While few would likely term the numbers alarming, most, we think would find them at least concerning. Health concerns related to vaping have made headlines in recent weeks, including an adult in Illinois who developed a lung disease after vaping and died.

Utah health officials also recently announced an investigation into 21 cases if a lung disease linked to vaping, while federal officials are looking into as many as 150 possible cases of breathing illnesses among vapers. As of Aug. 22, 193 potential vaping-related illnesses in 22 states had been reported to the Centers for Disease Control and Prevention.

Wisconsin, which first put out an alert in July, has at least 16 confirmed and 15 suspected cases. Illinois has reported 34 patients, including the adult who died; and Indiana is investigating 24 cases.

Kaiser Health News reported that lung doctors said they had seen warning signs for years that vaping could be hazardous as they treated patients.

Medically, it seemed problematic since it often involved inhaling chemicals not normally inhaled into the lungs. Still, assessing the safety of a new product storming the market fell between regulatory cracks, leaving doctors unsure where to register concerns before the current outbreak.

Adding to the problem, the Food and Drug Administration took years to regulate e-cigarettes once a court determined it had the authority to do so. When electronic cigarettes — not a food, not a drug and not a medical device — came to market about a decade ago, they fell outside the scope of the FDA’s mission.

Because e-cigarettes aren’t classified as drugs or medical devices, which have well-established FDA databases to track adverse events, doctors say there has been no clear way to report and track health problems related to vaping products.

In 2009, the FDA tried to block the imports of e-cigarettes, saying the combination drug-device products were unapproved and therefore illegal for sale in the United States. Two vaping companies sued, and a federal judge ruled in 2010 that the FDA should regulate e-cigarettes as tobacco products.

It took the FDA another six years to finalize rules in which it formally began regulating e-cigarettes and e-liquids. The agency began by banning e-cigarette sales to minors and requiring all new vaping products to submit applications for authorization before they could come to market.

In 2017, companies and retailers with thousands of products already on the market were granted two years to submit applications, and the FDA would get an additional year to evaluate the applications. In the meantime, existing products could be sold. A judge last month ordered applications, which were to have stretched to 2022 because of additional delays, must now be submitted by May 2020.

In the regulatory interim, teen vaping exploded. In 2011, 1.5% of high school students reported vaping. By 2018, the CDC reported the number had risen to 20.8%.

The vast majority of chemicals used in e-liquids have only been tested by ingesting them in small quantities. For most of the chemicals, there have been no tests to determine whether it is safe to inhale them, as happens when they are used in e-cigarettes.

The time is long past due for the FDA to determine if vaping and the products used for vaping are safe.

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