TIME Companies

This Big Tobacco Merger Would Unite 2 Major E-Cig Brands

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

Two of the three biggest tobacco companies, Reynolds American and Lorillard, sent shockwaves through the financial world Friday when they announced they were in talks about a possible merger. If the deal goes through, Reynolds, the maker of Camel cigarettes, would buy Lorillard, best known for its popular menthol cigarette, Newport.

It’s a complex deal with many factors at play, and there’s always a chance it won’t be completed. But the most surprising thing about the potential deal is that it marks the first time electronic cigarettes were one of the driving factors in merger talks between two tobacco companies.

“This transaction in our view will be very positive for the global tobacco industry and could be the just the beginning of future transactions with e-cigs/vapor being the underlying catalyst,” wrote Wells Fargo analyst Bonnie Herzog of the deal. That’s a pretty big milestone when you consider that the first patent for electronic cigarettes was awarded just a decade ago.

Each of the two companies has an electronic cigarette brand. Lorillard acquired its brand, Blu Ecigs, in April of 2012, and it’s the stronger of the two. With the help of celebrity spokespeople Stephen Dorff and Jenny McCarthy, Blu now has about 40% of the retail market share in the U.S. Reynold’s brand, Vuse, which stands out mostly because of its fancy engineering, has yet to be tested on the national market, having gone on sale nationwide only just last month after a trial period in select markets.

Less competition might be bad for smokers of traditional cigarettes, as it could mean higher prices and fewer options. But the merger, if it happens, could be good for smaller players in the electronic cigarette industry. The e-cig business is still small compared to traditional smokes, at roughly $2 billion in U.S. sales compared to tobacco cigarettes’ approximately $100 billion. The merger talks bring awareness and credibility, says John Weisehan Jr, the CEO of Mistic Electronic cigarettes. And J. Andries Verleur, the chief of VMR Products, the market leader in online sales of e-cigs, adds: “The more aware consumers are of the category, the better we do.”

 

TIME Education

Colleges Are Breaking the Law on Sex Crimes, Report Says

Demonstrators protest sexual assault on college campuses at the #YesAllWomen rally in solidarity with those affected by violence in Seattle on May 30, 2014.
Demonstrators protest sexual assault on college campuses at the #YesAllWomen rally in solidarity with those affected by violence in Seattle on May 30, 2014. Alex Garland—Demotix/Corbis

New survey amid push for congressional action

Many American colleges and universities are bucking federal law in their handling of campus sexual assaults, according to a survey released Wednesday by a top lawmaker on the issue.

Senator Claire McCaskill, a Missouri Democrat, said the results reveal a broad failure by many schools but also offer possible solutions as she and a bipartisan group of lawmakers draft legislation to address the problem. They’re likely to produce a bill around the time students head back to campus this fall.

The survey results come as pressure grows on higher-education institutions to improve their handling of sexual assault from the White House, Department of Education and student advocates. Schools are legally required to address sex crimes and sex harassment under Title IX, a law that prohibits schools that receive public funding from discriminating on the basis of sex. In May, the Department of Education began publicly listing the schools under investigation for violations of Title IX, and the number recently reached 64. The scrutiny has colleges scrambling to improve their policies and procedures.

Colleges and universities are not following even the most basic rules already required of them, according to the survey. Results from the 236 schools that responded to the survey revealed that even though colleges are legally required to have a Title IX coordinator (a staff member responsible for managing the school’s compliance with the laws on sexual harassment and sex crimes), 10% of schools did not. And 41% of schools surveyed had not conducted a single sexual-assault investigation in the past five years.

“That means that they are saying there have been zero incidents of sexual assault on their campuses,” McCaskill said in a call with reporters. “That is hard to believe.”

Schools are required by law to investigate when they know or reasonably should have known about a sex crime on their campus. But more than 21% of “the nation’s largest private institutions” surveyed conducted fewer investigations than they reported to the Department of Education, with some schools reporting as many as seven times the number of incidents of sexual violence than they investigated, which “on its face is violating the black-letter law in this country,” McCaskill said.

Other results revealed a lack of professionalism inherent in the process of handling sex crimes at many of the institutions. Even though most schools, 73%, had no protocol for how to work with the local police, many schools nonetheless had not adequately trained personnel on how to deal with these serious crimes internally. Twenty-one percent of the schools provided no training on sexual-assault response for members of faculty and staff, and 31% provided no training to students. A third of schools failed to provide basic training to the people adjudicating claims, 43% of the nation’s “largest public schools” let students help adjudicate cases, and 22% of institutions gave athletic departments oversight of cases involving athletes — a stat McCaskill called “borderline outrageous.”

The lack of police involvement combined with the institutions’ broad-based failure to handle these crimes adequately, means there is little deterrent for perpetrators on campus.

“We will ultimately have a system that is more of a deterrent than we have now,” McCaskill said. “The folks preying on college students — they have little to no fear of serious consequences.”

TIME E-Cigarettes

Snuff and E-Cigs Are Not Harmless, Say Scientists

New research casts doubt on nicotine's safety—even if you aren't smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.”

The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME.

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.

“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association.

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants.”

Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.

TIME Sexual Assault

Why Victims of Rape in College Don’t Report to the Police

Demonstrators protest sexual assault on college campuses at the #YesAllWomen rally in solidarity with those affected by violence in Seattle on May 30, 2014.
Demonstrators protest sexual assault on college campuses at the #YesAllWomen rally in solidarity with those affected by violence in Seattle on May 30, 2014. Alex Garland—Demotix/Corbis

Senator Claire McCaskill hosts a round table to address how and when law enforcement should be brought into campus sexual assault cases

The frustration in the room was palpable on Capitol Hill on Monday afternoon where a group sexual assault victim advocates and law enforcement experts in sex crimes met to talk about how the police and college administrators could better together to handle campus sexual assault.

The group had assembled for a roundtable hosted by Senator Claire McCaskill (D-Missouri), one of a team of three senators working to draft legislation that would address growing concerns about campus safety. As TIME wrote in a recent cover story, criticism of how college campuses have dealt with sexual assault has risen this year with accusations that officials have been sweeping the problem under the rug. But the tension over universities’ mishandling of these issues begs the question of why college administrators are expected to deal with these cases in the first place. A passive observer might wonder, shouldn’t these serious crimes be dealt with by the police? The answer, it turns out, is that administrators and police will have to work together to address the problem.

Yet the difficulty of building more effective partnerships became clear as the conversation unfolded at the round table today. Victim advocates articulated fears about anything that would make the relationship between law enforcement and the schools overly formal. For the advocates, doing right by the victim often means respecting her or his wishes not to report the crime to the police and even telling the victim about the possible downsides of the criminal justice system– which can lead to a months-long process that might threaten a victim’s confidentiality. In response, law enforcement officers explained how difficult it can be to pursue criminal action when they don’t collect evidence from the victim early in the process, making it difficult for them to get repeat offenders off the streets.

The question of when and how to involve the police in campus sexual assault is a salient one for administrators and politicians as they work together to overhaul the system of reporting and preventing these incidents. Alexandra Brodsky, a student at Yale law school and an organizer at Know Your IX, a grassroots organization that educates sexual assault survivors about their civil rights in the college setting, illustrated the tension beautifully during the discussion when she said: “When I reported violence to my school, I was told not to go to police. But I never would have told [the school] if I knew I was going to be forced into that option.”

If colleges are going to do a better job of handling sexual assault, college administrators are going to have to work together with police chiefs. But that collaboration is difficult, particularly because victims (especially those in college), are reluctant to report their assaults to the police.

In a 2007 study funded by the U.S. Department of Justice that surveyed 5,446 undergraduate women and 1,375 undergraduate men at two large public universities in the South and the Midwest, just 2% of sexual assault victims incapacitated by drugs or alcohol and just 13% of “physically forced” victims reported the crimes to law enforcement (that’s why increased reporting at colleges is, counter-intuitively, a good sign).

So, why don’t victims go to the police? Every victim is different, but there are a few common themes that ran through the testimony at the hearing and through conversations with experts in the field.

1. They don’t want anyone to know. In the round table, confidentiality was the most often sighted goal of both victim’s advocates and police officers and prosecutors who work most closely with victims. Survey data backs them up. Contrary to Washington Post columnist George Will’s bizarre theory that reporting sexual assault could confer a “coveted status” for victims, research shows that college victims don’t report sexual assault to the police because they don’t want anyone to know. In the 2007 study, 42% of the “physically forced” victims who did not report the incident to the police said it was because they “did not want anyone to know.” Nearly half of the victims gave the same answer in an earlier survey (also funded by the National Institute of Justice) that randomly surveyed 4, 446 women attending two or four year colleges during 1997.

Victims, especially those in college, know that reporting rape comes with a social risk, especially when the perpetrator is someone they know. At a small or midsize college, the rapist is likely to be part of the victim’s social circle. “I’ve seen this in every single case. The victim lose friends or becomes a social pariah. If you report on a really small campus, its really difficult to re-integrate after you report,” says Bruno.

Interestingly, even as the attitude towards victims has improved over the last several years in the broader culture and by police, self-blame and shame has persisted among victims, leaving them just as unwilling to come forward. Years ago, says Scott Berkowitz, the founder and president of the Rape Abuse & Incest National Network (RAINN), the most common reason victims gave for not reporting was: “‘I think I won’t be believed. I think I will be blamed.’ We hear that less often. Now it is much more common to hear: ‘I want to keep this private. I don’t want people to know. I’m embarrassed.’”

2. They don’t understand what constitutes rape. The 2007 survey showed that just over 35% of victims said that they didn’t report to law enforcement because it was “unclear that it was a crime or that harm was intended” (44% gave that same answer in the earlier 1990′s study).

The victims’ confusion does not mean that all of these crimes fell somewhere in the gray. More likely, their confusion reflects shame, denial, and internalized misconceptions that rape is always perpetrated by a stranger and involves physical violence, when often, rape happens between acquaintances and involves alcohol, threats, or other kinds of coercion.”Victims don’t often identify it as a crime because they know the person, they trusted the person, sense of denial or disbelief that it happened,”says Colby Bruno, Senior Legal Counsel at the Victim Rights Law Center, who represents victims of sexual violence in civil matters, with particular expertise in representing college students.

3. They are afraid the police won’t believe them. In the more recent 2007 study, 21% of physically forced victims and 12% of incapacitated victims did not report because they didn’t think the police would take the crime seriously and 13% of forced victims and 24% of incapacitated victims feared the police would treat them poorly. Victims have also reported that their colleges discouraged them from reporting.

Victims aren’t wrong in their perception. According to research funded by the U.S. Department of Justice, only 18% of reported rapes result in a conviction.

4. They don’t know how much control they will have after they report to the police. Victims are afraid of going through a public rape trial because of how awful it can be for the victim. Media portrayals of rape trials show how often they are about the victim’s character and credibility. Given the low rate of conviction, victim’s naturally decide it isn’t worth the risk. Unfortunately, there is wide discrepancy between how prosecutors and police officers in various jurisdictions handle sex crimes. Some will give broad power and control to the victim, while others may pursue the case against the victim’s wishes. Predicting those outcomes are difficult for victims and the advocates who advise them (a theme reflected in today’s round table). According to Carrie Hull, a detective with the Ashland Police Department in Ashland Oregon who attended the round table, said reporting was up 106% from 2010 to 2013 after the implemented a program called “You Have Options,” designed to decrease barriers in reporting, which gives women three options when reporting to police – to give information only, to trigger a partial investigation, or to trigger a complete investigation that will be referred to the prosecutor.

Bruno says that prosecutors are more likely than they were a few years ago to follow the victim’s wishes to drop a case. Still, it is impossible to predict the outcome, and victims are rightly scared by what they know of the system.

As I’ve reported before, rapists are very often repeat offenders. The best way to ensure that more victims report is to continue to create flexibility in the system for victims and change the wider culture so that victims will feel supported. Being the victim of rape will never reach George Will’s imagined “coveted status,” but at the very least, we have to work together to ensure it’s not a shameful one.

Read more on how campuses should handle sexual assault.

TIME

Electronic Cigarette Executives Get Schooled in Senate Hearing

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

"I think we have seen this movie before," Senator Richard Blumenthal said. "It is called big nicotine comes to children near you and you are using the same kinds of tactics and promotions and ads that were used by big tobacco and proved so effective"

In a hearing Wednesday afternoon that harkened back to the famous congressional Big Tobacco hearings two decades ago, Senators on the Commerce, Science and Transportation Committee eviscerated electronic cigarette executives Jason Healy, CEO of blue eCigs (owned by tobacco company Lorillard), and Craig Weiss, CEO of NJOY, leaders of the two leading e-cig brands.

The hearing was on the marketing practices by the electronic cigarette industry, which the Senators said appeals directly to kids, a lift straight from the tobacco industry’s playbook, when it began in the 1950s to try and hook young people early to addictive nicotine. Though nicotine is not the carcinogenic ingredient in tobacco cigarettes, it is the culprit behind why so many continue to smoke, and it’s hardly a benign substance either. Nicotine is highly toxic on its own, and there has recently been an increase in calls to poison control centers after contact with electronic cigarette liquid containing nicotine. Nor is the substance good for the developing teen brain.

The Senators and those offering testimony at the hearing, which included electronic cigarette executives and representatives from public health organizations, were in agreement that electronic cigarettes should not be sold to kids under the age of 18. At issue was whether the marketing practices employed by electronic cigarette makers, which are currently unregulated by the federal government, were designed to appeal to kids.

At the hearing, the e-cigarette executives were skewered by the Senators who had the facts on their side. A recent CDC report showed that the use of electronic cigarettes by middle school and high school students doubled from 2011 to 2012. The same survey showed that more than 1.78 million middle and high school students nationwide have tried electronic cigarettes. A recent American Legacy Foundation report found that last year 14 million kids saw ads for electronic cigarettes on TV, 9.5 million saw them in print.

A study from RTI International and the Florida Department of Public Health published in the Journal of Pediatrics showed that exposure to electronic cigarette advertising jumped 256% from 2011 to 2013 among adolescents aged 12 to 17. Mr. Healy’s company, blu eCigs was found responsible for almost 82% of the ads that reached that age group.

Slumped in their chairs, the beleaguered executives, Mr. Weiss and Mr. Healy, argued that their marketing was not directed at kids, but adults. Electronic cigarettes, both men argued, are designed to entice those who already smoke to use the product, claiming they are a valuable public health tool to help wean the 40 million adult smokers off of deadly cigarettes. “It is our corporate mission to [make] obsolete the combustion cigarette,” Weiss testified.

“Every time I use an e-cigarette instead of a combustible cigarette, that’s a good decision,” said Mr. Healy, a smoker who “vapes” (inhales through the e-cigarette vaporizer).

Healy and Weiss aren’t wrong that electronic cigarettes hold promise to improve the nation’s well-being if they can get America’s smokers off of combustible cigarettes–a view held by many in public health. Scientific research has not yet determined how or whether electronic cigarettes can really get people to quit smoking, but it is a technology we should embrace to see if it can. As Mitch Zeller, head of the FDA’s Center for Tobacco Control has said: “We have to have an open mind on the potential for these emerging technologies to benefit public health.”

But Senators including Richard Blumenthal (D-Connecticut) and Amy Klobuchar (D-Minnesota), both former prosecutors, undermined those health promotion claims during cross-examination, calling into question the brands’ use of celebrities, social media, free cigarettes, and TV and print advertisements in major television markets (NJOY advertised during the Super Bowl), and flavors that appeal to kids.

“The only difference between your testimony today and testimony of the tobacco executives is that you are not under oath,” said Senator Blumenthal. “I find in your testimony a sense of denial that I cannot credibly accept because it is defied by the numbers. 18 million teens were exposed to blu’s print TV ads in 6 months and NJOY’s ads reached 3 million teens [these statistics come from the American Legacy Foundation report]. There is a legal principle that people are responsible for the natural and logical effects of what you do, and you know that you are reaching children.”

“I think we have seen this movie before,” he continued. “It is called big nicotine comes to children near you and you are using the same kinds of tactics and promotions and ads that were used by big tobacco and proved so effective.”

Holding up a picture of Robert Pattinson, the star of the popular Twilight films, vaping an NJOY, Blumenthal asked Weiss, “Do you deny he is designed to appeal to teens?”

“He’s a 28 year old adult smoker,” Weiss replied. “Are you saying if they are older than 18, they have no impact on people under 18?”

“Our target is to reach adult smokers,” said Weiss.

Senator Klobuchar took over the same line of questioning. “Have you gone to the Twilight movies, Mr. Weiss? I’ve been to those movies with my daughter, who is 16, and I can tell you, in those theaters, the people in there are kids…[Pattinson] is an adult smoker that appears in movies that appeal to kids. That’s what matters to me.”

Klobuchar continued, “I’ve got to tell you that most people over fifty are not going to know Robert Pattinson. Justin Bieber is over 18, someone put him out there, I don’t think anyone is going to think [he is being] marketed to adults. This is my exhibit D, that heavy duty marketing [efforts] go on to youth.”

Another tense moment occurred between Senator Barbara Boxer from California, who grilled Weiss and Healy about flavored e-cigarettes.

Weiss and Healy both contended that having different flavors available appeals to adults, too. Some Senators referred to a website sponsored by blu’s parent company, Lorillard, stating that flavors like “cherry” and “vanilla” make children vulnerable to electronic cigarettes. Healy responded that the average age of a consumer using blu’s cherry flavor is in the high 40s. The average overall consumer of blu eCigs is 51, said Healy.

Responding to questions from Senator Boxer (D-California) about the flavors NJOY plans to introduce, Weiss made a slip, saying “for adults, we have single malt scotch.”

“Adult flavors?” said Boxer. “As opposed to those for children.” Weiss continued nervously, attempting to remember the new flavors off the top of his head: “In addition, there’s vanilla bean, there’s also peach tea, there’s also, um…”

At the end of her time to question, Boxer said: “Mr. Healy and Mr. Weiss, you can con yourself. But we don’t know if this product gets people off cigarettes yet, so don’t think you are doing some great mission. Don’t say you care about kids,” said Senator Boxer. “Don’t be a part of this, because you’ll regret it.”

But the harshest words came from Senator Jay Rockefeller (D- West Virginia), who said to the executives: “I’m ashamed of you. I don’t know how you go to sleep at night. I don’t know what gets you to work in the morning except the color green of dollars. You are what is wrong with this country.”

TIME E-Cigarettes

Industry Is Winning the E-Cig Regulation Battle

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris. Europe is moving faster than the U.S. to regulate. Kenzo Tribouillard—AFP/Getty Images

Correction appended: June 12, 2014

It’s a critical time for the e-cigarette industry. In April, the FDA announced proposed rules to regulate e-cigarettes as tobacco products. The announcement kicked off a period of public comment so that e-cig makers and public health experts can raise concerns and give the FDA the necessary facts to write an appropriate set of final rules. Regulation is just like writing the rules of a new game—on one side there are businesses vying for industry-friendly regs, and on the other are public health advocates.

So far, it looks like the businesses are winning. When the FDA first announced the start of the rule-making process, Time wrote about the positive reaction to them by e-cigarette executives, who saw them as a reasonable first step that would not greatly interfere with their businesses. Now, a few weeks into the rule-making process, business continues to be optimistic while public health advocates are getting worried.

“The deeming rule that the FDA has proposed is very, very, very limited in its scope,” says Stanton Glantz, a cardiology professor at the University of San Fransisco and one of the most vociferous proponents of strict rules for e-cigs. “It requires a useless warning label and says they can’t be sold to kids under 18, but it doesn’t put any restrictions on internet sales, which means kids under 18 can easily get them. It has no restrictions on marketing at all.” This puzzles Glantz. “You would think that the Obama administration would be supporting tobacco control because it would reduce health care costs.” As far as Glantz is concerned, the administration has erred on the side of the tobacco interests.

Naturally, one of the biggest concerns among health advocates is children’s access to e-cigarettes—and marketing of e-cigs to teens is up 321%, as TIME recently reported. The Centers for Disease Control and Prevention estimates that almost 2 million students in the U.S. have tried e-cigarettes. Policies to address the issue run the gambit from the least controversial—like establishing an age restriction on purchasing e-cigs and child proof packaging—to the more divisive, like prohibiting marketing to teens, prohibiting internet sales, and restricting the use of kid-friendly candy-like flavors.

But even the most basic restrictions—like better product labeling, and child proofing—were absent from the FDA’s initial deeming rules, making other restrictions on advocates’ wish lists seem that much further away. “Any meaningful rules on marketing of e-cigarettes are years, and years, and years away,” says Glanz, pointing out that if restrictions were imposed, e-cog companies would likely sue over marketing restrictions on first amendment grounds.

Craig Weiss, the CEO of NJOY in Scottsdale, Arizona, one of the leading electronic cigarette brands, also thinks the FDA rules will stay fairly restrained. “The FDA are smart people,” he says. “They have to read everything and they will, but I think what you saw in the proposed regulations, that’s what you are going to see in the ultimate regulations as well.”

As for whether any child-marketing restrictions would make sense down the line, Weiss says there are appropriate curbs, but there is no reason e-cigarette marketing should be as strict as tobacco. “You are confusing the arsonist with the firefighter,” he says. “Why would you treat products that are part of the solution as products that are part of the problem?” he says. Though NJOY is careful not to make direct claims that their products can help smokers quit, Weiss is a big believer in the potential for electronic cigarettes to replace cigarettes. Weiss supports limits on the age of actors in ads and rules against e-cigs appearing in cartoons, but he rejects the idea that there is anything wrong with his ads, which do feature young adults.

That’s not good enough for public health advocates. “The best way to market to kids is to market to young adults,” says Glantz, “If you designed marketing to stop smoking in a 50 year old, it could be done. That’s not what they are doing. It wouldn’t be on MTV, it would be on evening news.”

Weiss responds: “I’m interested in converting every adult smoker in the country to these products. I think it would be a tragedy for smokers to be smokers for decades before we advertise in a way that is appealing to them.”

The battle over e-cig regulation isn’t settled, but if what’s going on now is any indication, that battle may have actually been over—and won by industry—before it even started.
Correction appended: The original version of this story incorrectly described which restrictions are absent from the FDA’s initial deeming rules.

TIME

Here’s the Real Reason College Sex Assault Reports are Rising

It may actually be a sign of progress

+ READ ARTICLE

It would seem an odd cause for optimism: the number of sex crimes reported by colleges rose 52 percent between 2001 and 2011, according to a government report released on Tuesday, even as overall crime on campuses dropped.

Yet to many counselors and administrators, the increase is a sign that schools are getting better at handling sexual assault, a problem Time highlighted in a recent cover story. It sounds counterintuitive, but here’s why:

For a number of reasons — institutional resistance, lack of understanding, victims’ own fears — colleges have historically under-reported sex crimes on campus. The substantial jump in reports — from 2,200 to 3,300 over a decade — doesn’t necessarily mean that more sexual assaults occurred as much as it shows that colleges are getting better at acknowledging the ones that have always taken place. This is likely the result of a number of factors: schools becoming better educated about defining sexual assault and more transparent about disclosing when it happens, and victims feeling increasingly empowered to come forward because of these changes.

The Obama administration has made preventing campus sexual assault a priority, appointing a White House advisor on violence against woman, ramping up investigations into colleges’ alleged mishandling of sexual assaults, and threatening to withdraw federal funding from schools that fail to adequately address sexual violence. According to the new data, the increase in reported incidents was particularly high in 2010 and 2011, rising by 15% both years, which could be an indication that the administration’s efforts are having an effect.

There’s another development reflected in the data that shows how our understanding of what constitutes rape is evolving. While more “forcible” sexual offenses were reported between 2001 to 2011, there was a whopping 90% decline in “non forcible” sexual offenses, from 461 in 2001 to 45 in 2011. It’s not a stretch to infer that some of the rise in “forcible” offenses is because colleges stopped classifying so many assaults as “non forcible.”

Misconceptions about rape and sexual assault lead some college administrators to mistakenly believe that sexual assaults between intimate partners or involving a victim incapacitated by alcohol don’t count as “forcible” sexual assault. The change in reporting patterns likely reflects a reeducation of college administrators on the appropriate definitions of force, says W. Scott Lewis, a lawyer at the NCHERM group, a firm focused on safety and risk management in higher education. “They are now starting to realize that force also includes rendering someone incapacitated, coercion, and intimidation,” Lewis says. “If I take you out and watch you take shot after shot while I drink one glass of wine, there’s an element of force–using the alcohol instead of a knife.”

TIME Drugs

Legal Pot Might Make America’s Kids Stupider, Say Researchers

In the midst of the drumbeat toward legalization, it’s easy to forget that smoking pot isn’t great for you. Especially if you are a teenager.

A review of the research on the negative health affects of marijuana published today in the New England Journal of Medicine reports that smoking pot as a kid may have lasting impacts on intelligence and achievement.

For starters, smoking pot regularly from an early age is correlated with a lower IQ. The mechanism is not fully understood—experts are not claiming one necessarily causes the other—but scientists speculate the drug can interfere with a critical period for brain development during the teen years. “Adults who smoked regularly during adolescence” according to the review, have “impaired neural connectivity” in parts of the brain involving alertness and self conscious awareness, executive function, processing of habits and routines, learning, and memory.

Smoking marijuana as a teenager is also linked with poor grades, criminal behavior and increased risk of dropping out of school, according to the review. The research doesn’t prove that regular marijuana use causes these negative consequences. But the review article suggests that available evidence could explain the relationship. Though some research suggests that the harmful effects of marijuana subside after the drug leaves the brain and can be reversed after a person stops using, other studies show that “long term, heavy use of marijuana results in impairments in memory and attention that persist and worsen with increasing years of regular use.” The article also points out that marijuana can impair cognitive functioning for days after you toke up, increasing the likelihood that students could be functioning “below their natural ability” for periods of time.

None of this is really surprising. But since legalization in Colorado and Washington may contribute to the perception that, doctors’ notes aside, recreational marijuana is harmless, it’s worth paying close attention to links between marijuana use and negative outcomes in achievement—especially for teens.

TIME Drugs

Chicago Blames Big Pharma for Epidemic Addictions to Painkillers

Painkillers
Painkillers are at the center of a Chicago lawsuit James Brey; Getty Images/Vetta

The city fingers a new villain in the painkiller-addition epidemic

After a year of drug document subpoenas, interviews, and fact finding, the City of Chicago filed a lawsuit Monday against five pharmaceutical companies alleging that they deceptively marketed opioid painkillers like Percocet and OxyContin for chronic pain management, even though the companies knew the drugs were ineffective at treating chronic pain and carried a high risk of addiction.

The deceptive marketing practices have caused health problems in Chicago, the city alleged in a release, stating that opioid misuse resulted in 1,080 emergency room visits in Chicago in 2009. The city seeks to end deceptive marketing practices and seeks punitive damages. The city claims that the City’s Health Insurance plan “has reimbursed claims for approximately $9.5 million on these drugs since 2008.”

Chicago’s lawsuit has implications far beyond the city limits. If the allegations are true, they get at one root cause of the growing rates of addiction and death from opioid painkillers and heroin in the United States. Drug overdose deaths, the majority of which are caused by prescription painkillers, have more tripled since 1990, according to the CDC, and in 2010, prescription opioid painkillers caused 16,651 overdose deaths in the U.S.

In the 122-page complaint filed in Cook County Circuit Court on Monday, the City of Chicago argues that the shift in medical use of opioid painkillers was the direct result of deliberately misleading marketing from pharmaceutical companies. (Earlier this month, two counties in California filed a similar suit.) According to the complaint, “in 2010, 254 million prescriptions for opioids were filled in the U.S.” (By comparison, in 2009, there were 44 million prescriptions filled for the anti-depressant, Xanax.) It also reports that “20 percent of doctors visits resulted in the prescription of an opioid.” According to the press release, this accounted for a quadrupling of sales for these drugs from 1999 to 2010.

The complaint argues that the five companies named in the suit—Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis plc—led to a huge market ($8 billion in revenues in 2010) for these drugs by telling doctors (incorrectly) that they were effective for chronic pain management, which now accounts for roughly 87% of the opioid prescriptions given out in this country.

“They knew—and had known for years—that opioids were too addictive and too debilitating for long-term use for chronic non-cancer pain,” the complaint reads. “In order to expand the market for opioids and realize blockbuster profits, Defendants needed to create a sea-change in medical and public perception that would permit the use of opioids for long periods of time to treat more common aches and pains, like lower back pain, arthritis, and headaches.”

Purdue Pharma declined to comment. Teva, which owns Cephalon, Janssen, Endo, and Actavis could not be immediately reached for comment.

How did we get here? The recreational use of opioid painkillers began with a sea-change in the way doctors prescribed prescription painkillers, experts say. According to the CDC, there has been a tenfold increase in medical use of opioid painkillers for the treatment of pain since 1990.

This began, says Dr Jason Jerry, a psychiatrist and addiction expert at the Cleveland Clinic, with a cultural shift in the 1990′s in the medical community’s attitude toward pain and pain medication. Prior to that point, he says, most doctors wouldn’t have considered using prescription painkillers for problems like low back pain. “They were for end-stage cancer pain or patients who had recently undergone surgery,” he says, adding, “the marketing practices in the pharmaceutical industry shifted the culture of medicine to the point that there was a fifth vital sign in medicine: pain.”

The rise in use of prescription painkillers has also led to a resurgence in heroin use. A recent analysis from JAMA Psychiatry showed that prescription drug abuse has become a gateway for heroin use. In the 1960s, 80% of heroin users (who were mostly young city dwellers) initiated heroin first, but in recent years, as users have become older and more suburban; 75% of heroin users started using heroin after getting into opioid painkillers first.

Chicago’s lawsuit, if it succeeds, may mark a turning point in the epidemic of opioid abuse.

TIME Drugs

This Drug That Can Stop An Overdose. Why Is It So Hard to Get?

Naloxone can stop an opioid overdose, but it is hard to get

The rising death toll from opiate overdose in the U.S.—almost 17,000 involved prescription painkillers and 3,000 involved heroin in 2010, according to the CDC—has public health officials looking for an antidote.

There actually is one. The drug called naloxone is a kind of emergency break for overdose: it can stop and reverse an overdose from opioids like morphine, heroin, and oxycodone. And between 2006 and 2010, it stopped 10,171 overdoses after having been distributed to 53,032 people, according to the CDC. Approved by the FDA in 1971, naloxone has historically been used in hospitals and emergency rooms. But a recent push from government officials and public health experts in New York and elsewhere is trying to make naloxone more available, putting the life-saving drug in the hands of first responders, community organization leaders and pharmacists. But bringing the drug to the ever growing number of patients at risk for opiate overdose—more than 12 million people reported using prescription painkillers non-medically in 2010, says the CDC, and another nearly 700,000 reported using heroin in 2012—is not going to be easy.

There are several barriers to getting this drug to patients outside the hospital, experts say. The issue is that filling a naloxone prescription can be quite difficult, depending on where a patient lives. That’s because many doctors and pharmacists don’t know they can prescribe naloxone outside of the hospital and because the drug is not always reimbursed by insurance companies, says Daniel Wermeling, a professor of pharmacy at the University of Kentucky College of Pharmacy, who is developing a nasal naloxone spray, which, if approved, would be the the first nasal spray approved for use in the U.S. “Doctors don’t know how to write the prescription because there’s no template for it. If they do send it to CVS or Walmart, the pharmacist wouldn’t know what to do with it,” Wermeling says.

Currently, 23 states and the District of Columbia have laws of varying types to make naloxone more widely available in communities. Rhode Island, for example, has created what is called a “collaborative practice agreement” with Walgreens, a hospital doctor, and the Board of Pharmacy so that patients can walk in to the pharmacy and get the drug without seeing a doctor first. Reports about the program say insurance companies have paid for the drug.

As of a couple of years ago, some 15 states also had community programs that distributed naloxone with pretty good success. But those groups have come up against another structural problem with naloxone: The small market means few manufacturers, leading to high prices and occasional shortages. “The cost is going up and the supply is unpredictable,” explains Rain Henderson at the Clinton Health Matters Initiative at the Clinton Foundation, which is working to help bring together community groups and manufacturers to ensure a predictable and affordable supply of naloxone going forward.

And for reasons that aren’t entirely clear, several naloxone manufacturers have dropped out of the market over recent years, leaving two companies, Hospira and Amphastar, as the only sources of the drug until very recently. This has led to past shortages and a rise in price for the drug, community groups say. Confidentiality agreements prohibit them from disclosing the price they pay for the drug.

These challenges, paired with the relatively small U.S. market for naloxone—roughly $25 million in US sales, says Wermeling, compared with more than $2.5 billion in sales for the prescription painkiller OxyContin—have not given many companies the incentive to start making it. But, in March, Mylan, a drug company in Pittsburgh, announced the launch of a naloxone injection. The FDA also recently approved an auto-injector naloxone devise called Evsio. The good news about this new product is that it creates a precedent for prescription for naloxone—people on high-dose opioids may leave the doctor’s office with an Rx for this, in case of emergency—but it is also likely to be very expensive. Experts say it could cost up to $500.

Much still needs to happen across the country to get naloxone into more hands. Doctors will need to be better educated about how to prescribe, states and cities will need to remove regulatory barriers to getting the drug, and insurance companies will need to expand coverage. If all of these things happen, the sales might grow enticing more new manufacturers into the market. But that’s far from certain, says Wermeling, who may soon enter the market if the nasal spray he is developing succeeds. “It is still an untested market. We are hopeful, but it is really an unknown.”

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser