January 1, 2020
The recent paper “Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth” provides a very well documented case report of a 17 year old youth who developed serious lung disease, likely from vaping.
Unlike the cases of EVALI that have been attracting a lot of attention in the US, the authors make a good case that this young man developed bronchiolitis obliterans, a rare form of serious lung disease also known as “popcorn lung” because it was first identified among workers in a factory making microwave popcorn.
What’s the connection? Microwave popcorn is often flavored using diacetyl to give it a buttery flavor. While fine to eat, it seriously damages lungs. Diacetyl is a widely used flavoring agent in e-cigarettes.
Diacetyl causes different problems that vitamin E acetate, which has been identified as one likely casue of EVALI.
December 31, 2019
Updated January 1, 2020 to reflect more information. "Baby step" is being too kind; this is a complete capitulation to industry that portends a lax regulatory environment for e-cigs as companies submit their premarket applications.
Press reports on New Year’s eve indicated that the White House will allow the FDA to stop allowing the sales of flavored e-cigarettes except menthol for closed systems (like Juul pods), but continue to all sales of flavored tank (open) systems.
This is a big win for the big tobacco companies (including Juul) because menthol is the most important flavor. Juul, like the rest of the big tobacco companies, has been lobbying to keep menthol (and tobacco) flavors.
Why? When Juul stopped selling other flavors, sales of mint skyrocketed and made up the difference. (Menthol is derived from mint.)
As CNN reported when covering the announcement:
December 30, 2019
Last October, RJ Reynolds submitted its Premarket Tobacco Product Application (PMTA) to FDA seeking approval to market its Vuse e-cigarette. Because, unlike claims of modified risk, FDA is not required to make PMTA applications available for public comment, we have no idea what is in the RJR application or whether they meet the standard in the law that allowing marketing of Vuse would be “appropriate for the protection of public health.”
As the first known application for an e-cigarette, the Vuse decision will set important precedents for approval of all e-cigarettes. For this reason alone, FDA should submit the PMTA to its Tobacco Products Scientific Advisory Committee (TPSAC) for external assessment. Doing so will also make the PMTA available for outside public comment, through comments submitted to TPSAC.
December 29, 2019
Several people have commented on this blog asking how to get involved in class action lawsuits against Juul and other e-cigarette companies.
These two blog posts have links to the complaints, which have the lawyers' contact information in them. If you are interested, you can contact them.
In making this information available, I am simply answering questions, not urging any particular action or endorsing any particular lawyer.
https://tobacco.ucsf.edu/class-action-lawsuit-against-juul-moves-forward-san-francisco
https://tobacco.ucsf.edu/class-action-lawsuit-filed-against-juul-and-altriaphilip-morris-builds-past-litigation-against-big-tobacco
If there are other cases I missed, please send them and I will post them.
For completeness, here is California's case: https://tobacco.ucsf.edu/californias-lawsuit-against-juul-details-how-online-age-verification-joke
December 28, 2019
Jane Steinberg and colleagues recently published “A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications” in American Journal of Public Health. They did a comprehensive review of how the first eleven states that legalized adult use cannabis are dealing with public usage. Seven of the states allow some form of public use, which has the potential to undermine nonsmoking norms and protections from secondhand smoke.
They provide a good summary of the state of affairs, but don’t have any good solutions to the knotty problem of how to allow use of legal cannabis outside the home. This is a particular problem for people who live in multi-unit housing, where smoking is increasingly restricted. In public housing, using cannabis (which is still federally illegal) raises concerns about eviction.
One thing that they don’t address directly is that, unlike tobacco smoking, many state governments are still looking for ways to promote cannabis use as a cash cow. I don’t think that this will materialize because as time passes we will get a better understanding of the adverse effects of cannabis.