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The commissioner has repeatedly agreed that e-cigarettes can be an effective tool for adults trying to quit smoking, so his harsh words for the industry on Wednesday were all the more remarkable.

The warning from the Food and Drug Administration on Wednesday marks a stark shift in the agency's tone on e-cigarettes, which have become the most used tobacco product among teenagers.

In April the agency launched a Youth Tobacco Prevention Plan, created to address some of the known public health risks, such as flavors, that contribute to adolescent use of e-cigarettes.

Gottlieb announced a number of steps the agency planned to take as part of a broader crackdown on the sale and marketing of e-cigarettes to kids. Regulators are considering restricting e-cigarette manufacturers from selling flavored nicotine liquid or forcing the products to undergo an agency review, as reported by CNBC.

Even more significant, notices sent Wednesday morning demand that five leading e-cigarette manufacturers, including San Francisco-based Juul Labs, submit plans within 60 days detailing ways to sharply curb sales to underage consumers.

"We see clear signs that youth use of electronic cigarettes has reached an epidemic proportion, and we must adjust certain aspects of our comprehensive strategy to stem this clear and present danger", said FDA Commissioner Scott Gottlieb in a statement.

Meanwhile, tobacco and cigarette industry leaders have doubled down on innovation to meet the demands of a more health-conscious and informed consumer.

E-cigarettes are battery-powered devices that heat a nicotine liquid into a vapor that can be inhaled. Imperial Brands, which recently removed "Tobacco" from its name, is now offering alternative caffeinated products.

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The FDA banned e-cigarette sales to minors in 2016, meaning they can not be sold to people under 18.

The FDA says it has issued "more than 1,300 warning letters and fines to retailers" as a result of "a large-scale, undercover nationwide blitz to crack down on the sale of e-cigarettes to minors".

"I think it became clear to FDA that if they didn't get their arms around this issue the use of these products by kids across the nation would undo decades of progress", said Matthew Myers of the Campaign for Tobacco-Free Kids.

"By working together, we believe we can help adult smokers while preventing access to minors", the company said in a statement. "While we remain committed to advancing policies that promote the potential of e-cigarettes to help adult smokers move away from combustible cigarettes, that work can't come at the expense of kids", Gottlieb explained.

Gottlieb called the action the largest coordinated enforcement effort in the agency's history.

In the US, about 12 percent of high school students use e-cigarettes at least once a month, the US Centers for Disease Control and Protection estimated in 2017. If underage consumption does not justify a ban on tobacco cigarettes (and I don't think it does), it can not possibly justify a ban on competing products that are much safer. Shares of cigarette and e-cigarette maker Altria Group also rose more than 6 percent, while Philip Morris International shares were up 4 percent. Earlier this year, as criticism of the company mounted, it committed $30 million over the next three years for independent research, youth and parent education and community engagement.

However, he seemed reluctant to give up on flavored nicotine, because he said it appeals to adult cigarette smokers.


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