The American Academy of Family Physicians (AAFP) has released the results of a survey it commissioned to examine public attitudes regarding what CDC has incorrectly called the EVALI (e-cigarette, or vaping-associated lung illness) outbreak. The AAFP reports the results as follows:
"In the online survey of 1,000 people aged 16 to 30 who vape, 93% of
respondents said they were aware of the EVALI outbreak, and 65% said
they were closely following news regarding the issue. More than 70% of
respondents indicated they planned to be more careful about the products
they buy and to reduce their use of vape products, and 86% were
confident that they understood the health risks associated with vaping."
"Survey results, however, showed a different reality regarding that
understanding of risk. More than half of respondents said that only
people who vape cannabis products were at risk of vaping-related
illnesses and death. However, of 1,782 hospitalized patients with
complete information in the CDC report, 20% reported not using cannabis
"What's disturbing is that people aren't aware of their risks," Natasha Bhuyan, M.D., a family physician in Phoenix, told AAFP News. "They
think that people are only at risk if they are using cannabis products
or black-market products. They think, 'My apple-flavored vape juice is
just fine.' But it could be just as dangerous as whatever else is out
The Rest of the Story
What a depressing way to enter the holidays. The AAFP - the official national membership organization of the nation's family physicians - is upset because many people correctly link the EVALI outbreak with the use of THC vaping products! What this means is that the AAFP would rather that the public be misinformed about the cause of the EVALI outbreak. The AAFP would rather have people believe that e-cigarettes are causing the outbreak even though that is not true.
This is deeply disturbing to me. It's also terribly scary. It basically means that the evidence-based practice of medicine is severely threatened. This is truly dangerous territory because what the AAFP is doing is allowing their pre-existing biases drive their clinical recommendations rather than the scientific evidence.
As those who have followed the Rest of the Story well know, there is now nearly definitive evidence that the EVALI outbreak is caused by the inhalation of THC and CBD vaping products containing vitamin E acetate oil, which has been used as a thickening agent in some of these products and which is toxic to the lungs because it destroys surfactant, which is necessary to keep the alveoli open. It also may release a toxic chemical that causes direct lung injury, and the oil itself may impair the ability of the alveoli to function properly. In addition, the body's inflammatory response to the presence of this oil may further contribute to respiratory damage.
There is absolutely no evidence that electronic cigarettes are playing a role in the outbreak. Vitamin E acetate oil is not used in any legal e-cigarettes. Moreover, if e-cigarettes were playing a role in the outbreak, we would not be seeing the drastic reduction in the number of cases that is occurring. After all, nothing has changed in the e-cigarette market, so why would the cases just disappear? Clearly, what is causing the outbreak to wane is the decreased production and distribution of vitamin E acetate oil-laden THC and CBD vape cartridges.
The spokesperson for the AAFP is giving exactly the opposite advice of both the CDC and FDA. The CDC and FDA have explicitly warned people not to vape THC products, especially those purchased on the black market. The AAFP is directly refuting that, claiming that all e-cigarettes are involved in the outbreak and implying that people who use apple-flavored vape juice in their e-cigarettes are just as much at risk for respiratory failure as those who use black market THC vape carts like Dank Vapes, which alone is associated with 56% of the reported cases.
Sadly, the AAFP has left the realm of evidence-based medicine. Compounding their irresponsible recommendations regarding the EVALI outbreak is the misinformation they are providing on their fact sheet about e-cigarettes, which contains two outright lies:
First, the "fact" sheet informs the public that e-cigarettes are not safer than tobacco cigarettes. There is overwhelming evidence that although e-cigarettes are not safe in any absolute sense, they are certainly safer than smoking.
Second, the "fact" sheet informs the public that e-cigarettes cannot be used to quit smoking. This completely ignores the fact that National Health Interview Survey data from 2018 revealed that more than 3 million adult smokers have quit smoking completely using e-cigarettes.
The rest of the story is that the American Academy of Family Physicians has left the realm of evidence-based medicine and, at least with respect to e-cigarettes, is now being driven by ideology rather than science. We can only hope that the AAFP will take some time to reflect on this during the holidays and will return to an evidence-based approach in 2020.
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