The 2019 EVALI ‘Misinfodemic’
Part One (of three): Searching for ‘patient zero’
The Foundation for a Smoke-Free World recently commissioned an independent analysis of media coverage before, during, and after the 2019 US EVALI (e-cigarette, or vaping, product use-associated lung injury) outbreak. Our analysis covered over 18,000 news stories published by top-tier media outlets in the United States, United Kingdom, India, and South Africa between January 1, 2019 and March 31, 2020.
In August 2019, one month before the outbreak peaked in September, the US Centers for Disease Control and Prevention (CDC) coined the term EVALI. Our goal with this media analysis was to uncover how journalistic coverage of the EVALI outbreak influenced public perceptions surrounding nicotine.
The outbreak in a nutshell
Health officials in the United States noticed a sudden cluster of vaping-related lung injuries in July 2019. Most victims reported using bootleg tetrahydrocannabinol (THC) vaping products. Neither the geographic distribution nor the age distribution of EVALI patients correlated with legal nicotine vaping. All individuals with EVALI who were tested had vitamin E acetate (VEA) — a thickening agent used to ‘cut’ illegal THC vape oils — in their lungs. In April 2020, the EVALI lung poisonings were shown to be most common in US states where recreational cannabis and THC use are illegal.
In November 2019, the US CDC publicly confirmed the probable cause of EVALI (in May 2020, the CDC congratulated itself for pinpointing VEA as the culprit). VEA seems to have entered the bootleg THC vape oil supply chain in late 2018. By early 2019, legal THC vape oil producers were proudly proclaiming that their products did not contain VEA.
In September 2019, a prominent member of that community, who had raised alarms linking VEA to lung injuries as early as August, published a comprehensive article that traced the journey tainted bootleg THC cartridges took from China to the United States:
What we know is this: Near the end of 2018, a new additive entered the street THC vape cart supply. And hundreds of serious pulmonary injuries, and possibly as many as nine deaths, followed. Public health officials and labs have discovered the new additive — a form of vitamin E oil used as a cutting agent — tainting a large amount of the devices that sick people reported using.
Misdiagnosis and misperceptions
THC and nicotine vaping involve different devices, liquids, supply chains, people, and purposes. They should not be confused. But they were. Our analysis shows that evaluated news coverage focused primarily on nicotine vaping, and on nicotine itself. The public confusion that resulted is alarming for three reasons:
In response to a US EVALI outbreak, caused by illegal unregulated THC vaping products in the US only, many US states and countries around the world moved quickly to ban or restrict access to nicotine vaping products. As Australian researchers who studied this response have noted, “Media reporting in the US, Australia and the UK of the CDC’s analysis of the causes of the EVALI outbreak contributed to regulatory over-reactions to nicotine vaping by the public health community.”
The @FDATobacco's decision to ban #menthol cigarettes is a good start, but not enough. @JamesKGlassman1 believes we can accelerate an end to combustible cigarettes by countering disinformation & providing incentives to switch to harm reduced alternatives. https://amp.usatoday.com/amp/4972316001
Will the Biden-Harris administration’s embrace of #harmreduction extend to tobacco? Derek Yach (@swimdaily) believes recent policy choices bode well for #tobaccoharmreduction and represent an important step toward ending the smoking epidemic.
https://filtermag.org/evali-misinformation-increased-smoking/ The implications of @Alex_Norcia @Filtermag_org @mbsiegel comments are clear. #Disinformation (Deliberately spread false info) increases adult smoking & will kill people. @FDATobacco & @CDC need to aggressively oppose falsehoods. @SmokeFreeFdn @GregTHR
It’s #MentalHealthAwarenessWeek. Did you know that those who struggle with #mentalillness are also disproportionately suffering from smoking-related illnesses? #Smokingcessation services should be included in more #mentalhealth treatment plans. https://bit.ly/34EKUHI
.@Doctor_Sud was interviewed by @snusforum about the consequences of rampant nicotine misinformation. @Doctor_Sud says, “One of the most common nicotine misconceptions is that nicotine, in quantities consumed in cigarettes or pouches, is carcinogenic.”
Following up on my recently co-authored #OpenScience @qeios pre-print with Dr Fagerström, here is an interview discussing the prevalent nicotine illiteracy that is preventing the realisation of a world free from risky forms of tobacco.
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