{"id":91291,"date":"2019-11-24T10:31:04","date_gmt":"2019-11-24T18:31:04","guid":{"rendered":"http:\/\/69.46.6.243\/?p=91291"},"modified":"2019-11-24T10:31:04","modified_gmt":"2019-11-24T18:31:04","slug":"youth-vaping-epidemic-listening-session-at-white-house","status":"publish","type":"post","link":"https:\/\/new.thepinetree.net\/?p=91291","title":{"rendered":"Youth Vaping Epidemic Listening Session at White House"},"content":{"rendered":"<p>Washington, DC&#8230;I\u2019m Dr. Sally Goza.  I\u2019m a pediatrician from Fayetteville, Georgia.  And I\u2019m President-elect of the American Academy of Pediatrics.  And thank you so much.  The children are counting on us.<\/p>\n<p><iframe loading=\"lazy\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/wcaXaQIpChQ\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>THE PRESIDENT:  Good.  Thank you very much.<\/p>\n<p>MR. BUTLER:  Hi, I\u2019m Christopher Butler.  I\u2019m Executive Director of Americans for Tax Reform.  Thank you so much for having us.  We\u2019re concerned both about the public policy implications of this for adult vapers, but also we view it as something as a prerequisite of keeping people in the Liberty Coalition that are necessary to us doing everything that we care so much about on economic acts and regulatory policy.<\/p>\n<p>THE PRESIDENT:  Okay.  Very good.  Thank you very much.<\/p>\n<p>MR. REEDY:  Good afternoon, Mr. President.  I\u2019m Gary Reedy.  I am CEO of the American Cancer Society and the American Cancer Society Cancer Action Network.  And I want to thank you for making this public health epidemic a national priority.<\/p>\n<p>THE PRESIDENT:  So where are you?  What is your stance?  It\u2019s a very important position you have.  What is your stance on vaping e-cigarettes?  How are you \u2014 have you \u2014 have you taken a stance?<\/p>\n<p>MR. REEDY:  Yes, we have, and we are totally aligned and supportive with the position you took on September the 11th.  We think that is a \u2014<\/p>\n<p>THE PRESIDENT:  That I put forward as a concept?<\/p>\n<p>MR. REEDY:  That you put forward, correct.<\/p>\n<p>THE PRESIDENT:  Yeah.  Okay.  Okay.  Let me take a look.<\/p>\n<p>MR. GROGAN:  Joe Grogan, Director of the Domestic Policy Council.<\/p>\n<p>MR. ELEY:  Good afternoon, Mr. President.  My name is Scott Eley.  I\u2019m the President of the American E-Liquid Manufacturing Standards Association.  I know it\u2019s kind of a long; we call it \u201cAEMSA.\u201d  We were founded in 2012 and we open publish manufacturing standards for e-liquid products that anybody \u2014 any manufacturing industry may use.<\/p>\n<p>THE PRESIDENT:  And if you don\u2019t have high standards, you\u2019re going to have some very dangerous things happen?<\/p>\n<p>MR. ELEY:  Yes.<\/p>\n<p>THE PRESIDENT:  That\u2019s what been happening, right?<\/p>\n<p>MR. ELEY:  Absolutely.<\/p>\n<p>THE PRESIDENT:  Where people are using devices and other things that are not good.  Right?<\/p>\n<p>MR. ELEY:  They have that potential.  (Inaudible.)<\/p>\n<p>THE PRESIDENT:  I see.  That\u2019s a problem.  Thank you.<\/p>\n<p>MS. NANCE:  Mr. President \u2014 Penny Nance, CEO and President of Concerned Women for America.  And we very much support what you put forward in September.  We have half a million members, many of whom are moms that are very concerned.  And in addition, they asked me, begged me, (inaudible) me with notes to tell you that they love you and they support you all the way.  We appreciate you.<\/p>\n<p>THE PRESIDENT:  Thank you.  That is very nice.  Thank you.  That\u2019s really nice.<\/p>\n<p>MR. CHAPMAN:  Mr. President, thank you for having me here.  I\u2019m Tim Chapman, the Executive Director of Heritage Action.  We are very concerned about this issue.  We want to play an active role in helping you get to the right solutions.  More importantly, we are big supporters of many of the policies you\u2019ve been pushing, so thank you for that.<\/p>\n<p>THE PRESIDENT:  Well, thank you very much.<\/p>\n<p>MR. WIMMER:  Mr. President, thank you for the invitation to be here.  My name is Harold Wimmer.  I\u2019m the President and CEO for the American Lung Association.  And on behalf of our organization, I want to thank you for your leadership with bringing this issue to the public light.  That \u2014 it needed to be.  And for \u2014 also for you to also help us focus this on the kids and to really work on this regarding the addiction that kid have on e-cigarettes now.<\/p>\n<p>THE PRESIDENT:  And what is your position, may I ask?<\/p>\n<p>MR. WIMMER:  It\u2019s very similar to what you proposed on September 11: to ban all flavored e-cigarette products.<\/p>\n<p>THE PRESIDENT:  Good.  Thank you.<\/p>\n<p>SENATOR HOUGH:  Thank you very much, Mr. President, for having me here.  I\u2019m Mike Hough; I\u2019m a State Senator from Frederick and Carroll County.  We\u2019re actually home to Camp David \u2014<\/p>\n<p>THE PRESIDENT:  Good.<\/p>\n<p>SENATOR HOUGH:  So, we love to have you there.  And this is my part-time job.  My other job: I\u2019m the Chief of Staff for Congressman Alex Mooney from West Virginia, so we\u2019re both big fans of yours \u2014<\/p>\n<p>THE PRESIDENT:  Say hello to him.<\/p>\n<p>SENATOR HOUGH:  \u2014 probably second only to my wife, who was one of your original supporters after you came down the escalators.<\/p>\n<p>THE PRESIDENT:  Thank you.  And say hello.  Thank you.<\/p>\n<p>SENATOR HOUGH:  I will do that.<\/p>\n<p>THE PRESIDENT:  Kellyanne, go ahead.<\/p>\n<p>MS. CONWAY:  Kellyanne Conway, Counselor to the President.<\/p>\n<p>Mr. President, thank you very much for not shying away and looking the other way at an emergent public health crisis and for the courage to invite people from both sides of the issue in the Cabinet Room to have this conversation.  Thank you, Mr. President.<\/p>\n<p>THE PRESIDENT:  Thank you, Kellyanne.<\/p>\n<p>Mitt?<\/p>\n<p>SENATOR ROMNEY:  Mr. President, I\u2019m Senator Mitt Romney.  Myself and Senator Merkley have offered legislation that\u2019s very consistent with your policy from September \u2014 your discussion in September \u2014 which is to ban flavors so that we don\u2019t have kids getting hooked on nicotine products.  We also insist that cartridges are tamper-proof so kids can\u2019t add contaminants to the cartridges.  But that\u2019s very consistent with your point of view.<\/p>\n<p>THE PRESIDENT:  Thank you, Mitt.  Well, this is a very big subject and it\u2019s a very complex subject.  Probably a little bit less complex than some people think.  But I\u2019m here to listen and I have very divergent views.<\/p>\n<p>Who would like to start?  Maybe I\u2019d ask Alex to start and give us a little bit of a background on where we are and what we\u2019re doing and what we\u2019re thinking about.<\/p>\n<p>SECRETARY AZAR:  Sure.  Well, thank you, Mr. President.  And thank you for your work and leadership on this issue.  Your attention to it demonstrates your deep commitment to Americans\u2019 health and, in particular, the health and wellbeing of our youth.<\/p>\n<p>While e-cigarettes can potentially be an off-ramp for adults that are addicted to combustible tobacco, we can all agree that we can\u2019t allow them to become an on-ramp to nicotine addiction and combustible tobacco use for our kids.<\/p>\n<p>As the President said, we\u2019re here today to listen to you, individuals and organizations that represent many different aspects of this issue.  The question of how to regulate e-cigarettes is highly complex.  So it\u2019s vital to gather an array of perspectives to understand the best way to go about protecting America\u2019s youth.<\/p>\n<p>So, thank you, Mr. President, for organizing this gathering today, and we all look forward to hearing from our guests.<\/p>\n<p>THE PRESIDENT:  Good.  I do too.  And I want to.<\/p>\n<p>How about you start?  You had an interesting point of view early on.  Where do you stand?<\/p>\n<p>SENATOR ADAMS:  Well, I think that, you know, we clearly, in Kentucky, have a problem with teen smoking, but I think that having access to vaping products is not necessarily the answer.  And it goes beyond just flavors, in my opinion.  It is \u2014 we shouldn\u2019t have access for any vaping product, I think, until you\u2019re 21 years of age.<\/p>\n<p>The more you introduce nicotine into a kid\u2019s brain, the more it has shown that they become addicted to other substances.  So the longer that we can keep nicotine out of the hands of kids, I think it\u2019s in everyone\u2019s best interest.<\/p>\n<p>THE PRESIDENT:  Well, one of the things we\u2019ll be talking about will be age, because age is a big factor.  And we\u2019re going to be coming up with a number.  I think we have to come up with a hard number at some point, so we\u2019ll be doing that.<\/p>\n<p>Let me now \u2014 so, you had something very interesting to say before.  Go a step further, please.  Yeah, please.<\/p>\n<p>MS. BERKMAN:  Well, again, I also want to amplify what others have said.  You know, Mr. President, it is no secret that you have great instincts.  And your first instinct on solving this problem of the youth vaping epidemic we, and I think many people in this room, believe is the right one \u2014 and that is ridding the market of all of these flavors, including menthol flavor and mint flavor, because it\u2019s the flavors that have hooked the kids and that kept the kids from perceiving harm in these products, and the presence of nicotine.<\/p>\n<p>And so, you know, I\u2019m here; we\u2019ve stayed up all night \u2014 we\u2019re a grassroots group representing families all across the country \u2014 and we went through the thousands of emails and letters and social media outreach that we\u2019ve gotten from families in, you know, every state that I can think of \u2014 in Florida, in Ohio, Wisconsin, New York, Texas.<\/p>\n<p>These are real-life stories \u2014 I\u2019m happy to leave this for you \u2014 of families who have had their lives upended by the severe nicotine addiction that was caused by these flavored e-cigs.  Kids are in pain, and we need you to help us.<\/p>\n<p>THE PRESIDENT:  Well, a lot of people want to leave the menthol.  They say, \u201cGet rid of flavors but leave the menthol.\u201d  I\u2019ve heard that from a lot of people.<\/p>\n<p>MR. REEDY:  No.<\/p>\n<p>THE PRESIDENT:  No?  Go ahead.<\/p>\n<p>MR. REEDY:  Well, I think what we have seen in the data is that if you leave the menthol, then they\u2019ll just start using menthol.  So \u2014 and what we\u2019ve seen so far is that even when the flavors \u2014 some flavors are eliminated, that they\u2019ll still keep on going to anything that\u2019s flavored.  So that is not the solution.<\/p>\n<p>THE PRESIDENT:  So what are you suggesting?  What are you suggesting?<\/p>\n<p>MR. REEDY:  I\u2019m suggesting exactly as what you suggested: that you take all flavored e-cigarettes off the market \u2014<\/p>\n<p>THE PRESIDENT:  Including menthol?<\/p>\n<p>MR. REEDY:  \u2014 including mint and menthol.<\/p>\n<p>MS. CONWAY:  Well, the new NACS data suggests that kids don\u2019t use menthol, though.  So \u2014<\/p>\n<p>MR. ARMOUR:  I think there\u2019s a problem, because in the cigarette category, the a third of the category is menthol.  And there is no question this country needs to solve the problem of youth access to vaping.  I think we can do that.  I think your comment about going to be 21 is a step there.<\/p>\n<p>But I think things like no direct access to vaping products \u2014 i.e. keeping them behind the counter \u2014 I think things like that are important.  But menthol \u2014 if part of the reason why we have vaping is to try and help people that are smokers migrate to a lower-risk product, a third of the smokers are menthol smokers.  And by eliminating that, I think that cuts off that path.  But we have to really be very serious about preventing sales of vape products to any minor, and stores need to face the consequences if they do that.  I mean, they should get their licenses pulled.<\/p>\n<p>THE PRESIDENT:  So, how many stores do you represent?<\/p>\n<p>MR. ARMOUR:  A hundred and fifty-three thousand.  Two and a half million employees.<\/p>\n<p>THE PRESIDENT:  That\u2019s a lot of stores.<\/p>\n<p>MR. ARMOUR:  So that\u2019s 160 million transactions.<\/p>\n<p>THE PRESIDENT:  Now, were you higher in stores five years ago because of what\u2019s going on with the Internet?  I mean, you\u2019re losing stores now to the Internet, wouldn\u2019t you say?<\/p>\n<p>MR. ARMOUR:  Not \u2014<\/p>\n<p>THE PRESIDENT:  Would you say you\u2019re losing stores?<\/p>\n<p>MR. ARMOUR:  No.  Not convenience stores.<\/p>\n<p>THE PRESIDENT:  Not convenience stores?<\/p>\n<p>MR. ARMOUR:  No.<\/p>\n<p>THE PRESIDENT:  That\u2019s good.  That\u2019s a positive sign.<\/p>\n<p>MR. ARMOUR:  Remember that David Urban (inaudible) into a Wawa in Pennsylvania<\/p>\n<p>THE PRESIDENT:  Right.  That\u2019s right.<\/p>\n<p>MR. ARMOUR:  \u2014 during the campaign.  So those are my people.  And probably more importantly, they\u2019re your people.<\/p>\n<p>THE PRESIDENT:  Okay.  They are.  And they\u2019re \u2014 everybody.  They\u2019re great people.  And what are they saying about the vaping phenomena?  What are they saying?<\/p>\n<p>MR. ARMOUR:  They\u2019re saying the same thing as they say about our sales of beer, wine, cigarettes.  You know, we\u2019re in every community in the United States.  We have a reputational risk in those communities.<\/p>\n<p>And it is super important for our members to be socially responsible retailors.  So the focus we have on doing that \u2014 through training programs, through reprogramming POS terminals, to prohibiting the sales of products to people that are under age \u2014 super important.  I mean, we need to have very serious regulations about sales to underage people.<\/p>\n<p>THE PRESIDENT:  So then, representing all of those stores \u2014 great people.  What is your solution?  What is their solution and your solution?<\/p>\n<p>MR. ARMOUR:  So, kind of six points.  First, as I mentioned, prohibit direct access to the product, meaning put it behind the counter; only employees have access to it.  Second is restricting sales to people 21 years and older.<\/p>\n<p>THE PRESIDENT:  So, 21.<\/p>\n<p>MR. ARMOUR:  Third is restricting the number of items they can purchase per transaction.  So you can\u2019t \u2014 one of the problems you have is that adult-age people are buying multiple \u2014 more than they need, and then reselling it \u2014 social sales \u2014 to underage people.  We need to restrict that by restricting the number of items they can buy in a transaction.<\/p>\n<p>I think we need to require either a training program for employees or require reprogramming of POS terminals.  The FDA has the authority to do that under the Tobacco Control Act, and has never \u2014 never approved a training program.  If they did, they could fine and restrict and pull licenses for people who don\u2019t train.<\/p>\n<p>THE PRESIDENT:  And what about flavors?<\/p>\n<p>MR. ARMOUR:  You know, we \u2014 our most important thing is the level playing field that all retailors abide by the same laws, you know?  We think flavors are \u2014<\/p>\n<p>THE PRESIDENT:  So are you saying \u2014 would you not restrict \u2014<\/p>\n<p>MR. ARMOUR:  \u2014 probably good for adult smokers.  They are horrible for anyone else.  But if there\u2019s a level playing field, and you decide that this is what you\u2019re going to do \u2014<\/p>\n<p>THE PRESIDENT:  So what would you do with flavors?<\/p>\n<p>MR. ARMOUR:  We would abide by the law.  If the law decided to ban flavors, we would abide by that law.<\/p>\n<p>THE PRESIDENT:  Go ahead.<\/p>\n<p>MR. CONLEY:  Mr. President, your instincts on September 11th were correct, but facts and the situations changed.  On September 11th, you were under the impression what the CDC was saying was that vaping \u2014 vaping, in general, was killing people.  But now we know, from the CDC, that their main focus of their investigation, it\u2019s not store-bought nicotine products.  It\u2019s not the companies that Tony Abboud represents.  It was illicit THC oil cartridges \u2014<\/p>\n<p>THE PRESIDENT:  Right.  That\u2019s true.<\/p>\n<p>MR. CONLEY:  \u2014 sold by drug dealers.<\/p>\n<p>And so, right now, it\u2019s important that you know: Michael Bloomberg, who is no friend to your presidency, he is funding $160 million to try to ban these flavors.  And many people in this room are the recipients of those monies.  So they are not here with the position of \u201cwe can come to a compromise.\u201d  They have money specifically to get these products banned.  And the 10,000-plus small businesses, they can\u2019t survive with just tobacco and menthol.  They age restrict; they only allow adults in their store.<\/p>\n<p>THE PRESIDENT:  So what would you do?<\/p>\n<p>MR. CONLEY:  I think we need to raise the age to 21.  We need bulk sales purchase limits.  We need marketing restrictions.  And also, most importantly, there is \u2014 in May of 2020, every single vaping product on the market has to go through what\u2019s known as a pre-market review.  That\u2019s going to cost several million dollars per product.  So even if we solved this crisis today \u2014 which I hope we do, in five, six months \u2014 we\u2019re back where we started with potentially only the largest multi-billion dollar companies being able to survive.<\/p>\n<p>THE PRESIDENT:  Because people can\u2019t afford that.<\/p>\n<p>MR. CONLEY:  Exactly.  And all these small businesses, they\u2019re the ones that are employing people \u2014 70,000, 80,000 direct jobs; 70,000 indirect jobs.<\/p>\n<p>THE PRESIDENT:  So what are you recommending on flavors?<\/p>\n<p>MR. CONLEY:  On flavors, we think we need at least a wide-open market in some places.  So we would prefer only tobacco, 21; bulk sales limits \u2014 many things advocated by NACS.  But at the worst, products that haven\u2019t undergone FDA review should be able to be continue to be sold in adult-only stores.  But that\u2019s not the best.  We want smokers to be able to access these products everywhere they can purchase a pack of Marlboros.<\/p>\n<p>And if Senator Rand Paul, who is a doctor, just two weeks ago in the Senate, he said these products have likely saved hundreds of thousands of lives, and we can\u2019t forget about the adult smokers in this debate.<\/p>\n<p>Thank you, Mr. President.<\/p>\n<p>THE PRESIDENT:  Matthew?<\/p>\n<p>MR. MYERS:  Mr. President, thank you.  You know, we have tried \u2014 you know, it\u2019s already illegal to sell these products to people under 18.  And yet, we have seen the largest increase in youth use of nicotine product in the last four years, literally in the history of our nation.  And at the same time, with the availability of the flavors, we have seen no increase whatsoever in the percentage of adults who use these products.<\/p>\n<p>The flavors have fueled youth use of these products.  And what\u2019s particularly concerning is it led to a level of addiction that we have never seen, even with cigarettes, because these products deliver more nicotine more powerfully.  So what we\u2019re seeing, and others here can talk to you about it in more detail: kids becoming addicted quicker, unable to quit, suffering extraordinary withdrawal symptoms as a result.<\/p>\n<p>THE PRESIDENT:  Well, what would you do, Matthew?  You\u2019ve been working on this for a long time.<\/p>\n<p>MR. MYERS:  I think \u2014 I think the answer is, having worked on this issue for 35 years, I would, in fact, the sale of any flavors that haven\u2019t been approved by the Food and Drug Administration.  We\u2019re talking about a temporary step in order to prevent the continued, dramatic rise up there.<\/p>\n<p>FDA has the authority then to review these products.  And if any of them comply, and people can demonstrate that they actually help people quit and that they don\u2019t unduly appeal to kids, then they can be marketed.<\/p>\n<p>What we\u2019ve seen now, though, is just the opposite.  We have seen an epidemic among our kids that I haven\u2019t seen ever before.  We now have more kids using nicotine products than in any time in the last 20 years.  And what\u2019s more disturbing about it is that 34 percent of the kids who use these products use them more than 20 days a month, which means they\u2019re hooked.  They can\u2019t quit.  We have stories of young people who say, \u201cI started it because it was cool.  And then literally, within days, I lost control.\u201d  Kids sleep with these products because they need to wake up in the middle of the night.<\/p>\n<p>This is something we can do something about.  FDA has the authority to review these products.  The question is: What should we do in the interim with it?  And because we have seen no increase \u2014<\/p>\n<p>THE PRESIDENT:  So what would you do?<\/p>\n<p>MR. MYERS:  I would eliminate the flavors \u2014 all of them, except for \u2014<\/p>\n<p>THE PRESIDENT:  Menthol.<\/p>\n<p>MR. MYERS:  \u2014 tobacco flavored.<\/p>\n<p>THE PRESIDENT:  What about menthol?<\/p>\n<p>MR. MYERS:  Well, what we\u2019ve seen is, two years ago, JUUL said they were going to make mango less accessible.  Kids moved immediately to mint.  Now, if we eliminate mint \u2014 what many people don\u2019t realize is, do notice the the number one ingr- \u2014 number-one ingredient in mint is?  It\u2019s menthol.  We already have some companies that have multiple versions of menthol, and many of them taste a lot like mint.  And so, unless FDA actually constrains something very narrowly, it\u2019s one of those big Pandora\u2019s Box that we can\u2019t get out of.<\/p>\n<p>THE PRESIDENT:  Yeah.  Now, you\u2019re the head of JUUL.<\/p>\n<p>MR. CROSTHWAITE:  Yes, sir, Mr. President.<\/p>\n<p>THE PRESIDENT:  So, what do you \u2014 what do you say?<\/p>\n<p>MR. CROSTHWAITE:  Well, when I came into the job, we decided that action needed to be taken.  We agreed this was a serious issue.  So we have already removed our flavors from the market.  Most recently, we removed mint.<\/p>\n<p>THE PRESIDENT:  Right.<\/p>\n<p>MR. CROSTHWAITE:  And, for us, that was 70 percent of our business.  So it was a big \u2014 a big step for us, but felt it was the right thing to do with this youth data that came out and to deal with this issue.  Today, we\u2019re left with a tobacco and menthol portfolio.  But ultimately, we were going to defer to the FDA \u2014<\/p>\n<p>THE PRESIDENT:  And that\u2019s regardless of age?  It\u2019s just removed?<\/p>\n<p>MR. CROSTHWAITE:  We took it out.  We took out all of our flavor SKUs, including mint.  We sell menthol and tobacco SKUs.  But we will defer to the FDA.  We said we\u2019re not going to \u2014<\/p>\n<p>THE PRESIDENT:  Who makes \u2014 who makes the flavors, then?  I mean, you\u2019re the biggest of the group.  Who makes the flavors?  Different companies?<\/p>\n<p>MR. CROSTHWAITE:  Different companies, sir.<\/p>\n<p>THE PRESIDENT:  And they continue to make flavors?<\/p>\n<p>MR. CROSTHWAITE:  Yes, sir.<\/p>\n<p>MR. NIVAKOFF:  And, Mr. President, look, we are the second-largest vapor company in the country.  For every three JUUL products that are sold, one NJOY is sold.<\/p>\n<p>THE PRESIDENT:  Right.<\/p>\n<p>MR. NIVAKOFF:  We had 1.2 percent youth use, versus 60 percent youth use for JUUL.  It\u2019s not necessarily a flavor problem.<\/p>\n<p>THE PRESIDENT:  So what are you \u2014 what are you saying?<\/p>\n<p>MR. NIVAKOFF:  There are \u2014 there are two unassailable facts: The youth problem is a huge problem, and flavors definitively contribute to it.  But on the other hand, the other problem \u2014 which is macro to this situation \u2014 is that if you ban flavors \u2014 which there is some public health redeeming virtue to doing so \u2014<\/p>\n<p>THE PRESIDENT:  Right.<\/p>\n<p>MR. NIVAKOFF:  A hundred thousand Americans are going to lose their jobs.  It\u2019s not disputed by anybody in the public health \u2014<\/p>\n<p>THE PRESIDENT:  They\u2019re going to lose their jobs?<\/p>\n<p>MR. NIVAKOFF:  Their community and the vape shop community \u2014<\/p>\n<p>MR. ABBOUD:  Actually, the number is higher, Mr. President.  The number is a hundred and \u2014<\/p>\n<p>THE PRESIDENT:  They\u2019re going to lose their jobs?<\/p>\n<p>SENATOR ROMNEY:  (Inaudible) much lower.<\/p>\n<p>MR. NIVAKOFF:  They will lose their jobs, sir.  They sell \u2014 I\u2019d like to finish.  They sell exclusively flavors.  So the question really is: I don\u2019t think we need to argue the virtue of youth not using these products.  We all agree that they shouldn\u2019t.  NJOY, Reynolds American, represent number two and three in the country.  Eight with \u2014 in the absence of JUUL, represent the balance of the convenience store.  (Inaudible) electronic cigarette market had 1.2 and 2.4 percent youth use, respectively.<\/p>\n<p>THE PRESIDENT:  Where is Reynolds?<\/p>\n<p>MR. FRAGNITO:  We \u2014 we believe that you can market flavors responsibly, Mr. President.  Ninety percent of our (inaudible) consumers are above the age of 25.<\/p>\n<p>THE PRESIDENT:  You\u2019re still doing flavors?<\/p>\n<p>MR. FRAGNITO:  Yes, we are.<\/p>\n<p>THE PRESIDENT:  So JUUL is not doing it, and they are both doing it.  That\u2019s interesting, right?<\/p>\n<p>MR. NIVAKOFF:  And, sir, I think that the issue or the opportunity here is to make a deal for the industry to come here and say \u2014<\/p>\n<p>THE PRESIDENT:  Well, that\u2019s why I have you here.  I mean, I\u2019d like to see if we \u2014<\/p>\n<p>MR. NIVAKOFF:  We recognize that youth use is a problem.<\/p>\n<p>THE PRESIDENT:  \u2014 can do something for everybody, where everybody is happy.<\/p>\n<p>The one \u2014 the one thing I see though \u2014 and you watch prohibition, you look at \u2014 you know, with the alcohol, you look at cigarettes, you look at all \u2014 if you don\u2019t give it to them, it\u2019s going to come here illegally, okay?  They\u2019re going to make it.<\/p>\n<p>But instead of Reynolds or JUUL or, you know, legitimate companies, good companies making something that\u2019s safe, they\u2019re going to be selling stuff on a street corner that could be horrible.  That\u2019s the one problem I can\u2019t seem to forget.  I mean, I\u2019ve seen it.  You just have to look \u2014 you have to look at the history of it.  And now, instead of having a flavor that\u2019s at least safe, they\u2019re going to be having a flavor that\u2019s \u2014 that\u2019s poison.  That\u2019s a big problem.<\/p>\n<p>MR. ABBOUD:  (Inaudible) thousands of companies, Mr. President.  And there are very large e-cigarette companies at this table, but most of the members of our trade association are small mom-and-pop shops.  They\u2019re small manufacturers; they\u2019re small business that have built this industry from the ground up, not from the top down.<\/p>\n<p>THE PRESIDENT:  So what are you saying?<\/p>\n<p>MR. ABBOUD:  And we say, you have to implement \u2014 as you said, this is complex problem, so you need a sophisticated plan.  A flavor ban will not work.  And you\u2019ve articulated one critical reason why it will not work: People will just go to the black market.  And that\u2019s because adults are demanding these flavors \u2014<\/p>\n<p>THE PRESIDENT:  But doesn\u2019t that happen \u2014<\/p>\n<p>MR. ABBOUD:  This is the first product.<\/p>\n<p>THE PRESIDENT:  \u2014 let\u2019s say you enter \u2014 okay, you just ended the flavors, right?<\/p>\n<p>MR. CROSTHWAITE:  Except for tobacco and menthol.<\/p>\n<p>THE PRESIDENT:  Isn\u2019t that going to be \u2014 yeah.  Isn\u2019t that going to be just sold, you know, illegally, or somebody is going to open up a shop in China and ship it in with flavors and you don\u2019t know what standard you\u2019re getting?  Isn\u2019t that a problem?<\/p>\n<p>MR. NIVAKOFF:  We already see that.  In \u2014<\/p>\n<p>MR. CROSTHWAITE:  It is.  And unfortunately, today \u2014<\/p>\n<p>MR. NIVAKOFF:  \u2014 New York City, if you go to a bodega to buy the JUUL pods, you can buy 15 different versions of JUUL mango, which have been off the market since September.<\/p>\n<p>THE PRESIDENT:  And that\u2019s where the deaths are coming in.  It\u2019s, really, not from your product, it\u2019s from product that\u2019s made illicitly.  Right?<\/p>\n<p>MR. CONLEY:  Copycats from China, Mr. President.<\/p>\n<p>MR. CROSTHWAITE:  We have \u2014 we have China counterfeit products on the market today.  What we\u2019re very focused on is enforcement to get these products off the market.  But, yes, Mr. President, it\u2019s an issue.<\/p>\n<p>THE PRESIDENT:  What do you call it?  \u201cChina counter?\u201d<\/p>\n<p>MR. CROSTHWAITE:  Excuse me?<\/p>\n<p>THE PRESIDENT:  What is it called?<\/p>\n<p>MR. CROSTHWAITE:  Counterfeit products that are \u2014 that we\u2019re not producing that are on the market today.  It\u2019s an issue and it\u2019s something \u2014<\/p>\n<p>THE PRESIDENT:  And how bad are they?<\/p>\n<p>MR. CROSTHWAITE:  \u2014 we\u2019re very focused on.<\/p>\n<p>THE PRESIDENT:  How bad are they?  Bad product, right?<\/p>\n<p>MR. CROSTHWAITE:  They\u2019re bad products.<\/p>\n<p>THE PRESIDENT:  In some cases.<\/p>\n<p>MR. CROSTHWAITE:  The issue is, you just \u2014 you just don\u2019t know, Mr. President.<\/p>\n<p>MR. MYERS:  Mr. President, we have 5.3 million kids who are addicted, and it\u2019s separate from the lung disease.  5.3 million kids.  A million kids a day are using these products repetitively with addiction.<\/p>\n<p>Since the flavors have been introduced, we have seen a meteoric rise in use by kids.  We have seen no increase whatsoever.  Before flavors were marketed so heavily, candidly, by JUUL, the number-one flavor of e-cigarette on the market was tobacco flavor.  We\u2019re not talking about removing all e-cigarettes.  What we\u2019re talking about doing is removing the flavors that have fueled the epidemic among our kids.<\/p>\n<p>THE PRESIDENT:  I understand what you\u2019re saying, Matthew.  I\u2019m saying this: If you take out flavors, won\u2019t they just be made illegally \u2014 the same flavor, but maybe unsafe?<\/p>\n<p>MR. MYERS:  No.  The answer to that, I think, is: What you\u2019ll see is, last year, we saw a million and a half more kids become addicted.  We can close that on-ramp.  You said it correctly in September; former Commissioner Gottlieb has said the same thing.  We can close the on-ramp.  As long as flavors are legally available \u2014<\/p>\n<p>MR. BUTLER:  The on-ramp you\u2019re going to close is the on-ramp from adult smokers to vaper.  People need flavors in order to do it.  You\u2019re asking addicts \u2014<\/p>\n<p>SENATOR ROMNEY:  Most adults \u2014 most adults are not using flavors.<\/p>\n<p>PARTICIPANT:  Yes, they are.<\/p>\n<p>MR. BUTLER:  You\u2019re going to ask people that are using flavors today \u2014 you\u2019re going to ask people that are using flavors today to go back to using the flavor of the product that almost killed them.<\/p>\n<p>MR. NIVAKOFF:  Senator Romney, we represent the second-largest e-cigarette company in the country.  Ninety-two percent of my revenue is flavors, and I had 1.2 percent of U.S. (inaudible).<\/p>\n<p>SENATOR ROMNEY:  And his is the largest company, and none of his are flavors.<\/p>\n<p>MR. NIVAKOFF:  We\u2019re different companies.  We \u2014<\/p>\n<p>SENATOR ROMNEY:  I understand.  His is the largest.<\/p>\n<p>MR. NIVAKOFF:  We are not JUUL.  We are not JUUL, sir.<\/p>\n<p>SENATOR ROMNEY:  His is the largest.<\/p>\n<p>MR. ABBOUD:  Over 9,000 people \u2014<\/p>\n<p>MR. NIVAKOFF:  Seventy percent of youth, according to the National Youth Tobacco Survey, get their vapor products form social sources: friends, family, or other people that are 18 years or older.<\/p>\n<p>SENATOR ROMNEY:  You have 10,000 stores \u2014<\/p>\n<p>MR. NIVAKOFF:  Only 8.4 percent get them from convenience stores.<\/p>\n<p>SENATOR ROMNEY:  You have 10,000 stores selling these things.  Ten thousand stores.  The kids are overwhelmingly being able to get these by virtue of 10,000 stores selling flavors.<\/p>\n<p>MR. ABBOUD:  Not the vape shops.  The vape shops are typically adult-only shops, Mr. President.  And that\u2019s \u2014<\/p>\n<p>MR. MYERS:  And it turns out, the most recent \u2014<\/p>\n<p>MR. NIVAKOFF:  Hold on one second.  So it\u2019s very important for you to realize, it\u2019s separate and apart from the convenience stores and the gas stations where kids typically frequent, there is a whole separate distribution chain has grown up, which is a vape shop that is supplied by a distributor, that is supplied by a manufacturer.  And this is the new vapor industry, not the old tobacco industry.<\/p>\n<p>MS. KOVAL:  And that is the number-one outlet where young people purchase their vapes.<\/p>\n<p>MR. ABBOUD:  That is not \u2014 that is not accurate.<\/p>\n<p>THE PRESIDENT:  What did she say?<\/p>\n<p>MS. KOVAL:  The CDC issued a report just last week that said, yes, kids get their vapes from social sources.  That\u2019s to be expected.  The number one \u2014 16.5 percent of 9- to 17-year-olds get their vapes from a vape shop.  It is the number one retail source.  And in the same \u2014 in the same study, it also said that these kids are refused only 25 percent of the time.<\/p>\n<p>If a vape shop is willing to sell a 9-year-old a vape, 18 to 21 is not going to help.<\/p>\n<p>MR. NIVAKOFF:  That suggests we should change the rules if somebody illegally sells a product.  It shouldn\u2019t suggest that we should limit adult access.<\/p>\n<p>THE PRESIDENT:  Go ahead.  What?<\/p>\n<p>MR. ARMOUR:  The convenience store industry, as the lady here just said, has a much better compliance record than adult-only stores.  We sell a lot of age-restrictive products to make from \u2014 as I said earlier, beer, lottery tickets, and vape products, cigarettes.  It is vitally important to our members to do age-restrictive product sales properly.  And that\u2019s one of the reasons why our compliance rates are much better than just (inaudible).<\/p>\n<p>THE PRESIDENT:  And with flavor or without flavor?<\/p>\n<p>MR. ARMOUR:  Well, with anything.  If it\u2019s age restricted, we take it very, very seriously.  I think this whole debate over flavor says \u2014 you know, half the audience here firmly believes \u2014 and I think there\u2019s some strong evidence that flavors help adult cigarette smokers to reduce the risk.  There are also a huge concern about youths being attracted to vapor because of the flavors.  We have to do \u2014<\/p>\n<p>THE PRESIDENT:  So why did JUUL end flavors?<\/p>\n<p>MR. ARMOUR:  We have to double down and do really \u2014<\/p>\n<p>THE PRESIDENT:  Yeah.<\/p>\n<p>MR. ARMOUR:  \u2014 well on age-restricted products.<\/p>\n<p>THE PRESIDENT:  Okay.  I got it.  I got it.  Why did JUUL end flavors then?  You\u2019re the biggest \u2014<\/p>\n<p>MR. CROSTHWAITE:  When the data came out and we saw the youth usage \u2014 it was a serious problem.  We felt we needed to act quickly and we removed the flavors in our business.<\/p>\n<p>THE PRESIDENT:  So you think flavors are dangerous \u2014<\/p>\n<p>MR. CROSTHWAITE:  Well, when we \u2014<\/p>\n<p>THE PRESIDENT:  \u2014 essentially?<\/p>\n<p>MR. CROSTHWAITE:  When we saw the youth data, we felt the responsible thing to do, as the leader in the industry, was to remove the flavors, given that youth were getting access to flavors.<\/p>\n<p>THE PRESIDENT:  And yet you think we should have flavors?<\/p>\n<p>MR. NIVAKOFF:  Yes, sir.  I do.  I think that we\u2019ve demonstrated through our business model, which is unique to JUUL, that we can build an adult audience of smokers without creating \u2014 of former smokers \u2014 without creating a new audience of youth users.  And it\u2019s been demonstrated through the data.<\/p>\n<p>Over the last 12 months, NJOY has been the second-largest electronic cigarette company in the country.  The FDA has conducted 146,000 inspections of retail establishments.  We\u2019ve had 29 violations.  By way of comparison, JUUL has had 60 times more violations than us \u2014 60 times.  They sell three times more products than us and has had 60 times more violations.<\/p>\n<p>THE PRESIDENT:  And why is that?<\/p>\n<p>MR. NIVAKOFF:  It\u2019s because of the way that we have implemented self-policed policies that limit youth access.  There\u2019s no \u2014 nobody can intellectually, honestly tell you that you can permanently eliminate youth access.<\/p>\n<p>THE PRESIDENT:  What would you say about that?<\/p>\n<p>MR. CROSTHWAITE:  What we\u2019re focused on doing, Mr. President, is getting this back to science-based argument.  We\u2019re going to fully support the FDA in this process.  Flavors have demonstrated playing an important role for an adult to make an important choice, which is to put down using a cigarette if they can\u2019t quit and switch to a product that has less risk, in e-vapor.<\/p>\n<p>We think the science argument is very important.  That\u2019s what we\u2019re focused on.  We think the FDA is most appropriate to determine that \u2014 what\u2019s appropriate for public health.<\/p>\n<p>THE PRESIDENT:  So do you think you have it right, now?  You\u2019re okay?  You have \u2014 essentially, you\u2019ve gotten rid of the flavor?<\/p>\n<p>MR. CROSTHWAITE:  I think we\u2019ve made the right decision, and we\u2019re looking forward to filing our (inaudible) with the FDA.<\/p>\n<p>MR. NIVAKOFF:  JUUL removed mango in September 2018, and youth use rose.  It was the number one most popular product on the market.  Flavors are an issue; they are attractive to youth.<\/p>\n<p>SENATOR ROMNEY:  The kids.  How about the children?<\/p>\n<p>MR. NIVAKOFF:  Yes, sir.<\/p>\n<p>SENATOR ROMNEY:  We\u2019ve got almost 6 million kids addicted to nicotine.  And they\u2019re getting addicted to nicotine because of flavors.  Sixty-six percent of the kids addicted to these products are saying they didn\u2019t even know it had nicotine in it.  They thought it was just a candy-type product.  It\u2019s a \u2014 it\u2019s the flavor that\u2019s drawing the kids in.  It\u2019s a health emergency.  I salute the fact that JUUL has said, \u201cWe\u2019re taking these products off the market because we care about our kids.\u201d<\/p>\n<p>The kids \u2014 the adults \u2014 and the adults have access.  The adults have access to menthol products through JUUL.  They have tobacco-flavored products.<\/p>\n<p>THE PRESIDENT:  So that\u2019s why (inaudible).<\/p>\n<p>SENATOR ROMNEY:  By putting out \u2014 putting out cotton candy flavor and \u2014 what is it?  \u201cUnicorn Poop\u201d flavor.  I mean, look, this is kid product.  We have to put the kids first.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. ABBOUD:  (Inaudible) explains why marketing has not been addressed yet.  And that\u2019s why in our plan, \u201c21 &#038; DONE!,\u201d Mr. President, not only have we called for increasing the age to 21 \u2014 that\u2019s a no-brainer; that has to be done.  It has to be done because \u2014<\/p>\n<p>THE PRESIDENT:  I think we \u2014 we\u2019re going to be doing that.<\/p>\n<p>MR. ABBOUD:  \u2014 that keeps it away from the 18-year-olds.<\/p>\n<p>THE PRESIDENT:  We\u2019re going to be doing that.  Twenty-one, we\u2019re going to be doing that.  Go ahead.<\/p>\n<p>MS. BERKMAN:  But that\u2019s a first \u2014 that\u2019s a first step.<\/p>\n<p>MR. ABBOUD:  But on top of that, we\u2019ve \u2014 we\u2019ve laid out 21 different marketing restrictions: banning advertising on television, banning advertising on \u2014<\/p>\n<p>MR. NIVAKOFF:  We should ban advertising all together.  That there\u2019s no virtue \u2014<\/p>\n<p>MR. ABBOUD:  \u2014 banning advertising of the kind that Senator Romney is complaining about.  Everybody has criticized the industry for their marketing, but nobody is talking about actually putting in marketing restrictions.<\/p>\n<p>THE PRESIDENT:  What do you think of the Senate bill?<\/p>\n<p>MR. ABBOUD:  Well, we think it\u2019s the wrong approach, frankly.  And I think the better approach would be to raise the age to 21, put severe restrictions on how you market the product.  Then, on top of that, you have to increase penalties for retailers, because our retailers are fine with the increasing penalties because they do know that they are age-gating and keeping these products out of the hands of kids.<\/p>\n<p>So we say, \u201cthree strikes and you\u2019re out.\u201d  Today, the FDA can allow you to have seven strikes before you\u2019re actually told to stop selling tobacco products.  That\u2019s unacceptable. And that\u2019s perfectly okay from our perspective.<\/p>\n<p>On top of that: age verification.  We are in the day \u2014 age of technology.  And that is what this is; this is technology product that is helping people quit smoking.  And unfortunately, for some people \u2014<\/p>\n<p>THE PRESIDENT:  Well, in some cases.  Not all cases.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. ABBOUD:  In some cases, it is.  It is extremely important.  And that\u2019s why people are so devoted to this particular product.<\/p>\n<p>But third-party age verification is important.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>DR. GOZA:  Mr. President \u2014<\/p>\n<p>THE PRESIDENT:  Yeah, please.<\/p>\n<p>DR. GOZA:  I\u2019m a pediatrician and I take care of children every day.  I saw children yesterday.  And this is a crisis.  We have over 5 million children addicted to e-cigarettes.  And these parents and these children are counting on our help.  I had a teenage boy in my office crying, telling me, \u201cI was just dumb.  I was dumb.  I don\u2019t know how to get off of this.  I cannot get off of it.\u201d  It is a crisis.<\/p>\n<p>Children tell us they sleep with their JUULs under their pillows so that when they wake up in the middle of the night they can take a \u2014 a vape.  And these children \u2014 nicotine is so addictive, we really have nothing in arsenal to help them, except for behavioral \u2014<\/p>\n<p>THE PRESIDENT:  So, what are your suggesting, Sally?  Do you have a suggestion?<\/p>\n<p>DR. GOZA:  I\u2019m suggesting \u2014 and the nation\u2019s doctors are here and we\u2019re all of the same message \u2014 is that we need to take all flavors off the market, pending FDA investigation of that.  And then we are worried that if we leave one flavor on the market \u2014 even menthol \u2014 that the children will go to that, because they\u2019re going to want something to help \u2014 they \u2014 they\u2019re going to want something.  And that\u2019s why action is so desperately needed here.<\/p>\n<p>THE PRESIDENT:  How do you solve the counterfeit problem, if you do that?  Okay, so they\u2019re not going to \u2014 one of these guys are going to do it.  They\u2019re all legit companies.<\/p>\n<p>DR. GOZA:  So my \u2014 I \u2014<\/p>\n<p>THE PRESIDENT:  How do you solve the fact that it\u2019s going to be shipped in from Mexico?<\/p>\n<p>DR. GOZA:  I\u2019m looking at Secretary Azar and hoping he has the great solution for that, because I do believe the FDA is able to \u2014<\/p>\n<p>THE PRESIDENT:  Well, it\u2019s the problem.  I think you have the same problem with drugs and everything else.<\/p>\n<p>DR. GOZA:  But our big thing is that \u2014 and this really is where it goes back to the children, is that we have 5 million children addicted now, but what we don\u2019t want to do is have another 5 million addicted by leaving the flavors on the market.<\/p>\n<p>Because children like flavors.  We flavor medicines \u2014 amoxicillin in liquids in bubble-gum flavor \u2014 because it tastes good.  And medicine is good or children.  But e-cigarettes are not, so they should not have flavors.<\/p>\n<p>MS. KOVAL:  If I may, on the counterfeit issue: We know, actually, that many of these kids want to quit.  They need help quitting.  We asked kids, \u201cWhat would you do if all the flavors were taken off the market, including menthol?\u201d  Sixty percent \u2014 the number one answer was \u201cquit.\u201d<\/p>\n<p>We\u2019ve introduced a quit vaping program \u2014 use it on the phone.  Kids like to \u2014 they text in.  Since January, with almost no promotion, 60,000 kids have signed up for it.  These kids are angry.  They didn\u2019t sign up for this.  They thought it was all fun and flavors until \u2014<\/p>\n<p>THE PRESIDENT:  You mean they get addicted.  And they didn\u2019t know about that.  (Inaudible.)<\/p>\n<p>DR. HARRIS:  Thank you, Mr. President.  The American Medical Association commends you for the stance you took.  And I think you have an opportunity here to save a generation from addiction.  We know that the youth are attracted to these flavored cigarettes.<\/p>\n<p>And to those who argue that e-cigarettes are effective smoking cessation, the U.S. Preventative Services Task Force has not found the evidence.  They examined the evidence and have not found the evidence among adults that these products work for smoking cessation.  And if they had the evidence, then they should take it to the FDA, where we can evaluate \u2014 the FDA can evaluate and we can all make decisions based on science and the evidence.<\/p>\n<p>THE PRESIDENT:  Well, wouldn\u2019t you say it\u2019s a lesser problem than smoking cigarettes?  I mean, they say that \u2014 you know, the e-cigarettes, you stop smoking and that\u2019s better.  You don\u2019t think so, Sally?<\/p>\n<p>DR. GOZA:  No, sir.  Thank you, Mr. President.  No, it \u2014 nicotine addiction is not good.  It\u2019s bad for the children\u2019s brains.  It affects them with their attention.<\/p>\n<p>THE PRESIDENT:  So it\u2019s a similar thing?  Okay, how does that compare to, let\u2019s say, to normal smoking of cigarettes \u2014 what you\u2019re talking about?<\/p>\n<p>DR. GOZA:  Neither one are good.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. CONLEY:  They don\u2019t want to answer that question because they don\u2019t want to admit that if an adult smoker switches to vaping that they greatly benefit their health.  The Royal College of Physicians, Public Health England; even your own former commissioner, Scott Gottlieb, has stated, \u201csmokers who switch improve their health.\u201d<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. MYERS:  But the difference is (inaudible) that the kids who are using these products are not kids who are smokers and they\u2019re very often not kids who would have become smokers.  So that the measurement of the risk for this kids is \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. MYERS:  It is consistent with all of the government studies.  These are not our figures.<\/p>\n<p>THE PRESIDENT:  All right.  Tony, go ahead.<\/p>\n<p>MR. ABBOUD:  I\u2019m sorry, that\u2019s just not an accurate statistic.  It\u2019s less than 1 percent.  Most of the kids who have tried this product have already tried cigarettes or some other tobacco product.  These are kids that have at-risk behaviors.  And that is why, yes, we had to \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>SECRETARY AZAR:  I\u2019m sorry, but that is a completely false statement.<\/p>\n<p>SENATOR ROMNEY:  Utah is a Mormon state.  Utah is a Mormon state.  Half the kids in high school are vaping.  All right?  They wouldn\u2019t have used these products \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>THE PRESIDENT:  Go ahead.  Tell me about lungs.  Come on.  What do you think?<\/p>\n<p>MR. REEDY:  Well \u2014<\/p>\n<p>THE PRESIDENT:  Yeah.  Then we\u2019ll do that.  Go ahead.<\/p>\n<p>MR. REEDY:  Well, no.  I was going to say, you know, the American Cancer Society is an evidence-based organization like all of the public health groups in here.<\/p>\n<p>THE PRESIDENT:  Well, what is your public stance on this?<\/p>\n<p>MR. REEDY:  Our public \u2014<\/p>\n<p>THE PRESIDENT:  You say it\u2019s a \u201cnew modern-age problem\u201d that, five years ago, I guess \u2014 when did this really begin?<\/p>\n<p>PARTICIPANT:  About ten years.<\/p>\n<p>SECRETARY AZAR:  About two years ago \u2014<\/p>\n<p>THE PRESIDENT:  I mean, really \u2014 but, really two years ago \u2014<\/p>\n<p>SECRETARY AZAR:  \u2014 is when it exploded.<\/p>\n<p>THE PRESIDENT:  Go ahead.  Tell me what your stance is.<\/p>\n<p>MR. REEDY:  Our stance is very aligned with what you suggested on September the 11th.  We fully support that position to take all flavored e-cigarettes off of the market.  And it \u2014 I\u2019ll tell you \u2014<\/p>\n<p>THE PRESIDENT:  Regardless of age?<\/p>\n<p>MR. REEDY:  Yes, absolutely.<\/p>\n<p>THE PRESIDENT:  What about flavoring over 21 \u2014 no?<\/p>\n<p>MR. NIVAKOFF:  There\u2019s no way to do it.  Mr. President, again, the debate is not whether there is a virtue in youth using these products.  It\u2019s an epidemic of youth use.  Nobody disputes that in the industry.  It\u2019s a matter of \u2014 if we accept \u2014<\/p>\n<p>THE PRESIDENT:  But wouldn\u2019t they use it a lot less if they didn\u2019t have flavors?<\/p>\n<p>MR. NIVAKOFF:  Youth would.  They \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>THE PRESIDENT:  Then you get back to the counterfeits, still.  You still \u2014 you\u2019re always going to have that problem.<\/p>\n<p>MR. NIVAKOFF:  They would.  Then the counterfeit market would take place.  And if flavors didn\u2019t exist, their category, their entire industry would disappear.  Our business would be \u2014 would get severely damaged.<\/p>\n<p>THE PRESIDENT:  If what?  Disappear if what?<\/p>\n<p>MR. NIVAKOFF:  If flavors disappeared.  Youth use product \u2014<\/p>\n<p>THE PRESIDENT:  And yet the biggest company doesn\u2019t have flavors.<\/p>\n<p>MR. NIVAKOFF:  In 2000, 20 percent of American youth smoked cigarettes.<\/p>\n<p>THE PRESIDENT:  So why doesn\u2019t the biggest company \u2014<\/p>\n<p>MR. NIVAKOFF:  Cigarettes aren\u2019t flavored.<\/p>\n<p>THE PRESIDENT:  All right, I got it.  So, why doesn\u2019t the biggest company have flavors?<\/p>\n<p>MR. CONLEY:  Because they\u2019re playing a long-term goal.  I think they make an excellent product for adult smokers.  But they\u2019re long-term play is sit out, file applications with the FDA, let the small- and medium-sized businesses go the way of the dinosaurs, and then they can come back have 90 percent of the market.<\/p>\n<p>THE PRESIDENT:  Sounds like Rockefeller.  Rockefeller did that.<\/p>\n<p>MR. ABBOUD:  Well, we\u2019re talking about a 151,000 jobs.  An economic impact analysis that we just put out this morning from John Dunne &#038; Associates concluded that over 13,000 small businesses would close if you implement a flavor ban.  And 150 \u2014<\/p>\n<p>THE PRESIDENT:  A flavor ban?<\/p>\n<p>MR. ABBOUD:  Correct.  And if you would do that, it would also eliminate 151,000 \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>SENATOR ROMNEY:  That\u2019s just not \u2014 that\u2019s just not right.  That number is just not \u2014<\/p>\n<p>MR. ABBOUD:  Well, that\u2019s the analysis.<\/p>\n<p>SENATOR ROMNEY:  I\u2019m sorry, that\u2019s just not right.  I\u2019m sorry.<\/p>\n<p>MR. ABBOUD:  That is their economic \u2014<\/p>\n<p>SENATOR ROMNEY:  That\u2019s terrific.  I\u2019ve looked at the data.  And the data says there are approximately 10,000 vaping shops.  All right?  So, you\u2019ve got 10,000 shops.  Four employees \u2014 all right?  Four employees per.  All right?  Four full-time -equivalent employees per.  That\u2019s 40,000 employees.  It\u2019s not \u2014<\/p>\n<p>MR. ABBOUD:  You\u2019re leaving out the manufacturers and distributors.<\/p>\n<p>SENATOR ROMNEY:  Well, hold on.  The convenience stores \u2014 they sell a lot of products.  They\u2019re not going to go out of business because they don\u2019t have flavors.  All right.  So it\u2019s the vaping shops.  They\u2019re not all \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>SENATOR ROMNEY:  May I finish please?  So those \u2014 they\u2019re not all going to go out business because they can\u2019t sell flavors.  They\u2019re not all going to go out of business.  Some may.  That would be unfortunate, but some may.<\/p>\n<p>But don\u2019t \u2014 recognize, if there are 50,000 employees \u2014 full-time equivalents \u2014 at vaping shops, you\u2019ve got 5.5 million kids.  You\u2019re talking about 100 kids addicted for one employee, typically minimum wage.  I put the kids first.  All right?  It\u2019s a 100 \u2014 over 100 kids per full-time-equivalent employee.<\/p>\n<p>MR. ABBOUD:  But these are the shops \u2014 and this is the sector of the industry that has grown up to compete with cigarette companies.  You have a new industry that\u2019s competing, for the first time, for the cigarette smoker, trying to yank them off of that cigarette.  And so we have to do both things.  There is no reason we can\u2019t do both things in this country.<\/p>\n<p>But if you eliminate flavors, according to this report \u2014 because flavors make up about 85 to 90 percent of their sales \u2014<\/p>\n<p>THE PRESIDENT:  It\u2019ll destroy the business.<\/p>\n<p>MR. ABBOUD:  They will go out of business.  There is no question about that because no small-business owner could take that kind of hit to their revenue.<\/p>\n<p>THE PRESIDENT:  How does JUUL feel about that?  He is saying you\u2019re going out of business.  Basically, you\u2019re saying JUUL.<\/p>\n<p>MR. ABBOUD:  No.  No.  It\u2019s the small business.<\/p>\n<p>THE PRESIDENT:  Why is JUUL not going out of business if he doesn\u2019t do flavors?<\/p>\n<p>MR. ABBOUD:  They\u2019re the big guys.<\/p>\n<p>MR. CONLEY:  Investment capital.  They can wait it out.  They can wait a year, two years to go back to having the market share they have today.<\/p>\n<p>THE PRESIDENT:  So what\u2019s your game?<\/p>\n<p>MR. CROSTHWAITE:  Like I said earlier, I think this is a science-based evidence argument that we look forward to making.  We think preserving this opportunity for adult smokers who can\u2019t quit to have an option is really important work.  That\u2019s the mission of our company.<\/p>\n<p>SENATOR ROMNEY:  He\u2019s right.  He\u2019s right.<\/p>\n<p>MR. CROSTHWAITE:  This youth issue, we felt \u2014 and we were a part of it \u2014 we had to address it.  As a leader, we took the tough steps to change our portfolio.<\/p>\n<p>THE PRESIDENT:  So you really think flavors are very dangerous then, in terms of addiction and other things.<\/p>\n<p>MR. CROSTHWAITE:  I think flavors can play a role for adults to make a transition.  The issue is kids get access to the flavors.  The data supported it.  That\u2019s why we (inaudible).<\/p>\n<p>THE PRESIDENT:  So if you\u2019re out of it and if we take them out of it, who\u2019s going to take your place?<\/p>\n<p>(Cross-talk.)<\/p>\n<p>THE PRESIDENT:  Counterfeit.  Counterfeit.  No.  You\u2019re going to have counterfeiters and that gets dangerous, right?<\/p>\n<p>MR. MYERS:  Mr. President, I think what we\u2019ll see is, if that \u2014 first of all, we have not seen it grown \u2014 a growth in adults using these products, with the introduction of flavors.  So, there\u2019s a lot of myth going on here.<\/p>\n<p>If you look at the \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. MYERS:  Let me finish.  I did not interrupt you all with that.<\/p>\n<p>THE PRESIDENT:  It\u2019s a little difference, right?  Go on.<\/p>\n<p>MR. MYERS:  What you will have is: You will have companies who produce products that have tobacco flavor \u2014 which used to be the most the popular and may still be among adults, although not among kids.<\/p>\n<p>And then, second, what we\u2019re talking about here and what your proposal was: For the companies that then have data to show that they have a product, with or without a flavor, that actually promotes cessation and is doesn\u2019t unduly appeal to kids, can go to the Food and Drug Administration for the review.<\/p>\n<p>We\u2019re not talking about a permanent ban.  What we\u2019re talking about is making them develop the science, produce it to the agency that has the authority to review it, and then have a science-based decision made about what\u2019s in the public\u2019s interest.  And that\u2019s what we\u2019re really talking about.<\/p>\n<p>And what do you do in the interim?  If we do nothing in the interim, we\u2019re going to wake up six months from now, and another million and a half kids are going to be addicted, and they\u2019re not going to be able to quit.<\/p>\n<p>THE PRESIDENT:  So, let me ask you this: the concept of letting states make their own decision.  We talked about that the other day.  What about that?  A state.  We put a 21-limit on it because everyone seems to agree on that.  Right?  Do you agree on 21?<\/p>\n<p>PARTICIPANT: Absolutely.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>THE PRESIDENT:  You agree.  So, let\u2019s say, 21.  We put age limit: 21.  What about the concept of every state decides?<\/p>\n<p>MR. MYERS:  I think, nationwide, we need protection for our kids wherever they live.  And it shouldn\u2019t be that if you live in the state that doesn\u2019t address this issue, your children are at risk.  That\u2019s what worries me about this \u2014<\/p>\n<p>THE PRESIDENT:  And then they\u2019re going to go buy it and go back home.<\/p>\n<p>MR. MYERS:  And, you know, that\u2019s why \u2014 that\u2019s why FDA has this authority.  We have a governmental agency that has the authority to address the complicated questions that exist and put in place rules and make science-based decisions.<\/p>\n<p>MR. NIVAKOFF:  Every company in the country \u2014 every company in the country \u2014 including small vape shops, large companies, JUUL \u2014 has to do that by May of this year anyway.  And the FDA is under a statutory obligation to provide an answer within six months thereafter.<\/p>\n<p>So what we\u2019re really weighing is this near-term solution that\u2019s being proposed \u2014 and I value what Matt says and I value what Meredith says.  I have children.  I wouldn\u2019t want them using these products, too.  But are we \u2014 are we \u2014 we\u2019re valuing a six- to ten-month solution, where the FDA has to make the decision by December of next year anyway, versus 100,000 jobs.<\/p>\n<p>It\u2019s \u2014 by the way, for the record \u2014<\/p>\n<p>THE PRESIDENT:  But you know \u2014 you know it\u2019s going to be a much longer-term solution.  Yeah.  Go ahead.  Please.<\/p>\n<p>MS. BERKMAN:  So, Mr. President, I would just like to say: I understand this is an important conversation about jobs, but I\u2019m here because our group represents millions of families of moms all across this country, and dads across this country, and grandparents.  You can go to any state in this country and ask people with children; this is what people are worried about.<\/p>\n<p>THE PRESIDENT:  So what do you like as a solution?<\/p>\n<p>MS. BERKMAN:  So, I will tell you that this is a generation of children that would otherwise not have been initiated into to tobacco use.  And we know that because the youth-use figures were at the lowest they\u2019d ever been before JUUL came on the market with their patented nicotine salt technology, with huge amounts of nicotine going to the brain so quickly.  That\u2019s why the kids talk about the head rush.<\/p>\n<p>This addiction is severe addiction.  This is enormous amounts of nicotine \u2014 so much more than in combustible cigarettes.  And parents are terrified.<\/p>\n<p>We hear this every day from people all across the country, all walks of life \u2014 in cities, in suburbs, in the country.  And they feel like they\u2019ve lost their kids.  Straight-\u201cA\u201d students are flunking out of school.  Athletes \u2014 star athletes can\u2019t run a mile.<\/p>\n<p>And what I hear over and over \u2014 what we hear all the time is, \u201cI don\u2019t recognize my child.\u201d  The bouts of anger, the pain \u2014 parents are in pain.  And we need you.<\/p>\n<p>THE PRESIDENT:  So what are your \u2014 what is your solution?<\/p>\n<p>MS. BERKMAN:  I am \u2014 our solution is your solution.<\/p>\n<p>THE PRESIDENT:  I mean, your solution is just ban it, right?<\/p>\n<p>MS. BERKMAN:  No.  No.  Because we are not \u2014<\/p>\n<p>THE PRESIDENT:  No, no.  But if you had the real solution \u2014 just ban it, right?<\/p>\n<p>MS. BERKMAN:  No, that\u2019s not correct.<\/p>\n<p>THE PRESIDENT:  All right.  What\u2019s your solution?<\/p>\n<p>MS. BERKMAN:  My solution is what you had the right instinct for at the beginning, which is the flavors have hooked the kids.  So take the flavors \u2014 leave tobacco flavor for adults.<\/p>\n<p>THE PRESIDENT:  My original suggestion.<\/p>\n<p>MS. BERKMAN:  Your original suggestion \u2014<\/p>\n<p>THE PRESIDENT:  Go ahead.<\/p>\n<p>MS. BERKMAN:  \u2014 instinct was right.<\/p>\n<p>THE PRESIDENT:  Go ahead.<\/p>\n<p>MS. BERKMAN:  Leave tobacco \u2014 you know, we\u2019re not prohibitionists.  Leave tobacco flavor for adults.  Because, in the end \u2014 it\u2019s not there yet, but if the science ultimately proves that, \u201cYes, this is going to help people quit,\u201d then they should have that right.  We have no interest in telling adults what to do.<\/p>\n<p>THE PRESIDENT:  You don\u2019t think it does help people quit?<\/p>\n<p>MS. BERKMAN:  I don\u2019t think the science is there yet.  I think that we need more data.<\/p>\n<p>THE PRESIDENT:  A lot of people (inaudible) \u2014<\/p>\n<p>SECRETARY AZAR:  It\u2019s actually \u2014 I do want to clarify for everyone\u2019s benefit.  A lot of statements have been made about e-cigarettes and those as harm-reduction devices.  There has been no evidence presented to the FDA to that fact.  Any manufacturer who makes that claim will be enforced against.  And so, you may think there is that evidence.  That evidence does have to \u2014 that is exactly the process the Tobacco Control Act requires is bringing forth that evidence in the context of the pre-market authorization.<\/p>\n<p>THE PRESIDENT:  And we\u2019re doing that \u2014 we\u2019re doing that anyway, right?  We\u2019re doing that.<\/p>\n<p>SECRETARY AZAR:  That would be part of that process.<\/p>\n<p>THE PRESIDENT:  What do you think?<\/p>\n<p>MS. NANCE:  Mr. President, I \u2014 it\u2019s a little hard to take all of the virtue-signaling going on around, because you\u2019ve got to remember the history of this.  We all were excited that there was an opportunity \u2014 and, by the way, I come from Appalachia.  I came from \u2014 I come from blue-collar world.  My brother is a smoker.  I mean, like, I understand; it is a very addictive behavior.<\/p>\n<p>And it was exciting at the beginning to think, \u201cOh, look.  There\u2019s an opportunity for people to get off of tobacco.\u201d  But at that point, we were winning when it came with [to] kids.  The people who were buying their product were aging out.  Right?  They didn\u2019t have a generation coming up behind them until they came up with e-cigs.  And then, the truth is, they targeted kids.  They paid influencers on social media to make it look cool.  And suddenly, we had a youth problem again.<\/p>\n<p>And, by the way, many of these same people are in cahoots with the marijuana industry and the tobacco industry.<\/p>\n<p>So we get money from nobody.  We just care about the kids.<\/p>\n<p>THE PRESIDENT:  So what do you like as a solution?<\/p>\n<p>MS. NANCE:  I like you original solution.  I think we ban all flavors, I think we take it to 21, and we ban advertising.<\/p>\n<p>And you can say \u2014 what you said \u2014 your point earlier was correct.  There\u2019s always \u2014 when you make something illegal, there\u2019s always the black market.  We could say that about anything.  We could say it about heroin, right?  We could make it legal.  We could say that about opioids \u2014 that we could just sell it to whoever wants it.  There\u2019s always going to be something illegal.<\/p>\n<p>THE PRESIDENT:  Yeah.<\/p>\n<p>MS. NANCE:  So, I don\u2019t know if that works.<\/p>\n<p>THE PRESIDENT:  All right.  Good.  Thank you.<\/p>\n<p>Go ahead.<\/p>\n<p>MR. WIMMER:  Mr. President, I\u2019m from the American Lung Association.  And I certainly want to echo our public health partners, but, on a day-to-day basis, the number-one concern that we hear from our communities, from parents, from schools is that \u2014 how do we really address this epidemic that we\u2019re facing?<\/p>\n<p>So all of us are looking to you \u2014 your leadership role \u2014 in terms of really helping to create the next generation that\u2019s going to be free of addiction.<\/p>\n<p>THE PRESIDENT:  From American Lung, what is your recommended solution?<\/p>\n<p>MR. WIMMER:  It is to ban all flavors \u2014<\/p>\n<p>THE PRESIDENT:  All flavors.<\/p>\n<p>MR. WIMMER:  \u2014 including menthol.<\/p>\n<p>THE PRESIDENT:  In other words \u2014 including menthol?<\/p>\n<p>MR. WIMMER:  Mint and menthol.<\/p>\n<p>THE PRESIDENT:  That\u2019s a big \u2014 that\u2019s a big statement.<\/p>\n<p>PARTICIPANT:  Mr. President \u2014<\/p>\n<p>THE PRESIDENT:  That\u2019s a very big statement though, right?<\/p>\n<p>MR. REEDY:  And the American Cancer Society absolutely agrees with that.<\/p>\n<p>MR. WIMMER:  I mean, it\u2019s certainly an important step, Mr. President.  But it\u2019s one that you were putting out, in September, as \u2014 so.<\/p>\n<p>MR. CONLEY:  These groups have 160 million reasons from Michael Bloomberg to not come to the table and compromise on anything \u2014 $160 million to Michael Bloomberg.  Across from you.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MS. BERKMAN:  (Inaudible) volunteer parents around the country.  We are parent advocates, volunteers \u2014 because parents are in pain.<\/p>\n<p>I sat at a table, just on Monday, with 13 families from the state of Massachusetts.  Everyone\u2019s story was individual to them, but also the same.  People who said their kids were no longer recognizable.  Their kids couldn\u2019t focus in school.  Their kids were having trouble breathing.  Their kids were angry.<\/p>\n<p>This is not a small thing.  This kind of nicotine addiction, at these levels \u2014 people are in pain.  And parents across this country \u2014 all parents \u2014 care.  And we know that you care.<\/p>\n<p>THE PRESIDENT:  So you want to ban all flavors?<\/p>\n<p>MS. BERKMAN:  We want to ban all flavors \u2014<\/p>\n<p>THE PRESIDENT:  Including menthol?<\/p>\n<p>MS. BERKMAN:  \u2014 including menthol and mint.  Because, as was said earlier, that \u2014 if you get rid of \u2014 if you get rid of just the mint, the kids will go to menthol.  The kids are addicted.  Only now, when kids are frightened, do they understand they\u2019re not in control.<\/p>\n<p>And to the point about the predatory behavior, the reason that we started our group is because our sons came home from school one day, in 2018, and said there was a mixed-message presentation about JUULing, and that, in their school, with no other adults in the room, someone who came from an anti- \u2014 an outside, anti-addiction group \u2014 but, in the end, turned out to have been a JUUL representative \u2014 told the kids that JUULing was not for kids, but was totally safe, and that it would receive FDA approval any moment.  And both those statements were, and remain, untrue.<\/p>\n<p>And that\u2019s why a group of moms started doing their own research, and understood that this was an epidemic of enormous proportion, and, as you said earlier, that the kids were targeted.<\/p>\n<p>These are not \u2014 this is not about risk-taking kids.  This affects all families, all kids.  There are 5 million kids doing this.  That means there are millions of families who are in pain, and that they need you to save our generation of kids.<\/p>\n<p>THE PRESIDENT:  So how many children will do it if you get rid of the flavors?<\/p>\n<p>MS. BERKMAN:  I\u2019m sorry, I didn\u2019t hear that.<\/p>\n<p>MS. KOVAL:  97 percent use flavors.<\/p>\n<p>THE PRESIDENT:  How many children will do it?  Let\u2019s say you don\u2019t have flavors.<\/p>\n<p>MS. BERKMAN:  Okay, so right \u2014<\/p>\n<p>THE PRESIDENT:  So, now you have 5 million.  How many children will do it if you don\u2019t have flavors?<\/p>\n<p>MS. BERKMAN:  Well, so, here\u2019s the thing: 97 percent of kids who are vaping are using flavored vapes.  So it is \u2014 you know, it is \u2014<\/p>\n<p>THE PRESIDENT:  Do you agree with it?<\/p>\n<p>PARTICIPANT:  Youth numbers are certainly indicating that kids are getting access to flavors.<\/p>\n<p>MS. BERKMAN:  Well, it\u2019s a C- \u2014 it came from the CDC.<\/p>\n<p>MS. KOVAL:  It came from the CDC data.  It\u2019s 97 percent (inaudible).<\/p>\n<p>MS. BERKMAN:  It came from the government.  So it\u2019s 97 percent.  Really, what we\u2019re talking about it \u2014<\/p>\n<p>THE PRESIDENT:  Will they put their own flavors in?  Let\u2019s say you can\u2019t get flavors.  Are they going to inject it with flavor?  Will they put their own flavors in?<\/p>\n<p>SENATOR ROMNEY:  You can\u2019t.<\/p>\n<p>MR. CROSTHWAITE:  Our product is a single-use \u2014<\/p>\n<p>THE PRESIDENT:  You can\u2019t do it?<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. BUTLER:  I think it\u2019s worth pointing out that 100 percent of the deaths are the result of counterfeit \u2014 of counterfeit products.<\/p>\n<p>SENATOR ROMNEY:  That\u2019s a different issue.<\/p>\n<p>MR. BUTLER:  But I think it\u2019s worth pointing out.<\/p>\n<p>SENATOR ROMNEY:  Yeah, that\u2019s a different issue, but it\u2019s important.  It\u2019s an important issue.<\/p>\n<p>THE PRESIDENT:  It\u2019s an important issue, though.<\/p>\n<p>In other words \u2014 because I\u2019ve been reading about a lot of death.  And the death, really, is from counterfeit, right?<\/p>\n<p>SENATOR ROMNEY:  Right.<\/p>\n<p>THE PRESIDENT:  It\u2019s not from JUUL; it\u2019s not from you.<\/p>\n<p>SECRETARY AZAR:  From using marijuana, not (inaudible).<\/p>\n<p>THE PRESIDENT:  Yeah, it\u2019s also using other things with it.<\/p>\n<p>PARTICIPANT:  It\u2019s cannabis products.  It\u2019s not nicotine products; it\u2019s cannabis products.<\/p>\n<p>THE PRESIDENT:  That\u2019s another discussion.  That\u2019s another discussion.<\/p>\n<p>MR. MYERS:  Although CDC has also been careful to say that they\u2019re not 100 percent sure that that\u2019s the only cause.  There may be multiple causes out there.  So I think that\u2019s important to (inaudible).<\/p>\n<p>THE PRESIDENT:  Yeah.  But it seems to be \u2014 it seems to be counterfeit.<\/p>\n<p>MR. NIVAKOFF:  We\u2019ve already done a trial period.  JUUL took popular flavor in the world off of the market on November 13th.<\/p>\n<p>THE PRESIDENT:  What was the most popular?<\/p>\n<p>MR. NIVAKOFF:  Mango.  JUUL Mango.<\/p>\n<p>THE PRESIDENT:  (Inaudible) most popular.<\/p>\n<p>MR. NIVAKOFF:  November 13th, 2018.  And youth use has increased.  It\u2019s \u2014 yes.  Flavors are a conduit.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. NIVAKOFF:  Flavors taste better than tobacco.<\/p>\n<p>THE PRESIDENT:  So when JUUL took it off \u2014 you had all flavors.  You took it off.  What\u2019s your business now, compared to what it was when you had flavors?<\/p>\n<p>MR. NIVAKOFF:  It\u2019s three times bigger.<\/p>\n<p>MS. KOVAL:  Mr. President, here is \u2014<\/p>\n<p>THE PRESIDENT:  You \u2014 has your business gotten bigger?<\/p>\n<p>MR. CROSTHEWAITE:  Business grew, but we recently took mint off the market, which was 70 percent of our business.  So \u2014<\/p>\n<p>THE PRESIDENT:  So your business grew even without the flavor?<\/p>\n<p>MR. CROSTHEWAITE:  It grew without \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>SECRETARY AZAR:  They went from mango to mint.<\/p>\n<p>MR. CROSTHEWAITE:  Look \u2014 yes, very recently we took it off.  Very recently.  We don\u2019t know yet.  We just \u2014 we just took \u2014<\/p>\n<p>MR. NIVAKOFF:  Nobody is disputing children like \u2014 youth prefer flavors.  So do adults.  Ninety-three percent of adults use flavors as well.  That\u2019s not the point.<\/p>\n<p>Here\u2019s the point, Mr. President:  There are four companies \u2014<\/p>\n<p>THE PRESIDENT:  (Inaudible.)<\/p>\n<p>MR. NIVAKOFF:  There are four companies that will remain standing if you ban flavors.<\/p>\n<p>THE PRESIDENT:  Go ahead.<\/p>\n<p>MR. NIVAKOFF:  JUUL, NJOY, Reynolds, and Imperial Tobacco, which owns Blu.  Every other small \u2014 it\u2019s not bad for my business for you to ban flavors; it centralizes an oligopoly for me and three other brands that exist on shelves in 153,000 convenient stores.<\/p>\n<p>I\u2019m not arguing for the bottom line of my company.<\/p>\n<p>THE PRESIDENT:  So why are you fighting for flavors?<\/p>\n<p>MR. NIVAKOFF:  Because adults \u2014 just like flavors help as a conduit for kids to use it, it\u2019s a conduit for adults to switch from tobacco \u2014 which tastes terrible \u2014 and use the vapor product.<\/p>\n<p>And I believe \u2014 I\u2019m not speaking as a representative of the company making a cessation claim \u2014 that if I was an adult smoker or if my daughter, God forbid, was an adult smoker, I would prefer her to use a vapor product.  And if that vapor product was flavored and it gave her a seven-times greater chance of making the switch from combustible cigarettes \u2014 to me, as an individual, not as a representative of my company, that is a public-health virtue.<\/p>\n<p>Nobody is \u2014<\/p>\n<p>MS. BERKMAN:  But your daughter is six.  Let\u2019s \u2014<\/p>\n<p>MR. NIVAKOFF:  Yeah, my daughter is six, but it doesn\u2019t matter.<\/p>\n<p>MS. BERKMAN:  Your daughter is six.<\/p>\n<p>MR. NIVAKOFF:  If your child smoked Marlboro\u2019s, you would give your child a JUUL.  I guarantee it.<\/p>\n<p>MS. BERKMAN:  No, no, no.  Your daughter is six.<\/p>\n<p>MR. NIVAKOFF:  I guarantee it.<\/p>\n<p>MS. BERKMAN:  And so, God forbid she should ever use any tobacco product \u2014 God forbid.  And I mean that sincerely.<\/p>\n<p>MR. NIVAKOFF:  (Inaudible.)<\/p>\n<p>MS. BERKMAN:  But that\u2019s not what we\u2019re talking about.  We\u2019re talking about 5 million kids who are currently using these flavored vapes.<\/p>\n<p>MR. NIVAKOFF:  Not currently using.  Five million is a misrepresentation.  And I\u2019m not trying to trivialize \u2014<\/p>\n<p>MS. BERKMAN:  So the CDC\u2019s numbers are a misrepresentation?<\/p>\n<p>MR. NIVAKOFF:  No.  \u201cFive million\u201d is \u201cever tried.\u201d<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MS. HARRIS:  (Inaudible.)  have reported using in the last 30 days.<\/p>\n<p>MR. NIVAKOFF:  No, it\u2019s not.  Five million is not \u2014<\/p>\n<p>MR. LEROY:  So what is the number?  What is the number if it\u2019s not \u2014<\/p>\n<p>MS. BERKMAN:  What is \u2014 if it\u2019s not what the CDC says \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>THE PRESIDENT:  What percentage of your business is e-cigarette?<\/p>\n<p>MR. CROSTHEWAITE:  The vapors.  The vaping \u2014 the vape shops.<\/p>\n<p>THE PRESIDENT:  Oh, the vape \u2014<\/p>\n<p>MR. CROSTHEWAITE:  The vape shops.<\/p>\n<p>MR. CONLEY:  One hundred percent.<\/p>\n<p>SECRETARY AZAR:  Are e-cigarettes \u2014 nicotine e-cigarettes.  Not THC, not CBD \u2014 nicotine-delivery \u2014 nicotine-delivery devices.  What percent of your revenue?<\/p>\n<p>MR. ABBOUD:  85.7 to 90 percent.<\/p>\n<p>SECRETARY AZAR:  And what percent are cartridge versus open tank or non- \u2014 sort of the non-USP-type cartridges?<\/p>\n<p>MR. ABBOUD:  They have a mix.  But the \u2014 at vape shops, it\u2019s primarily the open systems.  They do sell closed systems as well.<\/p>\n<p>SECRETARY AZAR:  But mostly \u2014 it\u2019s mostly the open systems and the mix and the \u2014 but not the cartridges?<\/p>\n<p>MR. ABBOUD:  No, no, no \u2014 I\u2019m not sure what the mix is.<\/p>\n<p>SECRETARY AZAR:  They\u2019re not \u2014 where you would homebrew it.  Homebrew \u2014 sort of mix and \u2014<\/p>\n<p>MR. ABBOUD:  That\u2019s not \u2014 that\u2019s not homebrew.  As you know, all of the e-liquids that are being sold in vape shops have already been registered with the FDA, with their ingredients already on file with the FDA.  And those \u2014 those ingredients haven\u2019t been able to change for the last three years, since the deeming regulation went into effect.<\/p>\n<p>SECRETARY AZAR:  But what percent are cartridge-based, nicotine-delivery devices, like NJOY or JUUL, of your revenue?<\/p>\n<p>MR. ABBOUD:  I don\u2019t have the number for it.  I can get that for you, but \u2014<\/p>\n<p>SECRETARY AZAR:  Okay.  So would they go out \u2014 would your shops go out of business \u2014<\/p>\n<p>MR. ABBOUD:  Most certainly.<\/p>\n<p>SECRETARY AZAR:  \u2014 based on cartridge \u2014 flavored-cartridge products.<\/p>\n<p>MR. ABBOUD:  If you want to sell just flavored-cartridge products, then you are \u2014 then you are literally cutting off the entire \u2014 entire industry \u2014 the vape-shop industry.<\/p>\n<p>SECRETARY AZAR:  Well, no, I\u2019m sorry \u2014 no, the \u2014 you just said \u2014 you just said you don\u2019t know what percent of vape shops\u2019 business is flavor cartridges.<\/p>\n<p>MR. ABBOUD:  Well, I don\u2019t know the \u2014<\/p>\n<p>PARTICIPANT:  It\u2019s a small percentage.<\/p>\n<p>MR. ABBOUD:  I don\u2019t know the exact number \u2014<\/p>\n<p>(Cross-talk.)<\/p>\n<p>MR. ABBOUD:  It is a small percentage.<\/p>\n<p>PARTICIPANT:  Just say that.  Just say it\u2019s a small percentage.<\/p>\n<p>MR. NIVAKOFF:  Both systems are very rarely \u2014 both systems are infrequently sold in vape shops.<\/p>\n<p>SECRETARY AZAR:  Right.  Right.<\/p>\n<p>THE PRESIDENT:  Thank you very much, everybody.  Thank you very much.  Thank you.<\/p>\n<p>Q    Will you sign the Hong Kong bill, Mr. President?<\/p>\n<p>THE PRESIDENT:  It\u2019s being sent over.  We\u2019re going to take a very good look at it.  Okay?  Thank you.<\/p>\n<p>Thank you very much, everybody.  Thank you.<\/p>\n<p>(Cross-talk.)<\/p>\n<p>Q    On vaping, sir: Does your initial instinct from \u2014 does your initial instinct of September 11th \u2014 is that still your position today?<\/p>\n<p>THE PRESIDENT:  We\u2019re going to be announcing very soon.  We did have an instinct but we\u2019ll be announcing.  And we\u2019re going to continue this meeting for a little while.<\/p>\n<p>Q    Do you know which way you\u2019re leaning, Mr. President, on this issue?<\/p>\n<p>THE PRESIDENT:  It\u2019s going to be very interesting.  We\u2019ll let you know pretty soon.<\/p>\n<p>SENATOR ROMNEY:  It\u2019s interesting: All the public health people have the same point of view.  All the \u2014<\/p>\n<p>Q    Are you concerned about (inaudible)?<\/p>\n<p>THE PRESIDENT:  We want to \u2014 we want to take care of our kids.  We\u2019ve got to take care of our kids.<\/p>\n<p>Thank you very much, everybody.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Washington, DC&#8230;I\u2019m Dr. Sally Goza. I\u2019m a pediatrician from Fayetteville, Georgia. And I\u2019m President-elect of the American Academy of Pediatrics. And thank you so much. The children are counting on us. THE PRESIDENT: Good. Thank you very much. MR. BUTLER: Hi, I\u2019m Christopher Butler. I\u2019m Executive Director of Americans for Tax Reform. Thank you so [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":91293,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_cbd_carousel_blocks":"[]","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[20,5,33,4,1],"tags":[],"class_list":["post-91291","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-featured","category-government","category-health-fitness","category-life-style","category-news","last_archivepost"],"jetpack_featured_media_url":"https:\/\/new.thepinetree.net\/wp-content\/uploads\/2019\/11\/Fullscreen-capture-11242019-102920-AM.jpg","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts\/91291","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=91291"}],"version-history":[{"count":0,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts\/91291\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/media\/91293"}],"wp:attachment":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=91291"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=91291"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=91291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}