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Iowa's attorney general, who helped lead the charge against tobacco companies more than two decades ago, believes e-cigarettes could help further disrupt the industry and save lives.
Even in light of vaping-related illnesses around the country, Tom Miller told The Gazette he still believes products from e-cigarette manufacturers can help individuals quit tobacco - but should be kept out of the hands of teens and young adults.
'We should do everything we can to keep kids from e-cigarettes without keeping adult smokers away from e-cigarettes,” Miller said.
Miller said he is supportive of setting the legal age to purchase e-cigarettes at 21.
He also believes tightening the marketing of these products and pushing more education efforts on potential adverse effects of vaping would be beneficial.
Miller, a Democrat, was part of the 1998 landmark settlement between 46 states, including Iowa, and the four largest tobacco manufacturers in the country to recover billions of dollars in health care costs associated with smoking-related diseases. In 2017, Iowa's share of that settlement reached $1.1 billion.
Miller cited the thousands of Americans who die each year from tobacco-related disease as the reason why he got involved in the lawsuit negotiations and why, years later, he has aligned himself with San Francisco-based electronic cigarette manufacturer Juul Labs, believing these nicotine delivery systems are the right step in helping Iowans quit tobacco.
'It has the potential to disrupt the tobacco industry as we know it, but more importantly is the lives,” Miller said. 'We could do enormous good among adults by having them switch (to e-cigarettes). That's a big driver for me and it continues to be a big driver for me.”
Hindering the tobacco industry continues to be a motivator for Miller even as the number of vaping-related illnesses continues to rise in Iowa and has resulted in deaths nationwide.
In a letter to federal officials this month, Miller cautioned against over-regulating these products in response to the lung-injury cases.
'We believe the United States is heading for a crisis in this field in 2020 with potentially millions of Americans facing life-threatening regulation imposed by the federal government,” Miller wrote in a letter to the chief of staff at the U.S. Office of Management and Budget.
‘We need to clarify'
The Iowa Department of Public Health has reported 43 total cases of vaping-related illness as of Oct. 25, a sharp increase since August, when officials reported seven total cases.
Of those, 34 patients reported using THC, or tetrahydrocannabinol, the psychoactive component of marijuana, in the vaping devices, public health officials stated.
Similar reports from federal public health officials show most of the 1,600 cases of vaping-related lung injuries in 49 states have been linked to products containing THC. So far, 34 people have died from vaping-related lung illness nationwide.
Neither the Centers for Disease Control and Prevention nor the Food and Drug Administration has determined the cause of these cases, but some reports state they may be linked to vitamin E acetate, a diluting agent used by some in the cannabis industry.
'I think everything points to that black market THC that's causing this, not the standard e-cigarette product that you buy in a convenience store,” Miller said.
Wei Bao, assistant professor at the University of Iowa College of Public Health, echoed Miller's statements that vaping is not always an adverse habit.
'If e-cigarettes are used properly - just by people who need it - it is a very good thing,” he said. 'It's why people have proposed regulation similar to a prescription method. In a sense, people who need these can get these and people who do not need these, there's no way for them to get them.”
Miller does maintain e-cigarettes are good only for adults attempting to quit tobacco use.
'We're neglecting the adult side,” Miller said. 'We're not getting the message out for smokers to switch to e-cigarettes and there's enormous confusion about the health consequences. We need to clarify that.”
Some research does support e-cigarettes as a tobacco cessation tool, but nothing is definitive. A 2019 study published in the New England Journal of Medicine compared vaping with other common nicotine replacements, and their findings support the idea that vaping may help some smokers eventually quit tobacco.
Along comes Juul
However, the challenge for Miller is to maintain access to those who can use e-cigarettes to quit smoking, while at the same time keeping these products away from young adults and teens.
In 2018, he led the initiative with Juul Labs.
Fourteen officials were tapped for the committee, which included former state attorneys general and public health experts, and Juul pledged $30 million to put forth their recommendations. Since then, Juul proposed an action plan that included initiatives to stop certain flavored pod sales and to verify customers' age at purchase.
But use among youth has increased since the committee released its recommendations last year.
The UI's Bao recently published a study in the Journal of the American Medical Association that found e-cigarette use among middle and high school students increased between 2017 and 2018.
According to Monitoring the Future, a National Institutes of Health-funded survey of middle and high schoolers, more than 37 percent of 12th-graders and 32 percent of 10th-graders vaped in 2018. That's nearly a 10 percent increase from the year before for both grades, according to the most recent report.
Rima Afifi, a professor at the University of Iowa College of Public Health, has been conducting surveys of the university's undergraduate students to gain an understanding of e-cigarette habits.
So far in her research, she has seen a rapid uptick in use in just the past few years.
Researchers still are determining what the long-term effects of vaping may have on these individuals, but some studies do point to adverse health effects among young users.
In addition, a 2018 study published in the American Journal of Medicine found e-cigarette use among nonsmokers aged 18 to 30 increased their risk of tobacco use later on more than four times than their peers who did not vape.
'As more and more studies are published, the more it's clear that, for young people, this has the risk of actually reversing the decline of traditional tobacco,” Afifi said. 'There's a new group of young people, who have not even considered tobacco before, who are vaping and then move on to cigarettes.”
Miller added he is not supportive of a ban on vaping products 'because adults would stop using them and not have the benefit of the switch.”
Gov. Kim Reynolds also took a ban off the table last week after a closed-door meeting with experts to discuss health problems associated with vaping.
Other states have taken action against the sale of e-cigarettes and related products. But Reynolds stated after the meeting that it appears educational efforts to inform young Iowans about the potential risks of e-cigarettes were working.
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