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Heads Up – News – Updates 9.9.2019

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 Obfuscation of Link Between Illicit THC Carts and Lung Disease Outbreak is Worsening the Situation and Probably Leading to More Cases

Instead of simply acknowledging that a large number of cases in the recent outbreak of severe, acute respiratory failure are due to black market THC vape carts, the Centers for Disease Control and Prevention (CDC) is undermining that key information and continuing to do everything it can to pin the outbreak on the use of traditional, nicotine-containing electronic cigarettes. Today, I provide three examples to show how the CDC's fraudulent conduct is causing state officials to issue inappropriate warnings that are almost certainly worsening the situation and leading to more cases of disease.1. Montana: Today, health officials in Montana issued a warning to state residents concerning the disease outbreak. This warning was reported by the state's Public News Service. Instead of informing the public that oil-laden THC vape carts are associated with most of the cases and should absolutely be avoided, the state health department's medical director told the public that we have no idea what is causing the outbreak and that everyone should simply stop vaping. According to the article, the state medical director stated: "We have something that has serious consequences and we don't know what's exactly going on. Protect yourself and stay away from these products at this time, until we have a better understanding. And hopefully, this would be a good time to stop using the products completely."This is not only blatantly inaccurate information but it is highly irresponsible. However, I don't completely blame the Montana health department because they are simply relaying information that originates from the top: from the CDC.Inexplicably and inexcusably, the warning does not even mention the words marijuana or THC. Hiding the fact that oil-laden THC vape carts are right now extremely dangerous to use is going to result in the continued use of these products by young people and result in further cases of the disease that could be prevented by simply telling the public the truth. Again, this stems from the CDC's obfuscation of the observed link between marijuana vaping and most of the cases. By hiding the truth, the CDC is essentially lying to the public. It is a lie of omission. And it is endangering the health of our nation's young people. 2. Ohio: Mirroring a line that it obtained directly from the CDC, a Cincinnati public radio story informed the public that: "no specific e-cigarette device or substance has been linked to the illnesses. While some patients used marijuana-based products, others used marijuana and nicotine products, and a smaller group reported using nicotine products only." This statement deliberately obscures the role of marijuana-based products with high oil content in inducing the majority of the observed cases, many of which have been confirmed to have been caused by lipoid pneumonia due to oil inhalation. Again, the media are simply mimicking what they are hearing from CDC, so I'm not blaming them. It is the CDC that is to blame for this inaccurate and irresponsible information.3. Tennessee: A story run by the NBC News Knoxville affiliate reports that six cases of the disease have been reported in the state. The story reports only that these cases are associated with the use of e-cigarettes. Nothing more specific than that. However, if you dig in more closely, you'll find that (in small print in a different article) a Knox County teenager who was hospitalized for a "vape-related" illness actually reported that what he was using was an illicit THC vape cart. As the teen explained: "You buy these from people off the streets. Anywhere. You can find these anywhere. People make these. They put, what I've heard, butane, lighter fluid, other chemicals and stuff inside of these."It is a shame that this teen appears to know more about the outbreak than the Centers for Disease Control and Prevention and that the warning he is giving is far more accurate and effective than the CDC's.I'm sure we could go down the list of all 50 states and demonstrate that they are all putting out inaccurate and irresponsible warnings. But this all stems from the top - from the CDC. That is why it is absolutely inexcusable that the agency continues to try to blame the outbreak on traditional, legal e-cigarettes, even in the face of overwhelming and compelling evidence that the primary (if only) culprit is illegal, black market marijuana vaping products being made by an illicit drug cartel that is making millions of dollars spreading this poison to our nation's youth through an elaborate distribution of network of drug dealers.Original author: Michael Siegel
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Leaked papers: WHO to intensify its pointless and destructive war against innovation – expect many dead

September 9th, 2019

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A Flood of Irresponsible Actions and Advice on Respiratory Disease Outbreak

There is a wave of irresponsible recommendations and actions that are taking place in response to the outbreak of more than 400 cases of severe, acute respiratory disease and five deaths that have occurred in the United States. Since there are far too many to write an individual commentary on each, I am combining three of the most important examples in this post.1. Dr. Thomas Eissenberg Implies that the Respiratory Disease Outbreak is being Caused by Traditional (nicotine-containing) Electronic CigarettesIn an op-ed piece in The Guardian entitled "Vaping Is Risky: Do Not Do It If You Care About Your Lungs," Dr. Thomas Eissenberg--a professor at Virginia Commonwealth University--advises the public to discontinue all vaping and ties the recent outbreak of severe, acute respiratory disease to nicotine-containing electronic cigarettes. He writes: "For the past seven years, a steady stream of scientific studies has uncovered potential health risks associated with vaping. These risks include nicotine dependence, airway injury, and cardiovascular disease. Now we must add debilitating lung disease to that list. Lipoid pneumonia is one such disease, probably caused by inhalation of oil-containing vapor: the body’s immune response to oil in the lungs involves inflammation that can be fatal."I find this to be irresponsible. It implies that lipoid pnemonia is being caused by traditional, nicotine-containing electronic cigarettes and that these products are implicated in the respiratory disease outbreak. Most if not close to all traditional, nicotine-containing electronic cigarette liquids are not oil-based, but water and alcohol-based. They are nearly uniformly made up of some combination of propylene glycol, glycerin, water, nicotine, and flavorings. Thus, there is little risk of lipoid pneumonia associated with traditional e-cigarettes.What is almost certainly causing the recently reported rash of lipoid pneumonia cases is the vaping of THC oils, which are - as the description suggests - oil-based products. While the regulated dispensaries that produce legal, recreational THC e-liquids for vaping generally implement complex procedures to eliminate oils from their products, black market manufacturers do not. This means that there are many bootleg marijuana vape pens and vape carts on the market that contain oils. These oils are not vaporized when heated because their boiling point tends to be above the temperatures achievable with the vaping pens. Instead, the liquid oil droplets are inhaled into the lung. This is a disastrous situation as the oil essentially coats the alveoli in the lungs and makes it impossible for the lungs to work. Macrophages (scavenger cells) try their best to get rid of the oil by encircling the droplets but not before the patient may experience respiratory failure. This is why when a patient with lipoid pneumonia undergoes a bronchoalveolar lavage, pathologists are able to detect "lipid-laden macrophages" in the lung cells. This has been a common feature of a large number of the observed cases in the outbreak, and the overwhelming majority of these cases are due to the vaping of illicit THC oils purchased off the black market.Lipoid pneumonia does not need to be added to the list of diseases caused by legal electronic cigarettes sold by stores or e-cigarette companies. It needs to be added to the list of diseases caused by vaping marijuana carts purchased from illegal drug dealers.Furthermore, the recommendation that every ex-smoker stop vaping if they care about their lungs is exactly the opposite of what we should be telling them. The most important thing you can do if you are an ex-smokers who has quit smoking is to not go back to smoking. But that is exactly what is going to happen to the overwhelming majority of ex-smoking vapers if they follow the advice provided in this op-ed. Yes, in an ideal world, one free of addiction, we would simply advise anyone using any drug to stop. But that doesn't really help us in the real world. In the real world of drug addiction, we have something called harm reduction. For people who are unable to immediately stop their drug use, we (public health practitioners) advise them to switch to an alternative that is much safer, even if it still involves addiction. For heroin users, it would be irresponsible to put out an op-ed saying: "Shooting Up with Heroin is Risky: Don't Do It If You Care About Your Health." Instead, what we do is everything in our power to recruit and encourage people addicted to heroin to get into treatment programs, most of which work by providing a safer alternative, such as methadone or another opiate agonist. For people who are addicted to smoking and cannot quit using traditional NRT or other drugs, we should be encouraging them to, not dissuading them from, switching to electronic cigarettes.2. New York Governor Andrew Cuomo Urges All New Yorkers to Halt VapingIn an alert issued today, New York governor Andrew Cuomo urged everyone in the state to immediately stop vaping. As quoted in an NBC News article, Governor Cuomo stated: "There is an investigation ongoing. Nobody knows exactly what it is. There is some suggestion that is linked to Vitamin E, et cetera. Our health guidance is no one should be using vaping products, period, until we know what it is."This is inexcusably irresponsible in two ways:First, the governor completely undermines what we do know about the causes of the disease outbreak by substituting an explanation of the link between marijuana vaping and most of the disease cases and replacing it with a dismissive "et cetera." No - it is not "et cetera." It is the terribly serious and important information that the vast majority of cases of lung disease have been caused by vaping illicit THC oils purchased off the black market. There is simply no excuse for the governor to be hiding this information from the public.Second, for the reasons stated above, it is terrible advice to tell everyone to immediately stop vaping. Ex-smokers who have quit smoking by switching to vaping should absolutely continue vaping, because if they don't, they will almost certainly return to deadly cigarette smoking. These are people who are addicted to nicotine and are not simply going to stop using nicotine overnight because the governor tells them to. If they heed his advice, we are going to have a large increase in the number of smokers in the state of New York.Although the New York State Department of Health also issued the same warning, I am not blaming the department because it is quite clear that they were forced to do so by the governor. If there are any additional cases of respiratory disease in New York that result from young people using black market THC vape carts or vape pens, it is - as far as I'm concerned - partly on the shoulders of the governor, who bears some responsibility for those illnesses and if they occur, deaths.3. Senator Dick Durbin Blames the Outbreak on the FDA and Believes that the FDA Should Be Controlling and Preventing these DiseasesAccording to an article in The Hill, Senator Dick Durbin (D-IL) has told the FDA commissioner to "stop this vaping epidemic" or resign. He was apparently referring to an alarming outbreak of severe respiratory diseases that have affected more than 400 (mostly) young people and caused five deaths. Durbin pointedly asked the FDA commissioner: "Will FDA act now that 193 people across 22 states have severe lung illness associated with e-cigarettes? Will FDA act now that a person in Illinois has died?"I think Senator Durbin should have done his homework and examined the scientific evidence regarding the cause of the 193 people having severe lung illnesses and the person in Illinois who has died. Right now, it appears that the major cause of this outbreak is the production and distribution by a small cartel of illegal drug manufacturers of illicit, bootleg THC oil-containing vape pens and carts. Thus, the FDA likely has nothing to do with this outbreak and there is really nothing that the FDA can do to prevent further cases. Why? Because the FDA does not have jurisdiction over the illegal production, distribution, and sale of illicit drugs. The FDA has jurisdiction over legal drugs, not illegal ones.In other words, Senator Durbin is turning his ire against the wrong person. Who Senator Durbin should be angry at, and who he should call into his office for an explanation, are the drug manufacturers and distributors who are running a multi-million dollar business out of producing and selling illicit THC cartridges for vaping that are being used by thousands of young people across the country who are obtaining these products on the black market.The FDA does not currently have any jurisdiction over these dealers. To the best of my knowledge, the DEA (Drug Enforcement Agency) is probably the government agency with the most direct jurisdiction at this time. If Senator Durbin wants the FDA to try to get to the bottom of this, then what he should do is immediately introduce legislation to give the FDA jurisdiction over illicit cannabis product manufacturing, distribution, and sale. That's the only way that we are truly going to get to the bottom of this, unless the DEA is able to put an end to it.Original author: Michael Siegel
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The Most Telling Sign that CDC is Protecting Illicit Marijuana Drug Dealers While Doing Everything it Can to Pin this Outbreak on Traditional E-Cigarettes

It is clear to me that in its investigation of more than 400 cases of acute respiratory failure tied to the vaping of certain products, the CDC is doing everything it can to undermine the proven connection between most of these cases and illicit marijuana vape carts, while exaggerating a potential, but completely unproven connection with traditional electronic cigarettes.This was highlighted last Friday with the complete split between the FDA and CDC with respect to their public communications and warnings regarding the disease outbreak.The CDC is undermining the observed connection between black market THC/CBD oils and the majority of the reported cases as well as the finding of high levels of tocopherol acetate in many of the product samples provided by affected patients. The CDC's primary warning is to avoid electronic cigarettes and vaping altogether. This is tantamount to advising ex-smokers who quit by switching to vaping to return to smoking. This irresponsible advice completely ignores the principle of addiction and the lack of a clear and unambiguous warning not to use black market marijuana vape carts is inexcusable and puts youths' lives at risk.In contrast, the FDA has issued a specific and unequivocal warning not to use THC/CBD oils, especially black market vape carts. The FDA stated that: "consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores." Although the FDA noted that youth should not vape at all, they did not back down from or undermine the finding of tocopherol acetate in many of the tested samples. Unlike the CDC, the FDA did not issue a recommendation that ex-smokers who vape should return to smoking.Former FDA commissioner Dr. Scott Gottlieb has also been very clear in his Twitter communications, warning that: "Based on current reports it’s likely to be case most of the vaping injuries are related to illegal products and mostly THC and CBD." He also astutely pointed out that "permissive state laws on recreational THC and our conflicted attitude toward cannabis create a lot of risk. These products and vape pens sold to aerosolize stuff other than nicotine (and thus probably not regulated by FDA) fall into dangerous gap where there’s no proper oversight."Dr. Gottlieb also noted that: "Legitimate e-liquids are generally based on chemicals that are water soluble, not oils that can cause acute lung injury. High levels of vitamin E acetate were found in nearly all cannabis-containing vapes tested by NYS Department of Health. Nobody should use illegal vape products." I applaud Dr. Gottlieb for stepping in where CDC failed and providing helpful and specific recommendations based on the best available information at the present time.In contrast to Dr. Gottlieb, the CDC is actually undermining the connection between illicit THC oils and the outbreak. For example, they relentlessly emphasize that many of the patients who reported using THC oils also used "nicotine-containing products": "While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products." This completely undermines the previous phrase and downplays the connection between THC oils and the disease, while implying that traditional e-cigarettes are still a likely cause. They also mention that although vitamin E acetate was found in many of the samples, it was not found in every single one of them. Again, this undermines this important finding.Both of these examples of undermining the role of illegal THC vaping products are completely unnecessary and irrelevant. If THC oils are related to the disease, then it doesn't matter whether the patients also vaped traditional e-cigarettes. If THC oils are causing a large number of cases, then there is no need to invoke the traditional e-cigarettes, even though some patients are using multiple products. In addition, the CDC should know full well that in a disease outbreak investigation, you almost never find a single exposure that ties together every case. The fact that vitamin E acetate was not found in every sample does not eliminate its potential role. Nor does the fact that not every patient reported using THC oils eliminate the possibility that THC oils are responsible for the entirety of the outbreak. Despite the sharp deviation between CDC and FDA, the most telling sign that the CDC is intentionally protecting illicit marijuana drug dealers in its zeal to go after the legal e-cigarette industry is a glaring omission from its recommendations to clinicians that no one seems to have picked up on.The Rest of the StoryThe CDC issued a Health Alert Network alert which advises clinicians of what they should do with every suspected case.  Here is the entirety of the CDC's recommendations for clinicians: Recommendations for CliniciansReport cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to your state or local health department. Reporting of cases may help CDC and state health departments determine the cause or causes of these pulmonary illnesses.Ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness.If e-cigarette product use is suspected as a possible etiology of a patient’s severe pulmonary disease, obtain detailed history regarding: Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substancesSubstance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquidsDevice(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)Where the product(s) were purchasedMethod of substance use: aerosolization, dabbing, or drippingOther potential cases: sharing e-cigarette products (devices, liquids, refill pods, or cartridges) with othersDetermine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with the local or state health departments.Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms and of e-cigarette product use. Evaluate and treat for other possible causes of illness (e.g., infectious, rheumatologic, neoplastic) as clinically indicated. Consider consultation with specialists (pulmonary, infectious disease, critical care, medical toxicology) as appropriate.Clinical improvement of patients with severe pulmonary disease associated with e-cigarette use has been reported with the use of corticosteroids. The decision to use corticosteroids should be made on a case-by-case basis based on risks and benefits and the likelihood of other etiologies.Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL) and lipid staining (e.g., oil red O). The decision about whether to perform a BAL should be based on individual clinical circumstances.Lung biopsies have been performed on some patients. If a lung biopsy is obtained, lipid staining may be considered during pathologic examination, and is best performed on fresh tissue. Routine pathology tissue processing (including formalin-fixation and paraffin-embedding) can remove lipids. Conducting routine tissue processing and histopathologic evaluation is still important. Consider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan.Patients who have received treatment for severe pulmonary disease related to e-cigarette product use should undergo follow-up evaluation as clinically indicated to monitor pulmonary function.Do you see the glaring omission here? Do you see the omission that I think demonstrates that the CDC is actively attempting to decrease its ability to conclude that THC oils are causing these reported cases? The glaring omission in the CDC's recommendations for clinicians is that they failed to recommend that clinicians conduct a sensitive urine drug screen for THC in every patient. This is the only way to determine with reasonable accuracy whether a patient used a THC-containing product. Simply relying on self-reports is not sensitive enough because many youth will understandably hide the fact that they were using an illicit, black market drug that was essentially obtained from drug dealers. Every patient needs to be tested for THC. The failure to recommend this testing indicates to me that the CDC is not serious about really wanting to be able to invoke THC oils as a cause of these illnesses if they truly are the cause. By not recommending this testing, the CDC is ensuring that there is no way that THC will be implicated in every case. This, by definition, will leave open the possibility that traditional e-cigarettes are causing some of the cases, allowing the CDC to emphasize that people should not use e-cigarettes!The rest of the story is that the parameters that the CDC has established for its investigation will ensure that it has the ability to invoke electronic cigarettes as being a possible cause for the outbreak. This tells me that the CDC is more interested in protecting the illicit, underground THC vape cart black market than truly protecting the health of our nation's youth. Apparently, being able to continue to demonize electronic cigarettes is more of a priority.  Original author: Michael Siegel
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Consumer Advisory: If you are afraid of going back to smoking, seek out other smoke-free alternatives.

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: Alex Clark
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American Lung Association Criticizes CDC for Giving a Vague Warning on Respiratory Disease Outbreak; Then Issues a Warning that is Even More Vague

In a Politico article published today, the American Lung Association criticized the CDC for issuing too vague a warning regarding what people should do to avoid the "vaping"-associated outbreak of acute, severe respiratory disease.The American Lung Association was quoted as stating: "We know that it’s important with health communication to deliver very clear messaging, unambiguous meaning."The Rest of the StoryAt first, when I saw this quote, I thought that the American Lung Association was absolutely on-point with its criticism because the CDC has been far too vague by warning people not to use "e-cigarettes" generally instead of focusing on the illicit, bootleg marijuana vape carts that have been associated with the vast majority of the cases. However, I then read what the American Lung Association suggested as a less vague and more appropriate warning.It was: "Don't use these products.""These" products? What products? Ironically, while criticizing the CDC for being too vague and ambiguous, the American Lung Association is issuing a warning that is even more vague and more ambiguous. At least with the CDC warning, we have some idea of what products they are talking about, even though they are lumping together products that are clearly not responsible for the observed cases with those that are. But with the American Lung Association's warning, it is not even clear what products they are talking about. It would hard to be more vague or more ambiguous if you tried.In fact, the most recent warning posted on the American Lung Association's web site is almost as ambiguous. It states: "The American Lung Association has been raising the alarm about e-cigarettes and their use for more than a decade, and reiterates the recommendation that the public should not use any tobacco product, including e-cigarettes." Essentially, the American Lung Association's warning is "don't use e-cigarettes."The warning does not even mention that the majority of cases are linked not to e-cigarettes, but to e-marijuana. The words marijuana and THC do not even appear anywhere in the statement.Since the American Lung Association still seems to believe that we have no idea what is causing this outbreak, perhaps they should make their warning even more ambiguous:"Don't use products."This would actually be quite funny, except for the fact that people's lives are at risk, especially young people, among whom the prevalence of vaping marijuana is quite high.The American Lung Association is quite right when it states that "it’s important with health communication to deliver very clear messaging, unambiguous meaning." But maybe it should examine its own messages before criticizing others.Original author: Michael Siegel
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CDC Has No Problem Attacking Vaping Companies so Why are They Protecting the Marijuana Drug Cartel?

We now know that the majority of cases of the severe respiratory disease outbreak that has affected more than 300 people and resulted in three deaths across the United States are associated with the use of illicit, bootleg marijuana vape carts that are produced by what is most likely a relatively small cartel of illegal manufacturers. E-liquid samples from patients across multiple states have tested positive for tocopherol acetate and at high levels, with at least one sample reported to be comprised of 50% tocopherol acetate. The CDC itself reported today that a cluster of cases of lipoid pnemonia in North Carolina were all associated with the use of bootleg THC oils.In spite of this information, the CDC continues to avoid clearly warning the public not to vape THC oils! Instead, they are continuing to focus on all vaping products and their primary advice is still: "don't vape."Shockingly, in the CDC's most recent alert, the recommendations to the public do not include a specific warning against vaping marijuana vape carts. The CDC's primary warning is: "While this investigation is ongoing, people should consider not using e-cigarette products." Moreover, nowhere in the paragraph that contains the CDC's recommendations do the words "marijuana" or "THC" even appear! Not even once.The CDC's failure to warn the public about vaping bootleg marijuana carts is unfortunately filtering down to nearly all reports regarding this outbreak. Even in the prestigious New England Journal of Medicine, today's featured article mimicked CDC in its recommendations. The primary recommendation was that the public should consider not using e-cigarettes. There was not a clear and specific warning to stringently avoid vaping illegal marijuana.The Rest of the StoryGiven what we now know, I find it completely irresponsible for the CDC to continue to obscure the truth and to continue to try to blame this outbreak on legal, nicotine-containing e-cigarettes that have been on the market for years and have not caused any previous problems, rather than to acknowledge that the vast majority of the cases seem to be due to the use of illegal marijuana vape carts.Why is the CDC going to such great lengths to try to demonize the vaping industry while protecting the illegal marijuana cartel that is producing and widely distributing unregulated THC carts that are apparently contaminated with high levels of a thickening agent that likely coats the lungs with oil and prevents the lungs from working?We do know that many of the cases are presenting as lipoid pneumonia, that lipid-laden macrophages are being detected in most of these presentations, and that recent changes in illicit vaping marijuana production has apparently resulted in the introduction of a large amount of an oil into THC vape carts that does not vaporize (except at extreme temperatures not achievable with most vape pens) and therefore, youth are inhaling liquid oil into their lungs which is retained. No wonder this is such an extremely dangerous situation and no wonder we are seeing such unexpectedly severe lung failure in these patients. I don't think this can be said to be a complete "mystery" any longer.In today's New England Journal article, it reports that of all reported cases in Illinois and Wisconsin in which patients were rigorously interviewed, 87% eventually admitted to vaping marijuana, not (just) nicotine e-liquids. It is certainly possible that most or all of the others were just reluctant to admit buying bootleg vape carts from drug dealers.While the CDC and other health groups are still trying as hard as they can to blame legal, retail e-cigarettes, it is difficult to understand two things: (1) what changed such that we are seeing such an enormous outbreak at this particular time? (2) since there is not one product implicated, how could there possibly be contamination of multiple brands of e-liquids when they are all manufactured at different facilities?We can potentially explain both of these with marijuana vaping. First, there was apparently a change made by the illicit marijuana vape cart manufacturers late last year and it appears that they started to use tocopherol acetate as a new thickening agent. One would expect that they would put a large amount of the agent into the cart because their chief goal is to make money. Second, the bootleg vape carts are apparently made by a very small number of manufacturers (possibly by one very large production in the Los Angeles area) and then distributed widely throughout the country. This would explain why we are seeing a multi-state outbreak with multiple products and brands. It is thought that the same contaminated THC oil may be used in multiple products, just packaged differently.I am by no means arguing that we can explain every single case and that no nicotine-containing e-liquid is involved. However, it is clear that this outbreak is primarily related to the illicit, wide distribution of dangerous THC oils by an illegal drug operation.The rest of the story is that the CDC is doing everything in its power to protect this illegal operation and to deflect blame onto the vaping companies. And the end result is that it is putting the lives of our youth at risk.Original author: Michael Siegel
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Heads Up – News – Updates 9.5.2019

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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ALERT: Major Breakthrough in Investigation of "Mysterious" Lung Disease Outbreak

There has been a major breakthrough in the investigation of the outbreak of more than 300 cases of a "mysterious" lung disease that the CDC and many other health agencies have told the public is due to the vaping of electronic cigarettes. And now, everything is starting to make some sense.Illicit THC vape carts that were obtained from a number of case patients that were tested in federal and state laboratories have tested positive for vitamin E acetate, an oil that just started to be used late last year as a thickening agent in bootleg THC vape carts. Apparently, for every single case in New York State for which testing is complete, vitamin E acetate was found in at least one of the THC vape carts that were used by the patient. Almost simultaneously, testing of recovered THC vape carts by the FDA revealed vitamin E acetate in 10 of 18 tested samples. Importantly, the FDA reported that it found no contamination in any of the nicotine e-liquids tested.The Rest of the StoryWhile there are still a lot of unknowns, the pieces of the puzzle are just beginning to fit together. One the great mysteries about this outbreak is "Why now?" Nicotine e-liquids have been on the market for many years and are being used by millions of vapers but there has never been a problem. Something must have changed to result in the outbreak occurring at this time. But what?Now there is a possible explanation: it turns out that there was a major change made in the bootleg THC vape cart drug dealing industry late last year. It appears that a new thickening agent started to be used in bootleg THC vape carts. Very possibly, that new agent was vitamin E acetate. Tocopherol acetate (the fancy name for vitamin E acetate) is a thickening agent that is typically used in cosmetics like skin cleansers. But late last year, it apparently began to be used for thickening the THC oil (presumably to hide the fact that it had been highly diluted, which is a clue to some buyers that they are not getting much product). Here is what leafly.com has to say:"Peter Hackett of Air Vapor Systems and Disinger and Heldreth of True Terpenes both mentioned the recent introduction of a novel diluent thickener called Honey Cut. The product swept through LA’s pen factories late last year. Honey Cut maintains a website, but the identity of the product manufacturer remains unknown, as does the chemical makeup of the substance. Leafly has made many attempts to reach officials at Honey Cut, but they have chosen not to respond.Honey Cut’s introduction last year proved so popular that competing products by other diluent makers soon began appearing."What was the new diluent thickener in Honey Cut?You guessed it ... tocopherol acetate.An insightful article at WebMD adds this information:"Investigators are also trying to figure out what may have changed in vape cartridges that could have triggered this rash of respiratory illnesses. According to David Downs, writing in the publication Leafly.com, a marijuana information source, underground sellers began using a new tasteless and odorless thickening agent in late 2018. Buyers often judge THC potency by its thickness.'This new additive may or may not play a role in the current health crisis,' writes Downs, Leafly's California bureau chief. 'But it is one of the major new ingredients in illegal vape cart oil in widespread use this summer.'"If tocopherol acetate is playing a role in the outbreak, it would help to explain why the observed lung illnesses are so severe and why the patients' lungs basically stop working. As explained in the Washington Post:"Vitamin E acetate is basically grease, said Michelle Francl, a chemistry professor at Bryn Mawr College. Its molecular structure means that “you have to heat it up pretty hot” for it to vaporize. Its boiling point is 363 degrees Fahrenheit, which is well above the 212 degree F boiling point for water, and nearly four times higher than normal human body temperature. Once the oil is heated hot enough to vaporize, it can potentially decompose and “now you’re breathing in who-knows-what,” Francl said. When that vapor cools down in the lungs, it returns to its original state at that temperature and pressure, she said, which means “it has now coated the inside of your lungs with that oil,” she said.It is not difficult to imagine why the lungs would stop working if they became coated with grease or oil.It will be interesting to see how long it takes the CDC to issue an unequivocal warning to the public that they should absolutely not vape marijuana using THC vape carts obtained off the street.This emerging story shows the dangers of bias in public health. The long-standing bias of the CDC against vaping has resulted in the agency failing to warn the public in clear and specific terms about the risks associated with the use of bootleg THC vape carts and instead, issuing warnings against "vaping" and "e-cigarettes" generally and making meaningless statements like "e-cigarette aerosol is not harmless water vapor."On my blog, I first issued a warning about the use of black market THC oils on August 25, and then on August 28 I blogged and tweeted an unequivocal warning, since the CDC had failed to do so. It is now 11 days later, and we are still waiting for the CDC, HHS, and other health groups to issue a clear and specific warning against the use of bootleg THC vape carts. We are still waiting for these groups to stop blaming the outbreak on vaping or on e-cigarettes. Although we cannot completely rule out any role of e-cigarettes, it now appears very unlikely that they have anything to do with the outbreak, which appears to be due to e-cannabis, not e-cigarettes.The truly unfortunate rest of the story is that in their zeal to demonize e-cigarettes, the CDC and other health agencies have put the lives of our nation's youth at risk. They should have issued a warning 11 days ago. During the past 11 days, how many youth continued to vape THC oils because of the failure of health agencies to accurately convey the known information about the potential causes of the outbreak? The CDC and other health agencies and some anti-tobacco groups have gone to great lengths to protect the illicit cannabis industry. But they have no problem with attacking the e-cigarette companies and telling ex-smokers to return to smoking rather than continuing to vape. Why?Original author: Michael Siegel
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Exploiting Outlier Lung Disease Cases Does a Disservice to Public Health



In her excellent August 28 USA Today articleon the recent emergence of vaping-related lung illnesses, Jayne O’Donnell noted that “Some state health department and news reports suggest many of the cases of lung problems involve tetrahydrocannabinol, known as THC, the chemical in marijuana that causes psychological effects.” I fully agree with Boston University’s Dr. Michael Siegel, who said, “The Centers for Disease Control and Prevention is being ‘unnecessarily vague’ about describing the injuries as simply vaping-related when many people might have been injured by vaping THC oil.”  As he and New York University public health professor Ray Niaura pointed out, millions of Americans have vaped nicotine e-liquids over the last ten years, yet no lung problems were reported until recently.  The sudden appearance of these cases and links to THC strongly suggest that contaminated street liquids are at fault, not legitimate retailers’ e-cigarettes or vape products. Despite this, as noted by Jacob Sullum, the CDC Office on Smoking and Health’s Dr. Brian King focused his public remarks primarily on a purported general link between e-cigarettes and vapor products with lung disease: “So there’s a variety of harmful ingredients identified, including things like ultrafine particulates, heavy metals like lead and cancer causing chemicals. And flavoring used in e-cigarettes to give it a buttery flavor.  Diacetyl and it’s been related to severe respiratory illness.  That being said we haven’t specifically linked any of those specific ingredients to the current cases but we know that e-cigarette aerosol is not harmless…But the bottom line is there’s a variety of things in e-cigarette aerosol that could have implications for lung health.  A review recently identified a number of adverse health effects associated with e-cigarette use.”   Dr. Siegel excoriated federal officials for this approach: “In a disease outbreak such as this one, responsible public warnings need to be as specific as possible about the risk. In an outbreak of E. coli caused by a contaminated batch of lettuce, we don't tell the public that the disease is associated with eating, or even that it is associated with eating lettuce. People need much more specific guidance if they are to take appropriate action to avoid or reduce the risk of further spread of the outbreak. “Here, we need to start telling the public the truth. However much physicians or anti-nicotine groups may not like it, the truth is that the outbreak we are seeing is not due to the risks of using standard vaping products. It appears much more likely that the outbreak is mostly, if not completely attributable to illicit products--especially THC extracts--that are being sold by unlicensed sellers on the black market. Unless people are provided with this specific information, they will not take action to avoid the products that could put them at risk.” The potential downside of this scaremongering is even worse.  How many thousands of former smokers who currently vape will conclude that the risks aren’t worth it, and return to smoking?  How many millions of smokers will never consider this vastly safer smoke-free option? CDC’s hypocrisy was demonstrated in the August 23 statement of Director Dr. Robert R. Redfield: “We are saddened to hear of the first death related to the outbreak of severe lung disease in those who use e-cigarette or ‘vaping’ devices…This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents.” The lung disease fatality was tragic, but Dr. Redfield exploited it by implicating all e-cigarettes and vapes.  Where is CDC’s sorrow for the 1,300+ smokers who die every day from cancers, circulatory diseases and emphysema?September 5, Reported by the Washington Post: "State & federal health officials investigating mysterious lung illnesses... have found the same chemical in samples of marijuana products used by people sickened in different parts of the country. The chemical is an oil derived from vitamin E." Original author: Brad Rodu
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Health Officials Continue to Warn People Not to Use E-Cigarettes While Youth Get Life-Threatening Diseases from Vaping Marijuana

There is a complete disconnect between the facts regarding the investigation of the "mysterious" illness that is affecting more than 300 people in the U.S. (mostly youth and young adults) and the health warning messages that are being communicated by public health officials. The majority of the cases have been associated not with the use of electronic cigarettes (which use nicotine-containing e-liquids) purchased at stores, but with the use of marijuana (THC) vaping carts purchased from drug dealers.I have already reported that across California, New Mexico, and Wisconsin, 54 of the 57 cases that were reported as of last week were confirmed to have been associated with the use of THC oil (California: 21 of 21 cases; New Mexico: 8 of 8 cases; Wisconsin: 24 of 27 cases).Yesterday, it was reported that of eight case patients interviewed in Minnesota, every single one of them reported having vaped THC, not nicotine. According to a state health department official quoted in a Minneapolis Star-Tribune article: "All of the ones we’ve interviewed, eight of eight, said they used an illegal THC product."In addition, the second death caused by the outbreak, which occurred in Oregon, was also associated with the vaping of cannabis, although the product was apparently purchased at a licensed dispensary, not on the black market. So we now have five states, widely separated geographically, in which the vaping of THC oils or marijuana vape carts has been identified as the primary cause of the outbreak.In light of this information, you would think that health officials would be issuing very clear warnings to our nation's youth not to vape marijuana, especially THC oils purchased off the street. Instead, health officials continue to emphasize that the primary risk factor for these severe illnesses is "vaping" or "e-cigarettes" generally.This stark contrast is evidenced in an article reporting the death of a person in Oregon from vaping marijuana. After readers are informed about this marijuana-related death, they are given a CDC warning "that people who vape consider avoiding e-cigarettes while they investigate." Don't consider avoiding vaping marijuana, just avoid using an e-cigarette. Since many youth do not associate e-cigarettes with marijuana, even this broad recommendation is likely to go unheeded.Original author: Michael Siegel
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Michigan Ban on Flavored E-Cigarettes is a Terrible Policy with Devastating Public Health Consequences

Yesterday, Michigan Governor Gretchen Whitmer signed into law an executive order that bans the sale of all flavored e-cigarettes in the state. The ban includes both retail sales and online sales of all e-cigarettes, with the sole exception of tobacco-flavored products. In doing so, Michigan becomes the first state in the nation to promulgate a complete ban on the sale of the overwhelming majority of vaping products.In defending the ban, state health officials "pointed to studies indicating that young people who vape are more likely to start smoking regular cigarettes."The Rest of the StoryI cannot overemphasize how insane this policy is. From a public health perspective, it makes absolutely no sense to ban these fake cigarettes, but to allow the real ones to remain on the shelves. If electronic cigarettes, which have not been confirmed to have caused a single death, are so dangerous that they cannot be sold anywhere in the state, then certainly real tobacco cigarettes which kill more than 400,000 Americans each year should not be sold in Michigan.And if the chief concern of the governor and health officials is that e-cigarette use may lead to youth smoking, then how ludicrous is it to allow the sale of cigarettes to continue while thousands of kids in the state are apparently at high risk of starting to smoke?Certainly, if youth vaping is a public health emergency then youth smoking is even more of an emergency and so is youth alcohol use, especially youth binge drinking. But the governor is not banning the sale of cigarettes or alcohol. Why? There is simply no public health justification for this selective ban on the sale of electronic cigarettes.Not only is this terrible public policy, but it is going to have a devastating effect on the health of Michiganders. Tens of thousands of ex-smokers in Michigan rely upon flavored e-cigarettes to remain off of cigarettes. They successfully quit smoking completely by switching to vaping. When these products are taken off the market, they are not going to drive down to Ohio to purchase their favored vaping products. Instead, most of the them are going to simply go back to smoking. It's simply too inconvenient for them to have to drive long distances to continue vaping. And if you think that these tends of thousands of vapers are going to quit nicotine cold turkey, then you don't know anything about nicotine addiction.The other thing that some vapers will do is to start purchasing their products off what will be a new black market in Michigan. Unlike all other vaping products in the nation, these products will be the only ones that are completely unregulated. As of May 2020, the FDA will have complete scrutiny over every electronic cigarette device and e-liquid on the market throughout the nation, except for those in Michigan, which will be completely unregulated. This makes no sense at all. Given the outbreak of severe respiratory disease we are now seeing due to black market marijuana vaping products, the last thing we need is to have a new black market of nicotine e-liquids being developed. But vapers in Michigan will have no choice. For the overwhelming majority, it will be either returning to smoking or purchasing off the black market.I hope that the state legislature will override this completely irresponsible decision by the governor, but if not, I think there are strong grounds for a lawsuit to enjoin this regulation from taking effect. By banning electronic cigarettes but not real cigarettes, which are similarly situated with regards to their public health consequences (actually, not similarly situated but much more deadly), this is an arbitrary and capricious action and is therefore not justified as a health regulation.The rest of the story is that Michigan's ban on flavored e-cigarettes is an irresponsible and unjustified public health policy that is going to have devastating public health consequences. This is an example to the nation of exactly what not to do to respond to the epidemic of youth vaping.Instead, the state should simply restrict the sale of all tobacco products - including cigarettes and vaping products - to adult-only (age 21+) establishments that only sell these products. This would help to reduce youth vaping while at the same time allowing ex-smokers to continue accessing the vaping products that are literally saving their lives. And it would save thousands of small businesses - the vaping shops in Michigan that are essentially acting as smoking cessation clinics for the state's smokers. It's like having a statewide smoking cessation program without having to put out a penny in funding. Now why would you want to get rid of that?Original author: Michael Siegel
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Governor Whitmer’s Executive Ban on Vapor Products Is a Hazard to Public Health

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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DHHS Secretary's Statement on "E-Cigarette-Related" Respiratory Illnesses is Irresponsible; Does Not Even Mention E-Cannabis

Last Friday, the Secretary of the Department of Health and Human Services (DHHS) issued a statement on the recent upsurge in reported cases of respiratory illnesses that have occurred among more than 200 youth and young adults, all of whom reported "vaping."The statement made two recommendations to the public: "Americans who use e-cigarettes and are concerned about these specific, potential risks of illness should consider refraining from their use, and should not buy them off the street or modify them or add substances in ways not intended by the manufacturer.""Youth, young adults, and pregnant women should never be using e-cigarettes, and Americans who do not use tobacco products should not start using e-cigarettes."So essentially, the warning from the nation's leading public health official regarding this alarming outbreak of severe respiratory disease is: "Do not use e-cigarettes."The Rest of the StoryWhat is so irresponsible about this warning is not what is says, but what it doesn't say. Nowhere in the statement does it even mention that the majority of the cases have been associated not with the use of e-cigarettes, but with the use of e-cannabis, specifically, with THC oils purchased off the black market. Nowhere does it warn the public not to use THC oils, unless they are purchased from a licensed and regulated cannabis dispensary.What the HHS secretary is telling the public is that all we know is that these cases are associated with vaping, so don't vape. That's ridiculous advice. First of all, it will have no effect because it's far too vague to change anyone's behavior. Second of all, it is not specific enough to provide an appropriate warning.Inexplicably, the CDC has not released the most critical information that we need: What percentage of cases have been attributed to the use of THC oils, synthetic marijuana, or e-joints, as they are sometimes called? Why is the CDC hiding this information from the public?So far, three health departments have been responsible enough to tell us exactly what percentage of cases were linked to e-joints compared to e-cigarettes:California21 of 21 cases apparently were linked to vaping THC oil (100% of cases)New Mexico8 out of 8 cases confirmed to be associated with vaping THC oil (100% of cases)Wisconsin24 of 27 cases confirmed to be associated with vaping THC oil (89% of cases)Across these three states combined, 95% of the cases have been linked to the use of e-joints, not e-cigarettes.Even in the cases that have not been linked to the use of e-cannabis, it is still very possible that e-cannabis was involved. Youth may simply be reluctant to report that they were using cannabis that was purchased illegally from drug dealers. You can certainly understand why a youth may not want to readily admit this. In many cases, youth have initially failed to report the use of e-cannabis, but only reported it after further questioning. As the recent New York Times article reports, at least some youth did not reveal their THC use. This is understandable: in many high schools, the use of cannabis is punishable by a suspension of as much as 180 days.I am not arguing that we have enough information to conclude that no e-cigarette products are involved in these cases. However, we do have enough information to conclude that most of these cases are associated with the use of illicit e-cannabis products. Thus, it is imperative that people be warned very specifically about this connection.A fascinating question is why health officials are failing to describe this as an e-cannabis problem, rather than a "vaping" or "e-cigarette" problem. I don't think there's any doubt why: the CDC and other health agencies have demonstrated a strong bias against e-cigarettes from the beginning and are taking advantage of this unique opportunity to further bash e-cigarettes. They've been doing that for years. Only now, there's one difference. The health and lives of many youths are imminently at risk. Original author: Michael Siegel
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Tobacco Company Claims that Smoking is No Worse than Vaping for Human Lung Disease

A major U.S. tobacco company on Saturday issued a press release boasting that smoking its cigarettes is no more harmful than vaping an e-cigarette that contains no tobacco and involves no combustion, at least in terms of lung disease. A spokesperson for the company was kind enough to allow The Rest of the Story to interview him. The transcript appears below, with only slight editing for purposes of clarity. I was given permission to publish the interview, but under the condition that I not name the spokesperson.The Rest of the Story: Let me first make sure I have this correctly. You are saying that in terms of lung disease, smoking is no more dangerous than using an e-cigarette?Tobacco company spokesperson: That's right. E-cigarettes are as dangerous as cigarettes for human lung disease."The Rest of the Story: But that is almost impossible to believe. I mean, cigarettes cause more than 400,000 deaths a year, and more than 100,000 of those deaths are from chronic obstructive lung disease. You're saying that soon we're going to have more than 100,000 vapers dying every year from emphysema and chronic bronchitis?Tobacco company spokesperson: Yes.The Rest of the Story: But we haven't seen a single case. Shouldn't we observe a single case of vaping-induced COPD before we draw such a massive conclusion? I mean, as you know, there is probably no human disease that we conclude is caused by a particular exposure before we actually have at least one case. There were hundreds of thousands of deaths from smoking when the Surgeon General concluded that smoking causes heart disease, lung cancer, and chronic lung disease.Tobacco company spokesperson: No, we don't need to wait for the evidence. We can conclude that vaping is as dangerous as smoking based on what we know right now.The Rest of the Story: There are three types of epidemiological studies that are typically used to draw causal conclusions about an exposure and a disease. Going from the most definitive to the least, we have cohort studies, case control studies, and case studies. But even in the case studies - which are the weakest form of evidence - you have at least one case of the disease! Tobacco company spokesperson: But there is evidence.The Rest of the Story: OK, what is the evidence.Tobacco company spokesperson: Well, a paper came out recently in the American Journal of Respiratory and Critical Care Medicine showing e-cigarette use increases neutrophil elastase and matrix metalloprotease levels in the lung. The levels of enzymes in the vapers were actually about the same as those in the smokers. Thus, smoking is as hazardous as vaping.The Rest of the Story: And?Tobacco company spokesperson: And we know that higher levels of elastase and protease in the lung can lead to chronic obstructive lung disease.The Rest of the Story: OK, so how many of the vapers in the study had signs of chronic lung disease?Tobacco company spokesperson: None.The Rest of the Story: Well, what about a marker for early disease? How many of the vapers in the study had abnormal spirometry measurements?Tobacco company spokesperson: None.The Rest of the Story: Now will you acknowledge that if a lot of the vapers in the study were actually ex-smokers and they had a long history of smoking in the past, the observed changes in their lung enzymes might be attributable to their smoking history?Tobacco company spokesperson: Yes, and the paper clearly states that is the case.The Rest of the Story: OK, so how many vapers were there in the study, and how many were nonsmokers as opposed to former smokers?Tobacco company spokesperson: There were a total of 14 vapers in the study. Nine of them were former smokers. Only five were nonsmokers.The Rest of the Story: OK, so the majority of the vapers had actually smoked in the past. For how many years did they smoke and how long had it been since they quit smoking?Tobacco company spokesperson: It's not reported in the paper.The Rest of the Story: OK, well I assume that they reported results just for the vapers who were neversmokers. How did their enzyme levels compare with those of the smokers?Tobacco company spokesperson: It's not reported in the paper?The Rest of the Story: So the results of this paper could possibly be due to the fact that ex-smokers had suffered lung injury in the past, rather than that the investigators were finding signs of chronic lung damage in never smokers who started vaping?Tobacco company spokesperson: I suppose so.The Rest of the Story: Well, if that remains a possibility, then how can you possibly conclude that vaping as just as hazardous as smoking, even if you're only talking about the risk of chronic obstructive lung disease?Tobacco company spokesperson: We're not going to worry about the nit-picky details. This is simply a wonderful marketing opportunity for us. By equating smoking with being no more dangerous than vaping, which people don't generally view as particularly hazardous, we are able to make smoking look much less benign than was previously thought. This is helping us to undermine decades of public health education about the severe hazards of smoking.The Rest of the Story: Well aren't you worried about being attacked by anti-tobacco groups? I mean you're making a statement that is not supported by scientific evidence and which undermines the public's appreciation of the severe hazards of smoking. Tobacco company spokesperson: We don't worry about the anti-tobacco groups any more. They are too obsessed with criticizing vaping companies. They have practically forgotten that we even exist. They have basically forgotten that there are still 35 million smokers out there who are enjoying our products and sending our profits and stocks soaring. Frankly, the only thing that stands in the way of achieving our full stock value is the threat that e-cigarettes pose as an alternative for many smokers. So being able to convince people that vaping is just as bad as smoking is a dream-come-true for us. And we're licking our chops waiting for the FDA's regulations to go into effect next May. That's going to decimate the vaping product market and basically hand over the entire nicotine product market to us.The Rest of the Story: Sounds like I should go out and buy some stock in your company.Tobacco company spokesperson: You're not the only one. Our financial outlook has never been more positive.The Rest of the StoryCORRECTION: I apologize. I made a mistake. I pulled the trigger too quickly. Hearing that a press release was issued claiming that smoking was no more hazardous than vaping, I naturally assumed that it must have originated from a tobacco company. Who else would draw such a sweeping conclusion from a single study showing cellular changes in vapers, most of whom had a long history of smoking? And especially in light of the fact that the paper didn't even bother to present the results for the vapers who didn't smoke? But I stand corrected. The claim was actually made by an anti-tobacco researcher on his blog. I apologize for any inconvenience my mistake may have caused.Original author: Michael Siegel
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American Lung Association Condemns 2.5 Million Ex-Smokers for Using E-Cigarettes to Quit

What do you say to a person who smoked two packs of cigarettes per day for 30 years and then quits completely by switching to vaping?I would say: Congratulations on this amazing and difficult accomplishment. You've saved your life and done a huge service not only to yourself but to your family and friends.The American Lung Association, in contrast, is saying to vapers: Shame on you! You shouldn't have done that. You're a bad person because you're still using a tobacco product. And you're at risk of dying from acute respiratory failure.Specifically, the American Lung Association stated: "The bottom line is that e-cigarettes are not safe, and from the American Lung Association’s perspective, no one should be using e-cigarettes."By saying that "no one" should be using e-cigarettes, that obviously includes ex-smokers who have quit smoking successfully using e-cigarettes and are reliant on these products to remain smoke-free. Based on data from the National Health Interview Survey, there are more than 2.5 million of these ex-smokers in the United States.Essentially, what the American Lung Association is saying to the 2.5 million vapers who accomplished the difficult task of quitting smoking is: "F... you."The Rest of the StoryI find this incredibly interesting because it demonstrates that the American Lung Association simply cannot tolerate the thought that someone could use a product in a way that "looks like" smoking to quit smoking, even though it is much safer than smoking and has been shown to be a much more effective of quitting smoking than using a nicotine patch or other nicotine replacement products. The efficacy of e-cigarettes for smoking cessation is on par with, if not better than that of varenicline, making it the most effective strategy for quitting smoking for anyone who is unable to quit cold turkey (which is the overwhelming majority of smokers).It's fascinating to me that the American Lung Association, whose goal is supposed to be to prevent lung disease, would be condemning vapers rather than congratulating them. That the ALA is essentially flipping vapers the bird is a clear sign that they really don't care if someone quits smoking; they only care that someone quit the way the ALA thinks they should quit: that is, using pharmaceutical products from companies with which the American Lung Association has had a financial relationship. If you look at the financial supporters of the ALA, you'll see almost the entire roster of Big Pharma, including corporations that manufacture smoking cessation products, such as Pfizer and GlaxoSmithKline.In addition to rubbing vapers' noses in the ground and showing them disrespect, the American Lung Association is lying through its teeth about the health consequences of e-cigarette use, claiming that they cause "popcorn lung" and "irreversible lung damage" and that e-liquid contains "formaldehyde and acrolein."All of these claims are false. E-liquid does not contain formaldehyde or acrolein. Think about what the ALA is saying: they are accusing e-liquid manufacturers of purposely putting formaldehyde and acrolein into the e-liquids, which would be criminal. The truth is that in some devices, the e-liquid may be overheated and the excipients (propylene glycol and glycerin) may degrade, resulting in the formation of aldehydes. But these chemicals are not present in the e-liquid as the American Lung Association is falsely claiming.The American Lung Association continues to tell the public that the use of e-cigarettes can cause "popcorn lung," even though there has not been a single case of this disease associated with vaping despite these products being used by millions of people and being on the market for more than a decade.The rest of the story is that the American Lung Association is acting in a way suggesting that protecting the public's health is not their most critical value. Their primary value seems to be purity: that is, freedom from any tobacco product. This suggests that they are viewing tobacco use on moral terms, not health ones. If you use tobacco products, you are a bad person. It is a character flaw. It is a vice that cannot be tolerated or accepted. You have to cleanse yourself completely or you remain tainted. Even if switching to vaping has saved your life!This is not public health. It is some form of puritanism. But more importantly, it is a type of public health malpractice. Recommending that ex-smokers who are relying on vaping to keep them smoke-free stop vaping is tantamount to telling them to return to smoking, since that would be the practical effect if they actually took such advice. If a physician instructed a vaping patient to return to smoking, that would essentially be malpractice.Whatever the biases or political views that are motivating the American Lung Association, it is clear that this organization is not in any position to be giving medical advice.Original author: Michael Siegel
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Boston Pulmonologist Provides Misinformation About the Cause of Severe Lung Disease Associated with "Vaping"

In an article published today in the Boston Herald, a Boston pulmonologist attributed the growing number of cases of severe, acute respiratory disease to "vaping" in general, giving the impression that the risk factor for these illnesses is any type of e-cigarette use and implying that any youth who uses electronic cigarettes is at risk. She hyped up this claim about calling vaping "the number one respiratory public health concern in youth and young adults worldwide."The more than 200 cases of severe lung illness that have been reported in 22 states is indeed an important public health concern. But it is misleading, alarmist, and irresponsible to tell the public that these cases are being caused by retail e-cigarette products generally. Moreover, it is damaging misinformation because it does nothing to prevent further cases from occurring. The attribution for these cases is so broad that it is tantamount to giving no advice at all. Scaring people into believing that any vaping could cause you to die of respiratory failure is not only untrue, but it is not going to result in any change in behavior because it is far too vague.This is a public health crisis and I think that any physician who makes public statements about these cases has a responsibility to provide accurate information that will actually help to prevent further cases from occurring. Scaring people into thinking that any vaping product can cause respiratory failure is not only inaccurate, but it is irresponsible because it doesn't provide useful information that can help youth avoid the specific products that are responsible for the observed cases. The Rest of the StoryAs an trained epidemiologist, it was immediately clear to me that these cases are not being caused by vaping products generally because these products have been on the market for years without any significant problems and because the reports are clustered in specific geographic areas. Now that further information is available, it is clear that the majority of the observed cases are associated with the use of THC oils that were obtained from unlicensed sellers. It is also likely that cases occurring among people using nicotine-containing e-liquids without THC are due to a contaminant that is appearing in products being sold on the black market, not in retail stores.According to an article in yesterday's Washington Post, "Officials are narrowing the possible culprits to adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products."The article also states that: "The sudden onset of these mysterious illnesses and the patients’ severe and distinctive symptoms have led investigators to focus on contaminants, rather than standard vaping products that have been in wide use for many years" and that "The investigation is “starting to point to what solvents are being used, and that can vary a lot” — especially in counterfeit or black-market products, including potentially mislabeled solvents that consumers buy themselves to make do-it-yourself “home brews,” said an official at the Centers for Disease Control and Prevention, which is heading the investigation."The Boston pulmonologist quoted in the Boston Herald story is telling the public just the opposite, as she is attributing these cases to standard vaping products. This undermines the warnings that several state health departments have given to avoid black market products, especially THC oils. It also unduly scares parents into thinking, for example, that if their child is JUULing, they may die of acute respiratory distress syndrome. There is plenty for a parent of a youth who is JUULing to worry about (namely, the fact that it is addictive), but there is no reason to believe that acute respiratory disease is one of them.In a disease outbreak such as this one, responsible public warnings need to be as specific as possible about the risk. In an outbreak of E. coli caused by a contaminated batch of lettuce, we don't tell the public that the disease is associated with eating, or even that it is associated with eating lettuce. People need much more specific guidance if they are to take appropriate action to avoid or reduce the risk of further spread of the outbreak.Here, we need to start telling the public the truth. However much physicians or anti-nicotine groups may not like it, the truth is that the outbreak we are seeing is not due to the risks of using standard vaping products. It appears much more likely that the outbreak is mostly, if not completely attributable to illicit products--especially THC extracts--that are being sold by unlicensed sellers on the black market. Unless people are provided with this specific information, they will not take action to avoid the products that could put them at risk.Original author: Michael Siegel
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Lancet commentary – Nicotine without smoke: fighting the tobacco epidemic with harm reduction


August 29th, 2019

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Why is the American Lung Association More Interested in Demonizing Electronic Cigarettes than Saving Kids' Lives?

In response to former FDA Commissioner Scott Gottlieb's warning that the spike in vaping-related lung disease among young people appears to be largely associated with counterfeit e-liquid products, especially THC oils, the American Lung Association contradicted Dr. Gottlieb and tried to cast the blame on traditional nicotine-containing e-cigarettes instead.The spokesperson for the American Lung Association was quoted as saying: "With all due respect to former FDA Commissioner Gottlieb, I think it's too soon to speculate about the cause or the reason why we're seeing this ... I firmly believe that had FDA not delayed the oversight of these products in July of 2017 that we would be in a much different position than we are today. ... The tobacco industry has long been happy to place fingers when there have been issues of counterfeit cigarettes … The bottom line is that e-cigarettes are not safe, and from the American Lung Association’s perspective, no one should be using e-cigarettes."The Rest of the StoryAlas, the truth is revealed. At the end of the day, the American Lung Association's chief aim is to demonize e-cigarettes and anyone who is using them.What's astounding to me is that the American Lung Association is actually undermining Dr. Gottlieb's warning to the public to avoid vaping THC oils and counterfeit e-liquids purchased off the street. Moreover, Dr. Gottlieb is not "speculating." At least five different health departments and the CDC itself have stated that many of the reported cases appear to be associated with the use of THC oils purchased off the street. We don't need to wait until there is absolute certainty about the cause of every single case. There is enough information to warn people not to use THC oils or any e-liquids purchased from unlicensed sellers or pop-up shops. That's exactly what Dr. Gottlieb was doing and it's deplorable that the American Lung Association would attempt to undermine his warning just to get in a jab against vapers.Seriously, it's very clear to me that the American Lung Association truly hates vapers and wishes them nothing but the worst. It's almost as if they are hoping that the cases end up being tied to traditional vaping products so they can say "We told you so."Ironically, while the American Lung Association castigated Dr. Gottlieb for jumping to conclusions, it then proceeded to jump to conclusions itself, asserting that the cause of these cases is the failure of the FDA to implement the pre-market tobacco application requirement. But that presupposes that the cases are due to e-liquids being manufactured by legitimate companies that would be complying with the FDA regulations. If the cause of many or most of these cases is THC oils, then those wouldn't be subject to FDA regulation in the first place. The ALA's statement is essentially concluding that the THC oils are not a major cause. This is irresponsible and dangerous and threatens the health and lives of the nation's young people.Original author: Michael Siegel
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