Farsalinos, Polosa blast recent report claiming vaping causes lipoid pneumonia

Last week, the U.S. Centers for Disease Control and Prevention (CDC) issued a press release updating its public health warning on the “vaping related” hysteria over flavored vapes.  After conducting an extensive internal investigation, the CDC now attributes the lion’s share of medical diagnoses to the vaping of THC-containing products.

Furthermore, the study also indicates that 78 percent of all EVALI patients admitted to purchasing their THC vapes from “informal sources” which the CDC defines as friends, family members, in-person dealers, or other questionable venues.  In a January 14 tweet, the CDC made the following statement. 

“CDC recommends that you should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources. Data suggest these products play a major role in the current lung injury outbreak. Learn more: http://cdc.gov/lunginjury. “

Related Article:  CDC issues updated warning: Most lung patients purchased THC vapes from ‘informal sources’

While the CDC is finally acknowledging publicly what the U.S. Food and Drug Administration (FDA) has been claiming for months, the anti-vaping activists are not willing to give up the fight.  In a recently published article in the American Thoracic Society (ARS), Drs. Thomas Eissenberg and Wasim Maziak make the argument that the CDC should not yet rule out nicotine-based vapes as a contributing culprit to the mysterious outbreak of respiratory disorders of this past fall.

Bogus study suggests vegetable glycerin can cause lipoid pneumonia

Eissenberg and Maziak contend that because the majority of e-liquids used in vaping contain vegetable glycerin (VG), they are still infinitely capable of inducing lipoid pneumonia – a respiratory disorder which allegedly manufactures many of the same symptoms of EVALI.  The co-authors further suggest that because the ingredient VG is so prevalent, manufacturers of e-liquids may sometimes choose to cut corners by using a cheaper and less safe substitute.  In an ATS press release, Eissenberg and Maziak made the following assertions.

“The fact that not all e-cigarette related lung injury cases were associated with THC use, and that THC ‘vaping’ usually involves an oil vehicle (e.g. butane hash oils) do not rule out an important role for lipid-mediated lung injury in this clinical entity. This is particularly important to keep in mind given that most e-cigarette liquids contain VG as an essential component (helps make the e-cigarette aerosol visible). The implication is that many e-cigarette users, currently asymptomatic (or experiencing milder symptoms for which they do not seek medical attention), maybe undergoing lipid deposition in their airway, with concomitant inflammatory changes induced by lipid-laden macrophages and other immune cells.”

Related Article:  AHA study is bogus; vaping is NOT as bad for the heart as smoking, says Siegel

However, when the article was published on PubPeer, a website devoted to the peer-review by other academics and scientists of newly published research, the Eissenberg and Maziak report drew immediate criticism from a number of tobacco control and respiratory disease experts.

Dr. Konstantinos Farsalinos blasts VG allegations

Dr. Farsalinos of the Onassis Cardiac Surgery Greece, Department of Pharmacology, University of Patras, Greece, called the Eissenberg and Maziak statements “unreasonable” and “irrelevant.”  He also notably points out that this “vaping related” lung scare is largely confined to the United States, which contradicts the argument that vegetable glycerin – “adulterated or not” – may be at play.

“The experience in the US over the past several months clearly shows that the culprit for the acute lung intoxication cases are black market THC oils which were sold as THC oils, not e-cigarette products. There were no e-cigarette liquids (adulterated or not) implicated in these cases. It is a matter of basic epidemiology: there are millions of vapers all over the world but the epidemic is confined to the US only, with the vast majority of cases being confirmed to using THC (the rest were probably false reports as is the case with EVERY epidemiological investigation - rarely, if ever, can you verify that 100% of cases in an epidemic were definitely exposed to the culprit).”

Dr. Riccardo Polosa rebukes report

Dr. Polosa, Professor of Internal Medicine and specialist of Respiratory Diseases and Clinical Immunology at the University of Catania in Italy, was much more succinct in his reprimands.  He says there is “no way” that conventional nicotine-based vapes containing VG can cause lipoid pneumonia. 

“Lipoid pneumonia is a rare respiratory illness that may occur from aspiration or inhalation of fat-like material in the lung; this has been reported in elderly people after accidental ingestion of oil-based laxatives.
“There is no way vaping could put people at risk for lipoid pneumonia simply because vaporization of commercially available e-liquids do not contain fat-like material.”

Clive Bates weighs in

Vaping advocate and the Former Director General of Wales, England, Clive Bates was one of the first academics to respond.  In his rebuttal, Bates suggests that Eissenberg and Maziak revisit their impossible theory before this disinformation “can spread further.”

“The problem is that vegetable glycerin (glycerol) is not a lipid it is an alcohol. It cannot cause the lipoid pneumonia symptoms mentioned...
“I'm not sure, but doesn't that leave the entire argument in this paper in ruins? No doubt the authors will wish to address this concern before the misunderstanding can spread further.”

Related Article:  Farsalinos rebukes study citing increased toxicities of e-cig vapor

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