Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Vaping

Episode Date: September 13, 2019

On Sawbones, we like to take a lot of hard lines and make grand proclamations: Vaccines good, viruses bad, that sort of thing. But when it comes to vaping, things get a little ... cloudier? Music: "Medicines" by The Taxpayers

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one to Saul Bones, For the mouth! Hello, everybody and welcome to Saubone's Metal Tour of Miscite Medicine. I'm your co-host Justin McAroy.

And I'm Sydney McAroy. And I'm pretty excited about this exhibit, Sid. You are. I am. I'm excited about it. You're kind of a semi-expert on this topic. Semi-izer kind, but, uh... Yeah, I guess so, Sid. I guess we're both the doctors today.

No, no, I'm still the only doctor. I'm a doctor of the biology. I went to school for a very long time and I was an enormous debt as a result of it. And so that's what it means to be a doctor in America. I went to the School of Hard Draws where you, you know, I mean, you can talk about vaping all you like, but you're never going to be able to understand like what it feels like to take a huge draw and have your arms cranked up way too high and just blow cotton and hurt

yourself. And that's the kind of sacrifices you have to go through to live the vape life. And you'll never understand that. That's true, that's true. I never quite got on the vaping bandwagon, not my thing. We call it the vape wagon. The vape wagon. Yeah.

We're gonna talk about vaping this week. It's very, it's very. You're gonna talk about it. I'm gonna live it. No. It's just a thought to use an idea. I should, we should preface that Justin no longer vapes. That's true.

Yes. That's true. That was important to me. Yes, it was important to city that that no longer happened. Yes, I'll be honest, mainly because you liked to vape those things that smelled like they were flavored things. And I was pregnant and the smell made me want to vomit because it was very sweet. I remember Paul Miller, who quit the internet for a year, once said to me, Justin, in my

day, all we had to vape was electronic enjoys tobacco flavor and you kids today are vaping blueberry pancakes. Well, yeah, I don't think here's what I will say, though I don't vaping anymore. Yes, I used to vape. This is not going to not going to be a lot of easy answers in this one. Would you say, Sid? I'm not like grand proclamations are common on sobans and I don't think this is the episode for them. No, I don't. And that's what I'm glad you said that because I wanted to preface with there, there's a lot of nuance to this topic. This isn't with vaccines. It's easy. Just get them.

They're great. But with with vaping, there's a lot of nuance. And I, I think that I respect our audience enough to know that they're up to it. This is why I'm a doctor and not a politician, because I live in the world of the things that are gray and not yet fully understood and nuanced. So let's talk about the history of vaping, and then I also want to address what's going on right now, and the reason why vaping is in the news. Thank you to Haley for sending us an email very recently to suggest this because I think there's a lot of misunderstanding and fear and that's always a good place to start addressing something. So do you know when the first e-sigarette, the first electronic cigarette was made?

cigarette was made. I kind of remember them catching on like late mid to late 2000s. That's what most people remember as the beginning of e-cigarettes and I think that's a fair place to start with modern e-sigs. But the very first one was actually patented in 1963. And now to be fair, people had talked about and kind of drawn pictures of what could be e-sigs even before that, like back to the 30s. But the first one that we have a good record of is with a guy named Herbert A. Gilbert. He lived in Beaver Falls, Pennsylvania. He sold scrap metal, and he was a two-pack a day smoker. And this was in that time period. this was 63, so it was a time period where... Everyone was smoking. Exactly.

Legally. Everyone was smoking. Had to smoke. I think like 42% of Americans were smoking. This was, I think the year that we saw, that the most cigarettes were consumed, I believe, by the American public was this year. If you didn't smoke in 63, real smokers were legally obligated to take your wallet and push you down some stairs.

And then go buy cigarettes with your money. Buy cigarettes with your money. Teach you how to smoke. Everybody was smoking, but it was also in that time period where I think a lot of people who lived through this time period will tell you, people knew at that point, or they had begun to understand at least on some level that smoking wasn't good for you. They, this was the year before the surgeon general would come out with the kind of ground

breaking, like smoking and cancer report that said, Hey, this causes lung cancer. But even before that, I always remember my grandpa said, well, we like to pretend that we figured out that smoking was bad for us in the 60s, but we were calling them coffin nails as long as I can remember. So we knew they weren't good for us. So Herbert Gilbert is at least somewhat aware that smoking is not the greatest thing because he decides to make his own invention called smokeless. That's what he dubbed it. It was made of aluminum, it was a little black canister with a silver tip and it was battery powered and it just heated up a

liquid that you inhaled. Vaping. He vaped. That's vaping. Maybe. That's vape. And he was vaping and he made 10 different flavors. His favorite was cinnamon. Mmm, it's when he liked the best. And he, by the way, didn't have nicotine in it. Oh man, I just realized something. This episode's really gonna make me want to vape. Oh no, cinnamon delicious.

You're not gonna vape. I know I'm can't. I'm talking to a microphone and they don't sell them within arms reach. No, especially not right now, but we'll get to that by the end of the episode. You're not gonna vape. I'm telling you, you're not going to vape. Okay. So anyway, so he makes this thing the smokeless and he tries to get interested in it. Like he he starts taking it around and he's like, look at this great thing. I invented it. It comes all these flavors and you could do this

instead of smoking. But at this time, like I said, everybody in America was smoking almost. Oh, wild about these things. Nobody cared. And again, it's the year before the surgeon general says that smoking causes cancer. And I mean, how many years before people really believed that and took that advice to heart. So basically, his patent expired and he was kind of unknown. Nobody knew that he made this thing. So fast forward to 2003. Hanlik, a Chinese pharmacist and an inventor, he already knew how to make. He was

mainly involved in like, ginseng like products at the time when he was working on. But he wanted to make something new to help him quit smoking. The inspiration for this was that his father had been a smoker and had died of lung cancer recently. And he was afraid that he would suffer the same fate. He knew he needed to quit, but he had not had any luck so far with other products that were around or other methods he had tried.

So drawing on a lot of past ideas, probably Gilbert's involved, but not just on his, because this was Hanleyck's own invention. It was definitely different than this smokeless that Gilbert had made. He created his own electronic cigarette. And now this one would have nicotine in it obviously and you could and he just kind of thought it was the obvious next Step it was like anything else that we were taking from an analog to a digital right more variety yes Let's waste funner Well, I don't his idea was really that this would be a safer alternative to smoking.

You could get the nicotine and it would fulfill like kind of the behavioral part of it, the habit. But it wasn't as dangerous. Now, there have been attempts to do this with cigarettes way back in the day. I know this isn't where you're sort of going with this, but they have actually done, there was a line for a while called Quest, and Quest was a line of cigarettes that had stepped down nicotine content, actually. So they've tried, this is not a new idea. Now, Quest were terrible, and the absolute worst and felt like death. But the idea is the same.

The idea is the same. Well, and to be fair, in vaping, there are different levels of nicotine content, right? So, you do have that advantage too of being able to step down the nicotine content in a way that like It's you can't do a cigarette so let's see your smoking terrible quest much the same way that nicotine patches do That's why nicotine patches come in different strengths So that you can step down right exactly So he brought this to market under his employer who would Eventually become drag-on-ite international limited in 2006

eventually become Dragonite International Limited in 2006. It's introduced in China first and then kind of spread all over by 2006. And as you already alluded to, even though this was the first big e-cigarette to come to market and for people to like start buying and recognizing and to kind of popularize vaping, there were other companies that said, hey, hey, hey, we've been working on this for a long time. Philip Morris is an example, said, we've been trying to make an electronic cigarette since the 90s.

This isn't new. We've been doing this since the 90s, but they had had a lot of problems in the US because the FDA had stopped them. Because the question, and we're gonna talk a lot about this, the question is what is an e-cigarette? What is an electronic cigarette really? Is it a tobacco product like a cigarette?

No. Or like smokeless tobacco? Is it in that genre of products? Or is it a drug delivery device? And so initially, when Philip Morris had tried to kind of bring these things to market in the 90s, the FDA had stopped stepped in and said, no, whoa, whoa, whoa, whoa, this is a drug delivery device.

That is a whole other ball game. You have to have studies and research and science. This is regulated by the FDA. This is not something that you can just sell. And so that had, had halted any progress in that field until Hanlik invented his e-cigarette that really broke through the market. And by 2007, the US was seen. These e-cigarettes largely imported at first. Yeah, that's what is you have to remember at the time when this sort of like all got going, when vaping was first or be a thing, like there wasn't the jewels and all these other things lining the gas station stuff. They weren't at gas stations. It was like you were buying them

from a vape shop or buying them online and ordering all your stuff online for a long time. That was the way everybody was doing it and then moving into the vape shops is that kind of caught popularity there. But the gas station stuff, the mass reduced stuff wasn't even a thing. Well, and initially it was because they weren't illegal in the US, but they weren't legal either. Right. Kind of like a salvia fell through the cracks for a while. Yes. It's like, this is a drug. Well, you shouldn't legal either. Right. Kind of like a, Salvia fell through the cracks for a while.

Yeah. It's like this is a drug. We shouldn't have this. And you could order it online for a while. Yeah. Just buy it. Or buy it at a head shop or whatever. Or buy it at the store.

But so for a while, the FDA would put out like alerts on imports, like stop these imports. You know, they don't let this vape, don't let these materials or this equipment or the actual, you know, e6 themselves. Don't let this materials or this equipment or the actual, you know, e6 themselves, don't let this come into the country because we, we, we are still taking the position that

this is a drug delivery device and you can't just mail those to people, you know, the US regulates them a certain way and this is not okay. So, you know, stop. But it didn't, it didn't stop people. never works right never stop Please this never an effective method. So they so they said stop nobody was listening the vapes came in And then people started making them as well. I mean it doesn't take long for People who can manufacture these products in the US to start saying whoa hey vaping huh, huh? Everybody wants to vape. And so despite the fact that the FDA was trying to stop them, and despite the fact that in this time period, all over the world, as e-cigarettes are becoming

more popular, different countries are reacting in different ways. There are a lot of places where almost immediately they were banned. Just like from the jump. No, we don't want these. Just forget them. Not here. Now, some of those have been overturned since, some of those have been changed somewhat. There's still some places in the world where you just can't, but I think there are some places in the world where you can't smoke either.

But there was all this kind of like time period where there were no clear rules. And so they flourished. Sure, right. So the FDA in the meantime is trying to figure out what these things are so that they can figure out how to regulate them. If initially if it was a tobacco product, then the FDA wouldn't have had jurisdiction because at this point in time when they first- The ETF, right?

Yeah, at the time. When they first, I assume, because when they first came into the US, the FDA didn't have any jurisdiction over tobacco products. So, if it was, then they were kind of cut out of the loop, and they had no power there. And then it would be, like you said, ATF is a good example, because then it would be regulated that same way, like, maybe it's dangerous, maybe it's not, it doesn't really matter the FDA because it's not a medical device.

It's a party device. Right. It's like a cigarette, like a combustible cigarette or alcohol or a gun. Right. Yes, they're dangerous, but we still sell them in stores. But they were pretty convinced that it was a drug delivery device. And so they were still, and even though at this point, you're starting to see research come out, what could this do for smoking cessation? Because this was the idea from the jump,

the idea is that this was supposed to be a tool for smokers to quit smoking. And so you're seeing some early evidence, but it's not really enough to, and they're not huge studies, nobody's doing these big giant trials to see, like what's better this or a nicotine patch, this or behavioral therapy,

nobody's doing these trials. So like it's not enough evidence for the FDA to say, yes or no, these could help. People are making medical claims for them somewhat, but all of this is kind of unofficial. And so of course, what happens a lawsuit ensues. So the FDA is trying to clamp down on these several brands of e-cigarettes,

as well as what began to form were consumer organizations, backing e-cigarettes. The electronic cigarette association was formed, which was a bunch of like vape like distributors and people who sold the accessories and stuff to like come together and fight the FDA to say, these are tobacco products, you have no jurisdiction here. Let us sell our vapes. Let us vape. Let us vape. Just let us vape. And it's funny because in the midst of all this fight, because this lawsuit would stretch out over a couple years, right? It was a huge lawsuit. And in that time period, the Obama administration actually gave the FDA regulatory power

over tobacco products anyway. So the whole thing would still fall to the FDA, but it's still different, right? I mean, at the end of the day, a cigarette is still regulated differently than a prescription medication. Right. Yeah, obviously. So this definition still matters. What the outcome of this lawsuit is still important to the fate of vaping. Because imagine if they said it was a drug delivery device. Then it's like a prescription drug. It's regulated. Yeah. Yeah, then no jewel.

Oh, yeah. I think you have a hard time arguing that you need flavors for the drug delivery device. That's fair, yes. Although, although Advil's candy coated. Yeah. Although, although Advil's candy coated. Yeah, that was such a good point. You don't even know what to say back to it. It was so smart and it's like, it's helpful. To be fair, we do add flavorings to a lot of children's medications to help

them tolerate them, but I still think you, I think we're, again, I guess this is nuanced. No, I have to drink tons of the stuff to have an effect on me. Why don't they make it for adults? That's my question. Eventually by the end of 2010, by December of 2010, a ruling, the ruling was that electronic cigarettes, vaping products would be regulated like tobacco products. So they are under the FDA, but they're not drug delivery devices unless they make medical claims, as long as they're not making medical claims, which is the true of, which

is true of a lot of stuff at the drug store, right? You see a lot of supplements and things, a lot of vitamins, they, they, they always say this is not used to diagnose or treat anything. Yeah. That's how they're scurrying the FDA. So as long as it wasn't making a medical claim, anecdotally testimonials, whatever you wanna say, but you can't say, our vape will help you quit smoking, because that would be a medical claim. That makes sense. So as long as they didn't say that, they were fine.

Now since then, things are still in flux. From a legal perspective, when it comes to vaping, it's not that cut and dried, right? Because on more local levels, not just on a federal level, but on more local levels, there have been a lot of restrictions. In different states and different municipalities, there are different rules about where you can vape, what kind of vapes can be sold. Their places where flavored vapes are not sold. State regulations.

It's just so hard. It seems like in the internet age, it's like trying to put the genie back in the bottle, right? Like, anybody can buy anything online. And it's like, it's kind of run, ran rough rough shot for so long that that culture is like so established of like hundreds of or thousands of different rigs or mods that people are selling and like tens of thousands of different flavors or juices. It is and it is it's interesting because and a lot of the scientific papers that I've read to research this episode, even like the doctors

and scientists will note that patients seem to be, we always call them patients, but in this case, I think we're also talking about just people who like to vape, seem to be more passionately devoted to this form of nicotine replacement therapy than others. I read that in one of the studies and I thought, oh, well, I don't think you're getting the whole picture there. It's not like people are passionately devoted to their nicotine patches. I get that. But. Right. I don't think that's exactly what's happening here.

So again, they've been banned on places like Plains. Sure. That's the right. Also because they can be a hazard, especially the ones that are... You don't see this as much anymore, but for a long time, the, the danger of vaping was exploding. Mods. They have exploded.

They had gotten from, uh, shifty online retailers. So it makes sense on a plane, you don't want to, you know, now the, the big concern as time has gone on is well twofold. One, are there long-term health effects? Right? Right. And I want to get into that. But before I get into that too, the other big concern has been as these have become more popular and the kinds and flavors and all that stuff has, I mean, just multiplied. There's so many different things. They also look a lot cooler.

Yes. Right. Yeah. Like I've seen the ones that look like cigarettes. Yeah. It just looks like a cigarette, but it's made of plastic or whatever. There's something that look like that. There's something that look like, um, like somehow the jewels and like some of the other brands that are the kind of like the

mass produced brands are kind of like slightly bigger chunkier kind of like I mean they're going for futuristic right they're not they don't want it to look like a cigarette and I think that that's like you saw push towards that at the beginning of the mass produced vapes stuff that like our Gerennels and stuff like that were doing was like, it was trying to replicate that experience. It looked like the pretend cigarette that you use in a play. Exactly, right? Yes, exactly.

But the stuff that is popular these days is much more like, it looks futuristic, right? It looks like you're a, the caterpillar in Alice in Wonderland. Yeah, well, yeah, or more accurately, like a character in a William Gibson novel, like, you know, a Neuromancer or something, like ingesting your cyber smoke.

And with all these changes, another big concern has been, will younger people start using them. Specifically people who have, yes, specifically people who have never smoked, will instead, they need to frame this as a question. Yes. By 2017, we were supposed to,

the FDA was supposed to come out with like, new guidelines basically for ESIGs because of all these concerns. We need better rules in place. We still don't, I mean, they're regulated like cigarettes sort of, but we still don't have any idea of all the specific rules. But the Trump administration had those changes delayed until 2022. So we still don't have that set of rules from the FDA.

And the numbers of users of vapes have risen dramatically. There are about 35 million in recent counts as opposed to 7 million in the beginning in 2007. And when it comes to young people specifically, just from 2017 to 2018, the prevalence of e-sig users increased from 11.7% to 20.8% among US high school students. That's a big jump. And we're probably missing people because I found it interesting. I was reading a lot of articles about the recent Vaporlated illnesses. And they were saying that doctors aren't very good at screening for vaping because

what they'll say is, do you smoke? No. Do you use an electronic cigarette? And people will say, no. Now, if you say, do you vape, a certain percentage of people who said no to the e-sig will say yes when you say vape. And if you say specifically, if they say no to vaping, if you specifically say, do you use a jewel, another percentage will say yes to that question because they do not see jewelline as vaping. That's wild because it definitely is. But also, I don't think it's smart to try to bill. I don't think you want a Xerox situation with this stuff, right? Like, I think it's smart to try to bill. I don't think you want a Xerox situation with this stuff, right? Like, I think it makes it harder to talk about. Well, but the point is we're not, we're missing

kids who are vaping because we're not asking the questions the right way. Yeah, I guess. And, and kids aren't necessarily knowing what they're doing. Yeah, I guess that's true. There's an education gap here on both sides. It's as much on our end as the educators as it is on the young people who are doing this without really knowing what they're doing need to be educated. And there's also, obviously now we've expanded beyond nicotine. So there are, you can vape nicotine. That was the original purpose, right?

And then you could vape just flavored liquids. Weird, but yes. And then you could maybe start vaping other substances. And now, of course, we've seen THC. It's something that you can vape. CBD can be vaped. There's something butane hash oils can be vaped. These are called dabs.

And if you do this, it's called dabbing. And if somebody said they were dabbing, I as an old person would have assumed they were doing that thing with their arms that kids do. Right. And I would have no idea. You wouldn't have it any, you wouldn't know. So as a physician who should be screening for this,

or as a parent, would you think to say, now honey, be honest with me, are you dabbing? I feel like kids aren't stupid. And if you said to them, are you vaping? And they're like, no, but they're using a jewel. They know what you were asking. Like they're not. This is like so spacious to be like, kids don't even know that you mean vaping. When you say, of course, they do Sydney kids are liars and they don't want to tell the doctor They're using a jewel because they think the doctor will tell their mom and dad Yeah, how far removed are you from being a teenager that you think kids don't know

vaping when you say jewel This is why I do a whole other show where I learn about being a teacher right Teenagers are lying just like we lied all the time So what's the problem with all this? I mean, I think we've hit on one of them, which is, are if you are a smoker, if you use combustible cigarettes and you decide cigarettes are dangerous, that's, I mean, you don't need to decide that. I'm gonna tell you right now. That's a lot. Sigarettes are bad for you and they're bad for the people

around you and smoking is something that, you know, preferably no one would do for their health. So I want a quit smoking, should I use an e-sig? The answer to that question for a long time has been maybe. the answer to that question for a long time has been, maybe? But the question, I am a teenager and I don't smoke anything, but my friend's jewel and I'd like to try it, should I? The answer's definitively, no, no, no, no, no.

Because kids who use electronic cigarettes are more likely to also try combustible cigarettes. We do have some studies that indicate that. It's a gateway. It's, I hate gateway because I feel like once you use gateway drug, you're just talking about, I don't know. I feel like that's a very loaded, but yes, I mean, that is the concept. That is the concept and there is some accuracy at that.

I mean, I understand your hesitance. I think that a lot of that stuff is kind of silly because I think the gateway is often misused to describe a socio economic status like more than it is like. Yes. There's a causation correlation issue with a lot of the gateway stuff where like kids who try this or more likely to try this, it's like well that's probably because of their living situation and a lot of other factors other than they just happen to have also smoking or want. Anyway, and a lot of other factors other than they just happen to have also smoking or want. Anyway, I mean, it's an addiction. Like, if you, if you, if you, you will develop a nicotine addiction, it's not like, yes, a wild stretch to think like, you know what, you might try to be more likely to,

because you already have the addiction. I mean, the addiction's there and that's a, that's a key component. Well, and I think that's where we need to start looking at the evidence. So like, if, if we're going to as a society, decide like vaping is a good thing, we need some evidence that it, uh, one, helps people quit smoking. And two is less harmful than smoking. And three doesn't have its own set of other harms that we don't know about that are way worse, I guess. So what do we know so far about vaping?

Well, there is conclusive evidence that an e-cigarette device has less other toxic substances in it than a combustible cigarette. So we have good, good strong evidence that, actually I should say, it's substantial evidence. These words mean things. It's not conclusive. There's substantial evidence that, except for nicotine under typical conditions, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes. So when people start saying vaping is better for you than smoking, that's what they're talking about. And then we have substantial evidence for that, right?

Right. We have, the problem with the nicotine piece of it is that it really depends on how you use it. You can get just as much nicotine from a vape in a day as you do from combustible cigarettes in a day if you use it that way. So it's hard for me to say you're gonna get less nicotine from a vape in a day as you do from combustible cigarettes in a day if you use it that way. So it's hard for me to say you're gonna get less nicotine from a vape.

You can, but you could also get the same amount. Right. So that's a little harder. But there are fewer of the other toxic substances. Now in terms of its ability to help you quit smoking, the evidence looks like it's headed in that direction. There have been some studies that have shown when you compare the use of a nicotine, other nicotine replacement therapies to e-cigarettes for smoking cessation.

The e-cigarettes are a little better, but the quality of this evidence so far is low. It would be greated pretty low. There's low evidence that vaping is a useful and perhaps better way to quit smoking than other nicotine replacement therapies. Right now, because the grade of evidence is so low, we don't recommend it over nicotine replacement therapy or other medications that we can use or behavioral therapy, other methods, right? Right now, it's like an alternative, but it is not one of the things we recommend strongly. Now, there are tons of studies ongoing

and that might change. We might find that it is just as good or even better than these other ways of quitting smoking, but I don't have enough evidence to tell you conclusively that it does that just yet. Um, I mean, it makes sense. It's logical, but like I'm suspicious of all in our teas. Like I don't, I think that we over rely on them as like a necessary,

a necessary part of smoking cessation, but that's just my own personal beliefs that I'm bringing to the table there. Well, and I mean, evidence has backed up that in our teas can be effect, nicotine replacement therapies can be effective for some people in smoking cessation. So I'm not going to say that nobody should use them because I've got evidence that some people will benefit from them. I think ideally, if people were using e-cigarettes to quit nicotine completely and then stop e-cigarettes, there probably wouldn't be such a debate. But that's not necessarily what's happening, right? One, we see people who use them both instead of replacing combustible cigarettes with vapes. We see people who just kind of go back

and forth between the two, which is that better? Probably. But it's not like lung cancer from cigarettes is directly correlated with how many cigarettes you smoke. We don't see that. And so that it's not necessarily better. And if you just replace it with vaping forever, but you're still using nicotine forever, is that better? Probably.

I mean, there's also the issue of like lifestyle. When I was a smoker, I smoked outdoors because I worked in lived in places where smoking was not permitted. But if you're vaping, you can do that pretty much constantly. And like, doesn't that, you know, are you going to become more dependent on on nicotine in that case? That's one fear and the other fear that goes along with that, which we don't have evidence of at this point, but has been hypothesized as, as a possible consequence is the re-normalization of smoking. You, if you can vape places that you can't smoke and you see smoking more often, and this gets back to young people again, are we re-normalizing smoking when what we've

seen so far is that the more laws we've passed about tobacco in this country, the less normalized smoking behavior is in this country. If we reintroduce vaping all these places, do we re-normalize it? I don't have evidence to support that, but that is at least a concern. You know, that merits further exploration. The other piece of it is vaping safe period. Well, like I said, so up until the last couple months, the evidence has been overwhelmingly that we don't know long-term what the effects of vaping are. We just don't know. But so far, it seems to be at least a safer alternative to smoking cigarettes.

Now of course, we are concerned about people who never smoked starting vaping. We don't want that to happen. But if you are someone who was using combustible cigarettes and you've switched to vaping up until the last couple months, we've all, we've, we've all felt pretty confident that that was a safer choice you were making. I want to adjust one thing. Actually, before we move on, I hate to break your flow like this, but nicotine is still a bad chemical for you, right? It is still a harmful chemical for your body. Exactly. Exactly. nicotine is not good for you, but we have accepted and smoking cessation for a long time, whether it be via a gum or a lozenge or a patch or a vape that perhaps exposing someone

to nicotine longer to get them to stop using cigarettes was a like risk benefit reward. We were rewarded. I wanted that right. I think that a lot of people assume that if you're just getting the, like all the other stuff is the dangerous stuff and it's not the nicotine. No, nicotine is dangerous in and of itself. Right. And it's addictive.

Well, obviously it's addictive. Yes. But like it is all bad for you. Yes. It is a harmful substance to your body. Yes. Yes. Nicotine is bad just all on its own.

There are other things in there that are bad too. Of course, and vaping reduces those. But if you vape a lot with nicotine in your vape, you might be getting the same amount of nicotine that you were when you smoked, depending on how much you smoked and how much you're vaping and all those things. So what is going on right now?

Because obviously things have changed in the last couple months. So over the last two months, we are noticing a pattern of unexplained respiratory diseases. About 36 states so far in the US have reported these cases in one territory. Since one case, I think, dates back to April, but most of them have been in July and August. Since July, essentially. There are around 404.50 depending on how exactly you're defining them probable versus confirmed cases as of two days ago

when the press release from the CDC came out. And the way that most of these patients are presenting, not all, but typically we're talking about young, otherwise healthy people who are presenting to emergency rooms with severe respiratory disease and they are becoming very ill very quickly. Now some of these have been slower onset, like I said one case dated back to April, but most of these have been pretty acute onset.

People start getting a cough, some shortness of breath, some chest pain, a lot of them are getting some GI symptoms like nausea, vomiting, abdominal pain, diarrhea, those kinds of things as well. They might have a fever. They come in. A lot of them were seen once and treated for like an outpatient community acquired pneumonia type picture. They just thought, oh, well, you got pneumonia or an upper respiratory infection.

A lot of them were given some antibiotics, maybe some steroids sometimes and sent out and then come back because they're getting worse. They get worse very quickly. All of their infection markers, all the blood work, all the blood tests we do to look for infections seem to point to infection initially. Your white blood cell counts, those are your fighter cells, are up, which they would be with an infection.

The types of white blood cells that are up look like a bacterial infection. Inflammatory markers like CRP and ESR and Procal, the important thing to note is that for all intense purposes, it looks like you got an infection. Inflammatory markers like CRP and ESR and Procal, the important thing to note is that for all intense purposes, it looks like you got an infection. Your chest x-ray will usually show what we call infiltrates in both lungs, which is consistent most of the time with a pneumonia. So it looks like you got a bad pneumonia, except we treat you with antibiotics and you don't get better, and we test you for all kinds of infections and all of them come back negative.

And a lot of these patients get worse. Over half have ended up in the intensive care unit, and about a third have spent some time on mechanical ventilation, intubated on a vent. And so far, six people have died. We've seen some patients respond really well to steroids, and then others have just slowly improved with a variety of treatments every time. The question is, why is this happening?

Because we are not finding a common infectious etiology cause, we're not finding a common infectious cause. The one thing that we have found in common is that they all used to vape within the last 90 days. Most within the last week and many of them use it regularly. But I mean, again, and I have to jump ahead, you just said 36 million people, right? Yes, they breathe.

Like that's one of the 10 almost. It's a very small, what yeah. It's a very calm, it's not? Yes, the vapor, like that's one out of 10 almost. It's a very small, what, yeah. It's a very calm, it's not a small, I mean, it's like, that's a sizeable, I mean, run the numbers, right? If like weird stuff happens to people, one out of 10 times, like it could be somebody who's vaping, right? Like,

yeah. They recently, they, they're like 35 million vapors, but there's only been three hundred or four and 50 or so cases of this. Okay. It's different ways of looking at it. What I'm saying is, there is a small number of people affected by it. That's weird to start out with.

But also, it could just be weird. There's a lot more percentage wise of the population vaping. I see what you're saying. I see what you're saying. If weird things are just randomly happening, you know, there's a higher chance that they'll happen to someone who has also vaped. It's a correlation causation thing.

I see what you're saying. And that is, which is not the same way. Obviously, it's just like, well, you know, we want to be, you know, as, as regreate a picture and regress the right as well. Yeah, no, I agree.

And that's why nobody is conclusively saying their vape caused this. We are seeing vape associated vape related. You'll see these words use very... Vapagecens. Very particularly, because we're not saying vape caused illness, because we don't know exactly what is going on in all of these patients' lungs. Have you ever said vape so many times in a half hour? No.

I have. Never. Most of the patients had vaped THC. So there was some thought that this was connection with something to do with THC, but some had just used a nicotine vape. So it wasn't 100%. All their rigs were different.

All the liquids were different. Some were buying things from stores some more mods Some were like homemade kind of things. I mean it was all over the place and more and more by the way if you buy something from a store Because of how many different vape shops there are The idea that this is it's they keep saying don't buy vapes off the street I'm using air quotes for off the street. Buying one in a store, you might be buying the same thing that you would be buying off the street.

I don't even know what off the street means. I don't think that means anything anymore. Off the street is nothing. I mean, it's like, right. I mean, there are so many products being made in so many different ways by so many people that that's really hard to. Off the street pretty much means vape shop, right? I mean, like, there's no,

nobody's opening up a briefcase of vapes. They're talking about people who are buying marijuana products in places where it's illegal. Oh, okay, got it. But what the point is what is happening? Like why are people all the sudden? People have been vaping for a long time. Why is this happening in July and August of 2019?

I don't know. I mean, it's 2019, so that might be reason enough. But are we just now noticing as one question? Have vapes been killing people and we didn't notice? Did we just all the sudden like put it together? That's one theory. It seems a little wild because if you see a rash of young healthy people coming into ERs

and then ended up on ventilators and nobody can explain why, that usually makes news. So it seems weird, right, that we wouldn't have noticed. But I mean, perhaps that is like something that happens. It's a bias. You notice one happens with shark attacks all the time. Right, right. You notice one and all of a sudden everyone makes news. Yeah. So is it that? Is it a particular product? We can't find anything in common, but is there something we're missing? Is it something being added? There's been a lot of talk

about vitamin E oil. You'll see a lot about that in the news. Vitamin E acetate. It's added as a thickener. And I guess it's also like flavor wise, it's similar to THC. So that's why you see it a lot in marijuana and THC, I should say not, just marijuana, THC vapes products. And it thickens it as well and it's just the oil. And we have seen in the lungs, when they've done, for some of these patients,

they've actually done biopsies of their lungs. And they've seen like cells, what they call lipid-laden cells, lipid-laden macrophages, which is certain kind of cell that is eaten a bunch of like a fatty substance. And so the question is, like, are these cells clogged with vitamin E oil, which we don't really have definitive evidence for, because it's not in every patient, not every patient used vitamin E, It's not 100%. And then also when cells are damaged, they release lipids.

So are we just seeing lipids there because cells were damaged by something else? Chicken or the egg. So none of that is conclusive right now, but you'll see that in the news a lot. Is it vitamin E? I don't know, maybe? Theoretically, it could be,

but we don't have definitive evidence of that for sure. Is it because people are making more stuff at home, there's been some theories like, is there a YouTuber out there who just put out a bad vape recipe? Possible. Maybe, because it's been so scattered, is it something that would be,

you would need something like the internet to get it to that many disparate people that quickly? I mean, it's so, because it doesn't seem like it's coming from a common single supplier. It's also some unique pieces like you could combine things in a really dangerous way easily, right? Like you get weird chemicals and you're heating them up very hot and then you're inhaling them like, who knows?

And the way thing, and that's been noted a lot, like the way things break down, we can't always predict and there's a lot of stuff in there. And if you're buying it, you don't know exactly what's in there anymore because we can't always predict and there's a lot of stuff in there and if you're buying it you don't know exactly what's in there anymore Because we don't have great rules on how they're regulated yet There's also been I saw one suggestion that it was even the recent tariffs on China because More traditional vaping equipment might have become more expensive are people making stuff and so now we're seeing like the result of Kind of a DIY approach to vaping that maybe isn't 100% Well, it was never 100% safe to begin with, but even less safe here.

It would have happened. I don't know. If that was it, it would have happened five years ago. It would have happened five or ten years ago. That's true. It was the wild, wild west, five to ten years ago. Like I feel like if that was the thing, that would have been happening back then.

And again, that could be the media bias, right? Maybe it was happening, which didn't clock it. It's hard to say, right now there are more questions and answers. We know that these patients all vaped, but that's. But everybody vaped. And I mean, the presentations have all been pretty similar. There's a case definition for it. So we can like lump them into a category based on certain

features. But then there are also lots of things that don't line up. For instance, the lung biopsies don't all look the same. The kinds of stuff they've raped aren't all the same. The substances in their vapes, whether they use THC or nicotine, all that stuff is different. Most of them are young and healthy. Some of them weren't. In one case, one of the patients who unfortunately passed away was older and did have some other

chronic illnesses as well. So, it's not all just, you know, young, healthy, like, athletic college student who all the sudden is on a ventilator. I mean, it's varied. Right. So what are we missing? What's the common thread? It's a really, it's right now we're in the midst of, if you remember our episode on

cholera, have they had to figure out that it was the hand pump that caused, that was the source of the cholera? We're in one of those moments in medical history. This is the investigation that's ongoing and we don't know the answer. In the meantime, the recommendations from the CDC are, if you can stop vaping, you should. Yeah. That is what all medical organizations are coming out and saying. That's what pretty much the official position is. If you can stop vaping, you should stop vaping. If you aren't vaping right now, don't start vaping. So if you are a young person whose friends are using a jewel, I wouldn't, I mean, don't do that. I would have said don't do that anyway, but really don't do that. Not that jewel

is the culprit. I didn't mean to implicate jewel. We don't know. We have no idea where this comes from. If you are smoking, you should still quit. But I would, as a physician, recommend using another method to quit right now, aside from an electronic cigarette. I mean, that has to be the official position until we figure out what the heck is going on. And it may be that your specific vape is not a risk to you, but I don't know. We have no idea. So the safest, I mean, I don't like to take hard lines like that a lot, but my advice would be like, if you can stop vaping, you should right now. Speaking as a colonel.

I wouldn't say start smoking though. I wouldn't say like, please quit vaping and go back to combustible cigarettes because we know that combustible cigarettes cause chronic lung disease and cancer. So. You know what, Sid? Something you said right at the beginning of the episode of your grandfather said that everybody knew they were dangerous.

Like I, I wouldn't speak for everybody else who has done vaping, but like there is definitely a little bit of head in the sand going on with people who vape like you know it is not good for you. There's no, I mean like you know it is not good for you. There's no, I mean, like, you know, it's not good. So the odds of it being zero, like non-applicable are very slim. That seems unlikely. So the only thing left is bad, right? Like, you, it doesn't, I don't think it's a huge, you can wait for the government and science to tell you why it's not good and the extent to which it is not good. But you kind of know that it's not good right now, I think.

I mean, I think that's the truth. It's hard because I've dealt with this on a personal level for a long time as a physician. How do you advise people when it comes to vaping if they're quitting smoking using a vape? That's a really hard position to be in because for a long time, the answer has been, I don't know what the long term, I don't know what it's going to do to your lungs in 30 years. I have no idea. I think right now we have a lot of good evidence that says they're safer than cigarettes. So that's great that you quit using combustible cigarettes because those are very bad for you. But I don't really know, I mean, there's just not enough research to say much more.

And I mean, that's a hard place. People push for answers when they don't get them. And right now, I don't think there's a medical organization that can give you a definitive answer on what's going on right now and what the long-term consequences will be. So the best thing is, if you can, don't vape.

And I mean, there's other, if you're getting a nicotine replacement, like I feel like personally, I somebody who is both smoked and vape, and quit both many, many times, I think that the problem with vaping as a method to quit smoking is you are continuing the behavioral aspect of it and the nicotine aspect of it.

I don't feel like you're getting yourself any closer to Changing the behavior or of the addiction. I feel like you're just replicating it like you're not making the behavioral changes that would be a lasting Way to stop smoking would be my argument I agree But but all the flavors though. I mean you can't discount that so I guess it's would be my argument. Um, I agree. But? But? All the flavors, though. I mean, you can't discount that. So I guess it's anybody can say, nobody can say.

No, but I also, I would say just as kind of, because we don't know what's going on right now, one, if you do have a sudden onset of respiratory symptoms and you're concerned, well, you should always go to a doctor. That's not vape-specific. But you should tell your doctor if you vape. Or jewel kids. If they don't ask you tell them, that probably they will ask,

but we're not always 100% at this either. So tell them because right now that's something that's being looked for and we're trying to put all the pieces together. So I would definitely go see your doctor and tell them that you do vape. It may have nothing to do with anything, but it's good to tell them. And if you do vape and you have those little bottles of liquid in your house, please put them somewhere secure where young people or animals can't get to them. Just as a,

because that is another in addition to that some of them can explode. Some vapes do, they have been known to explode. The ingestion of those little bottles of vape liquid, the ones that contain nicotine, can be fatal. So that is a danger in your house. Folks, thank you so much for listening to this episode. We really appreciate you tuning in. Hey, I have a podcast plug. If you like solbons, but wish instead of medicine, it was about alcohol. I should check out neat a boost cast by Liz June, Sydney's sister and my

sister in law Taylor. Tomorrow is called neat. It's on iTunes just now. It's just hot off the presses. Check it out. It's wonderful. Well worth checking out. There's a video component too if that's more your thing, but it is on iTunes. So go subscribe and check that out. We have a book, Sydney and I wrote. It's called Sobans the Book. The Sobans book. It just starts with Sobans. I know I find it.

It is an audio book version. If you want to get a little silly, you can listen to an audio book version of a book of a podcast. You are more than welcome to do that. We do it. We do it. We recorded it.

It was very surreal to do. You, I want to say thank you to the Mexican Fun Network for having us as part of their podcasting family. Thank you to the taxpayers for these to their song medicines as the intro natural world program. And thank you to you for listening. We really appreciate it as always. So until next time, my name is Justin McAroy.

I'm Sydney McAroy. And as always, don't drill a hole in your head. Alright! Maximumfun.org Comedy and Culture Artist-owned? Audience-supported. you