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Comment by dr_dshiv | Hacker News Reader

This all seems like such terrible journalism. Vaping can refer to: 1. Juul and similar e-cigarette nicotine products 2. Iqos or Pax tobacco or marijuana non-combustion products 3. Legal Cannabis oil branded products 4. Illegal cannabis oil products.

All issues have come from illegal products. No brands are mentioned. Clearly, contamination is the issue. It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common.

About 10 people a day die in swimming pools. But 4 total deaths ever is an epidemic?

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>It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common

Is it irresponsible to criticize OxyContin because an alternative like fentanyl is even more dangerous?

Vaping might be safer than smoking, but it isn't necessarily safe. Vaping can and often is used by smokers to handle their nicotine addiction. That doesn't mean we should ignore that vaping can of often is used by people who aren't yet addicted to nicotine, namely teenagers. In those cases it can lead to nicotine addiction and eventual smoking.

I don't want to completely vilify vaping, but the whole idea that we should be fine with it because it is "safer" is completely flawed.

I'd like to understand why you think it is completely flawed. That is a strong statement that confuses me.

Because it sets up a false dichotomy that one can either be anti-vaping/pro-smoking or pro-vaping/anti-smoking. It is possible to recognize that vaping is safer than smoking but it is still dangerous and provides enough negative externalities that it should be highly discouraged.

Ok, fair enough. But you'd agree, then, that the degree of discouragement should be proportional to risk, right?

And that's where the 10 people per day dying in swimming pools seems relevant to bring up. Or the fact that 67% of smokers die from smoking, with hundreds of thousands of deaths per year. Or the fact that a majority of Americans believe that vaping is more harmful than smoking. https://reason.com/2019/04/10/the-percentage-of-americans-wh...

That's weird, right?

>But you'd agree, then, that the degree of discouragement should be proportional to risk, right?

Yes partially, but it should also be proportional to the public's knowledge too. That is why some products are recalled after a single accident. It isn't that people are destined to die. The problem is instead when people assume the level of risk is low when it is actually moderate. That can be more dangerous than a riskier option in which everyone knows it is risky. For example, a swimming pool is unquestionably more dangerous than a trampoline. However most parents know a swimming pool is dangerous and won't let their kids swim unsupervised. They might not be aware of the dangers of trampolines. That asymmetry in the knowledge of the risks might end up making the trampoline more likely to result in an accident.

The general public thinks vaping is safer than it is. The general public is already very well aware how dangerous smoking is. I therefore think it is perfectly reasonable to be louder in denouncing vaping, especially considering this recent news seems to show it is even riskier than initially thought.

Check this article out. I see where you are going, but we are talking about an alternative to smoking, which is really bad.

https://www.bmj.com/content/360/bmj.k575

Sure, but that is missing half the equation. Every person who vapes is not a person who previously smoked or would have chosen to smoke if vaping didn't exist. The rate of the growth in vaping is much higher than the rate in decline of smoking. Like I said before, vaping can help people who are already addicts become healthier, but it is also creating new addicts and that is a problem.

I like to vape. I like to drink coffee. I like potato chips. All are addictive. If potato chips and coffee were released in 2019, would they be banned in San Francisco because they are addictive and dangerous for public health?

If OxyContin and fentanyl were both available at grocery stores, and a bad batch of poorly formulated street Oxycontin caused a slew of numerous deaths. And the blame causes more people to switch to fentanyl then Oxycontin that blame could be dangerous

It's irresponsible because it's ignoring a very clear factor in all these cases is that they're all linked to illegal, off the street goods filled with who knows what. It would be more akin to saying oxycontin is bad because people die from contaminated heroin. Not that oxys don't have their own dangers and addiction issues.

> Is it irresponsible to criticize OxyContin because an alternative like fentanyl is even more dangerous?

Except that "fentanyl has a higher therapeutic index than morphine (400 vs 70)". Meaning that the difference between a therapeutic dose and lethal dose is much bigger with fentanyl (ie: safer!).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312206/

The main issue with fentanyl is that it's potent. Which our supply-driven interdiction system has favoured the movement toward.

But so potent that intermediaries can't mix it up right outside of a proper lab.

The issue which I understand is primary with fentanyl is purchasing black market fentanyl and selling it on the street as heroin or whatever other opiate and cutting it with various things leading to a wild variety of potency of street drugs, even within the same purchase (poorly ground, poorly mixed) which leads drug users to overdose much more frequently.

Fentanyl, absolutely is safer than many other popular pharmaceutical opiates but only when the dosing is done competently and accurately (even someone abusing opiates is safer using fentanyl IFF they are capable of knowing and distributing their desired dose)

Exactly. It would be better to dissolve easily-measurable-at-home quantities into large volumes of fluid, but it's hard to make powdered synthetic H substitutes that way.

Properly micronized and triturated, synthetic H made with fentanyl would be very safe stuff. Unless you could afford enough to OD yourself, which you might now be able to at the prices it could be sold at.

Are you certain this is only happening from illegal products?

Here are pictures of brands new york has flagged: https://www.flickr.com/photos/nysdoh/sets/72157710703391248/

And according to this article: https://beta.washingtonpost.com/health/2019/09/05/contaminan... a man died after using a product purchased from a dispensary:

  a middle-aged adult who died in late July of a severe respiratory illness had used an e-cigarette containing marijuana oil purchased from a legal dispensary. It’s the second death linked to vaping nationwide and the first to be linked to a product bought at a store.

I suspect it is only illegal products because they have only shown pictures of brands but not actually referred to any brands in the text of the article. I find that strange.

“All issues have come from illegal products.” You confidently state Yet claim terrible journalism...

The title of your first link is literally "Pulmonary illnesses associated with black market vaping products"

thanks for that, flickr cuts off a significant portion of the title for me:

  Pulmonary illnesses associated with b...

I also don't live in NY so I don't know those brands; the fancy packaging makes it appear similar to much of the recreational stuff I've seen in other states.

The second point still stands.

These are not actual brands. Black market vape manufacturers buy generic packaging that is sold to anyone. There's no actual company behind these "brands". They exist only on the black market.

Decent article on buying boxes and how "brands" like Dank Vapes can have a social presence on IG and other platforms but avoid responsibility for "official" or "unofficial" products.

"They act like a cannabis company, but they actually don’t exist. They’re in the packaging industry," ... "These are just people filling cartridges as 'Dank Vapes.' It's not a singular facility. It's just people in their garages filling them and selling them.”

https://www.inverse.com/article/58581-dank-vapes

Thanks for that info

I'm not hip to all the various state's stands on THC/CBD containing products, but from your first link:

>Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing. Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products that were tested.

One man died from _legally_ bought cannabis oil.

https://www.usatoday.com/story/news/health/2019/09/05/vaping...

That’s not entirely clear, it’s just stated that he purchased from a dispensary. That doesn’t mean that’s the product that caused his issues, that he never used (cheaper) black market products, etc.

https://www.google.com/amp/s/www.nytimes.com/2019/09/05/heal...

This is as much the CDC's fault, it seems like, digging in to the underlying sources.

This is the FDA's wheelhouse. CDC handles epidemiology.

epidemiology

> the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

disease

> a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

Is this not a disease? One of which the actual cause is still unknown and symptoms hitherto unseen? I guess it could still ultimately be the result of physical injury to the lungs, but it still seems up in the air. You may still be right, but I don't think it's as simple as "CDC handles epidemiology".

They don't regulate the use or sale of controlled substances.

Do they regulate funding of research around either the material or its affect on the human body?

Products like Juul do have harmful byproducts:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342216/

I think you misread this paper:

"Gas-phase benzene was not found above blank levels in any of the JUULTM samples for any of the four flavors. "

They detected benzene with two other tank-style vaporizers and seems benzene production is strongly correlated with wattage.

>All issues have come from illegal products. No brands are mentioned. Clearly, contamination is the issue. It is irresponsible to blame "vaping" especially considering that the alternative is "smoking" -- which won't ever result in a newspaper article about sickness/death because it is so common.

This doesn't sound like that:

>The Los Angeles County Department of Public Health was investigating a possible fifth death, saying on Friday afternoon that the fatality was “associated with the use of e-cigarettes, also known as vaping.”

I'm assuming e-cigarettes are the legitimate sort.

> Public health officials have underscored one fundamental point: that the surge in illnesses is a new phenomenon and not merely a recognition of a syndrome that may have been developing for years.

I'm pretty sure these cases are all from legal retail cannabis oil products.

> It is irresponsible to blame "vaping" especially considering that the alternative is "smoking"

False dichotomy. Not consuming nicotine is also an alternative.

Not breathing is also an alternative. Perhaps I should have said that vaping is an obvious alternative to smoking

I'm unclear why it's an obvious alternative. Nothing inevitable about the use of nicotine (or THC).

except for the rich and far-reaching history of human substance use (or abuse, depending on your perspective)

Also gums, patches, etc.

I'd guess patches as the best, because the slow release breaks a lot of the fun of the addiction cycle. Apparently though, it's best to use both patches and one other NRT - https://www.cochrane.org/CD013308/TOBACCO_what-best-way-use-...

Vaping is just too much like smoking. It's basically the same habit, it's got the same quick hit, you'll have very similar rituals (leave your desk, go for a vape break, "light up", etc).

There's also the community factor. There's no nicotine patch community, but there's a vaping community. Maybe the vaping community was originally all people trying to quit cigarettes, but now it's also a gateway to people getting into smoking.

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