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A RARE APPROACH

BioNews Services’ unique, patient-focused model developed over years of testing and evolving as a biotech and health publisher. After coming to recognize the unmet needs that rare disease patient populations face online in accessing fresh, accurate, authoritative content on a daily basis, we switched from an industry-facing model to a patient-facing approach, launching niche, disease-specific news websites that cover one rare disease. By writing news and other digital content with only the patient and caregiver in mind, we are able to meaningfully connect with online patient communities on a daily basis.

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"Hey, Charlie" app supports those struggling with opioids A novel use of social media

 A smartphone app developed by MIT alumna Emily Lindemer uses social contacts and location information to give recovering opioid addicts gentle reminders about how to stay clean.

In the spring of 2016, while Emily Lindemer was working toward her PhD at MIT, she was also struggling with something closer to home: watching someone she knew well fall in and out of recovery from opioid addiction.

Like many people in recovery, Lindemer’s friend had his ups and downs. There were promising periods of sobriety followed by relapses into old habits. As the months went by, Lindemer began to see patterns.

For example, when he lost his driver's license — a common occurrence for people struggling with substance abuse who have run-ins with police — he had to call his friends to give him rides to work. If the friends he called for a lift were also people he used drugs with, Lindemer says, he’d relapse within a week.

“His relapses were predictable almost to a T, just based on the people he was associating with — who he was talking to, calling, texting, and hanging out with,” she says.

This realization turned out to be an inspiration. What if, she thought, there was a way to provide gentle moments of pause to people struggling with substance-abuse disorders? And what if those reminders could come through a smartphone application that monitors users’ contacts, location, and behaviors — and, using the information it gathers, offers encouragement when they are communicating with risky people or when they’re near a trigger area?

Lindemer, then a PhD student in the Harvard-MIT Health Sciences and Technology program, formed a team, which started thinking through the basics of what would become an app called Hey, Charlie. She knew of dozens of existing apps to help people in recovery. Some, like MySoberLife, offer simple lifestyle tracking services. Others, like reSET, are prescription-only and share patients’ responses to questionnaires with doctors. But none addressed the primary trigger Lindemer saw for relapses: social contacts.

Lindemer and her team participated in MIT Hacking Medicine, a worldwide event in which people have a short time to come up with solutions to health care-related problems. They emerged from that experience with sharper ideas, and with a clear sense that they would need funding and more advice. So Lindemer applied to the MIT Sandbox Innovation Fund, a program that provides seed funding for students’ ideas. The team received $25,000 and was connected to mentors with relevant experience. Lindemer and her team streamlined the application and designed a business model, and recently they ran a successful usability pilot.

The Hey, Charlie app works on several levels. When someone downloads it, it prompts them to enter general information about a few of their contacts, including questions that might prove helpful on the road to recovery, for example: “How often does this person express doubt about your ability to continue your recovery process?”

“They are objective questions, not subjective, and they aren't stigmatizing,” Lindemer says. “They do not ask the person in recovery to incriminate anybody. We try to figure out things like, is this a person that even knows that you are struggling with substance abuse disorder? Is this a person who contributes to stress levels in your life? Or is this the type of person who encourages your sobriety?”

The app also asks new users for a unique set of spatial information. Where are the areas of their city or region that could be triggers for users — locations where they bought drugs, or where their friends who use drugs are living? The app's users identify a particular point and then drag a wider circle depending on the size of the area. As they users go about their day, if they approach a place they have identified as risk-related, the app sends a notification: “Hey, I know you’re near a risky area. You can do this.”

Even when users aren’t engaged with the app, Hey, Charlie collects data on their activity and interactions — very, very securely, says Lindemer.

“Anything that gets sent into the cloud for Hey, Charlie is encrypted,” she says. “What we get is anonymized communication data. So we might know this user is talking to five unique risky people, but we have no idea who those risky people are, what their phone numbers are, or anything. It’s not the specific people and places that are necessarily important. It is the volume of communication with people that are helpful versus unhelpful.”

Christopher Shanaha, the director of Hey, Charlie’s recent usability pilot at Boston Medical Center and Mattapan Community Center says the app’s nudges can help patients stay engaged with their recovery when they’re outside of the clinic.

“As clinicians we only see patients in the clinic 15 or 20 minutes a week, and yet patients have to live 24 hours a day and deal with their addictions all of the time,” Shanahan says. “This is one small way to support our patients in those interim time periods.”

During the pilot, which tracked 24 people using the app over the course of the month, Shanahan says he was surprised at how enthusiastic the responses were — users felt positively toward the app and indicated they would use it again in the future.

Michael Barros, an advisor on Hey, Charlie’s user interface who has been in recovery for heroin addiction, told Lindemer that many treatment facilities are run using old methods that are often ineffective.

“One of the most interesting thing about Hey, Charlie is having PhDs like Emily working to bring some science into a part of medicine that is still running on pen, paper, and hunches about what worked for people in the past,” Barros says. “The data that can be collected with an app like Hey, Charlie is badly needed.”

contact . https://twitter.com/EmilyLindemer

"Hey, Charlie" app supports those struggling with opioids | MIT News:

Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model

Calvin Brown doesn’t have a primary care doctor — and the peripatetic 23-year-old doesn’t want one.

Since his graduation last year from the University of San Diego, Brown has held a series of jobs that have taken him to several California cities. “As a young person in a nomadic state,” Brown said, he prefers finding a walk-in clinic on the rare occasions when he’s sick.

“The whole ‘going to the doctor’ phenomenon is something that’s fading away from our generation,” said Brown, who now lives in Daly City outside San Francisco. “It means getting in a car [and] going to a waiting room.” In his view, urgent care, which costs him about $40 per visit, is more convenient — “like speed dating. Services are rendered in a quick manner.”

Brown’s views appear to be shared by many millennials, the 83 million Americans born between 1981 and 1996 who constitute the nation’s biggest generation. Their preferences — for convenience, fast service, connectivity and price transparency — are upending the time-honored model of office-based primary care.

Many young adults are turning to a fast-growing constellation of alternatives: retail clinics carved out of drugstores or big-box retail outlets, free-standing urgent care centers that tout evening and weekend hours, and online telemedicine sites that offer virtual visits without having to leave home. Unlike doctors’ offices, where charges are often opaque and disclosed only after services are rendered, many clinics and telemedicine sites post their prices.

A national poll of 1,200 randomly selected adults conducted in July by the Kaiser Family Foundation for this story found that 26 percent said they did not have a primary care pr
ovider. There was a pronounced difference among age groups: 45 percent of 18- to 29-year-olds had no primary care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50 to 64 and 12 percent age 65 and older. (Kaiser Health News is an editorially independent program of the foundation.)

A 2017 survey by the Employee Benefit Research Institute, a Washington think tank, and Greenwald and Associates yielded similar results: 33 percent of millennials did not have a regular doctor, compared with 15 percent of those age 50 to 64.

“There is a generational shift,” said Dr. Ateev Mehrotra, an internist and associate professor in the Department of Health Care Policy at Harvard Medical School. “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives,” from shopping to online banking.

So is speed. Younger patients, Mehrotra noted, are unwilling to wait a few days to see a doctor for an acute problem, a situation that used to be routine. “Now,” Mehrotra said, “people say, ‘That’s crazy, why would I wait that long?'”

Until recently, the after-hours alternative to a doctor’s office for treatment of a strep throat or other acute problem was a hospital emergency room, which usually meant a long wait and a big bill.

Luring Millennials

For decades, primary care physicians have been the doctors with whom patients had the closest relationship, a bond that can last years. An internist, family physician, geriatrician or general practitioner traditionally served as a trusted adviser who coordinated care, ordered tests, helped sort out treatment options and made referrals to specialists.



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Viagra no more: The changing face of drug ads on TV

What happened to those TV ads for Viagra and Cialis?

There's a reason the Trump administration wants to require drugmakers to include list prices in advertisements for prescription medicines on TV: It's where the money is.

In recent years, direct-to-consumer advertising has touted to consumers prescription medicines for relatively common ailments like high cholesterol or impotence. Think Lipitor (atorvastatin) or Viagra (sildenafil). While pharma has never liked the idea of price disclosure, the cost of drugs previously most familiar to the American public are nowhere near the cost of the most commonly advertised products today.

Patent expirations, along with the rise of specialty drugs and biologics, have shifted the line-up of drugs consumers are likely to see hawked on TV.

In 2018, a traditional 60-second spot is likely to come from one of a handful of large pharmas and feature a specialty medicine approved for sale in the past five years. Gone are the twin bathtubs and little blue pills, replaced instead with promotions for new psoriasis biologics and cancer drugs.

Spending, though, remains high. Through the first nine months of this year, pharma companies have spent more than $2.8 billion on TV drug ads, up from around $2.5 billion through the same time period last year, according to analytics firm iSpot.tv.

Here are five common themes among the top ranks of pharma TV advertising:

A handful of drugmakers account for the lion's share of drug ads on TV

In proposing to mandate inclusion of prices in drugs ads last week, the Department of Health and Human Services estimated its rule would affect roughly 25 drugmakers that air about 300 commercials a quarter.

Data from iSpot.tv, though, shows that the number of pharma companies putting up serious money on television drug ads is an even narrower group.

Spending by Pfizer, Eli Lilly, AbbVie and Bristol-Myers Squib, for example, represented about 40% of the $2.81 billion spent on TV drug ads through the first nine months of 2018, according to an analysis of iSpot.tv numbers

AbbVie's investment in promoting its blockbuster drug Humira (adalimumab) made up 8.5% of the total just by itself.

Top 5 spenders on TV drug ads, first nine months of 2018

Company	TV ad spending for top drugs	Drugs advertised	Number of ad spots
Pfizer	$481 million	Lyrica, Xeljanz, Ibrance and Eucrisa	24
Eli Lilly	$318 million	Trulicity, Jardiance, Taltz and Verzenio	15
AbbVie	$236 million	Humira	15
J&J	$113 million	Xarelto	4
Celgene	$104 million	Otezla	2

Note: Pfizer's figures above don't include Eliquis, which it co-promotes with Bristol-Myers Squibb SOURCE:Data from iSpot.tv

Viagra no more: The changing face of drug ads on TV | Healthcare Dive: Healthcare

The Food We Eat

Food is more than nourishment. It's a source of pleasure — and guilt — and an agent of change. This episode, TED speakers explore our deep connection to food, and where it's headed.

This, from NPR

 

TED Radio Hour : NPR

Follow along and learn how we arrived at this place in the foods we eat, where we are guided by economics and marketing, 

Sanofi Genzyme, PerkinElmer to offer no-cost DNA testing for lysosomal storage disorders

Sanofi Genzyme and PerkinElmer Genomics have launched a free genetic testing program that aims to spot certain undiagnosed lysosomal storage disorders, while raising awareness of the group of rare diseases whose symptoms may initially be ascribed to more common ailments.

The Lantern Project will provide no-cost comprehensive diagnostic services and DNA-based blood testing in the U.S., targeting the tens of thousands of people that the companies estimate go undiagnosed for years at a time—with the goal of getting patients on-treatment faster and creating a larger market for rare disease drugs.

The project will begin with screening for Gaucher, Fabry and Pompe disease, as well as mucopolysaccharidosis type I and acid sphingomyelinase deficiency, which also known as Niemann-Pick disease.

Some underlying lysosomal storage disorders can take over 10 years and as different physicians before a proper diagnosis, with symptoms presenting as common diseases. (Darwin Laganzon)

It will also offer an enzyme panel for seven mucopolysaccharidoses, and a 105-gene next-generation sequencing panel for limb-girdle muscular dystrophies and other myopathies, in addition to diseases that may cause similar symptoms such as Pompe disease and spinal muscular atrophy.

"While we have seen many significant advances in research over the past 30-plus years, there are still tremendous challenges in helping patients get a diagnosis for many rare diseases,” said Sarah Gonzalez, head of medical diagnostics at Sanofi Genzyme.

For example, proper diagnoses of Gaucher disease can take 10 years or more, while late-onset Pompe disease—with symptoms including impaired cough, difficulty swallowing and persistent chest infections—can take an average of 16 years from symptom onset to the patient seeking treatment, according to Sanofi Genzyme.

Lysosomal storage disorders are inherited diseases resulting from defects in the enzymes that govern metabolic processes, such as the breakdown of large molecules within cells. These waste molecules accumulate, disrupt cell function and can lead to progressive organ damage. They can be frequently misdiagnosed, with a range of symptoms and disease progression from early childhood to late adulthood.

RELATED: Enzyvant and PerkinElmer to develop gene test for ultrarare Farber disease

The two companies hope genetic testing can help confirm diagnoses and advance patients to treatment faster. Sanofi Genzyme’s investigational pipeline includes olipudase alfa, which has received a breakthrough designation in acid sphingomyelinase deficiency and is in a phase 2/3 trial—as well as venglustat, which is being studied in Gaucher, Fabry and Parkinson’s disease, in addition to autosomal dominant polycystic kidney disease. Sanofi Genzyme also received approval for Lumizyme in Pompe disease.

Meanwhile, PerkinElmer teamed up with Roivant Sciences’ rare disease arm Enzyvant, to develop a genetic test for Farber disease that has fewer than 100 confirmed cases worldwide, according to the National Institutes of Health. The test aims to create a wider market for Enzyvant’s enzyme replacement therapy currently in preclinical studies, RVT 801, a recombinant form of acid ceramidase.

Read More OnMedTech Sanofi Genzyme, PerkinElmer to offer no-cost DNA testing for lysosomal storage disorders

MedTech Sanofi Genzyme, PerkinElmer to offer no-cost DNA testing for lysosomal storage disorders

Breast Cancer Wariness: Half Pursued by Debt Collectors

Staggering news !

Nearly half of a sample of American patients with metastatic breast cancer reported being pursued by debt collectors, according to a financial survey reported last week at the American Society of Clinical Oncology (ASCO) Quality Care Symposium (QCS) in Phoenix, Arizona.

The 1054-patient survey included individuals from 41 states; 49% reported contact from debt collectors related to cancer treatment bills.

"We found a very high level of debt collection," lead author Stephanie Wheeler, PhD, MPH, of the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, told Medscape Medical News.

This is a "staggering statistic on financial toxicity in cancer care," commented Nate Handley, MD, MBA, of the Kimmel Cancer Center at Jefferson University in Philadelphia, who attended the meeting and mentioned the study on Twitter.

The study participants were a mix of insured (n = 738) and uninsured (n = 316) patients.

Unsurprisingly, most of the uninsured patients (90%) were subject to debt collection. By contrast, only about one third of the insured patients were.

We found a very high level of debt collection. Dr Stephanie Wheeler

The survey did not explore the frequency of the collections contacts or the methods (eg, telephone calls, email, postal service). Wheeler explained: "Most of the time when debt collectors contact patients, they do it in multiple formats."

The survey also found that 54% of participants reported stopping or refusing treatment because of cost.

Unfortunately this is not confined to cancer patients. It is also common for many other chronic and potentially fatal outcomes.

Is there a possibility that medical debts should be excluded from collection methods.  Many physicians and/or hospitals will adjust off residual debt rather than pursuing debtors.

Alternative methods have been proposed for charitable organizations or groups to purchase debt for a markedly reduced amount, just as collection agencies purchase medical debt from providers and hospitals..

Should I pay a medical bill in collections?

Recent legislation has required FICO scores to be adjusted for medical debt.

FICO's new formula
FICO, the source of the score used by most lenders, said Thursday that it is rolling out a new formula called FICO Score 9. The new score will drop collection agency accounts that are paid off, whether paid in full or settled, FICO spokesman Anthony Sprauve said. It will also differentiate medical debt from other types of unpaid debt.

Under the new formula, the typical credit score of 711 should rise 25 points for people with medical debts but no other serious demerits on their credit record, Sprauve said. Of all accounts in collections, only about 10 percent are paid off, he said.

Reference:

Breast Cancer Wariness: 

Half Pursued by Debt CollectorsBreast Cancer Wariness: Half Pursued by Debt Collectors:  

Is it Physician burnout or Moral Injury ?

As an emergency physician and former Harvard faculty, Dr. Kevin Ban has always been fascinated with the connections that bind clinicians to their patients and to each other (and their community). We talk about restoring these connections in Health 3.0.

Go4Life | from the National Institute on Aging at NIH

Experts say that strength, endurance, and flexibility are the three factors for staying fit

How Exercise Helps                 

Sample Workouts: Getting Fit for Life

                                         

                                                                            

   
Go4Life | from the National Institute on Aging at NIH: Go4Life is the exercise and physical activity campaign from the National Institute on Aging at NIH. Find exercises to do, safety tips, and ways to be motivated!

What Makes a Physician take their own life ?

http://www.idealmedicalcare.org/contact/

 
During Suicide Awareness Week, I hosted a free two-day retreat in NYC (in collaboration with Emmy-winner Robyn Symon’s preview of her award-winning film, Do No Harm—sold out both nights at Angelika Film Center’s largest theater). Nearly 500 physicians (from as far as Hawaii and Alaska) joined in activities on September 12 & 13—from afternoon empowerment sessions to evening receptions and open mic until 2:00 am where doctors shared their suicide attempts openly. For many the most poignant moment was the Manhattan Memorial March to the site where one of medicine’s pioneers died by suicide earlier this year. At the location of her death, I delivered this eulogy to the countless doctors we’ve lost to suicide (fully transcribed & mildly edited for clarity).

Eulogy to 10,000 Doctors

Physician Suicide Letters

Many more residents and physicians shared their suicide attempts. I chose not to publish their accounts without permission. Please know that suicide is an epidemic among medical professionals. Start the conversation about doctor suicide at your medical institution. Please contact Robyn Symon to screen Do No Harm—the film that exposes causes and reveals solutions to the doctor suicide crisis.

As we walked away from the memorial we experienced an unexpected surprise..

                  

                    Cheering and applause from resident physicians at Starbucks!

                       Why “happy” doctors die by suicide

He was the go-to sports guy in Washington, DC. A masterful surgeon with countless academic publications, he trained orthopaedic surgeons across the world and was the top physician for professional sports teams and Olympians.

Dr. Benjamin Shaffer had it all.

Yet Ben was more than a stellar surgeon. He was a kind, sweet, brilliant, and sensitive soul who could relate to anyone—from inner city children to Supreme Court justices. He was gorgeous and magnetic with a sense of humor and a zest for life that was contagious. Most of all, he loved helping people. Patients came to him in pain and left his office laughing. They called him “Dr. Smiles.”

Ben was at the top of his game when he ended his life. So why did he die?

High doctor suicide rates have been reported since 1858 (1). Yet 160 years later the root causes of these suicides remain unaddressed. Physician suicide is a global public health crisis. More than one million Americans lose their doctors each year to suicide—just in the US (2). Many doctors have lost several colleagues to suicide. One doctor told me he lost eight physicians during his career with no chance to grieve.

Of these 1,013 suicides, 888 are physicians and 125 are medical students. The majority (867) are in the USA and 146 are international. Surgeons have the greatest number of suicides on my registry, then anesthesiologists. (3)

 NEED TO TALK ?

Ref:  Pamela Wible, M.D.  Thanks to her commitment and dedication there is hope.

How to Save Primary Care and Family Practice.

An absolutely amazing discussion of how to transform primary care medicine, and how to stop the “moral injury” of doctors that causes them to burnout and leave the profession.

The enclosed video is supplied by ZdoggMD, a well known vlogger. The discussion with Dr. John Bender is excellent, discussing Direct Primary Care, fee for service, and the impact of increasing regulation. He discusses the credibility of current quality measures by various insurance companies, medicare and other standards organizations.

Dr. Bender estimates the administrative load requires 40 hours of time per day, which is not achievable.

How To Save Primary Care (w/Dr. John Bender) | Incident Report 185

John Bender presents an articulate description of the current state of health finance. As a member of Doctors for Patient Care he presents an alternative method for affordable health care. Currently there are formidable barriers imposed by CMS which are encouraged by myths propagated by the insurance industry.

Some comments from viewers of the video,

Knowrain Knowrainbows

Placing patient care and improved outcomes first? Incorporating a holistic approach beginning with the “primary” (care) provider? Encouraging stronger and better client/patient - healthcare provider relationships? Promoting fiscal stewardship? Striving toward excellence in quality outcomes? Developing a healthcare model which is attractive and beneficial to patients, employers, insurance companies, facilities, communities AND the healthcare providers (primary as well as specialty)? Radically exceptional! As a RN with 40 years of “practice” in a variety of clinical settings, including mental health, I thank you for having already demonstrated the new model’s feasibility ... “Change for the better” ... It’s just what the doctor ordered! Hugzzz!

The Hidden Secret: New Film 'Pulls Back Curtain' on Physician Suicide |

New Film 'Pulls Back Curtain' on Physician Suicide

And doctors, med students march for victims for National 

Suicide Prevention Week

 Nearly 200 clinicians, residents, and patients filled the Angelika Film Center here on Wednesday for a screening of "Do No Harm," a documentary on the national suicide crisis among physicians, who kill themselves at a rate twice the national average.

And on Thursday, hosted by the film's director, Robyn Symon, and physician suicide prevention advocate Pamela Wible, MD, a group of physicians, residents, and students gathered at the Watson Hotel here and marched to Mount Sinai Hospital in honor of doctors lost to suicide.

"Do No Harm" largely follows two families -- the Dietls and Mechams -- facing the consequences of the pressure-filled and stress-inducing demands of medical education, training, and practice, which leads an estimated 300 to 400 physicians to take their own lives each year.

"I believe this is the first film to pull back the curtain on the toxic medical culture that doctors have been trapped in for decades, but have been too disempowered to speak out on because of the fear of consequences to their career," Symon told MedPage Today. "The goal of this film is to open a dialogue because dialogue is the first step to change."

In the film, Hawkins Mecham, DO, attests to the unrealistic hours expected of residents, the highly competitive nature of medical programs, and his immense fear of making a mistake and losing it all. Eventually these factors -- along with the pressure of being hundreds of thousands of dollars in debt -- caused him to be stuck in what he described as a "tunnel vision," where in seeking a way out during his fourth year of residency, he made an attempt on his life.

During a panel discussion following the screening that featured Symon and Wible, as well as John and Michele Dietl (who lost their son Kevin to suicide 3 months before he would have graduated from medical school), Mecham described the path that led him there.

"I finally got to my first rotation of my fourth year and it hit me when I started getting interview requests and realized, just to be able to attend interviews, I had to take out private loans because I'd already maxed out my federal loans," he said. "It overwhelmed me among other things, and got to the point where I thought it wasn't worth it. The only way to erase this for [my family] was for me to die. That was part of my thought process in my spiral downwards."

Mecham got in touch with Wible, who connected him with the Dietls. The parallels between Kevin and Mecham gave John and Michele Dietl an opportunity to heal, allowing them to ask Mecham questions they were no longer able to ask their son. Namely, why?

"When we started doing this film I was very hesitant because I was afraid of Kevin's legacy -- what would he think of everyone in the world knowing what happened to him?" Michele Dietl said at the panel. "I want these students to know from a younger age: Get help. Don't wait until it's a crisis situation and you're ready to kill yourself because you think you're trapped and you have all this debt and you're never going to be able to get your license. I hope he'd be proud of us and not ashamed."

Also on the panel were Thomas Madejski, MD, president of the Medical Society of the State of New York (MSSNY), and Michael Myers, MD, author of "Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared."

When asked what the MSSNY is doing to help alleviate some of the stressors physicians face, Madejski cited the Physician Wellness and Resilience task force, which his predecessor Charles Rothberg, MD, created, as well as a collective negotiation bill they are working to pass. Additionally, he hopes to increase the number of physician-led health systems.

"Do No Harm" will be shown throughout 2018-2019 at various locations.

If you or your organization would like to sponsor these events, please contact 

Robyn Simon, Producer. email 

Due to a technical error this blog post may not display properly.



New Film 'Pulls Back Curtain' on Physician Suicide | Medpage Today: And doctors, med students march for victims for National Suicide Prevention Week

An 'epidemic of nicotine addiction' among kids prompts FDA to get tough on e-cigarette makers

An 'epidemic of nicotine addiction' among kids prompts FDA to get tough on e-cigarette makers: Responding to an “epidemic of nicotine addiction” among American youths, the FDA announced a comprehensive crackdown on e-cigarette manufacturers, directing the industry’s giants to draw up detailed plans for halting sales to minors and threatening to pull a wide range or products from the market.

In response to a nationwide undercover investigation of brick-and-mortar and online stores over the summer, the FDA levied civil fines ranging from $279 to $11,182 on e-cigarette retailers found to have sold their products to minors and issued more than 1,300 warning letters.

What’s more, Gottlieb said the vaping industry appears to have turned a blind eye to the online practice of “straw purchasing” by retailers and individuals intent on buying vaping products and reselling them to minors.

The agency also ordered 12 online retailers to halt their continued marketing of e-liquids resembling kid-friendly products like candy and cookies. Although the FDA had acted in May to limit the sale of such products, they were still being offered, with the offending labeling and advertising, by the 12 online retailers, several of whom were also cited for sales to minors.

The new enforcement actions mark the start of a “sustained campaign to monitor, penalize and prevent e-cigarette sales in convenience stores and other retail sites” to minors, Gottlieb said. He promised, too, that the FDA would be keeping close tabs on manufacturers’ own internet storefronts and distribution practices to detect sales to minors.

“The FDA has at its disposal both civil and criminal remedies to address demonstrated violations of the law,” he said.

The actions were greeted with defiance and derision from the vaping industry.

“Thousands of small-business vape shops across America do not engage in irresponsible marketing practices and don't even sell the products being targeted by the FDA with threatening letters,” said Gregory Conley, president of the American Vaping Assn., a nonprofit organization that advocates for what it calls sensible regulation.