Science Vs - Vaping: What the Hell is Going On?!

Episode Date: October 25, 2019

Vaping is all the rage in the U.S., but young people are turning up at hospitals barely able to breathe. Over a thousand vapers have gotten sick⁠—34 are dead⁠—and no one knows why. We investigated the case of the mysterious vaping disease with help from Geri Sullivan, pulmonologist Dr. Louella Amos, lab director Iniobong Afia, inhalation toxicologist Prof. Ilona Jaspers and researcher Dr. Jamie Hartmann-Boyce.  Check out the full transcript here: http://bit.ly/33VzzRi Selected references:  CDC Outbreak Page: http://bit.ly/2PheKvO  Case reports from 53 vaping patients who got sick over the summer: https://www.nejm.org/doi/full/10.1056/NEJMoa1911614 “Chemical burn” analysis of patients’ lungs: https://bit.ly/2oexalC Jamie’s review “Electronic cigarettes for smoking cessation”: https://bit.ly/32GTN14 Credits:  This episode was produced by our senior producer Kaitlyn Sawrey and producer Michelle Dang, with help from me, Wendy Zukerman, Lexi Krupp, Rose Rimler and Meryl Horn. We’re edited by Caitlin Kenney. Fact checking by Michelle Harris. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Bobby Lord and Emma Munger. A huge thanks to all the people we spoke to for this episode including: Dr Yasmeen Butt, Dr Sean Callahan, Dr Travis Henry, Professor Irfan Rahman, Christopher Harvel, Alex Sandorf, Dr James Pankow, Dr. Konstantinos Farsalinos, Professor Lorraine Martin, Professor Moon-Shong Tang, Dr. Kevin Davidson and Myron Ronay. Extra thanks to Conor Duffy, Zukerman Family and Joseph Lavelle Wilson.  Learn more about your ad choices. Visit podcastchoices.com/adchoices

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And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. This is the show that pits facts against fumes. On today's show, vaping. It's putting people in hospitals and some have even died. And this is freaking America out, partly because a lot of those getting sick are young and were perfectly healthy before. Oh my gosh, every time they put those little statistics up on the screen,

I'm like, my kid is one of those cases. Like, he's technically a statistic now. Jerry Sullivan first realized that her 17-year-old son Eddie was vaping about a year ago when she found his Juul pods in the washing machine, and she had no idea what they were. Oh, I totally thought it was a USB the first time I saw it. When Jerry confronted her son, he was like, Mom, it's nothing to worry about. idea what they were. Oh, I totally thought it was a USB the first time I saw it. When Geri confronted

her son, he was like, mom, it's nothing to worry about. He tried to justify it and say like it's mango vapor. Oh, it's just fruit vapor. It's not really a big deal. I'm like, it doesn't quite sound correct. Eddie was also messing around with vapes that had weed in them, though Geri didn't know it then. She tried to get him to stop vaping, but months went by and he didn't. And then in July, Eddie woke his mom up in the middle of the night. It was about 2.30 in the morning and I was sound asleep and he came into my bedroom, he turned on all my lights, and he was like, Mom, I've thrown up three times since midnight.

I'm in a lot of pain. My stomach really, really hurts. They went to hospital and the doctors took a look and said, we think it's pneumonia. Take these antibiotics. And they sent Eddie home. The next day, though, he was worse. He looked gray. He just was like very ashy colored.

He was very sweaty. He was just very like clammy and he was like just sweating profusely. His t-shirt was soaking wet. Eddie told his mum he couldn't breathe properly. He definitely said a couple of times, he goes, it feels like I only have one lung working. He couldn't take a deep breath.

They drove to the hospital again, and this time, Eddie couldn't even cross the parking lot to get to the waiting room without his mom's help. And for a kid like him, he's a football player, otherwise pretty healthy. This was shocking. Inside, the nursing staff tried to figure out what was going on. They put the little pulse oxygen clip on his finger,

and I remember the nurse saying, Eddie little pulse oxygen clip on his finger. And I remember the nurse saying, Eddie, put the clip on your finger. And he said, it is on my finger. Eddie had so little oxygen in his blood that this device had trouble detecting it. And there was like a look of panic between the nurses that were there. Immediately, Eddie was whisked away. And after days of trying everything, the doctors were getting desperate. They talked to Geri about their last resort, putting her son into a medically induced coma.

And that terrified her. I lost my husband when my son was one. And that was sudden. He's my only child. He's my whole world. I remember thinking, like, you can't do this to him, and I thought I was going to lose my son. What Jerry didn't know at the time

was that this wasn't just happening to Eddie. By August, all around the country, other kids were turning up to hospitals with very similar symptoms. Several teenagers in Milwaukee have been hospitalized with lung damage. The agency says it is now investigating about 530 cases. 26 deaths in 21 states.

Since this outbreak began, 34 people have died from vaping and more than 1,600 have been injured. And in the U.S., more than 10 million people vape. So many are wondering, how bad will this get? But also... What the hell is going on? Are you kidding me? Like, this is all related to those dumb mango-flavored pods I would find.

And here we are, like, I could have lost you. Today on the show, the case of the mysterious vaping lung disease. We've scoured through scores of case reports, put a magnifying glass up to the latest findings and followed the clues to try to find out what is causing all these lung injuries and is it ever safe to vape? When it comes to vaping, there's lots of...

What the hell is going on? But then there's science. Science versus vaping is coming up just after the break. Welcome back. In the last few months, more than 1,600 people have been injured from vaping. And vapes, for the uninitiated, are battery-powered devices that heat up a liquid. That liquid can be full of nicotine, flavours or THC.

The heat turns that liquid into an aerosol, so then you can inhale it. Vapes have been on the market for about a decade and up until now there's only been a handful of case reports of people getting sick from vaping. So the big question on everyone's mind is why is this ratcheting up now? To crack this case, we first called up Dr Luella Amos from Children's Wisconsin Hospital.

After a cluster of sick teenagers landed in her hospital, her team was the first to warn the public that this could all be from vaping. So it was pretty bad and it's very hard to ventilate them. The lungs were stiff, they were sore, they were inflamed and they were sick. To see what the hell was going on, her team took chest scans of the patients. So you should see mostly black in the lungs.

However, when you look at the scan of these patients, it's more diffuse white haziness. That haziness is bad news. It suggests there's a lot of inflammation in the lungs. To get a better look, Luella and her team did what's called a bronchoscopy. We use a camera. So this little camera, probably the size of a spaghetti noodle, we put that in the airway. When they got into the lungs, they could really see how messed up things were. One had blood.

Others have had just redness. Others have had kind of these little pockets in them. I don't know how to explain it, like divots in the lining of the lung that we've never seen before. Now, inflammation is often a sign of infection. But when the doctors tested these patients for different viruses or bacteria, the tests all came back negative. This wasn't an infection.

Something in the vapes was triggering this reaction and making the lungs sick. Another team of doctors looked at the lung tissue of injured patients up close, and they said it looked like a chemical burn, like something you'd see in an industrial accident. So what in the vapes was causing this chemical burn? Something suspicious caught Luella's eye.

Fat, essentially. Fat in the lungs. Fat shouldn't be in the lungs. And yet every patient she looked at had it. So how did it get there? Could this be the culprit? Could people be inhaling fat somehow? Perhaps it was the vape oil. At first, investigators thought yes, and this actually got a ton of press.

But later research has suggested that it could be from something else. You see, all of our cells have some fat in them. So there are lipids essentially in every cell. So when cells die and they break down, there's lipid release. When cells die, they kind of spew out this fat and you're finding fat in these lungs. Exactly. If that's how the fat got in there from dying cells, it actually couldn't help us work out what in the vapes is making people sick.

It means this is a dead end. A red herring. A MacGuffin. After all, Luella already knew that cells were dying. The question was how? But then, another clue. Health officials who were interviewing sick patients realised that the vast majority of the people who had gotten sick were vaping illegal THC-containing products,

also known as black market weed vapes, like what Eddie had sometimes vaped. And at the top of the authorities' most wanted list was a label of black market vapes called Dank Vapes. And that means that there is a bunch of buttoned up CDC folks sitting around saying the phrase dank vapes over and over again dank vapes dank vapes now when the authorities broke down these and other illicit vapes to find out what was inside them they noticed that a ton of them contained

this one specific ingredient. Vitamin E acetate has been found in vaping products containing THC. The problem? Illegal vape sellers are mixing cannabis with harmful oils like vitamin E. These are black market products, stuff that people are buying off the street.

Who knows what's in them? And this takes us to suspect number one of our investigation, vitamin E acetate. So why is vitamin E ending up in something that's supposed to be mainly THC? You know, honestly, costs. It is cheap, so you can get it in bulk amounts and they can easily make more money. This is Inia Bong-Afia. He's the scientific director for Canisafe Labs, which is a cannabis testing company based in California. And Inia told us that vitamin E acetate has another benefit, you know, other than being cheap. Vitamin E oil is a very, very viscous oil. So if you compare it to consistency of raw honey, it's almost thicker

in its raw form. Being such a thick and viscous oil, it interestingly produce very thick smoke. Thick smoke is great for a weed vape because it makes it look like it's high quality. And it also kind of looks like you're ripping a fat bong. Iny had heard that the CDC kept finding this stuff in illegal vapes, and it made him curious about how much vitamin E acetate was actually being added to these vapes. So Innie started his own investigation, went undercover... ..and had to shut his gob about it, you know, to avoid the boys in blue.

Didn't want to land himself in the big house. And he became a real tough guy. But we went in just normally. Hey, you have any dang vape cards? And of course, they had plenty. About three quarters of the vapes he tested had vitamin E acetate in them. And the amount of it was really high. The very first card that I tested

jumped out at 30% and I was shocked. And my instrument just lit up like crazy. Oh my God, you know, that's when it hit us. Wow, this is bigger than we thought. One lab has tested a vape that had 88% vitamin E acetate in it. And that is just ridiculous. Researchers told us that generally speaking, it's not good to inhale oils and stuff like vitamin E acetate. But before you put this chemical in the slammer without a trial, there are actually no studies looking into exactly what vitamin E acetate does to your lungs when you heat it and then inhale it. We spoke to one toxicologist who is testing this in mice right now

and he said we just don't know if vitamin E is the guilty party. But this case hasn't gone cold. In his testing of these black market vapes has also turned up a second suspect. 100% of them contain pesticides and not just one pesticide, but a myriad of pesticides. Legal weed vapes are regulated, so there's very few pesticides allowed in them. But the black market world, it's like the wild, wild west. And on average, how many different pesticides did you see in one vape?

On average, we were seeing about at least five. And these pesticides could be found at high doses. Now, from the little we know, inhaling certain pesticides at high doses can be dangerous. Following the crumbs of evidence, one of the pesticides found in a lot of the vapes, a fungicide, well, when it heats up, it becomes hydrogen cyanide, which is not exactly something you want to be inhaling.

Another pesticide found in more than half of Innie's illegal vapes killed rats that inhaled it at high doses. Now, we can't do that kind of experiment in people, but when a farm worker in Japan sprayed that pesticide without protective clothing, he started sweating and vomiting. And by the end of the week, he had died. So that's two possible suspects.

Vitamin E acetate and pesticides. Both of which are showing up in lots of black market weed vapes. For one dang vape card, you get more vitamin E and pesticides into your lungs than you do THC. Oh my gosh. Don't get me wrong, you will definitely get high, but you add all the other crap that are in there into your lungs as well. But my dear Watson, not everyone who's gotten sick is getting high off dank vapes. There are some other suspects that have recently emerged and they're rather unusual. Here's the lineup. Candy Crash, Cinnablaze, Berry Blast. How dangerous are the flavours in vapes? That's coming up after the break.

Welcome back. We're halfway through our investigation into what's driving the outbreak of lung injuries from vaping. Two possible culprits have been named. Pesticides and vitamin E acetate. But the hunt for this perp is about to get juicy as we enter the world of vaping flavours. And these flavours have been getting a lot of attention recently. Several states have tried to ban them altogether.

Today, Michigan will become the first state in the nation to ban flavoured e-cigarettes and vaping products. Starting next week, flavoured vaping products will be banned from stores in Rhode Island. New York State now set to ban all flavoured e-cigarettes except menthol. So will banning these flavours help solve this problem? Well, for that, we have to take a trip to Flavortown. And our tour guide is Ilona Jaspers,

an inhalation toxicologist and professor at UNC Chapel Hill in North Carolina. Ilona studies the flavours in e-cigarettes. So I asked her. So if you were to do a personality quiz that was asking what vape flavour are you, what vape flavour would you be? I love meat products and I love blood sausage. I love bologna.

Probably say I would be one of those. To first know if these flavours are safe, you have to know what's in them. So we asked Alona about Eddie, who you heard at the beginning of the show, about his favorite flavor, mango. You're a kid. You're thinking like they just boil up a mango and save the essence of it. Yeah, well, I can guarantee you that is not the case. You're making a different mixture

of chemicals that basically then taste like mango. The food industry does this all the time. Yeah, just like your favorite ice creams and sodas, these vapes are all flavored with a hodgepodge of flavored chemicals. And they use all kinds of different chemicals with names like cinnamaldehyde, benzoaldehyde and isoamyl acetate. Rebranded, of course, as cinnamon, cherry almond and banana. And because these flavour chemicals are not all the same, you have to test them individually to see what they might do to human cells. So, Elona douses blood and lung cells in these different chemicals to see what happens. And some flavours, like cinnamon, were worrying. For one, cinnamon could affect these things in

your lungs called cilia. They're little hair-like structures that help you get rid of gunk in your lungs. One of the things that we saw was that this cinnamaldehyde completely abolishes the cilia from actually working the way they are designed to work. In a different group of experiments, Alona wanted to test what the flavors might do to our immune cells. So she put immune cells in a petri dish along with some bacteria and cinnamon flavour. Now, normally, immune cells, even in Petri dishes, can gobble up bacteria. But when we expose it to cinnamaldehyde, we see that it can no longer do that. She found the vanilla flavour also affected your immune cells. For this experiment, though, banana flavour didn't look so bad.

Shame it's gross, though. Anyway, Alona says you put her work together and it suggests that inhaling some of these flavours could increase your chance of getting sick. You're compromising or suppressing the sort of first line of defence in your lungs and that's just not good. Now, Ilona's studies are just in petri dishes. We don't know if this is really happening in cases like Eddie's or anyone's.

But what is crazy here is that these petri dish studies are basically all we have. In the US, vaping has fallen into some strange regulatory grey area, which meant that no one was testing what these flavours do to our body when we inhaled them. And this is not lost on a loner. We're doing this in the completely wrong order. When you have a new product, the safety testing is first done in the petri dish and in mice. And if that fails, it never makes it into a human.

Wait, but that's bonkers because in this case, everyone's, like, tried it already and now you're backtracking. I know. I know. And if you are sitting there thinking to yourselves, how the hell did we let this happen? Why didn't we test this stuff? Well, Alona says, hey, we've done this before. I mean, think about it.

We didn't know what smoking did until decades later. And so why would we expect we already know everything about e-cigarettes? That's crazy. Yes. Welcome to the free market, hey. Yes. Now, these flavors aren't completely unknown to science. They were studied somewhere along the way by the FDA, but for use in food. And Alona says that just because something is safe to eat, it doesn't mean it's safe to inhale. Take a chemical

called diacetyl. It's used to give things like popcorn and vapes a buttery flavor. That's always our example as to why something that's perfectly safe to eat is not perfectly safe to inhale. As far as we know, diacetyl is safe to eat. Your popcorn is fine. But about two decades ago, when a bunch of workers in a popcorn factory inhaled this stuff at high doses, they got really serious lung injuries. A few even needed a lung transplant. And why did this happen?

Well, lots of researchers told us that many things are safer to eat than to inhale, and this is for a very simple reason. When stuff gets in your stomach, it gets hit with acid and then filtered out to your liver. But the lungs, they just don't give you this industrial-style clean. Yeah, so the lung is really not well-equipped to detoxify. The lung is really there to take oxygen in and CO2, carbon dioxide, back out. And that's why buttery popcorn is safe to eat but not to inhale.

And a few years ago, a case report described someone who was using vapes with this chemical, diacetyl, and he injured his lungs. Okay, so for the case of the mysterious vaping disease, our suspect list. Vitamin E acetate, pesticides, and certain flavouring chemicals. But the thing is, vapes have been around for more than 10 years. So why is this outbreak happening now? Well, there have been isolated case reports of people getting sick over the years, but nothing at this scale.

So clearly something has changed in the vape market. It could be that black market vape manufacturers just recently started using things like vitamin E acetate to make vapes. We don't know because we weren't testing vapes for this before the outbreak started. Or it could be that these shady vape makers just started using way more of this crap than they had in the past and that's what's making people sick.

Or the culprit could be something that we haven't identified yet. There are other chemicals that can be found in the aerosols of vapes, from thickeners to the metal in the vape pen that can leach into the stuff you inhale. And since we haven't found one common culprit that everyone who's gotten sick has inhaled, it suggests that maybe there's more than one guilty suspect in this lineup. That's what Alona thinks. I don't think it's caused by one thing. I don't think it's one

chemical that's causing all of this. I think it's a combination. But although this outbreak can feel really scary, this mysterious lung injury is actually super rare. There are some 10 million vapers in the US and so far only around 1600 have been diagnosed with this. That is a tiny fraction of people who vape. But the thing is, because we don't know what's causing this, we don't know how to stop you from being that unlucky person who lands in hospital, which is why the CDC is saying, stop vaping if you can. There is one place where picking up a still might be a good idea, and that's if you're using vapes to replace cigarettes. In this world of vaping companies peddling flavours to kids, it can be easy to forget that vaping was originally invented to help adults quit smoking.

And a lot of researchers thought that was a good idea because vaping was safer than smoking. Jamie Hartman-Boyce is a senior researcher at Oxford University and she's been studying how to get people to quit smoking for years. And Jamie told us that to understand why vaping might be better, just think about how bad smoking is. Imagine that you've literally put your mouth on, like, I don't know, an exhaust pipe of a car, and you're inhaling kind of thick, grey smoke full of all sorts of nasty things that are going to make you feel unwell. I would kind of think about it that way.

Scientists have been convinced that vaping is safer than smoking, partly because of studies that have looked at people who are regular smokers to then see what happens when they switch to plain vaping, so no flavours, no weed. Scientists probe the chemicals in these people who have switched to vaping. They look at their pee and blood and breath and they've found some pretty stark changes.

And what we've seen in some of those studies is that if someone switches from smoking to vaping, they have improvements that are similar to what we'd see if they'd perhaps quit smoking altogether. An Italian study of around 200 smokers found that the ones who switched to vaping were breathing out far fewer harmful chemicals a year later. And a National Academies of Science report from last year

wrote that there is, quote, conclusive evidence, end quote, that subbing vapes for cigarettes reduces your exposure to dangerous chemicals in ciggies. But these studies were all done before the outbreak in the US. So should what's happening now change how we feel about vapes? We put this to Jamie. With this new lung disease that we're seeing in America, it's killing some people, it's hospitalising others. Does that change the equation for you? So absolutely, these deaths

in the States from vaping are incredibly concerning and warrant urgent investigation. But I think in this area, it's always in comparison to smoking when we're talking about safety. What I'm saying is that smoking is incredibly and uniquely deadly for something that's legal. I mean, it's just unbelievable that it's legal, right? And when you're comparing vaping-regulated products to smoking, all the evidence we have so far overwhelmingly suggests

that vaping is safer. Cigarettes kill more than a thousand people in the US every day. And so far, vapes have just killed over 30. But I think we never thought e-cigarettes were risk-free. We always thought that they were considerably safer than smoking and nothing I've seen so far has convinced me otherwise. And as freaked out as the CDC currently is about vaping, they've also said that if you're vaping instead of smoking, don't go back to ciggies. Okay, but what if you're currently a smoker and you want to quit? There's other things to try, patches, medication. Should you go for the vapes?

For me at the pub, with a ciggy in my hand, what's the message for me? I think the message for you is there are lots of ways to quit smoking that have been proven to be safe and increase chances of success. Give those a try. If you tried them and they haven't worked, or for some reason you don't want to try them, really think about switching to an e-cigarette. In studies, it's clear that vapes help some people to quit smoking. But the reason that Jamie says try everything else first is because when you look at these vaping studies, on a whole, they're actually pretty underwhelming.

So a lot of people who try vapes go back to smoking cigarettes. And ultimately, we just have more studies on stuff like patches. But bottom line, despite this outbreak making vapes look pretty scary, Jamie says cigarettes are still scarier. And she is so confident that legal vapes are safer that she and her colleague wrote a little ditty about it. So next time down the pub when you're offered a smoke Here's what you can say to your friend

Switching to vaping is safer than smoking May help you quit in the end Ah, nerds and their acoustic guitars. So, when it comes to vaping, where are we up to now? The FDA and CDC have an ongoing investigation into what's causing this. They've recommended for now that if you can, stop vaping until the situation is sorted. As for the people who are already sick, we don't know what's going to happen to them. But when we at Science Versus looked at more than a dozen case reports from people whose lungs were injured from vaping over the last five years,

the vast majority did recover. And what about Eddie, who you heard from at the beginning of the show? Well, his mum says that months later, he's still not fully recovered. Geri, talk to our senior producer, Caitlin Sori, about it. So how's he feeling? He does have an inhaler if he needs it. He has these moments where he gets winded, walking up steps. It's football season. Is he allowed to play football?

He is not. So there was definitely some disappointment from him. It's a scary world to know that these products are being made in people's basements and sold in the black market because we don't know what's in them. Yeah, I mean, I find all of it to be very, very scary. That's Science vs. Vaping. Happy Halloween. Hi, Caitlin Sorey, Senior Producer of Science vs. Hello, Wendy Zuckerman, Host and Executive Producer of Science vs. Oh, enough.

You, how many citations in this week's episode? There's lots. There is 141. Do you vape a little? No. No. No, it's not my wheelhouse. But I have friends who have switched from ciggies to vaping.

And I feel like there was a question there, like, are we doing the right thing? Yeah. Should we stop? Should we go back to ciggies? And I feel like now I can be like, don't go back to ciggies. That's bad. Do you have the song? I'm not going to sing it.

You all know it. You just heard it. And if people want to see these citations, where should they go? They can go to the show notes. They can also go to our website, which is scienceverses.show. Thank you so much. Thank you. And if you're interested in the business side of vaping,

you should check out the Journal's episode on this, the Journal. We'll link to the episode in our show notes. Next week, we're tackling 5G technology. We've had a lot of requests for this one. So should you be worried about the rollout of 5G? We are, of course, making one huge experiment because we are exposing almost the entire human population of the Earth. This episode was produced by our senior producer, Caitlin Sorey,

as well as producer Michelle Dang. With help from me, Wendy Zuckerman, Lexi Krupp, Rose Rimler and Meryl Horn. We're edited by Caitlin Kenny. Fact-checking by Michelle Harris. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Bobby Lord and Emma Munger. A huge thanks to all the people we spoke to for this episode, including Dr Yasmeen Butt, Dr Sean Callaghan, Dr Travis Henry,

Professor Irfan Rahman, Christopher Harville, Alex Sandorf, Dr James Panko, Dr Konstantinos Farsalinos, Dr Lorraine Martin, Dr Moon Chong Tang, Dr Kevin Davidson and Myron Rene. An extra thanks to Connor Duffy, the Zuckerman family and Joseph Lavelle Wilson. I'm Wendy Zuckerman. Back to you next time. Thank you.