Some flavours of e-liquid should be treated as guilty until proven innocent, two U.S. cancer associations have suggested.
“ENDS [electronic nicotine delivery systems] and ENDS liquid containing candy and other youth-friendly/youth-oriented flavors should be banned unless there is evidence demonstrating these products do not encourage youth uptake,” the American Association for Cancer Research (AACR) and American Society of Clinical Oncology (ASCO) said in a joint statement.
Although there have been proposals in many countries – including the U.S. – for bans on flavours, the two professional associations’ is unusual in that it seems to suggest that only specific ones should be targeted.
“Research shows that flavored tobacco is particularly appealing to youth, and some flavored combustible products potentiate continued use and addiction. There is concern that flavored ENDS may have a similar effect on youth,” according to an article published in the AACR’s Clinical Cancer Research to coincide with the release of the organisations’ policy statement.
Whatever it takes
Calling on the Food and Drug Administration (FDA) to move ahead with its proposed regulation of e-cigarettes, the two associations also advocate that the FDA should use “other appropriate authorities” to regulate ENDS that it cannot classify as tobacco products, which is the rationale for its planned measures on e-cigs.
And they say that “ENDS use should be prohibited in places where combustible tobacco product use is prohibited by federal, state, or local law until the safety of secondhand aerosol exposure is established”.
“Internet and other mail-order sellers of ENDS should be required to check the age and identification of customers at the point of purchase and delivery,” they add.
Their statement echoes a similar call made last year by the American Medical Association (AMA). Other bodies such as the American Heart Association (AHA) have been gentler in their tone, while still expressing concern that possible risk to minors needs to be balanced with any positive roles for e-cigs, and stressing the urgency of federal-level regulation.
Less unusual suggestions from the AACR and ASCO include registration of manufacturers and reporting of products and ingredients to the FDA; safety labels on packaging and advertising; restrictions on sale to minors; and mandatory child-proof caps for all e-liquid containers. Most of those measures are already included in the FDA’s proposed regulations.
What This Means: The associations do acknowledge that ENDS have a potential role in smoking cessation, and that more research is needed. Their article gives welcome details on a wide range of topics for examination, and they say research should be funded by taxation on tobacco products and e-cigs.
But the tenor of their approach is overwhelmingly negative. While it is difficult to see how the ban they propose on supposedly child-friendly flavours could actually work – how would appeal specifically to minors be defined? what proof would be required to lift the prohibition? – this is a reminder that much of the health establishment in the U.S. remains strongly in the anti-e-cig camp, and that pressure on the FDA to implement or even go beyond the regulations it released in 2014 is not likely to let up.
– Barnaby Page ECigIntelligence staff
Photo: Hannah Nicole