The first thing you notice in some pediatric ICU emergencies isn’t the monitors, it’s the smell.
Walking into the room of a teenager in a life-threatening asthma crisis, I caught artificial blue raspberry and cotton candy. Her chest had gone silent: airways so tight there was nothing left to hear. That silence is what status asthmaticus sounds like, and the candy-shop smell told me what had helped put her there.
I trained in Ireland and Canada before coming to Iowa, and I have seen public health crises up close in three countries. Nothing prepared me for the grip flavored e-cigarettes hold on the teenagers I now care for. The overwhelming majority of young people who vape use flavored products. Fruit, candy, dessert, you name it. That is not an accident of taste, but the business model. These devices hide airway irritants and highly addictive nicotine behind neon packaging and flavors engineered for customers who are not yet old enough to buy them.
Iowa lawmakers know this is a problem. This past session, the Legislature passed a nickel-per-milliliter tax on vape products, with revenue directed to pediatric cancer research at the University of Iowa. That research funding is genuinely welcome. But legislators on both sides of the aisle said out loud, on the floor, what every pediatrician already knows: a nickel will not deter a single teenager. Some called the bill an industry-friendly substitute for real action. They were right.
Meanwhile, the state’s other attempt at regulation, a registry law that would have pulled most unauthorized flavored products from shelves, sits blocked in federal court. But here is what has been lost in that fight: In blocking the registry, the court affirmed that states retain full authority to regulate tobacco sales directly, including restricting flavored products. The legally durable path has been in front of us the whole time. Iowa has simply not taken it.
I understand the objections. Some adults use flavored vapes to quit smoking, and vape retailers worry about their businesses. But an adult trying to quit cigarettes does not need cotton candy to do it, and no legitimate business model should depend on products whose flavor profiles read like a candy aisle. Several states have already restricted flavored nicotine products. Our emergency departments, meanwhile, are seeing teenagers who cannot breathe.
When the Legislature convenes in January, it should do two things: Restrict the sale of flavored nicotine products, and raise the vape tax from a nickel to a level that actually deters a 15-year-old with lawn-mowing money. Pediatric cancer research funded by pediatric nicotine addiction is not a health policy. It is an irony.
I chose to train in Iowa, and I intend to spend my career caring for children’s hearts. The lungs and the heart share one circulation and one fate. Our children’s share of both should be filled with air, not the candy-scented clouds of a preventable emergency.
Dr. Karl McNamara is a pediatric resident physician-scientist at the University of Iowa Stead Family Children’s Hospital, where his research focuses on children’s heart disease. He writes and advocates on child health policy. These views are his own and do not represent the university or hospital.
This article originally appeared on Des Moines Register: Iowa pediatric ICUs have a candy-scented crisis | Opinion
Reporting by Karl McNamara, Guest columnist / Des Moines Register
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By Karl McNamara, Guest columnist | USA TODAY Network
