Friday, August 30, 2019

Boston Pulmonologist Provides Misinformation About the Cause of Severe Lung Disease Associated with "Vaping"

In an article published today in the Boston Herald, a Boston pulmonologist attributed the growing number of cases of severe, acute respiratory disease to "vaping" in general, giving the impression that the risk factor for these illnesses is any type of e-cigarette use and implying that any youth who uses electronic cigarettes is at risk. She hyped up this claim about calling vaping "the number one respiratory public health concern in youth and young adults worldwide."

The more than 200 cases of severe lung illness that have been reported in 22 states is indeed an important public health concern. But it is misleading, alarmist, and irresponsible to tell the public that these cases are being caused by retail e-cigarette products generally. Moreover, it is damaging misinformation because it does nothing to prevent further cases from occurring. The attribution for these cases is so broad that it is tantamount to giving no advice at all. Scaring people into believing that any vaping could cause you to die of respiratory failure is not only untrue, but it is not going to result in any change in behavior because it is far too vague.

This is a public health crisis and I think that any physician who makes public statements about these cases has a responsibility to provide accurate information that will actually help to prevent further cases from occurring. Scaring people into thinking that any vaping product can cause respiratory failure is not only inaccurate, but it is irresponsible because it doesn't provide useful information that can help youth avoid the specific products that are responsible for the observed cases.

The Rest of the Story

As an trained epidemiologist, it was immediately clear to me that these cases are not being caused by vaping products generally because these products have been on the market for years without any significant problems and because the reports are clustered in specific geographic areas. Now that further information is available, it is clear that the majority of the observed cases are associated with the use of THC oils that were obtained from unlicensed sellers. It is also likely that cases occurring among people using nicotine-containing e-liquids without THC are due to a contaminant that is appearing in products being sold on the black market, not in retail stores.

According to an article in yesterday's Washington Post, "Officials are narrowing the possible culprits to adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products."

The article also states that: "The sudden onset of these mysterious illnesses and the patients’ severe and distinctive symptoms have led investigators to focus on contaminants, rather than standard vaping products that have been in wide use for many years" and that "The investigation is “starting to point to what solvents are being used, and that can vary a lot” — especially in counterfeit or black-market products, including potentially mislabeled solvents that consumers buy themselves to make do-it-yourself “home brews,” said an official at the Centers for Disease Control and Prevention, which is heading the investigation."

The Boston pulmonologist quoted in the Boston Herald story is telling the public just the opposite, as she is attributing these cases to standard vaping products. This undermines the warnings that several state health departments have given to avoid black market products, especially THC oils. It also unduly scares parents into thinking, for example, that if their child is JUULing, they may die of acute respiratory distress syndrome. There is plenty for a parent of a youth who is JUULing to worry about (namely, the fact that it is addictive), but there is no reason to believe that acute respiratory disease is one of them.

In a disease outbreak such as this one, responsible public warnings need to be as specific as possible about the risk. In an outbreak of E. coli caused by a contaminated batch of lettuce, we don't tell the public that the disease is associated with eating, or even that it is associated with eating lettuce. People need much more specific guidance if they are to take appropriate action to avoid or reduce the risk of further spread of the outbreak.

Here, we need to start telling the public the truth. However much physicians or anti-nicotine groups may not like it, the truth is that the outbreak we are seeing is not due to the risks of using standard vaping products. It appears much more likely that the outbreak is mostly, if not completely attributable to illicit products--especially THC extracts--that are being sold by unlicensed sellers on the black market. Unless people are provided with this specific information, they will not take action to avoid the products that could put them at risk.

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