Did Vaping Cause Fatal Lung Failure? Basic Epidemiology Says No

Following several deaths from acute lung failure among e-cigarette users, the U.S. government has intensified its crackdown on e-cigarettes.

Michigan became the first state to impose a comprehensive ban on the sale of flavored e-cigarettes. Former New York City Mayor Michael Bloomberg announced a $160 million campaign to ban flavored e-cigarettes in at least 20 cities and states. Ultimately, the New York health group voted to ban the sale of flavored e-cigarettes in the state.
 

Moreover, some scholars even claim that menthol-flavored e-cigarettes, which are not included in the ban, must also be banned because teenagers have switched to menthol after being unable to access various fruit and sweet-flavored e-cigarettes. However, since last year, the media has been on a full-scale crackdown on e-cigarettes, and the government has taken continuous action, but what has been the result?

The latest survey results show that one in four high school students in the U.S. vape. There has been no reflection from those who insist on banning; their response has been to continue and strengthen the bans.

In this context, renowned medical expert and e-cigarette supporter Farsalinos Konstantinos wrote this article to highlight the absurdity of the current crackdown on e-cigarettes.

Below is an excerpt from the paper

I have been closely following the recent developments and announcements regarding acute respiratory failure in the U.S., cases that have been labeled as "e-cigarette-related." To call the reactions of certain authorities, regulatory agencies, and scientists hysterical is not an exaggeration. Undoubtedly, while they are emotionally charged, they lack any scientific or epidemiological basis.

Almost all announcements, whether from health organizations or local public health authorities, refer to these cases as "e-cigarette-related." In news headlines, they fail to mention that many of the cases have been confirmed to involve individuals who used cannabis through battery-operated and resistant devices (such as e-cigarettes). They dare not admit that these cases are actually related to THC/cannabis and not e-cigarettes.

Let's start with the most basic question. Why is it incorrect to label these cases as "e-cigarette-related"?

Even without information about the deceased using cannabis or THC, simple principles of epidemiology can clear e-cigarettes of blame.

Since 2009-2010, e-cigarettes have been popular in the U.S. and globally. Today, approximately 10 million people in the U.S. use e-cigarettes, many of whom have been using them for years, and the number of e-cigarette users in other countries is certainly higher.

In the U.S., the average age of adult vapers is about 40 years (based on my research data from the upcoming NHIS survey). Until this summer, there have been no reports of disease outbreaks in any age group in any other region of the world. Suddenly, in a short period, in specific geographic areas (where e-cigarettes can be purchased worldwide, not just within the U.S.), and among specific age groups (teenagers or young adults), there have been severe cases of acute respiratory failure leading to two deaths and multiple hospitalizations.
 

Ignoring any information regarding cannabis/THC use, what does this tell us from an epidemiological perspective?

These cases are unrelated to long-term e-cigarette use. Authorities have clarified that this is an emergency situation. Despite various media describing it as a mysterious lung disease, it is actually a clinical manifestation of poisoning in the lungs, presenting as severe respiratory failure (perhaps acute respiratory distress syndrome or some form of severe lung inflammation leading to respiratory failure).

These cases are unrelated to vaping products that have been on the market for years in the U.S. and globally. It makes no sense that the same products that have been used by millions for years without causing any disease outbreaks suddenly cause acute illnesses today, rather than chronic diseases.

These cases are related to newly released products, or to changes in the composition of products recently available on the market, or to recent issues in the manufacturing process or original products. This explains the timing of the outbreak. These products may be nicotine-containing or nicotine-free (remember, we assume no information regarding THC/cannabis). #p#分页标题#e#

All these conclusions stem from applying simple principles of epidemiology, but most authorities, regulatory agencies, and scientists have overlooked these conclusions. Instead, we have witnessed a continued, frenzied, unprecedented campaign against e-cigarettes, which effectively conveys a clear message to consumers: it is better to continue smoking traditional cigarettes than to use (or switch to) e-cigarettes.

Now, let’s consider reports linking THC/cannabis vaping to lung outbreaks. Although several reports and announcements from health departments have mentioned this, not a single case has been identified as "THC/cannabis-related." Why? Well, it seems that some states that have legalized THC/cannabis cannot suddenly admit they were wrong and that their decisions led to the outbreak of acute illnesses. So far, it has been easier and more convenient to blame "evil" e-cigarettes for all consequences.

But should they blame the outbreak of this disease on THC/cannabis and label it as "THC/cannabis-related disease"? I think not. If THC/cannabis does not cause acute respiratory failure from smoking, then it is unlikely (if not impossible) that inhaling tobacco via e-cigarettes would cause disease.

The culprit is not THC/cannabis itself. These cases likely involve other compounds or contaminants used in the preparation of liquids containing THC/cannabis. While there have been reports of plant oils being used as solvents (certainly consistent with cases of lipoid pneumonia) or sterilizers, we have yet to determine the cause.
  If the culprit is illegal products containing illicit substances obtained from the black market, then this is no different from blaming syringes for deaths caused by intravenous drug use; it is also no different from blaming whiskey for deaths and blindness caused by illegal alcohol containing methanol. Sounds silly, right?

However, all of this remains hypothetical. Currently, there is no clear report on the cause. Therefore, we should focus on the aforementioned epidemiological principles: millions of consumers have purchased and used products for years that are now almost impossible to cause acute lung failure. While I understand the CDC's cautious attitude, it is certain that they fully understand the epidemiology behind this outbreak, and they should do more to quickly identify the cause. Other organizations have exploited this disease outbreak to advocate that no one should use e-cigarettes.

There have been several health crises in the past, such as chicken contaminated with dioxins (a few years ago in Europe), mad cow disease, and recent outbreaks of salmonella in chicken in the U.S. that led to two deaths and 175 hospitalizations. For the latter, I am sure that all these individuals were not only consuming backyard poultry but also eating poultry from markets or fast-food restaurants. However, no one viewed it as a disease related to chicken overall, nor was there a general recommendation against consuming poultry (despite being safe for decades). I wonder if, once the exact cause of the outbreak is identified, the passionate statements made by the media, scientists, and authorities will be corrected. I even doubt whether the media will report this story with the same "enthusiasm" as today.

In summary, from an epidemiological perspective, the cases of acute respiratory failure reported in the U.S. are extremely unlikely (I would say certainly not) to be attributed to products that have been sold globally for years and have been used by millions. Millions of consumers should urgently identify the exact cause of these situations and quickly put an end to the emotional, irrational hysteria against e-cigarettes.