
Outbreak of Lung Illness Associated with Using E-Cigarette Products - colund
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
======
_Marak_
I've been following this for months and New York State seems to be reporting
the most accurate information.

[https://www.health.ny.gov/press/releases/2019/2019-09-05_vap...](https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm)

[https://www.flickr.com/photos/nysdoh/sets/72157710703391248/](https://www.flickr.com/photos/nysdoh/sets/72157710703391248/)

The sickness is suspected to be caused by blackmarket THC vape cartridges
which have been cut with Vitamin E Acetate.

There is a huge problem with black market / counterfeit THC vape products.

There are two communities tracking this on Reddit:

[https://www.reddit.com/r/fakecartridges/](https://www.reddit.com/r/fakecartridges/)

[https://www.reddit.com/r/cleancarts/](https://www.reddit.com/r/cleancarts/)

------
kyriakos
Is it worse than regular smoking? or how about the new IQOS type?

Obviously not smoking is the best option but assuming smokers will continue
smoking even knowing the risks - which is the case unfortunately for a big
majority, i believe the best thing to do is give them a way to get their fix
that poses the smallest risk.

~~~
leephillips
Surely there are several ways to deliver nicotine that are far safer than
electronic cigarettes. There is mounting evidence that these are worse than
tobacco.

~~~
hnarn
Disclaimer: I'm Swedish so I guess you could say I'm culturally biased, but I
have no economic interest in this.

You can always try "snus". Snuff has a bad rep in the US because of the
association with chewing tobacco and old westerns, but snus in a pouch under
your lip is actually very hygienic, easily disposable, practically invisible
and obviously spares your lungs, while still giving you a nicotine buzz.

Obviously no way of consuming nicotine is risk free, but I use it every now
and then and I enjoy it, especially with beer or coffee.

I think Swedish Match is attempting to market snus in the US under the
"General" brand[1], might be worth checking out if you want to try an
alternate way of consuming tobacco.

[1]: [https://www.generalsnus.com](https://www.generalsnus.com)

~~~
dmix
A lot of hockey players here in Canada use snus and even after learning how to
do it properly it still makes me want to vomit. Plus the idea of a 'spit
bottle' is even more anti-social than massive vape clouds (which are entirely
unnecessary and becoming taboo).

~~~
hnarn
There's no such thing as a "spit bottle" required for "proper" usage of snus.
Perhaps if you are using snus that isn't portioned in bags and you wish to
keep it in for a long time, you'll need to spit at some point -- but the vast
majority of people _do_ use portioned snus, and it is normally discarded
before it starts running in a dedicated part of the box you took it from.[1]

[1]:
[https://proxy.duckduckgo.com/iu/?u=https%3A%2F%2Fd13o5qkgojw...](https://proxy.duckduckgo.com/iu/?u=https%3A%2F%2Fd13o5qkgojw0n2.cloudfront.net%2Fimage%2Fcache%2Fcatalog%2FPresenter%2FSnusdosor%2F2019%2Fsnusdosa-
portion-med-gravyr-innebandyzap-1002-4822-4-0-1-2-800x800.jpg&f=1&nofb=1)

~~~
dmix
Strange, I wonder why all the hockey players I know used one. I'll ask them
next time, I'm not much an expert on the subject. But I do know one gets his
from Europe.

~~~
hnarn
> I wonder why all the hockey players I know used one.

My guess would be that they did not use "portioned" snus. It's a bit of a
macho thing, so the prevalence of the loose kind that you have to bake into a
ball yourself and get your hands dirty is much higher among professional
athletes, car mechanics and the like, while most regular consumers prefer the
portioned bags. If you're interested in the statistics, about 77% prefer
portioned snus.[1]

I believe one of the major reasons that people prefer to take their snus
"straight" is because it's stronger, but the whole thing about dirtying your
hands, making a mess when discarding it, going around spitting etc. creates
some obvious issues for regular office workers or other consumer groups with
similar opinions.

[1]: [https://news.cision.com/se/nordic-snus/r/hur-snusar-
svenskar...](https://news.cision.com/se/nordic-snus/r/hur-snusar-svenskarna-
egentligen-,c2881751)

------
tau255
In Vienna, the shop I bought my supplies had all products tested by local TÜV
NORD and they mixed liquids on site. Nowadays I buy and mix myself from
standard 50/50 PG/VG mix from known source. I had mixed results with imported
premixed liquids (off smell, not consistent viscosity - went to bin) and that
promptly stopped me from buying more of premixed stuff (along with problematic
regulations of container sizes).

Anything you add to the liqiud other than nicotine and PG/VG may be
problematic. You never really know what is in imported premixed liquid, what
cutting agents were used, what purity of source material was.

It seems that CDC is seeing some results of cost cutting, using stuff that was
not really meant to be vaped mixed to keep margins better.

------
thompo
I have asthma and have lived in Denver since before legalization.

When vape pens first came out I never had any issues. In the last few years I
very well could have easily been one of those statistics.

Vape pens make my lungs _hurt_ and I have to use my rescue inhaler for days
afterwards. It’s terrible. I don’t know if they changed how they make the oil
but I completely gave up on vaping. I tried one with pineapple flavoring and
man... it almost was the death of me.

~~~
gtirloni
Shouldn't any kind of smoking be a big no-no with ashtma? Really curious
because I have rhinitis and can't stand smoke around me.

~~~
thompo
I mean, probably. Cigarettes make me hurt (haven’t smoked one in a decade at
least). Vapes make me hurt. Smoking weed from a clean pipe gives me almost
zero negative effects unless I smoke significantly more than usual over the
course of a few days.

~~~
scoobyyabbadoo
What's the effect of not smoking anything?

------
Barrin92
i said right at the beginning when people were starting to recommend
e-cigarettes as a replacement for cigarettes that they should keep the good
old 'unknown unknowns' in mind and that a recommendation without knowledge of
long term risk is dangerous.

This should maybe be a general lesson when people advocate unproven
replacements for unhealthy habits.

~~~
EpicEng
Yet all we know is that these people vape and many of them were vaping black
market THC oil with high levels of vitamin E. An estimated 10M people vape in
the US and here we have an acute health issue with a few hundred people.

[https://www.nbcnews.com/health/vaping/vitamin-e-now-focus-
in...](https://www.nbcnews.com/health/vaping/vitamin-e-now-focus-
investigation-some-vaping-illnesses-n1050361)

------
h2odragon
Pretty certain I've had lipid pneumonia through vaped bad oils; but the
gastrointestinal involvement and elevated heart rate and white blood cell
count sound like there might be something more specific happening? Please
someone educate us further?

------
ohiovr
I thc vaped for a little while. Everything seemed fine till the next batch
which was a cough factory. It is unregulated and blackmarket. For all I know
huffing paint is safer.

------
doktrin
I'm another person who for whatever reason was never able to adjust to vaping.
It quite literally hurts, even with modest inhales, despite trying numerous
models (disposables, cartridges, expensive sub ohm systems, you name it). This
applies both for nicotine and thc vaping. I just wrote it off as something
that was a personal eccentricity.

Honestly it was for the best - I ended up using gum and eventually just
quitting, and stopped using thc for other reasons.

------
merricksb
Related discussion yesterday:

[https://news.ycombinator.com/item?id=20899523](https://news.ycombinator.com/item?id=20899523)

------
Havoc
Bit confused how they've got 450 cases but no certainty?

Surely 1 out of 450 has a sample left that can be tested thoroughly?

~~~
dmix
Hasn't stopped them from making completely generic recommendations against
vaping when most information points to specific kinds of THC pens.

~~~
Havoc
Well no. As I pointed out in another comment. All have vaping in common...only
some have THC associations (with some allowance for underreporting).

So they're right to ere on the side of caution here. The CDC isn't exactly
incompetent...if they could pin this down to THC pens only they would.

I do think you're right in that this is probably some dodgy THC solvent, but
based on current known info I think CDC called it cautiously...but right.

------
newbrict
Recommendation is to not use e cig until they finish investigating but I
wonder if a real cig is a worse alternative still?

~~~
JohnJamesRambo
It’s hard to imagine anything worse than a real cig with regard to the wide
scale negative effects it has on nearly every system in the body. Maybe
inhaling plutonium. :)

~~~
Aloha
The most harmful part about cigarettes is inhaling byproducts from something
burning. I'm even mildly allergic to pretty much every vape product, and I'd
acknowledge that provided there is nothing toxic in vape juice, it has to be
much less harmful than smoking - simply because of the lack of combustion
products.

------
todipa
I'm not a doctor but are there any theories on how one might die from vaping?

~~~
thompo
I have asthma. Even legal dispensary bought THC cartridges put my lungs in
such a bad spot that my rescue inhaler barely brings relief. If I wasn’t well
aware of that and hit one a dozen times over the course of the day I would be
in serious trouble.

------
mistermann
The way this is being reported, I feel quite confident that this is some sort
of a _deliberate_ propaganda campaign.

The two biggest red flags for me:

1) Language used in official press releases, weasel wording like:

a) "over 450 possible cases of lung illness _associated with_ the use of
e-cigarette products"

b) "The investigation has not identified any [single - my addition] _specific_
substance or e-cigarette product that is linked to all cases. _Many_ [how
many? do you have no statistics on that? why?] patients report using
e-cigarette products with liquids that contain cannabinoid products, such as
tetrahydrocannabinol (THC)".

It seems written in a manner to maximize plausible deniability, hinting at one
thing strongly [but not saying it _outright_ ], and making an _extremely_
subtle acknowledgement of alternative causes [in the spirit of professionalism
and "full disclosure"], but not reporting the magnitude of the "many", which
could very well be 100%.

That's the beauty (and shortcoming) of written language for communication -
when something is written in a _seemingly_ deceitful style like this, there's
no way for sure of knowing whether it is accidental or not. Unnecessary
vagueness from a facts based organization like the CDC and #2 (below) make me
lean strongly towards the deliberately deceitful interpretation.

2) Vaping has been _extremely_ widespread for years, with few reports like
these. And then out of the blue, 450 cases (5 deaths) occur _in one country_.
No curiosity whatsoever about why everything is fine for years and then a
massive spike in a very short period of time, in one country.

I could very well be wrong, but I will make a prediction: this will play
_heavily_ in the media for a few more weeks and then subtly degrade to a "gee,
we don't really know what the real issue was, but our research is ongoing",
and we won't hear about it again.

EDIT: From another HN comment:

\--------------------------------------------------

[https://www.health.ny.gov/press/releases/2019/2019-09-05_vap...](https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm)

New York State Department of Health Announces Update on Investigation into
Vaping-Associated Pulmonary Illnesses

Department Warns Against Use of Black Market Vaping Products

Lab Test Results Show High Levels of Vitamin E Acetate, Now Focus of
Investigation

The Department issued a health advisory in August, alerting health care
providers of this emerging health threat and listing symptoms they should look
for in patients. As of September 5, 2019, the Department has received 34
reports from New York State physicians of severe pulmonary illness among
patients ranging from 15 to 46 years of age who were using at least one
cannabis-containing vape product before they became ill. However, all patients
reported recent use of various vape products.

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

As a result, vitamin E acetate is now a key focus of the Department's
investigation of potential causes of vaping-associated pulmonary illnesses.
Vitamin E acetate is a commonly available nutritional supplement that is not
known to cause harm when ingested as a vitamin supplement or applied to the
skin. However, the Department continues to investigate its health effects when
inhaled because its oil-like properties could be associated with the observed
symptoms.

The Wadsworth Center is testing both cannabis and nicotine-containing vape
products as part of this investigation and continues testing the purity of New
York's approved medical marijuana products. More than a dozen product samples,
in some cases multiple samples from a single product, from patients reporting
symptoms have been tested. These samples have been tested for a range of
substances, including THC and other cannabis-derived cannabinoids, nicotine,
synthetic cannabinoids, opioids and pesticides. Products tested include a
variety of labels and packaging. Many are suspected to be counterfeits of
recreational cannabis-containing vape products available in other states.

\--------------------------------------------------

It's rather interesting that absolutely none of these extra details, which
have been available for quite some time now, appear in any official CDC
reports.

------
algaeontoast
Lungs were made for air, not smoke or atomized vapor (aside from drugs meant
to be administered as a vapor).

Is this really that hard for people to figure out?

~~~
washadjeffmad
> air, not ...

Relevant:
[https://simple.wikipedia.org/wiki/Air](https://simple.wikipedia.org/wiki/Air)

------
golemotron
I am not surprised at all, and I'm surprised that anyone is surprised. The
idea that one can breathe particulate or droplet matter into their lungs
without causing problems seems absurd on its face given everything we've known
about the effects of air pollution for decades. Tobacco is not special.

~~~
brokenmachine
The more I read the comments of any discussion about e-cigarettes, the more I
am convinced that there is a dedicated astroturfing campaign so any real
discussion of the possible risks of e-cigarettes is derailed.

Any suggestion that e-cigarettes could be dangerous at all is instantly
downvoted into oblivion or shouted down with, "you want me to smoke? It's
deadly!"

Well, either a dedicated campaign or just a lot of addicts with their head
firmly buried in the sand.

Is there any real chance that e-cigs could be more dangerous, or comparable to
smoking? Would we even know yet? It can take decades for smokers to start
developing bad symptoms, could vaping be similar?

~~~
golemotron
It's possible. I would go further and say that the idea that smoke and vapor
-of any kind- might not be great for your lungs is also suppressed by people
who want marijuana legalized. I'm one of them, but the idea that breathing
non-gaseous things doesn't have negative health effects is just weird.

~~~
brokenmachine
There's also edibles if people don't want to smoke or vape.

------
aclimatt
Let's fast forward a few years from now to the point where we determine that
e-cigarettes contain some sort of cancer or lung disease-causing product /
additive, just like we figured out with cigarettes decades ago.

What I don't understand is why the FDA will not outright ban them immediately.
(Well I probably do, and the answer is lobbying.)

Regardless of your stance on whether or not the FDA _should_ ban ingredients
that pose health risks (government intervention on liberties et cetera), the
fact is that this is the FDA's policy. It bans harmful ingredients (usually).

So with that policy in place, what's the deal here? If and when e-cigarettes
are found to contain a chemical that is directly linked to cancer or lung
disease, will the FDA ban it? Or will it conspicuously let it slide, and just
slap a warning on it, like it did cigarettes?

[https://www.fda.gov/cosmetics/cosmetics-laws-
regulations/pro...](https://www.fda.gov/cosmetics/cosmetics-laws-
regulations/prohibited-restricted-ingredients-cosmetics)

[https://www.fda.gov/food/food-additives-petitions/food-
addit...](https://www.fda.gov/food/food-additives-petitions/food-additive-
status-list)

~~~
jdietrich
There's no evidence that any of the ingredients of e-cigarette vapour are
significantly carcinogenic. That may well continue to be true; there is no
natural law saying that a habit you dislike must be carcinogenic.

There are many possible formulations of e-cigarette liquid, with the only
common factor being nicotine. We are extremely confident that nicotine isn't
carcinogenic, although it may cause mild cardiovascular harm. If we find out
that some of the other ingredients in e-cigarette vapour are toxic or
carcinogenic, the industry will voluntarily stop using those ingredients
immediately; they already did so with diacetyl.

~~~
sosilkj
"We are extremely confident that nicotine isn't carcinogenic"

I would not say that's the case. This article is a good place to start:

[https://tobacco.ucsf.edu/cellular-evidence-how-nicotine-
and-...](https://tobacco.ucsf.edu/cellular-evidence-how-nicotine-and-e-
cigarettes-increase-cancer-risk-humans-and-mice)

