Transcripts For CSPAN Hearing On E-Cigarettes Lung Disease 20240714

The subcommittee will come to order. Without objection, the chairs are authorized to declare a recess of the committee at any time. Without objection, id like to have a few members waved onto the committee. Congressman jordan, congressman meadows, and congressman cox. Shall be prorated to join the subcommittee on the guys and. Irected dais i now recognize myself for five minutes to give an opening statement. We are here to amplify the recent Health Warnings issued by the centers for Disease Control related to 530 e cigarette related incidents of lung disease in 38 states and the u. S. Virgin islands. First, i want to make clear that we did not plan to have this emergency hearing at the beginning of this congress, let alone this time last month. On august 23, officials from my home state of illinois reported the first death due to a mysterious vaping related illness. And since then, a total of eight individuals have tragically died in this outbreak. In response to this crisis, cdc is warning the American Public to consider not using e cigarettes of any kind. Because the subcommittee has investigated the youth vaping epidemic and the companies behind it, we feel its our duty to draw attention to recent government Health Warnings about the dangers of ecigarette use. The longterm Health Effects of continued vaping is unknown. What we do know should give us pause. State Health Departments continue to conduct retro active analysis of patient records to better understand exactly when this outbreak began. As they do, the number of affected people will grow. Unfortunately, illness related to ecigarettes is not new. The fda has received 127 reports of seizures and other neurological conditions caused by e cigarettes. When a product is released onto the market without safety testing or Clinical Trials, this is what we fear. This is a problem exacerbated by ecigarette companies that take what appear to be unfounded and illegal claims that their products are safer and healthier than combustible cigarettes. People trust and rely on those claims even when theres no evidence to back them up. Thats why this subcommittee wrote a detailed letter to the fda outlining our finding about juul illegally marketing its products as safe healthand healthy. Safe and healthy smoking device. With us and days after our letter, respond with declaringtter to jull juul declaring that juul had broken the law. The fda will have the opportunity to act. I encourage you all of you to develop that development closely. We certainly will. Just days after the fda responded to our letter, the administration in part citing our investigation announced it would move to ban all ecigarette flavors, including mint and menthol. The fact that flavors hook kids is a point this subcommittee hammered home over our two days of hearings in july. The administration cited our hearings in rolling out its proposal proposal. Democrats and republicans are coming together when the health of our nations youth comes under attack. Today, as we focus on the tragic outcomes of this lung disease outbreak, we must view it as a chance to come together to protect Public Health. At the heart of the recent vaping related outbreak, families are being blindsided. With us today is ruby johnson. A mother of seven from your chicago. As she prepared to drop her near chicago. As she prepared to drop her oldest daughter off to start college, already a stressful time, the Johnson Family faced a terrifying health scare. Instead of moving into a dorm room, her daughter moved into a hospital bed far from home where she stayed for what would have been her first week of classes. Rubys daughter could have died. Thankfully, she recovered enough from her bout of lung disease to be released, but she still has trouble breathing and doctors cannot tell her how much longer that may last. Mrs. Johnson, thank you for coming to share your familys harrowing experience. Were also joined by leaders from the Public Health community to provide their advice to the public they serve. We have a doctor from the cdc, a doctor from the Illinois Department of Public Health and dr. Albert rizzo of the American Lung association. Thank you all for joining us today. We look forward to learning more about how we can avoid more preventible deaths. And with that, i recognize the Ranking Member, mr. Cloud of texas, for five minutes for an opening statement. Thank you, mr. Chairman. Over the last several weeks its been clear that users of certain vaping products have become ill. Some tragallyically to the point of death. I appreciate your desire to hold this meeting. In the center for Disease Controls prevention september 19 update, the number of those sick reached 530 and eight deaths have been confirmed. This is concerning and its clear we need to examine the cause and what can be done to prevent it. To the best information of available, many of these cases seem linked to the use of products that are claiming to be something they are not. Based on the limited Data Available, about those impacted by this mysterious lung illness, approximately 16 are under 18 years of age. And while each life is affected is important, these recent incidents also serve to bring attention to what has become an epidemic increase in teaspoon in teen vaping. Add to that the decades long of traditional tobacco, as a father of three, this is very concerning. I wish we had a quick fix to insure that each child is protected, that no american finds themselves bound by a substance and that all of us are able to find personal fulfillment in experiencing the purpose for which we were created. Today, we are here to discuss what should be the appropriate response to lung illnesses associated with certain vaping products. Complicating this discussion is a lack of Scientific Data and studies available, products, untraceable supply lines, lack of enforcement that allows players to pass the buck of accountability. For example, Data Available leads us to believe that many of the recently reported 530 cases involve vaping canproducts. Cannaboid products. I hope were able to do the work, i believe theres a lot of bipartisan support for addressing the situation. I appreciate the chairmans heart in this and to the point of examining this to find the solution and our desire to end teen vaping, there is unity. Please know my heart goes out to those impacted and my condolence condolences to those who have lost loved ones. I appreciate the germanss work for this issue and look forward to a reductive discussion today. Chairmans work for this issue and look forward to a productive discussion today. Thank you, mr. Cloud. I should say we recently started a caucus, and today happens to be National Recovery day. A bipartisan endeavor to recognize the folks in our lives who may be affected by Substance Abuse disorders and our attempts to wean their off their addictions. I hope vaping is not that Substance Abuse disorder. Today were joined on panel one by the Principle Deputy director of the cdc. If you would please rise and raise your right hand. Ill swear you in. Do you swear or affirm the testimony youre about to give is the truth, the whole truth and nothing but the truth, so help you god . I do. Let the record show the witness answered in the affirmative. Thank you very much and please be seated. The microphones are sensitive, so please speak directly into them. Without objection, your written statement will be made part of the record. With that, doctor, youre now recognized for five minutes. Thank you. Good morning, chairman, Ranking Member cloud, and members of the subcommittee. Thank you for the opportunity to testify today about cdcs investigation into lung injury associated with using ecigarettes or vaping products. Today, ill discuss with you what we know and dont know and what were doing to dress this outbreak of lung injury. Ill also discuss our efforts to address the epidemic of youth e cigarette use or vaping. I want to make four key points. First, as soon as we learned about the initial cases of lung injury, cdc has been working 24 7 hand in hand with the fda and our state and local Public Health partners to find the cause. Secondly, our ability to do this will type of investigation relies on a critical underlying Public Health infrastructure, including data systems that need modernization and a trainedmoded Public Health workforce. Cdc has made important recommendations to the public, including the following. Investigation is ongoing, people that are concerned about lung disease associated with the cigarette use or vaping should consider refraining from using ecigarette products or vaping. People should not buy these products off the street and should not modify them further. Orlts who use ecigarettes vaping products because they have quit cigarette smoking should not return to smoking cigarettes. Need to address the epidemic of youth use of ecigarettes. This current outbreak reinforces the need to address the broader use ecigarette epidemic. What do we know so far . As you have heard, several hundred cases have been reported from nearly all dates. States. We have had a number of deaths. One half of all cases are less than 25 years old. With cough,nt shortness of breath, chest pain, and symptoms like nausea, vomiting, fatigue, or fever. Withof the cases information so far have reported use of either thc or thc and nicotine containing products. Some have reported nicotine only. There maybe be challenges with the history of exposure in some subset of the patients. What do we not know so far . Probably the most important thing. We dont know the cause. Product, brand, substance, or additives has been linked to all cases. This investigation is ongoing and very dynamic. What are we doing to respond . Theis working closely with fda and Clinical Community to get to the bottom of this. To helpdeployed staff states with their investigation. Standardized clinical guidance and a reporting system, they are working on coordinating parts of the investigation and response. We has set up an Incident Operations Center as we do in other situations. Have convened the Public Health, clinical, and media numerous times to share what we know and dont know. One such example is a clinical outreach and communication activity call that we held in the past few days that had 2500 lines active. They were listening to the latest information. We are working with the fda on the Laboratory Aspects trying to trace back and study the products from affected patients. There are challenges with this response including the nature of the outbreak itself. Casestates, some of the reported using illicit products and may not be fully forthcoming. The marketplace is wide and diverse and it may be very complicated to tease out the problematic exposures. And the Public Health Data Collection system is in need of an upgrade. In terms of the cigarette use, were seeing an epidemic. I would be happy to go into many more details about that. But the most recent data is continuing to be concerning. I will leave you with this. Cdc is dedicated to working around the clock with state and local Health Officials to identify the cause or causes of the outbreak. We will continue to update you during the course of the investigation. Think you very much. I recognize myself for five minutes of questioning. Thank you for the work that youre doing. The cdc has been very clear that it is not yet possible to determine the cause of the vaping related lung disease outbreak. Cdc has recommended people consider not using any ecigarettes. From that we gather nothing is off the table. Lets first described the general types of ecigarettes out there. I understand there are two major categories. There are nicotine ecigarettes which of been the focus of this subcommittee hearing. Ecigarettes thc that replicate the effects of marijuana. You are examining both of those types of rodericks as factors in the current outbreak of lung illness. Is it correct to say that you cant rule out either as it contributes to the outbreak . We think it is very important until we know more that the recommendations be very broad. , werate from this outbreak are concerned about the rise in nicotine containing ecigarette use, which is really epidemic. This particular outbreak, we dont know what the product or products are and whether the components of the products might be contained. I want to focus on the nicotine ecigarettes for a second. Almost 20 of victims were using only nicotine ecigarettes. Or using, among other ecigarettes, nicotine ecigarettes as well. There may be people out there that would like for this to be a thc only problem so that they can go back to vaping nicotine ecigarettes. If almost 20 of victims are using, do we need to be concerned about all of them at this point . I think caution containing all products is recommended. It may not even be the thc or nicotine part. It may be additives or substances that might be common. It might be material that is not labeled appropriately. We think we need to be cautious right now. And you cant rule out any brand . No additive has been ruled out as of today. I would also like to understand the contributive factors that you are considering. August 22, cdcn said, even though the cases seem similar, it is not clear if these cases have a common cause or if they are different diseases with similar presentations. Could there be multiple separate problems causing similar results . That is right. Respiratory symptoms are not specific and xray findings are diverse. Product in one state is the same as the problematic that havere so many the same results. Inhaling liquid particles into our lungs . We do not know enough about vaping produces in terms of the short or longterm health impact. And it maybe that the process itself is risky. While they are considered safe in food, a recent study thed those solvents reduce lungs ability to fight infection, increase the chances of getting the flu, and of dying from it. Are and allts ecigarettes. Can the cdc rule them out as a factor . We have not ruled out any substance yet. Many of the victims are using flavored products. To add flavor requires additional chemicals on top of the various solvents that we just talked about. Rule out the chemicals in flavors as a factor in the current outbreak . No, we cant. I want to remind everybody that you took a farreaching warning that the cdc advises the public not using any ecigarettes at this point. The cdc also advises those that do not date, not to start. The children and pregnant women never use ecigarettes. And for others to use an fda approved device. Ecigarettes are not approved by fda. Thank you. I recognize esther clout for five minutes of questioning. Cloud for five minutes of questioning. The resultt is not of infections but rather chemical exposure. You maintain that distinction, or is it possible leadingical exposures to the immune system are therefore leading to infection . One thing is to rule out infections as a cause. In these episodes, we dont believe infection is what is causing the problem. It we think it is one or more chemical exposure. Do symptoms happen immediately after vaping . We understand that there is a progression, days or weeks of worsening symptoms until the difficulties are severe enough to present for hospitalization. Many have required intensive care unit ventilation. Have you been able to investigate supply lines . It is difficult to backtrack where a number of these products are coming from. This is a very active investigation. The fda is leading the product trace back. Theyre also working with the dea in that effort. Also working together information. Many people have used more than one product and may have acquired them from a variety of retail, online, social sources, or on the street. Comes to teen vaping, do you have a sense of where teens are acquiring products . I dont have that data right now, but we do see a significant rise in the use of ecigarettes among teenagers, both middle school and High School Students. One of the things they see in common are the role of flavors. They are a big attractor for teenagers. Arethe first product people using flavored. But in terms of where they are getting them, i dont have the data. Sometimes it is really just a friend or peer. In most states, it is illegal for teens to acquire vaping products. Right . Is right. Ecigarette use is not supposed to be for anyone under 18. That has been since the 2016 legislation. Tois there effort underway determine where teens are getting products . That would be the realm of the fda in terms of federal legislation. There is certainly the issue of access. Barrier. Ct is a key the stricter it is, the better. Where in support of making it extremely difficult for young people to get products that they are not supposed to have. What are the recommendations you have when it comes to that . There are a variety of populationbased strategies that are shown to be effective to limit access to cigarettes or ecigarettes at this point. One of the issues is the advertising that is particularly appealing to use. And we have seen it again with ecigarettes more recently. Another is the retail site acquiring proof of age. There are a number of other efforts were doing in terms of raising that we dont do, but the state will raise the price as well as using efforts to educate schools. Talking about product lines and supply chains, do you have any sense of how much is coming from counterfeit places or china . There are a lot of loopholes when it comes to freight. Of where thesense product is coming from . I would say this is an extremely Dynamic Market. The Dynamic Market and the are dynamic. T we have seen changes in market share for ecigarettes. Believe there is likely to be an illicit market that is mirroring the rise of the illegal market. I now recognize congressman to sony i desonea. Cdcn the timber six, the issued the following statement during the press Conference Announcing this investigation, individuals consider not using ecigarettes because as of now, this is the primary means of preventing this type of severe lung disease. Ecigarette use is never safe for use, young adults, or pregnant women. During the same press conference, you announced an Emergency Operations center. Can you describe what factors led to cdc to that . And given the lifethreatening emergency that we are faced with, how do we make sure that dont lose anyone else . This is a fastmoving and serious outbreak of a new condition. Established in Incident Management System to respond to the outbreak and it took the additional step of activating the operations center. We have more than 100 people responding to the outbreak right now as well as deployed to affected states. We are also supporting local health on the frontline. We have hundreds of cases reported all across the nation. In order to work efficiently and effectively with states as well as the fda and others, the eeoc activation facilitates that. I am from the San Francisco bay area. When i go home, jewel is now spending 40 million or more in overturning local events. The San Francisco municipal government says they ecigarettes are banned until the fda comes up with the end of their investigation. Recently, we had an executive and founder of jewel secure and from my perspective, say that their product is helpful to keep people away from tobacco. Particularly young people. Passedistrict, they just similar ordinance. It seems to me to be a preventative and cautious approach. There is a product out there that is leading in deaths. What can we do to make sure that . His doesnt happen in the business of young people, willing to spend 40 million. I hope they investigate their Political Consultants as well. They are shameless when it comes to the information. Getting the look Health Officials involved, this is a daunting task to see that the public understands, particularly young people. I appreciate the interest in the topic and the attention you have given to this. We know that youth should not use ecigarettes. That nicotine is one of the most addictive substances there is and that nicotine is dangerous for the developing brain. We also know that flavors are a major attractant for young people and that they often are the first ecigarette types that children use. Has a latest generation higher available nicotine level that is particularly addictive. In terms of the epidemic of ecigarette use, i appreciate all that the community is doing to address that. Do you need Statutory Authority . Particularly when lifeanddeath is on the line, would it be theful for the cdc have authority to not just encourage people, but prohibit people from using this until your investigation is done . The cdc doesnt have Regulatory Authority over this kind of matter and the fda does. Fda is taking many measures to intensify the work in light of this epidemic. Think one of the key things that could help with this investigation in terms of the outbreak is modernization of our data systems that are really outdated, slow. The epidemic is moving faster than datagathering. We are losing people in the meantime. The reason i ask the question is to suggest that the fda is moving too slowly. Efficientht be more that the cdc had the authority to say that this product should be removed from being legally sold. I recognize the congressman for five minutes of questioning. Long have these ecigarettes been on the market . We are on the fourth generation of products. First1 we were seeing the of the products and by 2012, there was a doubling in their use. The first work in 2011 . We started measuring. 2007. Is just in you said maybe 80 of the people that got sick admitted in theirhc ecigarettes. How do you determine if they had illegal substance or not . The information is based on history of what officials individual thought they were using. I will tell you what im trying to get at. You testified 80 of the people that got sick may have had thc in their product. Thc is illegal in most states in the country and i assume that some people dont like to volunteer that they have been doing something illegal. A hardr if that is number or if it is closer to 100 because some people dont admit. The number comes from an wisconsin report in the new england journal of medicine about what a small number of patients described using. We acknowledge individuals may be reluctant. Self reporting. You guys report that about 72 of the people that got sick were male. Tell me, ecigarettes overall, what percentage of people that buy illegally are male or female . More males by ecigarettes than females. 72 hits me as a high number. The statistics on the lung injury cases has been decreasing as we get more cases reported to us. We will be updating the numbers but you are right, nearly three and four of the reported cases are in boys or men. That bybout people ecigarettes to prevent smoking. Way ofthis new preventing people from smoking and we had over 400,000 people a year dying. 10 years ago, this was perceived to be a good thing. The people that buy to stop smoking, do you have a breakdown of male and female . Ecigarette uses much more frequent in young people that adults. But i dont have the breakdown of those using ecigarettes for cessation. Thc isost states, illegal. Over time, more and more states are legalizing marijuana. I dont know who to blame for that. Including my neighbor to the south, illinois. These cartridges legal in states that legalize marijuana . The legal provinces it is a very diverse landscape and i dont have the specifics on individual states. I wish you would look into that. Of wisconsin,outh illinois has decided to go all in in making marijuana legal. You do not know if the illinois statute will make these things legal or not. Thing about the substance or additive linked to the cases in this outbreak. Thatt you dont know illinois made this stuff legal . Which stuff . Thc cartridges. I dont know. I feel like it is something that we should know and big trouble if illinois just made these things legal. We dealtain why with this in the state legislature. Why is this a new thing happening now . And you never heard about it eight years ago. You to vaping or the outbreak of lung injury . People dying. Thank you. We dont know. But we know the products out there have changed a lot. Increased. Bably but we do not know if there is a particularly risky product or a substance in the product or manipulation that is dangerous. Is a fourth generation of ecigarette products out there that may perhaps be related in some way and we dont know why this condition is occurring in this particular epidemic. I recognize congresswoman hill. On september 6, l. A. County had their first reported vaping death. A teenager began an antivaping campaign from her hospital bed. L. A. County Public Health officer dr. Davis has compared the revelations about ecigarettes to the slow discovery of the danger of cigarettes several decades ago. Been 57 cases of acute lung disease among people with a history of vaping since late june according to officials. Parents, kids, and adult vapors are scared. The cdc and state Health Departments have been working together to investigate the outbreak. A couple days ago, the cdc reported 530 confirmed and probable cases of lung disease in 38 states. Are those numbers expected to grow . We are seeing more and more cases each day. Diseaseoes the dzs present itself . People have days or weeks of ,orsening breathing problems shortness of breath and with fever, nausea, and vomiting. What do we know about the timeframe . It may be days or weeks. For those affected, how long are they being hospitalized . The average hospitalization length is six days. Care, manyensive mechanical intervention. What percentage require medical intervention . A large portion. Effecttics dont have an. It is not an infection. At some seat improvement after use of steroids. We dont have evidence about the benefits and risks, but we think individuals and clinicians should consider the use of clinical steroids. Potentially some kind of acute inflammation. The joint study found a median and 32 ofears old those affected are under 18. Why is this affecting otherwise healthy kids . Have all the answers and as we gather more data, we look at more individuals that are older. We do see half of the cases are under 25. Thee are deeply alarmed by nine deaths. Is it anything we have learned about how the lung disease results in death . We are looking into that closely right now. We do expect more. That is one of the reasons we have been trying to get the Health Recommendations out there. So that people who are concerned about the health risks refrain from using vaping products. Is it possible this disease has been going on longer and it is just now linked to ecigarette use . Likely that large scale we have seen this and missed it. We are using syndromic surveillance to look back in time at Emergency Department visits and we have evidence things really started to pick up in the spring or summer for this condition. Theyre probably have been individual instances that we missed. When i think about individuals that have kids they being, this is one of the most important questions. When should someone go to the doctor and what information should they convey . Been vaping anding youre having difficulty breathing or cough and the kind of symptoms weve described, you should talk to your doctor about that. We dont know exactly how rapidly people progress, but we are concerned about the very severe cases that we have been seeing in young people. Patientsrd from some of doctors have not asked and vapers say no. Doctorsquestions that should ask patients . Yes, we recommend that doctors not only ask do you smoke cigarettes, but ask if you use ecigarettes or vaping products. We think its really important for clinicians and parents to educate themselves about the types of products out there and to ask the right questions. Rep. Hill patients who have recovered and released are being told theyll need periodic lung scans. Do we know whether this outbreak will result in longterm or permanent lung damage . I fear it may, but we dont know yet and we recommend clinicians do regular follow up of individuals. The Clinical Community, the pull pulmonologists, and so forth, are studying parents and its so new that we dont have longterm follow up yet. Rep. Hill thank you so much. Im out of time and yield back. Recognize thew congressman for five minutes of questioning. I want to spend my five minutes talking about cbd. I believe theres a lot of misinformation and confusion is, andactly what cbd what thc is. Cbd is cannabidoil and something that a lot of people talk. A lot of people in Congress Take cbd. Millions of americans take cbd. I take cbd. These are two of the cbd products that i take, and i will talk about that in a minute. Theres two sources of cbd hemp and marijuana. , like broccoli and cauliflower. Bear in the same family. If you can imagine what broccoli and cauliflower look like, to have some similarities, but are also different. That is the way it is with hemp and marijuana. Thc, an acronym that measures the level of psychoactive material in cbd. , a lot oflook at cbd the majority of cbd that most americans are taking, and having really positive effects from cbd m is coming from hemp, not marijuana. The hemp cbd has little to no thc. Theres a lot of confusion when i hear people talk about cbd and thc. Prior to coming to congress, i was the agricultural commissioner in kentucky. This was something that was not formed for minor nose elected to make Industrial Hemp a reality in america. Youre not growing hemp in america, america was the only industrialized nation that didnt grow Industrial Hemp. So in kentucky, we became the state to grow hemp. Firsttoday, kentucky is a leading hempproducing state in the nation. There are at least 15 hemp processes in kentucky that are making cbd oil. I have been these two. Exe undertake, i have been in those companies and seen their labs. Those companies are, in my opinion, producing a good and legitimate product. But those Companies Want the industry to be regulated. Currently, there are no fda oil. Ations on the beautcbd those gentlemen, those Companies Want regulation. I have worked with the congresswoman in maine, we have sent a bipartisan letter asking the fda to hurry up and issue fda regulations with respect to cbd. Any cbd pods,sell all their parts are nicotine pods. So the sickness that came, they were using ecigarettes with cbd, these are counterfeit pods. Not only were they counterfeit, the people producing them dont know what level of thc they were putting in the pods, because there was no regulation on it. It is a good industry, it is a good product, but there need to be regulations. Normally i am a guest weulations, but sometimes need regulations. A young man in my district was recently hospitalized from vaping cbd with an excessive amount of thc. He bought the pods from a friend. They released him from hospital and he was hospitalized again with a collapsed lung and he had life support in my district. To be put on mr. Chairman, i ask your consent for this article detailing my constituents story be inserted into the record. Chairman without objection. rep. Comer the Associated Press has tested 30 vapor product that were marketed containing cbd and found ten of the 30 contained synthetic marijuana. 22 of the 30 contained little or no cbd. This cbd produced in my Congressional District processed in my Congressional District has no thc. Zero thc. So there is a lot of misinformation and confusion about cbd that i wanted to make sure that everyone understood. The Associated Press also reported on testing that the dea had done and found that product they tested contained synthetic marijuana. 128 of the cbd products. Three of these contained fentanyl. Mr. Chairman, i ask unanimous consent that the two articles from the Associated Press be inserted into the record. Chairman without objection, so order. Rep. Comer and if i may, ill conclude by saying that i think that there is a lot of positive benefits from cannabis oil, but this Industry Needs to be regulated. This industry is very prevalent in my Congressional District and they want regulation to make sure there are no bad actors, no flybynight companies producing cannabid oil with excessive amounts of thc. So thats something that im working on. I had chairman Collin Peterson in my Congressional District sunday visiting with some of these hemp processors. Our office is working with usda and fda to try to see that we have good regulations that product the consumers while helping the industry grow. Thank you, i yield back. Comer. N thank you, mr. I now recognize the congressman for five minutes of questioning. Thank you, mr. Chairman. And thank you for your leadership on this issue. Doctor am a is it true that 28 of 12th graders reported vaping nicotine in the last 30 days . Those data are from the preliminary results of the 2019 National Youth Tobacco Survey. The final results arent quite available, but thats right. And is there a Statistical Analysis that found that for one smoker that successfully quits thanks to ecigarettes, 81 young ecigarette users will become traditional cigarette smokers . Are you familiar with that . I dont have that statistics, but what i can say is that ecigarette use is much more frequent among young people, youth, than it is among adults. That theu familiar people who use these cigarettes and outgoing and using regular cigarettes . Thats right. The national akadcademy of academy of medicine looked at bat, in terms may lead to of whether ecigarette use may lead to tobacco use and theres moderate evidence about that. The newest generation of e cigarettes isnt really covered under that study, and the newest generation seems to have a number of factors that make it even more addictive and even youth, so weamong dont have a longterm follow up on them. Khanna on september 11, 2019, President Trump announced a ban on flavored e cigarettes. Finally did something that i agree with, that it hasnt been implemented. The cdc came out in strong support of the flavor ban with the director stating needed to reduce the epidemic. But washington is a very political place. So now, you have the president s advisors telling him that this is granted hurt his reelection in battleground states, because there are hundreds of thousands of people in battleground states from vape. What would you tell the president about that argument his advisers are making and whether he should stick to his original ban . Let me just say that the regulation of Tobacco Products is under the fda not the cdc. As a Public Health expert and as a leader at the c. D. C. , i can say that we are extremely concerned about flavors and the role they play in hooking young people to life of nicotine and we really want to avoid another generation being addicted to nicotine. So addressing favors directly is a good idea in terms of the role that they play in young people, particularly middle and High School Students beginning to use ecigarettes. On a substantive level, how would you answer the tradeoff where people say, we agree with you with children not having these flavors, that is why i support a ban. Adultst do you say should do if they want to transition off cigarettes . Are there ways they can still use these severance when only the tobacco flavor . Suggest any evidence to that it would diminish their ability to reduce their addiction to cigarettes . We dont think that flavors are the critical factor for adults who are trying to get off of smoking cigarettes. We think the nicotine level is the principle issue there. We certainly encourage adults to quit smoking and use fda approved devices or approaches to do that, Behavioral Counseling is also recommended, and there is an emerging data are being looked at about the roles of these cigarettes. None of these companies have applied to the fda to be considered as cessation devices as of yet. Rep. Khanna so would it be fair to say then that you dont think banning flavors in e cigarettes would in any way harm harm adults who seek to quit regular cigarettes by using regular cigarette products . I think they really have characterized that, i would agree with. Rep. Khanna no further questions. Would the gentleman yield his 30 seconds . Rep. Khanna i yield. Doctor, the fourth generation devices, you keep referring to this. What are those . What i am trying to imply is that the juul andrylated products use nicotine salts. They can lead to much more available nicotine. We believe the product can cross the bloodbrain barrier and lead to potentially more effect on the developing brain in adolescence. Fourth was this generation introduced to the market . While some of the juul was 2015. But the market share really ratcheted it up more recently. So the 2018 dayta was 78 higher than 2017 for High School Students. And the preliminary data is even higher for 2019. And thats based on the fourth generation device really taking off. Right and we know that juul went up to over 70 market share more recently than 2015. It had a tiny market share. Thank you so much. I now recognize congresswoman miller for five minutes of questioning. Thank you, chairman krishnamurthy, and Ranking Member cloud and thank you for being here today. There are two key issues that we must keep in mind surrounding e cigarette usage. First, we must do everything we can to keep ecigarettes out of the hands of those who are under age. Secondly, we must also recognize ecigarettes Critical Role in Harm Reduction. For that reason, we must not throw the baby out with the bathwater. We can both prevent children from using ecigarettes, while also ensuring that there remain available for those adults who choosing to quit smoking and trying to do it through such a mechanism. We have to Work Together with our federal agencies to curb the online procurement of ecigarettes, pods and vape fluid by underaged individuals. Unregulated black market doesnt have any of the protections for those to use their products and or pose a safety risk and they pose a safety risk for the public. I understand that there are companyies who sell in the United States that have taken a proactive and positive step to prevent underaged individuals from procuring their products both online and in stores. Dr. Schuchat, can you first discuss the dangers of buying illegal or counterfeit vape Products Online . Dr. Schuchat we think it is really critical to know what you are using, and it is very difficult right now in terms of Online Purchases or off the street purchases, or getting products from a friend, to know what you have. We also know that labels may be misleading and counterfeited. So right now, the products are , and vastly changing, and it is really one of those errors where consumers have to be aware. We do think that Retail Stores giving you to be enforcing the rules about not selling to underage individuals, and we companiessure that are not marketing to youth directly or indirectly through influences on social media. There has been a lot of evidence that a that are attractive to use help themds begin ads that are attractive to youth help them begin. Testing found that some black market dhc cartridges contained more than 30 vitamin d acetate come and some just positive for pesticides. What would substances like this do to the lungs of an unsuspecting user . You point out a couple of different substances that nobody would want to have in the middle of their lungs. Right now we are working vigorously on trying to understand what other products that individuals who come down with this lung injury use, and what was in them in a lot of other products. So the fda laboratories are working very hard on that issue right now. Rep. Miller is that something that the cdcs monitoring right now, isnt it present in those cases . Dr. Schuchat we dont have full data yet. It is important to know that there may not be much remaining product from an individual who may have used up the pod, and there may be differences in what you measure in the pod, and what the lungs are exposed to when the substance is heated to a very high temperature. So there are sophisticated studies going on to try to analyze both the product, and potentially the vapor or the aerosol as well, so we cant say that any particular substance has been linked to all cases or a majority of cases as of yet. Rep. Miller is there a name of this disease people are getting . Dr. Schuchat we are calling it lung injury associated with e cigarettes or vaping. Its not particularly catchy, so we dont have a name thats shorter yet. Rep. Miller lung disease. Dr. Schuchat were saying lung injury because it really looks like an injury, not a longterm disease. Like emphysema. Of course, longterm, there may be consequences of the injury that were seeing. Rep. Miller isnt it true that counterfeit products sometimes design their packaging to look like legitimate manufacturers , and is the cdcs seeing cases of pulmonary illness coming from these counterfeit products . Dr. Schuchat i dont have information about counterfeit products, but thats exactly why counterfeit products make labels to deceive the consumer. Rep. Miller okay. I yield back my time. Thank you. Krishnamurthi i now recognize congresswoman pressley for five minutes of questioning. Rep. Pressley thank you, mr. Chairman for your leadership on this committee on this Public Health crisis. I heartened to see the am bipartisan interest and commitment to address what is a fastmoving outbreak and am hopeful we will show similar and equitable outrage when it comes to gun violence, which is also a Public Health crisis. Dr. Schuchat, thank you for being here, and rank you for your efforts in addressing this outbreak. I wanted to revisit the line of questioning from representative khanna in talking about the trump administrations intent to ban all th ecigarettes from the market. It states that mint and menthol will be included and i wanted to get this answer on the record. Mint and menthol are, of course, flavors, correct . Dr. Schuchat correct. Rep. Pressley yes or no. To be effective, do you agree the ban needs to include mint and menthol . Dr. Schuchat yes. Rep. Pressley thank you. Im encouraged on banning flavors especially as flavors continue to be a main driver of why youth are using these products. I want to do a special bit of acknowledgment, my home state, the commonwealth of massachusetts, our attorney oferal, and leadership cities like summerville and cambridge. Even where 63 of juul users ages 15 to 25 have no idea the product contains nicotine, they think it just has flavors. A dangerous misconception considering all juul products deliver nicotine and according to the companys website, a single juul pod is e equivalent to smoking one pad of cigarettes. Are you familiar with term nick said . Dr. Schuchat no. Rep. Pressley what about nicotine poisoning . Dr. Schuchat yes. Rep. Pressley can you describe how these syndromes might present themselves in children with a high intake of nicotine . Dr. Schuchat the variety of things that can occur is scary. The specifics, i will probably have to get to you. But we are aware of a number of poison control calls related to ecigarette use and overdosing, if you will, and then in terms of usurers having been reported as adverse events. But for the specifics, i would have to get back to you. Rep. Pressley what impact are the harms of high dose nicotine when it comes to adolescent development . We talked about how it might more acutely present, but whats the impact on development . Dr. Schuchat the concerns about the developing brain in adolescents are that nicotine can lead to difficulty with memory, learning, and attention. Andan also prime the brain the body for addiction to other substances, and that is a particular concern. Rep. Pressley i am curious, have any other states observed improvements of any of the 530 cases since they fell ill . In other words, are you noting any improvements for those that have been diagnosed with a lung injury . And what best practices would you recommend to states and homt hospitals as they begin to track longterm impacts . Dr. Schuchat we know that in small numbers, the use of steroids during treatment may improve outcome, but we dont have Scientific Data or large scale numbers yet on that. Were recommending now that clinicians individualize care, but they consider the use of steroids in terms of its benefit and its potential harm since sometimes steroids can be risky if you do think theres infection going on. We also recommend that clinician clinicians follow patients after discharge including with pulmonary function tests to see whether the lungs really come back fully to what you would expect in an otherwise healthy young person and clinical communities are gathering the day the to come out with more official recommendations. Chairman krishnamoorthi thank you. Will the gentlewoman yield her time for questioning fourth generation ecigarette and the nicotine salts, what is the importance of that . You said it penetrates the blood brain barrier. Whats the import of that . Dr. Schuchat you know the issue is easier of access to nicotine to the brain may have a higher risk of leading to those issues ive mentioned. The learning difficulty, the attention problems. Memory issues. And so as well as priming for addiction. So i think that the brain is pretty central in the issue of addiction as well as in cognitive functioning, and we are concerned that higher doses of nicotine getting into the brain may lead to larger problems. That fourth generation is not just juul, it is the other pod mod combos. And the other factor that i hadnt mentioned yet is just the devices, they are ones that are very easy to conceal. You can have them in the classroom. The teacher doesnt even know that you are using the ecigarette. So between the very high levels of accessible nicotine and the discreet use of the products, we think that the rise in teen use is particularly dangerous. Chairman krishnamoorthi thank you. I know recognize Ranking Member jordan for five minutes of questioning. Rep. Jordan thank you, mr. Chairman. Doctor, 530 cases and then is it accurate deaths as well have , eight been thats associated with the lung illness and vaping . Dr. Schuchat yes, its even more than that now, but well be updating the official numbers on thursday. We believe that probably hundreds more have come in since the numbers we released last week. Jordan no additional people passed away, right . Dr. Schuchat there may when a death occurs, the state investigates to identify whether they do believe its related to this condition. And then they report to us and so we let the states report publicly before we report on the amassed number. I think were above eight at this point. Rep. Jordan ok. Lets stick with the numbers 530 and 8. You said this about the 530 case cases. Most patients have reported a history of using ecigarette products containing thc. Many have reported using thc and nicotine. Some have reported the use of e cigarette products containing only nicotine. Most, many and some. If i get the distinctions right. Can you give me percentages on each of those . So, most of the 530 have used e cigarette products with thc. What is the percentage is that . Dr. Schuchat actually, those terms are related to the very small number that had been described in the illinoiswisconsin series. This is really about less than 50 cases. Most were about 80 , many was about 60 , and some was less than 20 . But we will be updating the numbers. Rep. Jordan you dont have the percentages on the 530 . Just on the smaller population sample in illinois and wisconsin . Dr. Schuchat thats right. Rep. Jordan any guess at the 530 . Would you think it would be similar . 80 have used, do you think it would be similar, that 80 of the 530 cases were using the thc . Dr. Schuchat the trend continues in the preliminary numbers, but i dont have the precise, final numbers yet. So i do believe that the majority report use of thc or thc and nicotine products. Then, ofan and course, there is the issue that the gentleman from wisconsin raised that the people who say they on the used ecigarette products containing only nicotine may not be totally forthcoming, that they may be fudging a little bit on that. Dr. Schuchat absolutely. Rep. Jordan ok. So it could be potentially that this thc is linked to all cases of a health concern. Now do you have the data on the eight people who have passed away . Do you know if it was, do you have any data on those, or theyre using thc or not . Dr. Schuchat i dont have that data, but a really important point is that it may not the thc or the nicotine, but it may be something associated with those products that people are using. Rep. Jordan you just dont know yet . Dr. Schuchat right. Rep. Jordan okay. Now you also said you talked about the epidemic at the youth level particularly high school level. What were the numbers and i agree, i dont want any kids using this product, a bunch of other things are there, but what was the number of High School Students were using the product . Dr. Schuchat the preliminary data that was reported from the fda preliminary look at 2019 data was about 28 of High School Students reported using e cigarettes, which is a big jump from about 20 the year before. Rep. Jordan that is. Do you know the numbers for High School Students who have used marijuana . ,r. Schuchat it is less common but i dont have the numbers right in front of me. Rep. Jordan my understanding is that it is over 20 as well. Is that right . Dr. Schuchat i think you need to differentiate numbers used in the past year versus the past month. The numbers i was giving you for ecigarettes was used in the past month, but i dont have the numbers for marijuana. Rep. Jordan is it over 20 as well . Dr. Schuchat i dont know. Im sorry. Rep. Jordan okay. Okay. I mean, i figured it was. I just was curious on some of these numbers. It seems to me we got an epidemic with marijuana use, vaping, all kinds of things and we should be talking about all of those issues that are of concern to for young people. With matt, i yield back, mr. Chairman. Actually, sorry, i did find the number. I knew that i had seen it. The number that i have for adolescents use of marijuana is 12. 5 in the past year. So a bit less than the 28 in the past month for ecigarettes. Rep. Jordan ok. Chairman krishnamoorthi mr. Jordan, would you yield your remaining 14 seconds for questioning . Okay. Dr. Schuchat how many of them were related to fourth generation devices . Dr. Schuchat i dont have that data yet. Chairman krishnamoorthi okay. Thank you. I now recognize congresswoman talib for five minutes of questioning. Rep. Tlaib thank you, mr. Chairman. Earlier this month, my home state of michigan became the first to ban flavored e cigarettes, this after news of ecigarette smokers showing up in Emergency Rooms with shortness of breath, chest pain, coughing, vomiting. Nationally, we have seen as we have repeated, at least 530 cases of lung disease in 38 states, users in and it exposes just how little we know about these products. Nicotine ecigarettes were allowed onto the markets with regulation, and advertises better practice of ecigarettes. In truth, i believe we have become a testing ground, most notably our american youth, and there is so much we dont know about the longterm impact of ecigarettes. But what we know now currently is pretty alarming. Believechat, why do you ecigarettes have not been improved as cessation methods . Because they are advertised that way. Dr. Schuchat to my knowledge, the companies have not submitted the data in support of getting them approved as cessation devices . Rep. Jolly so why . Dr. Schuchat the Companies Need to answer that. The companies would need to answer that, but it can be a costly process and it may be that they would also need to describe the Public Health standard being met and that may be difficult at this time. Rep. Kelly yes or no. Is it ever safe for kids or young adults to use ecigarettes . What about traditional cigarettes . Dr. Schuchat no, and no. Rep. Tlaib the c. D. C. Has stated that ecigarettes harm the part of the brain that control attention, learning, mood, impulses. Could that account for why weve heard so many teen juulers complain about mood swings, spouts like anger, depression and trouble concentrating . Dr. Schuchat well, theres a lot going on in adolescents, but it may be part of that. Rep. Tlaib we have also heard from many people who believe ecigarettes were safe and its easy to see why as weve continually see the misleading and analyze to the American Public. Earlier this month, we wrote a letter to the fda outlining our finding of instances of juul , telling the public that its products were safe. They included testimony at our went torings but juul schools and told night graders that its products were totally safe. They used the word totally safe. We were pleased to see the fda answer our call by declaring that juul broke the law and issuing a warning letter, they gave them until september 30 to respond. To those listening, please Pay Attention to that response and what we hope will be prompt action by fda to hold juul action by fda to hold juul accountable. Dr. Schuchat, the c. D. C. Has asked the public to consider not using ecigarettes. Has the industrys false safety narrative made it more difficult to get your message out . Dr. Schuchat we know that there is a lot of noise out there, and have been repeating our messages. We hope the seriousness of the disease, including death, is getting attention, but there are a lot of competing messages. Rep. Tlaib as much as ecigarette companies imply they are a smoke Smoking Cessation products, none are approved by the fda for that purpose. The c. D. C. Has recommended that adult smokers to quit smoking should instead use evidencebased treatments, including counseling and fda approved medications. Has there ever been any outbreak of lung disease associated with fda approved devices like patches and gum. Dr. Schuchat not to my knowledge. Rep. Kildee thank you so much and i yield the rest of my time. Chairman krishnamoorthi thank you, congresswoman talib. Without objection, miss watt wassermanschults. Gentleman from florida will be permitted to join the committee and is promoted to asked questions for five minutes. Rep. Wasserman schultz thank you, i thank the committees indulgence for including me. Doctor, welcome and thank you so much. Ive had the honor of working with the c. D. C. On a number of different important initiatives and work of you and your colleagues is really remarkable. I want to ask you a couple of basic questions and a few ill illustrative ones. Is there evidence that nicotine addiction is harmful to an individuals health . Dr. Schuchat yes. Rep. Wasserman schultz could you elaborate . Dr. Schuchat were particularly concerned about nicotine use in youth, in women who are pregnant or more and in adults who are not using already using cigarettes. The issue is the developing brain. The developing fetus. And the risk of going on to cigarette smoking. In the developing brain, i think its key most people dont realize, the brain continues to develop until age 25 in most people. And nicotine can cause many problems. Including difficulties with attention, memory, learning problems. It can also prime the individual for addiction to other substances. Rep. Wasserman schultz i asked you that because sometimes you ask a question that you already basically know the answer to, but as a parent of twin 20yearolds and a 16yearold, having children and young adults in the target audience for these vaping products, thats Important Information to note. Particularly in light of the fact that we had juul executives testify here in what i found to be a very deceptive way including a direct answer to a question of mine in which the juul executive that sat where you are sitting actually had the audacity to say they didnt market their product as a smoke Smoking Cessation product splitting hairs between the idea they are a safer alternative to smoking, versus marketing it specifically as a Smoking Cessation product. That, to me, is a distinction without a difference. So having neck spurt, a Public Health expert actually say that no Health Benefits to nicotine, in fact, nicotine addiction is harmful, particularly to the developing brain, is critical. Particularly because we have a very real human impact of this outbreak and i think its important that it not be lost. There is a story that i want to share of a mother of three in abilene, texas. Sheree, who nearly died from vaping. She had never smoked cigarettes before. She tried ecigarettes because she liked the taste of the flavors, and she became addicted. She initially thought she had the flu, but within days, she had to be rushed to the emergency room and put in a medically induced coma. There are now countless people who have had to be put into toically induced comas due the impacts of vaping and she spent nearly a month in the hospital. She was a nonsmoker drawn to ecigarettes by their flavors. Is there evidence that you found that other nonsmokers are being drawn in by the attraction to flavors . Dr. Schuchat yes, thats right. Among youth right now, were seeing that ecigarettes are more common than cigarettes and that flavors are pretty much always what brings the youth in. Rep. Wasserman schultz and you think a ban on flavors of any type would bring a dramatic reduction to to people who either might be attracted to begin vaping or if they were no longer available have people cease to vape . Dr. Schuchat we know flavors are a attract attractant so i hope if flavors were not there, fewer people would take the product up in their teen years. Rep. Issa rep. Wasserman schultz ecigarette use is still relatively new. I support Harm Reduction Public Health activities, advocates often describe ecigarettes as a Harm Reduction for cigarette smokers. Im concerned that we dont actually know enough to say with confidence that ecigarettes reduce harm and in fact, there have been juul is being federally prosecuted because of their criminally deceptive practices. Can you talk to us about the challenges of being able to accurately assess the safety of ecigarettes . Dr. Schuchat the products have been changing quite a bit over the past several years, so the shortterm effects might have been looked at, but the longterm effects, we dont know yet. The aerosol ecigarettes have can have a lot of substances in it, and the longterm effect we just dont know. Rep. Wasserman schultz its not just the nicotine thats the Public Health problem and the threat. So, i mean hyperfocusing on , nicotine or any other substance that is found to have been mixed in with all of the other chemicals that could be harmful and likely are harmful, is misleading. At best. Dr. Schuchat mhmm. Rep. Wasserman schultz thank you. Thank you for your indulgence, mr. Chairman. I yield back. Chairman krishnamoorthi thank you. Now i recognize congressman cox for five minutes of questioning. Rep. Cox want to thank chairman murphy, cloud for allowing me to i want to thank chairman krishnamoorthi, and Ranking Member cloud for allowing me to waive on to this very important hearing. As youve pointed out, the recent cdc effort show that at least 500 people have experienced vaping lung related injuries and at least eight people have died. I represent the Central Valley of california. One of those most recent deaths was from one of my communities. I am troubled to hear that we have yet another Health Crisis in our hands, and this one is a special threat to our children and our families. We need to know why that has happened. We need to understand what your agency is doing to combat this epidemic, and certainly, we need solutions to prevent this from happening again so not one more american dies needlessly. I understand that your agency is in coordination with others. Last week there was an individual who was struck by this disease. We called to see what happened to this individual, and they didnt have much information. Im concerned about the collection efforts were employing to stop this outbreak from worsening. Earlier, you pointed out one of the actions that your office , the c. D. C. , is doing to consider refraining from using the product. No disrespect, but to me, that sounds like pretty weak tea. Would it be more accurate to state simply that use of the product could cause death . Dr. Schuchat were trying to be careful when we dont know what that is at risk is, and were trying to sustain credibility against those who may think were exaggerating. We know that people are dying right now in this outbreak of lung injury, and we really want people to protect themselves and not take risks unnecessarily. Rep. Cox sorry, doctor, but im really looking for a yes or no. Would it be accurate to state that the use of this product could cause death . Dr. Schuchat the this product part is hard to say. Rep. Cox one of these vaping products. Dr. Schuchat right, so our recommendations are very broad. Because something that is in ecigarettes or other vaping products is leading to death, so use of whatever that product, or substance, or additive is, can cause death. I think your comment is right, but when we dont have a specific product, consumers may not take action. So were trying to make them take this seriously in a way that theyll believe us. Rep. Cox yeah. I think the admission that i could cause death could be a warning that they could take seriously. Regulations are really protections. So when this administration boasts of deregulating things, what is really happening is that protections are being eliminated, and these deaths could be prevented if we enforce preventative Public Health measures. Evaluating your products before they hit the market, especially products with known harm like nicotine. The question is really why is the default procedure for letting products on to the market first and then evaluating whether or not they present a Public Safety or health risk . Dr. Schuchat i dont know. Rep. Cox all right. True. Right . I can tell you that do you think that any product delivered through inhalation should be rigorously evaluated before marketing . Dr. Schuchat yes. Rep. Cox i can tell you that the c. D. C. , in this regard, in my opinion, needs to find its voice again, and we in congress are committed to helping you do just that. Further, some specifics about what the cdc is currently doing, id like to know a little bit more about the individuals that have got the confirmed lung illnesses from ecigarettes and although very little is known about the longterm Health Consequences of using these products, what is the c. D. C. Going to do about tracking the consequences and so on . Dr. Schuchat the individuals who have the condition right now, majority are male. Half are under 25. Many are previously healthy. Were just gathering data now in more detail, but were working with a clinical communities we are working with clinical communities, including lung specialists, to try to understand what longterm followup should look like, and how that information should be collected. We are also working with the n. I. H. On some of the research questions, but the pulmonary community may help us come up with guidance for systematic evaluation and followup. Rep. Cox thanks so much. We really appreciate what you and the cdc are doing on our benefit. Chairman krishnamoorthi thank you, dr. Schuchat. I think that concluded panel one and we will now commence panel two. Thank you again for your testimony. I would also like to remind everybody, the witnesses, reminder that there may be additional questions for the record, and the Committee Requests that you answer them properly. If the second panel could please come forward. We are pleased to have you here. [chatter] chairman krishnamoorthi thank you so much. We begin our second panel here. You have the director of the Illinois Department of Public Health. You have the chief medical officer of the American Lung association. Ruby johnson, the parent of a teenager affected by an ecigarette related lung disease outbreak. And i will yield to my colleague, mr. Grothman, to introduce his constituent. Rep. Grothman i would like to take this opportunity to introduce a good friend from wisconsin, a passionate advocate for tobacco Harm Reductions. She has helped countless people quit smoking by sharing her story, nikki porter. Chairman krishnamoorthi thank you so much. If you would all please rise and raise your right hand, i will begin by swearing you in. Do you swear or affirm that the testimony youre about to give is the truth, the whole truth and nothing but the truth, so help you god . Chairman krishnamoorthi let the record show that the witnesses answered in the affirmative. Thank you and please be seated. The microphones are sensitive, so please speak directly into them. Without objection, your written statements will be made part of the record. You aret, dr. Azike, not recognized for five minutes. Chairman krishnamoorthi, Ranking Member cloud, and distinguished members of the subcommittee, thank you for inviting me to discuss this concerning situation where hundreds of people across the country, including 69 in illinois have experienced severe respiratory illness after vaping or using ecigarettes and tragically, there has been one death in illinois. An additional suspected cases are being reported to the department every day. Our patience in illinois have ranged in age our patients in illinois have ranged in age from 15 to 42 with a median age of 22. The majority of the patients have been male representing many counties throughout the state, both rural and urban areas. Over 95 of our cases required hospitalization. Threefourths have needed placement in the intensive care unit, and over one third have required mechanical ventilation. While we have yet to clearly define the causative agent, what is clear is that there is nothing healthy about vaping and there are heightened consequences for youth. Dr. Schuchat has amply covered the details of the current outbreak, and it is imperative that the Investigation Continues so as to identify the etiology of the acute illnesses, but there is another matter that needs to be addressed. We need to address that in parallel to the ill this investigation, and that matter is the youth vaping epidemic. Perhaps Public Health should the alarm even louder, as epidemiology showed the current rates of vaping. Even so, the current investigation has highlighted the creation of the next generation of nicotineaddicted americans. Ecigarette use increased 900 among middle school and High School Students from 20112015, according to dr. Wangs june 2018 mmwr report. The 2019 National Youth Tobacco Survey showed 68 of youth vapors used flavored ecigarette products. Vapers useduth flavored ecigarette products. In december 2018 the u. S. Surgeon general did discuss , notingarming Trends Research that found that more than 3. 6 million youth were using ecigarettes. Action is required now to protect our youth. I have led youthfocused groups in the state, and i have heard recurring reports of symptoms that depict nicotine withdrawal middle and High School Students, many who have been vaping as little as three to six months. We must permanently change the narrative around vaping and ecigarettes. Ecigarettes are harmful, they are highly addictive, because they are so efficient at delivering nicotine directly to the brain. Nicotine has no redeeming qualities for youth and young developing brains. In 2018, traditional cigarette smoking among Illinois High School seniors was down to 5 . But also in 2018, ecigarette use was already at 27 among High School Students. Our top priority has to be keeping these harmful products out of the grasp of our nations youth. Most youth that are currently vaping never smoked traditional cigarettes before they took their first hit on the ecigarette ecigarette. Contemporary product designs, attractive technology, they sync up with their iphones. The vapeware merchandise is all targeted to youth. Chat, theres on cap are cities there are ads on snapchat, there are hoodies that allow the wearer to take a hit from their ecigarette using the drawstring of the hood. Clearly a tool to conceal the vaping. We cannot stand idly by and with watching the hightech ecigarettes there is the progress against youth smoking, with enticements to vape with the marketing of trendy devices, cool accessories, and ejuice flavors like strawberry, watermelon and mango. In the state of illinois, governor prince gore supports moving forward governor prtizker supports moving forward with strong legislation to ban flavored vaping products which are exceed exceedingly popular amongst youths. We must revise curriculum among elementary and middle school to discuss the dangers of vaping. I urge congress to take up similar initiatives to protect our youth, urging all people not to vape, especially while this National Investigation is ongoing. Thank you. Chairman krishnamoorthi thank you, dr. Ezike. , you arer. Rizzo not recognized for five minutes. Zo mr. Chairman, Ranking Member cloud, and members of the committee, thank you so much for the opportunity to testify today. Im dr. Albert rizzo, chief medical officer of the American Lung association. I still see patients in my pulmonary practice in delaware. Im here to speak about the dangers of ecigarette use. For more than a decade, the American Lung association has been raising the alarm about ecigarettes. Well continue to reiterate our recommendation that the public not use any Tobacco Products, including ecigarettes. We believe that all Tobacco Products harm health, and there is no proven benefit for cigarettes. Our nation is currently in the midst of two different ecigarette crises. First, according to the 2019 National Tobacco youth survey, 27. 5 of youth are now using ecigarettes, which is a 135 increase from just two years ago. According to a c. D. C. Study, one of the primary reasons teenagers use these products are because the candy and fruit flavors are so appealing. This high use of flavored ecigarettes among youth is alarming, and requires immediate action. The national Lung Association comments President Trump and his administrations announcement that they will remove all flavored ecigarettes from the marketplace. We believe this is a vital and positive step to address the youth ecigarette epidemic, and we urge the fda and congress to act. The second Health Crisis is the current cluster of pulmonary illnesses related to vaping. As we have heard today, c. D. C. And state and local Health Departments are conducting an Ongoing Investigation into these pulmonaryrelated illnesses due to vaping. Both crises are caused by the failure of two different administrations to fully implement the Tobacco Control act of 2009, and protect Public Health. The delay in the fda has left unregulated products with unknown chemicals on the market. Some mechanicals found in ecigarettes are carcinogenic. Will the use of ecigarettes cause cancer . Well the inhalation of chemicals in ecigarettes cause lung diseases like copd . How do they impact people with asthma . And the latest question is, what will be the longterm Health Consequences of those who have been hospitalized as we deal with the pulmonary ecigarette illness outbreaks . The first report on Health Hazards of smoking including it concluding that smoking ecigarettes cause cancer. 50 years later the Surgeon Generals report added even more smokingrelated diseases. It is hard to predict the possible Health Consequences that we will see in another 50 years as a result of ecigarettes, but we are very troubled by what we see so far. Ecigarettes contain nicotine. In addition to being extremely addictive, it can increase blood rate, andheart according to the c. D. C. , nicotine use among youth and adults can alter brain development, cause learning and brain problems. Two of the chemicals can expose users to high levels of toxins , and can cause irreversible lung and Heart Disease. This is why the American Lung association has long advocated for the removal of flavored ecigarette products from the market. 81 of youth who have ever used Tobacco Products initiated with a flavored product. The American Lung association believes everyone who uses Tobacco Products can quit if they use proven, safe and effective drugs by the fda. The fda has not found any ecigarettes to be safe and effective and help smokers quit. We are often asked about a study from earlier this year in the new england journal of medicine comparing ecigarettes to nicotine replacement therapy. In this study, over 90 of the smokers using nicotine replacement therapy could smoking, ending their nicotine addiction entirely. 80 of smokers given ecigarettes did not quit but switched and remained addicted to ecigarettes and, therefore, nicotine. Switching is not quitting. Quitting means ending your addiction to nicotine which can be very difficult. I have patients who have switched to ecigarettes believing that they had quit. Some remain addicted to nicotine. Some have been dual users, and some have returned to regular cigarettes. In conclusion, the American Lung association supports President Trump championship call to clear the market of flavored ecigarettes. They have not been shown to be safe. Theyre responsible for another loss of possible generation to tobacco use, death and disease. Thank you for the opportunity to testify. Ill be happy to take questions later. Chairman krishnamoorthi thank you, dr. Rizzo. Next we have mr. Johnson, you are recognized for five minutes. Johnson thank you so much for having me. My name is ruby john, and i am a mother of seven children ranging from an 18yearold College Freshman all the way down to a 5yearold kindergartenner from illinois. I am here to tell you about the biggest blessing in my life, which is that my oldest child is still alive. As you will hear, that could have easily not been the case. On august 16th i loaded up my daughter, and all the makings of to drive her to begin her freshman year in college. As we drove, she began to cough, complain of pain in her chest when she took a deep breath and shiver election was running a fever. She also admitted to me she was have been vaping. What started as an exciting right of passage, turned into a neardeath experience that involved a weeklong hospital stay where my daughter went there a healthy, vibrant 18yearold to a patient who needed rapidly increasing amounts of oxygen and medications to treat her declining health. When we arrived in her college town, we went directly to the hospital. She was nauseous, tachycardic, coughing, running a high fever, and take a deep breath without intense pain, and struggled to saturation up to even the mid a ct scan showed 80s. What doctors called a diffuse pneumonia all over her lungs. Though antibiotics appropriate for pneumonia were started immediately, her condition continued to worsen as her oxygen needs increased steadily, and she was transferred to the icu in case more extreme measures needed to help her were necessary. With every doctor came the same question. Have you traveled out of the of country recently . Have you had a cold, and the milliondollar question, are you a smoker . We answered all those questions with no. Finally they asked, how about ecigarettes . Her answer to that question was, yes, though it wasnt until we got to the third dr. To see her, but it actually seemed to be taken seriously. It was a doctor who paid attention to the fact that she said she had recently been vaping, and she was now experiencing symptoms that matched with the newly reported cases of a mysterious lung illness popping up. He did his research by contacting doctors and hospitals that had already seen similar cases in order to determine the best course of treatment. I will never forget watching her cry, that she literally couldnt breathe without excruciating pain, as she was pumped full of iv fluids, antibiotics, steroids, pain meds, antinausea meds, and a diuretic to clear fluids from her badly inflamed lungs. She couldnt even get up to walk to the bathroom without her alarm screaming, because her oxygen saturation was dipping so low. Her belly was purple from the nightly injections to prevent blood clots as she lay in a hospital bed. Our daughter ended up being one of the lucky ones because she got to leave the hospital and can breathe without supplemental oxygen. But it could have so easily been a totally different tragic outcome. Her pulmonologist said he feared that had berated 24 hours to seek medical attention, she most likely would have been were grateful she received the care that she did. We dont all the terms of permanent damage. Its hard enough to be a parent in todays world. Teenagers will inevitably make choices and we hope they learn from them. Its scary to think theres an industry a largely unregulated products with zero longterm Health Studies that are attractive and easy bull easy to use. Kidscarted that target the through social media, a popular had flavorse, and appealing to young people. We know how the youth have been fooled into believing these products are safe by companies that acted as if they could care less for their health or the wellbeing of these kids. We have the most serious adolescent Public Health crisis our country has faced in decades. The products are designed to be hidden from parents and teachers well, withish that smells and vapors that disappear as quickly as they appear and advice devices that look like flash drives. Ceosve read the juul statement by saying happens. It happened to my family. Im joined in the movement of my moms saying enough is enough. Kids should not be the guinea pigs. If products flooded the market without anyone knowing how they would cause damage, and we are trying to clean up the mess. Devices that are easily tampered with and teens who are addicted to nicotine. If it was romaine lettuce, the shelves would be empty. We need legislators to help us by banning the flavors including mint and methadone. Crisis,s to the bigger they are being helped by flavors. Kids who wouldve never picked up a cigarette instead started using flavored ecigarettes. Nicotine becomes a gateway to other substances. Of love these markets to proliferate, flourish, and remain for purchasing consumption without the market review. It was a terrifying experience and something that would have been easier to keep private. Im here to share our story with the hope that no other family will have to live the same nightmare. Im a mom who is in your business constantly edited the right things, and this happened. They are being targeted to manufacturers with appealing flavors and able to satisfy their nicotine addiction using satisfies devices designed to be secretive. This goes beyond party lines, because these are all of our children. Thank you. Miss porter, you have five minutes for your opening statement. Thank you. Lake knowles, wisconsin. Im 51 years old. Started smoking cigarettes in college. I remember the evening i started smoking. Dressed andotten was going out, i was listening to jazz records. Ultralightsack of that a friend had left behind in my dorm room. I took outincible, one of those cigarettes and lit it. What was better with whiskey and just . Was addicteds, i to cigarettes and began a lifestyle smoking that lasted f3 years. As it turns , it is actually rea. I stopped smoking only because of ecigarettes. It literally changed and probably saved my life. Nine years later, my doctor says my lungs are healthy. I can climb stairs without being winded, i exercise four times a week, i can walk for miles and miles. I can do things i havent done since before my lungs became overwhelmed with the filth and deadly toxicity of cigarettes. Vaping is a health miracle to me. If not, i would be on my way to a cancer diagnosis. 2 main reasons why they work. The inhalation of a less harmful nicotine dose similar to smoking without the deadly toxins caused by burning tobacco. Second, it is critically important. Adults matter to me, and exsmoker. Flavors are not an industry driven innovation, they are a user driven innovation. Big tobacco did not come up with idea. Consumers, adult smokers came up with the ideas. We demanded it. The tobacco flavors everyone thinks are so wonderful of early ecigarettes were awful. They mimicked the taste of a cigarette and were poor imitations of the cigarettes we liked to smoke. We dont want our vapor to taste like cigarettes, were trying to quit them. We want something that makes us want to keep vaping. Flavors keep us vaping, flavors keep us not smoking. I took a survey on my Facebook Page. About 150 people left comments. This is not scientific, but i last count, approximately 90 use flavors and tobacco. These are middleaged and older exsmokers. ,hey are demanded by adults sold by adults, consumed by adults. According to a recent survey of more than 69,000 vapors, 92 preferred nontobacco flavors. Much has been made of the lung but ites tied to vaping, is manifestly dishonest to blame ecigarettes and nicotine look at for these illnesses. All available for overwhelmingly suggesting information that the lungs being diagnosed have nothing to do with nicotine vapor products and everything to do with adulterated street drugs or products, notably oilbased thc. Ive been vaping for nine years, and ive never been healthier. None of the nicotine vapor products i use contain oil. Ecigarettes are a Public Health miracle that america is about to squander based on misinformation and disinformation. Let me remind the Committee Members of a few points. The fda and local agencies, communities, and parents, and need to do a better job of enforcing existing laws and obligations to see to it that kids dont use ecigarettes. You dont need to ban the product to make progress on that mission. In 2018, the uks Royal College of positions published a comprehensive scientific report which concluded vaping nicotine can eliminate almost all of the harm from smoking cigarettes. They recommended promoting the use of ecigarettes to smokers as widely as possible. The indicated a vaping nicotine is at least 95 less harmful than smoking. Health england concurs. Even the American Cancer Society is beginning to understand the promise of tobacco Harm Reduction, saying ecigarettes are likely to be significantly less harmful for adults than smoking regular cigarettes. They encourage adults who have failed other fda approved message methods to ecigarettes. Were the only thing that works for me that quit smoking. The product probably saved my life. It helped more than 8 million adult smokers quit when all of the other options failed for them. I think thats incredible. 8 Million People quit smoking. Smokers, if former hope you reject the general war on vaping and encourage you to proceed with these comments in mind. I need to correct the record on a couple of things that were just said. There is no evidence to suggest ecig words are safer than cigarettes. Thats when they released the regulations directed at juul. The cdc presented evidence that they dont know the cause of the current outbreak and did not rule out nicotine ecigarettes. And are about to start questioning. For fivecognize myself minutes. First, for five minutes. I think the chairman for his indulgence. I think the chairman for his indulgence. Thank you for joining us. My question was directed at the experts in Public Health. Thatere any evidence nicotine addiction is harmful to an individuals health and other Health Benefits at all, including the reduction of the likelihood of smoking cigarettes , to inhaling nicotine on a shortterm or longterm basis . There is no evidence nicotine is helpful of all two young kids or their developing brains. What was the second part of your question . Is it any evidence nicotine addiction is harmful to an individuals health . It is harmful. Individuals of any age . Yes, nicotine by itself affects the vascular system, blood pressure, heart rate, and can cause heart and lung disease by itself, especially the elderly. Do you have evidence that it is complicated by any chemical combined with nicotine utilized in a vaping product . I was referring to nicotine by itself, but when it is combined with other ingredients the excel lawrence, the chemicals, not just nicotine the accelerants, the chemicals, not just nicotine . Are there negative health impacts, including the potential for death, to the combination of chemicals in vaping . Yes. The cdc identified 530 cases of lung illnesses associated with the use of ecigarette products it is important that we hear from partners, like you at the state level collaborating with the government to stop a National Outbreak of lung illness. Illinois and wisconsin with the first states to identify the outbreak to spearhead investigations when this sprung up. Can you describe the severity of those cases and why your state felt compelled to act swiftly . As you continue to collaborate with cdc, what steps are you taking to prevent this, even prior to the outbreak . Unfortunately, we found ourselves at the epicenter of this outbreak. Because of the alert that the Wisconsin Department of health had released, people werent tuned to the possibility of these illnesses that were not well described, but had a connection between young, Healthy People without a reason withll so sick, presented severe respiratory illnesses and had a connection with vaping. When our first case was reported to the Public Health department, we did not waste any time. We sent out alerts to the professionals, pulmonologist, hospitals, er doctors, pediatricians, to alert everyone and encourage them to report any suspicious cases directly through their local departments, which would then come to the state department. Putting out press releases, information on social media, connecting with the state board of education, working with advocates in the community who put messaging to doctors. I want to piggyback on my question. Interviews, details 61 of them used ecigarettes, did report thc use. Is it safe to say you cannot rule out any nicotine ecigarettes or thc products contributing factors to the albert . That is correct. Your advice has been for people to not use ecigarettes products. I assume a decision like that is not made lightly. Why was that necessary to Public Health . Public, nott the knowing what the actual etiology is, but knowing the commonality along all of our 69 cases was vaping. We know something with the activity, whether the product, the device, the brand, something they are in is the culprit. Without knowing specifically, it seems safer to give a broader warning until we get more information out. Before my time expires, reports show ecigarettes aerosol is not harmless. Why is it dangerous to individuals . The chemicals within the aerosol are usually irritants to the lungs. Withungs then respond different kinds of reactions that we are seeing in some of the patients, which affects the oxygenation, the function of the lungs, which results sometimes in needing a breathing machine to perform that process of oxygenation. My time has expired. I want to confirm my understanding. The testimony of ms. Porter is anecdotal related, specifically to her opinion and that she is not a Public Health expert. I think thats correct. Grossman congress congressman grossman. I know you recently legalized marijuana in the state of illinois. Thc cartridge is legal under the law or not . There are legal through the medical cannabis act. For patients on the medical cannabis program, thc cartridges are available. It was a mistake . We have no cases of our 69 cases in illinois that are from the registry of medical cannabis patients. Once you make these things legal, there are more of them out there, it implies that we are waiting to identify the exact etiology. You mentioned in your study, the people who had a Health Problem selfreported they had some thc. I asked the last panel, i assume people dont usually admit they are doing something illegally. If 80 admitted they were using a product with thc in it, is it possible that actual number is higher . To give you an opportunity to say what you wanted to say. What i wanted to say was with regard to the chairmans comments that there is no evidence ecigarettes are harmful. It was a comprehensive scientific report generated by the United Kingdoms World College of physicians. It was not just an opinion. It was anecdotal. It was a scientific report. Im not sure how many people have a chance to see this on cbs this morning last week. Abundant evidence exists that the biomarkers associated with ecigarettes are vastly lower than the ones they are associating with smoking. I would also like to ask, what is the particular mechanism by which it could possibly cause disease . Andsaid something about pg dg. What is the mechanism that Vegetable Glycerin or programming glycol could cause disease . I dont think youre supposed to ask questions, but i will ask that question. The short answer, but i will expand, is we dont know anything about these devices, because they have not been studied in a rigorous manner. When you hit a substance of to the temperature ecigarettes do, you no longer have the same property of the compound that we knew before. A compound that could have been ingested safely is being vaporized and inhaled into the lungs, a much different part of the body than the stomach. In short, we dont know what the toxins are doing. We know they are created. Even if we say they are less than cigarettes, it is a very low bar to beat. Meanshemicals, tobacco, theres still 300 and 50 of ecigarettes. Banned ecigarettes, what would you do . What would be your fallback position . Chemicals the doctor was talking about are generated when tobacco is burnt. The nicotine extracted from the tobacco does not generate 7000 chemicals and 5 solution. Thats when you like something on fire and inhaled the matter, current monoxide, the percentages. I know this because i smoked and decided to learn about it. Way to probably find a get my ecigarettes. Thats what i would do. Im a very knowledgeable user and navigator of this marketplace. I would probably order from china. Anecdotally, would simply go back to smoking. The reason were vaping instead of smoking is because the fda approved methods have failed for us multiple times. I would probably order from china, but other people would start smoking. I am going to recognize myself for five minutes. Respond to theto claim that ecigarettes are safer than combustible cigarettes . Record about the decision of the United Kingdom that 95 safer than tobacco, if you read the articles about how the decision was made, a group of experts got together in europe. Some of them admitted to be working for the vaping industry. The European Respiratory Society and 14 professional societies in this country road letters to the u. K. Saying they dont agree with the Public Health decision. Is ain the u. K. , there much different aspect of ecigarettes. They are controlled and regulated more swiftly. The tobacco flavors are not there. You can compare what happens in england to this country. It really is faulty science based on it. That was a bogus study. Order the nicotine levels allowed for nicotine ecigarettes in the u. K. Versus america . I think 18 to 20 milligrams. Here it is 59 . Correct. Almost three times the amount of nicotine here in the u. S. In pod compared to britain. Mrs. Johnson, i want to ask you a couple of questions. How old is your daughter . 18. When did she first start vaping. After all of this happened. She tried it the first time when she was in high school, and she had tried it on and off for about 18 months before she became ill. What devices has she been vaping . She started using a juul the vast majority of what she used was nicotine ecigarettes. As well andping thc used mostly nicotine in the weeks leading up to her illness. How is she doing now . Better. S doing she is adjusting to life as a College Freshman. Breath when out of she has to walk quickly or far, and will see what the future will hold. There some kind of permanent injury associated with what happened . Unfortunately with this being cant make doctors any promises that there wont be permanent damage. We will follow up with repeat ct scans of her lungs and see what that reveals as time goes on. How did she first began vaping in high school . A friend offered it to her to try. Around the back rooms of the high schools, junior high. I have two sons in high school. It is kind of common for the High Schoolers to refer to the bathroom as the juul room. Thats what goes on most. 28 of High Schoolers today are vaping. 5 are middle schoolers that are vaping. What do you say to the parents who are concerned about their children getting hooked on ecigarettes . It is important to keep the conversation open. We have to ask questions. So many of us dont know what to look for. Its important we Work Together with our schools to educate parents with what the devices look like, what the signs could and toe child is vaping, educate ourselves. You segment was one of the ones that got her hooked . Yes, she has been honest as this happened. Shes terrified. She said she would never touch it again. She said mint was her favorite. You were very close to losing your daughter. Before they diagnosed what was you come up with the idea that it was ecigarettes . How did they arrive at the question of asking about ecigarettes . The timing worked in our favor, because there was enough talk of what was going on and enough cases that it was on my radar. I saw the news articles. She was honest, so she mentioned it to every doctor. It wasnt until the third dr. That it was paid attention to. I remember the night where she cried to her nurse saying it hurt so bad she couldnt take a deep breath. The nurse reached out to the doctor and he said since he admitted her, he was trying to reach out to other hospitals. Us wearing they had a mask thinking it was pneumonia, then they came off and they said what they thought they were dealing with. I would like to now recognize Ranking Member cloud for five minutes of questions. Thank you. Enlighten us on the distinction between Infectious Disease and chemical exposure, as it relates to lung injury . When someone presents with the symptoms mentioned, it can be a bacterial or viral pneumonia, meaning organisms have gotten into the long, the immune systems trying to fight off infection. That is information. When that occurs in the long and the dependence of the lung, it will fill air spaces with the fluid, pus, then the ability of the blood stream is diminished. Infection, you can coulter that with tubes put down the long, you look for organisms under the microscope. Once that is ruled out, the information must be deemed caused by something else. Situations like this is where history is very important. Find out what they could have been exposed to. A questioning, doctors started to realize there was a commonality in vaping something. What it isexplain much more of an issue for young people to start vaping . Start vapingpeople more because of the flavors. What does it do to their body . Lunghalation into the occurs and theres a couple of different things. It doesnt reach full development until about mid20s. You are dealing with a population with a lungs are growing and developing. Havinga sudden, you are information, you are changing the immune system. Now the body has to compensate for that and recover. It has lost ground, with regard to what the development will be. In cases like you have heard, the population will be need to monitored and follow for any damage that may occur. Can you explain the Legal Framework in illinois . As it relates to team vaping . Is it illegal for people under we have tobacco 21. It is illegal to use products under the age of 21. Isms. Johnson, first of all, a mom of seven children, i have a number of parenting questions that are not appropriate for this setting. Im happy to hear your daughter is doing well. Where she was obtaining the product from . She turned 18 in december. There was a small time where it was legal for her to buy vaping products. I do know she attained some from a local store. Im also fairly certain the store continued to sell to her july the law was passed in and she was no longer legally buying them. Theres a way for the kids to buy them, but they are also being passed around in schools, which we are scared as parents. Our educators are drowning, are notthe products only accessible to the kids, but they are very discreet. You mentioned a mix of legitimate and illegitimate products. We have a store that was a bad minerspeople getting product in the schools. What is being done on the enforcement and to prosecute bad actors in illinois . We are working with the Illinois State police. They are very much on top of this issue. They are going to step up enforcement. Has anyone been charged . Charged, but been they will step up, sending decoys coming in to put the products who dont look of age and seeing if they get carded. Those investigations and enforcement will be stepped up. Porter, you have used ecigarettes for a long time. What kind of regulation do you think is appropriate . I have used them for nine years. There are 11 million regular ecigarette users who are dogs. Im obtaining the products legally. The products i have been vaping are not 59 milligrams, they are 12 milligrams. I think regarding the product, the manufacturing, insisting on good manufacturing practices is something that is important. It is something i look for in the products i purchase as someone making sure nothing gets adulterated, that there is crosscontamination in the product. Kids, we dont even talk much about enforcement. In the state of wisconsin, police would send decoys in to see if young people could potentially buy a pack of cigarettes. We are buying substantially. Same with underage drinking. We did the same. That kind of regular enforcement is quite important. It doesnt seem to really be a priority. Folks are fully met deep in the if you get vaping rid of flavors from vaping or products, you are stranding 8 Million People who were ask smokers and 11 Million People from access to products that work so they dont pick up a pack of cigarettes. With regards to advertising, hoodies who makes this garbage. If it is marketed to children, it is appalling. Theres not a Single Person who uses a vapor product is an adult who think it is appropriate for young people, freshmen, eighth graders, ninth graders, to be able to pass around paper products. I also think we need to really understand it appears from all indications, and we dont have diseases, and i dont want one of these diseases. I dont want to suddenly wake up one day and not be able to breathe. Thats why i quit smoking. But i think we can do something about the adulterated products. Thank you. Congresswoman pressley, you have three minutes of questioning. An nih funded study found over 8000 flavors of currently on the market. Some of them include banana pudding, rainbow candy, and hawaiian punch. Do we know how many of these 8000 flavors have been tested toxicity . Juul the school of Public Health looked at 51 different flavors. 47 of them did have chemicals they thought were toxic to the lungs. I dont know any other studies at this point. 47 out of 51 . Yes. You have collected samples of the products that were used by victims of the outbreak. Those are in the process of being tested, correct . That is correct. They are with the fda. We are waiting for the results. As you search for the cause of the umbra, you have not ruled out components of flavors as possible could your bidding factors, having that is correct. Are any ecigarettes approved by the fda as Smoking Cessation devices . They are not. Havecigarette companies been able to apply for fda approval as Smoking Cessation devices, but they have not done so juul they have not. Manufacturers have an even conducted the Clinical Trials to back up the central claim. Thats correct. Im grateful for everyone adult smoker that ecigarettes are helping to quit nicotine, but for everyone adult smoker , 81 kidseing helped will be introduced to nicotine through cigarettes and graduate to cigarette addiction as an adult. None of us want that. Thats an impossible statistic. There are 11 million vapers. I was making a statement. Please let ms. Presley finish. I didnt want to take away from your own personal experience. We have seen no evidence that ecigarettes are useful for Smoking Cessation. Prevalent. Imply more is it safe . Ecigarettes adds and vaping, is it safe . No. Even if they were useful for cessation, do you see evidence that adults want to use them at that purpose would refuse to use tobacco flavored ecigarettes . No. Back. Ield , congresswoman pressley congresswoman miller, five minutes of questioning. Thank you. I want to vap all of you for being hit today. Thank you for sharing your story. I hope your daughter continues particularly after listening to the doctor say our lungs continue to form into our 20s. That is a positive. I pray that she gets better. Addictive . Yes, definitely. Is it also a depressant . Phase, it can be a stimulant, then a depressive. Its a chemical that acts as a neurotransmitter in our body. Receptors thate are all affected by nicotine. Foreople have been smoking centuries, havent they . And it wasnt until the 60s when they finally came out and established that it caused cancer. I also remember in the early vaportrucks putting out with ddt and children riding bicycles behind the truck does they thought it was neat. Were there studies done to see if ddt cause cancer . I would have to look, but i suspect it was looked at as an inhaled tocsin. I dont know the details. That was another vapor that they put out. I vividly remember that happening. Ms. Porter, you said you smoked for 20 years . 23. When you started, did you think it was really cool sure did. Coolestit was the thing. Listening to jazz, drinking whiskey, smoking a cigarette. I remember movies about world , everybody had a cigarette hanging out of their mouth. The message was that was a cool thing to happen in the 50s and 60s. My movie was house of games. That is a good one. You are concerned about use of ecigarette russia ecigarettesr . Yes, i am concerned about smoking. Youth smoking is so low. Testimony, im very concerned the 12. 5 of youth who , but kids are going to do things that are risky. D try and make sure they dont make dumb choices like i did when i was 18. Our nextdoor neighbor had a tree, and kids thought it would be cool to like those cigars that smelled terrible. When you went to ecigarettes, did you notice how bad your clothing smelled or your hair . Q yes. Ofhin about two weeks switching to ecigarettes, i cannot tolerate the smell of smoking. I could not tolerate the smell of some of you been smoking one hour earlier. I became one of those people who became an annoying exsmoker. It is very obvious. The more obvious change came about three months after i began vaping. Just to see, i went to my physician and asked for a chest xray to see if i had done permanent damage. I wanted to know if i was going to be sick and die of lung cancer, if i had the beginning of copd. In three months, did you think your lungs were going to change . Yes, because i felt better. Doctor i quit smoking and she said she could tell. Lesser,entioned a much of nicotine in the ecigarettes. . S there a step down theres a lot of misunderstanding about what the marketplace is for the products. It can go from zero milligrams as high as 60to milligrams. People like me, i dont use salt, i use regular oldfashioned e liquid, 12 milligrams. Depending on the device. There are multiple devices you can use. I can use as little as three milligrams of next thing and nicotine e liquid. There are multiple variations and concentrations of liquid itself. It would be possible you can step down . People do it all the time. I was on my Facebook Page when i asked for some stories. People began at 18, 1 212, then with a zero. Some are still vaping zero. Some just decided to use the zero point two quick vaping, as well. I didnt realize my time was up. Thank you. Congresswoman miller. I recognize congresswoman to leave for five minutes of questioning. Thank you for being here and conjure to this important conversation. Thank you, miss johnson, for coming here. I know its not easy, even for me speaking publicly, my stomach turns. I know how hard it is, especially something so personal. Ecigarettes were allowed onto the market without fully understanding the longterm effects. Yet. Safety was not tested Big Tobacco Companies like juul touted their products as safer than cigarettes. They seine river their lives ,nto schools to tell students and i repeat it, because it is tailored to kids, totally safe. It took off. Now, 27. 5 percent of High School Kids use ecigarettes. Those are used as guinea pigs. Were just now finding out the health risk they pose. Risks like those suffering right now from it. An outbreak of lung disease and so forth. Most ecigarettes hold and discharge numerous toxic formamide, such as benzene, found in car exhausts systems. Is it safe to inhale these liquids contained inside ecigarettes directly into your lungs . No. What are the outcomes of inhaling such toxins . Are there any links to lung damage or Heart Disease . Are there any studies to the Health Risks Associated with vaping . There are no longterm studies, since it has only been in the market place for about 10 years. The cigarette smoking process requires the user to inhale ultrafine particles that can possibly irritate the throw, eyes, and airways. Can these particles exasperate respiratory alignment that affects our breathing . The ultrafine particles are similar to the small particles talked about in air pollution. They get into the lungs, the bloodstream, it can affect the cardiovascular system. Abouty little is known the longterm Health Effects of ecigarettes using vaping, but there is a conscience as to nicotine danger if x on development of adolescent brain and increased risk of future addiction. Can you explain how nicotine Impacts Brain Development in adolescence . The brain is developing its almost age 26. Receptors are more susceptible to being addictive. They get addicted quicker and addiction is predisposed to future addicted to down the road. We have seen people who have had worse addictions started at earlier ages. This is very scary, and as a mom, i hope ecigarette users are aware of this fact and are not waiting for government to declare this kind of national crisis. Thelready know from hospitalization cases. Users hunting for chemicals and so forth. Highspeed to kids all the time. I do the second grade and thirdgrade reading cards. What do you do . I tell them where it is geography wise. When i was your age, i used to go to restaurants with my parents and they would ask how many people were in the group. When i was little, they said nonsmoking or smoking sections. Say that because they smoked cigarettes in Public Places like restaurants, hospitals, schools, planes, and their eyes are wide. They thought it was unbelievable. Even the scientist, people were saying secondhand smoking was worse than directly smoking cigarettes. Health experts were coming forward, you had corporate greed. Misleading information to the public. So it is important you continue to seek truth speak truth. The longterm effects are very dangerous, especially because they have been targeted towards youth. I want to know more about you. We all have different beliefs. Yourself a converted conservative and reform marxist. Are you a conspiracy theorist . My politics are irrelevant to this hearing. Why were you winking at one of my colleagues on the other side of the aisle. I know glenn grothman. He is a friend of mine. I didnt know what the winking was, because i thought maybe there was like 30 thing going on. You think theres a conspiracy . I think people are speaking truth and you can provide information. May i address the truth . The truth for you is different for the majority of people in the room who believe jordan r i quit smoking youre still smoking. I would like to recognize congressman connolly for five minutes of questioning. Thank you. Welcome to our panel. That this is a new crisis that came upon us fast. Is the lackproblem of any federal structure in which to look at this issue, leaving states like illinois on their own. Is that a fair summation of where you think illinois finds itself . Believe theres always room for improvement. Around dataresearch modernization tools so we can quickly upload information and shared across states or with federal partners is key to being able to disseminate information faster around these kinds of epidemic says they emerge. If the federal government is not regulating the product and hasnt done the research and analysis of the dangers, the you tos, extended leaves do nothing it kind of leaves you to do nothing or protect your state. We have a vacuum at the federal level. Fair enough . I agree. Steps should the federal government this remind me of were we havent done our job at the federal level in justifying how to categorize or classify marijuana. We have essentially limited the kind of studies we sponsor at the federal level and who gets to do them with a clear bias towards its dangerous. And as a result, we have lost control. Tohave 28 states moving legalization in some form. Meanwhile, the federal control is none. The federal government has not really acted. What would be helpful from your this of view to deal with in an expeditious way . If you look at smoking, you can take 40 to 50 years for somebody to have negative health impacts. What has shocked us about this crisis is that timeline has collapsed. Peopleooking at young who have engaged in vaping, and according to some medical reports, their lungs look like that of a chronic smoker of 40 years. How did that happen . What in the world is at work here that can do that . To protect the public and not take 10 years to do it . Step with the first regard to this recent crisis, everything is being done and will continue to be done. We are hoping they come up with answers. The Bigger Picture is should there have been and as the Lung Association, there should have been a premarket review of products that come into the marketplace to make sure they are appropriate for public protection. Authority byhat the fda for multiple reasons has been very slow in developing. Dr. Zika, anything . I concur with that. Ms. Johnson, would that have made a difference . I think so. That nobody really knows how these products are going to affect people, especially young people who understand should not be using them but have easy access to them. It is kind of russian roulette. You dont know what is going to happen. With developing lungs, it seems to be worse. Sometimes, we have mindless regulation, and all of it is bad. I bring attention to the fact that my colleague, mr. Coleman, conservative republican, but sometimes we need it. Its not all bad. Sometimes we need to protect the public. As you all said, the vacuum we created, nobody did it with malice, has cost lives and will cost more. We need to understand meaningful protects people and can save lives. Heres a great example where that is needed. My time is up. Thank you. Thank you so much. I would buy to thank our witnesses for their testimony today. Without objection, all members will have five legislative days to submit additional written questions for the witnesses to the chair, which will be for it the witnesses for responses. I ask you to respond as promptly as you are able. This hearing is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2019] coming up on the next washington journal, virginia congressman ben cline, a member of the house Judiciary Committee, on Speaker Pelosis announcement that the house will begin a formal impeachment inquiry of President Trump. At 9 30, al conversation about the house impeachment inquiry, and the whistleblower complaint continues, with texas congressman this into gonzales, a member of the Foreign Affairs committee. Live wednesday on the cspan networks, the house returns at 10 00 a. M. Eastern for general speeches. At noon, the house takes up a resolution on the whistleblower complaint against the president. That would require the complaint to be reported to the appropriate committees. The whistleblower would meet given protections. Thats on cspan. On cspan2, the senate votes on a solution of the disapproval on the president Emergency Declaration for border wall funding. Nine 15 a. M. , live coverage from the United Nations General Assembly continues, with a speech from the president of iran. The house. M. , Judiciary Committee looks at military and assault weapons underuse and their use in Mass Shootings in el paso and dayton. President trump spoke to the United Nations General Assembly President Trump delivered remarks at the 74th United Nations General Assembly in new york city. He focused his remarks on his America First policies, which he said should be emulated by other World Leaders who wanted to strengthen their own nations and International Institutions like the u. N. He directly addressed mexico and other Central American nations, saying migration from these nations to the u. S. Was destabilizing, and said opponents to his administrations immigration and border policies put their politics ahead of migrants well being. The president s remarks came before Speaker Pelosi announced a formal impeachment inquiry in the u. S. House. This is just over 35 minutes. On behalf of the general