by Shane Eubank August 27, 2019
I opened up Twitter this morning, as I often do at the start of my day. It’s a habit that I’m not entirely sure is conducive to good mental health but until I determine a faster way to scan the headlines, it’s one I’m stuck with. Along with the major world headlines following the G7 wrap-up, there were the posts that I expected with respect to the recent spate of serious respiratory illnesses in the United States. And, predictably, they could be divided up into two major camps: on the one hand, the groups linking lung disease to “vaping” (used as a broad term, intentionally vague) and those who (rightly) see vaping as a delivery system and the substance involved of greater concern.
Those who choose to highlight the delivery system are using the opportunity to lobby for further restrictions and/or bans on vaping or it’s associated products, or to spread the false narrative that there are no restrictions on vaping and conflating the health scare with teen uptake of e-cigarettes. These include groups like PAVE (Parents Against Vaping) who have finally toned down their message to “possible vaping-linked illnesses” but in the same statement name a specific company which has not been linked in any way to the rash of illnesses and demand that the FDA restrict flavoured e-liquids across the board.
Dr. Robert R. Redfield, the director of the CDC, issued a statement via Twitter that, “This tragic death in Illinois reinforces the serious risks associated with e-cigarette products” and that the CDC, “has been warning about the identified and potential dangers of e-cigarettes and vaping since these devices first appeared.” Without any note of irony he asserts that the CDC will “continue to educate all Americans” about the risks associated with e-cigarettes and vaping while acknowledging that they have yet to learn the “the cause or causes of the ongoing outbreak.”
Our own Canadian taxpayer-funded CBC broadcast a lengthy segment conflating the use of e-cigarettes and the health issues in the U.S., during which they made the false claim that nicotine causes cancer which they later had to retract in response to viewer feedback. Thank goodness for a better informed public than the ‘experts’ who deliver the news. Still, they made more errors in their replacement clip, stating that no restrictions are in place around vaping in Canada (false) and continuing to conflate the issues of e-cigarette use and the current health scare. I am still awaiting a response from their ombudsman, who no doubt is an overly busy man with the number of problematic reports issued by the CBC.
There are too many politicians who have entered the fray with their own statements to name, so I’ll take one as an example. Congressman Raja Krishnamoorthi seems to misunderstand the issue at hand so deeply that he issued the following Tweet with a link to an op ed that he wrote: “I'm sickened to learn an Illinois resident died of vaping-related causes. As Chair of the Subcommittee on Economic & Consumer Policy, I'm investigating the vaping epidemic and will do all I can to get dangerous products off the shelves and away from kids.” Firstly, the investigation is ongoing as authorities have reported so we do not have a conclusive answer to what is causing all of these illnesses but it’s not any more vaping-related than Salmonella poisoning is eating-related. Secondly, the cases that did name vaping as the delivery system also suggested vaping of a substance obtained via the black market. Nothing at all “on shelves.”
I’ll pause here to note how highly unusual it is for all of these bodies and individuals alike to blame a delivery system for a problem, never mind organizations with teams of fact checkers and experts. During a recent spate of foodborne illnesses, for example, eating was not blamed for contracting E.coli 0157 nor was eating lettuce more generally. Eating what happened to be Romaine lettuce tainted with E.coli was to blame for the illness (note the E.coli not the lettuce causes illness). Carry on eating your lettuce, but avoid this specific tainted lettuce from a specific source. Wash all of your lettuces in fact, in case it may also be contaminated. That is helpful public health information: identify the exact problem (in this case E.coli 0157), identify the possible source where possible (here, Romaine lettuce from a particular farming operation), advise people of the precautions they can take.
And that is what I am seeing from the second group of people that I mentioned at the start of this article: those concerned with the exact substance or substances involved in the recent outbreak of respiratory illness. Those people are scouring the internet for updates and advisories that help to identify the real problem. Critically important, in order to warn the public of what exactly they should be on the lookout for. Also important so that people who are vaping in place of smoking don’t get the false impression that they may be safer returning to smoking, as some of the current headlines suggest. In other words, the exact thing that public health should be concerned with.
But these people are largely being ignored as the group in good part consists of people with some tie to vaping: be it industry ties, advocacy groups, doctors who have aligned themselves with vaping as a valid harm reduction tool, journalists with a harm reduction bent, and so on. It is assumed that because a relationship can be proven, so can bias. But this is where the irony is as its fullest because the anti-vape bias is in full force, as evidenced by the headlines and statements noted above.
It is not at all surprising, or shouldn’t be, that those who are in some manner connected with the vaping community should be the ones seeking information in order to inform the public. There is a long history of marginalized people having to be the stewards of their own communities as authorities, and the general public, feel no responsibility. And make no mistake, just as smokers are a marginalized segment of the population, so are the people who quit smoking through vaping, as are the people who support their free choice full throatedly. So now, when there is a very real health scare with the potential to kill people at its worst, it makes perfect sense that those most concerned with getting information out to the community at threat are those from within. Who, if successful, will undoubtedly be helping the very children that PAVE et al claim to be worried about in addition to the many adults at risk. And thank goodness for them, because those vested with the responsibility of informing the public have been willfully negligent.
It turns out that there is commonality between a number of these cases: tainted cannabis oil sold on the black market. In Kings County California where eight cases of respiratory illness were recently reported (21 state wide), the assistant director of public health stated that: “Everyone was purchasing from these pop-up shops,” Gerking said, referring to unlicensed dealers of cannabis products. “That seems to be the similarity among the cases.” "The only connecting factor that tied them all together was a history of vaping THC or CBD or some combination of that," Teske (Kings County public health officer) said, referring to compounds in marijuana. That is significant. That is good for people to know in order to make informed decisions for their health and safety.
We also know that the illnesses occurred in clusters, in roughly the same geographic areas. That would seem to indicate that there is some 'bad stuff going around'. Vape shops source their products from the same suppliers, not only nation-wide but often globally. Cannabis dispensaries source their product from licensed producers. That the illnesses are relatively confined to specific areas would seem to indicate that these are indeed black market products.
Of course we don’t have information on all of the cases, yet, and we should hope to get to the bottom of as many as possible. But what we do know is that in the cases that do identify specific products, the product is THC cartridges and appear to be from unauthorized vendors.
One of the things that this information does tell us (apart from the very valuable insight of what to avoid) is that further restrictions or prohibition would exacerbate the problem rather than addressing it. Organizations that claim to be concerned about public health (and those charged with reporting on it) should be paying keen attention to how their bias affects their interpretation of events or it will undermine their ultimate stated goals. And that appears to be what is happening here.
Fear is being stoked about e-cigarettes (not implicated in any of the cases) and vaping more generally (a delivery system), the public is being warned about the wrong thing, and the media is widely circulating misinformation. In the meantime, the real problem is not being dealt with and people are not being advised of the real threat so that they can take appropriate action. This is the opposite of public health’s stated aim. Luckily, some have taken up the cause of evidence gathering and disseminating the information to the public in an effort to inform and protect. Godspeed to them.
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