FDA Poisons the Promise of E-Cigarettes With Its Latest No-Context Report

 

The FDA Center for Tobacco Products on June 23 published a report titled, “E-Cigarette–Associated Cases Reported to Poison Centers.”  Examining data for the most recent full year, they found that the total (n=7,043) represented “a further increase in the number of e-cigarette exposure cases, particularly among children aged <5 years” (6,074 cases or 88% of the total).

The document wrongly implies the existence of a poisoning nightmare: “Health care providers; the public health community; e-cigarette manufacturers, distributors, sellers, and marketers; and the public should be aware that e-cigarettes have the potential to cause poisoning exposure and are a continuing public health concern.” 

Furthering its effort to eliminate e-cigarettes and vaping products, the agency published its data with no context, and amplified it with a sky-is-falling press release (here).  Following is that missing context with full-year numbers from the most recent National Poison Data System annual report.

In 2021, there were 2,080,917 cases of human exposure reported to poison centers.  The five substances most frequently involved were analgesics (283,000), household cleaning products (189,000), cosmetics/personal care products (148,000), antidepressants (142,000) and sedatives/hypnotics/antipsychotics (116,000).  With the exception of cleaning products, those exposures total 689,000 cases, and the FDA has direct regulatory authority over all of them.

The NPDS report also traces deaths, and for e-cigarettes/vaping products there was one death.  For the other three FDA-regulated categories there were 804 deaths (720 for analgesics, 10 for cosmetics, 44 for antidepressants and 30 for sedatives). 

Tobacco products were involved in 13,142 cases, or just 0.63% of all poisonings, and e-cigarettes’ share of the total was 0.26%.   

Now let’s look at children age 5 years and under. (The FDA report defines this category as “under 5 years,” whereas the poison reports use “5 years and under;” I’ll use the latter.).  There were a total of 883,822 exposures, and cosmetics/personal care products took 1^st place (96,000), followed by cleaners (94,000), analgesics (72,000), dietary supplements/herbals/homeopathic (62,000) and foreign bodies/toys/miscellaneous (57,000).  Compared with poisonings at all ages, tobacco products had a slightly larger share of children’s exposures (n=10,249), at 1.17%; the e-cigarettes share was 0.47%. 

The FDA report furthers the agency’s misinformation campaign casting vaping as a public health crisis.     

 

Poison Control Centers' Data Puts E-Cigarette Exposure Risk in Perspective

The journal Pediatrics recently reported that “there were more than 8,200 calls to US poison centers regarding exposures to liquid nicotine and e-cigarettes among children younger than 6 years of age from January 2012 through April 2017, averaging 129 calls each month or more than 4 a day.” (here) As I previously noted (here), annual exposures (which were 1,548 according to the Pediatrics article) should be considered in appropriate perspective. 

While the journal article acknowledged that e-cigarette exposures “decreased by about 20% from 2015 to 2016,” its senior author called for additional regulation.  If children’s exposure to products should guide regulatory priorities, the following chart from the American Association of Poison Control Centers (2016 report available here) may be instructive.

Non-Pharmaceutical Exposures Reported To Poison Control Centers in the U.S., 2016
Product Category	Number Among Children Under 6 Years	Number Among All Ages	Deaths Per 100,000 Exposures*
Cosmetics, personal care products	136,004	180,065	3
Household cleaners	111,445	179,828	13
Foreign bodies	65,864	90,667	1
Pesticides	33,458	77,573	22
Plants	27,565	45,150	24
Arts, crafts, office supplies	20,096	27,319	0
Deodorizers	17,398	21,266	14
Essential oils (clove, etc.)	13,264	18,997	0
Tobacco	11,358	13,319	0
Cigarettes	6,331	6,699	--
E-Cigarettes	2,075	2,827	--
Chewing tobacco	1,220	1,357	--
Other	1,732	2,436	--
Foods, additives, spoilage	10,839	33,909	9
Alcohols	9,562	22,289	117
Chemicals	9,328	33,910	80
Gasoline, other hydrocarbons	8,821	27,807	76
Bites, venom	6,708	46,989	15
Paint, strippers	6,601	12,238	0
Batteries	5,483	9,651	41
Adhesives, glue	4,692	9,622	0
Fumes, vapors	3,673	31,337	214
Fertilizers	2,759	4,590	80
Other	35,859	94,024	44
All	540,777	980,550	26

* All Ages

Of the half million exposures among children under 6 years of age recorded by poison control centers in 2016, 45.8% involved cosmetics, personal care products or household cleaners, while e-cigarettes accounted for just 0.4%. 

Looking at product-related deaths per 100,000 exposures, rates were highest for fumes and vapors (which included carbon monoxide) and for alcohols, but there were no deaths recorded for tobacco exposures, including e-cigarettes.

Public health generally and children’s health in particular may benefit from regulatory reform that is keyed to demonstrated risk exposure.