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E-cigarettes were unregulated for a decade. Experts say the people who vape are now paying the price. Getty Images
  • Federal officials are investigating e-cigarette companies in light of lung illnesses in more than 800 people who vape.
  • Experts note that the e-cigarette industry was unregulated from 2006 to 2016.
  • Experts also say e-cigarette companies used strategies employed by the tobacco industry in the 1950s to market their vaping products.

The number of teens vaping nicotine has doubled in the past 2 years.

One of the top vaping manufacturers, Juul, saw its sales increase from 2 million devices to 16 million devices from 2016 to 2017.

But with the surge in popularity of e-cigarettes and other vaping products has come a rash of hospitalizations.

The Centers for Disease Control and Prevention (CDC) reported today that more than 800 people have now been affected by a mysterious vaping-related lung illness. That includes 12 deaths in 10 states.

As a result, the Food and Drug Administration (FDA) has begun a criminal probe into e-cigarette companies.

The Trump administration has also directed the agency to ban most flavored vaping products.

In the wake of all this, Juul announced this week that it would stop advertising its e-cigarette products in the United States. It also replaced its current CEO with a veteran of the tobacco industry.

“When they came out several years ago, people were thinking that vaping was a healthier form of tobacco delivery. But that had never been analyzed or reviewed,” Dr. Robert Y. Goldberg, a pulmonologist with Mission Hospital in Orange County, California, told Healthline.

“Vaping devices were not FDA regulated. So, a large population of smokers as well as nonsmokers were using these devices, and the smokers, they thought it would be an easy way to get off nicotine or cigarettes,” he said.

“The FDA has been tasked now with regulating these products, but all the products that are out there currently can have significant dangerous chemicals,” Goldberg added.

While prototype devices that vaporized nicotine have existed as far back as the late 1970s, e-cigarettes as we know them today hit the U.S. market in 2006.

They were pitched as smoking cessation devices. That has led some experts to ask why the FDA didn’t regulate the devices until 2016.

“That is a very good question that should be asked of the surgeon general, FDA commissioner, and head of [the Health and Human Services Department] between 2007 and 2016,” Dr. Neil Schachter, a professor of medicine, pulmonary medicine, and environmental and public health at Mount Sinai Medical Center in New York City, told Healthline.

“Unlike other smoking cessation aids such as Nicorette, Wellbutrin, and Chantix, whose makers had to provide extensive safety and efficacy data to the FDA to make such a claim, no such requirements were made of e-cigarettes,” he said.

The FDA has made some strides in the past few years, most recently issuing a proposed ruling that would codify the content, format, and FDA review procedures for premarket tobacco product applications (PMTAs) — ensuring e-cigarette products are safe before making it to market.

“When finalized, this proposed rule will help to ensure that PMTAs contain sufficient information for evaluation such as details regarding the physical aspects of a tobacco product and information on the product’s potential public health benefits and harms,” the agency said in a press release.

“Juul, which accounts for approximately 70 percent of the e-cig market, marketed its product as the final, lasting solution for smokers who cannot seem to quit,” Bridget Doherty, a staff writer at, told Healthline.

“This marketing strategy, while effective, was not backed by any scientific evidence, and the FDA issued a warning letter to Juul in September 2019,” she said.

But that may simply be too little too late.

As it stands, rules and regulations for sale of e-cigarettes vary from state to state and county to county, Schachter says.

“Given that 50 percent of e-cigarettes are bought online, state and local regulations have little effect on sales,” he said.

Marketing nicotine products as healthy, regardless of the weight of scientific evidence, has similarities to the playbook that Big Tobacco companies themselves used in the 1950s.

“I have an old ad for Camels, which has a doctor in hospital whites saying, ‘Nine out of 10 doctors recommend Camels,’” Schachter said. “This is parallel to marketing that recommends e-cigarettes as healthier than cigarettes and/or an effective tool for smoking cessation.”

Schachter also compares the glitz and glamour of cigarette marketing in movies, magazines, and other pop culture with the e-cigarette industry’s effective marketing to teens and young adults in the digital space.

“Today, heavy social media campaigns, especially on Instagram, show young people smiling and partying while holding an e-cigarette,” he said. “The difference is in the increased ability of brands to infiltrate culture with social media.”

Perhaps that’s one reason why the past 5 years have seen the major tobacco companies buy e-cigarette companies outright or significant stakes in them.

For instance, Lorillard, which makes Newport, Old Gold, and Kent, bought Blu e-cigarettes in 2012. RJ Reynolds launched Vuse e-cigarettes in 2013. Altria purchased a 35 percent stake in Juul for $12 billion in 2018.

Even if the FDA does effectively crack down on vaping products, that might just drive teens and adults back to cigarettes, many experts worry.

Suddenly, tobacco companies owning a big stake in the vaping market makes a lot of sense to some experts.

“I don’t think people realize is that the amount of nicotine that is delivered via vaping is much higher than that of cigarette smoke, and nicotine is one of the most addictive chemicals out in our environment,” Goldberg said.

“As a result, it’s possible we’re going to have a rebound in teen cigarette usage,” he said. “Because now you have a large population of children and teens who have become addicted to nicotine through vaping, and they’re going to have to meet their addiction.”

“It’s going to be interesting to see how the population of cigarette smokers changes over the next several years,” Goldberg added.