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FDA wants e-cigarette makers to extinguish use by kids

The Food and Drug Administration issued its toughest crackdown yet on the makers of electronic cigarettes that have become increasingly popular with young people. Manufacturers now have two months to prove they can keep their e-cigarettes out of the hands of minors; it's already illegal for anyone under 18 to buy nicotine products. William Brangham talks with FDA Commissioner Dr. Scott Gottlieb.

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  • Judy Woodruff:

    The U.S. Food and Drug Administration today issued its toughest crackdown yet on the makers of electronic cigarettes.

    These vaping devices have become increasingly popular with young people.

    And, as William Brangham reports, the FDA told manufacturers they have two months to prove they can keep their e-cigarettes out of the hands of minors.

  • William Brangham:

    In announcing its action today, the FDA said the use of e-cigarettes among young people had hit — quote — "an epidemic proportion."

    It's illegal for anyone under 18 to buy any tobacco or nicotine products, including these e-cigarettes.

    In a moment, I will talk with the head of the FDA, Dr. Scott Gottlieb.

    But, first, to give you a sense of what these e-cigarettes are and how kids are using them, here's an excerpt from a report special correspondent Kavitha Cardoza of Education Week did two months ago at a high school in Connecticut.

  • Kavitha Cardoza:

    Fran Thompson, the principal of Jonathan Law High School, opens what he calls his vaping drawer.

  • Fran Thompson:

    These are some of the items that we have confiscated this week.

  • Kavitha Cardoza:

    The items are all e-cigarettes. The most popular brand by far is called Juul.

  • Fran Thompson:

    This is a Juul. I know it looks like a flash drive, right? So, the liquid goes in here.

  • Kavitha Cardoza:

    Basically, they're devices that heat up a liquid, often nicotine, and you inhale the vapor.

  • Fran Thompson:

    And then they smoke it, they vape it.

  • Kavitha Cardoza:

    Kids can hide them anywhere.

  • Zane Berks:

    Their socks, their backpacks, their pockets, their wallets, their bras, back pockets, everywhere.

  • Emma Hud:

    Anywhere, yes, because they're so small.

  • Kavitha Cardoza:

    Students Zane Berks and Emma Hudd say that's part of a Juul's popularity.

  • Emma Hud:

    It's a lot easier than smoking a cigarette or drinking. People do it in class all the time. And kids like that it's sneaky and that they're getting away with it, because it gives you that, like, rebellion.

  • Francis Thompson:

    Are you really writing about Christopher Columbus?

    I have athletes doing it. I have honors kids doing it. There's absolutely no stereotype in terms of the spectrum of who would be doing this.

  • Kavitha Cardoza:

    That makes this school in Milford, Connecticut, typical.

    Juuling, as it's called, has spiked all over the country among youth. But, unlike alcohol or cigarettes, often, parents aren't even sure what it is. Parent Liz Goodwin has two teenagers in this school. She found nicotine liquid pods in their pockets while she was doing laundry.

  • Liz Goodwin:

    When I found the pods, I Googled it and looked for it, and I couldn't find anything. I just had a photo of it and tried to describe it, and what is this? And then I saw the amount of nicotine. It's the equivalent of one pack of cigarettes.

    I also understood some of my adult friends used e-cigarettes as a way to get off of smoking, so I didn't know how dangerous it was.

  • Francis Thompson:

    I will show you what was going on.

  • Kavitha Cardoza:

    Principal Thompson says his aha moment was in the bathroom.

  • Francis Thompson:

    So, your typical high school bathroom, right?

  • Kavitha Cardoza:

    Brings back memories.

  • Francis Thompson:

    Just like watching "Grease," right?"

    But what was happening was you might have five or six kids hanging out in here with the door closed and vaping.

  • Kavitha Cardoza:

    Suchitra Krishnan-Sarin Runs the Yale Tobacco Centers of Regulatory Science at Yale University. She says the flavors are a big part of e-cigarettes' popularity. They sound playful and harmless, mango, mint, cotton candy, blueberry pie.

  • Suchitra Krishnan-Sarin:

    These products come in over 7,000 different flavors. And they can also mix and match to create their own, which, again, introduces a sense of novelty.

  • Kavitha Cardoza:

    But the vapors inhaled has been found to contain lead, zinc, chromium and nickel.

    And Krishnan-Sarin says nicotine, the main liquid in these devices, is extremely addictive and can cause memory and attention loss, especially in the developing teenage brain.

  • William Brangham:

    That was from a report by special correspondent Kavitha Cardoza.

    In its warning today, the FDA told the four main manufacturers of e-cigarettes that if they can't prove within 60 days that they can keep these devices out of the hands of kids, the FDA would consider taking them off the market totally.

    The FDA also sent over 1,000 warning letters to retailers that sell them, places like drugstores and gas stations.

    For more on today's action by the Food and Drug Administration, I'm joined by the head of that agency, FDA Commissioner Dr. Scott Gottlieb.

    Commissioner, thank you very much for being here.

    Could you just explain to me? This clearly seems like an escalation on the FDA's part today. Why today? Why now?

  • Dr. Scott Gottlieb:

    Well, what we have access to right now is data that demonstrates to us that there's nothing short of an epidemic of use among teenagers.

    We knew use was rising among high school teenagers, among young people, kids. But we now have access to some preliminary — preliminary data that we will make public pretty soon that shows that this is nothing short of an epidemic of use.

    And we feel we need to step in with dramatic action to try to curtail that use. Unfortunately, we do see these e-cigarettes as a viable alternative for adult smokers to migrate off of combustible tobacco on to products that might not have all the risks associated with them of smoking.

    But, unfortunately, in order to close the on-ramp for kids, we're now going to have to take some actions that we think are going to narrow the off-ramp for adults. And that's a trade-off that we have to make based on what we're seeing in the market right now.

  • William Brangham:

    So you mentioned this, an epidemic level of use among kids.

    As a physician and as the head of the FDA, can you just sketch out for me, what do you see as the main health problems with kids using these products?

  • Dr. Scott Gottlieb:

    Well, there's multiple problems.

    First of all, we know that nicotine has direct effects on the developing brain. So, nicotine in a child is not — not harmless. It's not a benign substance.

    But, also, if we see the trend and use that we're seeing right now, that's creating a massive pool of young people who are becoming habituated on and addicted to nicotine, and some component of those young people are going to migrate on to combustible tobacco products.

    So if you believe, as we do, that no child should be using any tobacco product — and we certainly don't want to see a new generation of young people and kids become addicted to nicotine and start smoking — this pool of users of e-cigarettes — and it's a pool that's growing very sharply, based on the data that we have — represents risk for the future that some component of these kids are going to migrate onto cigarettes and ultimately become long-term smokers, with all the health effects that come from that.

  • William Brangham:

    So you have told the manufacturers, you guys have 60 days to prove to us that you can keep these out of kids' hands.

    Let's say the manufacturers fail to meet that test. What happens then?

  • Dr. Scott Gottlieb:

    Well, what we said today is we're actively looking at removing from the market the flavored products. We believe that one of the — one of the aspects of these products that makes them appealing to kids are the flavors.

    And some of those flavors come in fruity flavors and other kinds of flavors that we think are increasing the appeal of these products to kids. And so, right now, those products remain on the market because the agency allows them to remain on the market under what we call an exercise of enforcement discretion.

    We haven't required the manufacturers to file applications to prove that those flavors actually have a net public health benefit. But we have the ability to do that.

    We have the legal authority to do that. So what we would do is tell the manufacturers that the flavors need to come off the market, and if they want to reintroduce the flavored products onto the market, they will have to file successful applications with the FDA that demonstrate that the existence of flavors provide a net public health benefit, that the benefits of flavors in terms of helping adult smokers quit combustible tobacco outweigh the risk that it's going to also appeal to young people and get a — get a kid hooked on an e-cigarette.

  • William Brangham:

    So the FDA wouldn't be necessarily taking these products completely. You would be taking specifically the ones that have fruity flavors, candy flavors, dessert flavors, that it seems to me you're arguing those appeal particularly to kids?

  • Dr. Scott Gottlieb:

    Well, the bottom line is all options are on the table.

    And if the trends in use that we're seeing right now continue, we're going to have to take even more dramatic actions. We think right now we can step into this market with a combination of enforcement actions against the places that we know kids are getting access to these products, which includes retail establishments that are selling them without putting proper restrictions in place or without carding minors, as well as the online sites, where we think that there are a straw purchases being made, where — where someone's going online, buying a lot of these products, and then reselling them to kids.

    But the other action we would take immediately is look at removing these flavored products in the market. If we don't think that those actions are sufficient to try to curtail the scope of use that we're now seeing among kids, we're willing to step into the market and take even more dramatic action.

    Now, I will say we do think the e-cigarettes offer a viable alternative for adult smokers. So we don't want to — we don't want to extinguish this opportunity entirely, because we do see some potential benefit from having these products on the market as a way for adult smokers to get access to nicotine, without all the harmful effects of combusting tobacco.

    But it's going to have to come, I think, going forward with some additional limitations on the availability and the types of products being marketed in order to stem what we're seeing as an epidemic of use among kids.

  • William Brangham:

    JUUL Labs, which is one of the main manufacturers of these e-cigarettes, several months ago, they said, we're going to put $30 million into a campaign to keep these-cigarettes out of kids' hands. They said that they supported the idea of raising the national age to 21 for these products.

    They put out a conciliatory statement supporting what you did today. But, clearly, you don't think the manufacturers have done enough thus far.

  • Dr. Scott Gottlieb:

    Well, look, I'm measuring what the manufacturers are doing and, frankly, what we're doing based on the results, based on the data that we're seeing.

    And the data that we're seeing is showing that the proportion of teenagers and high school students using these products is growing at a very fast clip. Ultimately, that's going to be the measure that I judge the manufacturers and I judge our own success by. That's what I'm looking at.

  • William Brangham:

    All right, Dr. Scott Gottlieb, commissioner of the FDA, thanks very much.

  • Dr. Scott Gottlieb:

    Thank you.

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