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

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Chicago -- 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 / www.peterthompsonphoto.com

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.