The Daily - The Promise and Peril of Vaping, Part 1: A Mystery in Nebraska

Episode Date: October 28, 2019

When John Steffen died, his family had little doubt that a lifetime of cigarette smoking was to blame. Then, the Nebraska Department of Health got an unusual tip.Today, we begin a two-part series on the promise and the peril of vaping. Guest: Julie Bosman, a national correspondent for The New York Times, spoke with Kathleen Fimple and her daughter, Dulcia Steffen, in Omaha, Nebraska. For more information on today’s episode, visit nytimes.com/thedaily. Background reading: John Steffen trusted vaping could help him quit smoking. Instead, he became one of vaping’s first victims in Nebraska. Vaping can cause lung damage resembling toxic chemical burns, according to researchers at the Mayo Clinic.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. When John Stephan died, his family had little doubt that a lifetime of cigarette smoking was to blame. Then, the Nebraska Department of Health got an unusual tip. Part one of a two-part series on the promise and the peril of vaping. It's Monday, October 28th. You will see the animals on the wall. So there's a rainbow trout and an antelope and a deer above the fireplace. Julie, tell me about this trip you took to Nebraska. So a couple of weeks ago, I went to Omaha, Nebraska.

Julie Bosman is a national reporter at The Times. And I went to the home of Kathleen Fimple, where she lives with her dog, Bo, a little terrier. And Kathleen showed me around her house. And I sat down with Kathleen and her daughter, Dulcia, and her granddaughter. And they showed me something that Dulce had made after the death of her father, John Stephan. My daughter made this. It was a glass box. That's what we used for the funeral. And inside were mementos that represented his life.

He played guitar, so we've got guitar picks, and Grandma's Featherbed was a song we all liked to sing together. So John was a very active outdoorsman. There was a turkey feather from one of his hunting expeditions. There's a shotgun shell. There's the antler. This knife has an antler. There were badges and pins.

He was a scout leader. And there were dried flowers from his funeral spray. And how exactly did he die? So John died after a long illness. He was a lifelong smoker. What did he smoke? Marlboros. Not the lights, the...

Oh, no. No. So he started smoking back in the 60s when he was a teenager, and it was a habit that he really stuck with for most of his life. How did he feel about his smoking? Was he like, oh, I hate this or I love it and I don't want to quit? I love it and I don't want to quit. And also a lot of denial, especially early, early on. My grandpa lived to be whatever 80 something and he smoked so he was kind of clinging to the idea that smoking wasn't bad eventually i think he reconciled that yes smoking was bad and it could cause cancer he tried very very hard to quit. In his 30s, when we were first married, he quit several

times briefly. Sometimes he would be successful, and then he started up again. Yeah, he'd stop for a month or two, and then, yeah. And his daughter, when she had her own baby daughter, she would take little pictures of the baby and, like like tuck them into his packs of cigarettes. So that he would see her face every time he pulled out a cigarette. I was like, okay, I've tried all the little tactics. So she tried everything she could, but his addiction to nicotine was, you know, decades strong. but then he developed COPD chronic obstructive pulmonary disease which is a very common disease that many smokers develop and in his case it gave him a very bad cough and it made it difficult to breathe at times we'd go to church and he'd sing a line and then he'd stop and then he'd have to pick it

up later because he'd have to catch his breath in between. And he used to whistle all the time. He couldn't whistle anymore. He had atrial fibrillation and sometime later he got non-Hodgkin's lymphoma and had to have chemotherapy for years. I think that was when he started vaping. Do you know how he got the idea? No, we both, I'd kind of seen advertising, that's for it and thanks, but it was his idea and he bought one and came home with it. He bought one and came home with it. So John started vaping about five years ago.

Do you know which brand? Mystics. Then he had Blue, and then he went to Juul. And he only went to Juul less than a year ago. And he had heard about vaping as the cleaner, healthier alternative to cigarettes. So he became just as enthusiastic of a vapor as he was a smoker. So earlier this year, it was a cold winter and everybody had a cold and a cough and John kind of got it the worst. And it probably, in some ways, was less obvious to us because he had a smoker's cough.

Yeah. So he coughed. But it was also obvious that this was worse. And his daughter, Dulcia, started nagging at him and saying, Dad, you really need to go to the doctor. That's probably why he went, though, in April. Because you kept pushing him. Yeah. So he did. And he was diagnosed with pneumonia. Dr. Simon said, you have pneumonia. You're going to the hospital. And he was in the hospital for a week. and seven, eight days into his hospital stay.

His hands were like ice. They were starting to turn blue. He couldn't blink and his mouth was propped open and he wasn't breathing very often. And his last breath, I could tell because there was just a slight twitch in his neck. He died of acute respiratory failure, which the doctor said was a consequence of the COPD. So essentially, he died of smoking or smoking-related lung disease, it sounds like. Yes. His wife said that he always believed that he was going to die of lung cancer. So when the doctors said that he had died essentially as a consequence of COPD,

they had no reason to question the doctor's conclusion. And as tragic as that is, it all kind of lines up with our understanding of what a lifetime of smoking does to a person. Right. But then four months after John died, Kathleen was sitting at work one day. I was in a meeting when the Department of Health called. She got a phone call from an investigator at the Nebraska Department of Health. And he asked her all kinds of questions. He asked about any exposure in the past to like moldy wood or wood chips, to asbestos, to pesticides. Then they asked about symptoms. He asked if he had had any kind of vomiting

before his death. Did he lose weight? Was he coughing? And he also asked her about vaping. I said, I don't know why vaping. I mean, yes, he vaped, but I don't think it's from vaping. They said he had pneumonia, lifelong smoker, COPD. And the investigator got off the phone with her and said he would be in touch. So Julie, what was John's relationship to vaping? Kathleen told me that when he was smoking cigarettes, he would smoke a cigarette two or three times an hour. And very quickly, he was vaping two or three times an hour. It was a straight replacement for cigarettes.

Yeah. Yeah. Part of it was habit, you know. Years and years of habit. When you get in the vehicle, you light up a cigarette. So when he'd get in the vehicle and start to drive, he would vape. It was a good way to, you know, help him get his nicotine fix. I knew it wasn't the perfect solution. But again, figured it was better. Right. For him and for us.

Did you ever think like, could they be dangerous? No. We know when they first marketed them, they said it was a safer alternative. We assumed it was healthier for those around him as well. And then a few days later, Kathleen spoke to the medical investigator again, and he told her that it had been confirmed John was Nebraska's first official vaping-related death. This morning, Nebraska health officials have announced the state's first vaping-related death. This morning, Nebraska health officials have announced the state's first vaping-related death. That's right. The person was over 65 and from the Douglas County, which is the Omaha area. The individual died in May, but the state health department just identified it as vaping-related. So Julie, what exactly is going on here? Why is an original conclusion about John's cause of death now being re-evaluated?

And it seems challenged. What is happening? So back in May when John died, there really was no such thing as a vaping-related death or a vaping-related illness. But throughout the summer, all these illnesses and deaths began to be reported. And all over the country, people began to look back at cases of people who had died, people who had gotten sick, and started to think a little differently about them. And in Nebraska, the state health department wouldn't have even looked at John's death if they hadn't received a tip. We'll be right back.

So Julie, tell me about this tip. So here's what happened. Tell me about this tip. So here's what happened. John had an old friend who he went to high school with, and they saw each other at an alumni reunion a few years ago. They sat together with their spouses at this dinner, and throughout the dinner, as she described it, John was vaping constantly.

And she had never seen anyone vape before. This was in 2014. It was kind of a new thing. And she told me that she was very alarmed by what she saw. What exactly alarmed her? She was concerned because he was vaping so frequently. Of course, when you smoke, you generally have to go outside and do it. But John was vaping indoors, sitting at dinner.

And she also just had this kind of gut sense that there was something kind of wrong about it. And she couldn't quite shake the feeling even after the reunion was over and years had gone by. And she and John really didn't keep in touch. But earlier this year when John was sick, she had heard that he was in the hospital. And then she heard that he died in May. in the hospital. And then she heard that he died in May. So she waited all summer and she started seeing things in the news about people getting sick and dying from vaping. There is breaking news tonight in the nationwide vaping crisis, another death and new reports of possible lung disease. The CDC is looking into dozens of cases. The CDC can confirm 31 cases. 200 potential cases.

380 cases. The 450 cases. 530 cases. It's unclear just what's causing the problem. The CDC says it will continue to investigate. And she told me that she kept looking in the paper. She kept looking on the news to see if John was one of those people. And that never happened.

So at the end of the summer, she decided that she just couldn't get rid of this feeling that vaping was related to his death. So she called the state health department. So she was the tip. Yes. So her tip gets passed along to a medical investigator. And he was the investigator who called John's wife and spoke to her and interviewed her about his medical history. He did a bunch of other things too.

So he spoke to the physicians who attended to John, who treated him when he was sick in the hospital in Omaha. He examined his medical records. He looked at his chest x-rays. And it showed pneumonia in the lower lobe of one lung. But the rest of his lungs, both sides and upper and lower, were filled with what they call ground glass opacity. A ground glass appearance on the lungs is an injury to the lung that is typically consistent with vaping. And in some cases, it can look like there are kind of opaque white spots on the x-ray.

And I said, well, how does that, is that different from just a long-term smoker? And he said, yes. This is not what you would see in just routine, if you will, long-term smoking. And in this case, it was a very key piece of evidence for the investigator who was looking into John's death. And what's the understanding of how vaping might create this kind of ground glass looking damage in the lung?

So when you vape, of course, you use a device that heats liquid to a very high temperature and turns it into a vapor that you inhale. Now that liquid can contain THC, which is the ingredient in marijuana that gets you high, or it could contain nicotine. And doctors who are investigating all these illnesses and deaths don't know exactly what it is about vaping that is making people sick. But they have noticed that some of the people who have gotten sick or died have had the ground glass appearance on their lungs, or in some cases, they've had damage on their lungs that resembles a chemical burn. Hmm. Julie, my sense is that most of these vaping-related illnesses and the deaths that we have been reading about have been not from the well-known e-cigarette brands,

but from basically counterfeit and bootleg products, right? Yes. So here's what we know about that. Of the people who have gotten sick or died from vaping in the last year, about three quarters of them have vaped THC products. A little over half have vaped nicotine. And a lot of people do both, kind of toggle back and forth between vaping weed and vaping nicotine. But as best we can tell, John did not vape THC. When I asked his family, they kind of laughed at the idea that their 68-year-old husband and father would be procuring bootleg THC. Is that unthinkable? Do you have any, I mean, is that something that he might have possibly done? I don't think he would have even known where to go to get it.

We've been to Colorado since it was legalized and he wouldn't touch it. He was never interested. No, so I don't think he would have ever considered getting at Black Market either. They described his vaping habits as very above board. Do you know where he bought it? Walmart. Walgreens or Walmart. Walgreens or Walmart.

Uh-huh. I don't think he bought them anyplace else. He never went to any of the vape shops or anything. Oh, never. Never. I mean, is it possible that John was vaping something like THC, but just didn't tell his family that no one knew? His family very strongly discounts that possibility. He would have had to be doing it in secret. And they thought that

notion was rather ridiculous. So if he got sick from vaping, it was from regular old, I guess if the industry's old enough to call it this, but traditional vaping. Yes. And this really only deepens the medical mystery surrounding vaping because so many people who have gotten sick

or died from vaping have been using THC vapes and especially vaping devices or cartridges that were bought off the street. And no one really knows where they came from. But that's not the case with John. Right. So Julie, how does John's death, as defined and diagnosed by these medical professionals locally and nationally. How does it change our understanding of vaping and its consequences? I think that his death raises an alarming possibility. And that is that someone who apparently did not vape THC, did not buy any kind of products on the black market, could also become very sick and die from a vaping-related illness.

Right. And his family told you that he took up vaping, as many people do, because he thought it was actually going to make him healthier. It was going to help him quit smoking. Yeah. He thought that this would be the thing that would help him quit smoking for good, and it did. And, you know, people like John Stephan are exactly the kind of person that e-cigarettes were ostensibly created for. When e-cigarettes were invented and when companies started selling them on the mass market, they said that it was for people who wanted to quit smoking and wanted a healthier alternative. wanted to quit smoking, and wanted a healthier alternative.

And John was exactly that person. So what's the understanding of why so many people, not just John, but hundreds of people are getting sick from this and maybe even dying from it? Well, I would just point to cigarette smoking and when it was first introduced. Cigarette smoking really took off during World War I among American men. And it wasn't until the 1930s when doctors began to link an increase in lung cancer rates to an increase in cigarette smoking. And it took decades after that. It wasn't until 1964 when the Surgeon General released a landmark report saying, yes,

smoking does cause lung cancer. So I think what a lot of doctors out there are saying is that it is far too early to know what the long-term effects of vaping might be. In other words, the gestation period for any kind of public health problem is long, is maybe even decades. Yes, and it's very early in e-cigarettes' life. I mean, they really didn't enter the mainstream until the last 10 years. In which case, we would be at the beginning of whatever this is, not even the middle and definitely nowhere near the end. I think we can say for sure that the CDC believes that there are many,

many more cases coming and that this is only the tip of the iceberg. Julie, does John's family think that he would still be alive today if he hadn't taken up vaping? That's a difficult question. It's something that they do think about. And when they look back on his life, they know that taking up smoking as a teenager was certainly a bad decision. And continuing to smoke all those decades was something that they wish he had not done. But they thought that he made a really good decision when he switched to vaping.

They didn't worry about the health consequences of vaping. And when his daughter looked at the vaping container that was left over sitting on the coffee table, vaping container that was left over sitting on the coffee table she doesn't see something that is harmless or something that might have helped prolong his life she sees something very dangerous i think that that box right there could be the sole reason he's dead in some ways is like looking at a gun with a bullet. It's just a method of death. Julie, thank you very much. Thanks, Michael. We'll be right back.

Here's what else you need to know today. Last night, the United States brought the world's number one terrorist leader to justice. Abu Bakr al-Baghdadi is dead. On Sunday, President Trump announced that the founder and leader of the Islamic State died during a U.S. military operation in Syria. Capturing or killing Baghdadi has been the top national security priority of my administration. the top national security priority of my administration. Abu Barker al-Baghdadi inspired thousands of men and women from across the world to join ISIS and in 2014 created a caliphate for the terrorist group that at its height was the size of Britain and imposed a brutal form of Islam on its inhabitants. The thug who tried so hard to intimidate others spent his last moments in utter fear,

in total panic and dread, terrified of the American forces bearing down on him. After years of eluding American forces, al-Baghdadi was recently discovered in northwest Syria, where U.S. commandos chased him into a tunnel. There, he detonated a suicide vest that killed himself and three of his young children. He was a sick and depraved man, and now he's gone.

depraved man. And now he's gone. That's If The Daily. I'm Michael Bavaro. See you tomorrow.