(Elias Marat) The CDC is looking into “94 possible cases of severe lung illness associated with vaping reported in 14 states.”
(Elias Marat) The CDC is looking into “94 possible cases of severe lung illness associated with vaping reported in 14 states.”
E-cigarettes may be an effective way of helping people to quit smoking regular cigarettes, but studies show that vaping is far from safe. According to the research, people who vape are more likely to suffer heart attacks, strokes, and depression.
Using the National Health Interview Survey, researchers compared people who reported vaping to with those not reporting any e-cigarette use and found that e-cigarette users had a:
The risks were found to be significant for both regular e-cigarette users and those who only imbibe occasionally, though occasional users had slightly lower risks.
In a news release, Mohinder Vindhyal, a researcher at the University of Kansas School and the study lead author, said: 
“Until now, little has been known about cardiovascular events relative to e-cigarette use. These data are a real wake-up call and should prompt more action and awareness about the dangers of e-cigarettes.”
Those who reported vaping were more likely to complain of depression, anxiety, and emotional problems, the study found. These problems were 2.2-fold more common with e-cigarette use, and the risk was higher among vapers than among tobacco smokers. 
Vindhyal said: 
“When the risk of heart attack increases by as much as 55% among e-cigarette users compared to nonsmokers, I wouldn’t want any of my patients nor my family members to vape. When we dug deeper, we found that regardless of how frequently someone uses e-cigarettes, daily or just on some days, they are still more likely to have a heart attack or coronary artery disease.”
I suppose the main question is: did vaping lead to issues such as heart attacks, strokes, and depression in this study, or are people who experience these issues simply more likely to vape than others?
 MedPage Today
In recent months, federal health officials have increasingly warned that vaping has led to an epidemic of nicotine addiction among teens. But now the Food and Drug Administration says there may be a new worry associated with vaping: It could increase the risk of seizures in young people. 
“We have reports indicating that some people who use e-cigarettes, especially youth and young adults, are experiencing seizures following their use.”
Some 35 reports of seizures among teenage e-cigarette users have been made to the FDA since 2010. Experts aren’t sure what is causing them. Some of the seizures occurred in people who were vaping for the first time, while some were using other drugs at the time. Others may have had an underlying medical condition – even reporting that they had seizures before.
Frustratingly, many of the reports received by the FDA don’t include enough information for the agency to determine whether certain brands or ways of using the devices are to blame. 
The FDA said: 
“We can’t yet say for certain that e-cigarettes are causing these seizures. We’re sharing this early information with the public because as a public health agency, it’s our job to communicate about potential safety concerns associated with the products we regulate that are under scientific investigation by the agency.”
It is possible that teens are OD’ing on nicotine. Some e-cigarettes, such as Juul, deliver nicotine more quickly, leading kids to get more of the drug than they realize. Juul, in particular, delivers a much higher dose of nicotine than combustible cigarettes. Seizures, convulsions, vomiting, and brain injury are all associated with nicotine poisoning. Some infants and children have died as a result of swallowing liquids containing nicotine, such as those found in e-cigarettes.
There are a few things to consider with this press release if we’re to get a more accurate reading on the situation, as opposed to simply reading headlines. Here are a few quotes from the FDA report that may take away from the hard-hitting headline you may see on the internet.
“We want to be clear that we don’t yet know if there’s a direct relationship between the use of e-cigarettes and a risk of seizure. We can’t yet say for certain that e-cigarettes are causing these seizures. We’re sharing this early information with the public because as a public health agency, it’s our job to communicate about potential safety concerns associated with the products we regulate that are under scientific investigation by the agency. This also helps encourage the public to voluntarily report additional adverse events that can better inform our work.”
Further, it seems that of the relatively minimal amount of 35 reports spanning 9 years, some of these could be linked to other substance abuse and even a prior history of having seizures.
“In a few situations, e-cigarette users reported a prior history of seizure diagnosis. A few reported cases indicated that the seizures occurred in association with the use of other substances such as marijuana or amphetamines. Seizures have been reported as occurring after a few puffs or up to one day after use.”
Gottlieb and Principal Deputy Commissioner Amy Abernethy said: 
“The FDA is committed to monitoring this issue closely and taking additional steps as necessary to protect the public, especially our nation’s youth, from the dangers of e-cigarettes and other tobacco products. We will continue to provide updates as more is learned.”
The FDA is asking people to report seizures and any other unexpected health problems experienced with e-cigarettes to its Safety Reporting Portal. Just be on the look-out.
 USA Today
A new lawsuit alleges that JUUL Labs Inc. illegally underplays the dangers of its product to make it more appealing to kids.
Experts have warned in recent years that e-cigarettes are a gateway to tobacco use for teens. The problem has become so dire that the U.S. Food and Drug Administration (FDA) now says there is an “epidemic” of youth smoking. One of the most popular vaping devices among young people is JUUL, a small device that looks like a USB device, which includes a pod for liquid nicotine. 
Filed April 15, the lawsuit names Juul, it’s parent company Altria Group Inc., and Philip Morris USA Inc. as defendants. It was brought by the parents of a 15-year-old girl from Sarasota, Florida, who they say became addicted to nicotine through her JUUL use. The companies are accused in the suit of fraud and deceptive trade practices, among other things.
A lawyer for the girl’s parents said his clients filed the lawsuit as a putative class action on behalf of other children and parents facing similar circumstances. He pointed out that data from the U.S. Centers for Disease Control and Prevention (CDC) show that nearly 5 million middle and high school students were current users of a tobacco product in 2018. Much of the problem can be attributed to the popularity of JUUL among younger vapers, “creating an entirely new generation of nicotine addiction.”
JUUL e-cigarettes contain high levels of nicotine and its pods have as much nicotine as a pack of cigarettes. 
“It really is tragic. For decades the public health community worked against the powerful tobacco industry to reduce youth smoking. … That entire trend is now being reversed. … For the first time in decades, youth smoking of regular combustive cigarettes is up.” 
The lawsuit notes that Altria, which owns tobacco giant Philip Morris USA, recently purchased a 35% stake in JUUL after the e-cigarette maker vowed not to market its products to young people. But the agreement instead provides more shelf space for JUUL products and places them in predominant areas of retailers where teens can see them. 
Another lawyer for the girl’s parents said:
“JUUL has captured a broad segment of the adolescent and teenage market by applying the same techniques historically used by cigarette makers.
The companies tell regulators they are not marketing to that vulnerable age group while they simultaneously and knowingly created a massive increase in youth nicotine addiction.”
Juul Labs, makers of the highly popular Juul e-cigarettes, increased the nicotine content of their products, spurring other e-cigarette makers to do the same. This, experts say in a new report, has led to a serious vaping epidemic among teens and young adults, and a nicotine “arms race” among e-cigarette companies.
Juul e-cigarettes first hit the market in 2015. Their liquid nicotine “pods” contained 5% nicotine at the time, while similar products made by other companies only contained 1-2% nicotine concentrations. Today, some competing brands contain as much as 7% nicotine.
You may hear that a single 5% pod delivers the same amount of nicotine as a pack of cigarettes, and since many people vape more than 1 pod per day, the habit is causing nicotine addiction. Keep in mind, e-cigarettes are touted by the industry as a way to help adults quit smoking traditional cigarettes. When it comes to young people, e-cigarettes are having the opposite effect.
But it’s difficult to pinpoint exactly who should choose the various pod strengths based on one’s smoking habits. One pod may equal a pack of cigarettes in terms of how long it would last for a smoker, but based on the information available, it seems that the nicotine delivered is often much more than a pack of cigarettes. Vaping liquid has become extremely potent.
Robert Jackler, a researcher at Stanford University and study senior author, said during an interview:
“Until recently, most e-cigarette liquids carried 1 to 2 percent nicotine, with a few considered ‘super high’ at 3 percent, intended for the two-pack-a-day smoker.”
Hmmm, so is a 5% pod equal to a pack of cigarettes, or is as little as 3% equal to 2 packs a day?
From Juul’s website:
“Each 5% JUULpod is designed to contain approximately 0.7mL with 5% nicotine by weight (approx. 40 mg per pod based upon 59 mg/mL) at time of manufacture. Each 3% JUULpod is designed to contain approximately 0.7mL with 3% nicotine by weight (approx. 23 mg per pod based upon 35 mg/mL) at time of manufacture. Nicotine content may decrease over an extended period of time.”
According to various sellers of vaping products, a heavy smoker picking up vaping might want to start (though shouldn’t) with a strength of 24 mg/ml, while ‘normal’ smokers or those wanting to wean themselves off may begin with 14-18 mg/ml pods. Again, a 5% JUULpod contains 59 mg/ml.
Here is an image showing what I’m talking about. Note that it is from another e-cigarette seller.
On an equally-disturbing side note, a survey released earlier this year found that a whopping 63% of actual Juul users didn’t know that every Juul pod contains nicotine.
Dr. Frank T. Leone, director of the Comprehensive Smoking Treatment Program at Penn Medicine, explained that the nicotine found in Juul pods gets delivered to the brain very rapidly because of the method the company uses to increase nicotine concentrations. Leone did not participate in the study.
Juul used a patented “nicotine salt” – a mixture of nicotine and an organic acid – which masks the naturally unpleasant taste of nicotine.
Due to the wide variation of pods, nicotine liquids, and tank systems, it has been “almost impossible to put any regulatory guardrails around these products,” Leone said.
The U.S. Food and Drug Administration (FDA) currently does not require e-cigarettes go through pre-market approval before reaching store shelves. In 2017, the agency decided that vape products that were on the market prior to August 2016 could remain on store shelves through 2022 without any pre-market review. Health advocates are calling for more regulation, sooner rather than later.
Juul asserts that high-nicotine e-cigarette products existed on the market “prior to the rise and of the popularity of the Juul device.” However, Jackler pointed out that most e-cigarette products contained less nicotine. Therefore, it was the popularity of Juul that led to a widespread spike in nicotine concentrations throughout the industry.
“When Juul came out with very high-nicotine electronic cigarettes, it triggered a nicotine arms race amongst competitive companies seeking to emulate the success of Juul.”
There are 39 Juul knock-off e-cigarette devices that offer equal or higher amounts of nicotine than Juul. Worse, Jackler said many of them mislabel the amount of nicotine contained in the product. 
And because nicotine “juice” can be purchased in bottles, e-cig users can purchase high-nicotine liquids cheaper than they could purchase individual Juul nicotine pods. 
Adults and kids alike can become increasingly addicted, for less.
“The rush to higher and higher nicotine concentration has reduced the cost of nicotine addiction.”
Despite the deluge of warnings over the addictive nature of Juul and copycat products, sales of Juul skyrocketed 641% from 2017 to 2018. 
According to Jackler, e-cigarettes are not only a gateway to traditional cigarettes, but they may also be a gateway to harder drugs.
“For a teen, becoming nicotine-addicted greatly increases the likelihood that they will graduate to traditional, combustible cigarettes. Importantly, nicotine addiction during adolescence increases the vulnerability to subsequent addictions, like opioids or cocaine. For most users of illicit drugs, their initial addiction was to cocaine.”
The report is published in the journal Tobacco Control.
In the past year, it has become increasingly-evident that there is a vaping epidemic among the nation’s youth. Though it’s unknown how much of a ‘gateway’ vaping may be to regular tobacco use among teens and young adults, it’s certainly true that many more kids who wouldn’t smoke at all are trying e-cigarettes. To tackle the problem, the U.S. Food and Drug Administration (FDA) is threatening to remove e-cigarette products from the market.
Why not regular tobacco cigarettes? Let’s be honest – there’s too much money wrapped up in the tobacco industry to do that.
FDA Commissioner Scott Gottlieb said in mid-January that e-cigarette makers face an “existential threat” if they don’t take strict action to prevent youth vaping.
“I still believe e-cigs offer an opportunity for currently addicted adult smokers to transition off cigarettes and onto products that may not have the same level of risks. But if youth use continues to rise, the entire category faces an existential threat.
I believe if every currently addicted adult smoker switched completely to e-cigs it would provide a tremendous public health gain. But that opportunity is in significant risk if kids’ use continues to rise.”
The rise in youth vaping is indeed shocking. From 2017 to 2018, there was a 78% increase in current e-cigarette use among high school students and a 48% increase among middle school students, the 2018 National Youth Tobacco Survey shows.
With e-cigarette use skyrocketing among teens and pre-teens, Gottlieb said he is ready to yank all vape products from store shelves if e-cigarette makers don’t take the problem seriously and make strides toward tackling the issue.
“[I]f the epidemic continues to mount, I’m sure that the debate will change to one of whether these products should continue to be marketed at all without authorized pre-market tobacco applications.
It could be ‘game over’ for some of these products until they can successfully traverse the regulatory process. I think the stakes are that high. And would be a blow for all of the currently addicted adult smokers who, I believe, could potentially benefit from these products.”
Groups such as the Campaign for Tobacco-Free Kids, the American Heart Association, and the American Cancer Society Cancer Action Network would love to see e-cigarette products go through the formal FDA approval process, and have lamented the fact that the products have made it onto store shelves without it. 
But now the FDA isn’t playing around. In September 2018, the agency gave e-cigarette manufacturers 2 months to come up with a plan to prevent the sale of their products to young people. Failure to do so, the FDA warned, could result in the agency requiring companies to change their sales and marketing practices, stop distributing products to retailers who sell to kids, and remove flavored e-cigarette and nicotine products from the market. The warning was aimed particularly at Juul, a popular USB drive-like vaping device which dominates the e-cigarette market and is especially popular among kids.
Then, in October 2018, the FDA raided the office of Juul and confiscated thousands of documents as part of an investigation into whether the company was deliberately targeting minors in its sales and marketing practices.
Later that month, Marlboro maker Altria said that it would pull its pod-based e-cigarettes from store shelves. And in November, Juul promised to pull some of its flavored pods from retail stores, shut down all of its social media accounts, and introduce stricter age-verification tools on its website.
But that appeared to be a ruse to buy time, as Juul and Altria announced earlier this month that Altria had agreed to purchase a 35% stake in Juul, and Altria had agreed to give Juul access to shelf space in 230,000 retail outlets where Marlboro cigarettes and other Altria products are sold.
Gottlieb is skeptical that e-cigarette companies take the youth vaping epidemic seriously.
“I have questions about whether they are living up to the very modest promises that they made. It matters if the e-cig makers can’t honor even modest, voluntary commitments that they made to the FDA.” 
Dr. Bonnie Halpern-Felsher, who studies youth e-cigarette use at Stanford Children’s Health, says the FDA isn’t doing itself or young people any favors by consistently pointing out that vape products are safer than combustible cigarettes.
“We need to stop saying that e-cigarettes are safe or safer and prevent e-cigarette companies from making these unauthorized risk claims. Youth hear them. We need to stop saying that e-cigarettes help adults stop smoking when there is not enough clear evidence that this is the case.
That is giving them the idea that they are therefore safe and okay to use.”
 Consumer Affairs
 NBC News
Juul and Altria, both makers of e-cigarettes and vape products, are in trouble with the U.S. Food and Drug Administration (FDA) again, this time for reneging on a promise the companies made to the government to help curb the epidemic of youth vaping.
FDA Commissioner Scott Gottlieb said he is drafting letters to both companies that will criticize them for publicly vowing to remove flavored liquid nicotine pods from store shelves, while quietly working on a financial partnership that will, in fact, place even more nicotine pods on shelves.
Top executives from Juul and Altria will eventually be confronted in person at FDA headquarters, where Gottlieb said they will have to explain to agency officials how they plan to keep their promise in light of the new agreement.
On December 19, 2018, Altria, the nation’s largest traditional cigarette producer and the maker of Marlboro tobacco cigarettes, agreed to purchase a 35% stake in Juul, the rapidly-growing e-cigarette maker that has exploded in popularity among teens. Juul currently dominates more than 70% of the e-cigarette market. The deal is worth about $13 billion.
When e-cigarettes first hit the market, the products were touted as effective smoking-cessation tools. But vaping became highly attractive to teenagers and young adults in large part due to the flavored nicotine pods used in the devices. Juul, in particular, is a favorite among younger people.
Vaping has helped many people quit smoking, but a number of studies in recent years show that vaping may be creating a new generation of nicotine addicts. In fact, research indicates that a large percentage of teenagers who start vaping eventually graduate to traditional – and more dangerous – tobacco cigarettes.
Altria and Juul acknowledged this link and vowed to do their best to curb kids’ access to their products.
“Juul and Altria made very specific assertions in their letters and statements to the FDA about the drivers of the youth epidemic. Their recent actions and statements appear to be inconsistent with those commitments.”
Back in October, Altria agreed to stop selling pod-based e-cigarettes until the FDA gave the company permission to start up again, or until the youth problem was otherwise addressed. In a letter to the agency, Howard A. Willard III, Altria’s chief executive, agreed that pod-based vaping products significantly contribute to the rise in youth vaping. It also said at the time that it would support federal legislation to increase the legal age to purchase any tobacco or vaping product to 21.
But the new deal between Juul and Altria will give Juul access to shelf space in 230,000 retail outlets where Marlboro cigarettes and other Altria tobacco products are sold. (Juul products are currently sold in 90,000 stores.) The FDA could ask Altria to restrict sales of flavored nicotine pods on its shelf space, but it is unlikely the company will comply with that request.
In September, the FDA warned Altria, Juul and 3 other e-cigarette companies that they had 2 months to figure out how they would prove to the agency that they’d taken steps to prevent the sale of their products to young people. At the time, Gottlieb threatened that failure to do so would result in the companies’ products being pulled from store shelves and worse.
Shortly after the announcement, Altria, Juul, and the other companies laid out to the FDA detailed plans for how they would comply with the agency’s requirements. But if there is one thing the tobacco industry has taught us, it’s that money is more important than human health.
“I’m reaching out to both companies to ask them to come in and explain to me why they seem to be deviating from the representation that they already made to the agency about steps they are taking to restrict their products in a way that will decrease access to kids.”
The deal between Juul and Altria increased Juul’s value to about $38 billion, but even the company’s own employees argued that the deal contradicted Juul’s mission statement. 
If you vape, then you may have heard that e-cigarettes are safer than tobacco cigarettes. There might be some truth to that, but as a study shows, most e-cigarette users don’t really know what they’re inhaling, even if they take the time to look at the ingredients on the label. 
Study author Sven Jordt, an associate professor of anesthesiology, pharmacology and cancer biology at the Duke University School of Medicine, said:
“Flavor chemicals and the solvents, the liquids, that are in electronic cigarettes, they are forming new chemical compounds.”
These chemicals can become irritants that agitate your airways, the study shows.
“The new chemicals we identified in e-cigarettes activate these nerve endings more strongly. Especially when activated over a longer period, as in smokers, and potentially e-cigarette users, these mechanisms have been shown to cause inflammation and asthma and contribute to emphysema.”
E-cigarettes work by heating liquid called “e-juice” or “e-liquid,” which contains flavorings, propylene glycol, glycerine, and often nicotine until it vaporizes.
Researchers analyzed the chemical composition of 10 e-liquids, with 2 flavors and 5 different propylene glycol ratios for each flavor. A propylene glycol ratio refers to the amount of solvent found in e-liquid. The vape juices were purchased from an online store.
Specifically, Jordt and his colleagues analyzed vanilla (vanillin and ethylvanillin), cherry (benzaldehyde), and cinnamon (cinnamaldehyde).
The team also created and analyzed their own e-juice that included the flavors (aldehydes) and solvents commonly used in the e-cigarette industry.
The research shows that 40% of the flavored aldehydes became new compounds called aldehyde PG (propylene glycol) acetals when heated.
When the scientists vaporized the liquids they had created, 50%-80% of the acetals were carried over, which means that a significant amount of aldehyde PG acetal reaches the airways when the liquids are vaped.
These substances can stick around in the body for quite some time as they are stable in both water and other physiological solutions. It’s not clear what long-term effects they might have on health, according to Jordt.
And since these compounds are only created through heating, they are not listed on e-liquid ingredient labels. E-cigarette users think they know what they’re being exposed to because e-cigarette companies claim to use well-known chemicals, nicotine, and solvents, and that they remain stable when they are mixed together. The study shows that is not the case.
Ilona Jaspers, professor in pediatrics, microbiology, immunology, and environmental science and engineering at the University of North Carolina at Chapel Hill, said that many scientists suspected that the e-cigarette manufacturers’ claims were not true.
“These are very reactive chemicals, and it would be naive to think that they would stay in isolation and not react and cause secondary and tertiary products once they are put in the mixture.
One of the big items to take away from this here is that we have to look at this e-liquids as a dynamic mixture potentially, a chemical mixture that is not necessarily stagnant and may change over time.”
The U.S. Food and Drug Administration (FDA) is currently considering regulating flavored e-liquids, citing 2 main concerns: 
Jordt pointed out that if the chemicals created by vaporized e-liquid were severely irritating, you would see people giving up vaping en masse. The real concern is that chronic, low-level stimulation of the airways’ irritation receptors could lead to some sort of more serious lung damage in e-cigarette users.
“If they are more continuously activated they can lead to inflammation, chronic cough, they also promote asthma. That’s why we are concerned.”
The study is published in the journal Nicotine & Tobacco Research.
 The Verge
E-cigarette maker Juul Labs received a surprise inspection from the U.S. Food and Drug Administration (FDA) on September 28, with the agency walking out with more than 1,000 documents. 
The move is part of an effort by the FDA to pressure Juul, whose products are highly popular among teenagers, to do more to keep e-cigarette products out of the hands of young people. Juul controls 72% of the e-cigarette market in the United States, and the FDA said October 2 that it was investigating whether the company was deliberately targeting minors in its sales and marketing practices.
In a statement, the FDA said:
“The new and highly disturbing data we have on youth use demonstrates plainly that e-cigarettes are creating an epidemic of regular nicotine use among teens. It is vital that we take action to understand and address the particular appeal of, and ease of access to, these products among kids.”
The surprise inspection follows an April request made by the FDA for Juul’s marketing and research data. The company had already coughed up upwards of 50,000 pages of internal documents to the agency in response to that request, according to Kevin Burns, the company’s chief executive officer.
“We want to be part of the solution in preventing underage use, and we believe it will take industry and regulators working together to restrict youth access.”
FDA Commissioner Scott Gottlieb said there is growing concern among the agency over the skyrocketing use of e-cigarettes in high schools and even middle schools, saying the problem had reached “epidemic proportions.”
The use of e-cigarettes among high-schoolers in the last 30 days has catapulted by roughly 75% since last year to about 3 million, preliminary unpublished data released by the FDA show. E-cigarette products are especially tempting for young people because of the many candy-like flavors available, a problem that Gottlieb has repeatedly decried.
Another reason for Juul’s popularity among teenagers is the device’s USB flash drive-like design. The devices are easy to hide and it’s easy to fool teachers and administrators, who often assume it is a real USB drive used for schoolwork. 
Or it was easy to fool them until their popularity skyrocketed.
The FDA’s concern is compounded by evidence that vaping can lead to other harmful behaviors. A study published in January suggests that e-cigarettes are the “gateway” to smoking cigarettes for teens. Researchers found that teenagers who start vaping are 2-1/2 times more likely to become regular smokers within a year. 
That study is supported by a RAND Corporation study of 2,039 Californians ages 16 to 20 beginning in 2015 through 2017, released October 2. The findings show that as teenagers who used e-cigarettes aged, many moved onto traditional tobacco cigarettes. By the end of the study period, more than half of e-cigarette users were also smoking cigarettes. 
The gateway theory is all well and dandy, but it can easily be argued against. I’d say we’re simply in a similar situation as when cigarettes were popularized, where social pressures and image are at the core of the growing popularity.
Then, there’s this: A report published in JAMA by the U.S. Centers for Disease Control and Prevention (CDC) on October 2 reveals that Juul Lab’s sales jumped from 2.2 million devices in 2016 to 16.2 million devices last year. The data only encompassed sales originating from retail stores. With the prevalence of online sales, it’s likely that number is significantly higher.
E-cigarettes are touted as being safer than cigarettes, which is true – to a point. While they lack the carcinogens created by burning tobacco, they contain high levels of extremely addictive nicotine, particularly Juul, which can have negative effects on the developing brain. There is also a cocktail of chemicals in vaping juice, though again, not as much as cigarettes.
In September, the FDA gave Juul and 4 other e-cigarette manufacturers 2 months to find a way to prove to the agency that they had taken steps to prevent the sale of their products to young people. Gottlieb warned that companies that failed to do so could be required to:
Juul recently launched its own multimillion-dollar campaign of posters for high school bathrooms and public service announcements on popular websites to warn teens of the dangers of e-cigarette use.
The FDA said: 
“We are committed to taking all necessary actions, such as inspections and advancing new policies, to prevent a new generation of kids from becoming addicted to tobacco products.”
 USA Today