Media outlets, following the lead of the U.S. Centers for Disease Control and Prevention (CDC), continue to blame recent cases of severe respiratory illnesses among vapers on "vaping" and "e-cigarettes" in general, falsely implying a link to legal nicotine products. This misinformation is fostering public confusion that may lead to more disease and death, both from smoking and from the black-market products that have been implicated in the lung disease cases.
Based on the available information, the overwhelming majority of patients with respiratory illnesses had used black-market cannabis products. While a small percentage of patients say they vaped only nicotine, they may be reluctant to admit illegal drug use, and they may not know what they actually vaped if they purchased cartridges on the black market. If nicotine products are involved in any of these cases, it is almost certainly because of additives or contaminants in counterfeit cartridges or e-fluid, since legal e-cigarettes have been in wide use for years without reports like these.
That's what we know. But it is not, by and large, what we are hearing from the media. Yesterday I was invited to discuss vaping on AirTalk, the long-running show produced by KPCC, the NPR station in Pasadena, California. To his credit, the host, Larry Mantle, noted the concerns that banning e-cigarettes in general, or flavored e-cigarettes in particular, will drive vapers back to smoking or encourage people to use "adulterated vape solutions" that "might be more dangerous" than commercially available e-cigarettes such as Juul. But the way he framed the segment illustrates the misleading and dangerous conflation of black-market products with the legal vaping industry:
We begin this hour with a conversation on vaping and e-cigarettes. The news from the Centers for Disease Control is that there are nearly 400 [530, according to the CDC's latest count] confirmed and probable cases of lung disease associated with e-cigarette product use or vaping….Additionally, there have been six [now seven, per the CDC] deaths that have been confirmed….In the wake of those deaths and the CDC recommendation that Americans stop using vape products, that they stop vaping until more is understood about the causes of the lung illness and the deaths associated [with it], we have seen states consider bans on flavored vaping products.
Contrary to the implication, the official justification for those state bans, as well as the nationwide ban on flavored e-cigarettes that the Food and Drug Administration (FDA) plans to impose, is the increase in underage vaping, not the lung disease scare. During the radio show I emphasized that the respiratory illnesses are actually associated with black-market products, and black-market THC vapes in particular. But that did not stop the other guest, San Francisco surgeon John Maa, from claiming that "e-cigarettes could be more dangerous than traditional cigarettes if you develop one of these fatal lung illnesses."
Even when news outlets focus on the hazards of black-market vapes, they are weirdly reluctant to forthrightly state what we know about their prevalence in the lung disease cases. The Washington Post, in a story headlined "Potential Culprits in Mystery Lung Illnesses: Black-Market Vaping Products," reports that "many sick patients said they bought vape products containing THC, the psychoactive component of marijuana, on the black market." Not until the 22nd paragraph do readers learn that "most people used e-cigarette products containing THC, many of them illicit products" (emphasis added).
Even "most people" is an understatement. In states where the products used have been reported, the share of patients who admitted vaping THC ranges from 83 percent to 100 percent. And while "some people reported using only nicotine products," the Post says, "Jennifer Layden, Illinois's state epidemiologist, noted…that there is often 'hesitancy about sharing information' if patients used illicit products."
Notwithstanding that evidence, a recent Morning Consult poll found that 58 percent of respondents, based on what they had "seen, read, or heard on the news lately," believed people had "died from lung disease" caused by "ecigs, such as Juul," compared to 34 percent who said the cases involved "marijuana or THC e-cigs." The CDC is fostering such confusion by continuing to issue vague warnings.
"Until we know more," the CDC says, "if you are concerned about these specific health risks, CDC recommends that you consider refraining from using e-cigarette or vaping products." It adds that "anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer." But the main thrust of the CDC's message is that vaping, no matter the product, is potentially deadly.
The impact of that message was illustrated by "Arthur in Pasadena," a KPCC caller who had switched from smoking to vaping. "Hearing everything in the news around these mysterious deaths is [more than] a little bit concerning," he said. To assuage his anxiety, Arthur said, he'd like to see "more comprehensive studies with definitive findings" regarding "the black-market products that allegedly are making people die" and "the commercially available and seemingly safe products" that might "make you die in a few years."
The relevant question for Arthur is whether e-cigarettes are a less hazardous alternative to conventional cigarettes. And on that point, as much as vaping opponents like John Maa might try to muddy the truth, there is no serious scientific dispute: Vaping, because it delivers nicotine without tobacco or combustion, is much less dangerous than smoking.
David Abrams, a professor of social and behavioral sciences at New York University, estimates that if every smoker in the United States switched to vaping, it would prevent as many as 7 million smoking-related deaths. No wonder former FDA head Scott Gottlieb described e-cigarettes as "a tremendous public health opportunity." By portraying e-cigarettes as public health hazard, the CDC is doing a serious disservice to former smokers like Arthur and current smokers who might otherwise follow his example.