AAFP President Gary LeRoy, M.D., of Dayton, Ohio, said he and fellow medical and public health authorities appeared to have been been heard at the White House six weeks ago, when President Donald Trump convened a roundtable on a proposed ban on flavored electronic nicotine delivery system products.
Liquid refills for open-tank e-cigarette products were left out of the FDA's recent restrictions on flavored electronic nicotine delivery system products.
But the result of that Nov. 22 session -- a far narrower restriction(www.fda.gov) that the Trump administration announced on Jan. 2 -- illustrates the frustrating difference between being heard and being heeded.
"Today's FDA enforcement policy on e-cigarette manufacture and sale falls short," LeRoy said in a statement responding to the order.
"Eliminating the fruit flavors that attract youth to e-cigarettes is a step in the right direction. However, today's FDA enforcement policy allows continued manufacture and sale of menthol e-cigarettes, thereby leaving those who are addicted to menthol products at risk.
"It also spares vaping shops from enforcement by exempting flavored products that are mixed on-site in vendors' stores."
That second loophole is broadly understood to be an election-year concession to the vaping industry, which has proved to be as forceful a lobbying presence(www.latimes.com) as traditional tobacco companies.
It also leaves room for nicotine-addicted teens to seek tobacco- and menthol-flavored pods rather than the more Technicolor array of liquids that first hooked them.
"More than 5 million middle- and high-school students used e-cigarettes in the past 30 days," LeRoy said in the statement. "Of them, 1.6 million use the product frequently and nearly 1 million use e-cigarettes daily."
Among those in agreement that the FDA has much more to do is Scott Gottlieb, M.D., former commissioner of that agency, who told The Washington Post(www.washingtonpost.com) that the new policy would deliver "a limited impact" against teen nicotine use.
Gottlieb, the story added, "said all pod-based products -- including menthol and tobacco flavors -- should be blocked and only the open-tank products left on the market for adult users."
Gottlieb's emphasis on limiting ENDS sales to those at least 21 years old echoes advice the Academy sent him a year ago.
"The AAFP does not support the use of ENDS in any form as a formal cessation option or therapeutic nicotine product," the AAFP told Gottlieb in a December 2018 letter.(3 page PDF)
The administration's new rule fails to meet the challenges of ENDS products, LeRoy said in the statement, which called on the FDA to expand the policy by banning menthol flavors and all forms of mixing fruit flavors for use in e-cigarettes.
"Only by enforcing such a comprehensive prohibition can we expect to eliminate nicotine addiction among our young people," LeRoy said.
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