Marcia Frellick

June 09, 2014

CHICAGO — Physicians came together to urge the American Medical Association (AMA) to oppose the marketing and sales of electronic (e)-cigarettes and nicotine-delivery products to minors and to support regulation of the marketing of tobacco and drug-delivery devices.

The battery-operated devices that vaporize liquid nicotine are marketed as a more socially acceptable and healthier alternative to smoking.

The resolution, presented by a House of Delegates committee here at the AMA 2014 Annual Meeting, proposed that the AMA push for restrictions such as minimum age for purchasing, childproof packaging and design, and stronger product label warnings.

According to the Centers for Disease Control and Prevention, from September 2010 to February 2014, the number of calls to poison centers involving e-cigarettes rose from 1 per month to 215 per month, said Susan Baldassari, MD, a primary care physician from Buffalo, New York. She spoke in favor of tighter controls on behalf of the New York delegation. She said she hears stories of children who have been attracted to the bubblegum and fruit flavors of e-cigareettes who are then poisoned by a toxic dose of nicotine.

The "chaos, contradiction, and divisiveness" among e-cigarette makers, researchers, academics, and physicians was described by James Felsen, MD, MPH, a public health physician in Great Cacapon, West Virginia. "It's gotten nasty," he reported.

He said he agrees with the concept of restricting marketing to minors, but the reality is that the effort will be futile as long as children have access to the Internet.

The US Food and Drug Administration (FDA) has issued a proposed rule that would extend the agency's authority to cover products that meet the legal definition of a tobacco product, such as e-cigarettes. Several physicians urging tighter controls pointed out that the deadline for comments on the issue is July 9.

A recent study, reported by Medscape Medical News, found that science doesn't support claims that e-cigarettes help people quit; however, conclusions on whether the product is safe and whether it can lead to addiction are lacking.

What is clear is that the use of e-cigarettes is skyrocketing, said Jonathan Klein, MD, FAAP, a Chicago pediatrician and associate executive director of the American Association of Pediatrics.

The use of e-cigarettes "went from less than 2% to almost 14% of the population in the last 2 years," he said. In addition, "data have shown that users include never-smokers and distant or former smokers, people who have quit more than 5 years ago. These are not cessation products."

He warned that even if the FDA begins to classify e-cigarettes as a tobacco product, there is a 2-year window during which manufacturers can market them as they wish before being subjected to full regulation.

Dr. Klein said a critical component of the AMA policy should be to address the length of that window and the potential for harm during that time to young smokers, former smokers, and people inhaling second-hand vapor.

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