It's About the Kids

Co-authored by Louis W. Sullivan, M.D., U.S. Secretary of Health and Human Services from 1989 to1993 and President Emeritus, Morehouse School of Medicine.

The National Institute on Drug Abuse recently released its 2014 Monitoring the Future survey. For the first time, electronic cigarette use was included in the survey. What did the survey find? That e-cigarette use among teenagers has surpassed the use of traditional cigarettes. A senior investigator on the survey commented that "e-cigarettes have made rapid inroads into the lives of American adolescents." This is most certainly the result of the Food and Drug Administration's failure to regulate e-cigarettes in the same way as traditional cigarettes. And the "inroads into the lives of American adolescents" made by e-cigarettes will only get deeper given recent developments in the industry.

Big Tobacco now controls e-cigarettes. In 2012 Lorillard, maker of Newports, got to market first with its acquisition of the brand blu. In 2014 two of the other Big Tobacco companies had nationwide rollouts of their own. Altria, maker of Marlboros, rolled out MarkTen e-cigarettes while Reynolds, maker of Camels, rolled out its electronic Vuse cigarettes. Each company reportedly spent in excess of $150 million on their e-cigarette rollouts. The success of Altria's MarkTen and Reynolds' Vuse has been credited with turning the tide on electronic cigarette sales at convenience stores: after several months of declines, dollar sales are now up for consecutive months.

We must remember these are the same companies found guilty of nearly 150 counts of mail and wire fraud in a continuing "pattern of racketeering activity" with the "specific intent to defraud" the public under the Racketeer Influenced Corrupt Organizations (RICO) Act. While that case had to do with marketing of traditional cigarettes, can it be doubted that these companies will use the same sorts of tactics in marketing their e-cigarettes?

After capturing a sizeable market share among white males, Big Tobacco set its sights on women, blacks and adolescents. In the 1920s, advertising targeted at women appeared with slogans like "Mild as May" and female celebrity endorsements. In the 1950s and 1960s, blacks became the target for menthol cigarette advertising after a slight disparity in preference for menthols in that community was noted. Today, that disparity is anything but slight. In the 1980s, Joe Camel was born and Reynolds' saw a dramatic increase in its share of the adolescent cigarette market.

Big Tobacco knows that the earlier a person begins using tobacco products, the greater the likelihood of developing addiction to nicotine. They also know that the early years of smoking are critical for establishing brand loyalty. And they know that young people are their main source of replacement smokers for those lost to death, illness or cessation. All of this applies equally to electronic cigarettes. So let's not be naïve: it's about the kids.

Regulation is needed urgently to prevent a repeat performance by Big Tobacco. Our youth in particular need to be protected, given the disturbing trend of increased teen use of e-cigarettes and the accompanying potential rise in nicotine addiction. The same restrictions applicable to the sale, distribution and promotion of traditional cigarettes must be made applicable to e-cigarettes: restrictions on misleading advertising and that which targets youth, restrictions on brand name sponsorship of sporting and other events such as music festivals, restrictions on sales to minors, vending machine sales and the distribution of free samples where underage youth may be present, and, most importantly, restrictions on the sale of flavored e-cigarettes.

If it is true, as claimed by the e-cigarette industry, that their goal is simply to promote cessation of traditional cigarettes, so-called "harm reduction," let them be regulated as cessation drug products. But none of the e-cigarette companies are formally making the claim to have a tobacco cessation product. Why? If all current smokers switch to electronic cigarettes and no new smokers start smoking either traditional or electronic cigarettes, where will the industry be? That's a business plan for extinction - not the basis for a $150 million per product launch. Big Tobacco may be as old as the dinosaurs, but extinction is not on their mind; the next generation of smokers is - whether traditional or electronic. It's about the kids.

Louis W. Sullivan, M.D.
Joseph A. Califano, Jr.

Louis W. Sullivan, M.D. was U.S. Secretary of Health and Human Services from 1989 to 1993 and is President Emeritus, Morehouse School of Medicine.

Joseph A. Califano, Jr. is founder of National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia). He was Secretary of Health, Education, and Welfare from 1977 to 1979 and President Lyndon Johnson's Chief Assistant for Domestic Affairs from 1965 to 1969.