Monday, October 14, 2019

Like the Telephone Game, CDC's Lack of Clarity is Becoming Completely False Facts at the Local Level

Do you recall the telephone game? Players sit in a circle and the first person whispers a phrase into the ear of the second person, who whispers it to the third person, and so forth, until it gets to the last player, who then repeats the phrase that they heard. Typically, the phrase changes substantially from the beginning because a series of small, progressive changes add up to a completely different phrase at the end.

The only way to prevent this is for the first person to deliver such a clear message that it cannot be mistaken.

In this commentary, I show how the lack of clarity by the CDC and other health groups in communicating about the health risks of electronic cigarette use is leading to the dissemination of completely false information at the local level.

The Rest of the Story

In an article in the Williston Herald (North Dakota), a respiratory therapy care manager at CHI St. Alexius Health in Bismarck informs the public about the vaping-related lung disease outbreak that we are experiencing. She has apparently been involved in the management of several affected patients in North Dakota.

In the article, she tells the public that: "Propylene glycol is not water soluble, and that could be behind the recent vaping illnesses that are emerging. “The lungs don’t tend to absorb anything that is not water soluble, so they can’t get rid of it,” Backman said. “So those patients we are hearing about in the news who come into an ER or hospital are the ones heavily using these devices.”"

She did get some of the facts right. It is true that the lung has difficulty getting rid of oil-based liquids and that many of the outbreak patients who come into the hospital are using vaping devices with THC oils that are not water-soluble.

However, she gets one key fact wrong: "Propylene glycol is not water soluble," she tells the public, implying that the inhalation of propylene glycol is what is likely causing the outbreak. But propylene glycol is soluble in water and is almost certainly not the chemical responsible for the outbreak. If it were, we would see as patients many vapers of all ages using virtually all brands of nicotine-containing e-liquids, including many products sold at retail stores. If nicotine liquids were oil-based, I would be the first one telling everyone not to use e-cigarettes because they  pose a high risk of developing a potentially fatal lung disease.

I do not completely blame the individual who was passing along this misinformation because when the CDC communicated to the public about the fact that many of the identified case patients were presenting with lipoid pneumonia, it did not explain that all nicotine-based e-liquids sold in stores are water-based and thus cannot be the cause of lipoid pneumonia, but that many black market THC vape liquids are oil-based and must be avoided. This has apparently led to massive confusion among the public.

The rest of the story is that our communication about the health risks of vaping has been a complete failure. The public health community has completely fouled this up. This example shows how the lack of clarity at the level of the CDC can ultimately result in the provision of completely false information at the local level. This is why it is essential that CDC be as clear as possible in its messaging, something it has largely failed to do during this outbreak investigation.

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