Science

The Vaping Panic Is a Major Setback for Public Health

"There's no question public health would benefit dramatically if everybody switched completely to e-cigarettes."

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When tainted lettuce causes an outbreak of gastrointestinal disease, the federal government does not issue general warnings about the hazards of eating. Nor does it order a recall of all fresh vegetables. Instead it focuses on the specific products consumed by the people who got sick.

After doctors began to report respiratory illnesses among vapers last summer, by contrast, federal agencies urged the public to avoid all vaping products, including legal e-cigarettes that deliver nicotine, even though it was clear early on that the vast majority of cases involved black-market cannabis extracts. That indiscriminate approach undermined public health in two ways.

First, it did not provide specific guidance to cannabis consumers who might have avoided the products implicated in the lung disease outbreak if they had been adequately informed. Second, it scared smokers away from vaping products that offer potentially lifesaving alternatives to conventional cigarettes. The vague warnings also encouraged a series of panicky state bans that threatened to drive vapers toward illegal products that may pose special hazards.

As of November 5, the U.S. Centers for Disease Control and Prevention (CDC) had counted more than 2,000 lung injuries associated with vaping, including 39 deaths. In cases where the information was available, the CDC reported, just 11 percent of patients with respiratory symptoms said they had vaped only nicotine. As the CDC noted, some of those patients may have been reluctant to admit illegal drug use. Furthermore, it's not clear that any of them had used legal nicotine products, as opposed to black-market e-liquids of unknown provenance and composition.

While legal e-cigarettes have been used by millions of Americans for years, the reports of acute, life-threatening respiratory reactions did not emerge until recently. That suggests the problems are caused by relatively new additives or contaminants in black-market THC cartridges, and perhaps also in counterfeit e-cigarette pods or bootleg nicotine e-liquids.

An analysis of lung tissue samples from 17 patients by researchers at the Mayo Clinic, reported in The New England Journal of Medicine, suggested that many of the lung injuries were caused by exposure to toxic chemicals. Another possible culprit is vitamin E acetate, a cutting agent found in illegal THC vapes that is safe to swallow but may be hazardous when inhaled, leading to a rare form of pneumonia caused by fat particles in the lungs.

Despite the evidence pointing to black-market products (and THC cartridges in particular), the CDC and the Food and Drug Administration (FDA) continued to suggest that people "consider refraining from use of all e-cigarette and vaping products." At the same time, both agencies cautioned former smokers who are now vaping against returning to their old habits.

The reason for the latter recommendation is plain: E-cigarettes, which do not contain tobacco and do not burn anything, are much less dangerous than the conventional, combustible kind. Studies of biomarkers in smokers who have switched to vaping find that they are exposed to far fewer hazardous substances, at far lower levels, than people who continue to smoke. As David Abrams, a professor of social and behavioral sciences at New York University, noted in a September interview with CBS News, "e-cigarettes are way less harmful than cigarettes, and they can and do help smokers switch if they can't quit."

A controlled, randomized study reported last February in The New England Journal of Medicine found that e-cigarettes are nearly twice as effective in smoking cessation as alternative nicotine replacement products. The harm-reducing potential of e-cigarettes has been recognized by a wide range of public health agencies and organizations, including the FDA, the Royal College of Physicians, the American Cancer Society, and the National Academies of Sciences, Engineering, and Medicine. In 2015, Public Health England said "best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes."

That point was lost in government warnings that implied all vaping products are potentially deadly. "It seems there's too much conflating these tragic lung injuries with store-bought brands of regulated, legal e-cigs like Juul and NJOY," former FDA Commissioner Scott Gottlieb observed on Twitter in late September, "and far too little blaming THC, CBD, and bootleg nicotine vapes—where so far, the only available hard evidence points." A week later, Boston University public health professor Michael Siegel noted on his tobacco policy blog that "there are no cases that have been shown to be associated with the use of store-purchased nicotine e-liquids, and it seems extremely unlikely that these products have any involvement in the outbreak."

Washington, D.C., psychiatrist Sally Satel, a resident fellow at the American Enterprise Institute, made the same point in congressional testimony on October 16. "The lung injury problem is a story of the dangers of the black market, not of vaping," she said. "Consumers have been using commercially available vaping devices and nicotine products for 10 years without a single recorded death or any surge of illnesses…until this summer. What we are observing today is consistent with a relatively acute contamination."

That's not the message Americans have been getting from public health officials or news outlets influenced by the government's framing of the issue. A Morning Consult poll conducted in September 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 "e-cigs, such as Juul." By comparison, 34 percent said the cases involved "marijuana or THC e-cigs." Only 22 percent of respondents understood that e-cigarettes are less hazardous than the conventional kind, down from 36 percent in a June 2018 poll.

Muddled messages about vaping also have influenced policy makers. While Michigan Gov. Gretchen Whitmer (D) cited underage vaping as her justification for unilaterally banning flavored e-cigarettes in September, the governors of Massachusetts, Montana, New York, Oregon, Rhode Island, and Washington subsequently mentioned vaping-related respiratory illnesses while imposing similar "emergency" bans.

As Satel noted, "Eliminating flavored nicotine e-liquids will not prevent further cases of lung disease, because those products had nothing to do with the outbreak." Meanwhile, such bans deprive former smokers of the legal e-liquids they overwhelmingly prefer. Surveys find that supposedly kid-friendly flavors are highly popular among adult vapers, who say they are important in the process of giving up smoking. After those options are eliminated, some vapers may return to smoking, while others may start buying potentially tainted black-market e-liquids.

If every smoker in the United States switched to e-cigarettes, NYU's Abrams estimates, it would prevent as many as 7 million smoking-related deaths. No wonder Gottlieb, when he was running the FDA, called e-cigarettes "a tremendous public health opportunity." But that opportunity is threatened by misleading warnings about the hazards of vaping and bans on the e-liquids that former smokers demonstrably want.

"There's no question public health would benefit dramatically if everybody switched completely to e-cigarettes," Abrams told CBS News. "If we lose this opportunity, I think we will have blown the single biggest public health opportunity we've ever had in 120 years to get rid of cigarettes and replace them with a much safer form of nicotine."

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  1. Wait…..is this really a criticism of the CDC? Net Net: I think this is what the CDC is saying.

    1. Don’t smoke cigarettes. (Um, they will kill you eventually)
    2. Don’t vape nicotine. (Um…we know it is addictive; it is bad for you)

    Neither practice is good for your health. In fact, both practices are detrimental to your health. That is an objective fact. This is totally separate from the personal autonomy and responsibility aspect.

    1. Well, yeah, but smoking cigarettes is “ruin your health and may kill you outright” bad for you.

      While vaping is “Oh, yeah, and you should probably do more situps, too” bad for you.

      All the objective evidence says that vaping is an ordinary mild vice, like drinking sodas, eating potato chips, sitting on the couch watching TV. Not part of an ideal lifestyle, but no big deal, either.

      1. There’s a great deal of “Waaaah! You won’t do what we TOLD you to do!” in everything even remotely connected with smoking these days. Yes, smoking is a vice. It is, however, considerably less dangerous to your health than, say, unprotected anal sex with comparative strangers (based on Gay life expectancy vs. smoker life expectancy) and no government stooge or health nag would DARE criticize the ‘Gay Lifestyle’.

        The c0ld fact is that the Smart People ™ decided that Smoking was No Good back in the late 1960’s, and are peeved that a significant portion of the Unwashed won’t Do As They Are Told. Studies about smoking, and especially ‘secondhand smoke’ have sported an intensifying odor of sewage since the late 1970’s.

        Sooner or later the various efforts to find a cancer cure will bear fruit, and then where will the American Cancer Society be? Right where the March of Dimes was when some damned fool came up with a polio vaccine, that’s where.

        Somebody really ought to do an in-depth study of the money trails in the anti-smoking business. I suspect they are as murky as the ones in the Anti-Saloon League.

      2. Yeah, I think we are saying much the same thing, Brett. And they are both common sense to me. Hell, that is what I told my two children – don’t smoke because it will kill you; don’t vape because nicotine is addictive and bad for you. My bigger point is that the CDC simply stated two objective facts. Seems pretty uncontroversial to me. Not sure why Reason seems to be critiquing the CDC for what is basic common sense. It makes me wonder sometimes.

        Totally separate question from personal autonomy and responsibility. My attitude is…hey, you smoke at your own risk. But please do not ask me as a taxpayer to subsidize your smoking related health issues. Your choice, you pay. Currently, our system is not set up that way.

        1. “My bigger point is that the CDC simply stated two objective facts. Seems pretty uncontroversial to me.”

          “A truth that’s told with bad intent
          Beats all the lies you can invent.”
          —Blake

        2. “But please do not ask me as a taxpayer to subsidize your smoking related health issues. Your choice, you pay. Currently, our system is not set up that way.”

          Wasn’t always that way, and I sure as hell didn’t ask for it to be that way, so I’ll tell you what, you work on changing it, I’ll support the change if it’ll ever come, and leave my fucking vices alone.

    2. Zero evidence that nicotine is any more harmful or addictive than caffeine.

      1. *snort*

        This former smoker laughs at that statement.

        1. No one cares.

          1. Fuck off Tulpa.

            1. I’m not Tulpa idiot and the science is clear so snort and laugh all you want dumbass.

              1. The science is clear that nicotine is no more harmful to caffeine. It is also clear that nicotine is highly addictive, while caffeine is not.

                1. If you ingested caffeine via your lungs, it would be pretty addictive, too. It’s the extremely fast effect that causes your hind brain to associate the act with the effect, while delayed effects are more mediated by your higher brain functions.

                  1. Hm, like the difference between doing a line and smoking a rock.

                    1. There’s a physiologic “difference between doing a line and smoking a rock”? What is it, time to onset and duration of effect? Uptake across a mucosal surface in the nose or rectum is pretty fast, maybe not much different than through the lungs when smoked.

                      With limited resources ($$$), rock cocaine is a cheaper way to intoxication than powdered cocaine? Or it’s a matter of availability and convenience which abusers go with? No longer any difference in the penalties for use of one form or the other of the substance?

        2. “This former smoker laughs at that statement.” — While sipping down another pot of coffee with no shamed guilt about it?? We’ll just see how well banning coffee goes eh?

          1. Keep it up. You ban coffee and you will find out what the NRA is really about.

            1. No worries — It’ll be a $30B ( As in Billion ) dollar ad campaign.

              1. We’ll sue Foldgers for giving you Coffee.
              2. We’ll use our redemption money to pay for cherry-picked “gov” epidemiological (fake) studies.
              3. Then comes Propaganda-Ad repetition “baaaad,, baaaad”, see little children suffer and stuff…. Until the “sheeple” start repeating our “sheeple facts” all over the place.

              Wait for the sheeples mobster-majority mentality to set in (Chicken-Pecking)
              4. Ban Coffee from absolutely everywhere (No coffee in the park)
              5. Make it so expensive you’ll go broke buying it
              6. Throw in anything that “looks” like drinking coffee under the same bandwagon…

        3. That’s less a comment on nicotine than it is on caffeine. Caffeine is pretty goddamned addictive. Which isn’t a justification for banning it. Of course, I’m a Crank who thinks the justifications for banning heroin are shaky.

          1. I’m a Crank who thinks the justifications for banning heroin are shaky.

            They are shaky. Heroin is largely harmless, aside from its being highly addictive. Especially if you compare it to alcohol, which is both highly addictive and poisonous.

            But it was banning opium that gave us a morphine problem, it was banning morphine that gave us a heroin problem, and it was banning heroin that gave us the prescription-opioid ‘crisis.’

            Now we have fentanyl. I’m sure we’ve got the ‘problem’ licked this time.

      2. The world has decided that “icky” overrides absolutely any and all real “evidence” from prejudice-based personal judgements.

      3. Is there evidence nicotine is particularly bad for your health? Caffeine raises blood pressure and heart rate, so what’s the big deal?

        Of course, the liberty arguments override any health concerns in any case.

    3. What the CDC has been saying is that nicotine use *is the same as tobacco use* – with the same risks.

      Nicotine is addictive, but its not particularly bad for you. Certainly not at a ‘we need to prevent people from using it’ level. Which is what the CDC has been pushing. Not harm reduction – vaping is less bad – but abstinence – people must be prevented from using nicotine recreationally so we must prevent the rise of safer nicotine alternatives even if that means that people will go back to the worst form (cigarettes) because its easier to get this stuff banned if its cigarettes (with their associated health risks) that people are using.

      In any case, vaping doesn’t cause disease, nicotine doesn’t cause disease, its nothing to do with the Center for *Disease* Control.

      1. Funny story – years ago (early aughts) when my doctor was trying to convince me to quit smoking, he explicitly stated, “nicotine is actually a wonder drug with wonderful effects on the mind and body in small doses, it’s the tar and combustion products that are unhealthy” This was a fairly common knowledge among health professionals.

        Then came vaping, and now nicotine is the bad guy.

    4. If it weren’t for its long association with smoking, who today would even have been saying nicotine was harmful? (I suppose they might have associated it with the slight morbidity from dry snuff if using tobacco that way had been around but not smoking it.) Of all the phytochemicals that might be singled out as hazardous, there doesn’t seem to be great reason to finger nicotine. It might be thought on the order of, for instance, soy phytoestrogens, in terms of stuff that’d be talked about as a possible health danger.

  2. Quit smoking – your body recovers quickly

    1. Quit working – your body recovers quickly

    2. Quit thinking – comment on Reddit.

  3. “Politics is the art of looking for trouble, finding it whether it exists or not, diagnosing it incorrectly, and applying the wrong remedy.”
    –Sir Ernest John Pickstone Benn

  4. My 10-year old told me today is the first day of Kwanzaa, so I looked it up.

    Here are the principles:

    Umoja (Unity): To strive for and to maintain unity in the family, community, nation, and race.
    Kujichagulia (Self-Determination): To define and name ourselves, as well as to create and speak for ourselves.
    Ujima (Collective Work and Responsibility): To build and maintain our community together and make our brothers’ and sisters’ problems our problems and to solve them together.
    Ujamaa (Cooperative Economics): To build and maintain our own stores, shops, and other businesses and to profit from them together.
    Nia (Purpose): To make our collective vocation the building and developing of our community in order to restore our people to their traditional greatness.
    Kuumba (Creativity): To do always as much as we can, in the way we can, in order to leave our community more beautiful and beneficial than we inherited it.
    Imani (Faith): To believe with all our hearts in our people, our parents, our teachers, our leaders, and the righteousness and victory of our struggle.

    Can you even imagine the cries of racism is white people pledged “To strive for and to maintain unity in the family, community, nation, and race.”?

    It would be deafening.

    Principals, not principles. Who the person is matters more than what the person does.

    1. Any white business owner who pledged “To build and maintain our own stores, shops, and other businesses and to profit from them together.” would find their shop burned to the ground within a week in the name of tolerance.

        1. These seven Kwanzaa principles are identical to the seven principles of the infamous Symbionese Liberation Army, the murderous, bank-robbing gang of revolutionary terrorists who kidnapped newspaper heiress Patty Hearst in 1974.

          Timeless, Universal Principles!

    2. On the first day of Kwaanza Dr. Maulana Karenga
      gave them hos a whipping with electrical cords.

      1. On the second day of Kwaanza Dr. Maulana Karenga gave them hos
        karate baton blows,
        and a whipping with electrical cords.

      2. On the third day of Kwaanza Dr. Maulana Karenga gave them hos
        a vice to crush their toes ,
        karate baton blows,
        and a whipping with electrical cords.

      3. On the fourth day of Kwaanza Dr. Maulana Karenga gave them hos
        a toaster upside their domes,
        a vice to crush their toes ,
        karate baton blows,
        and a whipping with electrical cords.

      4. On the fifth day of Kwaanza Dr. Maulana Karenga gave them hos
        soldering irons in their pieholes,
        a toaster upside their domes,
        a vice to crush their toes ,
        karate baton blows,
        and a whipping with electrical cords.

      5. on the sixth day of Kwaanza Dr. Maulana Karenga gave them hos
        detergent down their throats,
        soldering irons in their pieholes,
        a toaster upside their domes,
        a vice to crush their toes ,
        karate baton blows,
        and a whipping with electrical cords.

    3. 1. It was created by Maulana Karenga and was first celebrated in 1966. (as made up a holiday as grandparents day)
      2. American Black Power activist and secular humanist Maulana Karenga created Kwanzaa in 1966 as a specifically African-American holiday
      3. Racist to the core.

      1. All holidays are made up.

    4. The principles of so-called kwanza are abhorrent, being that they’re commie (and openly racist) principles through and through, but why gnash teeth over it?

      In 43 years of living, never once have I known anyone to observe it. Even blacks know that Kwanza is fucking nonsense.

  5. But we are agreed that vaping is a matter of public health and not a matter of individual choice, right? It’s not like “public health” has to do just with communicable diseases and environmental factors that affect an entire community, for no man is an island and it takes a village and you didn’t build that and what affects one affects us all my neighbor’s business is mine as well, share and share alike. Speaking of which, I see my neighbor is eating a cinnamon roll and I’m going to have to go beat the shit out of that fat fuck to make him quit eating so goddamn much sugar. Not just for his own good, but for my own sake as well – it’s a matter of public health and I am a member of the public.

    1. The public is everyone except any individual. That’s why cops get away with treating people like shit. They’re serving the public, which is everyone except anyone they interact with. Same with “public health.” Individual aren’t allowed to make their own choices because the public, everyone else, makes choices for them. “The will of the people” is basically “the divine right of the king.” We live in a feudal society. The costumes have changed and the technology has evolved, but we’re still just peasants who suffer at the whims of knights in service of the king.

      1. The case of “the people versus…”.

    2. Sell your souls to the [WE] foundation… 🙂

    1. Smallpox infested hijabs?

    2. Why am I thinking about North By Northwest?

  6. A few dozen people have died and this creates a full blown panic. Hundreds of people die every year as a result of smoking cigarettes and crickets. Approximately 80 thousand people die every year from Alcohol related causes and crickets. Nobody dies from smoking Marijuana and yet it is still classified as a schedule 1 drug. We need to end the prohibition on Cannabis and tax it and regulate it the same as Alcohol and cigarettes.

    1. Hundreds of people die every year as a result of smoking cigarettes and crickets.

      Really? *REALLY*?!

      You haven’t been paying attention to the massive, multi-decade anti-smoking campaigns? The pushes to photoshop cigarettes out of old movies? The Master Settlement Agreement?

    2. tax it and regulate it the same as Alcohol and cigarettes.

      Fuck that. Rest I agree with but no luxury taxes or regulations needed. Tax all products at the same rate if you have sale taxes in your jurisdiction.

    3. They’re smoking crickets?

      1. I hear you can get a nice buzz from smoking crickets

  7. Government people are just stupid, I think there is no other explanation as harsh as it seems. 10 years of vaping and NO problems and now a tiny fraction suddenly develop symptoms so “all vaping products cause horrible lung disease”. It’s really sad that our tax dollars can be consumed by such incompetence. They are literally risking people’s health and lives with their poor guidance. Of course these are the same people who told us it was healthy to eat 8-11 servings of pasta a day.

    1. Excellent post. I was about to comment on the exact same thing.. It appears our over-funded CDC and FDA have become special interest lobbying (i.e. Lying) groups and wildly biased bloggers. The only problem with that is many people have put their faith in them to be more than just another biased special interest organization.

      Time to cut the CDC and FDA budget by 80% or more.

        1. That’s more than the undertaker makes!

      1. Congress has reached a spending agreement that includes $25 million for gun violence research…. The money will be split evenly between the Centers for Disease Control and Prevention and the National Institutes of Health.

        “It’s the biggest amount that the federal government has ever put into federal firearms research,” Rosenberg noted. “It signals an end to the drought of knowledge about preventing this significant problem.”

        Any predictions as to the cause(s) and solution(s) they’ll come up with?

        1. In 2013 — 33,636 or 0.000106% of the population suffered a gun related death (67% suicide) with 11,208 homicides according to FREE wikipedia research.

          That’s another $743 Per/Any-Gun related death.
          Or $2,230 Per/Gun related homicide.

          I’ll put my prediction in that they’ll waste all that money on nothing but “smoke-and-mirrors advertising” that’ll draw public support (like flies to a cow-pie) for more government dictation on its people and call it “gun-control” even though its really “people-control”. Don’t seem to be hearing them mention any more controls on guns since the safety switch.

        2. Nothing that (should) overrides the constitution.
          ‘Shall not be infringed’ means ‘shall not be infringed’.

          1. Rosenberg signals that another $25 Million dollars of propaganda might get even more people to support infringing the Constitution..

  8. The Comment that deserves repeated here….
    juris imprudent
    November.27.2019 at 2:22 pm

    Your facts cannot compete with the power of the Moral Panic.

    https://reason.com/2019/11/27/study-finds-nearly-all-minnesota-patients-with-vaping-related-lung-injuries-used-illegal-thc-products-containing-suspect-additive/#comment-8028859

  9. This has nothing to do with public health, and everything to do with conditioning the public to accepting federal government banning of anything for any reason.
    Soon there will be funding for studies to prove being republican is a health hazard, and recommending a ban on all conservative expressions of opinion.

  10. Sullum is too anti-government for his own good.
    Yes, it’s lamentable that the nanny state wants to enforce proper behavior on us all. But the flurry about vaping is completely legitimate, and Sullum is engaging in his own species of misinformation.

    As he points out, the lung disease panic affecting a couple of thousand people seems to be due to THC street products using Vitamin E additives. But there is a separate issue, which is that there is now serious evidence that e-cigs are creating an increase in lung ailments affecting much larger segments of the population. Yes, if you’re a smoker, you’re better off vaping and trading off the risk of lung cancer for emphysema, bronchitis and less deadly diseases. But there are a lot of new adopters of vaping, especially among teenagers, and these people (and their parents) need to know that nicotine addiction isn’t the only risk. I have two teenage daughters, and I hear about vaping daily. A lot of kids are doing it, and there is a lot of peer pressure to do it. For someone who is not a smoker, vaping is a bad idea, and that’s a big group.

    1. You’re too pro-government for you own good. The flurry about shaming fat people is completely legitimate and you are engaging in your own misinformation.

      I have two teenage daughters, and I hear about them eating daily. A lot of kids are doing it, and there is a lot of peer pressure to do it. For someone who is not an over-eater, over-eating is a bad idea, and that’s a BIGGER group and health RISK than anything in this article or on your completely BIASED radar..

      “baaaad, baaaaad, baaaaad” – The sheeple have become completely immune to their own disgusting prejudices.

      No; I don’t think any of the above – and I think it signals one sick SOB’s mentality; but sometimes an example has to be used to show people just how sickening and perverse their implanted propaganda driven prejudices have resorted them to be.

  11. Thank you but the CDC budget alone is $4,221 PER-PERSON that dies every year.

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