might just trigger another dramatic increase in teen smoking instead. 


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