As More Evidence Implicates Vitamin E Acetate in Lung Injuries, the Press Continues to Blame E-Cigarettes That Don't Contain It

The black-market additive showed up in lung fluid from 48 of 51 patients with "probable or confirmed" diagnoses.


The fourth paragraph of a recent New York Times story about vaping on college campuses notes "a growing health crisis that has killed more than 50 people and injured more than 2,500," which it says led Congress to raise the minimum purchase age for e-cigarettes to 21. Later the Times concedes that the deaths and injuries are "largely attributed to vaping products containing THC." But that inconvenient fact does not stop the Times from conflating college students' nicotine vaping—the main subject of the story—with vaping of potentially deadly black-market cannabis products.

That sort of misleading reporting remains sadly common despite the mounting evidence implicating vitamin E acetate, a cutting and thickening agent that began showing up in illegal THC products this year, in the recent outbreak of vaping-related respiratory illnesses. Two days before the Times published its story, The New England Journal of Medicine published the results of a study that strengthens the case against that additive, which is not found in legal e-cigarettes.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) analyzed lung fluid from 51 patients with "probable or confirmed" vaping-related respiratory conditions and found vitamin E acetate in 48, or 94 percent. As Boston University public health professor Michael Siegel notes, "the three cases in which vitamin E acetate was not detected were not confirmed cases, and each had other potential explanations for their illnesses. One had a multi-drug overdose, one had a fungal infection, and one may have had a bacterial lung infection."

These results, based on cases from 16 states, are similar to the findings of a November 15 CDC study that found vitamin E acetate in every lung fluid sample from 29 patients in 10 states. The new study also examined lung fluid samples from 99 healthy subjects, including 18 "exclusive users of nicotine-containing e-cigarette products," and found no vitamin E acetate. The study "provides evidence," the researchers say, that vaping products "can deliver vitamin E acetate to respiratory epithelial-lining fluid, the presumed site of injury in the lung." In light of this study and earlier findings, the CDC is now describing vitamin E acetate as "closely associated" with the lung injuries.

The NEJM study, which tested 47 lung fluid samples for THC, also provides further evidence that self-reports may not be reliable in identifying which patients have consumed cannabis extracts. "THC or its metabolites were detected in BAL [bronchoalveolar-lavage] fluid samples from 40 of 47 patients," the researchers report. "A total of 9 of 11 patients who reported no use of THC-containing e-cigarette products in the 90 days before the onset of illness had detectable THC or its metabolites in their BAL fluid. Among the patients who had available laboratory data or who reported product use, 47 of 50 (94%) had detectable THC or its metabolites in BAL fluid or reported vaping THC products in the 90 days before the onset of illness."

As a CDC official noted after the earlier BAL study, THC would not necessarily be detectable in the lung fluid of patients who had consumed it. Without urine testing, it's impossible to confirm the self-reports of patients who deny using cannabis products, possibly because they are reluctant to admit illegal drug use.

The researchers suggest two ways in which vitamin E acetate, which was first publicly identified as a potential lung disease culprit in early September, might be causing patients' symptoms (endnotes omitted):

Although the ingestion and dermal application of vitamin E acetate have not generally been associated with adverse health effects, the safety of inhaling vitamin E acetate has received little attention. Vitamin E acetate is the ester of vitamin E (α-tocopherol) and acetic acid. The structure shows a long aliphatic tail that can penetrate a layer of surfactant to align the molecule in parallel with phospholipids. Phosphatidylcholines undergo transition from a gel to a liquid crystalline phase when exposed to increasing amounts of tocopherols, such as vitamin E acetate. Transitioning to a liquid crystalline phase would cause the surfactant to lose its ability to maintain the surface tension that is necessary to support respiration in the lung, thus providing a possible mechanism by which vitamin E acetate could cause respiratory dysfunction.

Another potential harmful effect of vitamin E acetate that may contribute to lung injury occurs when it is heated in e-cigarette products. Heating vitamin E acetate in these devices may create ketene by splitting off the acetate group from some or all of the vitamin E acetate. Ketene is a reactive compound that has the potential to be a lung irritant, depending on concentration.

While the researchers caution that "the causative agents" responsible for the lung disease outbreak "have not been established," the evidence so far overwhelmingly points to relatively new additives or contaminants in black-market cannabis extracts, as opposed to legal nicotine e-liquids. Yet leading media outlets such as The New York Times continue to imply that nicotine-delivering e-cigarettes might be causing the lung injuries, suggesting that policies like raising the legal vaping age or banning flavored e-liquids are logical responses instead of panicky non sequiturs.

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  1. This sort of stuff is infuriating. I have a number of friends who have successfully used vaping devices to quit their cigarette smoking habit.

    If 35 out of 100 people with food poisoning say that they went to the same salad bar, the CDC has determined the cause to be the salad bar. 94 out of 100 lung injury patients say they used black market THC vapes, and the other 6 refuse to answer, but the CDC has no idea, and isn’t willing to speculate. Bullshit.

    P.S. The answer to the problem is not to ban, it’s to un-ban.

  2. Vitamin E oil has 8 forms
    Putting any oil in your lungs is bad.

  3. misleading reporting

    better known as FAKE NEWS

    1. Terminological inexactitude.

      1. Errors were made.

    2. Doctors and Scientists are just as capable of fake news as Alex Jones, and love the attention even more, and they never have to own up to their mistakes, like telling everyone that fat is bad for you but sugar is harmless. They just publish more BS because they know they will never get called out on it.

      1. WHAT? Alex Jones fake news? I AM SHOCKED! Truly shocked. LOL

  4. What else is new? The NY Times is a 21st shit-show composite of Mother Jones, Prevention, and the National Enquirer.

  5. To repeat, until Reason acknowledges it; The New York Times is NOT a news organization.

  6. Forget The NY Times. Worst science reporting ever.

    The article links a study published in the NEJM. You could call it a case control study. Two groups. One has the disease which is a diagnosis of exclusion. The other are healthy.

    The study has controls. There were 51 patients who met known criteria for the disease. There were 99 healthy participants.

    Both had bronchoalveolar lavage BAL. A bronchoscope is passed into the lungs and a small fluid collection is made and sent for lab analysis. It is not perfect.

    They used samples from multiple centers which is important.

    Small numbers yet they found one compound in near all patients with published criteria yet none in the control group.

    So the advice should be obvious and has been made. This does not relate to juul type products in what we are talking about. Nobody really knows but almost certainly less harmful than Marlboro.

    People who smoke weed should be careful about those cartridges. I have nothing against it but watch out.

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  8. That anti-vaping organization, “The Truth”, has money to burn, thanks to being funded by the “Master Settlement” in that lawsuit against tobacco companies. And the media are for sale, especially if you’re reasonable subtle about it, and coming from a left-wing perspective.

    1. The “lawsuit” itself was a coup — The tobacco companies had ALL private studies from many multiple sources to support them (as if society as a whole didn’t realize people smoke for 50+ years without problems) and the government had only their OWN “government” studies to lean on.

      It was an utter joke of a ruling.

      1. Well, yeah: The tobacco companies kept winning the cases based on the obvious fact that everybody knew tobacco was bad for you, so if it hurt you, that was a voluntarily assumed risk.

        Then some lawyer got the clever idea of bribing legislators to outlaw that defense. And the rest was history.

  9. The response of public health agencies to the outbreak of vaping deaths is a perfect example of Rahm Emanuel’s dictum to “never let a crisis go to waste”.

    The public health establishment hated vaping and tried to stop it for years but were never able to articulate a good scientific reason why it should be stopped.

    This outbreak has been just what they were waiting for, and they have seized the opportunity with gusto. In this they have been aided by a compliant Media, who have eagerly pushed the “vaping is bad” narrative without question.

  10. You have to wonder what the motivation is for these fake news orgs to publish false information like this. Is it just to get the click baits? Is it just because a poison big tobacco vape is such a jucier story than the truth? Or is it just ignorance and poor reporting, and not bothering with details anymore?

    They literally are killing people with their fake reporting! If people change their habits based on their fake news reporting, and take actions such as going back to smoking instead of vaping, then they’ve helped people die. It’s incredible the callousness of these fake news orgs.

    1. I would hazard a guess the governments motivation to ban e-cigarettes is largely due to the large amount of taxes the game from traditional cigarettes, California charges upwards to five dollars a pack and has many special interest and politically connected groups that are funded from these.

    2. I suspect it is mostly due to poor science education and training of journalists. For new and controversial areas it’s their instinct that campaign groups’ claims should be given equal prominence to scientific experts, so you get formulations like “but the CDC refused to categorically rule out a link, and campaigners argue that X, Y, Z…”. So it’s a mix of clickbait and also a genuine inability to filter the evidence themselves and work out what’s going on.

      You see it in the fracking debate as well, with journalists reporting fearfully on earthquakes that too small to be felt by humans and methane in tapwater that is present in nearby areas where there hasn’t been any fracking.

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  12. baaaahhhh… baaaaahhhh…. “Smoking kills” and “Nobodies dies unless they smoke”… baaahhh.. baaaahhh…

    Beware; The power a vast quantity of sheeple has in turning lies into “sheeple facts”.

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