Vaping — don’t do it until we know more

If you have kids, I’d advise them to stop vaping entirely until we know more. Here’s why — granted that there have been ‘only’ several hundred cases of ‘lung injury’ and a few deaths  in a 300+ million population, but in any new illness (AIDs, SARs, Legionnaire’s diseases) only the most severe cases are seen first.  

Addendum 19 Mar — from PNAS – When exposed to high temperatures in a vaping device , vitamin E acetate can release the very toxic gas ketene CH2 = C = O which has been shown (in animal studies, dosage not given) to damage the lungs and impair the central nervous system

This is exactly the way it was with AIDs, the first few cases seroconverting (showing they’d been infected with the virus) had their immune system collapse almost immediately after infection.  As time wore on, we’d see seroconverters who remained healthy for 1 year, 2 years, 5 years, because (for reasons we still don’t understand) they were resistant to the virus or had a stronger immune system.  But eventually they got sick and died as well.

So it is with vaping related lung illness.  How many more cases we’ll see in  more resistant individuals in the coming years isn’t known. Will we have a nation of 30 year olds crippled with chronic lung disease?  Unlike AIDS, SARS or Legionnaire’s disease where there is a single organism, there are thousands of vaping products, and what people are putting into the machines is completely unknown.  Perhaps it’s just one drug.  Perhaps it’s a contaminated drug.  Perhaps its the particular machine.  At this point we don’t know.  It’s just like the early days of the AIDs epidemic — plausible theories abound and reliable data is scarce.  I was practicing medicine when AIDs came out in the late 70s and it was scary as hell, not knowing what was causing it.  At least with this we’re pretty sure it’s the vaping, given the age distribution and the positive histories in all.

We have one excellent example of a genetic condition predisposing to lung disease — alpha1 antitrypsin deficiency predisposes to emphysema and chronic obstructive pulmonary disease  — https://en.wikipedia.org/wiki/Alpha1_antitrypsin.  It would be useful  to see how many of the vaping cases have this deficiency.

This just in – according to the Wall Street Journal 2 hours ago 31 October ’19 ago the CDC says there have been 1,888 cases with 37 deaths.  Hopefully this is NOT the tip of the iceberg  — but probably it is.

Addendum 1 Nov ’19 I wrote this to a niece who has an 18 year old daughter entering college.  She is a teacher in a standard American high school (not in the ghetto, not filthy rich).  If any one has boots on the ground she does. Her response:  “Yes it’s very common in high school” — scary.

Addendum 8 Nov ’19  — The following comment by Peter Shenkin is so important that it belongs in the body of the blog proper —

It’s pretty impressive, but these are early times in the investigation.

If you have kids, I’d advise them to stop vaping entirely until we know more. Here’s why — granted that there have been ‘only’ …

You wrote: “Vaping — don’t do it until we know more”

We now know more; source of the following quote is at the end.

“CDC Announces “Major Breakthrough” that I Recognized and Reported Two Months Ago; Outbreak is Almost Certainly Not Associated with Legal Nicotine Vapes
Minutes ago, the Centers for Disease Control and Prevention (CDC) announced what they called a “major breakthrough” in its investigation of the vaping-associated respiratory illness outbreak. They tested lung tissue samples from 29 case patients and all 29 (100%) were found to contain vitamin E acetate oil.

This finding does represent a major breakthrough for four reasons:

1. The vitamin E acetate oil was detected in the actual lung tissue of the case patients.

2. The vitamin E acetate oil was detected in every single one of the lung tissue samples from these 29 case patients.

3. The samples came from 10 different states, confirming that the outbreak seems to have a common cause, rather than geographic variation.

4. Three of the patients whose lung samples revealed vitamin E acetate had reported using only nicotine-containing products, thus confirming that there is significant under-reporting which may explain why about 11% of the patients do not report vaping THC.”

The above quote is from: https://tobaccoanalysis.blogspot.com/2019/11/cdc-announces-major-breakthrough-that-i.html.

Full disclosure: Michael Siegel, a Public Health and Epidemiology doc who writes this blog, is my first cousin once removed. In another blog entry, he lambasts the FDA for disallowing mint vaping liquids while giving cigarette companies a pass on mint-flavored cigarettes.

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Comments

  • Peter Shenkin  On October 31, 2019 at 7:00 pm

    I don’t think minors should vape nicotine, which is addictive. But I think the evidence is pretty clear that the recent spate of serious incidents are due in all or nearly all cases to lipid pneumonia, in turn due to vaping of oils, such as vitamin E, in almost all cases done so that hydrophobic substances, such as (in almost all cases) CBD can be vaped. It’s not clear that even the few remaining cases came from vaping bona-fide mixtures obtained from large manufacturers, such as Juul. There are a lot of el-cheapo products being sold on the street, and even the ones that don’t contain CBD likely contain oils if lipid pneumonia is the diagnosis. I’m not sure there are any serious cases that don’t involve lipid pneumonia or unaltered cartridges from major manufacturers. You may know otherwise.

  • Peter Shenkin  On October 31, 2019 at 7:15 pm

    The end should have read:

    “I’m not sure there are any serious cases that don’t involve lipid pneumonia or THAT DO INVOLVE unaltered cartridges from major manufacturers. You may know otherwise.”

    • luysii  On November 1, 2019 at 7:58 am

      I’m really not an expert in lung disease, but I read somewhere that lipoid pneumonia is what is seen after a single massive inhalation of lipid, whereas these diseases are presumably due to small but multiple inhalations. I don’t know enough about the clinical presentation to know if they are a sudden onset after a single dose gone wrong, or a slowly progressive chronic deterioration. I think it’s the latter.

      The prudent course is to avoid vaping until we know more (but how prudent were any of us as adolescents ?).

  • Handles  On October 31, 2019 at 10:44 pm

    According to Nature, no evidence of lipoid pneumonia in lung tissue from 17 patients: https://www.nature.com/articles/d41586-019-03033-1, ref 2 proposes alternative hypothesis based on 3 years exposure of mice to just propylene glycol and glycerol.

    Contamination hypothesis is interesting given this news item:
    https://www.sfchronicle.com/business/article/Juul-accused-of-selling-contaminated-pods-lawsuit-14575874.php

    • luysii  On November 1, 2019 at 8:23 am

      As I said above “I’m really not an expert in lung disease, but I read somewhere that lipoid pneumonia is what is seen after a single massive inhalation of lipid, whereas these diseases are presumably due to small but multiple inhalations.” We’re at the stage where there are multiple plausible intriguing hypotheses as to what’s going on (just as I (but perhaps not you) was 40 years ago when AIDS was first appearing). At least we’re pretty sure that what we’re seeing in these people is due to in some way to the process of vaping (unless cases start appearing in people who have never vaped).

      “Yes it’s very common in high school” — this from a niece who is a high school teacher down in Richmond, Va.

      SCARY

  • Peter Shenkin  On November 2, 2019 at 1:43 am

    If the problem is due to long exposure, why this sudden appearance of serious, sometimes fatal cases? Have there been other cases that we have missed, and we’re just seeing many now because we’re on the lookout for them? This seems to be the key unanswered question.

    • luysii  On November 2, 2019 at 3:41 pm

      “Have there been other cases that we have missed, and we’re just seeing many now because we’re on the lookout for them? ” Exactly this happened with AIDs in Africa. I remember reading about it.

      https://www.sciencedaily.com/releases/2008/10/081001145024.htm

      “New research indicates that the most pervasive global strain of HIV began spreading among humans between 1884 and 1924, suggesting that growing urbanization in colonial Africa set the stage for the HIV/AIDS pandemic.”

    • luysii  On November 2, 2019 at 3:43 pm

      Exactly this happened in Africa with AIDS https://www.sciencedaily.com/releases/2008/10/081001145024.html

      New research indicates that the most pervasive global strain of HIV began spreading among humans between 1884 and 1924, suggesting that growing urbanization in colonial Africa set the stage for the HIV/AIDS pandemic.

  • Peter Shenkin  On November 2, 2019 at 1:46 am

    @Handles re contaminated pods, I have seen no specification of what the pods were alleged to be contaminated with. This seems odd.

  • Peter Shenkin  On November 8, 2019 at 11:47 pm

    You wrote: “Vaping — don’t do it until we know more”

    We now know more; source of the following quote is at the end.

    “CDC Announces “Major Breakthrough” that I Recognized and Reported Two Months Ago; Outbreak is Almost Certainly Not Associated with Legal Nicotine Vapes
    Minutes ago, the Centers for Disease Control and Prevention (CDC) announced what they called a “major breakthrough” in its investigation of the vaping-associated respiratory illness outbreak. They tested lung tissue samples from 29 case patients and all 29 (100%) were found to contain vitamin E acetate oil.

    This finding does represent a major breakthrough for four reasons:

    1. The vitamin E acetate oil was detected in the actual lung tissue of the case patients.

    2. The vitamin E acetate oil was detected in every single one of the lung tissue samples from these 29 case patients.

    3. The samples came from 10 different states, confirming that the outbreak seems to have a common cause, rather than geographic variation.

    4. Three of the patients whose lung samples revealed vitamin E acetate had reported using only nicotine-containing products, thus confirming that there is significant under-reporting which may explain why about 11% of the patients do not report vaping THC.”

    The above quote is from: https://tobaccoanalysis.blogspot.com/2019/11/cdc-announces-major-breakthrough-that-i.html.

    Full disclosure: Michael Siegel, a Public Health and Epidemiology doc who writes this blog, is my first cousin once removed. In another blog entry, he lambasts the FDA for disallowing mint vaping liquids while giving cigarette companies a pass on mint-flavored cigarettes.

  • luysii  On November 9, 2019 at 7:31 am

    I though this was so significant, that I copied it and put it in the body of the post

    • Peter Shenkin  On November 9, 2019 at 9:11 pm

      Thanks. Glad you agree on its importance!

  • loupgarous  On December 30, 2019 at 9:41 pm

    It might be interesting if the FBI did a “freeze and seize” raid at Juul and Philip Morris/Altria to determine if and when they knew that inhaling vaping mixtures could injure the lungs.

    It seems weird, given the tobacco industry’s history and its resources, that they’d set themselves up as Public Health Enemy Number One – again. But odder things have happened when big bucks were at stake.

  • Tobacco Prevention  On June 15, 2020 at 2:55 pm

    Everything is very open with a clear description of the issues.
    It was really informative. Your website is very helpful.

    Thanks for sharing!

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