Separating Fact from Fiction in Ongoing Vaping Investigation

Posted on Sep 09, 2019. 0 comments

While hundreds of people have suffered from acute lung illnesses, federal authorities are still seeking clarity and causes

Despite ample evidence indicating that properly sourced and operated vaporizer devices are cleaner alternatives to traditional smoking, the digital arts have never fully vacated themselves from controversy. Now, federal authorities are linking an ongoing -- and in many ways -- enigmatic rash of lung illnesses to vaping. Unfortunately, the ensuing panic has created an environment of misinterpretations and a rush to judgment among influential parties.

That being said, the surge in speculation, along with the subtle finger-pointing toward vaporizers is understandable. Naturally, people fear the unknown. When an anxiety-provoking incident occurs, instinctively, the masses respond to their base inclinations. In prior controversies involving e-cigarettes, the vaping industry has borne the brunt of public conjecture. But now with various health officials citing concerns about vaping, the issue has taken on a life of its own.

Additionally, various media outlets have reported on the ever-growing occurrences of lung illness. Even more shocking, the death toll allegedly related to this acute lung syndrome has steadily risen. The general lack of vaping expertise among mainstream journalists, combined with the public’s unfamiliarity with the platform has sparked heavy misguidance toward this topic.

To bring both clarity to this controversial subject and to help dial down the associated emotions, we’ve put together a fact-based report sourcing only primary and provenanced secondary sources, such as The New York Times or CNBC. It’s our hope that with this account, you, our deeply valued customer, can make the most informed decisions.

With that, let’s turn to a brief summary of what initially sparked this controversy.

 

A Mysterious Torrent of Lung Disease

Earlier this year, federal health officials noticed a spike in patients, mostly young and male, with severe lung-related illnesses. Analyzing over a hundred cases, the Centers for Disease Control and Prevention determined a connection between the epidemic and vaping devices. However, this investigation started sometime around the middle of summer when suspected cases were fewer in number.

To conduct a thorough investigation, the CDC has worked closely with the Food and Drug Administration, along with state health officials and public health partners. Furthermore, the CDC has asked all clinicians and medical professionals to report suspected cases of vaping-related lung illnesses. Under such circumstances, the federal agency has requested a detailed history of vaping devices and substances used.

Yet in spite of a full-blown nationwide effort to crack down on causality, hard facts are indeed hard to come by. For instance, according to an investigation by The New York Times, the first reported case of this acute lung illness occurred in Illinois this past April. However, federal authorities and officials have so far cited mid-June as the initial date of the outbreak.

Even with the outbreak’s ground-zero date, leading experts on the case have no consensus. You will find that this is alarmingly par for the course in this alleged “vaping crisis.”

Tellingly, Acting FDA Commissioner Ned Sharpless, M.D. admitted that the investigation is still in its infancy. Authorities are still laying out possible culprits, including a carrier oil called Vitamin E acetate, which some vapers have used illicitly and against vaporizer manufacturers’ instructions and guidelines. Dr. Sharpless stated:

“Our laboratory is working closely with our federal and state partners to identify the products or substances that may be causing the illnesses and have received more than 120 samples from the states so far. The FDA is analyzing these for a broad range of chemicals but no one substance, including Vitamin E acetate, has been identified in all of the samples tested. Importantly, identifying any compounds present in the samples will be one piece of the puzzle but won’t necessarily answer questions about causality, which makes our ongoing work critical” (emphasis ours).

Notably, the CDC agrees with the FDA that causation of the lung illnesses is yet to be determined. Though short on definitive evidence, the CDC nevertheless jumped the gun, recommending that consumers stay away from all vaporizers and e-cigarettes until the investigation is finished.

And yet this is another oddity within this vaping saga which speaks to the credibility – or lack thereof, among opposing views – of watchdog health agencies.

 

Vaping Caught in a Political Crossfire

On Friday, the retail vaporizer platform was supposedly dealt a crippling blow. With the CDC issuing their warning not to use vaporizers until an investigation into a vaping-related epidemic could be resolved, the optics for this burgeoning industry couldn’t have looked worse.

And while several mainstream media outlets and medical practitioners heaped both subtle and direct blame on e-cigarettes, that was only half the story.

The CDC wasn’t the only organization disclosing their initial findings regarding the lung-illness epidemic. As CNBC reported, the FDA had their own say. The agency that actually oversees vaping products – and one that is not necessarily the most helpful to the underlying industry – didn’t mention anything about vaporizers. That’s right: not a single word, outside of encouraging consumers to report product or technical issues that could be related to this outbreak.

Instead, the FDA focused their concerns on the botanical department. Based on their findings, the oversight agency warned consumers not to vape materials containing THC. That’s a far cry from what the CDC has stated.

So, which one is it? Vaping as a platform or THC as an ingredient? As their own federal data indicates, nobody really knows.

Proponents of e-cigarettes are quick to point out that lack of defining evidence – that is, innocent until proven guilty – should exempt the digital arts from what is essentially high-level persecution. Yet one thing that muddies this water is an aspect that natively has nothing to do with vaporizers: marijuana legalization.

Unlike vaporizers, cannabis oils represent a largely unregulated market. While several states have elected various forms of legalization, under federal law, marijuana is classified as a Schedule I drug. This has prevented the U.S. from truly actualizing the cannabis sativa plant as an economic force.

Moreover, Schedule I classification has led to a now sick irony. While the FDA oversees vaping because it’s a perfectly legal platform, it does not regulate cannabis oils because they are illegal at the federal level. The FDA being a federal agency, it has no practical influence on how individual states regulate these oils.

Hence, unproven and untested oil carriers such as Vitamin E acetate have found their way in otherwise state-legalized cannabis products. Many states are simply underfunded or lack the technical expertise to control marijuana-related “innovations.” Further, as we just explained, the FDA by law and mandate cannot get involved either.

This creates pockets of dangerous, illicit behaviors, which unfortunately marry a legal platform (vaporizers and e-cigarettes) with an illegal substance or non-recommended operation (vaping an untested carrier oil).

 

Opportunism Against the Vaporizer Industry

One of the regrettable components of this ongoing investigation is for interested parties to turn this matter into a political or agenda-based cause. For instance, The New England Journal of Medicine recently published a report about acute or subacute inhalation lung injuries.

Timing aside, it is a compelling read about a fast-rising epidemic impacting at least 25 states. But in the midst of the Journal’s concern, they have quickly assigned blame on e-cigarettes and vaporizers. In fact, the title of their report is “Vaping-Induced Lung Injury.”

Immediately, readers have a question, and it has to do with the content of the report itself. After summarizing the lung-illness epidemic and the supposed association with vaping, the Journal then makes a curious admission, stating:

“Though the precise manifestations of the respiratory injury may be diverse, there are clues to the precipitants that warrant attention. About 80% of the persons who vaped and became ill reported having used both nicotine products and tetrahydrocannabinol (THC) or cannabidiol (CBD) products.”

What this statement suggests is a broader lack of awareness of the legal and proper vaping industry. The lion’s share of vaping enthusiasts chooses the vaporizer platform to get away from the harmful, addictive components inherent in analog smoking “devices.” The fact that substances such as nicotine or THC are reported with apparently significant magnitude indicates that these lung illness subjects are not typical of the average, everyday vape user.

We’re not just saying that because vaping is our business. Rather CNN Health in July of this year reported that adult smokers who vape “are more likely to quit using cigarettes.” Yes, relapses occur among some individuals in this group. However, vaping manufacturers are researching and distributing fresh innovations, particularly through mouth-to-lung (MTL) vaping devices which better mimic the traditional smoking sensation. The aim here is to help mitigate the relapse effect.

Now to be completely fair and transparent, many medical professionals emphasize that there is no evidence of the vaporizer platform’s long-term cessation benefit. That said, it’s also fair to point out that vaping is a relatively young industry. Thus, in order to make a long-term quantification, you must first have a long-term basis. Plus, most historical vaping studies are only a few years old because the vaping subculture didn’t attract mainstream attention until only recently.

In light of this context, the shorter-term studies should carry more weight. And in study after study, vaping – when used properly according to reputable manufacturers’ instructions – have helped countless of users quit the analog smoking habit for good.

 

A Possible Demographic Exoneration of the Vaporizer Platform

Despite many misgivings about the mainstream medical community’s interpretation of vaping as a platform and industry, admittedly, the complex has articulated a valid problem: underage vaping.

At Vapor Authority, we take this issue with utmost seriousness. Through meticulous safety and preventative mechanisms, we operate via a rigorous process – one of the retail vaping industry’s highest standards – to ensure that our products only ship to customers of legal age.

At times, this has created frustration among perfectly legal customers. Moreover, this has led to lost sales opportunities. But to run afoul of legal and ethical obligations to make a quick buck? That’s never been our way of doing business, nor will it ever be.

In fact, a rising number of legal vaporizer and e-liquid manufacturers have supported initiatives to stop underage vaping. And that really shouldn’t come as a surprise to any unbiased observer. Nothing kills a business faster than a negative reputation, let alone committing illegal acts.

Thus, the legal vaping industry and federal, state, and medical communities are all on the same page: underage vaping is wrong, and any efforts to curb its tide is a welcome and beneficial endeavor for all parties.

What the legal vaping industry doesn’t appreciate, though, is the framework often imposed by the mainstream media: we are partners against underage vaping, not adversaries.

And within the segment of underage vaping, we find evidence that further disassociates the epidemic of lung illnesses from vaporizers. In 2018, the Ohio Department of Health ran a study on the prevalence of teenage (underage) vaping. This was a unique study in that it’s perhaps the only publicly available report that segments vaping use between genders, as well as those who identify as alternative categorizations.

For our purposes, it’s helpful to look at traditional gender identifications and their associated underage vaping use. Between the years 2016 and 2017, 10.7% of Ohio male teens vaped in the last 30 days since the study was conducted. In contrast, 7.6% of Ohio female teens vaped during the same timeframe.

But in the years between 2017 and 2018, a dramatic shift occurred. Perhaps owing to the illicit popularity of underground vaping channels, the percentage of Ohio male teens who vaped increased to 12%. In that same period, 10.8%, or nearly 11% of female teens vaped.

Chart

Why is this so significant? Aside from the collective jump in underage vaping, the variance spread between male and female teen vaping narrowed exponentially. Between 2016 and 2017, the variance between male teen vaping (10.7%) and female teen vaping (7.6%) measured 41%. From 2017 to 2018, that variance slipped to 11%.

In other words, the difference in prevalence among teenage male and female vaping dropped a staggering 73% in just one year. Putting this into lay terms, teenaged boys and girls are vaping (illegally) with similar frequencies. While a study has not been conducted for the years 2018 to 2019, based on these trends, it’s reasonable to assume that the male-female spread has closed even further.

Interestingly, Dr. Jennifer Layden of the Illinois Department of Public Health, in commenting on the lung-illness epidemic to The New York Times, stated that patients were typically “healthy, young, with a median age of 19 years and a majority have been men.”

If the majority of these lung illness cases are young males, and the vaping frequencies between the traditional genders are extremely similar, then it suggests that vaporizers are not to blame. Rather, males, who usually engage in far riskier behaviors than females, are more likely to push beyond the stated guidelines of vaporizer manufacturers, jeopardizing their health in the process.

 

But Are Cannabis-Based Products to Blame?

When even the medical reports seemingly designed to protest against the vaporizer industry indicate quite clearly that vaping is one of myriad possible explanations, it’s reasonable to consider more likely casual factors. And in this frantic search, it appears that some consensus against cannabis-based products, particularly cannabis oils, should shoulder responsibility. But is this assessment fair?

At first glance, it appears a reasonable scenario. Most, but not all of the cases have involved vaping substances like cannabis or cannabidiol (CBD) against manufacturer’s guidelines and recommendations. But at the same time, these same experts are conflating the rash of illnesses with the broader legal cannabis industry.

As with vaporizers, we must be careful not to assign immediate blame on certain products or formats simply because of their mere association. For instance, on a purely quantifiable basis, a study between ice cream sales and ambient temperatures will provide a strong correlation. But correlation does not necessarily mean causation; otherwise, uninformed statisticians may arrive at the erroneous conclusion that ice cream demand causes hot weather.

While that example sounds ridiculous to us, that’s also because we all know how seasons and environmental cycles work. But imagine if we had visitors from another galaxy: what we accept as normal would not be intuitive to them.

In much the same way, the medical and health advocacy communities are diving headfirst into an arena of which they lack knowledge and experience. Thus, it’s much easier for them to unwittingly make fallacious or spurious arguments. What might sound very reasonable from an outside perspective doesn’t compute for those who are familiar with the involved granularity.

Related to cannabis-based products, we must distinguish between legally and properly sourced cannabis products versus those that are distributed illegally or from questionable sources. As mentioned earlier, federal agencies have no say toward state-mandated enforcement of cannabis products. In the eyes of the FDA, cannabis is illegal; thus, it would contradict their mandate to regulate an illegal product.

This is one of many confusing scenarios involving the legal cannabis market. Essentially, the FDA is powerless to stop the influx of illegally sourced or modified cannabis products because doing so is akin to a plaintiff suing a defendant for failure to perform an illegal contract: by law, the FDA cannot regulate anything that is illegal, no matter how harmful to the general public.

But in reality, no federal agency should have to get involved in terms of properly used cannabis solutions. For one thing, cannabis has a history of personal and therapeutic use that extends back more than 5,000 years ago. Even during the times when it was completely illegal throughout the nation, marijuana was a choice compound for recreational use.

Put differently, anti-vaping or anti-botanical advocates have a wealth of data extending multiple centuries. Yet the acute lung illnesses that have captured mainstream attention have only occurred within the past few months.

This almost surely suggests that legally and properly sourced cannabis products are not the root cause of this epidemic.

 

So, What’s the Real Cause Behind the Lung Illnesses?

While mainstream institutions have been trigger-happy to place definitive causations, it’s important to remind ourselves that the available data does not facilitate such immediate pronouncements. Moreover, we do not even have consensus among the high-level organizations leading this investigation.

Glaringly, we documented that the CDC and FDA have two drastically different recommendations for avoiding this health dilemma. On one hand, the CDC has unambiguously eyeballed vaporizers and e-cigarettes, recommending their entire cessation. But on the other hand, the FDA makes no true mention of e-cigarettes; instead, they recommend avoiding products containing THC or nicotine.

This confusion isn’t just a punchline for the stereotypical ineffectiveness of government policies and procedures. For instance, Michigan became the first state to ban sales of flavored vaping products, according to CNBC.

But is that really the catalyst for underage vaping? In fairness to the state of Michigan and to play devil’s advocate, we can appreciate the dilemma from their point of view. The CDC has been adamant about voluntary elimination of vaping until the investigation concludes. Therefore, Michigan is taking a pro-active approach for the safety of their citizens.

Obviously, there are clear concerns about government overreach and the violation of commercial and individual rights. Since the available causal evidence points to an illegal activity, it makes zero sense to penalize legal institutions and infrastructures

These infrastructures, by the way, employ tens of thousands of people. According to Forbes, the legal marijuana industry is one of the fastest growing job markets. By the year 2020, the botanical industry might create more employment opportunities than manufacturing. Therefore, it’s really in the government’s best interest to tread carefully in this matter.

Regarding this delicate balance, the concerned agencies have a likely and reasonable answer to the lung illnesses: the prevalence of young men to engage in risky behaviors.

Political correctness aside, we instinctively know that young male adolescents often have a boisterous need to prove their manhood. But according to The Journals of Gerontology, this is a quantifiable social phenomenon. Typically, younger males tend to engage in risky behaviors than their older counterparts. Moreover, this is especially true for “recreational risks.”

Combined with the social pressures involved in smoking/vaping/marijuana, it’s very much reasonable that at-risk youth are susceptible to pushing the stated boundaries of vaporizer systems. Furthermore, the existence of materials like Vitamin E acetate indicates that these youth are purchasing their vaporizers and components through black markets.

That would also make sense in that most vaping retail institutions are patently disincentivized from illegally selling to minors.

 

Real Questions to Ask

When The New England Journal of Medicine headlined their assumed connection between vaping and the rash of lung illnesses, readers also had another obvious question: why is this occurring now?

It’s an absolutely fair point to bring up. In 2003, a Chinese pharmacist named Hon Lik invented the first modern e-cigarette. Within a few years, e-cigarettes and vaporizers inspired by Lik’s design entered into the U.S. and European markets. Realistically, we’re talking about a robust market that’s been in place for at least a decade.

Thus, why is this acute illness starting to appear now?

Some journalists have speculated that these issues may have occurred in lower frequencies in the past but have only now started to catch mainstream attention. Moreover, industry data does admittedly lend credence to this argument. For instance, several vaping manufacturers have increased their unit sales over the past few years, in some cases quite dramatically.

But under closer investigation, this line of thinking doesn’t quite pass muster. According to a 2015 report from the CDC, about 3.7% of the U.S. adult population, or more than 9 million people at the time vaped on a regular basis. Surely, that figure has increased significantly since then. But even using this conservative figure, the reported 450 cases of acute lung illnesses amount to 0.005% of the vaping enthusiast population.

In other words, even if there was a proven connection between vaping and these lung illnesses, your risk of falling ill would be 1 in 20,000. To put that into perspective, you would have better odds of winning an Oscar (1 in 11,500 odds, according to Forbes).

Therefore, the quantifiable and contextual evidence points to some cause other than vaping or legally sourced cannabis products. Mathematically, a 0.005% incidence rate would count as an anomaly, as it would mean that 99.995% of the vaping community regularly vape without incident.

Further, vaping is a global phenomenon. While traditional smoking rates have flatlined, vaping has veritably skyrocketed. In 2011, 7 million people vaped worldwide. Five years later, that stat jumped to 35 million. Euromonitor, a market research group estimates that global adult vapers will reach nearly 55 million within two years’ time.

So, where are the international cases? While we account for the largest vaping market share at roughly one-third, the remaining two-thirds are spread across other, predominantly developed nations, such as Japan, the U.K., and Sweden.

And you should know that these countries have universal healthcare. Translation: they are much more incentivized to go to the hospital for any health-related concerns. Combined with their smaller populations, we should see similar alarm due to their robust (against a per-capita basis) vaping behaviors. However, the mainstream media has been so far silent on this issue, again casting doubt that the vaporizer is the main culprit.

 

Summary of Lung Illness Epidemic

We’ve covered an extensive amount of information regarding the recent surge in acute lung illnesses. To summarize, below are the main points and arguments:

  • Federal health agencies noticed a spike in acute lung illnesses. According to recent reports, there are 450 cases and possibly 5 deaths across 33 states.
  • Health organizations, medical professionals, and anti-smoking advocates have quickly pointed to vaporizers as the main culprit.
  • However, these same organizations admit that they do not know the true cause of the lung illnesses and are therefore conducting investigations.
  • Federal agencies have not delivered a clear, consolidated message. In the interim pending conclusion of their ongoing investigation, the CDC has recommended that everyone cease vaping immediately. On the other hand, the FDA has made no such pronouncement, instead recommending vapers to not vape e-liquids or materials containing THC.
  • The medical community has been quick to blame vaping in their headlines but contradict themselves in that the underlying pattern in these lung illnesses revolve around (illegally sourced or modified) cannabis products and consumption.
  • Underage vaping statistics demonstrate that the variance between male and female vapers have narrowed exponentially. This contradicts the narrative that vaporizers are to blame for the lung illnesses because the majority of cases involve young men. Based on recent underage vaping trends, we should see much higher representation of sick female vapers.
  • Cannabis itself has a 5,000-year history, thus providing centuries of data for health agency analysts. Yet the fact that the illness is suddenly sprouting now is strange, to say the least.
  • While possible explanations are speculative at this point, the available evidence suggests that risky behaviors (such as illegally modifying vaporizers or ingesting illegally sourced materials like Vitamin E acetate) linked to young males’ psychological profiles is the root cause.
  • Statistically, the lung-illness incidence rate is only 0.005%, hardly the basis for a direct correlation with vaping.
  • Significantly, there are no reported international lung-illness cases at time of writing.

Finally, it’s crucial to point out the realities of our litigious society. Nowadays, everyone must cover their hind end to protect against devastating lawsuits.

As federal agencies, the CDC and FDA have a responsibility to protect the American people. With the CDC in particular, we must appreciate that they have their hands tied. For them, the flack that they receive from the vaping industry is a small price to pay relative to liabilities associated with not warning the public adequately.

It’s an unfortunate circumstance, but we also understand the politics behind it. Therefore, we have not adopted an antagonistic approach with federal oversight committees as that would be unhelpful in the long run.

Instead, the more productive approach is to provide fact-based analyses, empowering the vaping customer with contextually accurate information. We hope that this report has eased your minds about some of the sensationalist claims arising from various media outlets.

As always, you are free to call us at 888-927-VAPE (8273) regarding this or any other concern. Alternatively, for the fastest response, you may reach us at management@vaporauthority.com.

We thank you for your patronage and hope to hear from you soon.

 

Sincerely,

Team Vapor Authority


Citations

Blaha, Michael Joseph, M.D., M.P.H. “5 Vaping Facts You Need to Know”. Johns Hopkins Medicine. Hopkinsmedicine.org.

Centers for Disease Control and Prevention. “Initial State Findings Point to Clinical Similarities in Illnesses Among People Who Use E-cigarettes”. CDC.gov.

Richtel, Matt; Grady, Denise. “Cases of Vaping-Related Lung Illness Surge, Health Officials Say”. The New York Times. Sept. 6, 2019. Nytimes.com.

LaVito, Angelica. “What should people avoid inhaling during mysterious lung disease outbreak? Health officials disagree”. CNBC. Sept.7, 2019. Cnbc.com.

Christiani, David C. “Vaping-Induced Lung Injury”. The New England Journal of Medicine. Sept. 6, 2019. Nejm.org.

Azad, Arman. “Adults who vape are more likely to quit cigarettes, study finds”. CNN Health. July 15, 2019. Cnn.com.

Washington, Julie. “Teens who vape: Underage e-cigarette use heats up”. The Plain Dealer (distributed by Cleveland.com). July 8, 2018. Cleveland.com.

Bridgeman, Mary Barna, PharmD, BCPS, BCGP; Abazia, Daniel T, PharmD, BCPS, CPE. “Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting”. Pharmacy and Therapeutics. March 2017. Ncbi.nlm.nih.gov.

LaVito, Angelica. “Michigan becomes first state to ban sales of flavored e-cigarettes”. CNBC. Sept. 4, 2019. Cnbc.com.

Detroit Free Press. “Michigan vaping rules: Necessary step, or government over-reach?”. Sept. 8, 2019. Freep.com.

Borchardt, Debra. “Marijuana Industry Projected To Create More Jobs Than Manufacturing By 2020”. Forbes. Feb. 22, 2017. Forbes.com.

Rolison, Jonathan J.; Hanoch, Yaniv; Wood, Stacey. Liu, Pi-Ju. “Risk-Taking Differences Across the Adult Life Span: A Question of Age and Domain”. The Journals of Gerontology. Oct. 22, 2013. Academic.oup.com.

King, Brian A., PhD, MPH, et al. “Electronic Cigarette Sales in the United States, 2013-2017”. JAMA Network. U.S. National Library of Medicine. National Institutes of Health. Oct. 2, 2018. Ncbi.nlm.nih.gov.

Herndon, Neil; Arch Enemy Entertainment. “The Odds Are Against You: Things More Likely Than Winning The Powerball”. Forbes. Jan. 13, 2016. Forbes.com.

Jones, Lora. “Vaping - the rise in five charts”. BBC. May 31, 2018. Bbc.com.

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