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What’s the health care system to do when thousands of individuals, many of them between the ages of 18 and 34, arrive at hospitals across the country with serious, previously unknown breathing problems that may be related to their use of e-cigarettes and vapes? Maybe take a lesson from Hippocrates: First, do no harm.

Reports of this lung problem, now being called e-cigarette or vaping product use associated lung injury (EVALI), began emerging in June 2019. The Centers for Disease Control and Prevention says that more than 2,600 cases have been reported from every state except Alaska, the District of Columbia, and one U.S. territory; dozens of deaths have been confirmed. The supposed culprits in these illnesses range from vaping THC to using modified equipment, inhaling black-market liquids and, most recently, vitamin E acetate, a chemical used as an additive or thickening agent in some vaping products.

The knee-jerk reaction by some states has been to pull e-cigarettes and vapes off the market. Even the federal government has suggested it might push for a ban on some vaping and e-cigarette related products. But these products have been shown to be effective at helping smokers quit — more effective, in fact, than any other nicotine-replacement therapy on the market, including nicotine patches and nicotine gum.


We don’t need to ban vaping. What we need to do is the research needed to build a better vape.

Taking the wrong action — meaning action not backed by scientific evidence — could do more harm than good. For instance, bringing down the regulatory hammer before we understand EVALI could lead those who use e-cigarettes or vapes as replacements for cigarettes to return to smoking or purchase black-market vaping liquids, which may make the problem worse.


By building a better vape that can be used as an effective cigarette replacement without getting people sick, we can ensure that these nicotine therapies continue to help people quit smoking traditional cigarettes — which we know causes cancer and other diseases — without creating a new public health crisis. But doing this will require a combination of research, innovation, and regulatory oversight.

To a certain extent, the research has already begun. The Food and Drug Administration and the CDC are now collecting samples of e-liquids connected to EVALI cases in hopes of determining if there are any toxic ingredients these samples have in common. But often there’s barely enough liquid left in the cartridges in question to test, leaving researchers unable to determine what the toxic ingredient could be, let alone draw connections between ingredients from liquid to liquid.

I believe that the biggest hurdle lies in how the scientific community predicts what is actually toxic to humans. For instance, many ingredients in e-liquids, such as vitamin E acetate, flavorings, propylene glycol, and glycerin, are seen as safe for humans to ingest or put on their skin, but we don’t know the risks of inhaling large amounts of them over time. Much of the current research is done in animal models, which are slow, expensive, and don’t necessarily predict toxicity in humans.

To learn whether these ingredients are contributing to the EVALI problem, the FDA will need to test them specifically in human lung tissue. But studying just cells from human lungs — or in the case of the CDC’s most recent findings, in samples of lung fluid — doesn’t provide accurate data, as it doesn’t include mucus or the lung conditions that can affect the absorption of inhaled drugs.

As a biomedical engineer who works on formulating inhaled drug therapies for lung diseases, I spend a lot of time thinking about how to build accurate models of the human lung and what features to include: mucus, types of cells, fluid, blood circulation, and the like. To study if my treatments actually work, I need both an accurate model of the lung disease I am trying to treat and the accurate dose of inhaled therapy that would be administered to someone. Without measures of these two things, a study won’t hold up in the lab.

When it comes to EVALI, we don’t have either one.

If e-cigarette companies want to stay in business, they need to invest in the research needed to make safer products. It’s possible that a single ingredient or component could be replaced to make vaping safer. It could be that vape pens themselves give off toxic fumes when heated and reheated at high temperatures. Or it could be something else. But we won’t truly know until vape manufacturers are willing — or forced by the government — to invest in the research.

We have an opportunity here to avoid making the same mistakes with vaping as we did with cigarettes. By waiting too long to invest in research into cigarette toxicity, we caused a global lung cancer epidemic, the effects of which are still being felt today.

Regulatory and scientific processes are underway to ensure that the health risks of vaping are known earlier. Banning e-cigarettes and vaping devices may halt some illnesses related to their use, but it won’t further our understanding of the cause of these illnesses. In fact, there are other products, like inhaled insulin, that also cause mysterious lung injuries. What we need is to invest in research that gives us a clearer picture of exactly what’s going on in the lungs when we inhale any type of drug or additive.

By doing that we can increase the overall safety of inhaled medicine, which includes building a better vape: one that can help cigarette smokers quit without risking the dangers of EVALI.

Diane Nelson, Ph.D., is a postdoctoral fellow in Carnegie Mellon University’s chemical engineering department studying the effects of drugs and toxins on the pulmonary system with funding from the Burroughs Wellcome Fund. She was named a 2018 STAT Wunderkind in recognition of her research.

  • And the cigarette companies and the American government knew long before they admitted it about the harms of tobacco. There are far worse thing we could be focusing on. Not one person has died from any e cigarette related illness. The evali nonsense caused by thc cartos is not an ecig. Understand the technology before you publish your misinformation.

  • Its not about quitting for some, it is harm reduction. I am choosing to not quit, but use the less harmful alternative. Sure if I really wanted, I could quit like I did with drugs and alcohol, but for now I am enjoying nicotine.

  • Lets start with the statement, that everything is better than regular cigarettes, there is no doubt. If vaping works for you to quit smoking, it’s ok. But Would you be able to quit this habit eventualy? In my opinion e-cigarettes is not an answer, because you’re not stoping the smoking habit, so even if you’ll get rid of the nicotine, you will not be completely free and with big chance for relapse. I succeed thanks to this book – net-bossorg/the-easiest-way-to-quit-smoking-for-life and shurely can recommend it.

    • And besides, vaping has been shown to be twice as effective as any other nicotine replacement like the gum and patch. I smoked for 15 years and tried to quit countless times. I ended up wearing a patch and smoking at the same time. It’s not so much the nicotine as for me it was the ritual. Vaping allows you to keep the ritual which makes it in my opinion the path of least resistance. I was handed my cousins ecig at the Santa Monica pier where smoking is not allowed and I thought it was the greatest thing since sliced bread . And this is 7 years ago when all we really had was the crappy cartomizers. The next day I had my own. And I wasn’t doing it to quit smoking . I just liked it better. And without intending to I didn’t buy another pack of smokes again. So the lesson here is after numerous attempts to quit smoking, vaping allowed me to finally achieve that goal, without even thinking about it. So for all those who have a beef with vaping, it is the most effective tool our society has to combat addiction to combustible cigarettes. The creator should be given the Nobel prize and statues of him built in bronze at every hospital. If you think about how many lives cigarettes can claim, this dude is a savior. And somehow as a society we have our heads so far up our ass , that we are banning it and freedom at the same time. Imagine banning the cure for all cancer because it had to be administered i.v. and then claimed it was a gate way to hard drugs like heroin. Cuz even if that was true, it’s still worth the trade off. If you are against vaping I imagine you just hate everything that other people do anyways.

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