AMA House of Delegates

Smokers should "know exactly what they're inhaling," says Atlanta internist Sandra Fryhofer, MD. Photo by Judy Fidkowski-Tetzlaff

AMA meeting: E-cigarettes need FDA regulation, limits on sales

The AMA recommends that electronic cigarettes be classified as drug delivery devices. The Association also supports a ban on smoking in multiunit housing.

By Christine S. Moyer — Posted June 28, 2010

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Testing and safety information on electronic cigarettes is limited, the American Medical Association said, and the devices should be restricted.

The AMA House of Delegates adopted policy at the organization's Annual Meeting in June recommending that e-cigarettes be classified as drug delivery devices that are subject to regulation by the Food and Drug Administration. In addition, state legislatures should prohibit the sale of e-cigarettes and all other nicotine devices that are not FDA-approved, and the products should be covered by smoke-free laws, the policy says.

"I want them subject to [FDA] regulations so people know exactly what they're inhaling," said Atlanta internist Sandra Fryhofer, MD, a member of the AMA Council on Science and Public Health.

The FDA said it detected diethylene glycol, a chemical used in antifreeze that is toxic to humans, during examination of a small sample of cartridges from two leading e-cigarette brands. In several other samples, the agency identified carcinogens in the cartridges, including nitrosamines, which can be found in tobacco smoke.

FDA spokeswoman Siobhan DeLancey said the agency welcomes the AMA's support. The FDA also wants the products regulated as drug delivery devices. She said the agency is in litigation with two e-cigarette firms over the regulatory status of the products. The companies did not return requests for comment as of this article's deadline.


"There is an emerging social justice framework requiring us to protect others from secondhand smoke," says Jonathan Klein, MD, MPH, from the American Academy of Pediatrics. Photo by Peter Wynn Thompson /

Also during the Annual Meeting, delegates debated whether individuals should be banned from smoking tobacco products in multiunit buildings because of the possible adverse health impact on other people who live there.

Jonathan Klein, MD, MPH, associate executive director of the American Academy of Pediatrics and an alternate delegate for the academy, from Elk Grove Village, Ill., noted that multiunit housing often has shared ventilation systems, meaning that smoke can filter into residences where children and nonsmoking adults live.

Tobacco smoke also can move through cracks in walls and floors, through elevator shafts, and along plumbing and electrical lines, according to an article in the June 17 New England Journal of Medicine that advocates a ban on smoking in public housing.

"I'm against smoking and secondhand smoke, and I don't think people should be exposed to it in their apartments. But how do you tell someone they can't smoke in their own house? Some individual rights are in conflict there," said Daniel Koretz, MD, an Ontario, N.Y., internist and alternate delegate for the Medical Society of the State of New York, who spoke on his own behalf.

The Association moved in favor of the greater public health, adopting policy that recommends prohibiting smoking in multiunit housing.

"There is an emerging social justice framework requiring us to protect others from secondhand smoke," Dr. Klein said.

Delegates also adopted policy that advocates for a tobacco-free school environment as defined by the Centers for Disease Control and Prevention. The CDC definition prohibits tobacco smoking, and use of spit or chewing tobacco, by students, faculty, staff and visitors in school buildings, on school grounds and in school buses or other vehicles that transport students. The tobacco ban also applies to off-campus, school-sponsored events.

The AMA policy recommends that the Association provide on its website resources that could help people implement tobacco-free school environments in their communities.

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Meeting notes: Public health

Issue: Despite efforts to educate parents about the safety of vaccines, a 2010 Pediatrics study found that 25% of American parents still believe that some immunizations cause autism in healthy children.

Proposed action: Ask the Office of the Surgeon General to offer a definitive repudiation of the link between either thimerosol-containing vaccines or the measles, mumps and rubella vaccine and developmental disorders, such as autism. [Adopted]

Issue: People of color are significantly affected by skin cancer, but awareness of prevention and screening is low.

Proposed action: Encourage and support efforts that increase awareness of skin cancer risks and sun-protective behavior in communities of color. [Adopted]

Issue: Prescription monitoring programs help physicians track the narcotics their patients are on, but confidentiality rules mean that those medications given as part of opioid treatment programs are not included.

Proposed action: Seek changes to allow states more flexibility in requiring reporting to prescription monitoring programs. [Adopted]

Issue: An increasing number of children and adolescents are being treated with atypical antipsychotic medications, but there is limited evidence on their safety and efficacy in this age group.

Proposed action: Ask the AMA Council on Science and Public Health to prepare a report on the safety and appropriate use of drugs in the pediatric population. [Adopted]

Issue: Unused over-the-counter and prescription drugs are getting into the hands of those who shouldn't have them, such as children. They also are polluting the environment.

Proposed action: Support initiatives designed to promote safe and proper disposal of unused medications. [Adopted]

Issue: Adolescents are not getting enough sleep, and this is leading to a host of health problems.

Proposed action: Identify insufficient sleep and sleepiness in adolescents as a public health issue. [Adopted]

Issue: The adult film industry is an $11 billion industry in the U.S., and performers in this occupation are subject to public health concerns, including multiple sex partners during short periods. More than 2,850 cases of sexually transmitted diseases, including HIV, were diagnosed among 2,000 such performers from 2004 to 2008.

Proposed action: Support legislation that requires mandatory condom use in the production of adult films. That would make it easier for local health departments and the Occupational Safety and Health Administration to investigate and control occupational exposures to infectious diseases and enforce workplace regulations in a timely manner. Urge that occupational standards be enforced to reduce exposure to infectious diseases within the adult film industry. [Adopted]

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External links

"Regulation of Smoking in Public Housing," New England Journal of Medicine, June 17 (link)

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