US denies authorization to many vaping products

The US drug regulator on Thursday denied market authorization to a number of vaping products after finding they failed to show that smoking cessation benefits to adults outweigh risks posed to youth.

The products included flavors, such as "Apple Crumble," "Dr Cola" and "Cinnamon Toast Cereal" by companies JD Nova Group, Great American Vapes, and Vapor Salon.

It comes as the Food and Drug Administration (FDA) is nearing a court-ordered September 9 deadline for submission of applications to remain on the market under new stricter rules that are reshaping the industry.

"Congress gave the FDA the authority to regulate tobacco products to protect the public from the harmful effects of tobacco use through science-based regulation," said Acting FDA Commissioner Janet Woodcock.

"We know that flavored tobacco products are very appealing to young people, therefore assessing the impact of potential or actual youth use is a critical factor in our decision-making about which products may be marketed." 

The products denied authorization may not be delivered to the market, or have to be removed if they have already reached shelves.

In all, the FDA has received applications from over 500 companies.

No decisions have so far been announced about the companies with the leading market share, Juul Labs and Reynolds American which makes Vuse e-cigarettes. 

E-cigarettes entered the US market in 2007 and have been the most commonly used tobacco product among American youths since 2014.

To curb youth vaping, the FDA last year barred flavors from smaller e-cigarettes that use pods, such as those made by market leader Juul.

Tank-based rechargeable vaping devices, primarily sold in vape shops, were left exempt.

US lawmakers also raised the federal minimum age for tobacco and e-cigarette sales from 18 to 21 in December 2019. 

About 3.6 million young people in the US were current (in the past 30 days) e-cigarette users in 2020, down from 5.4 million in 2019, according to the National Youth Tobacco Survey.

Agence France-Presse

Vaping kills a 15-year-old in Texas

Cases of lung illness and deaths from vaping have tapered off since peaking in September, health officials said on Thursday, but the outbreak also reached a grim new milestone: The youngest death, of a 15-year-old, was reported by Dallas County Health and Human Services.

The teenager had “a chronic underlying medical condition,” Texas officials said in a statement on Dec. 31, but they did not identify the condition, the patient’s gender or what products the patient had been vaping.

“Reporting a death in a teen due to Evali is so tragic,” Dr. Philip Huang, the Dallas County health director, said in a statement, referring to the official name for the disorder, E-cigarette or Vaping-Associated Lung Injury. “We are seeing that severe lung damage, and even death, can occur with just short-term use of these products.”

The statement said that one teenager in the Dallas area who was hospitalized with the illness reported having vaped for only one month.

Nationwide, there have been 2,602 cases of the illness and 57 deaths as of Tuesday, the Centers for Disease Control and Prevention reported on Thursday. The median age of those who died was 51, with a range of 15 to 75 years. Before the Texas teenager’s death, the youngest reported vaping fatality was a 17-year-old Bronx resident.

Many of the older patients who died were reported to have underlying health conditions. On Wednesday, Massachusetts reported its fourth death: a man in his 70s from Middlesex County who had vaped THC, state health officials said.

Although the outbreak seems to be slowing, states are still reporting new cases every week, and more deaths are being investigated, the CDC said.

Most patients had vaped THC, the high-inducing chemical in marijuana. The CDC said the cause of their lung damage was very likely to be vitamin E acetate, an oily substance added to stretch the supply of THC. Laboratories have found the vitamin in illegal THC products and in fluid samples from patients’ lungs.

How vitamin E acetate could injure the lungs is not known. Researchers have suggested that it might disrupt a natural substance in the lungs called surfactant, which helps keep air sacs open and is essential for breathing. Another possibility is that the vitamin oil, when heated in a vaping device, may break down into a powerful toxin that leaves the lungs with damage similar to the chemical burns seen in war victims attacked with poison gas.

Though much of the evidence points to THC, health officials say that does not mean nicotine vaping can be considered safe.

“While it appears that vitamin E acetate is associated with Evali, there are many different substances and product sources that are being investigated, and there may be more than one cause,” the CDC says on its website. “Therefore, the best way for people to ensure that they are not at risk while the investigation continues is to consider refraining from the use of all e-cigarette, or vaping, products.”

It adds: “There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.”

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US unveils partial ban on flavored e-cigarettes

WASHINGTON—The US government on Thursday announced it would soon ban most flavored e-cigarettes as it tries to curb a rising tide of youth vaping, but stopped short of the full ban promised in September by President Donald Trump.

The Food and Drug Administration said cartridge-based e-cigarettes in flavors "other than tobacco or menthol" would be illegal unless they receive specific authorization from the government.

Companies that do not cease making and selling such cartridges within 30 days will face punishment, the FDA said.

"The United States has never seen an epidemic of substance use arise as quickly as our current epidemic of youth use of e-cigarettes," Health Secretary Alex Azar said in a statement.

Azar said prioritizing flavors most widely used by children would ensure e-cigarettes were a potential "off-ramp" for adult smokers but not an "on-ramp" to nicotine addiction for youngsters. 

"We will not stand idly by as this crisis among America's youth grows and evolves, and we will continue monitoring the situation and take further actions as necessary," he added.

The 2019 National Youth Tobacco Survey shows that more than 5 million US middle and high school students are e-cigarette users, with nearly 1 million using daily. 

"Additional data from another federal survey further underscore that youth are particularly attracted to e-cigarette flavors such as fruit and mint, much more so than tobacco or menthol flavored e-cigarettes," the Department of Health and Human Services said.

The flavor ban will exempt large, tank-based vaping devices, however, which are primarily sold in vape shops that cater to adult smokers.

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Smokers who switch to e-cigarette vapes rapidly boost heart health: study

LONDON - Chronic smokers who switched from tobacco cigarettes to e-cigarette vapes in a large randomized control trial saw a significant improvement in markers of heart health after just a month, researchers said on Friday.

In study results likely to be closely scrutinized by health specialists worldwide, British scientists found that cigarette smokers who switched to nicotine-containing vapes saw a marked boost to their vascular function - a change that could lead to a significantly lower risk of cardiovascular disease.

“By switching from cigarettes to e-cigarettes we found an average percentage point improvement of 1.5 within just one month,” Jacob George, a professor of cardiovascular medicine and therapeutics at Britain’s Dundee University, told a briefing about the study.

“And to put that into context, each percentage point improvement in vascular function results in a 13% reduction in cardiovascular event rates, such as heart attack.”

Jacob stressed, however, that the study looked specifically at vaping compared with tobacco smoking, which causes lung and other cancers and sharply increases the risk of deadly strokes, heart attacks and many other cardiovascular diseases.

“It is crucial to emphasize that e-cigarettes are not safe, just less harmful than tobacco cigarettes when it comes to vascular health,” George said. “They should not be seen as harmless devices for non-smokers or young people to try.”

The findings, published in the Journal of the American College of Cardiology, will fuel further international debate about the potential risks and benefits of e-cigarettes amid more than 2,000 cases of vaping-related lung illness and more than 40 deaths in the United States in recent months.

U.S. Centers for Disease Control and Prevention experts say their investigations suggest the injuries are linked to vapes containing THC - the component of marijuana that gets people high - and Vitamin E acetate, which is believed to be used as a cutting agent in illicit THC vaping products.

British addiction and toxicology experts said last month that the American vaping illnesses were most likely “a U.S.-specific phenomenon,” and there was no evidence of a similar outbreak in Britain or elsewhere where the suspect products were not widely used.

For the Dundee-led switching trial, which took two years and was funded by the British Heart Foundation charity, researchers recruited 114 long-term cigarette smokers who had smoked at least 15 cigarettes a day for at least two years.

They were put into one of three groups for a month and had vascular testing before and after. One group stuck to tobacco cigarettes, the second switched to e-cigarettes with nicotine, and the third switched to e-cigarettes without nicotine.

The results showed that, whether or not the e-cigarettes contained nicotine, those who switched away from tobacco smoking found their endothelial function - a measure of how easily blood flows around the body - was significantly improved.

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Facing 'certain death', boy, 17, with vaping injury gets double lung transplant

A 17-year-old boy whose lungs were irreversibly damaged by vaping received a double-lung transplant at the Henry Ford Hospital in Detroit, a lifesaving measure taken when a patient’s own lungs are diseased or damaged beyond repair and there is no other hope of survival, doctors said Tuesday.

Without the transplant, performed last month, the patient “would have faced certain death,” Dr. Hassan Nemeh, who led the surgical team, said during a news conference at the hospital.

The patient’s lungs were scarred, stiffened, pocked with dead spots and extremely inflamed, he said. On a CT scan before the surgery, the patient’s chest appeared almost empty, as if the lungs had vanished. Normal lungs look dark on imaging because they are full of air; the patient’s were not visible because they were not working. There was no air.

“What I saw in his lungs is like nothing I’ve seen before, and I’ve been doing lung transplants for 20 years,” Nemeh said. He added, “This is an evil I haven’t faced before.”

The patient is recovering well and is up and about now, but still in the hospital. His name is being withheld to protect his privacy, but he and his family wanted to release information about his case in the hope that it might persuade other people to quit vaping or never start, hospital officials said.

A doctor at the briefing read a statement from the family, which said, in part:

“We asked Henry Ford doctors to share that the horrific life-threatening effects of vaping are very real! Our family could never have imagined being at the center of the largest adolescent public health crisis to face our country in decades.

“Within a very short period of time, our lives have been forever changed. He has gone from the typical life of a perfectly healthy 16-year-old athlete — attending high school, hanging out with friends, sailing and playing video games — to waking up intubated and with two new lungs, facing a long and painful recovery process as he struggles to regain his strength and mobility, which has been severely impacted.”

The doctors declined to say what products the patient had been vaping, how long he had been doing it or how often. About 86% of the patients with lung injuries in this outbreak had vaped THC, the chemical in marijuana that makes people high.

The case is the first transplant reported in the nationwide outbreak of vaping-related lung injuries, and it highlights the severity of an illness that, as of Nov. 5, had sickened 2,051 people and killed 40. Researchers have described the lung damage from vaping as chemical burns, similar to the injuries in people who have inhaled toxic fumes in industrial accidents, or in soldiers attacked with mustard gas in World War I.

The patient was first admitted to a different hospital on Sept. 6 with what was thought to be pneumonia. His condition worsened and he was placed on a ventilator on Sept. 12. He continued to deteriorate. On Sept. 17, he was transferred to a second hospital, where he was connected to a machine that delivers oxygen directly to the bloodstream.

His health continued to decline, and in early October, he was transferred to Henry Ford Hospital, where he was put on the waiting list for a lung transplant. A national organization sets the criteria for eligibility, not individual hospitals. Several factors quickly pushed him to the to top of the list, Nemeh said: He was a child, the lung damage was irreversible and he would die without the transplant.


The surgery was performed on Oct. 15. The doctors said they could not reveal any information about the source except to say that the donor had been healthy.

Health officials investigating the outbreak described a major advance last week: Researchers found a “very strong culprit,” a form of vitamin E, in the lungs of patients who had the vaping illness. The substance, vitamin E acetate, is sometimes used by illicit sellers to “cut” or dilute THC and increase profits.

Finding the chemical in the lungs meshed with earlier investigations that had already found it in vaping products.

The vitamin compound is thick and sticky. Precisely how it might damage the lungs is not yet known, and health authorities say it is still possible that other chemicals added to vaping fluids may also contribute to lung disease.

The doctors in Detroit did not say whether vitamin E acetate had been found in the patient’s lungs.

“We’re going to see more of this,” said Dr. Mangala Narasimhan, a lung specialist at Long Island Jewish Medical Center and Northwell Health’s regional director of critical care, who has treated several severe cases of the illness. “We definitely see some patients who have such severe lung damage, we are thinking that some of it might not be completely reversible.”

None of her patients have needed transplants.

In general, lungs for transplantation are difficult to obtain, she said. “A huge number of patients die waiting.”

About 2,500 lung transplants were performed in the United States in 2018, compared with more than 21,000 kidney transplants.

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Trump wants to raise minimum age for vaping to 21

US President Donald Trump on Friday said he supported raising the minimum age for the purchase of e-cigarettes from 18 to 21 as part of a plan to curtail youth vaping.

But he also indicated that he was concerned about over-regulation on business, a sign the administration is considering stepping back from a previously announced complete ban on flavored e-juices popular among adolescents.

The federal minimum age for purchasing tobacco products is 18, but 18 states and the District of Columbia have set their minimum age at 21.

Raising the federal minimum age requires an act of Congress, and the cause has attracted bipartisan support, with one proposed bill co-sponsored by Republican Senate Majority Leader Mitch McConnell.

"We're going to be coming out with a very important position on vaping," Trump told reporters. "We have to take care of our kids most importantly, so we're going to have an age limit of 21 or so." 

He added that a policy paper would be issued next week.

The administration announced in September it would soon ban flavored products, but it appeared lobbying efforts by the vaping industry may have changed that position.

"We have a lot of people to look at, including jobs frankly," said Trump. "It has become a big industry. We're going take care of it."

- Health fears -

The vaping industry is facing unprecedented scrutiny amid a mysterious epidemic of lung conditions linked to e-cigarette use that has killed 39 and sickened more than 2,000 mostly young people in the US in recent months.

Investigators say no single substance is behind the outbreak, which has been named "e-cigarette or vaping product use associated lung injury" or "EVALI".

But preliminary work has linked a cutting agent used in cannabis flavorings, usually sold on the black market, to lung injury.

Vaping is increasingly popular among youth, with a government survey this week finding that more than five million middle and high school students reported using e-cigarettes in the past 30 days, an all-time high.

Youth vapers overwhelmingly chose flavors like mint, mango, cream, fruit and cucumber, unlike people who are trying to quit smoking and turn to tobacco flavored pods.

The proposed flavor ban has caused an outcry among vaping businesses, who argue they strictly ID their customers to confirm their age.

White House adviser Kellyanne Conway told reporters earlier this week vape shops may be exempted.

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Juul suspends US sales of some flavored e-cigarettes

WASHINGTON - The leading American maker of electronic cigarettes, Juul Labs, announced Thursday it is suspending sales of some flavored vaping products in the United States, as the US government prepares a nationwide ban.

Juul will stop selling mango, cream, fruit and cucumber flavored pods, while federal health authorities finalize new regulations on vaping, Juul said in a statement. Its tobacco, menthol and mint-flavored products will still be available.

"We must reset the vapor category by earning the trust of society and working cooperatively with regulators, policymakers and stakeholders to combat underage use while providing an alternative to adult smokers," Juul CEO CK Crosthwaite said.

The debate over regulating e-cigarettes comes amid a mysterious epidemic of lung conditions linked to vaping that has claimed the lives of at least 33 people in 24 states.

The latest tally by the Centers for Disease Control and Prevention puts the number of confirmed or probable lung injury cases at 1,479 as of October 15.

THC, the active ingredient in cannabis, was involved in more than 3 quarters of cases in which patients reported using e-cigarettes in the 3 months prior to their injuries.

E-cigarettes have soared in popularity among young people since they were introduced about a decade ago, according to multiple surveys.

The industry defends vaping as a healthier alternative to cigarettes that can help people quit smoking. But lawmakers around the country, and overseas, are seeking to impose total or partial bans.

President Donald Trump's administration has chosen the path of barring flavored e-cigarettes, including the popular mint and menthol flavors.

Health Secretary Alex Azar announced plans for a ban in September. The text has not been made public yet but will soon be, according to the Federal Drug Administration, which is responsible for regulating tobacco and e-cigarettes.

Juul assured that it would not challenge the FDA's coming regulations, but its action Thursday indicates it believes its mint and menthol flavored products should be authorized.

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US health officials expect 'hundreds more' cases of vaping-related illness

WASHINGTON, United States—Hundreds more Americans have been sickened by a severe vaping-related illness, with the official tally set to be updated on Thursday, according to a US health official speaking at a congressional hearing on Tuesday.

The House of Representatives began public hearings this week about the mystery lung disease that, as of last week, had sickened 530 people in 38 states. The illness has also claimed the lives of 9 people.

"We believe that probably hundreds more (cases) have come in since the numbers we released last week," said Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention (CDC).

The outbreak prompted Massachusetts on Tuesday to impose a 4-month ban on sales of all vaping products, including those used for tobacco and marijuana, which is legal in the state.

The move goes further than New York state and Michigan, which earlier this month banned the sale of flavored vaping products, out of concern that those products appeal to children.

E-cigarettes, which operate by heating a liquid to form an inhalable vapor, have been popular for nearly a decade in the United States.

At Tuesday's hearing Schuchat noted that latest-generation vaping devices use "nicotine salts" that boost the amount of the addictive substance that reaches the brain, presenting a particular risk to younger consumers, whose brains are still developing.

"It feels like that's kind of vaping on steroids," said Representative Raja Krishnamoorthi, chairman of the subcommittee on economic and consumer policy, as he called for further investigation.

Schuchat emphasized that the CDC has still not identified any specific product or compound - including tetrahydrocannabinol (THC), the high-inducing component of marijuana, or Vitamin E acetate - that is linked to all cases of the illness.

The CDC, which has activated its emergency operations center to coordinate an investigation, has advised that people quit vaping if they can.

A man over age 50 who used e-cigarettes died in Kansas as state health officials prepared to join the waves of experts testifying before Congress on Wednesday, Kansas Governor Laura Kelly announced.

“Today, I am saddened to announce the death of a second Kansan in association with this outbreak,” the governor said in a statement, noting the man had underlying medical conditions.

At Tuesday's subcommittee hearing, Dr. Ngozi Ezike of the Illinois Department of Public Health urged Congress to ban flavored vaping products, "which are particularly targeted to young people."

On Wednesday, the acting commissioner of the Food and Drug Administration will appear before a House Energy and Commerce subcommittee and be asked about the public health threats of e-cigarettes.

For those who continue vaping, public health officials urge consumers to avoid buying vaping products on the street, using marijuana-derived oil with the products or modifying a store-bought vape product.

The House Oversight Economic and Consumer Policy subcommittee's probe began in the summer, and so far has focused on the role e-cigarette maker Juul Labs Inc played in what the panel's chairman, Representative Raja Krishnamoorthi, an Illinois Democrat, has called a "youth vaping epidemic."

At Tuesday's hearing Representative Mark DeSaulnier, a Democrat from California, called Juul "shameless" in terms of the amount of information it has given to lawmakers.

In addition to Juul, in which Altria Group Inc has a minority stake, leading makers of nicotine e-cigarettes include British American Tobacco Plc and Imperial Brands Plc .

On Wednesday, health officials from Michigan, North Carolina, Kansas and Massachusetts will appear before the Energy and Commerce Health subcommittee along with Schuchat and the FDA's Norman Sharpless.

The FDA has warned Juul that it violated regulations because it marketed its vaping products as less risky than traditional cigarettes.

The popularity of e-cigarettes has now grown to the point where 1 in 4 12th-graders reported vaping a nicotine product during the previous 30 days. It is nearly 1 in 10 for 8th-graders, a study by the University of Michigan in Ann Arbor reported last week.

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India bans e-cigarettes as vaping backlash grows

NEW DELHI, India - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide about a technology promoted as less harmful than smoking tobacco.

The announcement by India came a day after New York became the second US state to ban flavored e-cigarettes following a string of vaping-linked deaths.

"The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes heat up a liquid -- tasting of anything from bourbon to bubble gum or just tobacco, and which usually contains nicotine -- into vapor which is inhaled.

The vapor is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.

They have been pushed by producers, and also by some governments including in Europe as a safer alternative -- and as a way to kick the habit.

However, critics say that apart from being potentially harmful in themselves, the flavors of some liquids have turned millions of children into vapers -- and potential future smokers.

The emergency legislation in New York, the second US state to ban flavored e-cigarettes, followed a mysterious outbreak of severe pulmonary disease that has killed 7 people and sickened hundreds.

President Donald Trump's administration announced last week that it would soon ban flavored e-cigarette products to stem a rising tide of youth users.

Legislation is also being tightened elsewhere, and in Singapore, e-cigarettes are already outlawed. In Japan, vaping and alternatives like "heat not burn" tobacco vaporizers are allowed but e-juices with nicotine are not.

China, home to almost a third of the world's smokers, indicated in July that it wants the "supervision of electronic cigarettes" to be "severely strengthened".

Big E-Tobacco

The Indian ban covers the production, manufacture, import, export, transport, sale, distribution, storage of e-cigarettes, as well as advertisements.

The government said it would "advance tobacco control efforts" and "contribute to a reduction in tobacco usage." Punishments include up to a year in prison.

Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.

"Big Tobacco" has been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and smoking bans, particularly in the West.

In 2018 Altria, the US maker of Marlboro and Chesterfield splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.

Big killer

According to the World Health Organization, India is the world's second-largest consumer of traditional tobacco products, which are not covered by the new ban, killing nearly 900,000 people every year.

Some 35 percent of adults are users, although chewing tobacco -- which can also have flavors like chocolate and which also causes cancer -- is more prevalent than smoking.

India is also the world's third-largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.

According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.

India also exports around a billion dollars worth of tobacco annually, and the government holds stakes in tobacco firms including ITC, one of India's biggest companies.

"I feel it's absolutely absurd," Aronjoy, 22, a student and occasional vaper, told AFP in a shop selling e-cigarettes.

"The government believes from my perspective that it's alright to smoke cigarettes... which is much more injurious for our health that vaping would be."

The Association of Vapers India said the government's move "indicates it is more concerned about protecting the cigarette industry than improving public health". 

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New York state bans flavored e-cigarettes over vaping concerns

NEW YORK - New York became the second US state to ban flavored e-cigarettes Tuesday, following several vaping-linked deaths that have raised fears about a product long promoted as less harmful than smoking.

A health council passed emergency legislation proposed by Governor Andrew Cuomo outlawing flavored vaping products amid an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.

The ban comes into force with immediate effect. Michigan became the first state to declare a ban earlier this month, but that law has yet to be implemented.

"It is undeniable that vaping companies are deliberately using flavors like bubblegum, Captain Crunch and cotton candy to get young people hooked on e-cigarettes -- it's a public health crisis and it ends today," said Cuomo.

President Donald Trump's administration announced last week that it would soon ban flavored e-cigarette products to stem a rising tide of youth users.

The move could later be extended to an outright prohibition of vaping if adolescents migrate to tobacco flavors, seen as more legitimate products that help smokers quit their habit, said the Food and Drug Administration (FDA), which regulates e-cigarettes.

"New York is not waiting for the federal government to act, and by banning flavored e-cigarettes we are safeguarding the public health and helping prevent countless young people from forming costly, unhealthy and potentially deadly life-long habits," Cuomo added.

POPULAR WITH ADOLESCENTS

Shops in New York now have two weeks to remove vaping products from their shelves. The ban does not prohibit menthol or tobacco-flavored e-cigarettes.

E-cigarettes have been available in the US since 2006 and are sometimes used as an aid to quit smoking traditional tobacco products like cigarettes.

Their use among adolescents has skyrocketed in recent years: some 3.6 million middle and high school students used vaping products in 2018, an increase of 1.5 million on the year before.

The Centers for Disease Control and Prevention (CDC) recently that there were now more than 450 possible cases of pulmonary illness associated with vaping in the US.

The CDC has cautioned against vaping as officials investigate the precise cause of the deaths. No single substance has been found to be present in all the laboratory samples being examined.

New York's health department found very high levels of vitamin E oil in cannabis cartridges used by dozens of people in the state who had fallen ill after using e-cigarettes.

Vitamin E is a commonly used nutritional supplement but is dangerous when inhaled.

San Francisco, the home of market leader Juul Labs, became the first American city to ban e-cigarettes in June last year.

The FDA has warned Juul to stop advertising itself as a less harmful alternative to smoking, noting in particular the company's attempts to attract young people.

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New York to ban flavored e-cigarettes after illnesses, deaths

NEW YORK - New York Governor Andrew Cuomo on Sunday announced a ban on all flavored e-cigarettes besides tobacco and menthol in response to a recent nationwide spate of sometimes deadly lung illnesses that US health officials have linked to vaping.

Cuomo said vaping was dangerous and that he was concerned fruit- and candy-flavored e-cigarettes were leading young people to get hooked on nicotine.

"These are obviously targeted to young people and highly effective at targeting young people," the Democratic governor said at a news conference in Manhattan.

Nearly 400 people around the country have been stricken with a lung illness that is potentially vaping-related, according to the US Centers for Disease Control and Prevention. Six have died.

Investigators are still trying to understand what causes the illnesses. Meanwhile, health officials have warned people against buying vaping products on the street or using marijuana-derived oil. They have said people should avoid inhaling vitamin E acetate, an ingredient found in some vaping products.

In New York, the state's health commissioner, Howard Zucker, will formally ban flavored e-cigarettes besides tobacco and menthol during an emergency meeting of the state's Public Health and Health Planning Council this week, Cuomo said.

Under state law, the council can vote to issue or amend certain regulations affecting public health.

New York would be only the second state in the nation to introduce such a ban. Michigan did so earlier this month. On Wednesday, the Trump administration announced plans to remove all flavored e-cigarettes from store shelves.

Sales of e-cigarettes are banned in New York to people under 18 years old, an age that will rise to 21 in November. Cuomo said he has told state police to increase enforcement against sales to underage people. 

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Amid US vaping crackdown, Juul enters China with online store openings

SHANGHAI - US e-cigarettes maker Juul Labs Inc, which faces a widening crackdown on vaping at home, has entered China, with online storefronts on e-commerce sites owned by Alibaba Group and JD.com to tap the world’s largest market of smokers.

Juul, in which tobacco giant Altria Group owns a 35 percent stake, has been launching its products in international markets such as South Korea, Indonesia and Philippines. It recently raised over $750 million in an expanded funding round.

The US government announced plans on Wednesday to remove all flavored e-cigarettes from store shelves, as officials warned that sweet flavors had drawn millions of children into nicotine addiction.

The move comes as US health officials are investigating a handful of deaths and potentially hundreds of lung illnesses tied to vaping.

A notice published on Juul's official virtual store on Tmall, an Alibaba e-commerce site, said it had opened on Sept. 9. Juul also had a similar store on JD.com, another major Chinese online retailer.

On Tmall, a Juul device with 2 flavor pods sells for 299 yuan (about $40). Flavors include mint, mango and strawberry.

Juul, Tmall and JD.com did not immediately respond to requests for comment on Thursday.

China, which is the world's largest single market for tobacco consumption with over 300 million smokers, represents a market with both opportunity and risk for the company.

It is already home to dozens of Chinese competitors with names such as Relx, Yooz, and SNOW+ that have taken tens of millions of dollars in venture capital funding from high-profile investors. Like Juul, the competitors have adopted the concept of producing discrete devices that vaporize potent nicotine salts.

China's government has perennially launched anti-smoking campaigns in an effort to improve public health. Earlier this year it released a draft document suggesting that China’s laws regulating e-cigarettes will eventually largely resemble those in Europe.

China’s tobacco industry, meanwhile, is tightly controlled by the government-run monopoly China Tobacco, which maintains complete oversight on the sale, production and distribution of tobacco products. Beijing relies on tobacco sales for a sizable percentage of China’s overall tax revenue.

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US billionaire Bloomberg pledges $160 million to fight vaping

NEW YORK - Billionaire and former New York mayor Michael Bloomberg on Tuesday announced a $160 million campaign to ban flavored e-cigarettes in the United States following a spike in vaping deaths.

At least 5 people have died in the US recently after vaping in an outbreak that has sickened hundreds with severe pulmonary disease and left several teenagers in induced comas.

"This is an urgent health crisis, and tobacco companies are behind it," said Bloomberg, a long-time anti-smoking activist who banned smoking in New York bars and restaurants when he was mayor in the early 2000s.

"We know Big Tobacco's playbook. We've seen this before. It is targeting kids -- and putting them in serious danger," he added in the New York Times op-ed co-written with Matt Myers, president of the Campaign for Tobacco-Free Kids.

Bloomberg denounced the inaction of the Food and Drug Administration (FDA) and said the money would be spent helping at least 20 cities and states ban all flavored tobacco and e-cigarettes.

E-cigarettes have been available in the US since 2006 and are sometimes used as an aid to quit smoking traditional tobacco products like cigarettes.

Their use among adolescents has skyrocketed in recent years: some 3.6 million middle and high school students used vaping products in 2018, an increase of 1.5 million on the year before.

The Centers for Disease Control and Prevention (CDC) said Friday that there were now more than 450 possible cases of pulmonary illness associated with vaping in the US, double the figure reported the previous week.

The CDC cautioned against vaping as officials investigate the precise cause of the deaths. No single substance has been found to be present in all the laboratory samples being examined.

New York's health department found very high levels of vitamin E oil in cannabis cartridges used by all 34 people in the state who had fallen ill after using e-cigarettes. 

Vitamin E is a commonly used nutritional supplement but is dangerous when inhaled.

San Francisco, the home of market leader Juul Labs, became the first American city to ban e-cigarettes in June last year.

The FDA has warned JUUL to stop advertising itself as a less harmful alternative to smoking, noting in particular the company's attempts to attract young people.

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Vaping-related lung illnesses: What you need to know

Hundreds of people across the US have been sickened by a severe lung illness linked to vaping, and a handful have died, according to public health officials. Many were otherwise healthy young people, in their teens or early 20s. Investigators from numerous states are working with the federal Centers for Disease Control and Prevention and the Food and Drug Administration in an urgent effort to figure out why.

Here’s what we know.

WHO IS AT RISK?

Anyone who uses e-cigarettes or other vaping devices, whether to consume nicotine or substances extracted from marijuana or hemp, may be at risk because investigators have not determined whether a specific device or type of vaping liquid is responsible.

The Food and Drug Administration is warning that there appears to be a particular danger for people who vape THC, the psychoactive chemical in marijuana. The FDA said a significant subset of samples of vaping fluid used by sick patients included THC and also contained a chemical called vitamin E acetate.

The FDA issued this statement: “Because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”

But some of the patients who have fallen severely ill said they did not vape THC. In 53 cases of the illness in Illinois and Wisconsin, 17 percent of the patients said they had vaped only nicotine products, according to an article published Friday in The New England Journal of Medicine.

The researchers who wrote the journal article cautioned, “e-cigarette aerosol is not harmless; it can expose users to substances known to have adverse health effects, including ultrafine particles, heavy metals, volatile organic compounds and other harmful ingredients.”

The health effects of some of those chemicals are not fully understood, the researchers wrote, even though the products are already on the market.

WHAT ARE THE SYMPTOMS?

The early symptoms include fatigue, nausea, vomiting, coughing and fever, escalating to shortness of breath, which can become so extreme it can prompt an emergency room visit or require hospitalization.

Some patients have needed supplementary oxygen, including a ventilator in as many as a third of cases analyzed in The New England Journal of Medicine.

On lung scans, the illness looks like a bacterial or viral pneumonia that has attacked the lungs, but no infection has been found in testing.

WHAT'S THE BEST WAY TO PREVENT THE ILLNESS?

Health officials say that the riskiest behavior is using vaping products bought on the street instead of from a retailer, or those that have been tampered with or mixed.

Mitch Zeller, director for the Center for Tobacco Products at the FDA, said, “If you’re thinking of purchasing one of these products off the street, out of the back of a car, out of a trunk, in an alley, or if you’re going to then go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice.”

The CDC and some state health officials have recommended that people give up vaping of any type until the cause of the lung damage is determined.

An editorial in The New England Journal of Medicine stated bluntly that doctors should discourage their patients from vaping.

E-cigarettes and other vaping devices were developed to help cigarette smokers quit their dangerous habit by providing a way to satisfy their nicotine addiction without inhaling the toxins that come from burning tobacco. But many medical experts now think even smokers should think twice about turning to e-cigarettes — and anyone who does not smoke should not vape.

“Adult smokers who are attempting to quit should consult with their health care provider and use proven treatments,” the authors of the analysis in The New England Journal of Medicine wrote.

They added, “Irrespective of these findings, e-cigarettes should never be used by youths, young adults, pregnant women and adults who do not currently use tobacco products.”

What should I do if I think I have the lung illness?

The CDC says: “If you are concerned about your health or the health of a loved one who is using an e-cigarette product, contact your health care provider, or your local poison control center at 1-800-222-1222.”

Anyone who has shortness of breath that lasts more than a few hours or becomes severe should seek medical attention quickly. It is a warning that should not be ignored, doctors say.

Why do health investigators think this is linked to vaping?

Health investigators believe the illnesses are linked to vaping for several key reasons: The patients have vaped nicotine or marijuana extracts, or both, and do not have an infection or other condition that would explain the lung disease. Patients are now characterized as having the illness only if they have reported vaping within 90 days. In many of the reported cases, the patients had vaped much more recently.

E-CIGARETTES HAVE BEEN AROUND FOR YEARS. WHY IS THIS HAPPENING NOW?

There are several theories. One is that some dangerous chemical or combination of chemicals has been introduced into the pipeline of vaping products. Public health officials believe that when people vape this noxious cocktail, it sets off a dangerous, even lethal, reaction inside the lungs. These officials have said repeatedly that they do not yet know which substance or device may be causing this reaction, and that is the subject of their urgent investigation.

A second theory is that this syndrome is not, in fact, entirely new and that some people had gotten sick previously, but that the condition had not been recognized and identified as being linked to vaping. As vaping has grown in popularity — both with nicotine and marijuana — more cases may be showing up.

For the time being, though, public health officials seem to believe that the first theory is more likely and they are hunting for a substance, substances or process that might explain the surge in illnesses.


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LA County resident dies of lung illness, fifth US death possibly tied to vaping

A Los Angeles County resident has died from a lung illness possibly tied to vaping, bringing the total number of such US deaths to five, health officials said on Friday.

Officials are warning against e-cigarette use as the exact cause of any link between vaping and the lung condition remains unknown.

The unidentified person was described as an older adult who had chronic underlying health conditions and was one of 12 cases of people in Los Angeles County experiencing severe and sudden lung disease after a history of vaping, said Muntu Davis, Los Angeles County Department of Public Health officer.

"Our recommendation... is that if you don't have to vape, don't do it right now. There really is a lot of unknowns. There is a lot of information that needs to be gathered," he said during a news conference.

Deaths have also been confirmed in Illinois, Indiana, Minnesota and Oregon, the US Centers for Disease Control and Prevention (CDC) said on Friday. In addition, the agency is probing 450 cases of lung illness that may have been caused by e-cigarette use around the country.

The CDC said the total count of confirmed cases of illness linked to vaping remained at 215, the same as its update last month, but a number of other cases of lung illnesses remained under investigation.

Staff from health agencies, including the US Food and Drug Administration (FDA), said they have not linked the illnesses to any specific e-cigarette product or any particular substance in the e-cigarettes.

The CDC said no evidence of infectious diseases has been identified and therefore the lung illnesses are likely associated with a chemical exposure.

"Something has to be done. There's not enough regulation. There's not enough action taken by our politicians," said Tim Johnson during a news conference in Illinois on Thursday after his daughter fell ill with a lung illness believed to have been caused by vaping.

"We may have dodged a bullet with our daughter."

E-cigarettes are generally thought to be safer than traditional cigarettes, which kill up to half of all lifetime users, according to the World Health Organization. But the long-term health effects of vaping are largely unknown.

Juul, in which Altria Group Inc. has an over 30-percent stake, is the dominant e-cigarette maker in the US market.

The New England Journal of Medicine published a study showing 84 percent of 53 patients with lung illnesses in Illinois and Wisconsin reported using tetrahydrocannabinol (THC), the psychoactive component of cannabis, in e-cigarettes.

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San Francisco bans sales, manufacture of e-cigarettes

LOS ANGELES - San Francisco on Tuesday became the first major US city to effectively ban the sale and manufacture of electronic cigarettes, as concerns grow over a sharp rise in vaping among youths.

The city's legislature unanimously approved an ordinance suspending the sale in shops or online of e-cigarette products that lack approval by federal health authorities. No such approvals currently exist.

Backers said the ban was necessary due to the "significant public health consequences" of a "dramatic surge" in e-cigarette use among teenagers.

But the move triggered a swift backlash from critics who say it could drive former smokers back to conventional cigarettes.

US health authorities are alarmed by the rise in popularity of e-cigarettes, battery-powered devices that enable users to inhale addictive nicotine liquids that are often fruit flavored.

The potential health consequences of vaping, including fears it could stunt adolescent development, remain largely unknown, in part because the practice is so new.

The number of young Americans using e-cigarettes grew by 1.5 million in 2018, with about 3.6 million middle and high school students using vaping products.

San Francisco is home to market-leading e-cigarette maker Juul.

City Attorney Dennis Herrera, who co-sponsored the ban, said it closed a loophole that the federal U.S. Food and Drug Administration should have tackled long ago.

"E-cigarettes are a product that, by law, are not allowed on the market without FDA review," he said in a statement after the second and final vote to implement the ban.

"For some reason, the FDA has so far refused to follow the law. If the federal government is not going to act, San Francisco will."

'DEADLY CIGARETTES'

The city's mayor London Breed has 10 days to sign the legislation -- which she has said she will do -- with the ban due to take effect seven months later.

"We need to take action to protect the health of San Francisco's youth and prevent the next generation of San Franciscans from becoming addicted to these products," Breed said in a statement Tuesday ahead of the vote.

She added that e-cigarette companies were "targeting our kids in their advertising and getting them hooked on addictive nicotine products."

But critics say the legislation will make it harder for people seeking alternatives to regular cigarettes.

E-cigarettes do not contain the cancer-causing products found in tobacco.

An editorial in the Los Angeles Times noted that regular cigarettes were still for sale in San Francisco, arguing that "it's bad public health policy to come down harder on the lesser of two tobacco evils."

Juul said in a statement following the vote that the ban would "drive former adult smokers who successfully switched to vapor products back to deadly cigarettes, deny the opportunity to switch for current adult smokers, and create a thriving black market."

The manufacturer called instead for stricter regulation and enforcement including proof-of-age identification.

'INCREASE RISK'

Traditional "Big Tobacco" companies have increasingly marketed "smoke-free" products like e-cigarettes as far less harmful alternatives to the deadly habit they have long been peddling.

But experts point out that it took decades to determine that smoking tobacco -- which accounts for more than seven million premature deaths worldwide every year -- is truly dangerous.

The San Francisco ordinance text said that nicotine exposure during adolescence "can harm the developing brain" and "can also increase risk for future addiction to other drugs."

It would introduce fines of up $1,000 for each violation by vendors.

Unlike an e-cigarette ban in force in Singapore, the San Francisco legislation does not restrict the use of vaping products -- only sales, manufacturing and distribution.

Recreational cannabis use has been legal for adults in California since January last year.

amz-ban/ft

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Vaping may boost pneumonia risk: study

PARIS, France – Vaping may help pneumonia-causing bacteria stick to cells lining the airways, likely boosting disease risk, researchers said Thursday.

A study published in the European Respiratory Journal did not directly compare vaping's effect to that of smoking tobacco cigarettes.

But the findings did suggest that users of electronic cigarettes may be at higher risk of lung infection than people who do not vape, the research team reported.

"If you choose to take up e-cigarettes... this indicates a red flag that there may be an increased susceptibility" to pneumococcal bacteria, study co-author Jonathan Grigg of the Queen Mary University of London told AFP.

Grigg and a team conducted three types of experiment. One exposed human nose lining cells to e-cigarette vapor in the lab, another involved mice inhaling vapor and then being exposed to pneumococcal bacteria, the main cause of pneumonia.

A third trial studied the nose lining of 11 e-cigarette users compared to six non-vapers.

The team noticed a sharp increase in the amount of bacteria sticking to airway cells after e-cigarette exposure. Such adhesion has previously been shown to increase susceptibility to disease.

"Some people may be vaping because they think it is totally safe, or in an attempt to quit smoking, but this study adds to growing evidence that inhaling vapor has the potential to cause adverse health effects," said Grigg.

"By contrast, other aids to quitting such as (nicotine) patches or gum do not result in airway cells being exposed to high concentrations of potentially toxic compounds."

- Less harmful? – 

Last month, a US study said vaping may increase cancer risk because it leads to DNA damage, despite containing fewer carcinogens than tobacco smoke.

That study, too, did not compare the effects of cigarette smoking directly to vaping.

Research in the journal Tobacco Control last October said a large-scale switch from tobacco to e-cigarettes would prevent millions of premature deaths by the year 2100, even assuming the gadgets are themselves not risk-free.

E-cigarettes, said to contain no tar and fewer toxins than tobacco cigarettes, were developed as a safer alternative to tobacco smoking.

But many people fear that a harmless veneer may make e-cigarettes a "gateway" for young people to lifelong nicotine addiction.

Commenting on the latest study, Peter Openshaw, an experimental medicine professor at Imperial College London, said any evidence that vaping raised lung infection risk was "only indirect".

"Although it is possible that vaping might increase susceptibility to pneumonia, the effect is likely to be lower than from smoking itself," he said via the Science Media Centre.

"This study should not be used as a reason to continue to smoke rather than vape –- the evidence to date is that e-cigarettes are far less harmful than smoking."

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Study of cancer-causing toxins finds e-cigarettes much safer than smoking

Consuming e-cigarettes is far safer and less toxic than smoking conventional tobacco cigarettes, according to the findings of a study analyzing levels of dangerous and cancer-causing substances in the body.

Researchers found that people who switched from smoking regular cigarettes to e-cigarettes or nicotine replacement therapy (NRT) such as gum or patches for at least six months had much lower levels of toxins in their saliva and urine than those who continued to smoke.

"Our study adds to existing evidence showing that e-cigarettes and NRT are far safer than smoking, and suggests that there is a very low risk associated with their long-term use," said Lion Shahab, a specialist in epidemiology and public health at University College London who led the work.

E-cigarettes, which heat nicotine-laced liquid into vapor, have grown into an $8 billion-a-year market, according to Euromonitor International - more than three times that of NRT products. They are, however, still dwarfed by a tobacco market estimated by Euromonitor to be worth around $700 billion.

Many health experts think e-cigarettes, or vapes, which do not contain tobacco, are a lower-risk alternative to smoking and potentially a major public health tool.

But some question their long-term safety and worry that they may act as a "gateway" to taking up conventional cigarettes. The U.S. surgeon general in December urged lawmakers to impose price and tax policies that would discourage their use.

Monday's study, published in the journal Annals of Internal Medicine, analyzed saliva and urine samples from long-term e-cigarette and NRT users as well as smokers, and compared levels of key chemicals found in their bodies.

It found that smokers who switched completely to e-cigarettes or NRT had significantly lower levels of toxic chemicals and carcinogens compared to people who continued to smoke tobacco cigarettes.

Those who used e-cigarettes or NRT but did not completely quit smoking did not show the same drop in toxin levels. This underlined that a complete switch was needed to get the long-term health benefits of quitting tobacco, the researchers said.

The World Health Organization says tobacco is the world's biggest preventable killer, with a predicted cumulative death toll of a billion by the end of this century if current trends continue. Tobacco smoking currently kills around 6 million people a year.

Kevin Fenton, national director of health and well-being at the government authority Public Health England, said the findings held a clear message for tobacco smokers.

"Switching to e-cigarettes can significantly reduce harm to smokers, with greatly reduced exposure to carcinogens and toxins," he said in a statement. "The findings also make clear that the benefit is only realized if people stop smoking completely and make a total switch.

"The best thing a smoker can do, for themselves and those around them, is to quit now, completely and forever."

(Reporting by Kate Kelland; Editing by Kevin Liffey)

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Experts fear e-cigarettes fuel teen addiction

E-cigarettes can be an effective tool for smokers aiming to kick their tobacco habit, but officials fear the devices are also creating nicotine addiction among adolescents
.
"E-cigarettes show tremendous promise as a tool for helping smokers who don't respond to other approaches for quitting smoking," Wilson Compton, deputy director of the US National Institute on Drug Abuse, said Friday, during a presentation with other health officials.

 "What concerns us is very recent data from the US showing surprising high rates of e-cigarette use by teenagers," he said, speaking at the annual meeting of the American Association for the Advancement of Science, in California.

A recent annual survey of more than 40,000 US high school students showed that in the last month, 8.7 percent of 14-year-olds had used the battery-operated devices that deliver vaporized nicotine into an aerosol inhaled by the user.

And the number only increased with age: 16.2 percent of 16-year-olds and 17.1 percent of 18-year-olds had done the same.

"That's a concern because this may be a unique and new pathway to nicotine exposure," Compton said.

In recent months, the US Centers for Disease Control and Prevention (CDC) reported that use of e-cigarettes by young non-smokers had tripled from 2011 to 2013, and warned that nicotine can affect brain development in teenagers.

The US Food and Drug Administration (FDA) in April proposed restrictions on the country's $2-billion e-cigarette industry, such as requiring sellers to enforce a minimum age.

- 'Far less dangerous' -

"Nicotine can be harmful to the growing brain, so it's best if young people avoid it," said Deborah Arnott, head of Britain-based nonprofit Action on Smoking and Health (ASH).

"But if they're going to experiment, it's better to use e-cigarettes, as vaping is far less dangerous than smoking and much less addictive," she said.

"So far in the UK and the US, smoking rates are going down more than e-cigarette use is growing. This would not be the case if vaping really were a gateway into smoking," Arnott added.

In the study of 40,000 US teenagers, only four percent of 14-year-olds, seven percent of 16-year-olds and 14 percent of 18-year-olds had smoked real cigarettes in the last month.

E-cigarettes play an important role in helping users quit or reduce smoking, according to the latest research published in December by the Cochrane Collaboration, an independent, international organization that evaluates medical research.

The group conducted two studies showing that around nine percent of those using e-cigarettes were able to stop smoking for at least a year, while only four percent of those who used placebo e-cigarettes were able to.

Among those who were unable to quit smoking, 36 percent of those using e-cigarettes were able to cut their tobacco consumption by half, compared to 28 percent in the placebo group.

"There are likely public health benefits from e-cigarettes if they provide a pathway for smokers to give up tobacco use," said Roy Harrison, professor of environmental health at Britain's University of Birmingham.

"There is evidence that this can happen, and little doubt that e-cigarettes are much less harmful to the smoker than tobacco," he said.

"However, if adolescents who have never used tobacco take up e-cigarette use, this is a matter of profound concern as they are deliberately exposing themselves to a highly addictive substance."

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