Federal Health Agency Engages in Baseless Scaremongering by Linking 'Severe Lung Illness' to 'E-Cigarette Aerosol'

What do respiratory conditions in people who vaped black-market cannabis extracts tell us about the hazards of Juul?


What happens when public health officials tell people to be on the lookout for respiratory conditions that might be related to "vaping"? They get a lot more cases, less clarity about what is going on, and a handy propaganda weapon to deploy against potentially lifesaving products they irrationally dislike.

Since early last week, when a couple dozen cases of breathing problems following vaping had been reported in Illinois, Minnesota, and Wisconsin, the number has climbed into the triple digits. According to an August 23 update from the Centers for Disease Control and Prevention (CDC), "193 potential cases of severe lung illness associated with e-cigarette product use had been reported by 22 states." Those cases include the first reported fatality, which happened in Illinois.

"The Illinois patient's death was disclosed during a news conference held by officials at the Centers for Disease Control and Prevention, the Food and Drug Administration and the state of Illinois," The New York Times reports. "They did not provide details about the patient's identity, saying only that the person was an adult who had vaped recently and then succumbed to a severe respiratory illness. Health officials did not say what product the patient had used, whether an e-cigarette or other vaping device; nor did they specify what substance was vaped."

We likewise do not know exactly what the other patients were vaping, or even whether it was actually the cause of their symptoms. We do know that many of these patients, in Illinois and elsewhere, were vaping black-market cannabis extracts, which may have been contaminated by dangerous chemicals or may have contained synthetic cannabinoids rather than the real thing. We also know that many patients were using refillable vaping systems rather than disposable e-cigarettes or pod-loaded products like Juul. But we don't know whether they were filled with store-bought e-liquid, DIY mixtures, or mysterious fluids purchased on the black market. In this context, it is more than a little misleading to say these cases involve "e-cigarettes" or "vaping"—terms that most people will understand as referring to commercially produced nicotine delivery devices.

Scott Gottlieb, former head of the Food and Drug Administration (FDA), does not think these respiratory illnesses are linked to legally produced e-cigarettes. "The legal vapes have been actively regulated by FDA since Aug 2017," he wrote on Twitter this week. "FDA has conducted thousands of inspections of manufacturers and vape stores, published manufacturing guidance, sought product removals etc. These tragedies point to illegal vapes and THC."

Boston University public health professor Michael Siegel elaborated on the cannabis angle in a recent National Review piece. "In at least some of the cases," he notes, "the use of a THC oil, such as butane hash oil, has been implicated. In January of this year, there was a published case report of a severe, acute respiratory illness attributable to the use of butane hash oil. All 21 cases reported in California were apparently attributed to vaping marijuana, with all the THC e-liquids being purchased on the street."

Last week, the National Organization for the Reform of Marijuana Laws (NORML) warned cannabis consumers to be wary of black-market products. "Unregulated illicit market cannabis products, like products in any unregulated marketplace, are of variable quality and may put some consumers at risk," said Paul Armentano, NORML's deputy director. "These incidents linked to the use of unregulated, illicit market vapor cartridges reinforce the need for greater market regulation, standardization, and oversight—principles which NORML has consistently called for in the cannabis space. Consumers must also be aware that not all products are created equal; quality control testing is critical and only exists in the legally regulated marketplace."

That problem has nothing to do with legally produced e-cigarettes that deliver nicotine. But journalists are still drawing a connection to products like Juul, and public health officials are using this vaping scare as an opportunity to warn the public that "e-cigarettes do not emit a harmless aerosol" and "can include a variety of potential[ly] harmful ingredients," as the CDC's Brian King put it during a press briefing last Friday. Although "we haven't specifically linked any of those specific ingredients to the current cases," King said, "we know that e-cigarette aerosol is not harmless."

This is blatant, baseless scaremongering. Because black-market cannabis products may pose unknown hazards, King seems to think, people should stay away from legal nicotine delivery devices, even though they are a much less dangerous alternative to conventional cigarettes. Siegel argues that the CDC's vague, blanket warnings about "e-cigarettes" and "vaping" are "irresponsible and a potential hazard to public health," driven by "a categorical anti-vaping stance that has become commonplace and threatens to undermine decades of anti-smoking efforts."

Yesterday, USA Today reported that the CDC, the FDA, and state health departments "say they are completing the painstaking work of tracing common factors that may have triggered the spate of vaping-related lung illnesses." But given the way these cases were identified, there may be no "common factors."

Doctors noticed that some patients with respiratory problems were vapers, leading to a post hoc, ergo propter hoc presumption that has colored all subsequent judgments about the causes of those symptoms. Public health officials invited reports about people who 1) vaped and 2) had breathing problems. They got a bunch of them, seemingly confirming the initial hypothesis. But some of these cases may have nothing to do with vaping, while those that do may involve a variety of specific agents. In fact, that is almost bound to be the case, since we know the patients used different products, delivering different drugs, purchased in different places.

What does this all have to do with a smoker who is considering a switch to a different source of nicotine that could save his life by eliminating the tobacco combustion products he is currently inhaling? Absolutely nothing. Officials who claim to be interested in promoting public health should stop pretending otherwise.

[This article has been updated with comments from Scott Gottlieb.]

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  1. This latest hysteria over vaping causing severe lung disease reminds me of the early 1980s when the media was hyping stories about getting AIDS from swimming pools and toilet seats. They retracted those pretty quickly, but have every incentive to make sure the shit sticks this time around because right-thinking folks hate vaping.

  2. But we don’t know whether they were filled with store-bought e-liquid, DIY mixtures, or mysterious fluids purchased on the black market.

    The mere fact that some people might be using dangerous black market concoctions in vaping devices tells me that we must ban said devices outright.

    1. The same can happen with food. Ever go to a carnival or county fair? You don’t know what you’re getting. If you buy the vaping liquid from an established company and follow the instructions on their website to verify that it is real then you’re safer than eating a funnel cake sold from a truck.

      1. Maybe you go to different county fairs and carnivals. The ones around here, including food trucks, are monitored by the same health folks who inspect our brick-and-mortar restaurants. A lot of our food trucks are run by local restaurants, and serve the same food, and the county fair is catered.

  3. Thanks for this Sullum! As a vocal vaping proponent in my community, I’ve been getting the shit kicked out of me lately because of all the headlines. You’ve given me some more counter talking points.

    Also, good luck on stopping that last sentence.

    1. One of my wife’s friends, who is a very proper ivy-educated, suburban soccer mom type, apparently has a secret THC vaping habit. She lives in the Bay Area which is the epicentre of the anti-vaping movement and the pro-pot movement. Hopefully she won’t be one of the ones to get sick, but if she does, it may well be that she thought only those icky nicotine vapers were the ones who needed to worry.

  4. On local talk radio (Atlanta), they were reporting a new study, I believe from CDC, decrying how absolutely deadly second-hand vapor “smoke” is. Like their deadlier counterpart, I do not and will never believe this scaremongering which has the aim of nothing but to outlaw smoking of any variety in any kind a public space. Any person with 2 functioning brain cells can tell you that, not only does the smoker directly inhale from the device (or cigarette), but they also inhale more side-stream than any other person in their vicinity (since the device is centrally located by the smoker). This means the smoker is receiving more than twice the amount of harmful chemicals as any by-stander. I am 50 years old, have smoked approximately 2 packs per day since age 13. I have yet to feel any side effects, except minor shortness of breath (occasionally) and some coughing up phlegm. So deadly. Cigarettes and vaping are absolutely not good for you, but neither are the lies told by the abolitionists.

  5. Vaping has been on a shit list by the CDC and various State Departments of Health from the get go; their position is that the only acceptable method of smoking cessation is smoking cessation. You call their 1-800 quit line or just stop cold turkey. Vaping is just not an acceptable alternative, no matter how many cases of lung cancer it may prevent. They don’t want the competition for their “solutions.”

    Similar tactics are used to promote idea of “human trafficking” as if your daughters are all tempting targets waiting to be “Taken” by some sex cartel. No end to mandatory inservices on that, with statements to the effect that “there may be as many as X million persons who are at risk…” Next thing you know floor nurses are suspecting patients of being part of a “ring” and it turns out they’re just weird.

    Propaganda and hysteria. It happens.

    1. Problem is that humans have vanquished most real diseases like smallpox and polio, greatly reduced child mortality, and infections, and aren’t killing each other like we used to. Nor do most of us need to worry about being eaten by wild beasts. So we are all living longer than any humans in history and don’t even really need to worry about nuclear war anymore.
      The downside of our lives being so perfect is that we are bored and conditioned to respond to fear, so the media feeds this need with stories about vaping, sex trafficking, and climate change.

    2. It isn’t about competition for their solutions… this is all about being moral scolds. The left aligned themselves with the anti-smoking movement because of Big Tobacco Profits. Plus, they get to tell people what to do.

      So now the vaping companies come along and their motives are made clear – it was never about public health for them. They are *livid* that corporations are profiting from vaping. So they are turning their ire towards all things vape. Hence the California bans on vaping in public. This is all about having someone to shame and taking profits from evil corporations.

    3. “their position is that the only acceptable method of smoking cessation is smoking cessation.”

      Sort of like absence-only sex education.
      A parallel is the decade-long resistance by the Red Cross and other official health groups to the Heimlich Hug with various footling objections, and their continuing recommendation to slap the victim on the back, which Heimlich had called a “death slap.” Their noses were much out of joint about that, you could bet. (Incidentally, someone saved my life with that maneuver back in 1963, years before Heimlich came out with his Hug. My savior told me he’d learned it in the army.)

      Health organizations also resisted an outsider’s promotion of “drownproofing,” a far more effective technique than what those organizations were recommending. (“Drownproofing was described ages ago in a Whole Earth Catalog publication. It involves spreading one’s arms out at one’s sides on the water’s surface, letting ones face lie in the water, and occasionally kicking with one’s feat to raise one’s face and taking and holding a deep breath at that time.) Their objections were equally footling, and drownproofing has become officially acceptable, after the old incumbants passed away.

      Their reactions are mostly a sort of NIH (not invented here) reflex—a dislike of hving their authority undermined by “public health” outsiders—plus stuck-in-the-mud conservatism. Plus, perhaps, something worse: a desire not to see the problem solved, as that would end the need for their positions, at least their positions on the public lectern.

  6. Vaping is such a blight on society that it just makes sense to sin tax it because society will need government funds to mitigate the blight.

  7. More finger wagging from the nanny state puppets.
    We all know the dangers and risks of smoking.
    We don’t need an army of over-paid and under-worked bureaucrats to remind us.

  8. Although “we haven’t specifically linked any of those specific ingredients to the current cases,” King said, “we know that e-cigarette aerosol is not harmless.”

    Dan Rather approves of the truthiness of this statement.

    1. Rocked by vape?

  9. There is such a thing a hypersensitivity pneumonitis. That is what we are seeing here. It is a broad diagnosis which is often unknown as to etiology.

    I think it is entirely plausible that a subset of people who vape either THC or nicotine products, often black market, can develop this constellation of symptoms and findings. It is also possible that commercial products such as Juul are much safer.

    What has been noticed and is under investigation by the CDC and the rest of the medical profession now, is a correlation likely underreported previously. More cases more knowledge.

    I have linked and quoted to what is known so far.

    Here is a background article about this spectrum of disease.

    In the meantime people who vape nicotine or THC should use caution and stick to tested or trusted brands.

    1. 10 years ago when I switched to vaping, you didn’t really know what you were getting because there were no established brands and lots of guys on the web selling dog piss from China as ejuice. You had to rely on word of mouth or vaping forums for what was good. That has changed now that vaping is “legit” same will happen with THC once it’s legal everywhere. But if the antis get their way and vaping becomes illegal, we will see a lot more of these lung diseases-of course, maybe that’s exactly what they want.

      1. That which is legit is easier to ban.

  10. Condescending tone aside, your nicotine delivery sticks aren’t healthy. Stop pretending it’s some inert substance that does nothing except make you addicted to it.

    1. Drug legalization should have very little to do with the health risks of the substance

      1. Good thing I didn’t comment on the legality of anything.

        1. What purpose does your comment serve then? It’s to your point anyway. Those advocating for legalization shouldn’t be doing so on the basis of safety or medicinal use. That misses the point entirely. People who feel the need to comment about the health risks of drugs to drug advocates also miss the point.

          1. It may not be “the point” you want to make, but most people aren’t radical libertarians and hence consider safety vs. danger to be an important consideration in whether to have something legal or illegal. They have the votes, so if we want to maximize our liberty, we need to convince them things are safe. We could not have made such progress on marijuana had it not been so popular, and it would not have been so popular if it were thought to be more dangerous.

            1. That’s an unprincipled approach my man. That’s the only thing I got.

    2. Stop pretending it’s some inert substance that does nothing except make you addicted to it.

      It’s not inert, but it’s not considerably more dangerous than a cup of coffee, likely not more dangerous than a cup of coffee with butter and MCT Oil, and almost certainly not more dangerous than 16 oz. of coffee with 68g of sugar and 20g of saturated fat.

      Peanut butter and french fries contain detectable levels of compounds known (outside the state of California) to be acute toxins and chronic carcinogens. We don’t ban them. We just hold dangerous purveyors legally culpable for their actions.

    3. Define healthy. Celery is good.

      An opiate addict maintained on buprenorphine or methadone is how healthy? A nicotine addict formerly smoking 1ppd chewing Nicorette gum is still addicted.

      Nobody ever died from condescending tone. These are not my nicotine delivery sticks. I do not sell, own nor have anything to do with them. Evidence proves that they result in harm reduction for smokers who cannot quit cigarettes by other measures. That is a good thing.

      I linked to articles and have posted here about a medical issue about vaping which is real and should not be dismissed. At this time it is not well defined.

      Always focus on the individual. Always try to learn something new.

  11. The vaping industry and its supporters seem determined to follow the trajectory of the tobacco industry. America’s improvement makes that a dumber choice than it was a half-century ago.

    1. Funny you mention that-seems to me that the Democrats reigned supreme and there was much less inequality back when everybody smoked (1932-1980).

      1. Seriously? What is your rationale for such a dubious statement? During that time, 8 out of 13 presidents were democrats in that timeframe, and democrats had control of both the house and senate 23 of the 26 sessions of congress, so that holds water, but ask virtually every minority and most women about how equal they felt during that period…

      2. The dumb part is linking cigarette smoking to democrat or republican politics.

        1. I was being sarcastic for the benefit of the reverend

    2. Per the CDC, “cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day. On average, smokers die 10 years earlier than nonsmokers.”

      This in spite of all the smoking cessation programs and 1-800 “Quit” lines.

      How many die from vaping?

  12. I rarely smoke and virtually never vape. Much like the ads, this sort of legal persecution makes me want to vape more than any Juul ad I have or have not seen.

  13. Really? The federal government is publishing pure bullshit about a subject?
    I am shocked!

  14. Unscientific statement by the CDC:

    We are saddened to hear of the first death related to the outbreak of severe lung disease in those who use e-cigarette or “vaping” devices. CDC’s investigation is ongoing. We are working with state and local health departments and FDA to learn the cause or causes of this ongoing outbreak.

    This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents.

    Jesus, where does one begin? We are “saddened to hear”. Ok, does the CDC comment on specific cases by writing open obituary type letters?

    Next, an outbreak of severe lung disease in “those” (we’re talking about a single death) who use vaping products. Correlation is not causation, and this correlation is particularly weak.

    Next, our “investigation is ongoing”. So they don’t have anything conclusive. That negates everything they said above.

    Next, they are working [with other agencies] to learn the cause of this “outbreak”. Again, they can make no conclusions about anything because they have no data, and one death is being conflated with an “outbreak”. The CDC should stick to what it knows best, printing pamphlets encouraging young girls to get into STEM fields, because lord knows no one at the CDC is much of a STEM candidate.

    1. “They” are looking into it. Something is causing a bump in an usual pattern of disease.

      Onset of symptoms in days to weeks. Primary is respiratory can include systemic including fever and GI symptoms.

      Ground glass opacities in a central or patchy distribution on CT.

      I can explain that. It means that alveoli, the airspaces in lungs exchanging for oxygen and CO2 are filling up. In this case lymphocytes and fluid. Not good.

      Infectious disease ruled out.

      Responds rapidly to corticosteroids.

      Forget politics for one day. Please.

      1. Forget politics for one day. Please.

        Politics *and* statistics *and* history. Also, not really one day, forget about them until TOP MEN have this particular problem under control.

        Remember the false alerts about ebola? How about zika? How about impending unnamed epidemics that resulted from AGW that were going to wipe us out? Are they still impending? Where did the daily news reports about bird and swine flu cases in remote parts of the world go? What about the (up to) 300,000 people who contract lime disease every year and don’t know it? What about the falsehoods perpetuated to this day about secondhand smoke? Crack babies? Should we wait until we see the first lady driving an APC into a vaper’s house between ‘This is your brain on vape juice’ commercials before we remember how this shit almost constantly spins out of control?

      2. I can explain that. It means that alveoli, the airspaces in lungs exchanging for oxygen and CO2 are filling up. In this case lymphocytes and fluid. Not good.

        *Assuming you’re a doctor, nurse, or a rad/cyto/histotech or something*; you’ve done the biopsies yourself or you’re armchairing it with a vague secondhand description?

        You can cram the ‘leave your politics out of this’ right up your ass.

        1. I have done the biopsies myself.

          Because the internets are what they are I will not say more. I do not ask you for personal information and certainly do not recommend cramming things up your ass which is an entire topic in medicine. If you give me the same courtesy we can have a discussion. If not I do not care either way.

          Libertarian or not the medical profession does regulate itself to a great extent. To the extent government and politics can stay out of it that is a good thing.

  15. Unusual.

    My typo.

  16. While inhaling most anything except air is not great for your lungs, the story here mentioned briefly at the end that the the young man in the story is an asthmatic. Again underlying illness caused the problem.

    1. While inhaling most anything except air is not great for your lungs,

      Incorrect. It’s been well known since before the practice of modern medicine that *some* moisture is required in the air we breath to prevent a host of conditions both internal and external such as edema and silicosis. I don’t mean to imply that our lungs balance on a knife’s edge, but the idea that air and only air is good for your lungs is a misstatement.

  17. When a federal agency makes a blatant error, lies, or otherwise screw up spectacularly, I propose that it promptly be disnanded.

    Spread false stories about vaping? Zeroed out

    Run arms to drug cartels ostensibly to track them and then lose track of them? Your department is disbanded.

    Operate an “undercover sting” operation to arrest Amish farmers who are selling raw milk to willing buyers? Kiss your agency goodbye.

    Think of the enormous budgetary savings! Nancy Pelosi once said the government was so lean that there is “nothing left to cut.” I say let’s start with cutting out the obvious huge rolls of fat: agencies that have no purpose and are clearly floundering and desperate to prove some kind of relevance at the cost of lying and outrageous behavior.

  18. “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy”
    Peter Hajek, Ph.D., et al.
    Abstract February 14, 2019
    N Engl J Med 2019; 380:629-637 DOI: 10.1056/NEJMoa1808779
    A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001)
    (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608.)

    This well-designed study was done in the UK, where the medical establishment seems to be more favorable to vaping than here.

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