CDC says stop vaping as mystery lung condition spreads | Hacker News Reader

CDC says stop vaping as mystery lung condition spreads

techcrunch.com

338 pointstinyduck428297 comments

Several things have failed to show up in the comments that might illuminate this discussion.

(1) The condition is called lipoid pneumonia, which comes from inhaling organic fats and oils.

(2) The CDC reports and early studies indicate that the condition has appeared in some people who only vaped with nicotine in glycerol (which is also sometimes called glycerin or glycerine).

(3) Glycerol (the Christmas molecule--HO HO HO) is a type of alcohol called a polyol, meaning that it has multiple (in this case, three) hydroxyl groups on a carbon chain.

(4) Glycerol is not a fat and cannot be responsible, on its own, for lipoid pneumonia.

(5) However, glycerol is the precursor to fat synthesis in the body: triglycerides, for example, are fats metabolized from glycerol.

(6) The reaction of glycerol -> triglycerides in the body is catalyzed by nicotine-containing enzymes mostly present in the liver, but expressed to a lesser extent in every cell.

(7) The reaction of carboxylic acid (derived from CO2) with glycerol creates fatty acid esters through the process of acid-catalyzed esterification.

(8) The key unanswered question is where does the fat that is found in the macrophages (a type of white blood cell whose function is to engulf and digest foreign substances) that is the sine qua non of lipoid pneumonia come from.

(9) Many vapers are formerly heavy smokers, meaning that they have some degree of chronic lung disease, that they retain CO2, and are very likely to have respiratory acidosis.

(10) Elevated CO2 also occurs in many other circumstances, such as opioid use and sleeping in poorly ventilated conditions.

(11) If the early reports are correct that lipoid pneumonia is occurring in vapers who have only used nicotine in glycerol with no flavoring or impurities, then we must ask the question: Is glycerol being converted to fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-catalyzed esterification in the presence of high CO2 levels and acidity?

I think >(9) Many vapers are formerly heavy smokers, meaning that they have some degree of chronic lung disease, that they retain CO2, and are very likely to have respiratory acidosis.

Is important to add to the discussions. A lot of articles are pointing the finger at THC carts. They may be the catalyst but according to this NEJM article[0]:

>About 80% of the persons who vaped and became ill reported having used both nicotine products and tetrahydrocannabinol (THC) or cannabidiol (CBD) products.

That's for 215 acute cases and 2 deaths that they cited.

[0]https://www.nejm.org/doi/full/10.1056/NEJMe1912032

lifetime smoking history is a major confounder that needs to be measured and highlighted.

> nicotine-containing enzymes mostly present in the liver

Nicotine from ingested smokee/vape/tobacco, or from other natural human physiology?

They are probably talking about nicotinamide adenine dinucleotide (NAD+/NADH), a common cofactor used in redox reactions. While nicotinamide the word appeads similar to nicotine, they are in fact completely different chemicals... There are no "nicotine-containing enzymes" in the human body.

> (3) The CDC reports and early studies indicate that the condition has appeared in some people who only vaped with nicotine in glycerol (which is also sometimes called glycerin or glycerine).

Are you sure? The article states ... "...most of the afflicted users reported using THC exclusively or as well as nicotine."

The information and wording used in these reports seems designed to maximize fear, but more importantly, maximize uncertainty, confusion, and speculative discussion.

From the TechCrunch article:

> One trend worth noting, however, is that very few of the cases involve only nicotine products

You'd have to read these articles very carefully to discern that.

> ...most of the afflicted users reported using THC exclusively or as well as nicotine.

Ditto.

If this is such a serious public health risk (as it seems to be, with more than one death involved so far), why the weasely language, why is this being communicated exclusively through the use of ambiguous terms like "some", "most", "associated with", etc?

> While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products. A smaller group reported using nicotine only.

"A smaller group reported using nicotine only" - how much smaller? Technically speaking, two people is a group, and is smaller than say 400.

Every official news release I've read on this (with the exception of one or more from particular state-level medical organizations) is written in this manner, a maximization of uncertainty and confusion, but with every single sentence being technically correct if taken literally as written. This is plausible deniability done right.

Why don't they simply publish a concise table of data that unambiguously states the actual numbers that they have in their possession (otherwise, how would they make these statements), but instead choose to take the far more laborious approach of describing that data, and in unclear and extremely ambiguous terms?

They currently have a small and changing dataset. These are news articles, not peer-reviewed scientific papers. When researchers publish datasets it’s to back up conclusions that they’ve made based on the data, and in this case they haven’t reached conclusions. Implying otherwise to the public would be irresponsible.

> They currently have a small and changing dataset. These are news articles, not peer-reviewed scientific papers.

Neither of these prevents them from publishing the dataset that they do have.

> When researchers publish datasets it’s to back up conclusions that they’ve made based on the data, and in this case they haven’t reached conclusions.

Correct, but they are broadcasting a high level of danger "associated with" vaping, and rather than transparently and fully disclosing the data that as-close-as-possible reflects the specific area of the danger, they are instead using ambiguous text to describe the data in a way that makes it highly uncertain where the actual danger lies, while "hinting" (but explicitly saying) that the danger lies in ecigs in general, not THC vapes in particular. Nothing about the data is forcing them to do this, they are choosing to do this. I am curious why.

> Implying otherwise to the public would be irresponsible.

Implying something, while hiding what actual facts (data) they have in their possession is precisely what they are doing now. And yes, it is irresponsible.

I can think of a several entities who would rather the actual data ("facts", to the best of our knowledge) is kept secret and have this (unnecessarily) vague story of danger drag out as long as possible in the media and public dialogue. However, I can think of no valid reason that the data needs to be kept secret - can you?

> has appeared in some people who only vaped with nicotine in glycerol

> most of the afflicted users reported using THC exclusively or as well as nicotine

"Some" being (in a loose sense) the complement of "most", I see no contradiction.

> (11) If the early reports are correct that lipoid pneumonia is occurring in vapers who have only used nicotine in glycerol with no flavoring or impurities, then we must ask the question: Is glycerol being converted to fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-catalyzed esterification in the presence of high CO2 levels and acidity?

How about also asking another question: do some people using cannabis "dank" vapes lie?

Police, perception, insurance: three good reasons cannabis smokers wouldn't give the truth and might just say they smoked nicotine.

I think that needs to be weighed against the fact that it seems unlikely 1) everyone would lie and 2) they would lie regarding a health issue that has killed people, meaning they have a strong interest in doctors having accurate information so it doesn't kill them too

> it seems unlikely 1) everyone would lie

From the article "One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine."

I struggle to see why GP is completely ignoring this and is insinuating that normal nicotine vaping is dangerous. It is fabulously unlikely we have only just "discovered" this.

Instead, something has changed, and that has been detected.

I worry because there seems to be a very strong media campaign of "don't vape nicotine", when the facts I have read say "don't vape THC carts". I imagine that there is an argument that it is safer to be over-cautious, but it also discourages smokers from converting to vaping. Vaping is not healthy, but it seems to be far healthier than smoking. I have very clearly seen the health positives of vaping within my own social circle. Maybe there is no disinformation campaign, but something seems majorly weird about this topic.

Disclaimer: never smoked nor vaped.

I just see a general "dont vape" trend and that is good. Until we know more, lay off.

Vaping often replaces smoking. Even with this recent health crisis accounted for vaping is far less risky and damaging to health than smoking.

I agree that it seems like contaminated THC cartridges from the reports I see.

Whatever the cause, it has to be something extremely subtle and very unlikely to occur. We know that from the simple numbers. Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases means that whatever is occurring is a freak occurrence and not some direct consequence that has a high likelihood of occurring in typical people.

And isn't one of the common threads within this whole thing the presence of Vitamin E acetate within the oil?

Earlier reports were suggesting that contaminated oils may be part of the cause, which could explain why all these cases are hitting at once. Not sure on the process of making these oils, but I could see new methods being introduced causing unforeseen side affects.

The initial NY report mentioned also that they were likely counterfeit products, which I could easily see as being prone to use an unsafe substitution.

> Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases

Vaping is new.

Maybe these are the early incidents of a yet-to-be-discovered chronic condition that takes a decade plus of vaping to develop.

Hey, millions of high schoolers smoke cigarettes and none of them have lung cancer! (yet)

18 and 19 year olds are in commas, dead right now, or will be soon. This is killing people far faster than cigarettes. I'm of the opinion the small fraction of people claiming they only smoked nicotine are probably lying for reasons mentioned before. They are young kids who don't want to disappoint their families with the fact that they are now dying at a very young age from what used to be a mostly harmless activity (marijuana smoking). There are also settlements and insurance including life insurance, AD & D to consider as well.

Juul Lab's and all the vaping shops need to be put out of business for claiming this is a harmless way of smoking. Kids took that and ran with it as they vaporize God knows what to get high in a stealthy and supposedly, more healthy way.

>18 and 19 year olds are in commas

Oh no, not commas! What other punctuation related illnesses hover over our head, waiting to descend when the clouds of vape smoke clear?

Missed periods?

Or, even worse, colon cancer. (A terrible affliction that can leave one with a semi-colon.)

(I'll get downvoted... like you... we will go down together.)

Wait, so in your first paragraph, you acknowledge the likeliness that the afflicted is almost certainly from contaminated THC cartridges.

But in the second paragraph, you say that Juul -- a legal company that produces NICOTINE cartridges, not THC -- should be shut down.

How does A lead to B here?

> 18 and 19 year olds are in commas, dead right now, or will be soon. This is killing people far faster than cigarettes.

According to the article, 5 people have died due to this vaping related illness. By contrast, cigarette smoking kills 480,000 people a year in the US: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

And this is a more or less useless comparison. Juul has only existed at all for about 4 years. Smoking kills huge numbers of people, but not in 4 years.

AFAIK, the data is consistent with vaping being more dangerous than smoking.

For what it’s worth, humans evolved in the presence of fire. Plant smoke, while quite dangerous, is something that mammal lungs have dealt with, in moderation, forever. Whatever chemical soup is present in vaping vapor is new. And saying “it’s just glycerol” makes no sense. Glycerol has very small vapor pressure at body temperature and boils well above the boiling point of water. Some websites suggest that the actual output from vaping is quite nasty indeed.

> Whatever the cause, it has to be something extremely subtle and very unlikely to occur.

We don't know that, or not with the interpretation I think you're making. I mean, the correlation here between vaping and lipoid pneumonia is objectively much stronger than it is between smoking and lung cancer after a similar amount of use.

I guess most epidemiologists would go with you and bet that this is "probably" not as bad, long term. But given the evidence at hand that's still a pretty significant risk.

Not a chemist so looking for a little clarification. The typical "base liquids" (that nicotine is suspended in) are vegetable glycerin ("VG") and propylene glycol ("PG"). When you say "glycerol", which exactly are you referring to? (Or is it both?)

(VG makes the larger "clouds" that some people prefer, typically with lower nicotine concentrations. PG is much less visible and dissipates quicker, but some people consider it a little more harsh, regardless of nicotine concentration)

Glycerol is glycerin, glycerin is glycerol - it's mainly a matter of UK (glycerol) vs. US (glycerin) terminology.

I had a startup in Vaping(nicotine) and am still fairly in touch with the industry. There has been no major innovation in nicotine eliquid that would cause a sudden cluster of issues. It's stayed pretty constant since 2013 with the exception of Salt Nicotine, which Pax labs has a gras study published for.

The majority of cases seems to be THC carts where it can be confirmed. One case was confirmed from a dispensary in Oregon. The "Dank Vapes" carts are sold on eBay/AliExpress and anyone can fill them with anything. Reading on here the VitE may have been to increase potency is not something I'm familiar with since I'm not in the TCH trade, but I do know that synthetic vitamin E is made from a petroleum product precursor, and a food grade level of purification may not mean a quality to which it should be vaporised and inhaled.

CDC's reaction is over the top, especially next to the FDA which is offering more precise warnings of avoiding THC carts. Be safe if you're using these thc products, especially since even larger suppliers have trouble tracking supply, bank accounts and company formation that typically cleans up quite a bit of the bad actors from an industry. Nicotine vapes have matured significantly because of this moving to clean labs and central production of the liquid.

As someone who was in the industry, what do you think about the argument of vaping being a safer alternative? I see pretty mixed things in the health community but it's tough because some of the argument seems to be that the tobacco industry has acted nefariously in the past so we can't trust any innovation in the space.

Is there any known experience similar to vaping/smoking of today that has really minimal health consequences but maybe isn't as addictive?

I think it's a lot safer than smoking, there's probably a lot safer methods, but vapings efficacy vs other quit methods is just too good to discard for even slight health risks vs smoking. Only Juul/Pax has a hidden Big Tobacco interest, the rest are either overt or companies that are dedicated to vapor only. Almost all the innovation came from outside Big Tobacco, but all that is coming to an end with FDA'S regulations of Vaping. No new products so I left, since I exclusively designed hardware.

Most vapor products can be used with eliquid that has varied levels of nicotine and most shops were (2012-2017) very active in promoting customers to reduce their nicotine level to 0, so addiction to the devices can be self regulated if that is your goal.

This seems to be the correct answer.

Vaping nicotine should be used only as part of a plan to cease smoking.

That’s the only sound advice, if people choose to ignore it then that’s on them. It’d still way less damaging than cigarettes.

The US seems to be in the process of legalizing recreational weed, which is often consumed by inhaling plant smoke. Relative to that (or alcohol), I wouldn't worry too much about vaping nicotine. It doesn't appear to have any significant harmful effects other than being addictive (https://en.wikipedia.org/wiki/Nicotine#Adverse_effects).

That being said, not chronically inhaling anything other than air is definitely the right way to go if you're taking long term health effects into consideration.

Yeah I'm sure inhaling weed smoke isn't healthy, but at least with weed, very few people inhale it as regularly as cigarette smokers do cigarette smoke.

But if someone doesn't have plans to cease smoking should they continue to smoke cigarettes instead of switching to vaping?

My personal opinion is yes.

What mean to say is, if you are a purveyor of nicotine products in a professional manner, probably best to not recommend nicotine containing products outside the context of smoking cessation.

Though this line of inquiry rapid segues in to a philosophical debate.

Just curious.

But is this because you think vaping is more dangerous than smoking?

Or because you think enabling a harmful activity, even if it's a less harmful than the activity it's being substituted for makes you morally culpable? So providing methadone would be a moral wrong?

Okay, didn't realize it was only Juul/Pax that had that hidden interest. I'm mainly in Eastern Europe these days and Philip Morris is pushing IQOS hard (I know it's in a different category but I think it eats at the same market share, younger more affluent health-conscious users who know cigs are bad but still want to smoke something)

You mention there probably being safer methods - any idea on them or where I should look for more info?

I've been researching tobacco, mainly taxation (which in theory is one of the most powerful ways to get people to quit things, by jacking up the prices) but I'm generally interested in the field, and it seems to me that a potentially even better methodology than making things too expensive for many to afford is to innovate and develop something that's just way healthier a replacement that gives consumers the same benefits.

Yes, Juul was bought for $4bn by ALCS which is the parent company behind Philip Morris USA, Marlboro and many other brands.

Philip Morris International (i.e. Europe) is technically a separate entity. They were separated out a while ago (probably to avoid anti-trust issues). In theory they share stuff with the US but the separation is why you're getting different products.

Interestingly, one big manufacturer I worked with specifically avoided making their device a 'cessation aid' - something to help give up. You can think what you want about their motivation, but the explanation they gave is that if you are a cessation aid then you get into medical device territory and so hit a load of extra regulation.

A bit off topic, but why hasn't the tech advanced too much in the RTA/RDTA area? I tried juul, but pods are just not for me, they produce too little vapour and feel awkward to use.

I've been using Creed and Zeus atomizers since I started and they are really low tech with lots of issues, they leak juice, the airflow is not ideal, sometimes they burn the coils too quickly, no one knows what the ideal wick size or thickness is and so on. I sometimes wonder, if the potential market for vaping is so huge, why are there no better products with better designs? I feel like there's a lot of simple/easy fixed to improve them.

I think it is because the big players know to not get involved, b/c of the FUD, pending legislation, and lawsuit potential.

I would think LG could create an amazong product.

> vaping being a safer alternative

A safer alternative to what? Smoking cigarettes? There's absolutely no question that it is.

One is a plant product (smoke is bad to inhale) that naturally contains a number chemicals that you probably don't want to be consuming. On top of this, there are additional additives (which vary by manufacturer) that also have significant health effects. Overview (https://en.wikipedia.org/wiki/List_of_additives_in_cigarette...) and more details (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040350/).

The other is almost entirely a mixture of Propylene Glycol and Vegetable Glycerin.

...except when it isn't, as seems to be happening here. The safety of vaping is entirely dependent on what's in the liquid you're vaporizing; always keep that in mind when purchasing it.

Also, do bear in mind that it's probably not fantastic for your health to be chronically inhaling anything other than highly purified air, no matter how benign it may seem. Relative to smoking cigarettes (or any other plant product), it's much safer. Relative to not vaping at all, there are likely to be at least some health risks, even if they haven't been clearly established yet.

> Is there any known experience similar to vaping/smoking of today that has really minimal health consequences but maybe isn't as addictive?

If you're asking about drugs with similar effects to nicotine that are less addictive, I'm not aware of any. You could always purchase vaping liquid that doesn't contain any nicotine though.

Sorry, yes, safer alternative to smoking cigarettes

Fair enough, I'm sure it's not healthy to chronically inhale anything other than air

> If you're asking about drugs with similar effects to nicotine that are less addictive, I'm not aware of any. You could always purchase vaping liquid that doesn't contain any nicotine though.

I was asking that but a broader question for me is, are there any safe replacements for cigarettes out there that match the qualities that cigarettes have without the harmful side effects (the idea being if you could create something that was just as fulfilling, addictive, etc. but without the negative side effects you could dramatically decrease the health toll of cigarette smoking). You could argue vapes are that product but it seems like the jury is still out on how much better they actually are than cigarettes and the trouble with attracting new users into the market

> it seems like the jury is still out on how much better they actually are than cigarettes

No. IT IS NOT. You have been mislead.

Unfortunately, for whatever reason, there is currently a lot of FUD and propaganda surrounding vaping. Perhaps due to the term "e-cigarette"?

Other than artificial flavors, the major constituents in the liquid are what I listed above - propylene glycol, vegetable glycerin, and nicotine. Only nicotine has significant documented health effects (at least that I am aware of), and even that's almost entirely down to it being addictive.

Bear in mind that I'm comparing this to smoking weed or drinking alcohol - both extremely common pastimes throughout the world, and both clearly more harmful than vaping. Anyone trying to scare you off of vaping while not worrying about those other two activities is out of touch with reality.

Of course, abstaining from all of those would be the best advice as far as your long term health is concerned.

Do you have any solid RCTs or meta analysis you could point me to about how much better they are than cigarettes?

Agreed, there's a lot of FUD, but a lot of it is coming from sources that give me a lot of hesitation to doubt (lots of public health leaders, tobacco control groups, WHO people)

I understand alcohol or weed is more harmful than vaping, I'm personally just interested in cigarettes as that seems to be the replacement part, I'm not sure someone would quit drinking or smoking weed and replace with vaping

Edit: I know you pointed me to a solid report in an earlier comment, any additional ones? There are huge numbers of reports on tobacco in general and it's easy to find 1 or 2 reports reflecting one opinion or another

See https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes which cites

> Public Health England's 2015 independent evidence review found that, based on the available evidence, vaping is around 95% less harmful than smoking. The Royal College of Physicians came to a similar conclusion in its 2016 report 'Nicotine without smoke: tobacco harm reduction'.

> Agreed, there's a lot of FUD, but a lot of it is coming from sources that give me a lot of hesitation to doubt (lots of public health leaders, tobacco control groups, WHO people)

None of these sources are saying that vaping is comparable to smoking in terms of harms caused.

They're saying that some harm is caused, and that we don't know what harms are caused, and so the precautionary principle means we should make sure that non-smokers do not take up vaping, and that smokers should use other nicotine replacement methods.

> we should make sure that non-smokers do not take up vaping

How about we let adults do as they please instead.

The most anybody should ever do about vaping is warn people that maybe it's not the safest thing in the world.

Instead in the EU we have a ridiculous law that makes it illegal to sell nicotine liquid in container bigger than 10ml, which means that if I don't want to spend twice what I used on cigarettes, I have to buy non-nicotine 100ml bottles of liquid and then buy separate 10ml bottles of nicotine concentrate and mix them myself, doing the math myself to get the proportion I used to be able to just order and generating a small pile of empty small plastic bottles every month because people who can't sleep at night unless somebody does something about everything!!!OHGODSTHECHILBREN!!! keep coming up with stupid ideas like that.

Please we should not be making sure of anything! We don't need to be sure that every body is absolutely safe all the time, put a warning label and let us do as we wish with our health.

Letting adults do as they please is a common refrain, but when you're living in a country with subsidized healthcare, the government has an incentive (at the macro level) to not let you do stupid things that raise healthcare costs, which are then passed on to the population at large.

In America, you break it, you buy it. Everywhere else, I have no problem with a bit of governmental oversight to make sure people don't hurry themselves to a quicker and more expensive death.

That is a savagely, tragically dangerous position to take in a country with subsidized healthcare. We have many examples of unintended consequences resulting from attempted behavior modification with the goal of improving health, and government policies, due to the way they are executed, are inherently much more difficult to reverse or change than education. Just for one example, look at the American Heart Association. In the 70s, they believed they saw evidence that the amount of the diet which came from saturated fats produced increased risks to heart health. So they pursued governmental avenues to reduce the saturated fat intake of Americans by 15%. They succeeded. Saturated fat was removed from many products available on store shelves. Which made them taste like cardboard. Which made sales fall. To restore flavor, they filled the products with sugar and salt. Sales improved. Average American caloric intake skyrocketed. It birthed an obesity epidemic, a diabetes epidemic, and yes, a heart disease epidemic. Meanwhile, research showed saturated fat wasn't quite so dangerous as once thought.

Trusting people to their own devices and doing no more than education is not perfect. But it reduces the odds of unintended consequences like this drastically. It also makes it much easier to change course when necessary.

But even in this supposed nanny-state of the UK with it's single payer commie healthcare there are no laws preventing people buying and using vapes.

Sounds like a good argument against subsidized healthcare to me

Since smokers use health services much less than non-smokers, your view is that non-US governments should encourage smoking then?

Not the case at all. We have subsidized healthcare in the USA and have had it for a long time. The poor (typically the demographics of vapers and smokers) rely on free healthcare quite a bit via Medicaid and or just having the tax payers foot their hospital bill for them. Older people have Medicare. We also subsidize addiction facilities and mental facilities as well. We pay way more for our healthcare than most other nations but we also have most of the medical innovations occurring in the states. All that said, yeah the government does not allow citizens to jump off buildings and run out into traffic because they think it's a good idea. We try to warn against those types of things and it's no different than what the CDC is doing by warning Americans to stop vaping until we know what is killing people.

> How about we let adults do as they please instead.

I don't understand why your post is so angry. In England there are no laws that stop people vaping. We have a government organisation that has to make recommendations for public health, and they've given their recommendation.

The link below is a systematic evidence review published by Public Health England, covering 415 studies relating to e-cigarettes and heated tobacco products. Key quotes:

One assessment of the published data on emissions from cigarettes and EC calculated the lifetime cancer risks. It concluded that the cancer potencies of EC were largely under 0.5% of the risk of smoking.

Comparative risks of cardiovascular disease and lung disease have not been quantified but are likely to be also substantially below the risks of smoking. Among EC users, two studies of biomarker data for acrolein, a potent respiratory irritant, found levels consistent with non-smoking levels.

Biomarkers of exposure assessed to date are consistent with significant reductions in harmful constituents and for a few biomarkers assessed in this chapter, similar levels to smokers abstaining from smoking or non-smokers were observed.

https://assets.publishing.service.gov.uk/government/uploads/...

Don't forget that most of the evidence they used comes from research funded by the tobacco industry, and when you exclude that data the research shows more harm.

It's all relative. I don't see the CDC telling people to stop stuffing donuts in their mouths, which is far more harmful for public health.

I mean, they definitely are doing that:

https://www.cdc.gov/healthyweight/losing_weight/eating_habit...

But that kind of content very definitely grabs fewer headlines.

You sound extremely biased.

> Bear in mind that I'm comparing this to smoking weed or drinking alcohol - both extremely common pastimes throughout the world, and both clearly more harmful than vaping.

What about the dosage though? The people I know who drink alcohol and have a beer or 2 on the weekend. The people I see who vape, do it constantly. Are there people who vape once or twice a week?

Here’s some detailed analyses from neutral third parties about just how much less hazardous vaping is than smoking: https://news.ycombinator.com/item?id=18717697#18718028

(For THC, strongly consider eliminating lung damage entirely by consuming edibles instead of either vaping or smoking.)

Thanks for this!

Agreed on THC, but I'm purely looking at cigarettes/tobacco right now

A few Swedes have also highly recommended looking into Snus as an alternative and I need to do some more research there

Snuff or chewing tobacco, as it is more commonly known in the states, still causes cancer.

> The other is almost entirely a mixture of Propylene Glycol and Vegetable Glycerin.

What an extraordinary meaningless statement. The question is the health effects of vaporizing those and inhaling them (along with other ingredients). You are happy to provide links about health effects of cigarettes, including ingredients present in n minute amounts, but will only provide a list of major ingredients in vaping products and provide no evidence on whether inhaling them is safe or not.

I believe the current scientific consensus is that more research is needed. These are fairly new products and studies have only started. There are definite impacts on the lung physiology and the heating process does cause chemical reactions between flavorants and the carrying solution creating new compounds such that even if the flavorants and major ingredients are safe independently (which they aren't, see next link), there are byproducts that are produce that may not be[2]. The glycerol in commercial vaping solution seems to be a source of impurities that are known to be harmful[3].

[1] https://www.ncbi.nlm.nih.gov/pubmed/31483291

[2] https://www.ncbi.nlm.nih.gov/pubmed/30335174

[3] https://www.ncbi.nlm.nih.gov/pubmed/31460462

Is the question "is vaping harmful?" (because it probably is) or "is vaping about as harmful as smoking?" (because it almost certainly isn't).

Unless vaping makes you smoke more compared to cigarettes. In my experience it does. Nicoteen us crazily addictive whatever form you provide it in people will do that too much. The more convenient the more they will do it.

I don't think even this is true. The nicotine isn't really what's bad for you, it's the smoke and 600+ carcinogens in cigarette smoke.

I'd imagine it'd be safer to vape 10x than smoke 1x.

That has not been my experience. With a cigarette, once you start it going, you basically need to finish the whole thing in a short period of time. If you really only wanted one or two drags, sorry, you're down for 10 minutes or so of smoke. (Or you could put it out and waste it, but given how expensive cigarettes are I doubt many smokers are inclined to do that.) With vaping, you can take one drag and put it down. Figuring out the volume or amount of nicotine consumed would be very complicated. And, of course, most of the negative effects of smoking have nothing to do with nicotine and it seems if there are negative effects from vaping, those will likely also not come from the nicotine itself.

I don't have time to thoroughly examine your references right now, but I can tell you off the bat that the third study is very poor - they measured vapor samples at 500°F and 600°F, which is substantially in excess of normal vaping temperatures and would almost certainly produce an acrid, foul-tasting vapor. The presence of CO in the vapor samples clearly indicates oxidation rather than vaporisation. Of course you get lots of nasty byproducts if you burn the liquid.

I think what's going on there is that one of the e-cigs they used had a configurable temperature (200-600 °F). I'll give them the benefit of the doubt and assume that they selected a reasonable one (they don't appear to specify in the methods).

Separately, there's the GC-MS machine - oven (30 - 220 °C ramp) and inlet (320 °C). This shouldn't be (much of) an issue though, as an inert carrier gas is used. Plus you always have controls, so if the GC-MS itself is tearing things apart it should hopefully be obvious.

That being said, I didn't see anything particularly concerning listed in their results (relative to recreational cigarette or alcohol consumption).

Recreational cigarette smoking? I've never met such a creature. Your either hooked or your not.

In the medical literature there is a classification referred to as a "chipper" who generally smokes only 1 or 2 cigarettes a week on average. Humans are many and varied.

> > The other is almost entirely a mixture of Propylene Glycol and Vegetable Glycerin.

> What an extraordinary meaningless statement.

Not at all. The point being made is that we're dealing with a product composed primarily (99%) of two chemicals that are very clearly established as safe for human consumption (propylene glycol is commonly _injected_). As such, it seems unreasonable to assume absent evidence that the chemicals themselves would pose any significant threat to health.

That leaves other additives (which I noted) and the inhalation itself (which I also noted). As I stated in my previous comment, chronic inhalation of anything is likely to be bad for your health.

You really seem to have missed the context of the question I was responding to - it asked not about absolute safety, but rather safety relative to cigarette consumption.

Yes, as you note, there is always the potential for chemical reactions when mixtures are heated. Given the particular chemical composition and temperatures involved, I'm not personally concerned absent solid evidence. None of the byproducts listed in the study you linked appear particularly worrisome to me. Compared to cigarette, weed, or wood smoke, the contents of vaping such aerosols appears downright healthy. (Only in comparison, of course!)

Rereading my previous comment, something I failed to mention is the risk of inhaling things that are too hot. Depending on what temperature the aerosol is heated to, it could burn you internally (but then we're comparing this to inhaling burning plant matter, so... meh).

> I believe the current scientific consensus is that more research is needed.

To establish what, their precise negative health effects? Of course. But not to establish that they are safer than smoking cigarettes - there's absolutely no question about that.

Fog machines also use a glycol solution, and have been shown to be harmful. Thus vaping glycol may not be safe. https://www.cdc.gov/niosh/hhe/reports/pdfs/1990-0355-2449.pd...

The report you linked shows quite the opposite, actually. They concluded:

> Based on the results of this study, there is no evidence that theatrical "smoke," at the levels found in the theaters studied, is a cause of occupational asthma among performers.

That being said, chronic exposure is probably not good for you. From a health perspective, don't inhale anything other than air!

Asthma is only one of many possible heath impacts. It was associated with others, just not Asthma.

When compared to actors from the non-"smoke" productions, actors from two or more of the four productions utilizing theatrical "smoke" reported experiencing a significantly greater prevalence of nasal symptoms (sneezing, runny or stuffy nose), respiratory symptoms (cough, wheeze, breathlessness, chest tightness), and mucous membrane symptoms (sore throat, hoarseness, dry throat, itchy/burning eyes, dry eyes) during their performances for the week prior to the survey.

The final line is: The quantity and frequency of use of the various fogs during a performance should be minimized.

PS: A method of action was suggested to be the breakdown of glycol due to high temperature.

The report he cited proved his point.

Fog machines cause noticeable effects on breathing at significantly lower exposure levels and concentrations than vaping. IOW, it provides a lower bound for the purported safety of vaping.

Here is the conclusion of that study to save a click:

"Based on the results of this study, there is no evidence that theatrical "smoke," at the levels found in the theaters studied, is a cause of occupational asthma among performers. Some of the constituents of theatrical "smoke," such as the aerolized glycols and mineral oil, could have irritative or mucous membrane drying properties in some individuals. Therefore, it is reasonable to minimize exposures by such means as relocating "smoke" machines to avoid exposing actors to the direct, concentrated release of the aerosols, minimizing the amount of "smoke" necessary for the production, and using only fog fluids approved by the manufacturers of the machines. The glycols used should be at the level of "food grade" or "high grade." Glycol-based systems should also be designed to heat the fog fluids only to the lowest temperature needed that achieve proper aerolsolization. This would help to avoid overheating the fluid and minimize the generation of decomposition products."

What grade of glycol is used in a vape and are they required by law to state what grade it is?

Mainstream vendors use USP grade PG/VG and food grade flavouring (which can also include a small amount of PG or VG as a carrier)

The ingredients you list are safe for human ingestion. It doesn't follow that they are safe for inhalation.

Your point that they are likely safer than cigarettes is well taken, but your insistence on the ingredients being known to be safe to inhale is faulty.

> your insistence on the ingredients being known to be safe to inhale is faulty

Please reread my comment - I never claimed that. I very explicitly stated that inhalation of anything is likely to be bad for your health.

Is that what the marketers of the product are claiming as well? I see quite the opposite in the world around me. I feel the vaping industry is just as corrupt if not more so than the awful cigarette companies. https://www.cbsnews.com/news/juul-came-to-a-9th-grade-classr...

> very clearly established as safe for human consumption (propylene glycol is commonly _injected_).

Consumption, injection, and inhalation are very different routes of introduction to the body, and safe for any one does not imply safe for the others.

Many things that will cause no problem if injected or eaten will cause problems in the lungs.

>> The other is almost entirely a mixture of Propylene Glycol and Vegetable Glycerin.

> What an extraordinary meaningless statement.

>> ...except when it isn't

Emphasis on "except when it isn't" which highlights the other impurities that might be there. I found the comment to be useful at highlighting what it was designed to highlight - that the safety depends entirely on what's inside the carts. You have no guarantees with some suppliers what the heck's actually inside, and I think saying "it's fairly simple at the base, but rather complicated in reality" is quite helpful for framing.

The number of people who have died within days or weeks of using a new cigarette from smoking-related causes they didn't have before the switch: 0.

The number of people who have died within days or weeks of trying a new vaping product: 5 and counting. Out of a much smaller user base.

Right now the evidence is that vaping is more dangerous in the short term, with no evidence that it is any healthier in the long term.

>The safety of vaping is entirely dependent on what's in the liquid you're vaporizing

This is statement is incorrect. It discludes the very real and proven health threats that heavy metal consumption can enlist.

A simple understanding of the chemistry involved is enough to infer the presence of dangers not dependant on the liquid being used. If you cook an acidic tomatoe sauce in a completely copper pot... the safty of consuming that sauce is not entirely dependant on the tomatoes and the same applies to vaping[0].

[0] https://www.webmd.com/smoking-cessation/news/20180226/toxic-...

If you are an existing smoker and if your device and liquid are from a reputable supplier, absolutely yes.

The problem is that a lot of the industry is not reputable and not well controlled. This means that you can get liquids that contain all sorts of things and devices that heat in an uncontrolled way. Even the perfect liquid if overheated (as it is in many large devices) produces aldehydes. As you might expect, breathing formaldehyde is bad.

The industry also seems to be taking the opportunity to up the nicotine numbers, so if your intention is to give up that's not helping.

My local news ran a segment about THC vapes. Some local doctors were talking about an increase in vape related hospital visits.

They interviewed the guy and he basically said he bought a random THC vial from some guy who walked up to him on the street. He said it didn’t feel right and was probably spice or something synthetic.

Be careful, YMMV.

In all my experience working for a non-profit that closely involves itself with the CDC and smoking related research, I would never describe the CDC's actions as over-the-top.

They do all their own research and are very measured and even handed with their messaging.

Contrast that to the FDA who have outsourced their job function to back to the companies they're supposed to be regulating.

Three are and have always been three components of e-liquid:

- propylene glycol (used in ice-cream soda etc)

- vegetable glycerin

- food flavoring

Besides proportions changing the only other variant is the type of flavoring. It's not actually too complicated. And If one of those ingredients was suddenly tainted people using vaporizers would not be the only ones affected, of course.

All three of those elements are not usually vaporized and then inhaled in large quantities. Extrapolation from their effects when ingested is unlikely to apply in these cases.

Your conclusion does not follow from the evidence.

propelene glycol is and has been used as an air santizer for a very long time. https://archive.epa.gov/pesticides/reregistration/web/pdf/pr...

In your document the Cat 4 exposure dose was stated to be 2.34 mg/L, a recent study[0] found that inhalation exposure at 0.442 mg/L resulted in slight irritation.

What's the exposure when vaping?

The document you link to actually avoids addressing Aggregate Exposure by stating there's insufficient information to draw any conclusions.

> "Since toxicological endpoints for risk assessment were not identified based on the available data, an aggregate risk assessment was not conducted for propylene glycol and dipropylene glycol."

Isn't Aggregate Exposure what we're concerned about with Vaping?

Additionally these studies all talk about aeroslized or nebulized pg, vaporizers are thermal in nature. Does heating pg matter?

The CDC is basically saying "We don't know what this shit does because no studies have ever exposed people to it in this manner. Until we know more you should probably not vape it".

[0] Dalton P, Soreth B, Maute C, Novaleski C, and Banton M (2018). "Lack of respiratory and ocular effects following acute propylene glycol exposure in healthy humans". Inhal. Toxicol. 30: 124–132.

Something just wasn't sitting with me about the document you shared [0] and toxicity categories [1], so I asked my partner, who is an environmental engineer, to explain it to me.

The EPA's toxicity categories [2] are determined by the amount of a substance that will kill you. So if it only takes 50mg/kg or less to kill you it's highly toxic, where as if it takes greater than 5000mg/kg to kill you it's considered non-toxic.

As my partner was explaining to me how to interpret the page, she furrowed her brow because she couldn't figure out how Dipropylene Glycol was Cat 4 and not Cat 3. Per the EPA guidelines the reported lethal levels for Dermal and Inhalation should make it Cat 3.

Further, the document says "Upon reviewing the available toxicity information, the Agency has concluded that there are no endpoints of concern for oral, dermal, or inhalation exposure to propylene glycol and dipropylene glycol." But if you look at the data provided, there is no inhalation exposure data for Propylene Glycol.

So why are we assuming PG is safe to inhale? And why is DG considered Cat 4 and not Cat 3? It's not entirely clear but my partner suspected lobbying which she said is quite common by industry groups like the American Chemistry Council.

I looked around and couldn't find anything specifically related to PG but the American Chemistry Council's Ethylene Glycol Ethers Panel petitions the EPA quite a bit to reclassify and remove reporting requirements. An example is their petition to remove reporting requirements for ethylene glycol monobutyl ether [3] which has similar toxicity categories to PG and DG. When you look at their section on Acute Toxicity, the rationale is not that it's safe but rather that it's unlikely to kill anyone the way it's used and stored in industry. So a lot of the justification that things are safe is based on how it's used. Vaping is a relatively new usage for PG.

When you look at the EPA's executive summary of propylene glycol [4] you can see that there's very little data around inhalation. The one thing I did find was a link to a Military Exposure Guidelines document [5] which indicates that Propylene Glycol exposure at 500 mg/kg (0.5 mg/l) was critically dangerous and resulted in convulsions in Monkeys. Wikipedia's article on propylene glycol [6] however references a study where subjects were exposed to 871 mg/m3 (0.8 mg/l) and only reported mild respiratory irritation. Keep in mind that your original document stated 2.4 m/l would kill you. So I'm inclined to believe that MEGs are closer to the truth than a Wikipedia study locked behind a pay wall.

The more I look into this, the more I see that there's very little research about the long term effects of exposure AND more importantly that much of the categorization, which predates vaping, is based on how it was being used at the time but does not take into account modern use cases.

My conclusion is that the CDC is right and people need to stop breathing this shit until we better understand it.

[0] https://archive.epa.gov/pesticides/reregistration/web/pdf/pr...

[1] https://en.wikipedia.org/wiki/Toxicity_category_rating

[2] https://www.govinfo.gov/content/pkg/CFR-2005-title40-vol23/p...

[3] https://19january2017snapshot.epa.gov/sites/production/files...

[4] https://comptox.epa.gov/dashboard/dsstoxdb/results?search=pr...

[5] https://phc.amedd.army.mil/PHC%20Resource%20Library/TG230-De...

[6] https://en.wikipedia.org/wiki/Propylene_glycol

This is the point everyone seems to be missing.

Everyone is defending the ingredients as being safe but it's like defending water as being safe in when you have a patient who has steam related third degree burns.

> it's like defending water as being safe in when you have a patient who has steam related third degree burns

Or even closer, after they just inhaled a bunch of it and are now drowning.

My remarks were made in context where it is being claimed that “a new mystery ingredient” is cause for concern. I stated what ingredients are used as a point about how unlikely it would be for something out-of-the-blue to permeate the market.

Not necessarily. The first two substances have been vaporized extensively in the past as fog juice. Modern fog fluids use (IIRC) a mix of different glycol formulations, but glycerin is no longer used in any commercial products due to health concerns.

[Edit] I'll add that they were studied extensively in regards to actors and performers, and Actors' Equity defines many guidelines around usage and exposure: https://www.actorsequity.org/resources/Producers/safe-and-sa...

> No Actor may be staged or choreographed within a distance from a specific product’s release point during the “wait” time listed on the product’s Time and Distance guidelines chart.

In Laymen's terms it says "Don't let the actor stand around breathing that shit any longer than necessary for the scene".

To me, that's very different from "inhale this shit directly into your lungs repeatedly multiple times a day".

The digestive system and the respiratory system are quite different systems.

You can safely drink lots of water. A fairly small quantity in your lungs is a big problem.

Just a sidenote, a lot of nebulized drugs also contain propylene glycol. I know it's not quite the same delivery mechanism as vaping, but it does end up in the lungs.

In addition to the delivery method being slightly different (because heat) the dosage is much higher.

The few studies out there, mostly related to theatrical fog, state that it causes irritation to mucus membranes. Is that what doctors are seeing in vaper's lungs?

VitE can be used as an antioxidant/preservative.

VitC is too, but E is fat soluble.

That’s directly from the CDC. They should probably stop using the word e-cigarette especially due to the fact nobody using the THC vapes calls them that.

Curious linguistic detail: they need to use the word that people using THC vapes expect them to use for clear communications to occur. As a stuffy international organization, they'd be expected to use something that sounds like a technical term. Vs for instance, some slang or cool-kid term.

They are called "cartridges".

Interesting consequence of the global supply chain (really, network). For every ingredient or process sourced from a different manufacturer or factory or farm, there's added difficulty in auditing quality and consistency, and a source of unwanted variation in the end product. It's feasible to comb over one factory to look for quality problems, but not for hundreds of suppliers around the world.

The CDC response seems very measured and not over the top at all. Some of this may have to do with how the news is actually reporting on the matter. For reference, here is published recommendation from the CDC website.

"While this investigation is ongoing, consider not using e-cigarette products.

If you do use e-cigarette products and you experience symptoms like those reported in this outbreak, seek medical care promptly. CDC and the FDA will continue to alert the public throughout this investigation. ..."

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/s...

>One case was confirmed from a dispensary in Oregon

can you source this for me? i keep hearing it but cant confirm

The last I saw in the Oregonian a few days ago they said that they suspect it is from one of two dispensaries but are not certain. Possibly they confirmed since then but I haven't seen it in the news at least if so.

The article (generally better than the submitted one IMO): https://www.oregonlive.com/marijuana/2019/09/vaping-death-an...

Vaping is great!

Take someone who smokes two packs a day, give him a niccotine vape, and he gets all the 'high' he needs to fuel his addiciton, with (by some sources) only 10% of the "bad things" going in his lungs (compared to cigarettes). Less coughing, easier to reduce the dosage (just buy a liquid with less nicotine - you still keep your rutine and cigarette breaks, but slowly lower your addiction level).

...but...

Then youtubers with smoke challenges come, and tutti frutti bubblegum pina colada reeses pieces flavoured liquids come... and 13yo kids (that would never have smoked otherwise) start buying vapes. And not just any 'normal' vapes (that the people from the top of this post use), but the ones with very high power heating elements, producing HUGE amounts of smoke (for the youtube likes), and making the "bad stuff" intake into lungs comparable to actually smoking 2+ packs of cigarettes.

...and now, when even that's not enough, someone's selling some "special" (or just really shitty, but really cheap) e-liquids, that make you sick.

I think if it really was purely a device for cessation then this could be solved by putting it behind the counter and requiring a prescription. I remember before weed was legal in California there would be a doc office next to a pot shop and you would get your prescription and then walk in. I imagine there would be a market for people who wanted to quit to go to a 5 min doc meeting, they'd verify you're a smoker and write you a prescription and then you could pick it up with any flavor your heart desired. That said, I'm not a big fan of creating another inefficiency in the healthcare market but it does seem like a way to stop the secondary effect of new users entering the market in a major way by creating a nontrivial hoop to jump through

"Inefficiency" is a weird word for including doctors in healthcare.

I'd say it's an inefficiency in the case I referenced because I don't think it's 'healthcare' per se. If you go to your primary care physician during a checkup or because of an issue (even if it's this specifically) then I would consider that healthcare, but what I saw was basically this tack on service that was rubber stamping anyone who paid $X for an appointment as cleared to use medical marijuana and I would consider than an inefficiency since the step was purely created as an administrative hurdle

To force the involvement of a doctor that is not performing any procedures or making a diagnosis is definitely an inefficiency.

They do that with cigarettes but kids still get them (atleast in my country). Banning a device is useless, beceause the same vaporizer could be used to other stuff, and it'd be still sold online (from places like china), and customs don't really check every package for what's inside (especially since it usually says "electronic gadget" on the CN22 form). Banning liquids would be easier, but in some places (eg, here), the liquids are sold separately as a mix of glycerins and a food-grade arome, where neither of those can be banned. Nicottine can be (and is), but while it's addictive, most of the "bad stuff" is in other ingredients, that again, cannot be baned easily. ...and you can also order niccotine concentrate online...

so yeah, it's hard. Making it unnatractive is a lot easier procedure with drugs and "bad things", but a machine that makes huge clouds of tutti frutti falvoured smoke is.. wel... fun.

Sure, people will always get around things like that if they want to badly enough (see any illegal drug) but if the rate of use is dramatically lowered then it changes the dynamic of the current usage where public health folks are worried many new smokers will enter the market because of the availability.

I agree it's super hard, even with pot (again in CA) when it was illegal it was a bit of a joke to me (and a surprise as someone moving from a conservative area where pot use definitely had to be hidden) because if enough people use it even illegally and it's not considered a police priority, then there's no enforcement/repercussion and people use it willy nilly, often publicly.

Regarding THC being illegal... Around 2012 I was at a concert in LA at the Palladium (indoor venue-- arguably most famous as the final scene of the blues brothers movie). As the night progressed, the venue was filled with a fog of pot smoke, and I was struck by the a couple of things.

One, the contrast between Orange County where one would not dare to dream to smoke in public. My (minor) career as a weed smoker was entirely indoors-- late nights and Boards of Canada albums, and whispers of, "Do you know anyone?"

Two, as a cigar enthusiast, how utterly unwelcome I would have been smoking tobacco.

One thing I'd wonder about is if this might reduce the number of people using it for cessation. One extra hurdle, especially seeing a person in such a formal setting, might be enough for some people.

Personally speaking, if I had to get a prescription to buy by e-juice and devices (replacement pods, etc) I would still be smoking traditional cigarettes. Former 2 pack a day smoker, quit with the help of a Juul/Uwell Caliburn.

> I think if it really was purely a device for cessation then this could be solved by putting it behind the counter and requiring a prescription.

That ignores the fact that cigarettes, which are orders of magnitude more dangerous, do not require such hoops to be jumped through.

If you’re going to make vaping by prescription, you then need to simultaneously ban tobacco outright.

Most nicotine replacements don't require a prescription and it seems silly to require a prescription for vaping but not smoking.

Why does everyone want to police what I put in my body? I personally think vaping is beyond lame, but I support any adults right to injest what they wish. The prohibition of thc is the reason for the bad carts in the first place. Your attitude created this.

but the ones with very high power heating elements, producing HUGE amounts of smoke (for the youtube likes), and making the "bad stuff" intake into lungs comparable to actually smoking 2+ packs of cigarettes

I don't think those "cloud chasers" actually vape nicotine.

As it seems, it's not the nicotine that is the problem in these cases here.

And nicotine is not a thing that kills your lungs (except making you addicted), it's the "other things", and those are also in non-niccotine vapes (and different ones in classic cigarettes).

>making the "bad stuff" intake into lungs comparable to actually smoking 2+ packs of cigarettes

Completely unquantifiable. We don't even know what the "bad stuff" is, and whether there can even be a fair comparison between burnt plant matter and vaporized nicotine oil (or propylene glycol or whatever it is).

How is vaping better than nicotine patch, assuming that the poison is not considered a feature?

It's not just the nicotine. It's how it is delivered that counts for a lot. Small nicotine blasts to the system that the user controls are much different than a patch which slowly seeps nicotine into the system.

We haven't done much research on vaping as a smoking cessation tool.

We've done a bit on other forms of nicotine replacement, and they are more effective when they're delivered as a package of treatment, and less effective if they're used alone with nothing else.

Some smokers who've switched to vaping are now in a weird super-position state: they don't smoke right now because they vape, but take the vaping away from them and they'll go back to cigarettes.

That's not ideal. But it's probably better than them sticking with cigarettes.

> take the vaping away from them and they'll go back to cigarettes.

That's not likely, unless their vapes were just ripped away without warning (even less likely). People that want(ed) to quit, including myself, gradually taper their nicotine to zero, and then one day just put down the vape and don't go back to nicotine in any form.

A big part that is often not talked about is the oral fixation. A lot of smokers smoke because they use it as a mental break--both day to day life at work and at home--and like having something to do idly. Feeling restless or anxious? Go have a cigarette and think about what to do next.

That physical habit is a powerful thing. Some people can replace cigarettes with vapes, but it isn't the same thing.

Same is true with patches and gum. Those can help with nicotine cravings, but they do nothing for the physical habit that many smokers really enjoy.

A nicotine patch doesn’t signal how cool you are and doesn’t allow you blow sick clouds behind the high school.

The thing causing this outbreak seems to have been someone using a vitamin e oil to increase the potency of their thx carts up to 95% or so. [0]

I also believe they were out of Chicago. Or at least they shipped a lot of carts to Chicago/Illinois and then they spread out from there. But this is just from the cases I've read.

Also from today Doctors have identified previously unrecognized characteristic of the vaping-related respiratory illness that has been emerging in clusters across the U.S. in recent months. Within the lungs of these patients are large immune cells containing numerous oily droplets, called lipid-laden macrophages. [1]

[0] https://www.theverge.com/2019/9/5/20851866/cdc-fda-investiga...

[1] https://www.reddit.com/r/science/comments/d17qm9/doctors_hav...

It might also explain why the cases seem confined to the USA and we're not seeing it amongst other large vaping populations like Canada and the UK

There are too many fly-by-night and backyard operators in both the device and liquid industries - it is very reminiscent of the prohibition era where people died from bad batches of alcohol

I'd really prefer to see a well-regulated industry as vaping is one of the best harm reducation methods for the billion or so smokers in the world

Are you sure vaping is actually reducing potential harm? Because our national health agency isn’t[1]. As I understand it, a few brands come with a lower risk of certain tobacco induced cancers compared to smoking. Which is harm reduction, I guess, but research is suggesting that all vaping comes with greater risk to the respiratory system and heart.

Of course the real issue in evaluating the safety of e-cigerates is that we need 30-50 years of people dying from them before we really know how they compare to regular smoking.

[1] https://www.sst.dk/da/sundhed-og-livsstil/tobak/andre-tobaks...

I’ve stated this before: cigarettes will kill me with a 100% probability (I was smoking over a pack a day).

Maybe vaping will not kill me. Maybe I’ll grow a third arm in 20 years. I don’t know. But I have to play the odds; “100% certainty” vs “maybe not”, I know which one I’m going for.

Also, I’ve gone from 9mg of nicotine to 1mg in 2 years, because vaping allows me to monitor and measure exactly how much nicotine I put in and consume. With cigarettes, I only grew more addicted, never less.

I appreciate your optimism about the unknown, but there is the frightening possibility that maybe e-cigerattes will kill you more efficiently than your regular smokes.

If you’re using it as a way to stop completely, then that’s awesome, but all Danish research on the subject has led to vaping being on our “not-recommended” list for ways of helping people quit.

Except for the fact that other ways don’t work. It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help.

But that only adresses one part of the issue: the nicotine addiction. Smoking is a lot more complex than just the nicotine addiction. I know a lot of smokers who managed to take a break from cigarettes for a few months, but I’ve never met a vaper who went back to cigarettes.

I’m slowly rewiring my brain to not need cigarettes or vaping. I smoked for 15 years, and started during my formative years, so I know this will be a long process. Just telling me to chew gum or apply patches is a cop out for the government to clear its conscience about not really helping its population kick the smoking habit. There’s a reason the tobacco industry doesn’t care about patches and gum: it doesn’t work for the majority of smokers.

Increase your copper intake to increase your Cu-Zn Super Oxide Dismutase enzymes[1] which will help neutralise the free radicals. Increase Vit C to gram level (ascorbic acid mixed in milk is good), this is a base for many enzymes and will also help reduce the free radicals in the body. Damage to sperm can be reversed at this level. The liver metabolises nicotine into an alkoid called Cotinine which is thought to be the main reason people smoke. Other studies have suggested other chemicals are also linked to addiction found in tobacco because rat studies have shown rats will prefer water sources without nicotine in, when given a choice. Tobacco also increases the level of copper in the blood stream, helping to make smokers go grey more quickly than peers. Water only fasting will reduce tobacco cravings within a few days, which then also gives the body a chance to clean itself up more quickly because White blood cell counts will remain elevated in the lungs for as much as 5 years after giving up smoking. No studies on vapours yet. Whilst its been shown that brain pathways take 42 days to rewire themselves which is the period of time thought to remove the addiction from the brain, the liver is more involved in the brain and addiction pathways than the medical profession will care to admit. Another easy way to give up smoking is consuming raw Ox liver. The enzymes in the liver like catalase, ceruloplasmin and others will remove the stress and desire to smoke plus will give you an immediate energy boost. The risk of consuming raw ox liver periodically throughout the day is from parasites, but the raw liver makes you feel very good and alive if you ever need a pick me up.

[1] https://en.wikipedia.org/wiki/Superoxide_dismutase [2] https://en.wikipedia.org/wiki/Cotinine

>It’s not possible to slowly reduce your nicotine intake with cigarettes. The only alternative is: stop all your smoking habits, and maybe one of these nicotine substitutes will help.

Why not? Just go from 2 packs a day to 1.9, to 1.8 etc..

It's easy to say but hard to do. Every smoker and ex-smoker I know has tried to quit multiple times, so there's a bunch of experience there. Their consensus (I don't smoke, so no firs-thand experience) seems to be that going from 2 packs a day to 0 (or a "party mode" where it's 0 most days but a pack during a festival or something) is actually easier than going from 2 packs to 1.

Habits and addiction work in ways that aren't entirely intuitive.

That tapers the physical addiction part of it, but worsens the psychological part of the addiction, because now that you're having less, you're craving each cigarette more, and start valuing those you allow yourself to have even more. In the end, by doing this, you're suffering continuous withdrawal while worsening your psychological addiction.

Have you found that you're reducing your vaping usage?

How about patch/gum plus fake cigarettes that just heat air you can suck on and breathe?

"cigarettes will kill me with a 100% probability"

The murder victim rate of smokers is non zero, the road accident fatality rate of smokers is non zero.

And on the other side the lung cancer rate of non smokers is non zero.

So you can't really say ahead of time you will even die of a smoking associated cause, and even if you did, you can't definitively state that it was caused by the smoking.

i would argue that on a long enough timescale, anything will 100% kill you. not trying to be cheeky, more just trying to say that that sort of argument only really works for people who are active antismokers; most smokers (i think, from personal experience) are very aware of the danger of smoking, but feel that it offsets some condition of reality that makes it more tolerable even compared to the reduced lifetime. that's just my perspective though

Yes, you described addiction, which is a local optimum compared to being a little less addicted, because addiction traps your brain. Breaking addiction is better buy not adjacent.

Smoking tobacco is remarkably harmful. It would be somewhat surprising if vaping could be anywhere near as harmful.

Your link (in translation) makes some good points:

E-Cigarettes are not a medicine and are not regulated as such and so might be lower quality; there's a lot of variation in types of product and ingredients used; liquid refill ratio may be unsuitable for one machine even though it's recommended for another;

> The National Board of Health recommends not using e-cigarettes

> There is considerable uncertainty about the potential health consequences of e-cigarettes both with and without nicotine, especially in the long term. Therefore, the National Board of Health does not recommend using e-cigarettes. This is especially true for pregnant women, nursing mothers, children and adolescents.

I don't think this link is saying that vaping does not reduce harm. I think it's using the precautionary principle to say we don't know what the harms are yet, and some harms are emerging.

I do think they're making reasonable points, especially if they're providing nicotine replacement as part of smoking cessation services that are freely available.

Other countries have health services that have come to different conclusions. In the UK Public Health England say that vaping is less harmful than smoking and that it's ok for smokers to switch to vaping, but that we really don't want anyone who doesn't smoke to start vaping.

> Are you sure vaping is actually reducing potential harm?

Yep. I quit smoking via 3 years of vaping and tapering down on nicotine. I've referred and seen no less than a half-dozen people I know do the same - some of the hardest smokers i've known (including my own fathers 40 year+ pack a day habit)

If anybody asks i'll always turn people onto vaping - even if they don't ask i'll push them towards it, nothing has gotten even close to working like vaping has a a quit mechanism

I really strongly believe that this is an area where regulations lag real-world experience and there are a ton of vested interests in preserving the existing regimes of either smoke tobacco or nothing at all

Congratulations on quitting! Do you feel you could explain the difference vaping made for tapering down, as opposed to trying to smoke fewer and fewer cigarettes?

As a person who smokes on and off, part of it is that you can continue your physical habit (take a break, hold something in your hand, breathe in warm air with a specific taste etc) but you can still drop the nicotine.

If you were to try and cut down on cigs you can only do it by reducing the number of smoking sessions, whereas with a vaporiser you can keep your sessions static and just reduce the addictive chemical compound.

In essence it's easier to reduce your nicotine addiction if you can continue to comfort yourself with the physical habit part of the addiction

I'm someone who used to crack up if he hadn't had a cigarette in 3 hours. Replacing cigarette with vape isn't some natural effort, but it is far from hard to do either. The nervous compulsion to have a cigarette is satisfied by a vape, after which, for reasons I simply do not understand, it becomes easier and easier to just not pick up the vape over time.

I don't know at what point it happened, but I can easily go a full day and 'forget to' vape. Smoking was never like that

It's because of the other stuff in the tobacco plant. There's a whole host of addictive things that aren't nicotine in there.

If you can switch from many addictive things to just nicotine, then you can get off the nicotine alone pretty easily. It only takes about 3 days for cravings to stop.

Anecdotal counterpoint: I was a 1-2 pack a day smoker for ten years. If I'd picked up vaping I'd probably still be smoking. I tried early e-cigarettes and didn't care for them because while I got the nicotine the actual practice wasn't as pleasant. But if that aspect of "this is fine for me" was present I may not have asserted my desire to stop so strongly. I had a hard time quitting until I went all-in with no surrogates.

A resolute mind and a week in bed/at home was what did it. From 100% -> 0%. I've had maybe 2 cigarettes since that time and they were enough to convince me I don't want the habit back. Because of whatever recovery processes were happening with my lungs/esophagus I was all kinds of sick for that week. Staying home let me be as gross as I needed to be to get past the worst of it. And really, the first 3-4 days are the worst of the physical symptoms. Once you make it to a week it gets easier, two weeks even moreso. Years out and it's hard to believe I kept it up for so long. I'm really glad I didn't start vaping.

How long ago did you quit?

Or just better identification/reporting: > The number of reported cases has skyrocketed, though this is likely a consequence of better information coming from state health authorities and hospitals, rather than a sudden epidemic.

To the contrary, all indication points to this being an isolated issue introduced during the supply chain - not something that had been going on for a while and only just got attention.

Wouldn’t diluting with vitamin E reduce potency?

Which, ironically, would mean that someone vaping THC would need to vape even more to achieve the same effects; consuming more of the liquid containing the dilutants.

From a thread on Reddit[0], written by a cannibis biologist:

“The reason [vitamin e is] being found in black market carts is because black market manufacturers are incentivized to dilute out their product as much as possible to maximize profit. They don't have to provide you with potency numbers, they just need the cartridge to look plausibly full of distillate.

This means they use any of the aforementioned dilution methods, or even other less safe methods and wind up with a thing and runny product that is obviously not high purity distillate.

So what do they do? They thicken it back up to be more believable. This is where Vitamin E acetate comes in. It can reliably dissolve a large range of organic compounds but is also similarly viscous to Maple syrup. This means it can be used to dilute distillate or thicken up heavily cut distillate, but leave it looking comparable to an actual high quality distillate. Thus they can turn a 1g cart into 5 1g carts, for the low low price of the health of the end user.”

[0] https://www.reddit.com/r/FLMedicalTrees/comments/d0wn7v/clea...

Which is further compounded by the fact that heavy vape users often have tolerances which require large doses. If the liquid is diluted, they'll potentially vape 5x the product to achieve the same perceived effects.

This is precisely why this industry needs to be regulated by the FDA .. or BATF? While I personally don't consume cannabis (it messes with my constitution way too much) there is no reason why it should still be illegal.

That person is incorrect. I know a toxicologist who actually had one of the carts tested due to a patient with these symptoms and the high potency was accurate. Not something I can source but the data is out there in the toxicology circles.

I've also heard talk that Vitamin E does something to increase the potency?

I don't know if the vitamin e thing has been totally confirmed yet. This is from the New England Journal of Medicine published 3 days ago (Sep 6, 2019)

>Until the investigation into the cause of this epidemic of vaping-induced respiratory injury is complete, no conclusions can be drawn as to which compound or compounds are the causes of injury. [0]

Until they confirm or deny which compound(s) or mixtures are leading to these effects, don't assume any carts are safe to use (even if they're not "black market").

https://www.nejm.org/doi/full/10.1056/NEJMe1912032

It's my opinion that the media has been irresponsible about its reporting on this issue, wildly jumping to conclusions before any actual facts have been established. Some of the most egregious reporting I've seen conflates vaping from e-cigarettes with dry plant vaping, which is an entirely different process.

Furthermore, vaping in this form has existed for over a decade, so if any of the health problems were related to the process itself and not contaminated cartridges, these issues would have already arisen. However, the media continues to report as if it's a fact that vaping is dangerous.

Reports are also coming out that users who originally stated their ailments came from nicotine cartridges are admitting they were actually using THC cartridges and lied because they feared the legal repercussions of admitting they were using illegal substances. I've yet to see a credible report linking a serious ailment to nicotine vaping.

As a vape user myself, there's no doubt in my mind that inhaling substances into the lungs may cause serious side effects in some individuals. But until the facts are released by the CDC and other medical authorities as to what the primary cause of these ailments are, the media needs to cease this fear mongering clickbait FUD.

So: there's an unknown number of contaminated liquid vape cartridges, all of which so far were THC? And since the substance is illegal it's going to be impossible to do a recall. This is a major health risk, and I wouldn't vape liquid THC for the near future.

My understanding of the issue is that the THC cartridges causing these problems are all done by unregulated black market producers. THC cartridges have been available for years in a number of legal states and there have been no reported issues with those cartridges purchased from licensed dispensaries. I've lived in legal and illegal states, and I would not buy or use black market cartridges. To further conflate things, many black market cartridges steal the branding of legitimate cartridges in order to pass themselves off as authentic.

Individuals can and should make their own personal decisions regarding their usage. My issue is with the media's inaccurate reporting causing people to make these decisions based on incorrect data. For instance, you have people who nicotine vape who are now concerned about their usage, despite the fact there's been no conclusive evidence linking these ailments to nicotine cartridges.

Conspiratorially, I have a feeling there are many corporate players who would benefit from and encourage this kind of fear mongering, but that is my own personal baseless speculation.

Source: https://www.cdc.gov/media/releases/2019/p0906-vaping-related...

CDC’s actual recommendation:

“What the public can do

While this investigation is ongoing, people should consider not using e-cigarette products. People who do use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention for any health concerns.”

That's the exact quote that is also in the article ...

They can start by listing what type of or what “brand” of ecigs and cartridges these patients were vaping. I don’t know why they won’t just do that, the public deserves to know that information. Like catching a suspect.

And if it is indeed THC related, there’s gotta have some form of traceability in place so it shouldn’t be that hard to find the source of the issue. Something about it all just has a weird vibe to it.

They say that so far they’ve only seen patients who used THC-based cartridges not nicotine ones. And they suspect it’s caused by some Vitamin E byproduct getting into their lungs.

That's not what the article says at all. It says that they don't know enough yet.

It's been discussed here before, the byproduct was some cheapass copy from China ( because the original one was more expensive)

When most high-tech luxury products are produced in China, it's disingenuous to use China as an example of low quality manufacturing.

There is definitely a problem with the reporting on this story and the CDCs messaging but it's pretty much happening in real time so not everything is a pretty picture yet.

I mean, vaping is not a new thing. And this is contained to the US and not worldwide. Both of those facts should tell us that this is likely an isolated issue, not universal to all e-cigs.

> Reports earlier this week suggested that Vitamin E acetate, a byproduct of the vitamin complex formed during the vaporization process, may be to blame. Delman downplayed this, saying that although they are working with the labs that made that connection, nothing has been established as yet.

> One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine. This could be the result of many factors, however, so take it with a grain of salt.

So I think you would right to say the way GP phrased it is misleading, but you're definitely wrong to say that it's not what the article says at all.

They are interested often in destroying the industry rather than limiting the harm. The best advice would be followed by all the products which are suspect and advice not to use those products and carefully monitor which products you are using, so that if symptoms appear they know what to try to single out.

If I have put the pieces together correctly, they were sketchy THC carts that used a vitamin e oil to achieve super high concentrations of THC (95%) or so. Normal THC carts don't have that high of a concentration. I'm guessing some backyard chemist realized they could cram more in using vitamin e oil over the more standard vape oils used (propylene glycol, etc).

It's not to achieve high concentrations, it's to disguise the fact that it's been cut at all.

Distillate that's minimally cut will typically be very very thick. The more it's cut, the thinner and runnier it will be. Customers figured this out and started equating runny pens with low quality.

Dealers basically responded by using cuts that aren't obvious. This doesn't make the concentration any higher but fools the end user.

Are you sure? Because it's not that easy to dissolve cannabinoids, except in lipids. I haven't been into making carts myself in a number of years, but back when I did the major hassle and challenge was actually getting your extract to dissolve, and people were experimenting with formulations to get better mixtures with less effort and heat.

Inhaling anything other than pure air has always seemed like a bad idea. Bob Newhart just turned 90...

>INTRODUCING TOBACCO TO CIVILISATION ... https://monologues.co.uk/Bob_Newhart/Tobacco.htm

You can chew it!... or put it in a pipe!... or you can shred it up... and put it in a piece of paper. ha! ha! ha!... and roll it up. ha ha ha... Don't tell me, Walt, don't tell me. ha! ha! ha! you stick it in your ear, right? ha! ha! ha!...

Oh! between your lips!...

Then what do you do, Walt? ha! ha! ha!...

You set fire to it! ha! ha! ha!...

Then what do you do, Walt?...

Ha! ha! ha! You inhale the smoke, huh! ha! ha! ha!...

You know, Walt... it seems you can stand in front of your own fireplace and have the same thing going for you!

You see, Walt... we've been a little worried about you, y'know, ever since you put your cape down over that mud.

Y'see, Walt... I think you're gonna have rather a tough time selling people on sticking burning leaves in their mouthes...

When the CDC tells people to stop eating a specific food because of disease outbreak, even if rare, people stop eating that food.

When you dive in to the comments here, keep in mind a number of the posts are from addicts minimizing cognitive dissonance. The internet would’ve looked the same when cigarettes were first blamed for lung disease as well.

When there is an e coli outbreak, authorities are very specific about which batch of produce was affected. They don't say to stop eating all spinach or all vegetables.

They don't work magic dude. One of the vials came from a legal dispensary in Oregon. Thoughts on that?

In 2016, all bagged spinach was recalled nationwide.

>The U.S. Food and Drug Administration (FDA) called for bagged fresh spinach to be removed from shelves and warned people not to eat any kind of fresh spinach or fresh spinach-containing products

It happens.

I had an e-cigarette for 1 or 2 years which I used almost exclusively. The benefits were big but charging, changing filter/liquid, buying liquid was a lot of effort. But at some point I had a burning sensation, actually the "smoke" felt really hot already when entering my mouth. I'm quite sure these were technical difficulties because I had a cheap replacement device as I lost the old one. Anyhow, I also had slight pain in my lungs if I remember correctly.

It seems like a very immature technology and I doubt that it is in general dangerous as I know several people that used heavily customized e-cigarettes with self-made liquids for years. The sensation is almost relaxing when using this combination. (Of course these people had become experts on this topic.) But honestly, if one feels pain with anything one should probably stop doing it. (Same with cigarettes, if one feels respiratory problems one should at least pause it. A former boss of mine had that sometimes so he only smoked seldomly and sometimes does pauses of half a year or so. He must be now 60 or so but he's always far away from being a regular smoker.)

I knew something like this would happen. The market is flooded with cheap foreign liquids which no-one has any idea what's been put into them. How they've managed to bypass national trading standards is beyond me.

But it means that now we've got an understudied activity, with people using liquids filled with who knows what. There was bound to be health risks sooner or later.

The cases are in the US and related THC containing liquids. So it makes no sense blaming foreign liquids.

Who benefits from a temporary demand reduction or regulatory shift in vaping?

* Health advocates

* Alcoholic beverage producers

* Tobacco producers (though I believe they have gone all-in on vaping as a healthier replacement)

* Black- and grey-market cannabis growers who prefer not to concentrate their product

Who else should be on that list?

I’m not suggesting a false-flag or major conspiracy, simply that some group(s) will see a disproportionate benefit from wide-spread social panic over, and rejection of, vaping. If you are interested in trying to forecast economic conditions in order to increase/decrease investment in an industry, where would you look?

Society, if those products are found unsafe earlier rather than later.

I agree, but my questions have to do with the economics of the panic, warranted or not.

To build on your comment: Vaping is not a new concept[0] and if the act of vaping itself— rather than a problem with the supply chain (product purity, dosages, etc.)—was the problem why has it taken 13 years in the U.S. to surface?

I can imagine the contemporary spike in numbers of users and frequency has effect on the number of cases. For all we know this condition with the same set of symptoms has been seen before but connections never drawn to a wider-spread problem.

This may be the “earlier discovery” you reference, compared to the decades it took for Society to recognize how dangerous cigarettes are.

[0] http://www.casaa.org/historical-timeline-of-electronic-cigar... (note: industry source)

This depends - see the alchohol prohibition, if there's a large enough market and the product is easy enough to make then banning the product just creates an unregulated black market.

Which can create more problems if there's tainted products being sold, legal users will have to avoid otherwise legitimate shops that have at least _some_ degree of liability vs some random friend of a friend who has "good stuff" - who has no incentive at all to care about health or safety.

> Who benefits from a temporary demand reduction or regulatory shift in vaping?

Every state receiving funds in the Master Settlement Agreement. They are effectively partnering with the tobacco companies and they lose money when people successfully quit smoking.

Interesting point. Do you know if the Master Settlement Agreement requires people to stop smoking cigarettes, specifically, or does it broadly classify any usage of nicotine-containing products as "continuing to smoke?" I could see someone who vapes being naively classified as a "smoker."

The agreement doesn't require the states to do anything. They simply cash tobacco checks, nothing requires them to spend the money on tobacco harm mitigation. There's a recommended level of funding the CDC advises: no state funds prevention at that level.[1]

>Over the years, the states have collected tremendous amounts of commercial tobacco revenue, but are spending little of it on tobacco prevention and cessation programs. According to A State-by-State Look at the 1998 Tobacco Settlement 19 Years Later, states will collect $27.5 billion from the MSA and taxes in Fiscal Year 2018, but will spend less than 3 percent of it on programs to prevent kids from smoking and help smokers quit. No state currently funds tobacco prevention at the level recommended by the Centers for Disease Control and Prevention (CDC); 29 states and the District of Columbia spend less than 20 percent of the CDC recommendation.

Thus the states are effectively partnered with the tobacco industry.

[1] https://www.publichealthlawcenter.org/topics/commercial-toba...

Screw it, let's wade into this one briefly (because I've searched and nobody has mentioned this as far as I can see):

I currently live in South East Asia, the land of palm-oil-plantations-as-far-as-you-can-see, and it's that time of year again: slash and burn.

There is so much particulate matter in the air, that you can see the street lights illuminating it, you can't see islands from the shoreline, and schools will be closed this week if gets any worse (smack bang in the middle of the exam period as well).

I sympathise entirely with the view that vaping is not safe, only "safer". I desperately want to know the underlying cause of the CDC cases so I know what to look out for when I buy juice.

But any argument that implies that vaping is dangerous for me, and I should stop - in light of the fact that I am breathing in what is essentially ash on my commute to work - is completely and utterly missing the forest for the trees.

Sai, I think you are in a pretty unique position compared to most people. For your average person who isn't breathing in ash on a daily basis, I think it's pretty safe to say that vaping is more dangerous then not vaping, just like I think it's safe to say vaping is still safer then smoking.

Well you do have to acknowledge that you cannot control whether someone does a slash and burn or not, while vaping is something you choose to do.

I largely agree with you though. I spent some time in Beijing, and within an hour of getting off the plane I was coughing up black stuff. I breathed that stuff 24/7 for months, and some people do it for their whole life.

Do you wear a mask outdoors for your commute?

The CDC is for a country that, for now, doesn't have massive open-air fires in populated areas. That's why it doesn't recommend wearing masks at all times like your local authority should.

I strongly suspect that it is somewhat harmful and dangerous but I am convinced that most vape products are much less harmful than cigarettes. I mean they are talking about 5 deaths. Cigarettes kill 500,000 per year.

Some people are literally going to see a headline like this and use it as a reason to go back to cigarettes. I think they should put declarations like this in context. They have no reason to believe that it's anywhere near as dangerous as cigarettes.

Cigarettes kill a lot of people per year, but they take decades to do it. Not many lifelong smokers in their 20s, 30s, or even 40s are dying from cigarettes.

With that said. Vaping has been around for about ten years and this appears to be the first thing we've seen like this. Some of the victims are 18 or 19. I've been vaping on and off for 6 years. I only feel better when I vape vs smoking. Of course, that is purely based on my feel for cardio, lung capacity, and how my chest feels. Who knows under the hood at a cellular or other level. I've never been a big cloud guy, but I know big cloud people who have vaped twice as much as I have and they are still alive. The whole situation is very confusing. I'm hoping science prevails here.

If the FDA wants to outlaw vaping, so be it, but please be even-handed and outlaw plant-based nicotine products as well.

This seems to be incredibly well correlated with the increase in use of oil based thickening agents, particularly for black market cartridges. This year we've seen a lot of these products gain popularity, along with the rise of people selling cartridges in packages that look legitimate (Dank Vapes, Mario Karts, etc.) but are just cartridge packages, with no company selling THC carts with that name or product line existing. We've also seen a rise of rip-off packaging of real brands appearing on sites like AliExpress. People purchase these, fill them with something that resembles THC concentrate, and then sell them.

I know that correlation isn't causation, but my gut feeling is that we're going to find out that these additives are the culprit. To my knowledge, we're not seeing any reports of this occurring for people that are part of a state-run and well regulated medical marijuana program, where many of these products have been available for years. For recreational use, even in states that have legalized it, the stringency of regulations vary for dispensaries, so I don't know that I would necessarily assume that a cartridge purchased at a dispensary is necessarily safe from this sort of thing, either.

I'm not a research scientist or medical professional of any sort, though, so no one should take any of this as anything but a layman's PoV.

The death in Oregon was linked to a "an electronic cigarette containing marijuana oil from a legal dispensary".

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

Yep! Thus why I mentioned I wouldn't necessarily trust something from a dispensary as being safe. People have reported seeing some of the Dank Vapes/Mario Kart/etc. cartridges in dispensaries in California as well, despite these 100% being 'black market' cartridges of unknown origin.

Something about all the sudden bans in flavored, (enjoyable) vapes, mixed with the fear mongering all over the news makes me feel like this is all FUD being pushed by the tobacco industry. I mean, consider what’s happening. “Why vape if it’s flavorless and tasteless? At that point, I might as well stick to my Marlboro Reds, at least they have some established flavor” - I’m just playing devils advocate.

And about the “Think of the children!” replies - Classic red herring fallacy. Decent parenting and better local regulation could solve this problem. Or maybe it wouldn’t. Teenagers under the smoking age buy cigarettes every day, so vaping is no different.

I realize people are getting sick, but why is everyone acting like it’s “average” people getting sick like this? It’s those “HUGE CLOUD XD” people who are taking ridiculous sized rips, and black market THC vape carts. Juuls aren’t perfect, but their popularity and the losses to the tobacco industry’s profits make me wonder....

Very similar to the FUD campaign put out against La Croix last year when the 18-24 crowd stopped drinking soda, and started drinking sparkling water instead.

Source: https://nypost.com/2018/10/05/la-croix-hit-with-class-action...

> It’s those “HUGE CLOUD XD” people who are taking ridiculous sized rips, and black market THC vape carts. Juuls aren’t perfect, but their popularity and the losses to the tobacco industry’s profits make me wonder....

From what I understand, the issue is almost purely surrounding THC carts because of the lipids many producers use to increase the THC's solubility. People who make those big clouds are using high concentrations of vegetable glycerin which has not yet been shown to contribute to this illness and has several decades of established prior use. It helps to be less judgemental about others' lifestyles and stick to the facts.

> It helps to be less judgemental about others' lifestyles and stick to the facts.

Sorry if I came off as judgemental. With that being said, we're still unsure of the long terms effects of vaping. Those hobbyists who set their temps to ridiculously high levels and push their coil designs to the max are definitely taking it too far. I don't have a source for this claim, but rock with me on this one. Inhaling anything other than air isn't good for your lungs, and huge, HOT vape clouds aren't innocent in this discussion. I could almost argue that people who engage in that type of behavior are abusing vapes, especially when you consider what e-cigarettes were originally designed to do.

I could also reference the numerous articles (.gov) that connects 'diacetyl', a flavorant used in numerous vape juices, to "popcorn lung". However, my original intent wasn't to attack vaping, but the people who take it way too far, and give casual e-cig users a bad image.

You're still passing undue judgement and exhibiting stereotypical categorization towards people who use atomizers, without having all the facts. Most of these people don't push their temps to the max because it ruins the flavor and destroys the compound. They actually use very precise temperature control and a higher temp doesn't mean more clouds. Except for extreme temperatures, temperature has also not been cited as contributing to this epidemic.

> Inhaling anything other than air isn't good for your lungs

What is "air"? The air quality where I live is pretty awful and filled with contaminants. Also, can you point to a case where inhaling marijuana smoke/vapor has lead to cancer or serious disease? Not all smoke/vapor is created equal. It matters what its composed of.

I can tell you aren’t willing to understand my argument, so I’ll just slowly back away.

We can respectfully disagree without you attempting to discredit my ability to understand what you're trying to say.

The fact is, regardless of what either of us believe, that this is an ill-formed opinion of yours and it needs more work. Instead of being quick to double down, consider working to refine it by listening to what others have to say.

> Juuls aren’t perfect, but their popularity and the losses to the tobacco industry’s profits make me wonder....

juul and marlboro are both owned by the same company.

Ah, I didn't realize that. +1

However, when you consider the shift away from tobacco products, my point still stands. Vaping is something that can be produced by small time entrepreneurs, so the power is still being taken away from big tobacco. How many people can realistically grow tobacco? How many people can start making their own vape juices? I'd say a lot - This claim is corroborated by the article, which discusses these small time, 'fly by night' companies making their own vape cartridges (albeit very poorly).

Companies like Phillip Morris/Altria also do understand that this kind of situation is semi-temporary however. Yes, anyone can make their own, but with the combination of marketing/name recognition and economies of scale (alongside existing industry connections) they can maintain a dominant position in the market with Juul as the overall market grows and solidifies.

I'm sure they'd love to maintain the old status quo if they could, but this sort of thing is probably the right play at migrating big tobacco into the new world given that they can't.

I agree with you, but that sounds like a great Plan B. The first step would be to spread fear via the delegitimization of vaping, and convince people that vaping is deadly RIGHT THIS SECOND. Of course most people know smoking will kill you, but it’s better than the “Vape Boogeyman” being portrayed. Source: Cognitive Dissonance.

> . Decent parenting and better local regulation could solve this problem.

I never had any desire to smoke or do drugs even though all my friends did. I'm 56 years old and hung out with musicians all my life. I've done gigs with guys who were shooting heroin and snorting coke.

I had good parents.

Worried about the possible dangers of certain flavors, I tried "flavorless" e-liquid (6mg) and it tastes TERRIBLE.

Its not flavorless, its unflavored, and the nicotine (and possibly also the VG/PG) tastes like pre-chewed nicotine gum.

Maybe also ask people to stop smoking, like unless they're actually on fire.

Yeah, if only they had a page that says "Smoking harms nearly every organ of the body, causing many diseases and affecting the health of smokers in general. Quitting smoking has immediate as well as long-term benefits for you and your loved ones." https://www.cdc.gov/tobacco/basic_information/

I hate how this comment is on every website's comment section when smoking is brought up.

Smokers know that smoking cigarettes is unhealthy. But it's difficult to stop, since they are addicted. I'm sure you feel enlightened saying "uh, just stop duh", but it's not that straight forward.

I wonder if this reddit comment was on to something: https://www.reddit.com/r/CannabisExtracts/comments/b1w76g/tr...

Some background information:

- Cannabis, particularly THC, extracts are quite viscous and require thinning in order to feed into a vaporizer’s heating element. In other words, even for very pure use, some thinning is necessary.

- Thinning agents include propylene glycol (PG) and polyethylene glycol (PEG), also commonly used in nicotine liquids

- A market for terpenes as a thinning agent has emerged amidst uncertainty about the long term effects of PG and PEG

I wonder if mineral oils sold as terpenes are behind the lipoid pneumonia as the commenter mentions. Considering at least some of the carts were tested to be of advertised potency, I could conceive of a contaminated batch of “terpenes” making it into a well-meaning producer’s cartridges.

Also, we have a first published study. They are a week or two behind.

https://www.nejm.org/doi/full/10.1056/NEJMoa1911614

This was bound to happen. For the life of me, I cannot understand how things have gone this long without even a whiff of regulation. This is what you're going to get when u let a market be the wild west for a decade.

It’s a worthy mention that it’s mostly THC vapes. Rarely nicotine vapes alone.

Would this apply to vaping 'dry herb'? Or is it specific to oil?

I'm guessing this is strictly related to people using bootleg THC cartridges. You can buy empty carts on ebay/Alibaba and fill them with whatever you want. I'm sure there is a proper way to make THC vape juice and it doesn't involve using vitamin E oil. THC is soluble in vegetable glycerin which is the same component used in standard nicotine vape juice so I don't understand why Vitamin E is being used in the mixtures. Only thing that makes sense is that is being used as a thinning agent or some moron thought THC "oil" was made by actually using oil.

Since vaping flower is similar to smoking flower I would think that the problem lies in the unregulated juice that black markets provide. I haven’t heard of any cases of legal carts being the causes but they haven’t been all that forthcoming with the sources.

I ordered 'vape juice' online for my nephew one time. For the past few months I've received spam about cheap CBD vaping juices. Most of these articles mention low quality or debased CBD formulations. I would bet on some connection between the spam I've been receiving and this recent vaping illness. Just my initial suspicion after seeing these articles crop up at the same time as my received spam emails.

I will admit that I am a little confused about all this. To the best of my understanding, LD50 for nicotine is appx. 13 mg and nicotine poisoning can cause all the issues listed ( including death ). The difference appears to be ease of passing those tresholds. I get that vapers add all sorts of enhancers, but why THC seems like an odd strawman to use here.

“One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine.“

Looks like this is an issue mainly related to home-brew liquids containing THC.

Edit: care to follow up on your downvotes and maybe post a clarifying comment? I just reported a passage of the article verbatim.

Ten of my friends got food poisoning eating at a Chinese restaurant in town. Conclusion: prawn crackers are unsafe.

> One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine

If victims used "THC exclusively", why are nicotine vapes being targeted? Were there any victims that used nicotine vapes exclusively?

> If victims used "THC exclusively", why are nicotine vapes being targeted? Were there any victims that used nicotine vapes exclusively?

See my comments above

Yeah, who could have thought...

It amazes me people freak out about GMOs and the material Starbucks cups are made out of yet will breathe vaporized chemicals of who knows what sorts directly into their lungs. Mind boggling.

Why are you assuming it's the same people?

It's not like a majority of the population vapes... while it seems to be at least somewhat popular, it's still very much the minority I see vaping.

Apparently 20% of US high school students vape.

Which is a minority, of an already small subset of the population.

That's because you can opt out of the former. "No, I won't buy from Starbucks because of their cups. No, I won't eat that because it has GMOs." It's a lot harder to make that commitment when it's the air you breathe - you either have to wear a mask all the time or move away and live in the wilderness.

wut? the conversation is about vaping. your comment makes no sense.

Oooor you can choose not to vaporize things to inhale? This isn't in normal air, it's specifically from vaping

No you can’t if someone is vaping near you. In fact it’s worse, since vapids make a point of blowing as much “smoke” as they can to make sure everyone sees them.

When you buy a cup from Starbucks you typically are only buying a single dose. If you buy a vape cartridge, you have dozens of doses. It's much harder to throw the latter away than the former.

Suppose someone bought a car, and found out that the car vents were spewing somewhat toxic that has a slight chance to kill them. If they needed to go to work in it to put food on the table, can you see how someone might say they had no choice but to use it?

Now take that logic and apply it to a vape cartridge. Say someone bought that cartridge which carries so many doses, along with paying the cost of the physical vape machine and the cost of electrically charging the machine, and spent the necessary time and emotional cost to wait for the machine to do so. Then they find it out it may be toxic. Is it really a realistic choice to take the financial and emotional burden of throwing away the cartridge, if it provides a needed soothing relief to their mind?

> Suppose someone bought a car, and found out that the car vents were spewing somewhat toxic that has a slight chance to kill them. If they needed to go to work in it to put food on the table, can you see how someone might say they had no choice but to use it?

It's funny to read this here because that's exactly what happened to me. I was driving a diesel car with a damaged firewall, which meant carcinogenic diesel exhaust fumes came through the floor and vents. I had absolutely no budget for a car, as I was paying for expensive medical insurance and bills. I had no choice but to drive it with the windows down. My clothes would smell of diesel after driving. I took it multiple times to the dealership until they found the problem, and they said it would be more costly to repair it than to buy a new car.

Fortunately, I eventually bought a new car. But I still might get lung cancer in the future.

Reminds me of the old joke about the guy at the fast-food joint: I’ll have a double bacon cheeseburger, a large fries, and a diet coke.

Like — why are you buying this totally unhealthy meal and then getting a diet coke? Who are you kidding?

Yet — I’ve been that guy. So it’s not so mind boggling.

Some groups like T1 diabetics can not have the amount of sugar in "normal" fizzy drinks. That amount of sugar can cause issues from nausea to messed up glucose levels needing hospitalization. Hamburgers and fries are not a problem (not healthy but not dangerous).

"Diet Coke" is just a stupid name for sugar free drinks.

Other advantages: no need to brush you teeth immediately after drinking soda to prevent cavities, lighter mouth feel, safer in a car (if you spill the drink there's no sticky residue), T2 diabetes risk reduction vs drinking regular soda, no added insulin response, and if you drink a lot of liquids you can have a few refills without thinking about calories.

You get all those benefits from water also.

Artificial sweeteners also increase appetite and cravings for sweet food, so if you are suffering food-related illness, it's better to stay away from them as well.

Is that actually true? Bread contains very high carbohydrate levels, I'd imagine a hamburger bun is not much worse than a glass of coke.

Drinking sugary liquid like coke causes very rapid rise in blood glucose levels and will require excessive amounts of injected insulin to maintain glucose in reasonable limits (which may lead to dangerous drop later).

Eating something with high carbs is much slower and can be managed with normal insulin doses. White bread is not the healthiest diet, but a burger and fries every now and then is not a problem for a T1 diabetic whose treatment is under control.

Not an expert, but I would imagine the speed at which these carbohydrates get metabolized is a factor in whether or not it messes them up? Carbs from bread take a much longer time to raise blood glucose levels and do so for longer than a spike induced by drinking what is essentially liquid sugar.

I've been that guy too. Reason: I like diet coke.

(Possible reason #2: a fat meal with diet coke is still healthier than the same meal with regular coke.)

yes, I don't see any problem with that order. Seems more like gatekeeping to me.

Not making it worse by piling on a huge amount more sugar?

I mean, it's not a weight loss strategy but it's some form of harm reduction...

You're acting like "people" is one cohesive group. I'd largely suspect there's minimal overlap between the GMO group and potent THC vapers.

While what you're saying is probably true, many people forget that humans are walking contradictions.

And also the important side point that being a hypocrite doesn't inherently make your point wrong. Sure it means you don't live consistently by it, but as you said, humans do this sort of thing constantly. Someone's arguments/beliefs should be evaluated on their own merits first and foremost.

You’re not wrong. Lungs are for air. If we came with instructions there would be a page on this.

Yes ok, it’s a bad batch of juice (probably), it won’t effect most vapers (probably), better regulation will solve the problem (maybe). But I have got to ask... was all the vaping done thus far and into the future worth even one person dying needlessly?

It’s cigarettes all over again. Who benefits except the people selling it? Yes freedom, yes whatabout other pointless harmful things in the world, but vaping has already caused more harm than we should accept, I think.

> was all the vaping done thus far and into the future worth even one person dying needlessly?

If it's saved significantly more than that, there's a decent argument that "yes it might have been".

But that's specifically for nicotine e-cigs, in my opinion. They have a clear harm reduction purpose; slightly less clear when talking about THC carts, I think? Thought I'm likely incorrect about my assumptions on that.

The people formerly smoking cigarettes that switched have likely benefited quite a bit, or will.

Have you ever done anything you enjoyed, even though it entailed greater than literally zero chance of your death? Like showering? Or walking down the street?

You see, for people who enjoy vaping, it's sort of like that.

You say, “yes freedom,” as if freedom is a valueless proposition if people use it to do things you consider pointless.

>...was all the vaping done thus far and into the future worth even one person dying needlessly?

This is a reduction to absurdity that I can't quite grasp: People die of all sorts of maladies every year and a single person dying from vaping is your apex priority because, "it could've been prevented by banning vaping"?

This almost seems like a variation of the "won't someone think of the children" argument.

To whit: What of all of the vehicular deaths every year? Or deaths via trains or planes? Should we just ban all life because it will result in death at an astounding success rate of 100%?

I am not on anyone's side here, but didn't you just answer a logical fallacy with another? Namely whataboutism?

Reductio ad absurdum is similar to whataboutism, but it's not the same. Whataboutism is more like an abrupt detour off into a different issue to try to confuse the conversation or transform the topic of discussion into a referendum on the personal morals/motivations of the involved parties. The appeal to extremes does have to ask the question "what about x" but it's relevant because it's done to demonstrate the logical consequences of the other person's line of argument. It's not trying to deflect, it's getting to the heart of the issue.

Something like 400,000 people a year die in the US due to smoking. Vaping is mostly a substitute for smoking. But even if millions of non-smokers start vaping, it's a net positive.

Not when it turns out vaping is even more deadly than smoking.

If vaping is that deadly then fog machines should be killing people all over the place. It's the same technology.

The only time vaping causes more harm than smoking is when people use dangerous solvents (eg: not propylene glycol) or when batteries explode.

Vaping is not more deadly than smoking cigarettes.

We'll see.

Are you willing to bet money on that? I'm willing to bet any amount up to 1 BTC (≈10,000 USD) that in the next decade, there will not be a year in which the CDC attributes more deaths to vaping than smoking. I'm also willing to bet on similar statements that would be true if vaping is more harmful than smoking.

If you want, we can find a neutral arbiter to determine the outcome of our predictions, though they may want a percentage of the stakes.

https://edition.cnn.com/2019/09/11/health/vaping-lung-illnes...

> Eventually, Adam said that he went from vaping over-the-counter e-liquids to vaping THC or tetrahydrocannabinol, which is the main psychoactive component of marijuana. Adam would get the THC from "a friend" or dealer. Over time, Adam said that he developed shivers and couldn't control them. Then, the vomiting began.

A very small number of people are getting sick and dying because they're vaping black market THC cartridges. Most vapers are doing nicotine, and they're buying Juuls and other brand name products that are much safer than smoking.

I ask again: Are you willing to bet money that the CDC will attribute more deaths to vaping than smoking (or some similar statement that would be true if vaping was deadlier than smoking)? If you're so sure you're right, why don't you take my money?

Do you not understand how deadly cigarettes are?

~34 million people smoke cigarettes in the US. US deaths from smoking is ~500k/yr.

Meanwhile, over 10 million vape in the US. US deaths from vaping is... only 5 people since vaping existed? And those deaths are likely from vaping juice that contains oils, rather than standard vape juice.

Reminder: millions and millions of people worldwide are vaping. This condition affects fewer than 500 people thus far.

"Mystery Lung Condition" aka cancer.

Chuckles at picturing Cult of the Dead Cow giving health advice :D.

Okay okay, "Centers for Disease Control and Prevention", one more US TLA unknown by non-US folks.

Solution: do not buy crappy weed juice off the street. VG, PG and nicotine do not have this effect when combined. This is a symptom of overregulation, not vaping.

If there’s one positive thing in all this it’s that we can stop pretending that vaping is safe. I hope this will save a lot of lives.

Does anyone have any idea if this is fatal/permanently debilitating or if it is temporary? That would seem kind of important.

EDIT: I guess I meant to say, yes, people have died, but of those that recovered is it a full recovery or a permanent disability?

There have been 5 confirmed deaths so it seems fairly serious.

5 deaths is fairly serious?

Almost 500k die from smoking cigarettes every year, so vaping seems like a great alternative.

Huh? How come they are not coming out saying to stop smoking regular cigarettes too? How are regular cigarettes still legal?

> How are regular cigarettes still legal?

Tax revenue & lobbying

This title totally sounds like one of those headlines in Plague Inc. :D

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