Young People are Dying and We’re on the Eve of a (Flavored) Vaping Ban

I have been working on this blog for ten days. I haven’t been able to publish it because the news just keeps worse by the day. Which is why I’m just going to push it out and let the numbers continue to take care of themselves.

I can’t wait any longer: I have to get this out.

We are now up to six deaths among more than 450 known cases of pulmonary illness related to vaping. (The number of known deaths when I started this column was zero. By the end of the first revision it was one. Today it is six. I expect it to rise again as health officials go back through the records and investigate previous mysterious cases of young people with pulmonary illness and discover they were vaping-related).

The Trump Administration announced its intention to take a step I never thought we’d see—and definitely not this quickly: A ban on nontobacco-flavored vaping products, details TBD, but FDA is scrambling to provide guidance. It’s a critically needed step in the right direction.

I look at it this way: If candy bars were placing this many young people in intensive care units and suddenly producing a body count, we’d probably be banning those candy bars—no questions asked.

What I Planned to Say Before the Ban

You know, it’s funny how expertise evolves.

I didn’t set out to become an “expert” on vaping and health. I just started following the science as it emerged. That’s what scientists do. We form hypotheses; we wait for evidence to confirm or disconfirm hypotheses.

Initially, I was interested because vaping was directly tied to the daily work of the oral health professionals I speak to and educate on a daily basis. And the earliest evidence about this “safer” alternative to smoking tobacco concerned me. It didn’t seem all that solid. Where was the evidence it was “safer?”

I didn’t see it.

So I spoke up. I questioned. I kept following the topic. And as evidence emerged, I kept passing along the evidence.

But honestly—really, truly—I never set out to be “That Vaping Guy.”

So it is with mixed emotions that I share, yet again, emerging evidence about potential serious emerging health risks of vaping—even without nicotine. (This is why I’m dubious about excluding nontobacco-flavored vapes from the ban, by the way.)

Unfortunately, mounting evidence is being reported and I’m getting questions about it at presentations, more than ever.

Here’s the latest.

Neurological risks of vaping: The FDA is investigating 127 reports of possible links between seizures and “other neurologic symptoms” in people who used nicotine-vaping devices. That number was accurate as of August 7, 2019; the investigation began in April, based on just thirty-five reports. Fainting and tremors are among other symptoms, in both adult and young users, traced back to as early as 2010. The FDA is also asking the public, health care workers, and the public to report detailed information about seizures or other neurological symptoms following e-cigarette use at the FDA Safety Reporting Portal.

Lung risks of vaping: At the same time FDA is probing worrisome neurological syndromes, the Centers for Disease Control is looking at outbreaks of respiratory illnesses in fourteen states states that may be associated with vaping. so far, CDC has said there is no infectious disease or etiology behind these illnesses. The syndrome, so far identified in ninety-four patients since June 28 (only ninety four! We were so innocent on August 18!) is a severe lung illness tied to vaping. Symptoms include coughing, fatigue, shortness of breath, and most concerning of all is that those suffering include teenagers and young adults, with some so seriously affected the required artificial ventilation. Some patients have also presented with anorexia and “ground glass opacities.” State health departments and the CDC are so far declining further comment and are not releasing further details; stay tuned.

A possible first vaping-related death. (And now, a second, third, fourth, fifth, and sixth.) On Friday, August 23, 2019, health department officials in Illinois confirmed the death of one patients in the cluster of individuals with respiratory illnesses being investigated by the CDC. Although specific identifying details have not yet been released, the patient is described as one of twenty-two patients in Illinois suffering from such ailments “between 17 and 38 years old”—not a demographic we typically expect to see affected in such severe ways.

Blood vessel compromise, even without nicotine: We also even more interesting and unsettling news about the pure biomechanics of vaping without nicotine, thanks to a recent study that investigated the vascular effects of nicotine-free vaping. Dr. Allessandra Caporale, primary researcher at University of Pennsylvania Perelman School of Medicine in Philadelphia, says “”We essentially found that using e-cigarettes is not equivalent to inhaling water vapor; in fact, it can exert acute, detrimental effects on (blood vessels) even when the liquid does not contain nicotine.” Based on earlier research that showed oxidative stress and inflammation in blood vessels for hours after vaping, her study used MRI technology to measure vascular function in thirty-one healthy non-smoking adults after they took sixteen three-second puffs of nicotine-free vaping liquid formulated from propylene glycol, glycerol, and flavoring. The results: Their blood vessel reactivity was “considerably and significantly impaired.” After one vaping session. In non-smokers.

While these studies, as all early studies, are neither conclusive nor should they be used to y confirm an association between vaping and any specific illness (science does not work that way), they are suggestive of evidence that continues to lead us in the direction of aggressive further study.

Question Everything

I am still asking questions about vaping.

For example: How (in a story published today of all days) did the Wall Street Journal publish this sentence?

“Public-health officials have encouraged adult smokers to switch to less risky products such as e-cigarettes, which deliver nicotine in a cloud of vapor.”  (Wait—less risky? By what possible criteria? Young people are on artificial respirators after vaping—and some no longer are—but not because they got better.)

When the story of The Great Vaping Debacle is finally written, I expect we’ll find—as we usually do in cases when a great deal of money is involved—that there were people all along who saw evidence that concerned them and raised questions.

We know this story already, actually.

It’s as old as the tobacco industry.