
A person has died from a vaping-related condition - amanzi
https://techcrunch.com/2019/08/23/vape-lung-has-claimed-its-first-victim-and-the-cdc-is-investigating/
======
singingfish
I'm guessing that if this really is associated with vaping then it's likely
due to the limited regulation of the ingredients. Bad batch of VG/PG/nicotine?
Some problematic flavouring?

I think the best article I've found is at the BMJ:
[https://www.bmj.com/content/366/bmj.l5228](https://www.bmj.com/content/366/bmj.l5228)
\- sorry, paywall. Very much inconslusive at the moment completely in the
public health triage stage.

Good idea to regulate it properly. I just stopped vaping after a 20 year
intermittent tobacco problem + 5 years of vaping[1]. Stopping vaping is
massively easier than giving up cigarettes in my experience.

[1] for almost that entire time I just went unflavoured. Less hassle and less
potential for contaminants.

~~~
imafish
Similar story here. Smoked for ten years. Actually found it easy to replace
smoking with vaping (strong menthol). Stopped vaping after 1 year because I
was suffering from GERD and suspected that vaping was an attributing factor.
Since I stopped 5 years ago, my GERD symptoms have more or less disappeared.

I really enjoyed vaping, probably more than smoking, but somehow it did not
seem to have the same addictive effect on me as smoking had. I did not find it
that hard to stop cold turkey.

~~~
singingfish
I stuck with it for 5 years because I was paranoid about relapse to
cigarettes. Spent a couple of weeks in countries where vaping is illegal as a
dry run, earlier this year, and then just waited for the juice to run out.

The addictive effect of nicotine seems much enhanced by the addition of a
monoamine oxidase compound (ie related to the early antidepressant drugs) -
which is present in burning tobacco - which seems to take nicotine from
approximately as addictive as caffeine to more addictive than heroin (citation
available).

~~~
exabrial
Not trying to call you out, but would you mind sharing? That coincides
generally with what I've read.

~~~
singingfish
there's references elsewhere on this thread.

------
beardedman
So I've been saying something like this for years now. HOW do we know
something is not going wrong without any long term/clinical data (ESPECIALLY
around these custom flavours that people sometimes roll out themselves)?

I think it's completely presumptuous when people tout vaping as being much
safer than cigarettes. We didn't all wake up one day knowing smoking was bad -
it was a long road filled with politics, science and data.

Vaping is in its infancy and already people's mantras sound like old Camel
commercials.

~~~
szbalint
We have to weight a complex set of circumstances:

\- smoking is an exceptionally harmful habit, so just by coming up with any
other activity at random one is likely to end up healthier

\- this also means advising smokers to switch to vaping even without knowing
the health effects of vaping makes sense \- marketing vaping to non-smokers
should be severely limited though

\- marketing vaping to kids like juul does, should be downright illegal

~~~
leetcrew
> marketing vaping to kids like juul does

do/did they actually do this? I did a quick Google search and I can find a lot
of articles making this claim but the only evidence given is that they have
twenty-somethings and bright colors in their ads. if this is "marketing to
kids", then that bar seems awfully low.

~~~
roywiggins
> Last summer, with public concern about teenage vaping growing, Juul Labs
> paid a charter school organization in Baltimore $134,000 to set up a five-
> week summer camp to teach children healthy lifestyles.

> The curriculum was created by Juul — maker of the very vaping devices that
> were causing the most alarm among parents, health experts and public
> officials.

> In April 2017, a Juul representative visited the Dwight School in New York
> City to meet with students — with no teachers present — and told them the
> company’s e-cigarettes were “totally safe.”

[https://www.nytimes.com/2019/07/25/health/juul-teens-
vaping....](https://www.nytimes.com/2019/07/25/health/juul-teens-vaping.html)

~~~
leetcrew
>> In April 2017, a Juul representative visited the Dwight School in New York
City to meet with students — with no teachers present — and told them the
company’s e-cigarettes were “totally safe.”

this one is pretty damning, but it's only one occurrence. I doubt NYT would
have held back if they had any more such anecdotes to offer.

as for the rest of the article, the education programs seem a bit sketchy, but
they could just as easily be a poorly conceived PR campaign.

~~~
DanBC
> but they could just as easily be a poorly conceived PR campaign.

We have decades of experience with terrible tobacco and alcohol companies and
that's pretty persuasive that Juul knew what they were doing and didn't care.

------
buildzr
> As the mechanism is unknown, it’s unclear what the actual danger is. Is it
> some byproduct of the nicotine cartidges, or THC ones? Is it the vapor
> itself? Is it only at certain temperatures or concentrations? Is it directly
> affecting the lungs or entering the bloodstream? No one knows yet — all
> they’ve seen is an sudden uptick in respiratory or pulmonary issues where
> the sufferer also uses vaping products.

We've seen a few studies suggesting certain flavoring agents may cause
significant problems, has this been investigated as a possible cause?

~~~
floatingatoll
Another vector of harm to consider —

Keep in mind that “vapor” is used to disguise that, in all cases whether
nicotine or pot or etc, people are heating up a substance to its smoke point
and inhaling that smoke. They use “vapor” because it sounds like “water vapor”
- which is harmless - but it’s definitely not that.

Marijuana cartridges use marijuana oil or MCT oil as a base, for example.
Nicotine uses glycol or other substances.

We have very little data on consuming glycol and/or MCT oil smoke. It’s
possible that it clogs up the lungs in a way that takes hours to heal _per
inhalation_ , and so we’re simply seeing smoke inhalation deaths as we would
from an oil factory burning for weeks or something.

(We have limited data on marijuana extract smoke - cold-processed oil is a
new-ish innovation, compared to resin which is high in impurities and not easy
to consume in significant quantities like marijuana oil apparently is.)

~~~
okcando
> Keep in mind that “vapor” is used to disguise that, in all cases whether
> nicotine or pot or etc, people are heating up a substance to its smoke point
> and inhaling that smoke. They use “vapor” because it sounds like “water
> vapor” - which is harmless - but it’s definitely not that.

This is not true. It's producing an aerosol, partially by condensation of
vapor produced by heating the glycerine and propylene glycol mixture to its
boiling point.

It isn't combusting, at least not when everything is working the way that it
should, and so is not properly a "smoke".

~~~
mirekrusin
There are also “coils” that vibrate to create vapour which happens at room
temperature.

~~~
justaj
This is interesting. Do you know what this technology is called?

I also wonder whether it's more efficient in terms of battery use.

~~~
jdietrich
_> Do you know what this technology is called?_

Ultrasonic atomization. It's used widely in manufacturing for applying thin-
film coatings, because it provides a very consistent and controllable spray of
very fine droplets. The technology has been applied to vaping by Usonicig, but
it's not hugely popular - most people prefer warm vapour.

------
magoon
“Vaping” can often mean people filling mod boxes (not Juuls) with any sort of
juice containing anything. Articles and studies often include any random juice
in any random shop, so there are endless unknowns.

Juuls and many other pens contain limited ingredients, namely nicotine and
propylene glycol. We already know what nicotine does.

Propylene glycol is food safe and is also used in albuterol asthma inhalers.

~~~
dazzawazza
Vaping fumes trigger my asthma, there is all sorts of stuff in the second hand
smoke. The smoking ban in the UK basically stopped me being admitted to
hospital every few years and I appreciate that most bars/clubs have banned
vaping inside (certainly in London).

~~~
EpicEng
I vape and I'm with you in that we cannot just assume it's benign. You do have
to be careful of some studies which have shown things like Formaldehyde though
as the conditions (far too hot, burning cotton, etc.) we just wrong.

That said, would excessive water vapor trigger an attack? Water based fog
machines have been known to[1], but are harmless for most people. The
flavorings can add all sorts of bad crap though.

[1]: [https://acaai.org/resources/connect/ask-allergist/fog-
machin...](https://acaai.org/resources/connect/ask-allergist/fog-machines-and-
asthma)

~~~
dazzawazza
I don't really know about fog machines. I've certainly had asthma in an
environment with fog machines but people were also smoking and that's a
definite trigger.

I was on a train a few years ago and had a very weird rapid-onset asthma
attack while sitting down. I could feel something weird in the air and taste
something very bitter. I looked around and someone was vaping behind me.
You're not allowed to vape on UK trains so I guess they turned the "smoke"
down? There was no visible cloud. Could easily be a coincidence but the lack
of regulation for the "carrier" chemicals is a bit worrying.

------
Alex3917
Meh. Even if they kill 100,000 Americans per year, that would probably be one
of the greatest public health wins in history.

~~~
sk5t
And suppose it's 1 million lives per year after a 10-year ramp-up period?

~~~
dmix
Just like smoking it's important that those 10yrs have context around the
deaths, assuming they ramp up, it's not just all vape usage = high risk. It's
how you use it too.

I personally quit smoking cigarettes and moved from 24mg->3mg of nicotine over
a few months (with zero withdrawl symptoms). 3mg is about as low as you can
go. You can't do that with smoking cigarettes, "light" cigarettes is mostly
just a flavour profile with only small differences in health and nicotine
levels.

With cigarettes there were plenty of people who smoked a pack or two a day,
those people on a 20yr span are at a higher risk. You see some people who
smoke these massive vape clouds and they smoke constantly with high nicotine
counts + high heat. Those are all voluntary options and the devices/juice is
getting better with time.

Currently nicotine salts are taking over in vape shops, which are smaller
devices, smaller amounts of liquid but higher nicotine-liquid ratios, and they
have a much smaller exhale clouds which I find easier on the chest and way
less anti-social when outside (the exhaled cloud is 10-50% of the size of a
normal cigarette, and way smaller than traditional vapes).

Finally, there's second-hand smoke. There was a study showing vape smoke
creates extremely small or non-existent second-hand transmission compared to
cigarettes. Cigarette smoke stays in the air in a inhale-able state far
longer.

> According to Drexel University toxicology expert Igor Burstyn, while the
> contents of e-cig vapor inhaled by users “justifies surveillance,” there is
> so little contamination in exhaled vapor that there is unlikely to be any
> risk.

[https://bmcpublichealth.biomedcentral.com/articles/10.1186/1...](https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-18)

^ This is a big deal for anyone who grew up with a parent who smoked around
them like I did.

~~~
macintux
It’s hard to get enthusiastic about something deadly and noxious just because
it’s less noxious than something truly awful.

Walking behind someone who was vaping recently is one of the least pleasant
experiences I’ve had for a while.

~~~
dmix
A whole lot of society and social policy is about lesser of evils. It's about
being realistic and practical. Which is something far more policy should be
conscious of, instead of some idealistic perfect world you wish to impose on
other people.

Not to mention people could just as quickly harm themselves going to a 7/11
every day to eat carbs or driving a motorcycle or drinking alcohol or engaging
in 'extreme' sports. But we people do those things anyway even though there's
plenty of science to show it's dumb.

Especially if those 'evils' are a) entirely non-violent and voluntary only
affecting the individual and b) are not going away ala drugs and the giant
shift towards harm reduction.

People seem to be mixing up the growing pains of a extremely fast-growing new
industry and the long-term realities once the legal, health, business, and
administrative systems mature and adapt. The rush to immediately ban
everything, well before we fully understand it and/or have experimented with
less freedom/fun-destroying strategies, while also accurate measures of usage
and risk, doesn't help anyone.

I will admit though, the 'think of the kids' people are making quite an
effective stir.

~~~
RhysU
> Not to mention people could just as quickly harm themselves going to a 7/11
> every day to eat carbs or driving a motorcycle or drinking alcohol or
> engaging in 'extreme' sports.

Motorcycling feels odd in that list of otherwise self-inflicted harms.

Sure, one can run into brick wall in a solo accident. But, often it's someone
else that kills the motorcyclist.

~~~
nucleardog
Technicality. You're still putting yourself into a situation that's known to
have a high likelihood of resulting in your serious injury or death.

You're talking like if you were to run across a live gun range and get shot
it's not really your fault, but instead it was the shooter that killed you.

That may be technically true but you knew the risks were basically a certainty
and chose to do it anyway.

------
rhacker
I don't smoke or vape. I think the world is way better off vaping than
smoking. I certainly do hope whatever caused this is discovered. I would hate
to see more cigarettes light up again.

I'm guessing (and hoping) that more regulation will come down on the vaping
industry to make sure whatever oils or additives are controlled so that we can
prevent this from happening with future additives they discover.

------
stjohnswarts
It's waaaaaaaayyyyy early to blame this on "vape lung". Always be skeptical of
people who have an agenda to eliminate something.

~~~
james_s_tayler
Radium. Cigarettes. Asbestos.

We've seen it plenty of times when a product comes out and people with an
agenda to make money off it say "buy this, it works" and then decades later it
is discovered to have been toxic or harmful in some way.

Especially given the nature of this product, skepticism should be the default
position.

~~~
Clubber
Remember when the news constantly threw out countless articles about cell
phones causing brain cancer? Remember, fear sells ads, so we should also be
very skeptical of articles like these.

~~~
james_s_tayler
Because skepticism turns out to sometimes be unwarranted we should be
skeptical of skepticism?

You can't have it both ways.

~~~
finnthehuman
Parent poster is talking about fearmongering. Fearmongering isn't skepticism.

------
gumby
I’d worry about the excipients (e.g. PGA). Several molecular weights are
deemed GRAS (“Generally Recognized As Safe”) thus their use is unregulated (of
course as bulk polymers, “molecular weight” is really just the fat part of the
distribution).

The problem is at point of use: the vehicle is vaporized by a simple heated
nichrome wire. This fractionates and agglomerates the polymers resulting in a
completely different distribution of polymer weights. The results of which
aren’t being analyzed.

------
SolaceQuantum
I’m less interested in speculation and more interested in the CDCs claims once
it’s investigation has been concluded. Please do note that the claim
specifically posits _there exists a cluster of illnesses associated with
vaping_ and that one person has died from it- not that only one person had
ever had this disease. This makes it interesting. I hope the cause can be
founds soon, given The popularity of vaping in teens.

------
innovateee
“We do know that e-cigarettes do not emit a harmless aerosol,” he explained.
“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, it’s
been related to severe respiratory illness.”

"People often assume that these e-liquids are a final product once they are
mixed. But the reactions create new molecules"

------
snarfy
I smoked cigarettes for about 25 years and switched to vaping about 5 years
ago. My anecdata is it's the flavorings which are most harmful. I had a pretty
consistent cough from cigarettes which got a little better after switching to
vapes, but it really depended on the flavor. Some flavors were much more harsh
and the cough would return. It didn't go away until I switched to completely
unflavored juice.

------
Zenst
However you look at this the take away from it all should be: Get a vape and
liquid from a large reputable supplier (keep receipts) and should we suddenly
find that this is the next product to have warning and danger signs slapped
all over due to health concerns, you have a large reputable supplier you can
sue, ala the original tobacco scandals.

~~~
jimhefferon
I perceive that this is the take-away: don't, just don't.

~~~
Zenst
Indeed, a qualifier of "If you are going too..." was a given, but yes, the
don't do it holds.

------
apta
How about putting a ban on smoking of all sorts? Seems pretty straightforward.

~~~
stallmanite
Awesome, can’t wait to replicate the resounding successes of alcohol and drug
prohibition. Alcohol usage dropped to zero throughout the 1920s and there were
no unintended consequences right?

~~~
apta
Strawman fallacy. Just ban smoking outdoors (like how it's banned indoors in
public places).

------
mikevm
Is vaping using things like DynaVap safer than other types of vaporizers?

~~~
colechristensen
Likely nobody can say with any amount of certainty.

There are vaporizers and liquids to treat very cautiously. Many materials you
could make a vaporizer and especially the heating assembly would include
hazardous offgassing.

Likewise you would want to be very careful about knowing the source and
content of liquids. They are essentially unregulated.

Strangers on the internet selling you ingest to make a small amount of money
are not particularly trustworthy.

~~~
jowsie
The DynaVap is a dry herb vaporiser. No liquids involved. As such, I'd assume
it's as safe as whatever you put in it.

~~~
colechristensen
The materials it is made of will still vaporize themselves a bit and what they
are and how it is constructed still can have health impacts. Not that they
will or won't, but that they could and it's hard to trust anyone.

------
javadocmd
Worth noting that the author makes a significant claim without any citation:

> That vaping works as a way to quit smoking... seems clear.

Studies have been fairly limited so far, given the recency of e-cigarettes
(relative to science's timescale). And the studies that we have seem pretty
mixed: some showing benefit over other accepted smoking cessation methods,
some not. Some showing higher relapse rates in the e-cigarette group. Nothing
about that seems clear to me.

