THE PROGNOSIS

Michigan today became the first state ever to ban the sales of flavored e-cigarettes — the latest crackdown by regulators amid an outbreak of vaping-related illnesses and a growing recognition of its threat to the country’s young people.

The ban on retail and online sales goes into effect immediately and applies to vaping products that use sweet, fruity, mint or menthol flavors. The state’s Gov. Gretchen Whitmer complained to my Post colleague Laurie McGinley that e-cigarette companies are using these types of flavors, such as bubble gum and fruit loops, to hook young people on nicotine.

“My number one priority is keeping our kids safe and protecting the health of the people of Michigan,” Whitmer said. 

There’s no doubt e-cigarettes have grown hugely popular (your Health 202 author admits to having puffed once on a mint-flavored e-cig, only to conclude she would rather eat mint ice cream). One in five high school students -- and 1 in 20 middle-schoolers — have used electronic cigarettes in the past month, according to data from the Centers for Disease Control and Prevention.

This raises two troubling issues for policymakers and health advocates to grapple with.

First, there’s strong evidence that e-cigarettes are a gateway for kids to get hooked on other tobacco products. Of kids ages 12 to 17 who have used a tobacco product, about 80 percent started with a flavor such as tutti-frutti, chocolate or watermelon, according to the Journal of the American Medical Association.

“Flavored products have been used to make the poison go down smoother and to attract kids,” Erika Sward, an American Lung Association spokeswoman, told The Post recently. “The tobacco industry has known that for decades.”

Second, while there’s little research on the long-term effects of e-cigarettes, many of the products allow users to ingest far more nicotine than they would with traditional cigarettes. Doctors say this is particularly concerning when it comes to teenagers, because they consume e-cigarettes at a much faster rate than traditional cigarettes.

Some teens consume a pod or more a day, roughly equal to the amount of nicotine in a pack of cigarettes. They’re able to do this because the vapor from e-cigarettes doesn’t burn the throat the same way as smoke and it’s possible to smoke them more discreetly.

And then there are the hundreds of people recently struck with mysterious vaping-related lung illnesses.

Health authorities are investigating on what caused up to 354 possible cases in 29 states, focusing on the potential role of contaminants or counterfeit substances as a likely cause. Officials say culprits could be adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products, The Post’s Lena H. Sun reported with Laurie over the weekend.

Last Friday, the CDC and the Food and Drug Administration issued a statement warning that “anyone who does use e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC or other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer.”

The strange lung illnesses aside, state and federal health regulators say the scale of e-cigarette use among kids requires swift action. Whitmer enacted the ban on sales after her state’s health department found youth vaping a public health emergency, citing studies showing the products contain chemicals and metal particles with unknown long-term effects, Laurie reports.

Whitmer also prohibited what she called misleading descriptions of vapor products as “clear,” “safe” and “healthy” and ordered the enforcement of an existing ban on using billboards to advertise e-cigarettes.

“While Michigan is the first state to prohibit sales of flavored e-cigarettes, several cities and communities have restricted or banned sales of e-cigarettes. In late June, San Francisco became the first major city in the United States to ban the sale and distribution of all e-cigarettes; the ban goes into effect early next year,” Laurie writes.

Industry is acting, too. CVS Health announced yesterday it would invest $50 million toward reducing youth e-cigarette use. Five years ago, the pharmacy pulled tobacco products from its stores and will include smoking cessation programs through Medicaid plans, including through Aetna’s managed Medicaid plans, according to a news release.

"Unfortunately, the trend of tobacco use is increasing among Medicaid recipients, and while many people want to quit, we understand how hard that can be,” CVS Health Chief Medical Officer Troyen Brennan said in a statement. “That's why we believe offering new resources to support efforts to quit will be valuable to many managed Medicaid plans.”

Restricting vaping was a top priority for former FDA head Scott Gottlieb. In March, the agency proposed a policy designed to restrict how and where flavored e-cigarettes are sold. The policy limits sales of fruity and kid-friendly vaping products to stores that bar minors or have separate adult-only sections. It also requires online sellers to tighten age verification and curb bulk sales.

Health advocates have applauded the federal and state actions. Nancy Brown, chief executive of the American Heart Association, called Michigan’s new ban “bold and appropriate.”

“In the absence of robust regulation by the Food and Drug Administration, we know shockingly little about the health impact of e-cigarettes being widely marketed to youth and adults,” Brown said in a statement.

AHH, OOF and OUCH

AHH: Former FDA commissioners and dozens of health groups sent a pair of letters to President Trump and Health and Human Services Secretary Alex Azar to push them to make acting FDA chief Ned Sharpless the permanent head of the agency, Laurie reports.

Sharpless has been leading the agency in the acting capacity since Gottlieb announced his exit in March. Under federal rules, Sharpless can continue serving only until early November.  

“The maneuvering underscored the importance of the FDA job, which is often overlooked in the hyper-political atmosphere in Washington,” she writes. “Headquartered in Silver Spring, Md., the agency regulates a huge slice of products consumed by Americans, from lettuce to e-cigarettes to cancer medications.”

Earlier this summer, it appeared Sharpless was one of three candidates in the running for the permanent gig, including Harvard dermatology professor Alexa Boer Kimball and another unnamed doctor at M.D. Anderson Cancer Center. The two letters say Sharpless is the best candidate for the role. While he is well liked in the research community, he has faced criticism from Democrats for not pushing more aggressively to combat youth vaping.

OOF: New York City says the largest measles outbreak in almost three decades is over, after 654 people were infected, our Post colleague Lena H. Sun reports.

There have been no new cases of measles reported since mid-July.

A 72 percent majority of cases were centered in four Brooklyn neighborhoods, spreading throughout an ultra-Orthodox Jewish community where there was misinformation dispersed about vaccine safety and effectiveness, city officials said.

“The city’s outbreak was the largest in the country, fueling a national increase that has resulted in the greatest number of cases in a single year in 27 years,” Lena writes. “As of Aug. 29, there were 1,234 cases nationwide, according to the Centers for Disease Control and Prevention. This year’s outbreaks represent a huge setback for public health after measles was declared eliminated in the United States in 2000.”

New York City spent more than $6 million amid the outbreak and issued an emergency vaccination order, after which New York City Health Commissioner Oxiris Barbot said there was a marked increase in vaccination coverage. “We are grateful to the New Yorkers who shared the truth about vaccines and protected the health of their friends and neighbors through this outbreak,” Barbot said.

OUCH: The gunman who killed seven people and injured nearly two dozen others in a mass shooting in western Texas over the weekend was banned by federal law from owning or purchasing a firearm after a court had deemed him mentally unfit, the Associated Press’s Paul J. Weber, Jake Bleiberg and Michael Balsamo report. A law enforcement official told the AP that the gunman had failed to buy a gun in 2014 because of a “mental health issue.”

Instead, the gunman sidestepped a federal background check by buying an AR-style rifle through a private sale.

“Online court records show [Seth Aaron Ator] was arrested in 2001 for a misdemeanor offense that would not have prevented him from legally purchasing firearms in Texas,” Paul, Jake and Michael write. “Federal law defines nine categories that would legally prevent a person from owning a gun, which include being convicted of a felony, a misdemeanor domestic violence charge, being adjudicated as a ‘mental defect’ or committed to a mental institution, the subject of a restraining order or having an active warrant.”

— Senate Majority Leader Mitch McConnell (R-Ky.) is making no promises about gun-control measures following the latest mass shooting in West Texas. During an interview with conservative radio host Hugh Hewitt, McConnell said he would be open to bringing gun legislation to the Senate floor as long as Trump supported the measure.

Hewitt asked him about a House-passed measure to expand background checks that has stalled in Congress following the Sandy Hook Elementary School shooting in 2012.

“Well, we’re in discussions about what to do on the gun issue in the wake of these horrendous shootings,” McConnell said. “I said several weeks ago if the president took a position on a bill so that we knew we’d actually be making a law, I’d be happy to put it on the floor.”

“The House, which passed its background checks bill in a 240-to-190 vote earlier in the year, is planning to take up additional gun control bills in the fall,” our Post colleague Colby Itkowitz reports. “The House Judiciary Committee had scheduled to debate the bills this week but postponed its meeting due to Hurricane Dorian.”

OPIOID OPTICS

—  A U.S. district judge has ruled that claims against Purdue Pharma and other drug companies can proceed even as Purdue seeks a nationwide settlement.

“U.S. District Judge Dan Polster, who oversees roughly 2,000 opioid lawsuits by states, counties and cities, said the plaintiffs can try to prove that drugmakers’ deceptive marketing of the painkillers caused a harmful, massive increase in supply that pharmacies and distributors did not do enough to stop,” Reuters’s Jonathan Stempel reports.

The ruling by Polster, which clears the path for the landmark trial scheduled for next month, was one of several other rulings and orders that dismissed requests from drug manufacturers, distributors and pharmacies ahead of the trial.

“A factfinder could reasonably infer that these failures were a substantial factor in producing the alleged harm suffered by plaintiffs,” the judge wrote in the ruling.

— And here are a few more good reads: 

INDUSTRY RX
Business
The changes come after recent shootings at Walmart stores left at least 24 people dead.
Abha Bhattarai
Insys Therapeutics is selling the fentanyl painkiller Subsys out of bankruptcy, unloading the opioid drug at the heart of racketeering convictions against the drugmaker’s former top brass.
Wall Street Journal
STATE SCAN
Religious exemptions for vaccinations are no longer available. With the start of the school year, some parents face a reckoning.
New York Times
A study of homelessness in New York City found the number of hospital visits—particularly to the emergency department—began to increase in the months leading up to shelter entry.
Wall Street Journal
The state Assembly passed a controversial bill to create state oversight of vaccine medical exemptions, but Gov. Gavin Newsom's office said to expect amendments to SB276.
Los Angeles Times
REPRODUCTIVE WARS
A proposed state law would require on-campus health centers to provide students with the medicines that allow them to end an unwanted pregnancy. Former Gov. Jerry Brown vetoed a similar bill last y…
KQED, NPR and Kaiser Health News.
AGENCY ALERT
The Trump administration gave new hope to marijuana researchers when the Drug Enforcement Administration (DEA) appeared to open the door for new applications for federally approved marijuana growers.
The Hill
MEDICAL MISSIVES
Health
New report published Monday tells a cautionary tale of the risks of poor nutrition on the nervous system.
Deanna Paul
DAYBOOK

Coming Up

  • The Research!America’s 2019 National Health Research Forum will be held on Thursday and can be livestreamed here
  • The American Enterprise Institute holds an event on “The Fair Care Act and the 2020 campaign plans” on Sept. 10.
SUGAR RUSH

As Dorian inches closer to Florida, locals prepare for the worst and hope for the best: