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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.

  • I know that vaping is better than smoking, but vaping is still the same habit, and when you’re addicted to something, you should change this habit in first place! Of course that it’s better to smoke e-cigarette that the normal one, it’s less harmful, better smell etc. But it’s not a good way for someone, who wants to quit at all. I would recommend to read this book – net-bossorg/the-easiest-way-to-quit-smoking-for-life

  • It is amazing that the US federal government can tell me what I can and cannot do. I quit smoking after 50 years by with JUUL. My sense of smell has returned, my chronic cough is gone, and I don’t stink. So now, I have to turn back to cigarettes? Time to give the job of parenting back to the parents and not the FDA and the Feds in DC. Time for parents to do their jobs!

  • Is there any connection to flavored Vapes and evali?
    Last I knew it was caused by vitamin e acetate or other oil based additives.
    Nicotine and flavors are water or alcohol based, which is why vapers for the most part don’t get evali.
    I don’t vape thc, but I suspect thc Vapes are melting the atty and or contaminated with oil based additives. Thc is also fat/oil soluble chemical, which makes me believe it should not be Vaped in an alcohol based solution in the first place.

  • It’s all about money. The government, tobacco companies and the pharmaceutical companies don’t want smokers to switch to vaping. Tobacco and pharmaceutical companies are losing money from vaping. They want you to continue to smoke and to continue to use their own nicotine replacement therapy products and drugs. Their lobbyists fund politicians to sway them in their favor as well States are losing money from the Master Settlement Agreement. The testing for vaping is quite expensive and will soon be required for FDA approval. Many small businesses will not be able to afford to do this and will have to close. Money is more important than health.

  • Yes. What we need is a better drug delivery system, NOT moe regulations. Even though nicotine addiction is a public health problem. Even though people have died vaping. Even though human beings do not have a need for tobacco, nicotine, vaping, or smoking. The answer is NOT ending people’s addiction to nicotine, it IS better delivery devices. Mabey an injectable form to bypass the lung altogether!

  • There is nothing wrong with electronic vaping devices. These devices have been around for almost over a decade. This was all black- market self made THC CONTAMINATED JUICE! Leave it to the vape shops and stop placing blame on anything other than the truth!
    This was all caused by tainted black-market thc juice! End of story!

  • The problem is, it isn’t the devices that are the issue, vaping has been around for over a decade using largely the same devices, and no one has gotten seriously ill or died from it. The recent illnesses have been conclusively linked to adulterants in THC products, NOT nicotine products at all.

    But the public health apparatus at large is in a period of overcorrection on tobacco, anti-scientifically attacking and restricting safer new alternatives even while tobacco remains legal. As a result the CDC and health departments were reluctant to be clear from the start that this probably was not related to nicotine vaping, and that black market THC cutting agents were probably the culprit. As a result more people got sick and died than should have.

    The solution is to kill some sacred cows — we need to accept that nicotine vaping isn’t really that bad and might even be good.

  • Sorry but you and several govt. health officials even the CDC keep making a fundamental mistake describing the cause of VALI in that.. The FDA has classified an e-cigarette as a Tobacco Product. (This is wrong imo. There is No tobacco in an e-cig) because an e-cigarette uses a nicotine solution. The primary solutions being propolyne glycol, vegitable glycerin, liquid nicotine & flavorings. All are Water Soluble! The vaping lung injury cases are being caused by an inhaled Oil Aerosol that is severely damaging the lung tissues. Marijuana (THC) vape Oil cartridges, that have been altered by adding vit E acetate (Oil based) are causing these patients severe lung damage! as is now stated by the CDC. Thus, if these cases are being caused by a THC vape pen with an Oil based solution, there is No Way an e-cigarette with a Water Based solution can cause it! The CDC wrongly conflates e-cigarettes, which are nicotine products, with THC vape pens. They even coined the name for this condition, EVALI, erroniously in that the first word is e-cigarette. Again, an e-cigarette Can Not cause this! Per the FDA’s classification! Wont do it! It is very important to use the correct termanology in this vaping crisis as e-cigarettes have a great benefit to public health by helping smokers quit. This misuse of vaping termanology has done great damage to nicotine vapers, the vaping industry, public perceptions, ect. Nicotine vaping, e-cigarettes have been on the market for 10 years. During this time No One has died from vaping nicotine. (except from battery malfunction). Over 5 Million former smokers are nicotine vapers! E-cigarettes dont need to be researched to be made better as to not to cause VALI. It is caused by illegal drug dealers altering a drug, marijuana oil, in order to make more money. Not sure how one reasurches that? What Govt. Science & Media can do is a much better job informing the public & polliticans about this situation. So that the public can stay healthy and politicans can enact sound policy. Sadly more of the public thinks nicotine vaping is harmful & thc users were not informed of the harm in a timely manner. Politicans have enacted ineffective emotionally motivated policies that actually harm public health. I am a former smoker who vapes – e-cigarettes – not marijuana vape pens – and my health is much improved. The e-cigarette industry makes quality reliable products that are critiqued by a well educated consumer. Most people in an offical capacity that are newly involved with vaping unfortunately do not understand all the different aspects of this technology. However, the Most important aspect is the fact that e-cigarettes Save Smokers Lives! They do Not cause lung injury, lung cancer or life threatening diseases! Vapers have known this all along. Note: e-juice or e-liquid does not either. Tainted Marijuana or THC Oil does. Their users refer to them as vape pens. Regards William

  • Do some research, vitamin E acetate is not used in e liquid today. It is a thickening agent used in illicit THC black market Cartridges to make them stretch further. In other news Most Modern vapes use Kanthal which does not produce harmful chemicals when heated and reheated. Do some research before posting fiction in an article.

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