Teens hospitalized and health officials say it's linked to vaping. How will the FDA respond?

SALT LAKE CITY — Shortness of breath, coughing and fatigue: These were just a few of the symptoms that landed 14 teenagers in the hospital in Illinois and Wisconsin in late July and early August. Eleven of them have severe lung disease, and health officials are saying the cases were caused by vaping.

Thomas Haupt of the Wisconsin Department of Health Services told CNN that the teens were "otherwise normally healthy, and they were coming in with severe respiratory illnesses, and in some cases, they actually had to go to the intensive care unit and were placed on ventilators."

Electronic cigarettes have been touted as safe alternatives to regular cigarettes and a pathway to quitting for adult smokers — at least, by the companies who make them. Current FDA regulations prohibit sales of the products to anyone under 18, but critics say the current and proposed rules don't go far enough, and the latest hospitalizations will likely kick off more calls for tighter restrictions.

Juul, the most popular e-cigarette on the market, states on its website that its mission is to "improve the lives of the world's one billion adult smokers by eliminating cigarettes." However, the brand is especially popular among young people. As one teen told the New Yorker, "I'm always surprised when I see an adult with a Juul."

Research conducted by JAMA Pediatrics concluded that 45% of Juul's Twitter followers were not old enough to legally buy the products.

Regulating e-cigarettes has traditionally been framed as a choice between the well-being of adult smokers and the teenagers who find vaping, but not necessarily cigarettes, appealing. One Vice article put it this way: "Are they after adult smokers trying to get off cigarettes and searching for an alternative, like vaping, to accomplish that? Or is the company seeking out teenagers and other young people who have never smoked before and see Juul as a fresh, technologically savvy way to get a nicotine rush?"

Craig Mitchelldyer, Associated Press

In this April 16, 2019 file photo, a woman exhales while vaping from a Juul pen e-cigarette in Vancouver, Wash.

The question may be a moot point if electronic cigarettes turn out to be just as harmful as their traditional counterpart.

"It's not safer than cigarettes. That's a common thought out there. It doesn't just release vapor, water vapor, that's something else that people think. It's releasing a lot of different harmful chemicals," Sarahjean Schluechtermann with Wisconsin's Winnebago County Health Department told WBAY-TV.

The FDA has also never approved e-cigarettes as cessation devices or confirmed that they are a "modified risk tobacco product."

And a study conducted at the University of Carolina found that two of the main ingredients found in e-cigarettes are "toxic to cells and that the more ingredients in an e-liquid, the greater the toxicity," according to the American Lung Association.

After the young people in Wisconsin were hospitalized, Andrea Palm, the state Department of Health Services secretary, told the Milwaukee Journal Sentinel, "We strongly urge people to avoid vaping products and e-cigarettes."

Some have grown frustrated with the FDA's slow-moving actions on e-cigarettes. In June, San Francisco took matters into its own hands and banned the devices outright, at least until the products are finally approved by the FDA. San Francisco officials told Wired that the ban was meant to send a message to regulators to "do what's required under the law" and they felt federal authorities had "abidcated" their duty to determine the safety of the devices.

In a press release, Juul protested the ban, claiming, "This effective prohibition will drive former adult smokers who successfully transitioned to vapor products back to combustible cigarettes, deny current adult smokers the opportunity to move off combustible use altogether, and create a thriving black market instead of addressing the actual causes of underage access and use."

Anti-smoking groups are frustrated that the FDA has given e-cigarette companies until 2022 to submit applications for approval. According to a UCSF Center for Tobacco Control Research and Education post, a federal court ruled in May that the 2022 deadline and allowance of the products to remain on the market during consideration was an abdication of duty. Anti-smoking groups are pushing to have e-cigarette manufacturers' applications for FDA approval in and processed as soon as possible.

The director of UCSF's tobacco research center, Stanton Glantz, argued in the post, "While some smokers do successfully use e-cigarettes to stop smoking cigarettes, for the population as a whole, smokers who use e-cigs are less, not more, likely to quit smoking, i.e., for most people, e-cigs keep smokers smoking."

If the health problems of the young adults and teens in Wisconsin and Illinois are definitively shown to be caused by e-cigarettes, that could further cast doubt over the safety of e-cigarettes. And if the FDA doesn't take more rigorous action, more states and cities could start instituting their own bans, following in San Francisco's steps.

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