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The CDC is Still Misleading the Public about the Cause of the Respiratory Disease Outbreak: Why?

Last Thursday, CDC finally revised its warning to the public about the vaping-associated respiratory disease outbreak to state clearly that vaping THC-containing products is playing a major role in the outbreak. It stated that: "The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak. Therefore, CDC recommends that you should not use e-cigarette, or vaping, products that contain THC."In addition, CDC finally recommended that clinicians test case patients for THC with a urine drug screen, something I recommended more than a month ago. This is a huge step forward because prior to this, the CDC was hiding from the public the fact that THC vaping was playing a major role in the outbreak and failed to provide an explicit warning to stop vaping THC. The Rest of the StoryHowever, the very next day, CDC issued the following Tweet:"CDC and @US_FDA have not identified the cause or causes of lung injuries associated with e-cigarette, or vaping, products. The only commonality among all cases is patients report the use of e-cigarette, or vaping, products." This is a meaningless statement because in an outbreak investigation, one almost never finds a commonality that ties together every single one of the patients. If you did, you wouldn't need a special CDC team to investigate it. The cause would be quite obvious. In fact, the reason why an epidemiologic investigation is necessary to identify the cause of a disease outbreak is that not all the cases report a common exposure and so special epidemiologic methods are required.For example, in 2017, CDC investigated an outbreak of Salmonella poisoning in which there were 19 identified cases in seven U.S. states and British Columbia. Many, but not all of the 19 cases reported eating pre-cut coconut pieces from grocery chain A. Specifically, 12 of the 19 cases (63%) reported eating pre-cut coconut pieces from grocery chain A. Records collected at grocery chain A locations and distribution centers uncovered that many of the cases had consumed products from a potentially contaminated lot of pre-cut coconut pieces imported from Indonesia. The CDC did not tell the public: "CDC has not identified the cause or causes of grocery A-related Salmonella poisoning. The only commonality among all cases is patients report having shopped at grocery store A. Most of the cases report having eaten pre-cut coconut pieces. However, no single product was common to all of the cases. CDC recommends that people who are concerned about Salmonella poisoning should consider not shopping at grocery chain A."What did CDC do? They concluded that the pre-cut coconut pieces were the source of the Salmonella outbreak and facilitated a recall of these products. They don't close every one of these stores down completely because they weren't able to find a single product that was common to all of the cases.Note that unlike youth THC use, there is no stigma associated with eating pre-cut coconut pieces and it is perfectly legal. So even without a good reason for under-reporting, the CDC was still able to identify a common exposure in only 63% of the cases. In fact, they did go back and re-interview some of the patients and in at least one case, they found a store receipt proving that the person had purchased pre-cut coconut pieces even though they had denied it.If that can happen for pre-cut coconut pieces, then one would certainly expect under-reporting to occur for the use of illegal black market THC vape carts purchased from drug dealers on the street.I have never before, in any outbreak investigation, heard the CDC withhold a specific warning because not every case reported a common exposure. There is something underneath the surface that is making the CDC reluctant to provide the public with the information and warnings that they need in order to curtail this outbreak. The rest of the story is that the CDC's communication about the cause of this outbreak has been steadily improving, but we still have a long way to go.Original author: Michael Siegel
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Like the Telephone Game, CDC's Lack of Clarity is Becoming Completely False Facts at the Local Level

Do you recall the telephone game? Players sit in a circle and the first person whispers a phrase into the ear of the second person, who whispers it to the third person, and so forth, until it gets to the last player, who then repeats the phrase that they heard. Typically, the phrase changes substantially from the beginning because a series of small, progressive changes add up to a completely different phrase at the end.The only way to prevent this is for the first person to deliver such a clear message that it cannot be mistaken.In this commentary, I show how the lack of clarity by the CDC and other health groups in communicating about the health risks of electronic cigarette use is leading to the dissemination of completely false information at the local level.The Rest of the StoryIn an article in the Williston Herald (North Dakota), a respiratory therapy care manager at CHI St. Alexius Health in Bismarck informs the public about the vaping-related lung disease outbreak that we are experiencing. She has apparently been involved in the management of several affected patients in North Dakota.In the article, she tells the public that: "Propylene glycol is not water soluble, and that could be behind the recent vaping illnesses that are emerging. “The lungs don’t tend to absorb anything that is not water soluble, so they can’t get rid of it,” Backman said. “So those patients we are hearing about in the news who come into an ER or hospital are the ones heavily using these devices.”"She did get some of the facts right. It is true that the lung has difficulty getting rid of oil-based liquids and that many of the outbreak patients who come into the hospital are using vaping devices with THC oils that are not water-soluble.However, she gets one key fact wrong: "Propylene glycol is not water soluble," she tells the public, implying that the inhalation of propylene glycol is what is likely causing the outbreak. But propylene glycol is soluble in water and is almost certainly not the chemical responsible for the outbreak. If it were, we would see as patients many vapers of all ages using virtually all brands of nicotine-containing e-liquids, including many products sold at retail stores. If nicotine liquids were oil-based, I would be the first one telling everyone not to use e-cigarettes because they  pose a high risk of developing a potentially fatal lung disease.I do not completely blame the individual who was passing along this misinformation because when the CDC communicated to the public about the fact that many of the identified case patients were presenting with lipoid pneumonia, it did not explain that all nicotine-based e-liquids sold in stores are water-based and thus cannot be the cause of lipoid pneumonia, but that many black market THC vape liquids are oil-based and must be avoided. This has apparently led to massive confusion among the public.The rest of the story is that our communication about the health risks of vaping has been a complete failure. The public health community has completely fouled this up. This example shows how the lack of clarity at the level of the CDC can ultimately result in the provision of completely false information at the local level. This is why it is essential that CDC be as clear as possible in its messaging, something it has largely failed to do during this outbreak investigation.Original author: Michael Siegel
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Age Counts: Who Vapes (Tobacco/Nicotine) and Who Gets Lung Injuries



Federal officials, most notably at the Centers for Disease Control and Prevention, continue to be remarkably vague about the cause of 1,299 acute lung disease injuries and 26 deaths among people who have vaped.  This ambiguity, which I believe is out of sync with normal CDC investigations, has led to a media frenzy and partial or full bans on e-cigarette sales in many localities.  Major retailers are scrapping e-cigarettes while continuing to sell cigarettes, which have killed 368,000 smokers already this year. Making vastly safer cigarette substitutes unavailable to 8 million adult vapers will inevitably increase cigarette consumption, driving the death count even higher.Officials have disclosed few details about the lung injuries and deaths.  On October 10, the CDC posted a report, once again highlighting “e-cigarettes, or vaping products” in the title while relegating critically important information about contaminated marijuana products to the fine print. CDC’s data on 1,043 cases confirmed that the injuries are concentrated among younger age groups.  If nicotine vaping was the cause, the age distribution of lung injuries would be similar to the age distribution of vapers.  I used the tobacco questions in the 2018 National Health Interview Survey and in the 2018 National Youth Tobacco Survey to generate estimates of the number of current adult and underage vapers (here).  The table shows the distribution of lung injuries compared with the distribution of current (tobacco/nicotine) vapers..nobr br { display: none } td { text-align: center} Age Distribution of Lung Injury Cases and Current VapersAge (years)Lung Injury Cases* Percent (number)Current Vapers** Percent (millions)Less than 1815% (156)8% (0.7)18 to 2021% (219)11% (1.0)21 to 2418% (188)14% (1.2)25 to 3426% (271)27% (2.4)35+20% (209)40% (3.5)All100% (1,043)100% (8.8)*Based on 1,043 patients https://www.cdc.gov/media/releases/2019/s-1010-vaping-injury-update.html  **Based on tobacco questions in the 2018 NHIS (18+ years, vaping every day or some days) and 2018 NYTS (< 18 years, vaping 20-30 days in past month)The table reveals starkly different age distributions.  While 36% of lung injuries affected those under 20 years, that group constitutes only 19% of all current vapers.  Forty percent of the 8.8 million current vapers were over age 35, compared with only 20% of lung injury patients.  The table underscores another striking comparison.  The main rationale for punitive action against e-cigarette retailers is the so-called teen vaping epidemic, which I have discussed previously (here, hereand here).  But federal surveys show that underage teens make up only 8% of the 8.8 million current vapers, or about 736,000 individuals.  Of those, about 59% (430,000) are current cigarette and/or cigar users.   Here’s the tradeoff: 92% of current U.S. vapers are adults, most of whom are either current or former smokers (here).  Federal and state actions that prohibit vape products to “save the children” will predominantly and permanently injure their smoking parents and grandparents who are desperate to stop.In summary, the age distribution of lung injury cases is considerably different than that of vapers, with injuries weighted toward the younger cohort.  This supports the emerging evidence that the outbreak is not related to commercial e-cigarettes and vape products, but rather to black market offerings.  Importantly, the misdirected campaign against the former threatens to disrupt availability to adult vapers, who desperately need them.Original author: Brad Rodu
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News Headline Shows How Misinformation About Respiratory Disease Outbreak is Spreading


The featured headline of a news article published yesterday at NorthJersey.com (the North Jersey Record) was: "Vaping with JUUL Damaged NJ Woman's Lungs, Left Her Hospitalized."The headline of the article itself read: "'My Lungs Were Chemically Burned': NJ Victim Speaks Out Against Vaping."These headlines certainly give the impression that this unfortunate 21-year-old woman developed acute respiratory failure due to her use of JUUL.If true, this would be an absolute disaster because there are an estimated 7 million JUUL users.This is no doubt going to contribute to the public's belief that electronic cigarettes sold at retail stores, not tainted THC vape carts sold mostly on the black market, are responsible for the terrible respiratory disease outbreak that has now affected nearly 1,300 people and caused 26 deaths.The first paragraph of the story reinforces the impression that JUUL was the cause of this woman's respiratory failure: "[She] started smoking cigarettes when she was 17 or 18, she said. Hoping to find a “safer alternative” — one that wouldn’t leave a smell — she picked up a Juul, a popular electronic cigarette device, and began vaping." The Rest of the StoryIt isn't until you get to the fine print that you found out the following:"[She] began using vaping devices more and more, eventually taking hits almost every 10 minutes, she said. She first had other people purchase her vapes, and she began buying them from stores and unregulated dealers as soon as she was old enough."Since nicotine products sold by retail stores are all regulated, it appears that by unregulated dealers she is referring essentially to illegal, black market products.Of course it is not clear what specific product caused the illness. However, it certainly cannot be definitively attributed to JUUL since the patient was also apparently purchasing black market vaping products as well.One must look at the overall epidemiologic data, and what those data tell us is that the vast majority of affected patients admit to vaping THC cartridges, most of which were purchased off the street or over the internet, not from licensed retail stores.But this story illustrates how easy it is for misinformation to be disseminated widely enough so that the public gets the inaccurate impression that JUUL products are responsible for this outbreak. There are plenty of dangers associated with youth use of JUUL - namely, the potential for addiction - but acute respiratory failure is not one of them. If it were, we would certainly be seeing numerous cases of the illness among adults of all ages who report using JUUL.Although there may be a tendency to blame the media, I believe that the media coverage is actually framed largely by the way we as health professionals communicate the information to the media. And I think the coverage is most profoundly influenced by the way the CDC has communicated about the causes of the outbreak.While the CDC's most recent communication finally admits that THC vaping products are playing a role in the outbreak, it may be too little too late. The public clearly has the impression that your every day, retail sold, nicotine-containing e-cigarettes are what is causing this outbreak. This is reflected by large reductions in the sale of these products over the last few weeks.Sadly, the tragic consequences of this failed communication include an increase in the sale of real cigarettes (as many vapers try to avoid the alleged risks by switching back to smoking) and I suspect a larger number of people continuing to use THC vape carts than would be had the CDC been transparent from the start.Original author: Michael Siegel
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Throwing “lifeboat ethics” thinking overboard

Posted on 11 October 2019 by Carl V Phillips | 2 Comments

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Heads Up – News – Updates 10.10.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Heads Up – News – Updates 10.09.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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Why is there anti-THR? (5) Needing an enemy and control for its own sake

by Carl V Phillips

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CDC Recognizes THC in Lung Injury Outbreak, But Teen Marijuana Use Ignored



The Centers for Disease Control and Prevention finally acknowledged on September 27 that contaminated liquids containing tetrahydrocannabinol (THC) and cannabinoid (CBD) oils are the likely cause of the recent outbreak of lung injuries.  The agency said that “Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak.” As of October 1, there were 1,080 cases and 18 deaths.  Unfortunately, the lung injuries and deaths have been conflated with the so-called teen vaping epidemic, which I have put into perspective in this blog (here, here, here and here).  Federal officials, however, continue to ignore one critical link: teen marijuana use.  Government surveys document that the prevalence of current (past 30 days) marijuana use has been high among high schoolers for 25 years.  The link is further demonstrated in the 2018 National Youth Tobacco Survey.  Although officials portray current high school vapers as caught up in a tobacco/nicotine epidemic, they rarely acknowledged that the students had vaped marijuana, as shown in the chart that I presented on September 25 at the Global Tobacco and Nicotine Forum in Washington, DC.  Of the 3.1 million high school vapers in 2018, over half had vaped marijuana.  The more teens vaped, the more likely they had used marijuana.  It is therefore not surprising that 16% of the lung injuries occurred in high schoolers. Although the new CDC statement about THC is helpful, it over-emphasizes e-cigarettes, and it came weeks after state health authoritiesand the FDA implicated illicit liquids related to marijuana.  The CDC’s slow-walking and its continued conflation of e-cigarette use and nicotine vaping have had significant consequences.  First, officials have eroded the commitment of vapers who quit smoking, which may lead them to return to smoking.  Second, the CDC is discouraging current smokers from switching to e-cigarettes, even though such products have been used by millions of consumers nationwide for over a decade with no acute lung injuries.  Third, the CDC failed to warn consumers about using illicit THC liquids.  Earlier, more detailed warnings from the CDC might have save lives and limited injuries. The vaping-related injuries and deaths are clearly tragic, but so are the deaths from smoking: nearly a half million annually for the past 30+ years, or more than 1,300 every single day. Original author: Brad Rodu
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Utah Department of Health Concludes that THC Vape Cartridges are Causing Respiratory Disease Outbreak; Issues Specific Warning against Use of THC Oils

Unlike most other state health departments, which are conflating the respiratory disease outbreak associated with black market (and a few legal dispensary-sold) THC vaping products and the general problem of youth e-cigarette use, the Utah Department of Health has issued a report which unequivocally concludes that vaping marijuana is causing severe respiratory illness, which has now affected 71 residents in the state.Unlike the CDC and many state health departments, which are doing everything they can to undermine the observed connection between outbreak cases and marijuana vaping, the Utah Department of Health concluded that: "Given the evidence outlined below, vaping THC cartridges or “carts” is likely the driver of this outbreak of severe lung injury. The UDOH recommends people do not vape THC cartridges until we learn more."The evidence presented in the report is overwhelming:Of 36 cases who reported on product usage, 34 (94%) admitted to vaping THC cartridges.  Of 19 THC cartridges tested, 17 (89%) contained vitamin E acetate oil.No contaminants or abnormalities were detected in any of the 20 nicotine cartridges tested.Most of the THC cartridges were purchased illegally on the black market.At least one of four black market THC vape cart "brands" were mentioned by all 34 of the cases who reported using THC: Dank Vapes, Rove, Golden Gorilla, and Smart Cart.These brands are consistent with those reported by case patients in other states and with those confiscated in drug busts of large, illegal THC vape cart production operations.  The Rest of the StoryIn contrast, take a look at the health advisory issued by the Michigan Department of Health and Human Services. Its recommendation to the public is: "Individuals should consider refraining from vaping until the specific cause of the vaping-related lung injuries has been identified."This is completely irresponsible in three respects:It makes absolutely no mention of avoiding THC vape carts.It is unnecessarily vague and invokes legally sold nicotine e-cigarettes that are being purchased from retail stores, none of which have been implicated in the outbreak.Given the severity of this disease, how can the Department merely urge people to "consider" refraining from vaping. That's hardly a warning at all. In fact, it absolutely minimizes the severity of the disease and undermines the seriousness of the entire warning. Even worse, the Department apparently changed this advisory, which previously did specifically mention THC vape carts. In other words, they made a conscious decision to remove the mention of THC entirely from the warning.This is completely irresponsible and inexcusable. It puts Michigan youth and the entire public at risk by hiding from them the fact that most of the observed cases have been specifically associated with the use of black market THC vape carts.In my view, the Michigan Department of Health and Human Services should be held responsible for future cases of respiratory disease or death among state residents who were not adequately and properly warned against the specific dangers of vaping THC oils.Original author: Michael Siegel
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A Surge Strategy for Smokefree New Zealand 2025


October 7th, 2019

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Heads Up – News – Updates 10.04.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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CDC's Communications are Likely Making this Outbreak Much Worse

A new survey released yesterday by the National Opinion Research Center (NORC) at the University of Chicago found that the public believes that vaping nicotine-based e-liquids is much more harmful than vaping THC e-liquids.While 54% of the public believes that vaping nicotine is very harmful, only 38% believe that vaping THC is very harmful. And while just 16% of the public does not believe that nicotine vapes are harmful, an amazing one-third (33%) of the public does not believe that vaping marijuana carries any risk.These data are shocking in light of the fact that we are a good two months into an outbreak of severe respiratory failure and death, affecting more than 1,000 people, in which the overwhelming majority of cases vaped THC oils and contaminated, bootleg THC vape cartridges have been clearly tied to the outbreak, while there is currently no evidence that nicotine vapes are involved at all.Given the life-threatening risks associated with vaping black market THC oils at this time, it is simply devastating to find that the public has very little appreciation of the severe risks associated with marijuana vaping and thinks that vaping nicotine e-liquids is much more harmful. This result is almost certainly related to the CDC's failure to clearly communicate to the public the extremely high level of risk associated with vaping THC and its concerted effort to try to blame traditional, legal, store-bought nicotine-containing electronic cigarettes for the outbreak.The evidence that contaminated THC oils are linked to the outbreak continues to get stronger every day. Today it was revealed that 10 of the 11 reported outbreak case patients in Delaware admitted to the use of THC vapes. The other patient apparently did not admit to vaping marijuana but the results of a THC urine screen were either not announced or the test was not conducted.Also today, a North Carolina Health News article revealed that early this summer, physicians at a North Carolina hospital observed the first three cases of the outbreak in the state and noticed that all three patients had vaped THC oils. The physicians immediately notified the CDC. Later, the same physicians published an article reporting five patients with lipoid pneumonia that was related to the use of THC oils.Even though 100% of these patients were vaping black market THC, the CDC made nothing of that information and refused to warn the public not to vape black market THC, instead remaining deliberately vague in its warning in order to be able to implicate nicotine electronic cigarettes, which it has despised ever since they came on the market.The authors of that article explicitly noted that their findings "highlight the importance of awareness of a potential association between use of marijuana oils or concentrates in e-cigarettes and lipoid pneumonia." Two weeks later, the CDC had yet to have clearly communicated that information to the public. And now, a full three weeks later, the CDC still stated (in today's North Carolina Health News article) that they just don't have any answers.The CDC might not have any answers, but any guy off the street could have told you back in early September that if five young patients present with a severe, newly seen respiratory disease and all five report having vaped THC oils that the outbreak likely has something to do with vaping THC oils. It is incredible that the CDC hasn't advanced beyond that obvious conclusion after two months of investigation and has in fact gone backwards from that conclusion, trying to convince the public that we really don't know if THC oils have any involvement in the outbreak in the first place. We just don't have any answers, they continue to say.I cannot overemphasize the level of irresponsibility that we are witnessing from the CDC. I can assure you that if I still worked at the CDC (I worked in the office that is leading this investigation), I would never have allowed this to occur.After seeing this new survey results, I am now convinced beyond a doubt that this failed communication is making the outbreak worse than it would have been had the CDC clearly communicated to the public the connection that the guy on the street realized weeks ago. The message has simply not come across because the CDC, and in turn state health departments, are more concerned about implicating nicotine-containing electronic cigarettes than in actually trying to prevent further cases of this severe illness.Original author: Michael Siegel
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A False Connection Between E-Cigarettes and Heart Attacks



The Journal of the American Heart Association on June 5, 2019, published an article, “Electronic cigarette use and myocardial infarction among adults in the US Population Assessment of Tobacco and Health [PATH],” by Dharma N. Bhatta and Stanton A. Glantz (here).  In reading the article, I discovered that the authors misrepresented the research record;  presented a grossly inaccurate analysis of PATH Wave 1 survey data, and omitted critical information with respect to (a) when survey participants were first told that they had a heart attack, and (b) when participants first started using e-cigarettes.  The article reflected a significant departure from accepted research practices.  The authors reported that current e-cigarette users were twice as likely as never users to have had a heart attack, based on information from 38 survey participants.  They reported odds ratios (ORs) of 2.25 (95% confidence interval, CI = 1.23 – 4.11) for 19 daily vapers, and 1.99 (CI = 1.11 – 3.58) for 19 some-day users (Abstract, Table 3 and Table S6).  Drs. Bhatta and Glantz claimed that their study confirmed that “e-cigarette use is an independent risk factor for having had a myocardial infarction…”  In a blog post on the University of California San Francisco website, Dr. Glantz cited the study as “more evidence that e-cigs cause heart attacks” (here). I have extensive experience conducting research on the PATH data files.  I conducted an analysis of the Public Use Wave 1 data, which has no restrictions on release of results.  I found that at least 11 of the 38 current e-cigarette users were first told that they had a heart attack years before they first started using e-cigarettes.  My research team conducted further analyses that were discussed in letters we sent to JAHAeditors on July 11 and July 18; these letters were never acknowledged.  At the instruction of the Inter-university Consortium for Political and Social Research, I am not able to share those letters with you.Original author: Brad Rodu
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New Mayo Clinic Study Further Implicates Contaminated THC Oils in Respiratory Disease Outbreaks and Refutes Claim that Store-Bought Nicotine E-Liquids are Involved

A study published yesterday in the New England Journal of Medicine by a team of researchers at the Mayo Clinic provides further evidence that contaminated THC oils are likely playing a major role in the vaping-associated respiratory disease outbreak and makes it even less likely that store-bought nicotine e-liquids are playing any role at all. Here is the key evidence provided by the paper:1. The overwhelming majority of patients admitted to vaping THC oils.Approximately 76% of the patients studied who reported on product use admitted to vaping marijuana (13 out of 17 patients). Because urine THC testing was either not conducted or not reported, it is not possible to state that any of these cases occurred in a patient who had not vaped a marijuana-based product. In one case, a patient had been vaping nicotine e-liquids for five years, but then tried vaping marijuana and was in the hospital with respiratory distress within a few days. His vaping history was reported as: "vaping nicotine for 5 years; on weekend prior to presentation, started vaping nicotine with marijuana for the first time."2. The study authors suspect a direct chemical injury to the lungs, suggesting that a new contaminant, not traditional nicotine e-liquids, is the most likely cause.After examining the lung biopsies, the authors concluded that the most likely explanation for these cases is "direct lung toxicity from an inhaled noxious agent or agents." The ingredients of store-bought nicotine e-liquids is quite standard. These e-liquids contain propylene glycol, glycerin, water, nicotine, and flavorings. This formula is ubiquitous for all store-sold nicotine e-liquids and there have not been any recent changes to these ingredients. The FDA's testing of the recovered nicotine e-liquids from case patients have so far not revealed any contaminants. These products have been sold for years without reported problems of lung toxicity.In contrast, black market THC products and counterfeit vape cartridges sold over the internet and by street dealers are very susceptible to contamination. Unlike legal THC oils, the black market products are not tested, and therefore might contain pesticides, residual solvents, other noxious chemicals, or synthetic cannabinoids, each of which could potentially cause a direct chemical injury to the lung.In fact, acute respiratory toxicity from synthetic cannabinoids has been observed. So has acute alveolar hemorrhage and a more subacute lung injury characterized radiographically by diffuse hazy densities. Moreover, just lack week, testing of a large number of black market THC vape cartridges revealed that they "all contained myclobutanil, a fungicide that can transform into hydrogen cyanide when burned," which can have severe respiratory toxicity. It was also recently shown that vaping butane hash oil can result in severe lung toxicity that presents in a similar fashion to the current outbreak cases.3. The study findings are not necessarily inconsistent with lipoid pneumonia.Although the study authors opine that the pathological findings are not indicative of exogenous lipoid pneumonia, the basis for this conclusion is not clear. The authors' assertion seems to be based primarily on their failure to find "coalescent of lipid into large droplets." However, there are many previous reports of exogenous lipoid pneumonia in which the pathology examination did not report finding a coalescence of lipid into large droplets in the lung. The main finding in these previous studies (example) was the presence of lipid-laden macrophages, just as the primary finding in the current study was the presence of foamy (lipid-laden) macrophages. The radiographic findings in many of the cases and the finding of lipid-laden macrophages are consistent with a diagnosis of lipoid pneumonia in at least some of the observed cases. I think it is premature to rule out the significance of the inhalation of large quantities of viscous oil in the pathogenesis of the disease.The results of this study add to the growing evidence that contaminated black market THC oils or counterfeit, bootleg vape cartridges are the primary, if not sole, cause of the outbreak. In two cases, legally purchased THC oils from dispensaries in Oregon were implicated. However, there are no cases that have been shown to be associated with the use of store-purchased nicotine e-liquids and it seems extremely unlikely that these products have any involvement in the outbreak.Original author: Michael Siegel
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The “Other” Youth Vaping Epidemic: Why Has It Been Ignored?

While the CDC and many health groups have been obsessed with youth e-cigarette use, an even more troubling epidemic has been spreading among our nation’s youth. In contrast to the e-cigarette use explosion, which has not caused any significant disease or deaths, this other, ignored epidemic has caused hundreds of youth to develop life-threatening respiratory failure and has been responsible for 13 deaths. What is this “other” vaping epidemic?It’s not vaping of e-cigarettes. It’s the vaping of marijuana. In my analysis of data from the 2018 National Youth Tobacco Survey, I found that the majority of youth who currently use e-cigarettes also report having vaped marijuana or THC vape cartridges.Specifically:Of ever e-cigarette users, 41.8% report having vaped marijuana or THC.Of current e-cigarette users (those who used in the past 30 days), 51.9% report having vaped marijuana or THC.Of regular e-cigarette users (those who used at least 10 days in the past 30 days), 63.1% report having vaped marijuana or THC.Of heavy and potentially addicted e-cigarette users (those who used every day in the past 30 days), 66.8% report having vaped marijuana or THC.While the CDC and many state health departments have focused on the fact that many youth are vaping e-cigarettes with “kid-friendly” flavors, they have all overlooked the fact that the majority of these youth are also vaping marijuana vape carts or vape pens with even more “kid-friendly” flavors, including:         "Apple Jacks,"          "Banana OG,"          "Birthday Cake,"          "Black Berry Kush,"          "Blue Dream,"          "Blueberry Kush,"          "Bubble Gum,"          "Candy Land,"          "Cherry Pie,"          "Cotton Candy,"          "Fruity Pebbles,"          "Gelato,"          "Grape Ape,"          "Grape Stomper,"          "Green Crack,"          "Honey Berry,"          "Honey Dew,"          "Ice Blue Raspberry,"          "Key Lime Pie,"          "Lemon Berry,"          "Lemon Head,"          "Lemon Slushie,"          "LSD,"          "Mai Tai,"          "Mango Kush,"          "Maui Wowie,"          "Mimosa,"          "Mojito,"          "Orange Chai,"          "Orange Cookies,"          "Orange Daiquiri,"          "Peach,"          "Pineapple Express,"          "Pot of Gold,"          "Purple Punch,"          "Rose Gold,"          "Russian Cream,"          "Sour Apple,"          "Strawberry Shortcake,"          "Sweet Aromatic,"          "Tangie,"          "Vanilla Kush,"          "Water Melon,"          "Wedding Cake," and          "Zskittlez."In fact, this year, marijuana use among college-age students reached a 35-year high! According to an articlein The Hill: “43 percent of full-time college students ages 19-22 reported using marijuana at least once in the previous 12 months. One-quarter of students reported using marijuana at least once in the last 30 days.” Both “the annual and 30-day "prevalence levels" are at historic highs since 1983.”"In particular, there was a dramatic increase in marijuana vaping during the past year: “The number of students who said they vaped marijuana in the last 30 days rose by 5.7 percentage points between 2017 and 2018, according to the study, with 5.2 percent of college students saying they vaped marijuana in 2017 compared with 10.9 percent of students who said the same in 2018. ‘This doubling in vaping marijuana among college students is one of the greatest one-year proportional increases we have seen among the multitude of substances we measure since the study began over 40 years ago,’ said John Schulenberg, principal investigator of the Monitoring the Future Panel Study."So while anti-nicotine groups obsess over cotton candy and bubble gum e-cigarettes, they have paid no attention to cotton candy and bubble gum THC vape carts, which are in fact far more dangerous.Original author: Michael Siegel
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To Protect Youth from Progression to Cigarette Smoking, Truth Initiative Wants to Ban the Fake Ones But Let Real Cigarettes Remain on the Shelves

In an op-ed piece published by CNN last Friday, the president of the Truth Initiative bemoaned the "epidemic" of vaping among our nation's youth, arguing that electronic cigarette use leads to smoking. She cited research which shows "that young people who vape are more likely than their peers who don't vape to smoke traditional cigarettes in the future."And what does the Truth Initiative propose should be done to prevent a massive youth migration to cigarette smoking?A. Ban or severely restrict the sale of cigarettes.B. Ban or severely restrict the sale of both cigarettes and e-cigarettes.C. Neither of the above.The answer ...... C. Neither of the above.Instead, the Truth Initiative is calling for option D:D. Only ban flavored e-cigarettes, but leave cigarettes on the shelves, easily accessible to youth in every convenience store and gas station in the country.The Rest of the Story I'm sorry, but there is simply no justification for banning the sale of most electronic cigarettes but allowing real cigarettes, which kill more than 400,000 Americans each year, to remain on the shelves, almost completely unregulated.One of the major arguments that the Truth Initiative CEO offers to support her call for a ban on all flavored e-cigarettes is that when JUUL pulled its flavors other than mint and menthol from store shelves, youth simply switched to mint and menthol flavors. But if that's true, then shouldn't we be concerned that if flavored e-cigarettes are banned, youth will simply switch to tobacco-flavored e-cigarettes?If the Truth Initiative is genuinely concerned about youth vaping, then there is no justification for it failing to call for a ban on all e-cigarettes. By its own logic, leaving tobacco-flavored e-cigarettes will simply result in youth switching to tobacco-flavored e-cigarettes.OK, so you're thinking that kids are not going to switch from a candy- or fruit-flavored e-liquid to a tobacco-flavored one? Fine, but if that's the case, then it's even less logical to argue that kids are going to switch from fruit-flavored e-cigarettes to the harsh, tobacco-flavored real ones. You can't credibly make the argument that youth will avoid the tobacco flavor of e-cigarettes, but get hooked on the tobacco flavor of real cigarettes.The truth, of course, is that kids are not getting hooked on flavored e-cigarettes and then progressing to tobacco-flavored real cigarettes. They are using flavored e-cigarettes specifically because they want to avoid the health consequences that they all know are associated with the tobacco-flavored real cigarettes.So if youth are not going to switch from flavored e-liquids to tobacco-flavored e-liquids, what are they going to switch to?The answer is THC e-liquids, many of which are packaged in kid-friendly brands like "Apple Jacks," "Banana OG," "Birthday Cake," "Black Berry Kush," "Blue Dream," "Blueberry Kush," "Bubble Gum," "Candy Land," "Cherry Pie," "Cotton Candy," "Fruity Pebbles," "Gelato," "Grape Ape," "Grape Stomper," "Green Crack," "Honey Berry," "Honey Dew," "Ice Blue Raspberry," "Key Lime Pie," "Lemon Berry," "Lemon Head," "Lemon Slushie," "LSD," "Mai Tai," "Mango Kush," "Maui Wowie," "Mimosa," "Mojito," "Orange Chai," "Orange Cookies," "Orange Daiquiri," "Peach," "Pineapple Express," "Pot of Gold," "Purple Punch," "Rose Gold," "Russian Cream," "Sour Apple," "Strawberry Shortcake," "Sweet Aromatic," "Tangie," "Vanilla Kush," "Water Melon," "Wedding Cake," and "Zskittlez."These are precisely the black market products that have led to more than 800 cases of severe respiratory failure, most among young people, with 13 fatalities.The Truth Initiative's proposal to ban all flavored e-cigarettes would result in a shift from flavored e-liquids to the increased use of flavored e-joints, and it would make the current respiratory disease outbreak much worse, potentially resulting in more deaths. Does the Truth Initiative really want those severe illnesses and deaths on its hands?This is before we even get to talking about the effects that a flavored e-cigarette ban would have on adults, which include a mass return to cigarette smoking or entrance into a new black market for flavored e-liquids, which might eventually result in an even worse disease outbreak in the future, since the number of adults using these products and thus subject to any contaminant that may arise in these black market products will be immense. The Truth Initiative has apparently written off adult smokers completely at this point. The op-ed views them as being expendable: "the current environment is not about providing well-regulated e-cigarette technology for adult smokers who otherwise won't quit." This is a complete betrayal of a central part of the mission of the Truth Initiative, which was to "reduce tobacco use" by "increasing successful quit rates, and reducing disparities in access to prevention and cessation services."The rest of the story is that the Truth Initiative has steered away from its original mission and its policy proposal to ban flavored e-cigarettes would severely harm the health of both youth and adults across the nation.There is a better alternative, and it involves Option B above; specifically, restrict the sale of all tobacco products, including cigarettes and e-cigarettes to stores that can only sell these products and are only open to people ages 21+. Ironically, it is the nation's vape shops and most of the vaping industry -- and not health groups -- that are pushing for such a policy change.Original author: Michael Siegel
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Heads Up – News – Updates 9.30.2019

If you believe the security rule is affecting the normal operation of your website, contact your host support team and provide detailed instructions how to recreate this error.They will be able to assist you with rectifying the problem and adjusting the security configuration if needed.Original author: KNoll-Marsh
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In Response to Two Deaths Due to Marijuana Vaping, Oregon Health Department Recommends Ban on Nicotine-Containing Electronic Cigarettes

In response to two deaths that it says were attributable to vaping cannabis purchased from legal state dispensaries and three additional cases that were linked to cannabis products purchased from state dispensaries, the Oregon Health Authority is recommending that all nicotine-containing (non-cannabis) electronic cigarettes should be banned for six months.According to an article by Oregon Public Broadcasting: "Officials with the Oregon Health Authority recommended Gov. Kate Brown ban vaping products in the state for six months, following a second vaping-related death Thursday." This recommendation is for a ban on all vaping products, both THC and nicotine e-liquids.Later in the same article, we learn that: "the most recent death followed the same pattern as past cases: an adult, who experienced severe respiratory injuries after vaping cannabis products purchased from a licensed retailer." And in an article published in the Salem Reporter, we learn that all five of the reported cases in Oregon are associated with the use of "licensed cannabis products." The Oregon state health department warned the public against any vaping: "At a press conference Thursday announcing the latest death, health officials were adamant: No one in Oregon should still be vaping. “No level of vaping is safe,” Sidelinger said. “With these acute respiratory injuries and deaths, we do urge all individuals to stop vaping, whether that’s nicotine-based products, cannabis products or other products.”"The state health officer closed by saying that: "With the root cause of these vaping-related illnesses still unknown, Sidelinger said it’s likely health officials are going to see “increased number of cases and, tragically, more deaths.”"The Rest of the StoryActually, the reason that health officials are going to see increased number of cases and more deaths is not that the root cause of these vaping-related illnesses is still unknown, but because the root cause is known but officials like Dr. Sidelinger are disregarding this critical information.Even after the CDC has finally admitted that vaping THC, potentially contaminated with vitamin E acetate oil, is the chief culprit in the outbreak, and even after the Oregon Health Authority itself admits that all five of the state's outbreak cases are associated with the vaping of cannabis products purchased from state dispensaries, the Oregon state health department is still ignoring, undermining, and hiding that critical information from the public by claiming that we still have no idea what is going on and that people should stop vaping anything, no matter the situation, no matter what the ingredients are, no matter how long they have been using these products without a problem and without changes in their ingredients, and no matter where they are obtaining those vaping products.The health department's warning is so vague and so general that people - especially young people - are not going to take it seriously.By not issuing an explicit warning against vaping marijuana, the Oregon Health Authority is hiding critical information and undermining the known role that THC vape cartridges are known to be playing in this outbreak. And that is going to lead to people, especially youth, continuing to vape marijuana as the warning is just not specific enough.In fact, the health warning issued by the Oregon Health Authority specifically mentions not vaping e-cigarettes, but does not specifically caution against vaping THC vape cartridges.This all-too-vague warning is irresponsible not only because it is going to make the outbreak worse, not better, but because it is also going to cause enormous health damage to former smokers in the state who have quit smoking by switching to electronic cigarettes. The health department is telling them in no uncertain terms to discontinue the use of their e-cigarettes, which is tantamount to telling them to go back to smoking.Ironically, after the first death in Oregon occurred and was linked to THC vaping of a product purchased at a licensed state dispensary, the Oregon Health Authority decided not to close down the two dispensaries whose products were implicated, defending its decision by arguing that it would be unfair to close down a business without clear evidence that its products were implicated.According to an article in Willamette Week:"Jonathan Modie, spokesman for the OHA, says just because the person bought products from these two stores doesn't mean it was necessarily the stores' products that killed the person."It doesn't necessarily mean the individual got sick from products that they had purchased at these dispensaries, we just know that the individual shopped at a couple of dispensaries prior to getting ill," says Modie. "We're still waiting to get samples of the products and then we send that off for testing." "When WW asked if it wouldn't be better to shut down a store that potentially sold a lethal product to a customer, Modie replied, "How do you think the dispensary operator would feel if it turned out that the product wasn't theirs? We wouldn't want to name or point to a specific dispensary before we have all of the information that says unequivocally that that was the dispensary where the product was sold that made the individual sick," says Modie."So let's get this straight: When the Oregon Health Authority had a direct link between a death from the outbreak and cannabis vaping cartridges purchased at two dispensaries that they regulate, they emphasized that they didn't want the dispensary operators to feel bad if it turned out that the product wasn't responsible for the death, but weeks later - when it appears much clearer that vaping marijuana and not store-bought nicotine e-liquids is the primary culprit in the outbreak - they are perfectly OK with shutting down every vape shop in the state, even the hundreds that don't sell THC vape cartridges in the first place and whose products have not been implicated in the slightest way. There is now even more evidence that THC vaping products are playing a major role (if not the only role) in the outbreak. Iowa has now reported that of 23 cases in the state, 18 patients have admitted to using THC vapes. Officials in Texas have now reported that at least 75% of the case patients in that state have admitted to vaping THC. And it has now been revealed that the death reported in Indiana, which was previously not attributed to any particular product, was associated with THC vaping.Thus, every death for which information has been released about the products used has been associated with vaping marijuana. And more importantly, every single reported case in Oregon has been associated with vaping cannabis purchased at state dispensaries.The rest of the story is that the Oregon Health Authority appears to have a vendetta against nicotine-containing e-cigarettes, and it is going to great lengths to protect marijuana dispensaries that it regulates and whose products appear to be responsible for two deaths and three life-threatening cases, while attacking retail stores and vape shops whose products have not been implicated with even the slightest bit of evidence.In some ways, the Oregon Health Authority actually bears some responsibility for these two deaths because it apparently failed to properly regulate the state's marijuana dispensaries. It appears that the health department failed to require testing of dispensary vaping liquids for vitamin E acetate oil and other cutting agents. This is what led to the sale of an oil-based e-liquid that should never have been on the shelves in the first place. Rather than pointing the finger at every retail store and vape shape in the state that is selling water-based e-liquids, the Oregon Health Authority should first be pointing the finger at itself and apologizing to the victims' families for not properly regulating the state's marijuana dispensaries and allowing them to sell oil-laden THC liquids that have no business being sold anywhere.Original author: Michael Siegel
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CDC Finally Admits that Black Market THC Vape Carts are a Major Culprit in Respiratory Disease Outbreak

The CDC has finally admitted that black market THC vape carts are a major culprit in the respiratory disease outbreak that has affected 805 people and resulted in 13 deaths. Instead of continuing to emphasize that "no single product" is linked to all the cases, the CDC clearly stated yesterday that "THC is the most prominent link across patients" and the agency changed its warning to specifically mention THC: "While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC."Because of the CDC's long overdue acknowledgment of the primary role of illicit THC vape carts, newspaper headlines are finally telling the story like it should be told. For example, the headline of an article in the Regina Leader-Post reads: "CDC recommends against using vapes with THC due to lung illnesses." An article by NASDAQ is entitled: "U.S. CDC recommends against using vapes with marijuana ingredient." And the headline of a New York Times article reads: "Dank Vapes, TKO and Other THC Vaping Brands Are Linked to Illnesses, C.D.C. Says."These are the kinds of clear, specific messages that we should have seen in newspapers two months ago.In an emergency MMWR publication, the CDC reported that of cases in which there was information on the products used, 84% of patients admitted to vaping THC. But in contrast to previous publications, instead of immediately undermining this important finding by emphasizing that "no single product" can be linked to all the cases, the CDC instead emphasized that there are multiple reasons why many patients might not report using THC even if they did: "patients might not always know what substances they use or might be hesitant to reveal use of substances that are not legal in their state."In a separate article covering patients from Illinois and Wisconsin, the CDC revealed that: "Use of tetrahydrocannabinol (THC)-containing e-cigarette products, the majority of which were prefilled cartridges obtained from informal sources, was reported by 87% of patients during the 3 months preceding illness." Importantly, CDC finally admitted that: "the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role."The CDC also reported that: "In Wisconsin, eight patients initially denied using THC-containing products in interviews, but five (63%) were later found to have used THC through review of medical charts, reinterview, or cross-referencing with friends who were also interviewed as patients."Finally, the CDC finally provided very specific information about the black market THC vape carts that were used: "Although no single brand name was reported by all patients, a prefilled THC cartridge sold under the brand name Dank Vapes was reported by 57 (66%) patients. In Wisconsin, two groups of friends (two patients in one group and three in the second group) who became ill after using THC-containing cartridges specifically reported sharing Dank Vapes cartridges. Dank Vapes was the only e-cigarette product reported by one of the patients."The Rest of the StoryI checked my blog and Twitter feed to determine when I first issued an explicit warning for people to avoid vaping black market THC vape cartridges. I issued such a warning on my blog on August 25th and on Twitter the same day. On August 28th, I tweeted the following: "The CDC isn't warning the public, so I'll do it myself: PLEASE do not vape THC oils that were purchased from any unlicensed seller. And spread the word to youth who might be at risk. Hiding the truth is not an effective public health strategy."It took five weeks (35 days) after my warning before the CDC finally announced the major role of THC vape carts in the outbreak. During those 35 days, how many young people continued to use THC vape carts who might have stopped if the CDC had announced this connection 35 days earlier? How many people developed respiratory illness because of this failure? Now that it is clear that the outbreak is not being caused by store-bought electronic cigarettes, but by THC vaping cartridges and perhaps other counterfeit black market products, it is critical that the five states which have banned e-cigarettes or flavored e-cigarettes (Massachusetts, Rhode Island, Michigan, New York, and Washington) rescind these bans and focus on limiting the illegal distribution of THC vaping products.Original author: Michael Siegel
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