Taming the 'wild, Wild West' of e-cigarettes

The following opinion piece includes the collective thoughts of several MD Anderson prevention researchers

Recently, the Food and Drug Administration (FDA) took some long-overdue steps when it announced its proposed regulations on electronic cigarettes.

For the past few years, the booming e-cigarette industry, which saw sales jump from $500 million in 2012 to nearly $2 billion today, has operated with little oversight. The FDA’s plan would ban the sale of e-cigarettes to Americans below the age of 18, disclose their ingredients, halt the distribution of free samples and place health warnings on packages explaining that nicotine is very addictive.

Changes would also require the makers of e-cigarettes to register with the FDA and disclose their products’ ingredients, as well as their manufacturing processes. Their plants also would be subject to FDA inspection.

Under the proposed rules, e-cigarette manufacturers won’t be able to make claims about their products being safe alternatives to cigarettes without evidence to support such statements. Without scientific proof, no one can be certain.

We believe the proposal is a good start, but it must go further to curb the allure to young people. Here’s where it falls short: It won’t regulate e-cigarette advertisements on television, a tactic that was banned for cigarettes almost 45 years ago. There will be no restrictions on the use of flavorings, which can entice new users. In addition, online sales still will be allowed, hindering the ability to keep these potentially addictive products out of the hands of children.

It’s been three years since the FDA initially announced plans for regulation. During that time, electronic cigarette use has increased dramatically among teens. The Centers for Disease Control and Prevention reported this past September that the percentage of U.S. middle and high school students using e-cigarettes doubled between 2011 and 2012, from 3% to 7% — about 1.8 million kids.

We compare that data to smoking data: Of the approximately 42 million smokers in America, nearly 70 percent want to stop. That’s almost 29.5 million people — more than the combined populations of the 10 largest cities in the nation. These startling figures speak to the tremendous burden of addiction that comes with smoking.

But as we all know, quitting isn’t easy. Research shows that nicotine may be as addictive as heroin or cocaine. It often takes several attempts to permanently stop smoking. Effective evidence-based smoking cessation interventions include behavioral counseling and pharmacotherapy such as varenicline and nicotine replacements.

Here is what we propose: Standards for safe manufacturing must be established. Unbiased studies must quickly and rigorously investigate e-cigarettes to ensure they are reasonably safe. If studies show they are an effective alternative to cigarettes, the potential benefit would be significant. But science must inform public policy.

In fighting smoking, our country’s most preventable cause of death — 480,000 people annually — we need all the help we can get.

The FDA’s proposals are an encouraging step in the right direction, but there are still far too many questions about e-cigarettes, and not enough answers.