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Ben there, done that

What's the big deal with vaping?

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The electronic cigarette or vape industry has recently come under fire with the United States Food and Drug Administration, and many states are passing sweeping bans and other sanctions. A study of 11,000 people conducted by the National Cancer Institute’s Health Information survey found that positive public opinion of vaping has sharply declined. The information creates a few questions: are we witnessing the death of an industry or an outburst of public hysteria?

We first need to understand how the problem developed. In the last two decades, the vaping industry has rapidly gone mainstream. Companies like Blu and Juul have taken the world by storm by promising a safe alternative to traditional tobacco products. According to the British Broadcasting Corporation, the number of adult smokers using vapes has exploded from roughly seven million in 2011 to more than 41 million as of 2018. 

As tetrahydrocannabinol (THC) became legal in parts of the United States, it was quickly adapted for use in vaping cartridges, further fanning the flames of vape popularity; however, as is so often the case, research concerning the long-term effects of vaping lagged behind the explosive market growth. Many of the chemicals used in vaping solutions were considered generally safe but were relatively untested when it came to prolonged vaporized inhalation. 

When Juul arrived on the scene in 2015, the company began an aggressive marketing campaign around flavored vape cartridges. The company eventually came under scrutiny because its ads were attracting underage kids. Juul attracted so many youngsters that the companies name started to be used as a verb for vaping. 

In 2019 the Centers for Disease Control found that almost 30 percent of high schoolers were regularly using some form of vaping product, so the FDA stepped in. They pressured Juul to impose age restrictions for the purchase of flavored cartridges and to change advertising to target only adult smokers. These measures were somewhat effective, but there were still large numbers of young people using the products.

The fight between Juul and the FDA seemed to create a negative opinion about the product for some consumers. Before this year, there was no major evidence to connect vaping with any long-term health issues. Earlier this year, news broke that six young adults and teens in the United States died from a massive fluid build-up in their lungs. What was the common thread between them? All of them were avid vape users. This alarming turn-of-events sparked an investigation by the media. 

As of Oct. 24, the CDC reported 1,604 lung injury cases associated with the use of e-cigarette, or vaping, products from 49 states, the District of Columbia and one U.S. territory. The CDC also reported a total of 34 deaths in 24 states last week. The patients all exhibited shockingly similar symptoms even though they used a wide spectrum of vaping products, including cartridges with THC and nicotine.

The Washington Post followed the stories of 53 of the cases. They were mostly male with a median age of 19. Typically, the first symptoms to hit a patient were heavy coughing and trouble breathing, which would progress rapidly until the patient was brought to a hospital. Other symptoms included nausea, weight loss, fatigue and fever. 

At the hospital, most of the patients were immediately taken into the intensive care unit. More than a third of the cases were so severe that they had to be placed on a ventilator to keep them breathing. The majority of patients were diagnosed with Acute Respiratory Distress Syndrome, which is a major build-up of fluid in the lungs that prevents oxygen from reaching the bloodstream. ARDS is extremely rare in healthy individuals, occurring mostly in patients who are terminally ill or severely injured – not healthy young people. To make matters worse, ARDS is extremely dangerous and progresses quickly if not treated and often leads to death.

The scary part of all this is that the experts don’t know exactly what in the vaping solution is causing this to happen. Most officials agree that it isn’t the nicotine or THC but some other chemical or chemicals in the liquid that gets vaporized. 

According to Dr. Melodi Prizada, the chief of pediatric pulmonology at NYU Winthrop Hospital, a potential culprit could be the inhaling oils; specifically, the effects of vitamin e acetate on the alveoli. The alveoli are the part of the lungs that put oxygen into the bloodstream. The inhalation of vitamin e has the potential to interfere with the lining surrounding the alveoli, called pulmonary surfactant, and this could potentially lead to lung injury or ARDS; however, vitamin e acetate is only one of the dozens of other chemicals present in vaping products and is likely not the only guilty party.

All of these recent events have led the CDC to recommend that people stop vaping immediately until further research can be conducted and the culprit chemical or chemicals isolated. With such a high percentage of high schoolers using these products, there is increased concern that the number of incidents could increase rapidly leading to a national health crisis.

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