Iowa Doctor: Flavored Vapes Fueling Pediatric ICU Crisis, Lawmakers Must Act
A University of Iowa pediatrician is sounding the alarm on a growing crisis inside Iowa's hospital rooms: the candy-scented grip of flavored e-cigarettes on the state's teenagers. Dr. Karl McNamara, a resident physician-scientist at the UI Stead Family Children's Hospital, says the overwhelming majority of young vapers are using products designed to taste like fruit, candy, and dessert — a business model he calls a direct threat to children's health.
In a stark op-ed, McNamara describes walking into a pediatric ICU to find a teenager in a life-threatening asthma crisis. The room smelled of artificial blue raspberry and cotton candy. Her chest had gone silent. That silence, he explains, is what status asthmaticus sounds like. And the candy-shop smell told him exactly what had helped put her there.
What is driving the youth vaping crisis in Iowa?
McNamara, who trained in Ireland and Canada before coming to Iowa, says nothing prepared him for the grip flavored e-cigarettes hold on the teenagers he now cares for. The devices hide airway irritants and highly addictive nicotine behind neon packaging and flavors engineered for customers who are not yet old enough to buy them. He calls it a deliberate business model, not an accident of taste.
Iowa lawmakers have acknowledged the problem. This past session, the Legislature passed a nickel-per-milliliter tax on vape products, with revenue directed to pediatric cancer research at the University of Iowa. While McNamara welcomes the research funding, he says legislators on both sides of the aisle admitted on the floor what every pediatrician already knows: a nickel will not deter a single teenager. Some called the bill an industry-friendly substitute for real action. They were right.
Why has Iowa's flavored vape registry been blocked?
The state's other attempt at regulation, a registry law that would have pulled most unauthorized flavored products from shelves, sits blocked in federal court. But McNamara points out that in blocking the registry, the court affirmed that states retain full authority to regulate tobacco sales directly, including restricting flavored products. The legally durable path, he argues, has been in front of Iowa the whole time. The state has simply not taken it.
McNamara acknowledges the objections. Some adults use flavored vapes to quit smoking, and vape retailers worry about their businesses. But he pushes back: an adult trying to quit cigarettes does not need cotton candy to do it, and no legitimate business model should depend on products whose flavor profiles read like a candy aisle. Several states have already restricted flavored nicotine products. Meanwhile, Iowa's emergency departments are seeing teenagers who cannot breathe.
What should Iowa lawmakers do in January?
When the Legislature convenes in January, McNamara says it should do two things. First, restrict the sale of flavored nicotine products. Second, raise the vape tax from a nickel to a level that actually deters a 15-year-old with lawn-mowing money. He calls the current approach an irony: pediatric cancer research funded by pediatric nicotine addiction is not a health policy.
McNamara chose to train in Iowa and intends to spend his career caring for children's hearts. The lungs and the heart share one circulation and one fate, he says. Our children's share of both should be filled with air, not the candy-scented clouds of a preventable emergency.
Dr. Karl McNamara is a pediatric resident physician-scientist at the University of Iowa Stead Family Children's Hospital, where his research focuses on children's heart disease. He writes and advocates on child health policy. These views are his own and do not represent the university or hospital.