Going to show you some of the recent debate in congress and at the white house on the issue of vaping and underage use of ecigarettes. We are joined by andrew siddons, who covers health care for cq roll call. Tell us why the issue of underage vaping became a bigger issue in 2019. Andrew i think it was a combination of factors that really drove this to the front of the policy debate this year. One was just the year over year increases in the number of teens who are reporting ecigarette use. Thats been increasing for several years, but 2019, we saw another significant increase over last year. Another was interrelated, but a sort of distinct issue that we saw, starting over the summer with vaping related illnesses that were beginning to emerge, that weve now seen thousands injured and dozens dead from this. Thats related to illicit thc vaping, which is distinct from the problem of ecigarette use. But the urgency of those illnesses i think really prompted policymakers to want to respond more broadly to the vaping issues were dealing with in the u. S. Host and the Administration Starts the new year, starts with 2020 an announcement about vaping and ecigarettes. Andrew siddons, you are covering this story. What did they say . Andrew so, the Administration Says that in early february, products like juul, which are the most Popular Among Young People and use nicotine filled pods or cartridges, they will only be able to be sold and flavors like tobacco or menthol. Previously, juul had been available in flavors like mint, mango, fruit, and otherwise. The companys already taken those products off the market a few months back because of public pressure and anticipation of these flavor restrictions. And vuse,ts like njoy similar to juul, other things that are pod or cartridgebased, they will have to take their flavors off the market. The other type of ecigarettes products available, there are these devices that have tanks that the users can refill them with liquid nicotine themselves. These tend to be more popular among adults. Theyre harder to conceal than products like juul, and the shops that sell the flavors for those will continue to operate as they currently have as long as they have strict age verification procedures in place, and as long as theyre not selling flavors that are obviously marketing to children. So they wouldnt be able to sell things like flavors based on cereal or Something Like that. So, those shops will continue to operate as they normally have. Host President Trump was at maralago over the holiday break, and on new years eve, he previewed the announcement, speaking with reporters. Lets take a listen. Pres. Trump yeah, the vaping is coming out. We are just going to be announcing it very shortly. Some people already know about what were doing. We have to protect our families. At the same time, its a big industry. We want to protect the industry. And, as you know, well be taking it off, the flavors for a period of time. Certain flavors. Were going to protect our families, our children, and our industry. Hopefully, if everything is safe, they will be going quickly back onto the market. For the flavors well, off. So the flavors will come off. They will be checked. People have died from this. Theyve died from vaping. We think we understand why, but were doing a very exhaustive examination and hopefully everything will be back to the market very, very shortly. Look, vaping can be good from the standpoint you look at the ecigarettes, you stop smoking. If you can stop smoking, thats a big advantage. Back on we will get it the market very, very quickly, but we have to protect the children. We have to protect the families. At the same time, we have a very big industry. It has become a very big industry. Were going to take care of the industry. Host were going to show you some of President Trumps public deliberations on the issue a little bit later. Right now, part of a House Oversight subcommittee hearing from july. Well hear from High School Students and their parents. Two of the students say a representative of the eCigarette Company juul gave a presentation to their ninth grade classroom and said that ecigarettes are totally safe. Im meredith berkman, and i represent parents against vaping ecigarettes, we call it pave, a Grassroots Group founded over a year ago by three concerned moms. We already have groups of activated parents across the country, from california to new york and places in between. We have people with us today from texas, from georgia, from virginia, new york, new jersey, etc. My cofounders are behind me with members of our families. Between us, we have nine kids between the ages of seven to 19. Along with our friend mimi, also here, we created pave to the the juulingse to epidemic that has seemed to come out of nowhere. Yet experts consider one of the most serious adolescent Public Health crises our country has faced in decades. Our goal today is to give voice to this 3. 6 million teens who are vaping, most of them juuling. This most recent figure from the cdc is already outdated. As you said, between 2017 and 2018, there was a 78 rise in the use of these products by High School Students, and 48 rise in use by middle school students. And experts believe the new figures this fall will likely be much higher because nothing has happened to have them go down. We hear from desperate parents every day, who contact us seeking resources, information, and help further juul dependent, for their juuldependent, nicotineaddicted kids, but there is not any fda approved treatment for this addiction. I will share very briefly just one or two stories, because theyre heartbreaking and they come from every state represented here on the panel, and probably every state of people in this room. From massachusetts, our pave advocate speaking about her son, cade, a hockey player, described how he developed a cough and was complaining he could not breathe while skating. He became distant, moody, irritable, and had extreme bouts of anger, a very common thing people report. The home environment was toxic. And it turns out that cade has restrictive lung disease. He needs inhalers and oral steroids. He had been smoking a pod a day, the equivalent of a pack of cigarettes a day for three years. Kelly from North Carolina is here with her son, luca, whose addiction was so severe he spent 39 days as an inpatient in a Rehab Facility in california. And kelly said, we began living with a stranger. Our straight a students grades dropped to f. It was the extreme anger. It turned out our 14yearold had a Substance Abuse problem and that substance was juul. And now i want to share a personal story, a story about how juul went after our kids and their friends by coming into their School Without the knowledge of the school or of us concerned parents, juul sent a representative to talk to our kids about its product under the guise of education. On april 3, 2017, my then 15yearold son caleb, whos here, told me there had been an antiaddiction talk. The teachers left the room and the man gave a confusing talk about juul, telling them it was not for kids but for adults. It was much safer than cigarettes. The fda would approve it any day. When he was done, caleb and his friend philip went up to talk to him. He repeated juul was for adults, not kids. Then he took out this sleek looking juul, showed the boys how it worked, and called it the iphone of vapes. And thats when we moms decided to fight back. We had discovered a few months before that our kids were juuling at home, right under our noses, which is also very common. It doesnt mean youre a bad parent. It is stealth by design. We knew that nicotine was harmful to our kids brains. And as we researched and put pieces together, we learned that juuls Deceptive Behavior seemed to be part of this marketing strategy. In california, a retired superintendent was offering schools in his state and in massachusetts money that they would implement the antijuul curriculum that he was offering on juuls behalf. We came across the stanford medical schools tobacco prevention toolkit with an odd disclaimer that we immediately realized was a reference to juul taking information it shouldnt have. None of this is surprising. As i said, juul is stealth by design. Juul says it no longer restocks retail orders of flavors that research has proven are hooking the kids. Yet just the other day, in a one block radius in two different stores, i was able to buy these menthol sorry, these mango pods that juul says are no longer on the market, but they are still online. And thats the problem. If juul really wants to slow the youth epidemic and keep young kids from starting, they will immediately remove all flavors from the market, including menthol and mint, the most popular kids flavors, and stop spending millions of dollars on lobbyists to oppose sensible legislation that pave parents and our Many Coalition partners are fighting for all over this country, to restrict youth access to juul and other products. We hope todays hearing motivates members of congress on both sides. We all care about kids to hold juul accountable, not only for the epidemic, but for its predatory practices and causing harm to so many kids in this country. It is not a political issue, but a moral one. If we dont take action now, we face an entire generation addicted to nicotine, who are human guinea pigs for the juul experiment overall. Thank you, mrs. Bergman. First of all, after you discovered that a presenter representing juul gave a closed assembly at your childrens school, you researched the issue and formed an Advocacy Group to inform parents around the country about the dangers of adolescent ecigarette use. Thank you for your continued advocacy. As a parent of three Young Children myself, including a teenager, i was shocked to hear juul had access to children without the presence of teachers or administrators, and without parental permission. Juul continues to partner with youth organizations across the country, so its important to understand what outreach looks like on their part. Mrs. Berkman and mrs. Furman, id like to ask a couple of questions of your sons, if thats ok. Yes. Philip and caleb, can you please come to the table for a couple minutes . Id like to first address caleb. Caleb, what grades were you and philip in in the year of the juul presentation . Ninth grade. Can you speak directly into the microphone . Ninth grade. Thank you. What where students told before the presentation began . We were told we were having a Mental Health addiction seminar that we have three times a year. And the teachers are told to leave the room so it is a safe space for kids to talk. Did most of your classmates believe juul was safe prior to the presentation . I think many kids were already juuling and had their doubts. But i think a lot of kids still thought it was possibly dangerous. Did the presenter ever mention his connection to juul, and were your teachers in the room when he spoke . He did mention his connection to juul and my teacher was not in the room when he spoke. Did the presenter say juul was safe . Yes. Did the presenter call juul totally safe more than once . Yes. What impact did those totally safe comments have on your classmates, some of whom may have already started vaping . For my classmates who are already vaping, it was a sigh of relief because now they could vape without any concern. Erewere their kids w there kids who had never been juuling that were more likely to try after hearing it was totally safe . I cant say for sure, but i believe that after this meeting, kids were more inclined to vape because now they thought it was just a flavor device that didnt have any harmful substances in it. You and philip approached the presenter when the assembly concluded. What motivated you to even approach him in the first place . I believed the presenter was sending mixed messages by saying juul is totally safe, and following up every totally safe statement with, but we dont want you as customers. And i saw a mixed message being sent and i believe the presenter was playing on the rebellious side of teens, who when they are told not to do something, they are more likely to do it. Philip, let me ask you a couple questions. What was your experience speaking to the presenter . So, we went up and talked to him and caleb asked a question about what can you do if your friend is addicted to nicotine . Philip, were you addicted to juul at the time of this presentation . I was. And when caleb asked the presenter what he should do if he had a friend who was addicted to nicotine, was caleb referring to you . He was. How did the presenter answer calebs question . Since caleb was not specific on what kind of nicotine he was addicted to, whether it was in ecigarette or cigarettes, the speaker thought he was talking about cigarettes. He said he should mention juul to his friend because thats a safer alternative than smoking cigarettes and it would be better for the kid to use. So let me get this straight, he wanted you to switch from a combustible cigarette to juul . Yes. Did the presenter demonstrate the product to you . He didnt use it but he did take it out and show it to us. Ok, this is very disturbing behavior, to say the least. A person connected to juul pulled out a juul device to demonstrate its safety to teenagers, and then lied about the product being totally safe. Did he say anything else about whether the government had approved juul . He mentioned that the fda was about to come out and say that juul was 99 safer than cigarettes, and he said that would happen very soon, and that it was in fda approval while the talk was going on. Thank you, caleb and philip. Let me ask dorian, phillips mother, to say a couple words here. Dorian, thank you for coming today. Thank you. Your son philip just stated he was addicted to juul. Yes. How did his addiction impact your family . It was difficult. And at first, we didnt understand what was going on. As a young 14yearold, he was interested in so many things, from surfing to cooking to his little sister. And i started to find these flash drives and these green plastic caps in his pockets. And i didnt really know what it was at first. So he kept saying they belonged to a friend. And we would have fights about it. And i figured out what it was because i googled the name on the side. It was difficult. He changed kind of overnight. He started spending a lot of time in his room in the dark. He became moody. We had a very contentious relationship. I became very suspicious, obviously. And i think he didnt really understand what was going on himself, and neither did we. Thank you, dorian. Let me now recognize Ranking Member cloud for five minutes of questioning. Thank you, chairman. Ms. Berkman, im curious to the reaction. I assume you approached the school board, the principal. What was the reaction . The school had no idea that the outside group had brought a juul representative into the school. The school had hired a group yes. And we believe the outside group was naive, definitely, but in good faith. Because when i called to ask about this presentation, the staffer who answered the phone said, oh, you found the right person. I was researching antijuul education online, and i came across the name of a woman named julie henderson, who was listed then and no longer on the juul website as a youth prevention coordinator. Then she called and this woman says, i have the perfect person, and sent allie. Ok, thank you. Dr. , could you doctor, could you explain the difference, from a health perspective, between a traditional cigarette and an ecigarette . Is there one . Yeah, there are many differences. Traditional cigarettes consist of a preparation of tobacco leaves, which when burned, create smoke and contains roughly 7000 different chemicals, most of which are not good for the human body. Ecigarettes contain far fewer ingredients in addition to likeine, usually something li e commonly found ingredients in foodstuffs and some flavorings. And this, in general, the difference in number of compounds in ecigarettes versus cigarettes makes ecigarettes, in general, safer, although they can probably vary from product to product. A lot of the safety of these ecigarettes depend on temperature controls. So, for example, if products have adequate temperature control, they tend to be less toxic. Ok, weve known cigarettes for a while cause cancer. Talking about prevention, i remember in third grade seeing seeing lungs sitting in a jar third grade seeing lungs sitting in a jar that had somebody who had passed away from cigarette use. But i guess what im trying to get down to is, what are the Health Effects of the combustible side of it and what are the effects of the nicotine side . Yeah, and thats an important point to raise. So if we look at nicotine in and of itself, its not riskfree but its probably a lot less toxic compared to the other chemicals that come out of cigarette smoke. For example, nicotine probably does not cause cancer. It may have some small effects on existing cardiovascular disease and so forth. The brain might have to adapt to having a drug on board, neural adaptations, which are true for any drug. But the nicotine itself is not the culprit when it comes to things like cancers, at least as far as we know. Ok, we seem to have a kind of competing set of facts here. We have data that shows teen ecigarette use has gone up a tor, youthen, doc mentioned a lot of that is transitional. Is it not . Is it new use . I guess if you can clarify that a little bit for us to have a better understanding of what is new use, transitional use. Yeah, thats an important question that i dont think we have a good handle on yet, because a lot of the service we look at are crosssectional, meaning a slice in time. We see kids that report to us that they are using one or two days or every day and so forth. What we need are studies that track kids over time to actually see whether the ones who are starting out one or two days go on to use more. But once again, we dont know what the real implications are of these different patterns of use and i want to emphasize, share the concern that kids shouldnt be trying these products and they shouldnt be using them, certainly shouldnt be using them on a frequent basis. The cdc data shows huge use, over 2 million american High School Students and many hundreds of thousands of middle students. A fraction of them experiment. Others become regular users. I just want to touch as a physician on the health of this vaping. If you start smoking today, its 2040 years before you get lung cancer. No one knows what it does to the human lung to breathe this out over and over. Its an experiment, frankly. We will find out, years from now, the results. The flavor industry knows the compound we put into our food, that are safe in your intestinal tract, when you breathe them in, so, for example, the classic example is buttered popcorn, microwaved buttered popcorn. The compounds in the industrial setting cause severe restrictive lung disease on the part of industrial workers. Were taking a wide variety the ecigarette industry has taken flavored chemicals, cotton candy and cookie flavors, mixed them, and they are exposed over and over into the lungs. We just dont know yet the longterm results. There is no doubt in my mind that vaping is safer than conventional smoking. But that doesnt mean that its safe. Thank you, mr. Cloud. I know recognize congresswoman talib for five minutes of questioning. Congresswoman . Thank you so much, mr. Chairman. I want to thank the witnesses for being here. Sense your, i can frustration. Being here a short seven months and hearing some people call it rhetoric to discredit a lot of the things we are pushing for, but i just want you to know you have the truth on your side. Be stronger for that. Because we dont need more studies. We already know the truth here. In the few years after juul was founded in 2015, it dominated the market through a targeting targeted Advertising Campaign that seemed to be a winning strategy, as juul accounts for 76 of the ecigarette market, which is simply staggering. What i find troubling is that, in the same timeframe, the rate of teen nicotine addiction skyrocketed. The cdc found 75 increase in ecigarette use among High School Students from 20172018. So its no coincidence to me that teens who use ecigarettes almost exclusively refer to the activity as juuling. Professor, you studied marketing practices since the Company Started in 2015. Based on your expertise, should juul have been aware the marking campaign would appeal to youth and teens . The youth epidemic that happened. Two are from the same university paired have you ever met them . Yes i met james. Uul. Ent up to j he thanked us for the database we have of traditional tobacco ads. He said they were very helpful. This struck us so much that as we left the meaning, it was the very thing we talked about, how surprising it was that he juul was grounded. We know that there marketing which lights the methods used by the Tobacco Industry to target young people. That includes brand such as morrow state emulated, american spirit, newport. Thank you so the mission says it aims to improve the lives of the worlds one billion adult market are do juuls no longer are they promoting on social media. This happened long after a youth epidemic and was because of the unwanted attention by regulators and as mr. Munsey pointed out, they were concerned about their investors, particularly National Companies who was an early investor who didnt want to be associated with products who were widely seen. Social November Juul media. But it already had an impact on youth here and how do we continue to see initial Marketing Campaigns influence on kids on social media today . Taking off their marketing didnt stop it. In the first three years and five months, there are about a quarter of a million, mostly by , and itople on juul doubled over to half a million. Is important to know what astounded me the most is they deleted facebook and instagram but the followers, half of them are under the age of 18. Just because you delete them does not mean it never happened. That the advertising was based on the early advertising of the cigarette industry. Executiveay, a juul denied that. The labs and it serve as the chief product officer of that company. I am quite grateful for the opportunity to be here today. Beganhe moment adam and i what led to the system, we were clear in our goal to help improve the lives of adult smokers. We are proud of the progress we have made towards that goal. We never wanted any nonnicotine user and certainly nobody under products. R use juul the data shows a significant number of under age americans are doing so. This is a serious problem. Our company has no higher priority than fighting it. It iserstand our stance, held understand how the company came about in the first place. Adam and i smoked. We tried to quit and we failed. We were on our way to becoming one of the nearly 500,000 americans die each year from smokingrelated disease. For us, giving up smoking required an alternative and we labs to invent one. It holds the promise to do what no Previous Technology has done, help adult smokers stop smoking widespread and consistent basis. Recent behavioral studies find more than half of adult smokers switchedase lee used completely from smoking cigarettes within six months. The fact that we could not be more proud of. That study aligns with realworld experience. In 2018, cigarette sales declined 5 , the fastest rate of decline in a decade. Simply, juul put isnt big tobacco. We are here to put its product out of business. Involveuct does not burning tobacco which on leases 7000 chemicals, at least 250 of which are known to be harmful. The products to contain nicotine which is addictive but it is not directly responsible for the many diseases associated with smoking. Public Health Authorities such as Public Health england is concluded has concluded that baking is a faction of the risk of smoking. Ofis 95 less harmful and negligible risk to bystanders. Second, the Company Incentives are totally different from those of Tobacco Companies. Traditional Cigarette Companies face a saturated, concentrated Global Market. Reached 0. 3 of the Global Market of one billion the smokers. At 70 percent of whom want to incentive is our to help achieve their goal in transitioning. It is a Business Opportunity no doubt but a historic for Public Health. Under age use of our products does not advance medical advanced that goal. Unlike cigarette manufacturers, we act upon health data and we embrace appropriate regulations. We have acted voluntarily to restrict our own practices in service of Public Health goals these actions included unilaterally ccing sales of products to retail stores, investing funds to drive retailer compliance and proactively advocating for raising the legal age to buy our own products. We believe that if the steps we have already taken became the category wide standard, it would go along way to driving down under age access and usage of veep products vapor products. We are prepared to do more eared with met with many of the sharpest critics and have sought their suggestions for how we can improve. We remain open to their input. We are committed to cooperating with this committee, state attorneys general and other officials who wish to examine our practices. We are dedicated to learning from our mistakes and not repeating them. In doing so, we hope to earn the trust of this committee, congress, regulators, customers, and the american public. We are grateful for the opportunity to discuss these important topics and look forward to answering your questions. Yesterday, a professor from stanford university, testified under oath before the subcommittee that you confirmed to him that you reviewed stanfords Online Library of cigarette advertising and found designedhelpful as you s advertising. Did you meet with him and make that statement . I met with him but i did not make that. He may have misheard my commentary. The resource that he research he compiled is a useful resource back when we were at stanford and we were interested in understanding more about the historical bad actions of Tobacco Companies at that point we were very interested in using his research to understand actions oft the Tobacco Companies have taken to familiarize ourselves with how not to run a business. Deny his statement under oath. One. E show advertisement sir, these images that you see on advertisement one contain a few different images. Right over here is a picture of bles marlborough marloboros, and when you came up with, in the most recent j s. 2 juul in a set of board minutes from august 12, 2016 that you due to to us, it says requirements outlined in the pmi settlement, we removed all juul branding that use diamonds and tribal shapes. You settle a lawsuit that says that you copy their trade . That was what they said. How much did you pay as part of the settlement with Phillip Morris . Zero dollars. Change oflved no money but required you removed triangles similar to theirs. Is that correct . We never design the product to look anything like theres. Theirs. Respect, you are comparing packaging to hardware. There was no intent. The last thing we wanted was to be confused with any major tobacco company. Tophe board minutes say due outlinesm ini branding that uses triangles and diamond shapes. Do you deny that . Youould request that provide the subcommittee with the pmi Settlement Agreement within two weeks. Would you do that, please . I will have to get back to you on that. I dont see why that would be a problem but i will check with my colleagues. That marctor testified lboro is the leading youth cigarette. Unfortunately it says something oro. Juul chose marlb the marlboroare products and on the left are the juul products. The colors are very similar between the products and one very interesting thing i would flavorspoint out is the lets talk about the flavors for a second. Am, and meant, cre tobacco. Which is the topselling product . Currently after we pulled our and is now only on our website, the top product int followed by tobacco. Meant accounts for 74 percent of your sales and meant is a flavor mint is a flavor. It is a menthol based product to appeal to consumers using mentholbased cigarette. It is a mentholbased flavor, correct . Correct. Can you please put slide three or add three up . Hree up . You took an ad out in the washington post, and you said take flavored products out of stores. Problem here that i see is that you left what you called a mentholbased flavor in the stores, correct . Such as meant . Mint . Ch as that is correct. Though you say you took the flavors out of the stores you flavor. Mint mr. Chairman, with all due respect, i think you will find these were unprecedented actions that we took. We heard the concerns and i agree with you we should be concerned. Ever since we first heard the regulationithout new coming and be imposed, we took this action in and of ourselves. The products we pulled from the market represented more than 50 of our business at the time. I cant imagine a more responsive and proactive step that we could take to exactly the point you are making. When you pulled the other place. , mint took their it is a flavor and it took the place of the flavors. Do you disagree with that . Unfortunately i do. Int in your stores are not . Yes. I will now recognizing recognize the Ranking Member for five minutes of questioning. Thank you, mr. Chairman. Do you feel that juul has ever purposely used deceptive Marketing Tactics to convey their products are not harmful . No, never. What was the purpose of creating fruity flavor pods . The purpose of flavors is to create a more efficacious solution. The mission of this company is to eliminate improve the lives of a billion adult smokers around the world. We know that 70 of those people want to quit. There are a number of tools we used as we were designing the platform in the first place. Empathetic research with smokers where we could see opportunities to make a product that could be superior to cigarettes. It would make cigarettes ultimately obsolete. What we see in plenty of a studies we run now is that flavored products over index on advocacy, 54th percent of adult smokers who pick up juul and use it, quit smoking entirely after a sixmonth period. Upt number continues to go as we look more longitudinally. That number is much higher by as much as 30 when those consumers have access to flavored products erie that is our intent. So you created the company to disrupt the cigarette industry . Look, smoking cigarettes is the leading cause of vegetable death on earth. It kills almost 500,000 americans every year and it costs 300 billion. Are you concerned about the number of teenagers that report vaped and or using juul . I cannot be more concerned about that. Was your product ever intended for underage use . No, absolutely not. 100 not. Having thetended on rights of underage uses that it apparently has . Unfortunately the long history of tobacco in the underage use of those Tobacco Products, as long as they have been available, underage consumers have access those products and use them, often times premuch for always, illegally. It was one of those under age users. I bought them illegally and use them. There has not been a lot of advancement in the way we control access to those products. In building these products, not only are they not designed for youth, it imperils the business if you use these products. What we need to do is work with, hopefully this committee, every tobacco researcher and analyst possible, everyone we can get our hands on to help us create industrywide practices. We are trying to prove what they should be and can be. So preventing underage use is a priority for juul . There is no higher priority. What steps are you taking . , in november 2018, going back even further than that, we have taken escalating steps as we have learned about these problems. Most of the criticism we received is not come directly to the company. We welcome that and would like to work more directly with people who have critiques but when we hear the criticism, we hear that and take action. Those escalating steps move through and that i want to highlight. In november 2018, we pulled over 50 of our revenue off of the market, proactively. There was nothing that required us to do that we were hearing critique about flavored products. What we left on the market where mentholbasedand products, the same way cigarettes exist on the market. Working have you been working with the fda to prevent use of your product . There have been some conversation the fda has taken inthus to provide guidance particular how to run surveys. When we want to better understand the usage issue, it is very difficult for us to study use directly. One of the ways in which we had the most valuable or positive relationship with the fda was just getting guidance from them on how to better study usage. Thank you. Mr. Chairman, my time has expired. I want to take your statements in good faith that you are taking the epidemic seriously. There is so much evidence to the contrary. Im hoping you can offer me some answers and clarity. When youre product entered the you used a nicotine salt formulation that remove the bad taste and tripled the nicotine content over existing products, making juul the most potent cigarette on the market. The eu and u. K. Have capped nicotine levels at 20 milligrams per milliliter of liquid, one third of the west product. With that cap you do still sell a product in the eu and u. K. , correct . We do. Last year israel also capped product a juuls danger to Public Health. Recalled a product and entered a market in israel with a 20 milgram per milliliter product, correct . Correct at 20 milligrams per million adult smokershelp quit smoking conventional cigarettes . The first concentration, the 5 product you are talking about right now was designed to mimic but never exceed the pharmacokinetic curvature. I just want a clear answer of can you achieve your stated mission of helping adult smokers to quit smoking conventional cigarettes using a 20 milligram per milliliter product . We would love to try. But you are already trying in every country but this one. Cite thatften participants in the studies were using below the 20 milgram per milliliter number. Nowhere near the 59 level in your u. S. Product. Late last year it was reported a pod thatdeveloping would comply but would also increase the voltage and temperature of the device and therefore deliver more nicotine to the blood. Is that accurate . Im not sure what youre referring to with voltage and temperatures. Deviceactual delivery where you increase the voltage and the temperature of the device instead of having a 59 cap,liter per milliliter he would go down to 20 and deliver a more potent Delivery System of nicotine into the bloodstream. Is that accurate . What im not aware. Answer thatt question i would participated. Are you aware this would make it more addictive and heightening the risk for young people if that were the case . If we were to increase the voltage . And the temperature at which the liquid is delivered. Quite products are notably temperature controlled for product safety. Theyre the only product that has temperature control. We would never increase the temperature. So youre saying it is not accurate. Juul has been supportive of regulations but you developed a product that technically it seemswith caps but to disregard the spirit and intent of the law. You. To be marketing yourself as a Smoking Cessation device but you are not fda approved for that purpose. Efforts to increase nicotine delivery highlight why that is the case. Smoking sensation products include stepping down intake. Does your product come with these instructions . It does not and we would not market it as a cessation product. Let me be very clear, juul is not a cessation product. That is news to me and probably everyone in this room that juul is not marketing yourselves as a nicotine or a Smoking Cessation product. Every other vaping product except yours . ,hen someone starts on juul would you have any problem keeping them a customer for life . You dont want to use your product as a Smoking Cessation tool, you just want people to be addicted to nicotine for their entire lives should . Not. Solutely the most important thing they can do to improve the Life Expectancy is move away from cigarettes. That is the stage we are at right now. Juul does a great job of that. Yourself aonsider part of big tobacco . Traditional Big Tobacco Company as a major investor in our company. Actions speak louder than words. We heard from Debbie Wasserman schulz on her ideas. What are the major issues congress is considering regarding vaping and what are the prospects for any ecigarette legislation in 2020 . There is a lot of bills in congress right now. Most are from democrats a significant number of notable republicans have signed on as well. What the movement and congress is about is to do more to limit access to flavors and require any company who wants to sell a flavored ecigarette product to prove that the flavor is toential for the product help an adult switch from a traditional cigarette and also show the product isnt a risk for youth starting nicotine in the first place. This could be a difficult proposition for any ecigarette maker to prove. Because that is a tough standard to meet, the backers of this legislation think it will effectively ban flavors from the market. We will see more on that. We will question some cofounders. You have a product consumers like, dont you . Certainly, yes. Our young your friend people sitting around in college and you said we are going to develop a product, we would like to develop a product that is much less harmful than traditional cigarettes and could actually be away to get people away from smoking traditional cigarettes and you actually did that, right . . Thats correct. You develop the product and when you developed the product and started marketing the product, did you follow the law . We did. He never broke any laws. You had 70 percent growth in market share over the last couple of years. Is that right . That sounds about right. You had this tremendous market share growth and follow the law through the entire time you had that growth. Is that right . I believe so. Followed the law and followed a product that people wanted in a product that can help you phase off using nicotine altogether and somehow you are a terrible guy. Very complex company. Empathetically, i want to express this. This isnt my favorite thing to be here today. But i dont mind. I dont mind because this is extremely important. I very much understand the skepticism. This is an industry that has done wrong for a truly long period of time. We are changing that from the inside out with products delivered by innovative people, from a company 100 committed to changing the fabric of this market to eliminate ecigarettes for good. We are seeing these tools actually work. We do not and i think this was stated by the chairman extremely well at the beginning we dont want any underage consumers using this product. We need to Work Together to make sure that no underage consumers use this product. It is terrible for our business, for Public Health, for our reputation. We want to get onto the business of saving lives. You have this amazing growth in market share. You are no longer marketing on social media platforms, is that right . That is correct. You are placing limits on the quantity and types of things that can be sold at retail outlets. Is that right . That is correct. Even though you follow the law, you dont have to make those changes. For reputational concerns, you as a company decided to do those two things. For the safety of young people. And as an example. I stated this earlier and i will state it again, i think the actions we are taking we are trying to lead by example. We are trying to show we are willing to take independent action to protect young people from access to these products. If those standards were adopted on an industrywide basis, if we could stop these counterfeit products from entering the market, if other companies that werent willing to do these things were held to the same standards, then we believe we would be looking at substantially lower youth usage. How many people work for juul . 3000. 3000 jobs you provide. Yes. You developed a product as an alternative to harmful traditional cigarettes as a way to help people from hopefully stop smoking altogether. An amazing product that has a 76 growth in market share. You employed 3000 people. You made decisions you decided to change just to make sure young people dont get access to your products, like stopping marketing on social media. You have publicly said you dont think anyone should be using Tobacco Products, including your own, until they are 21. Yet the reward is you get brought to congress and yelled at by democrats. We think it is an incredibly important mission. We have 3000 people now. I have never met a more Mission Oriented group of folks. We know there is a lot of stigma in this industry historically. We know it is easy to assume we are tobacco 2. 0. We are quite the opposite. I yield back. We just heard juuls cofounder take credit from voluntarily removing flavored ecigarettes, other than menthol, from store shelves. The head of the American Vaping Association thinks flavored products should be should remain on the market. Flavors were invented long before the Tobacco Industry though ecigarettes were viable. They demanded flavors. They started creating their own. The industry responded. Users of tobacco flavors, adult users, are more likely to still be smoking. Tobacco flavors are simply a poor imitation for what ecigarette tastes like. That actually leads people to continue to smoke. Fruit and sweet flavors by far the most popular among adults who have switched. The most Public Health benefits come from that. In september, President Trump appeared in the oval office with help from the health and Human Services secretary to announce plans to ban flavored ecigarettes. President trump we have a problem in our country, a problem nobody thought about too much years ago, and it is called vaping. Especially as it pertains to innocent children. They are coming home, and they are saying, mom, i want to vape. The parents dont know too much about it. Nobody knows too much about it. They do know it is causing a lot of problems. We will have to do something about it. One of the reasons we are meeting today is to let you know it is out there. We want to have parents understand that we are studying it very carefully. It is, again, very new and potentially very bad. There have been deaths and a lot of other problems. People think it is an easy solution to cigarettes, but it turns out it has its own difficulties. I am going to ask secretary azar to say a few words. Actingn come if i could, director of the fda, and you have been doing a fantastic job, i want to thank you, and we want to discuss the situation. Not only was it a problem overall, but specifically with respect to children. We are getting some stories that we dont want to hear. We may very well have to do something strong about it. If i could ask you to say a few words, mr. Secretary. Thank you, mr. President. We briefed the president and first lady today on as yet undisclosed new data from the National Youth tobacco survey. This information shows continued surging in adolescent usage of ecigarettes. It also shows that youth are drawn to flavored ecigarettes, including mint and menthol. Currently about 8 million adults use ecigarettes, but 5 million children are using ecigarettes. This is exceptionally harmful to our children. An entire generation of children risk becoming addicted to nicotine because of the attractiveness and availability of these vaping products. So with the president s support, the fda intends to finalize a guidance document that would commence enforcement to require that all flavors, other than tobacco flavor, would be removed from the market. This would include mint and menthol flavoring, as well as candy flavors, bubblegum flavor, fruit flavor, alcohol flavor you get the drift. Once the fda would finalize this guidance, we would begin Enforcement Actions to remove all such products from the marketplace. We would allow tobacco flavoring to remain, subject to their filing, the manufacturers of the tobacco flavored ecigarette products filing for free premarket tobacco approval with the food and Drug Administration to assure the availability of their product is consistent with the standards set by the Tobacco Control act. Any other products which would be removed from the market would be able to apply under the similar regulatory pathway for approval. They would have to meet that standard. I want to caution that with the president s support, while we would allow flavored tobacco ecigarettes to be available for adults seeking to stop the use of combustible tobacco, if we find that children are being attracted to tobacco flavored ecigarettes, if we find manufacturers are marketing tobacco flavor ecigarettes to children, we will take enforcement action there also. Let me turn it over to the acting commissioner of the food and Drug Administration for any any Additional Details and comments he would have. Thank you mr. Secretary. The data gathered by the cdc and fda are as the secretary described. It shows an alarming trend of by children of flavored ecigarette products. The president is directing the fda to take Decisive Action against this problem, and to finalize our plans we have been working on. This would have the effect of severely curtailing access to flavored ecigarette products, which we believe drive childhood use and will help us get a handle on this concerning trend. President trump commissioner sharp has been working on this very hard, but he will double and triple up. We are looking at very strong rules and regulations. We already have laws as we need them, but we want to get to the bottom of a very unusual situation. It has become so big so fast. It could be a potential severe problem. Commissioner, you know what to do. It is something that frankly should have been looked into a few years ago in a much more advanced way. It wasnt, and we have something that will be interesting to see what turns up. You will be able to report back in the very near future. You have a lot of work on this and we will see what happens. President trump in september said his administration would report back on rules regarding flavored ecigarette. We talked about the announcement for the administration. What has happened in addition to that announcement in early january . Have they come out with additional rules . Will they come out with additional rules . There has been an evolution in the administrations thinking since the initial september announcement. At the time they said they would , clear the market entirely of flavors, with no exceptions. Doing in theed up end was making exceptions for the vape shops that are selling more adultoriented products and , for menthol flavors. They said they did this because, as they got data back from 2019 national surveys, it showed that among youth, the most popular products were juul or other cartridgebased products, that was the main target for the policy and that the most , popular flavors were things like mint, mango, and other fruit flavors, while a small percentage of High Schoolers were reporting tobacco or menthol flavors as their preferred choice. That is why they decided to exempt those two flavors. There is some fear that young people will continue to use juul, just with tobacco or menthol flavors. On the other hand, fewer kids were starting them because of the appeal of fruit flavors and otherwise might be less interested. They wanted to preserve the menthol option, because Menthol Cigarettes are still available. They would rather steer adults toward using Vape Products rather than combustible cigarettes. In november, President Trump held a meeting with representatives from the vaping industry and health groups. Here is some of that now. President trump if you dont give it to them, it will come here illegally. They are going to make it. Instead of legitimate Companies Making something safe, they will sell something on a Street Corner that will be horrible. That is the one problem i cant seem to forget. I have seen it. You have to look at the history of it. Instead of having a flavor that is at least safe, they will have a flavor that is poison. That is a big problem. There are very large at the table. Most members of our trade ecigarettes companiesmost members of our trade association are Small Businesses that have built this industry from the ground up. President trump what are you seeing . A flavor ban will not work. You have articulated one clinical reasons why it will not work. People will go to the black market. That is because adults are demanding these flavors. President trump isnt that going to be sold illegally . Someone can open up a shop in china and ship in flavors and you dont know what standard you are getting. Isnt that a problem . You can buy 15 different versions of juul mango, which has been off the market. President trump not your product, but products made illicitly. We have china counterfeit products on the market. What we are focused on is getting these products off the market. Pres. Trump what is it called . Counterfeit products we are not producing on the market today. President trump how bad are they . You just dont know. We have 3 million kids who are addicted. Separate from the lung disease, 5. 3 million kids. One million kids a day are using these products repetitively. Since the flavors have been introduced, we have seen a meteoric rise in use by kids. We have seen no increase whatsoever. The number one flavor of ecigarettes on the market was tobacco flavor. We are not talking about removing all ecigarettes. We are talking about removing the flavors that have fueled the epidemic with kids. Pres. Trump you are saying if we take the flavors wont they , just be made illegally . Same flavor but may be unsafe . What you will see last year, we saw 1. 5 million more kids become addicted. We can close that onramp. You said that in september. We can close the on ramp. Are illegal. Avors people need flavors in order to do it. Most adults are not using flavors. They are using flavors today. Youre going to ask them to go back to using the flavor of the product that almost kills. 92 of my revenue is flavors. There we are not juul, sir. Are different companies. We are not juul, sir. Is it the largest . 70 according to the survey of kids get them from friends or those 18 or older. 10,000 stores. Only 8. 4 get them. 10,000 stores. Kids are overwhelmingly able to get these flavors. Not the vape shops. These are not adult only shops. It is very important to realize it is separate from gas and convenience stores. There is a vape shop supplied by the manufacturer. That is the number one outlet where people purchase that is not [indiscernible] yes, kids get their vape from stores. 16. 5 of nineyearold to 17yearolds get their vapes from a vape shop. It is the number one retail source. In the same study, it also said these kids are refused only 25 of the time. Devotio hop gets we sell a lot of age restricted products. It is important to our members to restrict the Product Sales properly. That is one of the reasons why our compliance rates are much better than just we take it very seriously. This whole debate over flavors President Trump with or without flavor . We take it very seriously. This whole debate over flavors half the audience here firmly believes flavors dont help at all smokers to reduce risk. There is a huge concern about youth attracted to vape because of the flavors. We have to double down. We have to do really well. I get it. Usage is a serious problem. We felt we would act quickly and we remove the flavors from our business. Pres. Trump so you think they are dangerous . Without the responsible thing to do was to remove the flavors getting that use for were getting access. President trump yet you think we should have flavors. Yes. We demonstrated through our Business Model unique to juul that we can build an adult audience of smokers without creating a new audience of abusers. It has been illustrated through the data. Over the last 12, second largest Cigarette Company conducted 146,000 inspections of retail establishments. We had 29 violations. By way of comparison juul had 60 , times more violations. They sell three times more products than us. President trump why is that . Because of the way we implemented selfpolice policies. They limit youth access. Nobody can intellectually or honestly tell you you can permanently end youth use. We will fully support the fdas process. Flavors played an Important Role for an adult to make a choice which is to put down a cigarette and switch to a product which has less risk. We think the science is important. We think the fda is most appropriate to determine. Pres. Trump do you think you have it right now . Are you ok . You have gotten rid of flavors . We are making the right decision. Juul removed mango in 2018, and youth use rose. It was the number one most popular product on the market. Flavors are an issue. How about children . Almost 6 million kids addicted to nicotine. They are getting addicted to nicotine because of flavors. 66 of the kids are saying they did not even know it had nicotine in it. They thought it was a candy product. It is the flavor that is drawing the kids in. I salute the fact that juul said they are taking these products off the market because they care about kids. The adults have access to menthol products through juul, tobacco flavor products. Putting out cotton candy flavor and unicorn poop flavor this is kid products. We have to put the kids first. [indiscernible] not only have we called for increasing the age to 21, that is a nobrainer. That has to be done. That keeps it away from the 18yearolds. [indiscernible] we have rolled out 21 different marketing restrictions. Banning advertising is what senator romney is complaining about. Everyone criticizes the industry for their marketing, but nobody is talking about putting in marketing restrictions. President trump what do you think about the senate bill . I think a better approach would be to raise the age to 21. Put severe restrictions on how you market the product. On top of that, you have to increase penalties for retailers. Our retailers are fine with increased penalties. They do note that they are interested in keeping these products out of the hands of kids. Today, the fda can allow you seven strikes before you are told to stop selling Tobacco Products. That is unacceptable. That is perfectly ok for marketing. On top of we are in the age of that technology. , this is a Technology Product helping people quit smoking. Unfortunately President Trump in some cases. It is extremely important. [indiscernible] i am a pediatrician and take care of children every day. This is a crisis. I had a teenage boy in my office crying, saying he cant get off it. This is a crisis. Kids sleep with juuls under their pillows, so when they wake up in the middle of the night, they can vape. Nicotine is so addictive. We have nothing in our arsenal we all have the same message. We need to take all flavors off the market, pending fda investigation. We worry if we leave one flavor on the market, even menthol, the children will go to that, because they are going to want something. President trump so none of these guys are going to do it. They are legit companies. How do you feel that it will be shipped in from mexico . I hope secretary azar has a solution for that. This is where it goes back to the children. We have 5 million children addicted now, but we dont want another 5 million children addicted. Children like flavors. We flavor medicines because it tastes good. Medicine is good for children, but ecigarettes are not, so they should not have flavors. If i may on that issue, we know many of these kids want to quit. They need help quitting. We asked kids, what would you do if all flavors were taken off the market . Including menthol, 61 , the number one answer, was quit. We introduced a quit Vaping Program on your phone. In january, and with no promotion, 60,000 kids signed up for it. These kids are angry. They didnt sign up for this. They thought it was fun flavors. President trump and then they get addicted. [indiscernible] thank you. The American Medical Association commends you for the stance you took. We know youth are attracted to ecigarettes. To those who argue that ecigarettes help smoking sensation, Smoking Cessation, the u. S. Preventative Services Task force have not found evidence among adults that these products were for Smoking Cessation. If they had the evidence they , should take to the fda it to the fda so we can evaluate it and we can all make decisions. President trump wouldnt you say it is a lesser problem than smoking cigarettes . They say that the ecigarettes you stopped smoking and it is better. You dont think so . No, mr. President. Nicotine addiction is bad for childrens brains. It affects their attention. President trump how does it compare to normal smoking of cigarettes . Neither one are good. [indiscernible] the Royal College of physicians, the Public Health of england, stated [indiscernible] those using these products are not kids who are smokers. They are very often not kids who would have become smokers. So the risk for these kids [indiscernible] with all of the government studies, these are not our figures. That is just not accurate. It is less than 1 . Most of the kids who tried this product have already tried some other Tobacco Products. These kids have at risk behaviors. That is why, that is why yes, [indiscernible] i sorry, but that is false. That is a completely statement. Half of the kids in high school are vaping. [indiscernible] pres. Trump tell me about lungs. What do you think . The American Cancer Society is an evidencebased organization, like all Public Health groups here. President trump what is your public stance . It is a new, modern age problem. When did this begin . Two years ago. Pres. Trump it was really two years ago. Tell me what your stance is. Our stance is aligned on what you suggested september 11, to take all flavored ecigarettes off of the market. President trump regardless of age . Absolutely. President trump what about over 21 . No . Over 21 . It is an epidemic of use. It is a matter trump would they use it a lot less if they did not have labor . They would. And then the counter arguments take place. Business would be severely damaged. Trump but the Biggest Companies dont. Why doesnt the Biggest Company have flippers . They are playing a longterm goal. Their longterm play is to sit out, let the small and mediumsize businesses go away, and then they can come back and have 90 of the market. They dont have investors. About 151,000ing children smoking. The Economic Analysis we just put up concluded that over 13,000 Small Businesses would close if you implement a flavor been. Trump only flavors . Correct. They would also eliminate 150 1000 thats not right. Im sorry, that is just not right. Thats terrific, ive looked at data and the data says there are approximately 10,000 vaping shops four employees per. Thats 40,000 employees. The convenience stores, they sell a lot of products, they are not going to go out of business. Vaping shops. They are not going to all go out of business because they cant sell flavors. Some may, that would be unfortunate, some may. There are 50,000 fulltime employees at vaping shops. Youve got 5. 5 million kids, youre talking about 100 kids addicted for one employee, typically minimum wage. I put the kids first. Thats over 100 kids for fulltime employees. These are the shops and this is the sector of the industry that has grown up. You have a new industry competing for the first time for the cigarette smoker, trying to get them off of that cigarette. There is no reason we cant do both things in this country, but if you eliminate flavors, according to this report, because flavors make up about 85 to 95 of their sales, they will go out of business. There is no question about that. No Small Business owner could take that kind of hit to their revenue. Trump basically, youre saying juul . Why is juul not going out of business . That is the cap, they can wait it out. They can wait a year or two years to go back to having the market share. The sciencebased evidence argument that we look forward to making, we are reserving this opportunity for adult smokers who cant quit to have an option. That is the mission of our company. Felt and we were a part of it, we had to address it. We took the top steps to change. Trump you dont think flavors are very dangerous, then in terms of addiction . I think flavors can play a role for adults to make the transition. The issue is kids get access to the flavors. Trump if we take them out of it, who is going to take your place . Counterfeiters. That gets dangerous. Will. President , what you see is the first of all, we have not seen a growth in adult using these products, with the introduction of flavors. There is a lot of myths going on here. Let me finish. I did not interrupt you all. What you will have is you will have companies to purdues products who produce who may still have the most popular among adults, and then second, what were talking about here, what your proposal was, for the company to have a product with or without a flavor and doesally promotes not feel to kids can go to the fda for review. We are not talking about a permanent ban. Thate talking about making decision to listen to the agency who has the authority to review it and has a sciencebased decision made about what is in the public interest. What do you do in the interim . If we do nothing, we are going to wake up six months from now kidsanother 1. 5 million addicted and they are not going to be able to quit. The concept of letting states make their own decision, we talked about that the other day. What about that . We have put a 21 limit on tobacco. You put an age limit. What about the concept of every state decides . Nationwide, we need to catch this for our kids wherever they live and it should not be that if you live in a state who doesnt want would dress this issue, your children are at risk. That is what worries me. Trump and then they are going to go buy it. That is why the fda has this authority. We have the authority to address a complicated question that exist, and put in place rules and make sciencebased decisions. Every company in the country is putting small shops and large companies. Anyway, thedo that fda is under statutory obligation to provide an answer within six months. What we are really waiting is this nearterm solution, and i value that. I have children, i would not want them using these products, but we are valuing a sixmonth to 10 month solution where the fda has to make the decision by december of next year anyway versus 100,000 jobs. By the way, for the record trump there is a much longer term solution. I understand this is an important conversation about jobs, but im here because our group represents millions of families of moms all across the country and dads across the country and grandparents. Thecan go into any state in country and ask people with children, this is what people are worried about. Trump what would you propose . This is a generation of children that would otherwise not have been initiated into tobacco use and we know that because they use figures are at the lowest they have ever been before juul came on the market with their technology. Huge amounts of nicotine going to the brain so quickly. Addiction is severe addiction. It is enormous amounts of thinking, so much more than a couple of cigarettes. Parents are terrified. We hear this every day from people all across the country, all walks of life. In the cities, in the suburbs, in the country. They feel like straight a students are flunking out of schools. Star athletes cant run a mile. And what i hear over and over, all the time, i dont recognize my child. The bouts of anger, the pain. Parents are in pain and we need you. Trump so what is your solution . Our solution is your solution. Trump just ban it, right . No, thats not correct. My solution is what you had the right instinct for at the to leave, which is tobacco flavor for adults. Trump my original suggestion . We are not prohibitionists. Leave tobacco flavor for adults because in the end, it is not there yet, but if the science ultimately proves that, yes, this is going to help people flip, then they should have the right. We have no interest in telling adults what to do. I dont think science is there yet. We need more data. A of statements have been made about ecigarettes and Harm Reduction devices. There has been no evidence presented to the fda, or any manufacturer who makes that claim will be enforced against. You may think there is that evidence, but that is exactly that is required, bringing forth that evidence in the context of the market authorization. Trump what do you think . Mr. President , it is a little hard to take all the virtues going around. You have to remember the history. We all were excited that there was an opportunity either way, i come from appalachia. A bluecollar world, my brother is a smoker. I understand it is a very addictive behavior. It was exciting at the beginning to think there is an opportunity for people to get off of tobacco. At that point, we were winning when it came to kids. The people who were buying their products were aging out. Generationt have a coming up behind them until they came up with ecigarettes and the truth is, they targeted kids. They paid influencers on social media to make it look cool and suddenly we had a huge problem again. By the way, many of these same people are in cahoots with the Tobacco Industry. We get money from nobody. Trump so what is your suggestion . I like your original solution. We ban all flavors, we make it 21. And even your point earlier was correct. When you make something illegal, there is always a black market. We could say that about anything. We could say that about heroin. We could make it legal. We could say that about opioids. Theres always going to be something illegal. I dont know that that works. Mr. President , im from the American Lung association and i certainly want to echo our Public Health partners. On a day to day basis the number one concern from our communities from parents, from schools, is how do we really address this epidemic we are facing . All of us are looking to you, your leadership role, in terms of helping to create the next generation. Trump what is your recommended solution . To ban all flavors. Trump including menthol . Especially menthol. Trump thats a very big statement. The American Cancer Society absolutely degrees. It is certainly an important step, but it is one that you are putting out in september. Reasons are 160 million Michael Bloomberg did not come to the table to compromise. 160 million reasons. We are parent advocate volunteers because parents are in pain. On mondayhe table with 13 families from the state of massachusetts. Everyones story was the same. People who said their kids were no longer recognizable, their kids could not focus in school, their kids were angry. This is not a small thing. Parents across this country, all parents care and we know that you care. Trump so you want to ban all flavors . Including menthol because as if you get rid of just the mint, they go to menthol. Only now when kids are frightened they understand they are not in control. To the point about the predatory behavior, the reason that we started our group is because our sons came home from school one day in 2018 and said there was a mixed message presentation about juuling and that in their school, someone who came from an antiaddiction group in the end turned out to be a juul representative and told the kids was not for kids but was totally safe and that it would receive fda approval any moment. And both those statements were and remain untrue. Thats why a group of moms started doing their own research that this was an epidemic of enormous proportions and as we said earlier, at the kids were targeted. This is not about risktaking kids. This affects all families, all kids. There are 5 million kids doing this, that means there are millions of families who are in pain and they need you to say that our generation. Trump we could do it if you get rid of the flavors. Here is the thing. 97 of kids who are vaping are using flavored vapes. These numbers are indicating that kids are getting access to flavors. Really, what were talking about trump lets say they cant get flavors. Will pick their own flavors in . Cap product is single use, completely different. Deaths are from the counterfeits. Separate issues. Trump it is an important issue, though. In other words, ive been reading about a lot of death. The debt is not really so counterfeit. Deaths are not so counterfeit. Announcer our look at vaping and ecigarettes continues. Joining us, andrew. The president went through a bit of an evolution in his thinking on vaping and ecigarettes. How did his thinking evolve . President , after announcing what sounded like a widespread flavor been, he eventually seemed moved by some concerns raised by conservative groups and Small Businesses in the vaping industry about both economic and political impact of such a move. Industry is vaping pretty large corporations but there is a sizable segment of Small Businesses that produce thousandsidquids arnd of jobs at stake. Conservative groups are also emphasizing that the number of adults who va[e in some of the states that trump won like michigan, wisconsin, pennsylvania, the number of vapers exceed the margin of his victory and they were making the argument that if the band flavors, he could potentially lose those voters. In the days leading up to the january policy and that while trump was at his florida resort in maralago, there were apparently protesters with shirts and signs saying we vape, we vote. Did heart meeting, we some talk about banning the use of ecigarettes to those 21 and above. Where does that stand . The purchasing eight for Tobacco Products including ecigarettes is now 21 nationwide. When trump signed the spending bill into law at the end of 2019, that became the law of the land. The fda is still probably going to be taking a few months before it is fully and forth around the country and in the meantime, a lot of states already have the age 21 in place. States that dont might be a little slower to enforce it but for now, it is illegal for retailers to sell to anyone under 21 and they need to be checking the idea of anyone who looks under 30. Not long after that November White house meeting, the head of the fda center for Tobacco Products testify before congress. He was asked about where the fda plans to van flavored cigarettes. You are aware that on secretary11, the hss said it going to issue guidance clearing the market of nontobacco flavor ecigarettes including mint and menthol products, right . You are aware that he announced the band because the numbers show a continued rise in the disturbing rates of youth ecigarette use, especially through the use of nontobacco flavors that appeal to kids, correct . And he further stated that more than a quarter of High School Students were current ecigarette users in 2019 and the overwhelming majority of schoolers,of high but the overwhelming majority of youth ecigarette users side of the use of popular fruit and menthol or mint flavors, right . 6 correc. Orthe purpose of banning clearing the market of flavored ecigarettes was to decrease you the vaping, right . That would be consistent with what the secretary said. And there was urgency to this issue, that is why the president said that at the age action would come in a couple of weeks. That is what was said. And there was an urgency felt at that time, right . And on october 25, you stated the work on the flavor guidance a very, very high priority and we are trying to complete work on it as quickly as possible, right . I dont remember the date, but yes, i said that. Guidance has not yet been published, has it . No. According to a letter sent to fda drafted, the guidance and send it to an office within the omb on october 25, correct . Just to be clear, the fda guidance documents followed through on secretaries ares announcement, correct . Them not going to get into substance of the document. On what basis . There has been no final decision made because there are ongoing discussions taking place. And who instructed you not to get into the substance of it . This was based upon discussions internally at the the and it is Standard Practice when theres ongoing policymaking that we dont talk publicly about what is under consideration. To come back in brief you and your staff when there is a final decision and walk you through everything, but this remains an ongoing set of discussions. So according to the fda letter sent to me yesterday, they concluded the review on november 4, right . Correct. Did they make any changes to the initial guidance submitted by the at the ed . The fda . I cant go into the details. You are familiar with something called executive order 12866 . ,ccording to this catchy phrase the fda is not allowed to publish in the federal register until they have completed a review, right . For things subject to the executive order. And this is one of them. This was a policy that because of its significance, we sent for review, yes. And it would apply, it basically talks about the types of policies that would be submitted and then sent back, right . Correct. They have marked the review completed on its website. That means the policy is now back with the fda, right . They completed their review on november 4 and sent the document act to us, but there were still other ongoing policy related discussions going on in parallel, but they did complete the review and send it back to us on november 4. By you say there are policy discussions ongoing . Between who . There were parallel policy discussions going on between the fda and the department and the white house. According to executive order fda is not allowed to publish in the federal register until a lyra has completed its review. The fda can publish the guidance, right . If the complete executive branch review of the policy was done, that there were still, as i said, in parallel, other ongoing policy discussions going on in addition to the review of the guidance document. So these parallel discussions that sound like some kind of a regular channel of discussions independent of the standard submission of the guidance from the fda and back. Review thate other is happening right now that has nothing to do with the fda . There are ongoing policy related discussions between the agency, the department, and the white house about what the policy should be. Ok. So did they really complete the review if they are still discussing with you the documents . At otherted its review levels within the department and the white house and the agency. Again, in parallel. There were discussions continuing. And who is part of those . The leadership of the agencies and various parts of the white house. And that includes you . Peripherally. And at the white house, who has the leadership involved . Various offices from the Domestic Policy Council to the office of management and others. Ive not been directly involved in discussions with the white house. So, you would agree with me, sir, and the white house Domestic Policy Council is headed by joe rogan, is that right . You would agree with me that the fda should be regulating Tobacco Products . Thats our job. Not a waste of time . One of the most important things the agency can do. Thats why im so concerned by your prior answer that the White House Domestic Council is part of these discussions when a huge sai it wasd waste of time for the fda to regulate tobacco. Last week, massachusetts became a first in the nation to place a permanent ban on flavored ecigarette and mental cigarette products. If we are banning flavors, we must ban all flavors which includes mint and mental. To not do so would be discriminatory since menthol has imposed a unique and deadly burden on the black community. You must clamp down on the production of mental products and not the individual possession of it, because there are real intergenerational dramatic consequences of broken windows policing that is historically over criminalizing black and brown communities. That is something i called for in my peoples justice guarantee resolution. Simultaneously attuned to both Public Health and Public Safety to ensure that there are no more eric garners. For years, big Tobacco Companies disproportionately targeted more tobacco ads and more mental tobacco ads in black neighborhoods. In some instances, as many as 10 times more ads for mental products. Nearly nine out of 10 black smokers prefer Menthol Cigarettes. I think it is safe to say that the targeting was effective . I would agree. Billy. 5 of black smokers say they would quit smoking of Menthol Cigarettes were banned. A year ago, the fda announced plans to ban Menthol Cigarettes because menthol products disproportionately and adversely affect underserved communities. Years passed, and the fda has not followed through. Why is that . As he said, we went through an advanced notice on a variety of issues related waivers including the presence of menthol in cigarettes and i would add to what you said, that of the Public Health concerns is notenthol cigarettes just the disproportionate use of Menthol Cigarettes by africanamericans, the role they play in attracting kids of any color to experimenting with cigarettes. Review the to comments and explore what the regulatory options and policies should be but i absolutely here you and share your concern from a Public Health perspective. Time, justnterest of to be clear on the record, does the fda plan to follow through with this ban . I cannot give you a yes or no option in public during. All i can tell you is we are continuing to evidence related to labor that all Tobacco Products. I dont know what you are referring to. Would you like me to restate the question . I dont understand what you are referring to. Ill move on. The point we are reiterating and that i cant underscore enough, is at 47,000 black people die every year from smokingrelated illnesses. This is the largest cause of preventable death among black americans. We dont have more time. Seconds, i just want to go to a different line for a moment. Not ares are ecigarettes recognized as an effective smoking secession aid or not . They are not approved by the fda. Are not anttes effective device, menthol ecigarettes are not enough rent for a dull menthol smokers. They are a ramp to hooking a new generation of smokers. If we could go past the 20 seconds you have left, there was a public help balancing act that the agency has to do with whatever policy emerges on flavors. Balancing, are flavors helping adults successfully transition off of cigarettes completely to ecigarettes . What role are flavors playing . It is part of the balancing that we need to do. It is an easy call on the negative side of the ledger when it comes to the role that labors are playing in attracting kids to experiment, especially kids who are Walking Around thinking that these are harmless products. It is a balancing act because we have heard repeatedly from former smokers that it was the presence of certain flavors that help them successfully transitioned completely away from cigarettes. The fda official we just saw could not say if labor ecigarettes would be banned. The administration has since made that decision. What exactly has been banned . You will no longer be able to buy fruit flavored cartridges or pods for ecigarette brands. The only flavors you will be able to get for those are tobacco and menthol. That uses a product refillable tank that you can buy liquids for at they shops, at e shops, you will be able to continue to buy flavors as long as they are not explicitly targeted toward children. We heard from frank after the Administration Announcement on ecigarettes, the chair of the energy and Commerce Committee opposing some of the moves by the administration. What else might be here from congress in 2020 . One of the next steps we will see from the administration strongly it in enforces a deadline for ecigarette manufacturers to submit applications for sales authorizations to the fda. This is something that was required under the 2009 Tobacco Control act and for the first later, thees ecigarette manufacturers are finally going to have to submit these applications to the fda to show things about their products , safety, data about whether it helps adults quit, and how risky news in establishing nicotine users. In may, the fda will be considering those applications. Be, howquestion will much will the Trump Administration waita risks eigh the risks of potential youth use against the benefits of helping adult smokers quit traditional cigarettes . Thatess is concerned having any flavors on the market will mean that young people will continue to be attracted to ecigarettes. Of while the prospects Congress Getting anything unlikely, the house is likely to take up and pass bills that will put more restrictions on what the fda needs. It would put more restrictions considers the risks and benefits of permitting a flavor to be on sale. Joining us for our discussion, our program on vaping and flavored ecigarettes is andrew, he covers health care. He is also on twitter. Thanks so much. Guest thanks for having me. Host we will close out our program with another look at President Trumps remarks on new years eve. We are just going to be announcing it very shortly. Some people already know about what were doing. We have to protect our families. At the same time, it is a big industry, we want to protect the industry. Waiversbe taking off of for a time, certain flavors. We are going to protect our families, we are going to protect our children, and we are going to protect the industry. Things are going to be going very quickly back onto the market. The flavors will come off, they will be checked. People have died from this. We think we understand why, but we are doing a very exhaustive examination and hopefully, everything will be back to the market very, very shortly. Vaping can be good from a standpoint if you look at the ecigarettes, you stop smoking. If you can stop smoking, that is a big advantage. We think we are going to get it back onto the market very quickly, but we have to protect the children, we have to protect the families. , wead a very big industry are going to take care of the industry. With less than a month from the first vote, cspans Live Campaign 2020 coverage continues today at 1 45 p. M. Eastern from the state Historical Museum of iowa in des moines with a look inside the Iowa Caucuses with Political Science scholars and experts discussing i was first in the nation caucuses and the history, significance, and impact on president ial races. Watch our live Coverage Today at cspan, or listen live with the radio app. President trump spoke at the launch of his evangelicals for tron june at a megachurch in miami. The president discussed his commitment to protecting the rights of evangelicals in the United States and mentioned the killing of the iranian general by u. S. Military forces. This is an hour and