November 22, 2019 06:14 pm News Staff – AAFP President Gary LeRoy, M.D., arrived at the White House Nov. 22 ready to give President Donald Trump a forceful message during a listening session on youth vaping and e-cigarettes: Deliver on a recent pledge and move to halt an epidemic of youth nicotine use.
LeRoy, of Dayton, Ohio, entered with allies. He was among several invited physician and health groups that are unified in their support for an administration plan -- announced in September and quickly lauded by the Academy -- to ban nontobacco-flavored e-cigarettes.
This month, however, Trump seemed close to scuttling that plan under intensifying pressure from tobacco and vape groups, and Friday's hastily assembled meeting included leaders from those and other pro-nicotine industries.
Those groups argue that e-cigarettes are cessation devices and that thousands of so-called mom-and-pop vape shops wouldn't survive a flavor ban, and theirs was often the louder side of the table during what turned into a contentious session.
But for millions of young Americans, LeRoy told AAFP News after the meeting, vape products are smoking-initiation devices.
"If there's any validity to e-cigarettes being used as cessation aids for adults, that utility is almost nonexistent for young users," LeRoy said.
"We kept hammering at that fact -- that they're not really being sold to adults," he added, recapping the meeting. "We probably spent 45 minutes going round and round with the vaping and tobacco folks about the utility of getting rid of flavors. Because the reality is that e-cigarette flavors are aimed at young people and the industry acknowledges that, yes, this is the bulk of their sales."
Halting an epidemic of nicotine addiction, LeRoy said, must be the priority.
As of Nov. 20, the CDC had recorded 2,290 cases of vaping-related lung injury in 49 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands; and 47 vaping-related deaths in 25 states and D.C.
With those and other alarming numbers at the ready, the Academy and the other health and medical organizations at the White House meeting called on the administration not to delay or weaken its crackdown on flavored products.
Joining the AAFP were the American Academy of Pediatrics, the AMA, the Campaign for Tobacco-Free Kids, the American Cancer Society Cancer Action Network, the American Lung Association, Truth Initiative and Parents Against Vaping e-cigarettes.
"There is no time to waste as the youth e-cigarette epidemic continues to get worse and over 5 million kids now use e-cigarettes," the groups said in a statement released ahead of the roundtable.
The coalition reminded Trump during the meeting that many e-cigarette flavors are designed to appeal to children, and that, according to the FDA, 97% of youth who use e-cigarettes say they've used a flavored e-cigarette in the past month.
Meanwhile, some of the most kid-friendly flavors, such as gummy bear, cotton candy and mango, are sold only in retail stores dedicated to vape products or online, and they attract underage buyers. Medical groups at the meeting cited research published in JAMA Pediatrics that reports 44.7% of tobacco and vape shops in California have sold e-cigarettes to underage decoy buyers.
Flavors mixed on site at such stores are unregulated and haven't been reviewed to evaluate their potential harms.
"When it comes to evidence about vaping and flavors, we don't know what we don't know," LeRoy told AAFP News -- an information deficit he likened to the damage wrought by combustible tobacco over the past hundred years.
"America made a huge mistake in the 20th century when the tobacco industry said cigarettes were safe, then addicted a generation or more," LeRoy said. "The Academy and our allies were there today to say, 'We don't want to make the same societal mistake with e-cigarettes. We will not stand for that.'"
At times during the session, Trump seemed more animated by age-based restrictions to purchasing e-cigarettes rather than banning flavors, but "he wasn't showing his cards," LeRoy said.
Rather, LeRoy said Sen. Mitt Romney, R-Utah, offered some of the tougher rebuttals to the vape and tobacco representatives at the meeting. (Romney's portfolio is a unique intersection of the day's interests: He sits on the Health, Education, Labor and Pensions Committee as well as the Committee on Small Business and Entrepreneurship.)
"Sen. Romney and (HHS Secretary Alex) Azar clearly were attuned to and supportive of our message," LeRoy said.
And that message can't be overstated, he added.
"We, the Academy, must continue to put legislative and letter-writing pressure on, keep up the pressure on, the FDA," LeRoy told AAFP News.
"We were at the table with the president to restate the obvious: Flavored e-cigarettes are bad and shouldn't be in the hands of young people. We need to get the facts straight and complete evidence-based research on these products to see whether they belong on the market at all.
"I was glad we were at the table. We had some positive movement with the president and the administration," LeRoy said. "Absolutely, the president heard us."
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