Just 10 minutes from my office, there's a trendy hangout for teens and adults, women and men. Like any good coffee shop, this place has cozy seating, eye-catching décor and more than 180 enticing flavors; this month's specialty is a minty vanilla.
This is no coffee shop, though. It is part of the rapidly-exploding marketplace for e-cigarettes.
E-cigarettes, and the furtively named "vaping" industry it has spawned, are a mostly uncharted territory of the public health landscape that is finally -- finally -- getting some guidance from the Food and Drug Administration.
The FDA took its first step into these murky waters last week by proposing rules to ban the sale of these nicotine-delivery devices to minors and to require health warnings on them. Makers also would have to register products and their ingredients with the FDA, get FDA approval before marketing, make reduced risk claims only if there's supporting scientific evidence and proven public health benefits, and couldn't give away free samples.
It's a good start. Yet it is important to note that it is only a start.
- Where is a ban on advertising?
Click on TV or radio, flip through a magazine or newspaper, cruise across a highway or the information superhighway and you're bound to see it -- ads for e-cigarettes. While cigarette ads have been forced off TV and radio since the early 1970s, and other forms of advertising and marketing have gone away, campaigns for these new devices are everywhere. They are powerful, too, tapping into proven realms of marketing gold: cool and sexy, risqué and rebellious.
The FDA has left open a door that it needs to shut. It only makes sense to do it now, before this upstart industry develops icons like Marlboro Man or, worse yet, a kid-friendly character such as Joe Camel.
- Where is a restriction on flavorings?
With offerings made to taste like candies, fruits and even drinks such as coffee and root beer, e-cigarettes are dangerously appealing to kids. For instance, the store with the 180-plus flavors boasts, "Have your dessert anytime," over an image of a sweet, nutty treat. As if a name like Chocolate Fudge Brownie isn't enticing enough (for children of any age, really), the accompanying picture is further illustration of this challenging wrinkle.
As adults, we must be especially wary of anything and everything (words, images and tastes) that portrays these nicotine-delivery devices in a kid-friendly way.
- To be guided by facts, we need to collect them.
E-cigarettes only have been around in the United States since 2007, so there's a built in limit to how much long-term research is available. This is obviously an obstacle, but also an opportunity to get it right from the start.
An ambitious research agenda exists, which is encouraging. Yet we need to remain vigilant to ensure a flowing pipeline of projects adequately funded by unbiased sources. Because this subject is becoming so popular, making it easy to generate attention, we also must be certain that headlines only go to the studies done by the most trustworthy sources.
E-cigarettes are battery-operated tubes used to inhale aerosol from liquid nicotine and other additives. Instead of lighting up, users push a button. They then inhale the aerosol and exhale a puff of smoke. They aim to provide a similar sensation to smoking, and many even look like cigarettes.
The growing popularity of these devices has prompted many local governments to take action, often banning their use in places where anti-smoking (clean air) laws already exist. This, too, is a good start, a best practice for more cities and other entities to follow.
Now we need more from the federal level. We've been working to get to this point (proposed oversight rules) since 2009, when Congress passed the Tobacco Control Act.
In the interim, we've seen not only a proliferation of the devices, but also in the places to acquire them. They seem to be popping up everywhere, from high-end to low-end, and -- perhaps most frighteningly -- there are endless opportunities on the Internet, where the FDA's proposed 18-and-over rule will be toughest to monitor.
The challenges are wide and deep. This long-awaited first step heads us in the right direction, but there's still a lot of ground to cover.