ENDS EVALI VALI THCVALI: Difference between revisions

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<big>'''“E-cigarette or Vaping Product Use-Associated Lung Injury” (EVALI) -- Right Illness, Wrong Name. Will The CDC Correct It?'''</big>

The 2019–2020 outbreak of acute lung injuries in the United States was real. The name given to it was the problem.

The Centers for Disease Control and Prevention (CDC) named the outbreak “E-cigarette, or Vaping, Product Use-Associated Lung Injury,” or EVALI. That name embedded e-cigarettes and vaping into the medical language of the outbreak, even as clinical, laboratory, and epidemiological evidence increasingly pointed to vitamin E acetate in illicit, unregulated THC cartridges, not standard nicotine e-cigarettes.

The harm from the name “EVALI” did not end when the outbreak ended. By conflating nicotine vapor products with illicit THC cartridges, public health messaging distorted risk perceptions, contributed to widespread misunderstanding, and left many people believing that regulated nicotine vaping caused the injuries. That confusion affected many people. People who had switched from combustible tobacco to nicotine vaping went back to smoking. Some people who smoked tobacco became leery of switching. People using unregulated THC carts may not have recognized quickly enough that the warnings applied to the products they were using. With better messaging, some of the illnesses and deaths might have been averted.

This page documents efforts to get the CDC to correct that name, the consequences of leaving it unchanged, the scientific evidence identifying the source of the outbreak, and the people who tried to correct the record in real time. It does this by bringing together journal articles, formal policy critiques, media analysis, public health statements, and consumer-led documentation to show how one imprecise name became a lasting public health communication failure.

~~<big>'''“E-cigarette or Vaping Product Use-Associated Lung Injury” (EVALI) -- Right Illness, Wrong Name. Will The CDC Correct It?'''</big>~~

='''~~Communication With The~~ CDC'''=

='''CDC and the term "EVALI"'''=

*In chronological order. These are quotes from the linked sources.

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===2021 (Declined): [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view Letter from: Peter Briss, MD, MPH, EVALI Incident Manager, 2019-2020, Medical Director, National Center for Chronic Disease Prevention and Health Promotion, CDC]===

*Given the lack of evidence to rule out the contribution of other chemicals of concern to the EVALI outbreak, the possibility that chemicals of concern could be introduced into supply chains of either THC or non-THC-containing products in the future, the prudence of assessing substance use broadly where clinically indicated, and that some EVALI cases reported exclusive use of nicotine-containing products, CDC declines to rename EVALI.

===2021: [https://twitter.com/mikepesko/status/1468932559098757127 Mike Pesko]===

Thread on X (formerly Twitter) about the letters.

===2026 (Request): [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view Letter to: Jay Bhattacharya, Acting Director - Centers for Disease Control and Prevention]===

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==Articles, Op-Eds, Blogs, Media==

===2022: [https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187 The CDC’s EVALI screwup]===

*There’s no shame in being wrong. We all make mistakes. It is, however, shameful to fail to admit and correct a mistake — especially when lives are at stake.

**Citation: Gunther, M. (2022, January 17). The CDC’s EVALI screwup. The Great Vape Debate. Retrieved June 6, 2026.

===2026: [https://filtermag.org/cdc-abandon-evali/ Will the CDC Finally Abandon the Damaging Term “EVALI”?]===

*The CDC cannot undo the frightened headlines from 2019. It cannot reopen the vape shops that went under because of the panic. It cannot persuade every person who went back to cigarettes because they were falsely told, directly or by implication, that nicotine vaping had caused a wave of damaged lungs and death. But it can stop repeating the mistake.

**Citation: Murray, K. “Skip.” (2026, April 16). Will the CDC finally abandon the damaging term “EVALI”? Filter. Retrieved June 6, 2026

===2026: [https://www.cannabinoidsandthepeople.whitewhalecreations.com/p/stigma-more-anesthesia-cud-chs-and Harm reduction: US overdoses down everywhere except the West + CDC should abandon the term “EVALI”]===

*Basically, this EVALI phenomenon has now been linked distinctly to tainted illicit THC vape cartridges that contained vitamin E acetate, but ever since the confusion of when this story broke, EVALI has become associated with legal nicotine e-cigarettes. This is detrimental to public health because, despite the hand-wringing you might see in some places, vaping nicotine instead of smoking tobacco is a huge public-health win. But misunderstandings around the term EVALI have led to a reduction in nicotine vaping in favor of tobacco smoking. The CDC needs to fix this.

**Citation: Pelger, L. (2026, May 18). Stigma, more anesthesia, CUD, CHS & the War on Drugs. Cannabinoids & the People. Retrieved June 6, 2026.

===2026: [https://www.disobedientmargins.com/p/the-name-we-choose-for-what-happened The Name We Choose for What Happened]===

*As of April 2026, it is still possible to find headlines around the world linking lung injuries from the 2019 outbreak to nicotine e-cigarettes. The name continues to do the work that the evidence has already undone.

**Citation: Teixeira, C. (2026, June 4). The name we choose for what happened. Disobedient Margins, Substack. Retrieved June 6, 2026.

='''Misperceptions, Misinformation, Disinformation'''=

*Newest to oldest. These are quotes from the linked sources.

*Newest to oldest. These are quotes from the linked sources. All talk about EVALI.

*Note: At times, EVALI has been conflated with Popcorn Lung, COVID, Lipid Pneumonia, ARDS, etc. A true testament to how unclear messaging confuses health care providers, media, lawmakers, public health, and consumers.

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**Citation: Barros EM, Ferreira AC, Neelon B, Ravenel IE, Carpenter MJ, Smith TT. Shifting perceptions of e-cigarette risk: A secondary analysis from a nationwide, randomized controlled clinical trial of e-cigarettes among smokers. Addict Behav. 2026 Jul;178:108672. doi: 10.1016/j.addbeh.2026.108672. Epub 2026 Mar 15. PMID: 41865464.

***Acknowledgment: Funding for the parent study was provided by the National Cancer Institute (R01CA210625 to MJC). Ms. Barros was supported by a grant from the National Institute on Drug Abuse (R25DA020537). Ms. Ravenel was supported by the SC CHEER YES program funded by Hollings Cancer Center and TD Bank. MJC has served as a paid expert in e-cigarette litigation within the past 3 years.

===2025: [https://pmc.ncbi.nlm.nih.gov/articles/PMC12306916/ Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study]===

*Of 19,661 news reports on Tobacco Watcher that discussed EVALI, 55.9% mentioned cannabis. Among the 157,499 middle and high school students participating in the statewide survey in California, 75% had heard about EVALI. The awareness level was similarly high for 8th, 10th, and 12th graders (75.7%, 74.6%, and 74.8%, respectively). Their primary source of knowledge about EVALI was media (63.1%), followed by parents (16.6%), teachers (8.1%), friends (7.7%), and peers (4.6%). Most students, 55%, believed nicotine was the cause of EVALI, while only 11% thought it was related to cannabis in vapes.

**Citation: Wang J, Ayers J, Leas E, Gamst A, Zhu SH. Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study. J Med Internet Res. 2025 Jul 29;27:e69151. doi: 10.2196/69151. PMID: 40729669; PMCID: PMC12306916.

**Acknowledgment: JA is one of the creators of tobaccowatcher.org, a project of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health for the Bloomberg Philanthropies.

===2023: [https://tobaccocontrol.bmj.com/content/32/e2/e255 Over 1 year later: smokers’ EVALI awareness, knowledge and perceived impact on e-cigarette interest]===

*Approximately 54% of smokers had heard of EVALI. Among those who had heard of EVALI (n=542), 37.3% believed its main cause was e-cigarettes used to vape nicotine, like JUUL. Fewer (16.6%) thought the main cause was products for vaping marijuana/THC, and 20.2% did not know. About 29% had heard vitamin E acetate was associated with EVALI, and 50.9% indicated EVALI made them less interested in using e-cigarettes in the future. EVALI awareness was significantly associated with e-cigarette risk perceptions (ie, that e-cigarettes are as harmful as smoking).

**Citation: Wackowski OA, Gratale SK, Jeong M, et alOver 1 year later: smokers’ EVALI awareness, knowledge and perceived impact on e-cigarette interest. Tobacco Control 2023;32:e255-e259.

***Acknowledgment: This work was supported by the National Cancer Institute (NCI) of the National Institutes of Health under Award Number R37CA222002. Contributions by MJ were supported by K01CA242591, and those by CD and MBS were supported in part by R01CA190444, also from the NCI. Contributions by SKG and CD were also supported by U54CA229973 from the NCI and the Food and Drug Administration.

===2022: [https://onlinelibrary.wiley.com/doi/10.1111/add.16097 United States public health officials need to correct e-cigarette health misinformation]===

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**Citation: Katherine East, Jessica L Reid, Robin Burkhalter, Olivia A Wackowski, James F Thrasher, Harry Tattan-Birch, Christian Boudreau, Maansi Bansal-Travers, Alex C Liber, Ann McNeill, David Hammond, Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’), Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1386–1395, https://doi.org/10.1093/ntr/ntac088

*** Acknowledgment: This work was supported by a P01 Grant (1P01CA200512) from the US National Institutes of Health (NIH). Additional support was provided by a Canadian Institutes of Health Research (CIHR)–Public Health Agency of Canada (PHAC) Applied Public Health Research Chair (DH). The February 2020 Wave of the ITC Youth Tobacco and Vaping Survey was funded by a contribution from Health Canada’s Substance Use and Addictions Program (SUAP). KE is the recipient of Fellowship funding from the UK Society for the Study of Addiction (SSA). KE and AM also acknowledge support from Cancer Research UK (RE12936). Contributions by OAW were supported in part by the NIH (R37CA222002). The views expressed herein do not necessarily represent the views of any of the funding agencies. DH has served as a paid expert witness in legal challenges against tobacco and vaping companies.

===2022: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak]===

*Given the number of states that did not appear to update their messaging regarding the cause of EVALI, we believe that states should re-evaluate this messaging to accurately communicate the risks of e-cigarette use.

**Citation: Katchmar, A., Shafer, P. & Siegel, M. Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak. Harm Reduct J 19, 112 (2022). https://doi.org/10.1186/s12954-022-00694-6

***Acknowledgment: This work was supported by a supplies grant from the Kilachand Honor’s College at Boston University. The College did not review this work prior to submission.

===2022: [https://www.nber.org/system/files/working_papers/w30255/w30255.pdf MISINFORMATION, CONSUMER RISK PERCEPTIONS, AND MARKETS: THE IMPACT OF AN INFORMATION SHOCK ON VAPING AND SMOKING CESSATION]===

*We estimate that the misinformation shock created by the EVALI outbreak reduced ecigarette demand by 24-36 percent. Our results echo earlier research that finds that information shocks in the 1950s and 1960s reduced cigarette demand (Schneider, Klein, and Murphy 1981). However, in the 1950s and 1960s many consumers were unaware of the health consequences of smoking and altered their behavior when accurate information on health risks became available. The earlier information shocks thus helped to correct consumer mistakes and improved consumer health and welfare. In contrast, in the 2010s many consumers were either uninformed or already mistakenly believed that e-cigarettes were riskier than smoking. The EVALI information shock exacerbated consumer mistakes and likely worsened consumer health and welfare. Based on a population health model, we predict that over the next 50 years the EVALI information shock will lead to 450,000 life years lost due to deterred smoking cessation. As points of comparison, the CDC reports that seat belts saved almost 13,000 lives in 2009 and an estimated 255,000 lives from 1975 through 2009.31 Preventing EVALI entirely might have been very difficult, but a different set of risk communication policies could have prevented some of the pre-existing misinformation and some of the EVALI misinformation shock.

**Citation: Jin, L., Kenkel, D. S., Lovenheim, M. F., Mathios, A. D., & Wang, H. (2022). Misinformation, consumer risk perceptions, and markets: The impact of an information shock on vaping and smoking cessation (NBER Working Paper No. 30255). National Bureau of Economic Research. https://www.nber.org/papers/w30255

***Acknowledgment: Produced with the help of a grant to Cornell University from the Foundation for a Smoke-Free World, Inc. (FSFW), a U.S. nonprofit 501(c) (3) private foundation. This study is, under the terms of the grant agreement with FSFW, editorially independent of FSFW. The FSFW had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The contents, selection, and presentation of facts, as well as any opinions expressed herein are the sole responsibility of the authors and under no circumstances shall be regarded as reflecting the positions of FSFW. FSFW accepts charitable gifts from PMI Global Services Inc. (PMI), which manufactures cigarettes and other tobacco products. Under FSFW’s Bylaws and Pledge Agreement with PMI, FSFW is independent from PMI and the tobacco industry. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

===2022: Comments RE: [https://pubpeer.com/publications/053A4DD87764E36C0B9FF00B260480 Discussions of Flavored ENDS Sales Restrictions: Themes Related to Circumventing Policies on Reddit]===

*This article incorrectly states, “In the wake of the e-cigarette or vaping use-related lung injury (EVALI) outbreak in September 2019, electronic cigarette manufacturer JUUL voluntarily removed flavored pods aside from tobacco and menthol from the U.S. market” That sentence is false and creates a factually inaccurate and damaging link in a reader’s mind between JUUL products and the 2019 lung injuries (EVALI) when none exists. In fact, Juul Labs reduced its flavor portfolio to tobacco and menthol to combat underage use and the ingredients of JUUL products do not include vitamin E compounds or THC that were primarily linked to EVALI. (Murillo)

**Referring to: Silver N, Kucherlapaty P, Kostygina G, Tran H, Feng M, Emery S, Schillo B. Discussions of Flavored ENDS Sales Restrictions: Themes Related to Circumventing Policies on Reddit. Int J Environ Res Public Health. 2022 Jun 23;19(13):7668. PMID: 35805325; PMCID: PMC9266029. [https://doi.org/10.3390/ijerph19137668 doi: 10.3390/ijerph19137668]

===2021: [https://www.qeios.com/read/ZGVHM7.3 The outbreak of lung injuries often known as "EVALI" was nothing to do with nicotine vaping]===

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**Citation: Dave, D., Dench, D., Kenkel, D. et al. News that takes your breath away: risk perceptions during an outbreak of vaping-related lung injuries. J Risk Uncertain 60, 281–307 (2020). https://doi.org/10.1007/s11166-020-09329-2

***Acknowledgement: Dhaval Dave acknowledges support through grant R01DA039968 from the National Institute on Drug Abuse. The authors are grateful to Cornell University and the Health Thought Leadership Network at Bentley University for funding the data collection.

===2020: [https://journals.lww.com/anesthesiology/fulltext/2020/10000/sparking_the_discussion_about_vaping_and.47.aspx Sparking the Discussion about Vaping and Anesthesia: Comment]===

*To the Editors...

*'''The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil. This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.'''

**Oyston, John M.B., F.R.C.A.. Sparking the Discussion about Vaping and Anesthesia: Comment. Anesthesiology 133(4):p 948-949, October 2020. | DOI: 10.1097/ALN.0000000000003476

==Articles, Op-Eds, Blogs, Media==

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**Citation: Norcia, A. (2022, December 15). End vape misinformation, tobacco control experts urge Surgeon General. Filter. Retrieved June 6, 2026.

==~~Community Notes on X~~==

===2021: [https://filtermag.org/evali-misinformation-increased-smoking/ New Evidence Links “EVALI” Vaping Misinformation With Increased Cigarette Smoking]===

*A new study now suggests that legislation arising from misstatements about EVALI and e-cigarettes in Massachusetts actually caused an increase in cigarette consumption throughout Boston.

~~='''Lung Injury Research~~ (~~EVALI~~)~~'''=~~

**Citation: Norcia, A. (2021, May 7). New evidence links “EVALI” vaping misinformation with increased cigarette smoking. Filter. Retrieved June 6, 2026.

*Newest to oldest. ~~These are quotes from the linked sources~~.

==~~Journals~~==

===2020: [https://morningconsult.com/2020/02/05/electronic-cigarettes-increasingly-blamed-by-public-for-lung-illnesses-even-as-evidence-points-elsewhere/ Electronic Cigarettes Increasingly Blamed for Lung Illnesses, as Evidence Points Elsewhere]===

*CDC identified THC vapes with vitamin E acetate as culprit, but 66% of adults blame e-cigarettes for vaping deaths

**Citation: Wilson, S. (2020, February 5). E-cigarettes increasingly blamed for lung illnesses, as evidence points elsewhere. Morning Consult. Retrieved June 6, 2026.

==~~Articles~~, ~~Op-Eds~~, ~~Blogs~~, ~~Media==~~

===2019: [https://reason.com/2019/10/09/muddled-message-about-vaping-causes-costly-confusion/ Muddled Message About Vaping Causes Costly Confusion]===

*Vague lung disease warnings tar harm-reducing e-cigarettes while obscuring the role of black-market cannabis products.

**Citation: Sullum, J. (2019, October 9). Muddled message about vaping causes costly confusion. Reason. Retrieved June 7, 2026

-------~~--------------------------~~

==Tweets==

===2021: [https://x.com/KozlovichS/status/1373116501130051587 Dr. Shannon Kozlovich (thread)]===

*In 2019 there was a mysterious illness killing people known to use vaping devices. @CDCgov soon discovered that the additive causing the lung injury was Vitamin E Acetate. In Dec 2019 we mixed VEA with nicotine e-liquids and discovered that they don’t mix.

*This speaks to the need for a completely #legal and well regulated #cannabis market. These products would be safer and open to the vast resources at our research institutions. It is past time that we know when cannabis can help, when it can hurt, and how.

*We also took pure #nicotine (nicotine that was NOT in an e-liquid solution) and mixed it directly with VEA. We did fine that nicotine itself is miscible (can be mixed/visibly soluble) in VEA. The combination of VEA + nicotine is possible but also cost prohibitive.

*IF VEA was mixed with a nicotine e-liquid, it would form a visible layer that could be identified upon visual inspection of the liquid.

*The conditions we tested ranged in a-liquid solvent type and pH range. We created liquids from the most common nicotine solvents PG/VG and we used 0.3-3% nicotine. We tested nicotine base (used in tank e-cigs) and nicotine salt (made popular by JUUL).

*What doesn’t this paper tell us? Nothing in this publication says that nicotine products are safe. This paper only covered the mixture of VEA and nicotine e-liquids.

===2020: [https://twitter.com/ScottGottliebMD/status/1217893624353980416?s=20 Scott Gottlieb, MD] (thread)===

*An e-cigarette is an FDA regulated electronic nicotine delivery system (ENDS). It delivers nicotine. What CDC seems to be trying to refer to here are illegal vapes or “dabs” that contain THC. We develop precise regulatory nomenclature for a reason. It helps differentiate products

*CDC should reconsider the name it ascribed to these illnesses (EVALI) now that it seems to be definitively linked to THC vapes and dabs. By not speaking with precision it could leave a false impression as to the clear causal relationship between the tragic illnesses and THC vapes

*The public health risk is that kids using these illegal and dangerous THC products may not know that the CDC warnings relate to the THC products they’re using; since the CDC is not using a precise nomenclature to more clearly describe the THC vapes and dabs

===2019: [https://twitter.com/ScottGottliebMD/status/1177704654068748293?s=20 Scott Gottlieb MD]===

*My point is simply if you know a THC product hurt someone, don’t call it an e-cigarette, call it a THC vape or THC vaping product. Nomenclature matters in helping consumers properly identify which products are causing which kinds of risks. That’s why we develop naming systems.

==~~Studies~~ / ~~Papers=~~=

==Community Notes - EVALI Misinformation on X (Formerly Twitter)==

The misinformation about nicotine vaping and EVALI continues to spread around the globe years after the outbreak. The tweets below have a [https://x.com/i/communitynotes/about Community Note (CN)] that got enough votes to be made public. Anyone can see them and vote on them. There are many more tweets where the CN does not yet have enough votes. And there are 100s more (maybe 1000s!) without a community note. Community Notes are a way to help correct misinformation, and became [https://grok.com/share/c2hhcmQtMg_6d9005c7-f4ea-4f13-a8b3-0a6158fccc27?rid=535a5f53-cc73-4cd8-8655-5b407d99314b available] to most users late in 2022.

===2026===

*May 2: [https://x.com/ChronosIntelX/status/2050460076302119243 Chronos Intelligence @ChronosIntelX] (5816 followers)

*May 1: [https://x.com/forallcurious/status/2050433667282219081 All day Astronomy @forallcurious] (453.5K followers)

*April 11: [https://x.com/A3Noticias/status/2043066564996407378 Antena 3 Noticias @A3Noticias] (2M followers)

*February 3: [https://x.com/argosaki/status/2018870277107822947 GP Q @argosaki] (127.3K followers)

*February 3: [https://x.com/ClevelandClinic/status/2018713096404267388 Cleveland Clinic @ClevelandClinic] (1.7M followers)

===2025===

*December 24: [https://x.com/hemo_shk/status/2004010818732781789 Dr.Haitham Hamoud @hemo_shk] (17.8K followers)

*December 9: [https://x.com/drkaanyl/status/1998470605461701007 Prof. Dr. Kaan Yılancıoğlu @drkaanyl] (215.2K followers)

*December 2: [https://x.com/wdunlap/status/1995892820163658065 Wayne Dunlap @wdunlap] (250.1K followers)

*May 17: [https://x.com/DarrenPlymouth/status/1923710684556055002 Darren of Plymouth @DarrenPlymouth] (126.4K followers)

*May 6: [https://x.com/GMB/status/1919641214422253759 Good Morning Britain @GMB] (1M followers)

*March 26: [https://x.com/j00ny369T/status/1904861513527013715 Johnny @j00ny369T] (221.7K followers)

*Febrary 17: [https://x.com/LungAssociation/status/1891553473210057206 American Lung Association @LungAssociation] (44.6K followers)

===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151740/ Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent]===

===2024===

As of December 12, 2019, the Wadsworth Center has analyzed 206 vaporizer fluids from 61 NYS EVALI cases. Of these, 147 contained THC, and 59 contained nicotine. Of the 147 THC-containing fluids, 101 (69%) contained VEA. In the nicotine-containing products we analyzed, we detected no unusual compounds that appeared to be of concern.

*November 13: [https://x.com/BreakMyCoffee/status/1856902175844438254 The Coffee Break | Grow Smarter Daily @BreakMyCoffee] (19.8K followers)

~~There is additional evidence of a strong association of VEA with EVALI. In the initial analyses of bronchoalveolar lavage fluids from EVALI patients, 28 of 28 fluids contained vitamin E acetate.~~

*May 16: [https://x.com/MillsHayesTV/status/1791133326461313070 Mills Hayes @MillsHayesTV] (5,099 followers)

*May 16: [https://x.com/FoxNews/status/1791205781892645038 Fox News @FoxNews] (29.1M followers)

~~===2020~~: [https://~~www~~.~~nejm.org~~/~~doi~~/~~full~~/~~10.1056/nejmoa1916433 Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI]===~~

*April 23: [https://x.com/BFHD/status/1782912224597840165 Benton-Franklin Health District @BFHD] (1,542 followers)

~~The FDA detected no vitamin E acetate in 197 case-associated nicotine products analyzed to date.~~ The ~~viscosity of vitamin E acetate makes it undesirable as an additive to nicotine solutions.~~

Data that have been reported to date indicate that vitamin E acetate in the supply of THC-containing products and use among patients with EVALI aligns with the timing of the 2019 EVALI outbreak. In Minnesota, 10 of 10 products seized by law enforcement during 2018, before the EVALI outbreak, did not contain vitamin E acetate, whereas 20 of 20 THC-containing products seized by law enforcement during September 2019, at the peak of the outbreak, contained vitamin E acetate.

~~Pure THC oil has a viscosity like that of vitamin E acetate. Cutting THC oil with vitamin E acetate has been reported to be common in the illicit market.~~

~~===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878297/ Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states~~]~~===~~

These findings are consistent with evidence linking the EVALI outbreak to vitamin E acetate and informally purchased or modified THC e‐liquids, as opposed to use of well‐established nicotine e‐cigarettes.

~~===2019 - December 20~~: [https://~~www~~.~~nejm.org/doi~~/~~full~~/~~10.1056~~/~~NEJMoa1916433?fbclid=IwAR3Qt3IWJlBf3g3kW9RBWQJTza3CAMr0UsoRrFk3peCeEDX5wGooCAGkmBQ Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI~~]~~===~~

*Updated February 20, 2020

*Among the case patients for whom laboratory or epidemiologic data were available, ~~47 of 50 (94%~~) ~~had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness.~~

*~~Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in~~ 16 ~~states across the United States.~~

*[https://~~sci-hub~~.se/~~10.1056~~/~~NEJMoa1916433 PDF Version~~]

*Citation: See Study

*Acknowledgement: Supported by a grant (~~P50CA180908~~) ~~from the National Cancer Institute and a grant (P30CA016058) from the FDA Center for Tobacco Products; and by Ohio State University Pelotonia Intramural Research.~~

~~===2019~~: [https://~~ukhsa.blog.gov~~.uk/~~2019~~/~~10/29~~/~~vaping-and-lung-disease-in-the-us-phes~~-~~advice/ Vaping and lung disease in the US: PHE’s advice~~]~~===~~

~~Dr Dana Meaney-Delman~~, head of the CDC team investigating the outbreak has reported that “We've narrowed this clearly to THC-containing products that are associated with most patients who are experiencing lung injury. The specific substance or substances we have not identified yet”.

We need to be clear about what this outbreak is and is not. It is not a problem linked to long-term use of regulated nicotine vaping products. If it were, we would expect to see a very different demographic profile affected, more typical of long term vapers.

~~PHE has not changed its advice on nicotine containing e-cigarettes: Smokers should consider switching completely and vapers should stop smoking.~~

The evidence still shows that vaping carries a small fraction of the risk of smoking. Using a nicotine-containing e-cigarette makes it much more likely someone will quit successfully than relying on willpower alone. But it’s important to use regulated e-liquids and never risk vaping home-made or illicit e-liquids or adding substances.

==Expert Testimony==

===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===

*Signed by 24 experts from around the world

*Covers 12 key points including EVALI

='''Lung Injury Research EVALI and Coverage of the Cause'''=

*Newest to oldest. These are quotes from the linked sources.

==~~Media~~==

==Journals==

===2021: [https://pubmed.ncbi.nlm.nih.gov/34694926/ Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020]===

*Minnesota was among the first states in which health care providers reported suspected EVALI cases, and MDH responded quickly and effectively to the EVALI outbreak. Despite multiple challenges, MDH’s response had many successes, primarily collaboration with internal and external partners. Minnesota’s experience with the EVALI outbreak provided lessons learned that can be used to strengthen future responses to outbreaks of noncommunicable diseases. Although US public health agencies are well versed in handling outbreaks of infectious diseases, now is the time to ensure adequate capacity to respond to other types of outbreaks.

**Citation: Wiens T, Taylor J, Cole C, Saravia S, Peterson J, Lunda M, Margetta J, D'Heilly P, Holzbauer S, Lynfield R. Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020. Public Health Rep. 2022 Nov-Dec;137(6):1053-1060. doi: 10.1177/00333549211051394. Epub 2021 Oct 25. PMID: 34694926; PMCID: PMC9574319.

***Acknowledgment: Support for this project was provided by the Council of State and Territorial Epidemiologists through the Applied Epidemiology Fellowship Program.

===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151740/ Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent]===

*As of December 12, 2019, the Wadsworth Center has analyzed 206 vaporizer fluids from 61 NYS EVALI cases. Of these, 147 contained THC, and 59 contained nicotine. Of the 147 THC-containing fluids, 101 (69%) contained VEA. There is additional evidence of a strong association of VEA with EVALI. In the initial analyses of bronchoalveolar lavage fluids from EVALI patients, 28 of 28 fluids contained vitamin E acetate.

**Citation: Duffy B, Li L, Lu S, Durocher L, Dittmar M, Delaney-Baldwin E, Panawennage D, LeMaster D, Navarette K, Spink D. Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent. Toxics. 2020 Jan 24;8(1):8. doi: 10.3390/toxics8010008. PMID: 31991538; PMCID: PMC7151740.

***Acknowledgment: This research received no external funding. The authors gratefully acknowledge use of the Wadsworth Center Nuclear Magnetic Resonance Core Facility.

===~~2019 - October 29~~: [https://~~news~~.~~sky~~.~~com~~/~~story~~/us-vaping-~~deaths~~-~~linked~~-to-~~thc~~-~~not~~-~~nicotine~~-~~11848431 US~~ vaping ~~deaths linked to THC~~ - ~~not nicotine~~]===

===2020: [https://www.nejm.org/doi/full/10.1056/nejmoa1916433 Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI]===

*~~A series~~ of ~~vaping deaths~~ in the US have ~~been linked~~ to ~~THC,~~ the ~~illegal psychoactive compound~~ in ~~cannabis~~, and ~~not legal nicotine~~.

*BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015.

*State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%).

*NOTE: This paper has a comment on [https://pubpeer.com/publications/978008D6973E18B43D08A2995A9EAC PubPeer].

**Citation: Blount, B. C., Karwowski, M. P., Shields, P. G., Morel-Espinosa, M., Valentin-Blasini, L., Gardner, M., Braselton, M., Brosius, C. R., Caron, K. T., Chambers, D., Corstvet, J., Cowan, E., De Jesús, V. R., Espinosa, P., Fernandez, C., Holder, C., Kuklenyik, Z., Kusovschi, J. D., Newman, C., . . . Pirkle, J. L. (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. New England Journal of Medicine, 382(8), 697–705. https://doi.org/10.1056/NEJMoa1916433

***Acknowledgment: Supported by a grant (P50CA180908) from the National Cancer Institute and a grant (P30CA016058) from the FDA Center for Tobacco Products; and by Ohio State University Pelotonia Intramural Research.

===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878297/ Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states]===

*Contrary to the perception that EVALI cases stem from vaping per se, neither higher rates of vaping nor greater cannabis use predicted an elevated EVALI prevalence. Mapping state EVALI cases per capita suggests a geographically concentrated cluster of high prevalence states as well as several lower prevalence areas. This variation is less consistent with use of a common, nationally available product driving the outbreak than consumption of black market or locally modified e-liquids.

**Citation: Friedman AS. Association of vaping-related lung injuries with rates of e-cigarette and cannabis use across US states. Addiction. 2021 Mar;116(3):651-657. doi: 10.1111/add.15235. Epub 2020 Sep 28. PMID: 32840932; PMCID: PMC7878297.

***Acknowledgment: Research reported in this publication was supported by grant number 3U54DA036151–08S2 from the National Institute On Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP).

==Articles, Op-Eds, Blogs, Media==

===2019: [https://web.archive.org/web/20211002090904/https://ukhsa.blog.gov.uk/2019/10/29/vaping-and-lung-disease-in-the-us-phes-advice/ Vaping and lung disease in the US: PHE’s advice]===

*"Dr Dana Meaney-Delman, head of the CDC team investigating the outbreak has reported that “We've narrowed this clearly to THC-containing products that are associated with most patients who are experiencing lung injury. The specific substance or substances we have not identified yet”. THC is the main psychoactive component of cannabis and the CDC has said that the products identified are being obtained off the street or from other informal sources (e.g. friends, family members or illicit dealers)."

*The outbreak does not appear to be associated with long term use of nicotine e-cigarettes, which have been used in the US for over 10 years.

*Our concern is that the responses we have seen to the problem in the US and in other countries may increase the already widespread misunderstanding about the relative safety of nicotine e-cigarettes, deterring smokers from switching and risk driving vapers who have switched back to smoking. There is a real risk therefore that such a reaction will mean people continue to smoke, which will undoubtedly put lives at risk.

**Citation: Newton, J. (2019, October 29). Vaping and lung disease in the US: PHE’s advice. UK Health Security Agency. Retrieved June 6, 2026.

===2019: [https://www.inverse.com/mind-body/58581-dank-vapes Dank Vapes Is the "Biggest Conspiracy" in Pot That Can Put You in a Coma]===

*(Note: This is a long investigative article that will educate readers on how hard it is to track down sellers in an unregulated market or illicit sellers in a regulated one.)

*The vapor product DeGrave showed to reporters was distilled from cannabis. But it was also apparently made by the “company” Dank Vapes — an elusive, black-market brand that’s as tricky to pin down as vapor.

*Dank Vapes is not the only black market product that have made people sick, but it is most commonly used product. In September, the CDC released a report that described the spread of EVALI in Wisconsin and Illinois. Fifty-seven of the 86 people with EVALI in that survey reported using Dank Vapes. A report in Utah also noted that Dank Vapes were the most popular black market product used by people with EVALI.

**Citation: Betuel, E. (2019, November 15). Dank Vapes is the “biggest conspiracy” in pot that can put you in a coma. Inverse. Retrieved June 6, 2026.

===2019: [https://news.sky.com/story/us-vaping-deaths-linked-to-thc-not-nicotine-11848431 US vaping deaths linked to THC - not nicotine]===

*A series of vaping deaths in the US have been linked to THC, the illegal psychoactive compound in cannabis, and not legal nicotine.

**Citation: Sky News. (2019, October 29). US vaping deaths linked to THC—not nicotine. Retrieved June 6, 2026.

==~~Suggestions~~ to ~~add~~ to this ~~page==~~

===2019: [https://www.inverse.com/science/59207-vitamin-e-acetate-thc-vapes A Thickener Used in Pot Vaping Is a Hugely Popular Black-Market Scam]===

*(Note: This is a long and informative article that gives a lot of background into how Vitamin E Acetate ended up being a thickening agent, several companies involved, what they did when it was suspected it might be the cause of lung injuries, what companies were transparent and which ones weren't.)

*Sources familiar with the black market THC vape economy tell Inverse that vitamin E acetate is a newcomer — the “thickener” that in some circles was marketed as a “perfect” way to cut THC distillates to make them appear high quality.

*...thick oils are coveted — and sometimes thickeners are used to help mimic the look of high-quality distillate...

*Traditional cuts might have included medium chain triglycerides (MCT) — a component that’s found in coconut oil, for instance. But they also include an excess of terpenes or cuts that are more commonly associated with e-cigarettes, like vegetable glycerin or propylene glycol. More recently, vitamin E acetate has emerged as a new alternative because it offers an even thicker cut that allows sellers to beat the “bubble test,” a way that consumers used to be able to judge a quality distillate.

*Ronay says that his lab will test for vitamin E acetate in vaporizer cartridges in light of the investigation into the thickeners. They expect to have those tests up and running in the next few weeks. Before this, vitamin E wasn’t something labs even knew to test for.

*Several companies advertise branded thickening agents containing vitamin E acetate or other, sometimes unspecified ingredients. Brands like “Honey Cut,” an “all-natural” thickening agent, can be found on ebay. But there are many other thickening manufacturers out there. The Candy Cut, for instance, is a company reportedly based out of Tampa, Florida, claiming to sell thickening and cutting agents by the half-gallon but doesn’t disclose what is actually in them.

**Citation: Betuel, E. (2019, September 13). A thickener used in pot vaping is a hugely popular black-market scam. Inverse. Retrieved June 6, 2026.

===~~2023~~: [https://~~tobaccocontrol~~.~~bmj~~.com/~~content~~/32/e2/~~e255 Over 1 year later~~: ~~smokers’ EVALI awareness~~, ~~knowledge~~ and ~~perceived impact~~ on e-cigarette ~~interest~~]~~===~~

='''EVALI outbreak — Consumer-led research, warnings, and pushback'''=

===Mysterious "vape" illnesses and THC cutting agents===

*When the news broke of vaping lung injuries, consumers started doing their own research, often discussing their findings in Facebook chat groups. Here are some of the compiled notes as they started looking for patterns that might indicate a cause.

*[https://docs.google.com/document/d/1JOD0wBm_lZRmsTwGpkzFFaVXry23T46YMk_8enIFiQw/edit?usp=sharing THC Cutting Agents]

*[https://docs.google.com/document/d/1BMqv26yghILkKpKf%20POhNKQfLV3qFn8JfPEQbBBJN84/edit?usp=sharing Mysterious Lung Issues]

*[https://docs.google.com/document/d/1KeEEsLg9spwI5UigtfYDQwzc8OINZyRkdIBJaFKSvOE/edit?usp=sharing MN, WI, TX, etc - illegal THC carts]

===“DANKing” — A consumer-coined term to distinguish illicit THC carts from nicotine vaping===

*As the very real concern about the "vaping" illnesses and deaths spread, some states and cities moved quickly to ban nicotine vapes, or at least ban the flavors. They seemed to be unaware or ignored that it was unregulated THC products that were causing the outbreak. Consumers knew that the public needed an easy way to differentiate between THC and nicotine. Because so many illnesses were linked to a fake brand called "[https://www.wtvr.com/2019/09/27/in-lung-illness-outbreak-signs-point-to-majority-of-patients-vaping-thc-products Dank Vapes]," Andre Thov coined the term "DANKing." (See [https://www.facebook.com/share/p/1BNi6XLKdM/ comments] on this Facebook post.) Consumers began using the term on social media.

**Thov entered the term on [https://www.urbandictionary.com/define.php?term=Danking Urban Dictionary].

**Advocates wrote reports and press releases, sometimes using the term "danking," to educate the public (often more strongly than public health or the CDC did). Examples: [https://docs.google.com/document/d/1w7ErqSmO-moRR0ExYBCSEy0Bc_yGwxfjlYq7kH_bnEk/edit?usp=sharing “DANKing”, the frightening trend that’s making people sick!] and [https://docs.google.com/document/d/1PDihlSLQjE0VmDDtwftTsSPqByAv3T8cHlZpnN4NXAQ/edit?usp=sharing For Immediate Release From: Tobacco Harm Reduction 4Life Public Health Warning]

*At times, people with lived experience ("consumers") can feel unseen and unheard. They don't always know the power of their voices. Can they influence the conversation? They got their answer when they saw the word used on websites and media sources:

**[https://www.youtube.com/watch?v=exRRX0xrKvE Deadly Pesticides Found In Counterfeit Vaping Products | TODAY].

**Erin Mills, affiliated with PAVe (Parents Against Vaping e-cigarettes), [https://x.com/NYSMom4Kiddos/status/1171472581452419072 tweeted #danking].

**A 2019 webpage titled “FAQs about the vaping lung illness epidemic” on VapingHealthRisk.com used the term “danking” in reference to THC or marijuana vaping products. The page is no longer available at its original URL; a current attempt to access it returns a 502 Bad Gateway error. The original URL was: https://vapinghealthrisk.com/faqs-about-the-vaping-lung-illness-epidemic/. A screenshot of the FAQ text reads: "Are vaping THC or marijuana (aka danking) products worse than nicotine e-cigarettes? Maybe. It appears as if THC and marijuana-related vaping or e-cigarette products may increase the risk of vaping lung diseases. The CDC reports the following usage patterns in the 30 days prior to becoming sick:" (the screenshot does not include the list)

*Dray Moorman, who is both a consumer and a small business advocate, used the term in an Op-Ed published by NEWSMAX: [https://www.newsmax.com/newsfront/vape-vote-vaping-voters-trump/2019/10/11/id/936690/ Dray Moorman: Vape Vote Could Outweigh Impeachment Damage in 2020]. In part, it said: "Smoking black market oil is called danking. THC oil made in a drug dealer’s kitchen has nothing to do with e-cigs. Yet, opportunists and mainstream media are exploiting tragedy to attack vaping. And by doing so, they may be trying to force President Trump to alienate 12 million voters."

*Did those consumers have a lasting impact? While it was a thrill to have an influence on the narrative, most of them felt it wasn't big enough. But, perhaps, it was bigger than they thought. A 2025 WRTV Indianapolis article suggested the term may have had more staying power than consumers realized. In [https://www.wrtv.com/news/local-news/vape-shop-owner-shares-tips-to-avoid-black-market-products Vape shop owner shares tips to avoid black market products], Eskenazi Health Pulmonary Physician Graham Carlos said health officials haven't seen incidents like this since 2019. "People were what's called 'dabbing and danking.' That's when you add things to the pens and there was no regulation,"

~~===2022:~~ [~~https~~:~~//harmreductionjournal~~.~~biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak~~]~~===~~

[[File:Danking Today.png|center]]

~~===2022: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak]===~~

===~~2021: [https://www.ingentaconnect.com/contentone/trsg/trs/2021/00000007/00000002/art00004 Vitamin E Acetate is not Soluble in Nicotine E-liquids]~~===

===Ongoing misinformation and loss of trust===

*[https://twitter.~~com/KozlovichS/status/1373116501130051587 Twitter thread]~~

Consumers are still struggling to trust the CDC. They are left wondering why it was they who had to take to social media to warn the public about the danger of unregulated THC carts cut with vitamin E acetate. They are also left wondering why vape shops had to tell customers that their cannabis use was their own business, but that until things got sorted out, they should smoke cannabis instead of vaping it. Why were consumers and shops quicker at getting the word out than the CDC? Those consumers are left wondering if that was the right time for the CDC to practice the "precautionary principle?"

~~===2021: [https://pubmed.ncbi.nlm.nih.gov/34694926/ Lessons Learned From the E-cigarette~~, ~~or Vaping~~, ~~Product Use-Associated Lung Injury (~~EVALI~~) Outbreak Response~~, ~~Minnesota~~, ~~2019-2020]===~~

To this day, consumers and academics use up considerable amounts of their free time, pushing back against misinformation that is keeping some people trapped in smoking tobacco. "EVALI" is still something weaponized, fueling a moral panic about nicotine vaping, and encouraging policymakers to raise taxes and/or ban the products. The CDC's lack of urgency in addressing the source of the misinformation means the word "EVALI" keeps consumers from trusting anything the CDC says.

=~~==2019 and Beyond: The CDC, the FDA, and others: EVALI===~~

='''Suggestions to add to this page'''=

*Article: [https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187 The CDC’s EVALI screwup]

**Making a mistake is one thing. Failing to ~~correct it is worse.~~

**But there is no evidence–none at all— that anyone got sick with EVALI from using e-cigarettes.

*Twitter thread by [https://twitter.com/mikepesko/status/1468932559098757127 Mike Pesko] about the [https://drive.google.com/file/d/1o0mlqZaMMUeD7Eapc1H0CdSsTz4HsuxE/view letter to ~~the CDC] requesting them to change the name of EVALI, and the CDC~~'~~s [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view refusal] to do so. This letter was signed by 75 international tobacco control / public health experts.~~

*Paper: [https://www.ingentaconnect.com/content/aips/trs/2021/00000007/00000002/art00004 Vitamin E Acetate is not Soluble in Nicotine E-liquids]

**Vitamin E acetate is not soluble in formulations of nicotine e-liquids and if mixed into a nicotine e-liquid will form a visibly distinct layer. Therefore, it is unlikely that nicotine-only e-cig users will be exposed to vitamin E acetate.

*Paper: [https://www.qeios.com/read/ZGVHM7.3 The outbreak of lung injuries often known as "EVALI" was nothing to do with nicotine vaping]

**An examination of the evidence shows that EVALI cannot have been caused by nicotine vaping. The characteristics of the lung injury outbreak are consistent with localised supply chain contamination. The contaminant has been identified and is known to be Vitamin E Acetate. This had been used as a thickener or cutting agent in illicit Tetrahydrocannabinol (THC) cannabis vape pens. This agent cannot be mixed with nicotine vaping liquids and would serve no useful purpose if it could be.

*Article: [https://morningconsult.com/2020/02/05/electronic-cigarettes-increasingly-blamed-by-public-for-lung-illnesses-even-as-evidence-points-elsewhere/ E-Cigarettes Increasingly Blamed for Lung Illnesses, as Evidence Points Elsewhere]

**CDC identified THC vapes with vitamin E acetate as culprit, but 66% of adults blame e-cigarettes for vaping deaths

*Tweets by [https://twitter.com/ScottGottliebMD/status/1217893624353980416?s=20 Scott Gottlieb, MD]

**An e-cigarette is an FDA regulated electronic nicotine delivery system (ENDS). It delivers nicotine. What CDC seems to be trying to refer to here are illegal vapes or “dabs” that contain THC. We develop precise regulatory nomenclature for a reason. It helps differentiate products

**CDC should reconsider the name it ascribed to these illnesses (EVALI) now that it seems to be definitively linked to THC vapes and dabs. By not speaking with precision it could leave a false impression as to the clear causal relationship between the tragic illnesses and THC vapes

**The public health risk is that kids using these illegal and dangerous THC products may not know that the CDC warnings relate to the THC products they’re using; since the CDC is not using a precise nomenclature to more clearly describe the THC vapes and dabs

* Tweet by [https://twitter.com/ScottGottliebMD/status/1177704654068748293?s=~~20 Scott Gottlieb MD]~~

**My point is simply if you know a THC product hurt someone, don’t call it an e-cigarette, call it a THC vape or THC vaping product. Nomenclature matters in helping consumers properly identify which products are causing which kinds of risks. That’s why we develop naming systems.

[[Category:Studies, Surveys, and Papers]]

[[Category:Media - Movies, Videos, Vlogs, Blogs, OpEds, News, etc.]]

@@ Line 1: / Line 1: @@
 <br>
 [[File:Evali.png|center]]
+<br>
+<big>'''“E-cigarette or Vaping  Product Use-Associated Lung Injury” (EVALI) -- Right Illness, Wrong Name. Will The CDC Correct It?'''</big>
+<br>
+<br>
+The 2019–2020 outbreak of acute lung injuries in the United States was real. The name given to it was the problem.
+The Centers for Disease Control and Prevention (CDC) named the outbreak “E-cigarette, or Vaping, Product Use-Associated Lung Injury,” or EVALI. That name embedded e-cigarettes and vaping into the medical language of the outbreak, even as clinical, laboratory, and epidemiological evidence increasingly pointed to vitamin E acetate in illicit, unregulated THC cartridges, not standard nicotine e-cigarettes.
+The harm from the name “EVALI” did not end when the outbreak ended. By conflating nicotine vapor products with illicit THC cartridges, public health messaging distorted risk perceptions, contributed to widespread misunderstanding, and left many people believing that regulated nicotine vaping caused the injuries. That confusion affected many people. People who had switched from combustible tobacco to nicotine vaping went back to smoking. Some people who smoked tobacco became leery of switching. People using unregulated THC carts may not have recognized quickly enough that the warnings applied to the products they were using. With better messaging, some of the illnesses and deaths might have been averted.
+This page documents efforts to get the CDC to correct that name, the consequences of leaving it unchanged, the scientific evidence identifying the source of the outbreak, and the people who tried to correct the record in real time. It does this by bringing together journal articles, formal policy critiques, media analysis, public health statements, and consumer-led documentation to show how one imprecise name became a lasting public health communication failure.
 <br>
 <br>
-<big>'''“E-cigarette or Vaping  Product Use-Associated Lung Injury” (EVALI) -- Right Illness, Wrong Name. Will The CDC Correct It?'''</big>
-='''Communication With The CDC'''=
+='''CDC and the term "EVALI"'''=
 *In chronological order. These are quotes from the linked sources.
@@ Line 14: / Line 24: @@
 ===2021 (Declined): [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view Letter from: Peter Briss, MD, MPH, EVALI Incident Manager, 2019-2020, Medical Director, National Center for Chronic Disease Prevention and Health Promotion, CDC]===
 *Given the lack of evidence to rule out the contribution of other chemicals of concern to the EVALI outbreak, the possibility that chemicals of concern could be introduced into supply chains of either THC or non-THC-containing products in the future, the prudence of assessing substance use broadly where clinically indicated, and that some EVALI cases reported exclusive use of nicotine-containing products, CDC declines to rename EVALI.
+===2021: [https://twitter.com/mikepesko/status/1468932559098757127 Mike Pesko]===
+Thread on X (formerly Twitter) about the letters.
 ===2026 (Request): [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view Letter to: Jay Bhattacharya, Acting Director - Centers for Disease Control and Prevention]===
@@ Line 21: / Line 34: @@
 ==Articles, Op-Eds, Blogs, Media==
+===2022: [https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187 The CDC’s EVALI screwup]===
+*There’s no shame in being wrong. We all make mistakes. It is, however, shameful to fail to admit and correct a mistake — especially when lives are at stake.
+**Citation: Gunther, M. (2022, January 17). The CDC’s EVALI screwup. The Great Vape Debate. Retrieved June 6, 2026.
+===2026: [https://filtermag.org/cdc-abandon-evali/ Will the CDC Finally Abandon the Damaging Term “EVALI”?]===
+*The CDC cannot undo the frightened headlines from 2019. It cannot reopen the vape shops that went under because of the panic. It cannot persuade every person who went back to cigarettes because they were falsely told, directly or by implication, that nicotine vaping had caused a wave of damaged lungs and death. But it can stop repeating the mistake.
+**Citation: Murray, K. “Skip.” (2026, April 16). Will the CDC finally abandon the damaging term “EVALI”? Filter. Retrieved June 6, 2026
+===2026: [https://www.cannabinoidsandthepeople.whitewhalecreations.com/p/stigma-more-anesthesia-cud-chs-and Harm reduction: US overdoses down everywhere except the West + CDC should abandon the term “EVALI”]===
+*Basically, this EVALI phenomenon has now been linked distinctly to tainted illicit THC vape cartridges that contained vitamin E acetate, but ever since the confusion of when this story broke, EVALI has become associated with legal nicotine e-cigarettes. This is detrimental to public health because, despite the hand-wringing you might see in some places, vaping nicotine instead of smoking tobacco is a huge public-health win. But misunderstandings around the term EVALI have led to a reduction in nicotine vaping in favor of tobacco smoking. The CDC needs to fix this.
+**Citation: Pelger, L. (2026, May 18). Stigma, more anesthesia, CUD, CHS & the War on Drugs. Cannabinoids & the People. Retrieved June 6, 2026.
+===2026: [https://www.disobedientmargins.com/p/the-name-we-choose-for-what-happened The Name We Choose for What Happened]===
+*As of April 2026, it is still possible to find headlines around the world linking lung injuries from the 2019 outbreak to nicotine e-cigarettes. The name continues to do the work that the evidence has already undone.
+**Citation: Teixeira, C. (2026, June 4). The name we choose for what happened. Disobedient Margins, Substack. Retrieved June 6, 2026.
 ='''Misperceptions, Misinformation, Disinformation'''=
-*Newest to oldest. These are quotes from the linked sources.
+*Newest to oldest. These are quotes from the linked sources. All talk about EVALI.
 *Note: At times, EVALI has been conflated with Popcorn Lung, COVID, Lipid Pneumonia, ARDS, etc. A true testament to how unclear messaging confuses health care providers, media, lawmakers, public health, and consumers.
@@ Line 32: / Line 60: @@
 **Citation: Barros EM, Ferreira AC, Neelon B, Ravenel IE, Carpenter MJ, Smith TT. Shifting perceptions of e-cigarette risk: A secondary analysis from a nationwide, randomized controlled clinical trial of e-cigarettes among smokers. Addict Behav. 2026 Jul;178:108672. doi: 10.1016/j.addbeh.2026.108672. Epub 2026 Mar 15. PMID: 41865464.
 ***Acknowledgment: Funding for the parent study was provided by the National Cancer Institute (R01CA210625 to MJC). Ms. Barros was supported by a grant from the National Institute on Drug Abuse (R25DA020537). Ms. Ravenel was supported by the SC CHEER YES program funded by Hollings Cancer Center and TD Bank. MJC has served as a paid expert in e-cigarette litigation within the past 3 years.
+===2025: [https://pmc.ncbi.nlm.nih.gov/articles/PMC12306916/ Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study]===
+*Of 19,661 news reports on Tobacco Watcher that discussed EVALI, 55.9% mentioned cannabis. Among the 157,499 middle and high school students participating in the statewide survey in California, 75% had heard about EVALI. The awareness level was similarly high for 8th, 10th, and 12th graders (75.7%, 74.6%, and 74.8%, respectively). Their primary source of knowledge about EVALI was media (63.1%), followed by parents (16.6%), teachers (8.1%), friends (7.7%), and peers (4.6%). Most students, 55%, believed nicotine was the cause of EVALI, while only 11% thought it was related to cannabis in vapes.
+**Citation: Wang J, Ayers J, Leas E, Gamst A, Zhu SH. Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study. J Med Internet Res. 2025 Jul 29;27:e69151. doi: 10.2196/69151. PMID: 40729669; PMCID: PMC12306916.
+**Acknowledgment: JA is one of the creators of tobaccowatcher.org, a project of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health for the Bloomberg Philanthropies.
+===2023: [https://tobaccocontrol.bmj.com/content/32/e2/e255 Over 1 year later: smokers’ EVALI awareness, knowledge and perceived impact on e-cigarette interest]===
+*Approximately 54% of smokers had heard of EVALI. Among those who had heard of EVALI (n=542), 37.3% believed its main cause was e-cigarettes used to vape nicotine, like JUUL. Fewer (16.6%) thought the main cause was products for vaping marijuana/THC, and 20.2% did not know. About 29% had heard vitamin E acetate was associated with EVALI, and 50.9% indicated EVALI made them less interested in using e-cigarettes in the future. EVALI awareness was significantly associated with e-cigarette risk perceptions (ie, that e-cigarettes are as harmful as smoking).
+**Citation: Wackowski OA, Gratale SK, Jeong M, et alOver 1 year later: smokers’ EVALI awareness, knowledge and perceived impact on e-cigarette interest. Tobacco Control 2023;32:e255-e259.
+***Acknowledgment: This work was supported by the National Cancer Institute (NCI) of the National Institutes of Health under Award Number R37CA222002. Contributions by MJ were supported by K01CA242591, and those by CD and MBS were supported in part by R01CA190444, also from the NCI. Contributions by SKG and CD were also supported by U54CA229973 from the NCI and the Food and Drug Administration.
 ===2022: [https://onlinelibrary.wiley.com/doi/10.1111/add.16097 United States public health officials need to correct e-cigarette health misinformation]===
@@ Line 43: / Line 81: @@
 **Citation: Katherine East, Jessica L Reid, Robin Burkhalter, Olivia A Wackowski, James F Thrasher, Harry Tattan-Birch, Christian Boudreau, Maansi Bansal-Travers, Alex C Liber, Ann McNeill, David Hammond, Exposure to Negative News Stories About Vaping, and Harm Perceptions of Vaping, Among Youth in England, Canada, and the United States Before and After the Outbreak of E-cigarette or Vaping-Associated Lung Injury (‘EVALI’), Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1386–1395, https://doi.org/10.1093/ntr/ntac088
 *** Acknowledgment: This work was supported by a P01 Grant (1P01CA200512) from the US National Institutes of Health (NIH). Additional support was provided by a Canadian Institutes of Health Research (CIHR)–Public Health Agency of Canada (PHAC) Applied Public Health Research Chair (DH). The February 2020 Wave of the ITC Youth Tobacco and Vaping Survey was funded by a contribution from Health Canada’s Substance Use and Addictions Program (SUAP). KE is the recipient of Fellowship funding from the UK Society for the Study of Addiction (SSA). KE and AM also acknowledge support from Cancer Research UK (RE12936). Contributions by OAW were supported in part by the NIH (R37CA222002). The views expressed herein do not necessarily represent the views of any of the funding agencies. DH has served as a paid expert witness in legal challenges against tobacco and vaping companies.
+===2022: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak]===
+*Given the number of states that did not appear to update their messaging regarding the cause of EVALI, we believe that states should re-evaluate this messaging to accurately communicate the risks of e-cigarette use.
+**Citation: Katchmar, A., Shafer, P. & Siegel, M. Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak. Harm Reduct J 19, 112 (2022). https://doi.org/10.1186/s12954-022-00694-6
+***Acknowledgment: This work was supported by a supplies grant from the Kilachand Honor’s College at Boston University. The College did not review this work prior to submission.
+===2022: [https://www.nber.org/system/files/working_papers/w30255/w30255.pdf MISINFORMATION, CONSUMER RISK PERCEPTIONS, AND MARKETS: THE IMPACT OF AN INFORMATION SHOCK ON VAPING AND SMOKING CESSATION]===
+*We estimate that the misinformation shock created by the EVALI outbreak reduced ecigarette demand by 24-36 percent. Our results echo earlier research that finds that information shocks in the 1950s and 1960s reduced cigarette demand (Schneider, Klein, and Murphy 1981). However, in the 1950s and 1960s many consumers were unaware of the health consequences of smoking and altered their behavior when accurate information on health risks became available. The earlier information shocks thus helped to correct consumer mistakes and improved consumer health and welfare. In contrast, in the 2010s many consumers were either uninformed or already mistakenly believed that e-cigarettes were riskier than smoking. The EVALI information shock exacerbated consumer mistakes and likely worsened consumer health and welfare. Based on a population health model, we predict that over the next 50 years the EVALI information shock will lead to 450,000 life years lost due to deterred smoking cessation. As points of comparison, the CDC reports that seat belts saved almost 13,000 lives in 2009 and an estimated 255,000 lives from 1975 through 2009.31 Preventing EVALI entirely might have been very difficult, but a different set of risk communication policies could have prevented some of the pre-existing misinformation and some of the EVALI misinformation shock.
+**Citation: Jin, L., Kenkel, D. S., Lovenheim, M. F., Mathios, A. D., & Wang, H. (2022). Misinformation, consumer risk perceptions, and markets: The impact of an information shock on vaping and smoking cessation (NBER Working Paper No. 30255). National Bureau of Economic Research. https://www.nber.org/papers/w30255
+***Acknowledgment: Produced with the help of a grant to Cornell University from the Foundation for a Smoke-Free World, Inc. (FSFW), a U.S. nonprofit 501(c) (3) private foundation. This study is, under the terms of the grant agreement with FSFW, editorially independent of FSFW. The FSFW had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The contents, selection, and presentation of facts, as well as any opinions expressed herein are the sole responsibility of the authors and under no circumstances shall be regarded as reflecting the positions of FSFW. FSFW accepts charitable gifts from PMI Global Services Inc. (PMI), which manufactures cigarettes and other tobacco products. Under FSFW’s Bylaws and Pledge Agreement with PMI, FSFW is independent from PMI and the tobacco industry. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
+===2022: Comments RE: [https://pubpeer.com/publications/053A4DD87764E36C0B9FF00B260480 Discussions of Flavored ENDS Sales Restrictions: Themes Related to Circumventing Policies on Reddit]===
+*This article incorrectly states, “In the wake of the e-cigarette or vaping use-related lung injury (EVALI) outbreak in September 2019, electronic cigarette manufacturer JUUL voluntarily removed flavored pods aside from tobacco and menthol from the U.S. market” That sentence is false and creates a factually inaccurate and damaging link in a reader’s mind between JUUL products and the 2019 lung injuries (EVALI) when none exists. In fact, Juul Labs reduced its flavor portfolio to tobacco and menthol to combat underage use and the ingredients of JUUL products do not include vitamin E compounds or THC that were primarily linked to EVALI. (Murillo)
+**Referring to: Silver N, Kucherlapaty P, Kostygina G, Tran H, Feng M, Emery S, Schillo B. Discussions of Flavored ENDS Sales Restrictions: Themes Related to Circumventing Policies on Reddit. Int J Environ Res Public Health. 2022 Jun 23;19(13):7668. PMID: 35805325; PMCID: PMC9266029. [https://doi.org/10.3390/ijerph19137668 doi: 10.3390/ijerph19137668]
 ===2021: [https://www.qeios.com/read/ZGVHM7.3 The outbreak of lung injuries often known as "EVALI" was nothing to do with nicotine vaping]===
@@ Line 53: / Line 105: @@
 **Citation: Dave, D., Dench, D., Kenkel, D. et al. News that takes your breath away: risk perceptions during an outbreak of vaping-related lung injuries. J Risk Uncertain 60, 281–307 (2020). https://doi.org/10.1007/s11166-020-09329-2
 ***Acknowledgement: Dhaval Dave acknowledges support through grant R01DA039968 from the National Institute on Drug Abuse. The authors are grateful to Cornell University and the Health Thought Leadership Network at Bentley University for funding the data collection.
+===2020: [https://journals.lww.com/anesthesiology/fulltext/2020/10000/sparking_the_discussion_about_vaping_and.47.aspx Sparking the Discussion about Vaping and Anesthesia: Comment]===
+*To the Editors...
+*'''The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil.  This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.'''
+**Oyston, John M.B., F.R.C.A.. Sparking the Discussion about Vaping and Anesthesia: Comment. Anesthesiology 133(4):p 948-949, October 2020. | DOI: 10.1097/ALN.0000000000003476
 ==Articles, Op-Eds, Blogs, Media==
@@ Line 63: / Line 120: @@
 **Citation: Norcia, A. (2022, December 15). End vape misinformation, tobacco control experts urge Surgeon General. Filter. Retrieved June 6, 2026.
-==Community Notes on X==
+===2021: [https://filtermag.org/evali-misinformation-increased-smoking/ New Evidence Links “EVALI” Vaping Misinformation With Increased Cigarette Smoking]===
+*A new study now suggests that legislation arising from misstatements about EVALI and e-cigarettes in Massachusetts actually caused an increase in cigarette consumption throughout Boston.
-='''Lung Injury Research (EVALI)'''=
+**Citation: Norcia, A. (2021, May 7). New evidence links “EVALI” vaping misinformation with increased cigarette smoking. Filter. Retrieved June 6, 2026.
-*Newest to oldest. These are quotes from the linked sources.
-==Journals==
+===2020: [https://morningconsult.com/2020/02/05/electronic-cigarettes-increasingly-blamed-by-public-for-lung-illnesses-even-as-evidence-points-elsewhere/ Electronic Cigarettes Increasingly Blamed for Lung Illnesses, as Evidence Points Elsewhere]===
+*CDC identified THC vapes with vitamin E acetate as culprit, but 66% of adults blame e-cigarettes for vaping deaths
+**Citation: Wilson, S. (2020, February 5). E-cigarettes increasingly blamed for lung illnesses, as evidence points elsewhere. Morning Consult. Retrieved June 6, 2026.
-==Articles, Op-Eds, Blogs, Media==
+===2019: [https://reason.com/2019/10/09/muddled-message-about-vaping-causes-costly-confusion/ Muddled Message About Vaping Causes Costly Confusion]===
+*Vague lung disease warnings tar harm-reducing e-cigarettes while obscuring the role of black-market cannabis products.
+**Citation: Sullum, J. (2019, October 9). Muddled message about vaping causes costly confusion. Reason. Retrieved June 7, 2026
----------------------------------
+==Tweets==
+===2021: [https://x.com/KozlovichS/status/1373116501130051587 Dr. Shannon Kozlovich (thread)]===
+*In 2019 there was a mysterious illness killing people known to use vaping devices. @CDCgov soon discovered that the additive causing the lung injury was Vitamin E Acetate. In Dec 2019 we mixed VEA with nicotine e-liquids and discovered that they don’t mix.
+*This speaks to the need for a completely #legal and well regulated #cannabis market. These products would be safer and open to the vast resources at our research institutions. It is past time that we know when cannabis can help, when it can hurt, and how.
+*We also took pure #nicotine (nicotine that was NOT in an e-liquid solution) and mixed it directly with VEA. We did fine that nicotine itself is miscible (can be mixed/visibly soluble) in VEA. The combination of VEA + nicotine is possible but also cost prohibitive.
+*IF VEA was mixed with a nicotine e-liquid, it would form a visible layer that could be identified upon visual inspection of the liquid.
+*The conditions we tested ranged in a-liquid solvent type and pH range. We created liquids from the most common nicotine solvents PG/VG and we used 0.3-3% nicotine. We tested nicotine base (used in tank e-cigs) and nicotine salt (made popular by JUUL).
+*What doesn’t this paper tell us? Nothing in this publication says that nicotine products are  safe. This paper only covered the mixture of VEA and nicotine e-liquids.
+===2020: [https://twitter.com/ScottGottliebMD/status/1217893624353980416?s=20 Scott Gottlieb, MD] (thread)===
+*An e-cigarette is an FDA regulated electronic nicotine delivery system (ENDS). It delivers nicotine. What CDC seems to be trying to refer to here are illegal vapes or “dabs” that contain THC. We develop precise regulatory nomenclature for a reason. It helps differentiate products
+*CDC should reconsider the name it ascribed to these illnesses (EVALI) now that it seems to be definitively linked to THC vapes and dabs. By not speaking with precision it could leave a false impression as to the clear causal relationship between the tragic illnesses and THC vapes
+*The public health risk is that kids using these illegal and dangerous THC products may not know that the CDC warnings relate to the THC products they’re using; since the CDC is not using a precise nomenclature to more clearly describe the THC vapes and dabs
+===2019: [https://twitter.com/ScottGottliebMD/status/1177704654068748293?s=20 Scott Gottlieb MD]===
+*My point is simply if you know a THC product hurt someone, don’t call it an e-cigarette, call it a THC vape or THC vaping product. Nomenclature matters in helping consumers properly identify which products are causing which kinds of risks. That’s why we develop naming systems.
-==Studies / Papers==
+==Community Notes - EVALI Misinformation on X (Formerly Twitter)==
+The misinformation about nicotine vaping and EVALI continues to spread around the globe years after the outbreak. The tweets below have a [https://x.com/i/communitynotes/about Community Note (CN)] that got enough votes to be made public. Anyone can see them and vote on them. There are many more tweets where the CN does not yet have enough votes. And there are 100s more (maybe 1000s!) without a community note. Community Notes are a way to help correct misinformation, and became [https://grok.com/share/c2hhcmQtMg_6d9005c7-f4ea-4f13-a8b3-0a6158fccc27?rid=535a5f53-cc73-4cd8-8655-5b407d99314b available] to most users late in 2022.
+===2026===
+*May 2: [https://x.com/ChronosIntelX/status/2050460076302119243 Chronos Intelligence @ChronosIntelX] (5816 followers)
+*May 1: [https://x.com/forallcurious/status/2050433667282219081 All day Astronomy @forallcurious] (453.5K followers)
+*April 11: [https://x.com/A3Noticias/status/2043066564996407378 Antena 3 Noticias @A3Noticias] (2M followers)
+*February 3: [https://x.com/argosaki/status/2018870277107822947 GP Q @argosaki] (127.3K followers)
+*February 3: [https://x.com/ClevelandClinic/status/2018713096404267388 Cleveland Clinic @ClevelandClinic] (1.7M followers)
+===2025===
+*December 24: [https://x.com/hemo_shk/status/2004010818732781789 Dr.Haitham Hamoud @hemo_shk] (17.8K followers)
+*December 9: [https://x.com/drkaanyl/status/1998470605461701007  Prof. Dr. Kaan Yılancıoğlu @drkaanyl] (215.2K followers)
+*December 2: [https://x.com/wdunlap/status/1995892820163658065 Wayne Dunlap @wdunlap] (250.1K followers)
+*May 17: [https://x.com/DarrenPlymouth/status/1923710684556055002 Darren of Plymouth @DarrenPlymouth] (126.4K followers)
+*May 6: [https://x.com/GMB/status/1919641214422253759  Good Morning Britain @GMB] (1M followers)
+*March 26: [https://x.com/j00ny369T/status/1904861513527013715 Johnny @j00ny369T] (221.7K followers)
+*Febrary 17: [https://x.com/LungAssociation/status/1891553473210057206 American Lung Association @LungAssociation]  (44.6K followers)
-===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151740/ Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent]===
+===2024===
-As of December 12, 2019, the Wadsworth Center has analyzed 206 vaporizer fluids from 61 NYS EVALI cases. Of these, 147 contained THC, and 59 contained nicotine. Of the 147 THC-containing fluids, 101 (69%) contained VEA. In the nicotine-containing products we analyzed, we detected no unusual compounds that appeared to be of concern.
+*November 13: [https://x.com/BreakMyCoffee/status/1856902175844438254 The Coffee Break | Grow Smarter Daily @BreakMyCoffee] (19.8K followers)
-There is additional evidence of a strong association of VEA with EVALI. In the initial analyses of bronchoalveolar lavage fluids from EVALI patients, 28 of 28 fluids contained vitamin E acetate.
+*May 16: [https://x.com/MillsHayesTV/status/1791133326461313070 Mills Hayes @MillsHayesTV] (5,099 followers)
+*May 16: [https://x.com/FoxNews/status/1791205781892645038 Fox News @FoxNews] (29.1M followers)
-===2020: [https://www.nejm.org/doi/full/10.1056/nejmoa1916433 Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI]===
+*April 23: [https://x.com/BFHD/status/1782912224597840165 Benton-Franklin Health District @BFHD] (1,542 followers)
-The FDA detected no vitamin E acetate in 197 case-associated nicotine products analyzed to date. The viscosity of vitamin E acetate makes it undesirable as an additive to nicotine solutions.
-Data that have been reported to date indicate that vitamin E acetate in the supply of THC-containing products and use among patients with EVALI aligns with the timing of the 2019 EVALI outbreak. In Minnesota, 10 of 10 products seized by law enforcement during 2018, before the EVALI outbreak, did not contain vitamin E acetate, whereas 20 of 20 THC-containing products seized by law enforcement during September 2019, at the peak of the outbreak, contained vitamin E acetate.
-Pure THC oil has a viscosity like that of vitamin E acetate. Cutting THC oil with vitamin E acetate has been reported to be common in the illicit market.
-===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878297/ Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states]===
-These findings are consistent with evidence linking the EVALI outbreak to vitamin E acetate and informally purchased or modified THC e‐liquids, as opposed to use of well‐established nicotine e‐cigarettes.
-===2019 - December 20: [https://www.nejm.org/doi/full/10.1056/NEJMoa1916433?fbclid=IwAR3Qt3IWJlBf3g3kW9RBWQJTza3CAMr0UsoRrFk3peCeEDX5wGooCAGkmBQ Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI]===
-*Updated February 20, 2020
-*Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness.
-*Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States.
-*[https://sci-hub.se/10.1056/NEJMoa1916433 PDF Version]
-*Citation: See Study
-*Acknowledgement: Supported by a grant (P50CA180908) from the National Cancer Institute and a grant (P30CA016058) from the FDA Center for Tobacco Products; and by Ohio State University Pelotonia Intramural Research.
-===2019: [https://ukhsa.blog.gov.uk/2019/10/29/vaping-and-lung-disease-in-the-us-phes-advice/ Vaping and lung disease in the US: PHE’s advice]===
-Dr Dana Meaney-Delman, head of the CDC team investigating the outbreak has reported that “We've narrowed this clearly to THC-containing products that are associated with most patients who are experiencing lung injury. The specific substance or substances we have not identified yet”.
-We need to be clear about what this outbreak is and is not. It is not a problem linked to long-term use of regulated nicotine vaping products. If it were, we would expect to see a very different demographic profile affected, more typical of long term vapers.
-PHE has not changed its advice on nicotine containing e-cigarettes: Smokers should consider switching completely and vapers should stop smoking.
-The evidence still shows that vaping carries a small fraction of the risk of smoking. Using a nicotine-containing e-cigarette makes it much more likely someone will quit successfully than relying on willpower alone. But it’s important to use regulated e-liquids and never risk vaping home-made or illicit e-liquids or adding substances.
 ==Expert Testimony==
 ===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
 *Signed by 24 experts from around the world
 *Covers 12 key points including EVALI
+='''Lung Injury Research EVALI and Coverage of the Cause'''=
+*Newest to oldest. These are quotes from the linked sources.
-==Media==
+==Journals==
+===2021: [https://pubmed.ncbi.nlm.nih.gov/34694926/ Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020]===
+*Minnesota was among the first states in which health care providers reported suspected EVALI cases, and MDH responded quickly and effectively to the EVALI outbreak. Despite multiple challenges, MDH’s response had many successes, primarily collaboration with internal and external partners. Minnesota’s experience with the EVALI outbreak provided lessons learned that can be used to strengthen future responses to outbreaks of noncommunicable diseases. Although US public health agencies are well versed in handling outbreaks of infectious diseases, now is the time to ensure adequate capacity to respond to other types of outbreaks.
+**Citation: Wiens T, Taylor J, Cole C, Saravia S, Peterson J, Lunda M, Margetta J, D'Heilly P, Holzbauer S, Lynfield R. Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020. Public Health Rep. 2022 Nov-Dec;137(6):1053-1060. doi: 10.1177/00333549211051394. Epub 2021 Oct 25. PMID: 34694926; PMCID: PMC9574319.
+***Acknowledgment:  Support for this project was provided by the Council of State and Territorial Epidemiologists through the Applied Epidemiology Fellowship Program.
+===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151740/ Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent]===
+*As of December 12, 2019, the Wadsworth Center has analyzed 206 vaporizer fluids from 61 NYS EVALI cases. Of these, 147 contained THC, and 59 contained nicotine. Of the 147 THC-containing fluids, 101 (69%) contained VEA. There is additional evidence of a strong association of VEA with EVALI. In the initial analyses of bronchoalveolar lavage fluids from EVALI patients, 28 of 28 fluids contained vitamin E acetate.
+**Citation: Duffy B, Li L, Lu S, Durocher L, Dittmar M, Delaney-Baldwin E, Panawennage D, LeMaster D, Navarette K, Spink D. Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent. Toxics. 2020 Jan 24;8(1):8. doi: 10.3390/toxics8010008. PMID: 31991538; PMCID: PMC7151740.
+***Acknowledgment: This research received no external funding. The authors gratefully acknowledge use of the Wadsworth Center Nuclear Magnetic Resonance Core Facility.
-===2019 - October 29: [https://news.sky.com/story/us-vaping-deaths-linked-to-thc-not-nicotine-11848431 US vaping deaths linked to THC - not nicotine]===
+===2020: [https://www.nejm.org/doi/full/10.1056/nejmoa1916433 Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI]===
-*A series of vaping deaths in the US have been linked to THC, the illegal psychoactive compound in cannabis, and not legal nicotine.
+*BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015.
+*State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%).
+*NOTE: This paper has a comment on [https://pubpeer.com/publications/978008D6973E18B43D08A2995A9EAC PubPeer].
+**Citation: Blount, B. C., Karwowski, M. P., Shields, P. G., Morel-Espinosa, M., Valentin-Blasini, L., Gardner, M., Braselton, M., Brosius, C. R., Caron, K. T., Chambers, D., Corstvet, J., Cowan, E., De Jesús, V. R., Espinosa, P., Fernandez, C., Holder, C., Kuklenyik, Z., Kusovschi, J. D., Newman, C., . . . Pirkle, J. L. (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. New England Journal of Medicine, 382(8), 697–705. https://doi.org/10.1056/NEJMoa1916433
+***Acknowledgment: Supported by a grant (P50CA180908) from the National Cancer Institute and a grant (P30CA016058) from the FDA Center for Tobacco Products; and by Ohio State University Pelotonia Intramural Research.
+===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878297/ Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states]===
+*Contrary to the perception that EVALI cases stem from vaping per se, neither higher rates of vaping nor greater cannabis use predicted an elevated EVALI prevalence. Mapping state EVALI cases per capita suggests a geographically concentrated cluster of high prevalence states as well as several lower prevalence areas. This variation is less consistent with use of a common, nationally available product driving the outbreak than consumption of black market or locally modified e-liquids.
+**Citation: Friedman AS. Association of vaping-related lung injuries with rates of e-cigarette and cannabis use across US states. Addiction. 2021 Mar;116(3):651-657. doi: 10.1111/add.15235. Epub 2020 Sep 28. PMID: 32840932; PMCID: PMC7878297.
+***Acknowledgment: Research reported in this publication was supported by grant number 3U54DA036151–08S2 from the National Institute On Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP).
+==Articles, Op-Eds, Blogs, Media==
+===2019: [https://web.archive.org/web/20211002090904/https://ukhsa.blog.gov.uk/2019/10/29/vaping-and-lung-disease-in-the-us-phes-advice/ Vaping and lung disease in the US: PHE’s advice]===
+*"Dr Dana Meaney-Delman, head of the CDC team investigating the outbreak has reported that “We've narrowed this clearly to THC-containing products that are associated with most patients who are experiencing lung injury. The specific substance or substances we have not identified yet”. THC is the main psychoactive component of cannabis and the CDC has said that the products identified are being obtained off the street or from other informal sources (e.g. friends, family members or illicit dealers)."
+*The outbreak does not appear to be associated with long term use of nicotine e-cigarettes, which have been used in the US for over 10 years.
+*Our concern is that the responses we have seen to the problem in the US and in other countries may increase the already widespread misunderstanding about the relative safety of nicotine e-cigarettes, deterring smokers from switching and risk driving vapers who have switched back to smoking. There is a real risk therefore that such a reaction will mean people continue to smoke, which will undoubtedly put lives at risk.
+**Citation: Newton, J. (2019, October 29). Vaping and lung disease in the US: PHE’s advice. UK Health Security Agency. Retrieved June 6, 2026.
+===2019: [https://www.inverse.com/mind-body/58581-dank-vapes Dank Vapes Is the "Biggest Conspiracy" in Pot That Can Put You in a Coma]===
+*(Note: This is a long investigative article that will educate readers on how hard it is to track down sellers in an unregulated market or illicit sellers in a regulated one.)
+*The vapor product DeGrave showed to reporters was distilled from cannabis. But it was also apparently made by the “company” Dank Vapes — an elusive, black-market brand that’s as tricky to pin down as vapor.
+*Dank Vapes is not the only black market product that have made people sick, but it is most commonly used product. In September, the CDC released a report that described the spread of EVALI in Wisconsin and Illinois. Fifty-seven of the 86 people with EVALI in that survey reported using Dank Vapes. A report in Utah also noted that Dank Vapes were the most popular black market product used by people with EVALI.
+**Citation: Betuel, E. (2019, November 15). Dank Vapes is the “biggest conspiracy” in pot that can put you in a coma. Inverse. Retrieved June 6, 2026.
+===2019: [https://news.sky.com/story/us-vaping-deaths-linked-to-thc-not-nicotine-11848431 US vaping deaths linked to THC - not nicotine]===
+*A series of vaping deaths in the US have been linked to THC, the illegal psychoactive compound in cannabis, and not legal nicotine.
+**Citation: Sky News. (2019, October 29). US vaping deaths linked to THC—not nicotine. Retrieved June 6, 2026.
-==Suggestions to add to this page==
+===2019: [https://www.inverse.com/science/59207-vitamin-e-acetate-thc-vapes A Thickener Used in Pot Vaping Is a Hugely Popular Black-Market Scam]===
+*(Note: This is a long and informative article that gives a lot of background into how Vitamin E Acetate ended up being a thickening agent, several companies involved, what they did when it was suspected it might be the cause of lung injuries, what companies were transparent and which ones weren't.)
+*Sources familiar with the black market THC vape economy tell Inverse that vitamin E acetate is a newcomer — the “thickener” that in some circles was marketed as a “perfect” way to cut THC distillates to make them appear high quality.
+*...thick oils are coveted — and sometimes thickeners are used to help mimic the look of high-quality distillate...
+*Traditional cuts might have included medium chain triglycerides (MCT) — a component that’s found in coconut oil, for instance. But they also include an excess of terpenes or cuts that are more commonly associated with e-cigarettes, like vegetable glycerin or propylene glycol. More recently, vitamin E acetate has emerged as a new alternative because it offers an even thicker cut that allows sellers to beat the “bubble test,” a way that consumers used to be able to judge a quality distillate.
+*Ronay says that his lab will test for vitamin E acetate in vaporizer cartridges in light of the investigation into the thickeners. They expect to have those tests up and running in the next few weeks. Before this, vitamin E wasn’t something labs even knew to test for.
+*Several companies advertise branded thickening agents containing vitamin E acetate or other, sometimes unspecified ingredients. Brands like “Honey Cut,” an “all-natural” thickening agent, can be found on ebay. But there are many other thickening manufacturers out there. The Candy Cut, for instance, is a company reportedly based out of Tampa, Florida, claiming to sell thickening and cutting agents by the half-gallon but doesn’t disclose what is actually in them.
+**Citation: Betuel, E. (2019, September 13). A thickener used in pot vaping is a hugely popular black-market scam. Inverse. Retrieved June 6, 2026.
-===2023: [https://tobaccocontrol.bmj.com/content/32/e2/e255 Over 1 year later: smokers’ EVALI awareness, knowledge and perceived impact on e-cigarette interest]===
+='''EVALI outbreak — Consumer-led research, warnings, and pushback'''=
+===Mysterious "vape" illnesses and THC cutting agents===
+*When the news broke of vaping lung injuries, consumers started doing their own research, often discussing their findings in Facebook chat groups. Here are some of the compiled notes as they started looking for patterns that might indicate a cause.
+*[https://docs.google.com/document/d/1JOD0wBm_lZRmsTwGpkzFFaVXry23T46YMk_8enIFiQw/edit?usp=sharing THC Cutting Agents]
+*[https://docs.google.com/document/d/1BMqv26yghILkKpKf%20POhNKQfLV3qFn8JfPEQbBBJN84/edit?usp=sharing Mysterious Lung Issues]
+*[https://docs.google.com/document/d/1KeEEsLg9spwI5UigtfYDQwzc8OINZyRkdIBJaFKSvOE/edit?usp=sharing MN, WI, TX, etc - illegal THC carts]
+===“DANKing” — A consumer-coined term to distinguish illicit THC carts from nicotine vaping===
+*As the very real concern about the "vaping" illnesses and deaths spread, some states and cities moved quickly to ban nicotine vapes, or at least ban the flavors. They seemed to be unaware or ignored that it was unregulated THC products that were causing the outbreak. Consumers knew that the public needed an easy way to differentiate between THC and nicotine. Because so many illnesses were linked to a fake brand called "[https://www.wtvr.com/2019/09/27/in-lung-illness-outbreak-signs-point-to-majority-of-patients-vaping-thc-products Dank Vapes]," Andre Thov coined the term "DANKing." (See [https://www.facebook.com/share/p/1BNi6XLKdM/ comments] on this Facebook post.) Consumers began using the term on social media.
+**Thov entered the term on [https://www.urbandictionary.com/define.php?term=Danking Urban Dictionary].
+**Advocates wrote reports and press releases, sometimes using the term "danking," to educate the public (often more strongly than public health or the CDC did). Examples: [https://docs.google.com/document/d/1w7ErqSmO-moRR0ExYBCSEy0Bc_yGwxfjlYq7kH_bnEk/edit?usp=sharing “DANKing”, the frightening trend that’s making people sick!] and [https://docs.google.com/document/d/1PDihlSLQjE0VmDDtwftTsSPqByAv3T8cHlZpnN4NXAQ/edit?usp=sharing For Immediate Release From: Tobacco Harm Reduction 4Life Public Health Warning]
+*At times, people with lived experience ("consumers") can feel unseen and unheard. They don't always know the power of their voices. Can they influence the conversation? They got their answer when they saw the word used on websites and media sources:
+**[https://www.youtube.com/watch?v=exRRX0xrKvE Deadly Pesticides Found In Counterfeit Vaping Products | TODAY].
+**Erin Mills, affiliated with PAVe (Parents Against Vaping e-cigarettes), [https://x.com/NYSMom4Kiddos/status/1171472581452419072 tweeted #danking].
+**A 2019 webpage titled “FAQs about the vaping lung illness epidemic” on VapingHealthRisk.com used the term “danking” in reference to THC or marijuana vaping products. The page is no longer available at its original URL; a current attempt to access it returns a 502 Bad Gateway error. The original URL was: https://vapinghealthrisk.com/faqs-about-the-vaping-lung-illness-epidemic/. A screenshot of the FAQ text reads: "Are vaping THC or marijuana (aka danking) products worse than nicotine e-cigarettes? Maybe. It appears as if THC and marijuana-related vaping or e-cigarette products may increase the risk of vaping lung diseases. The CDC reports the following usage patterns in the 30 days prior to becoming sick:" (the screenshot does not include the list)
+*Dray Moorman, who is both a consumer and a small business advocate, used the term in an Op-Ed published by NEWSMAX: [https://www.newsmax.com/newsfront/vape-vote-vaping-voters-trump/2019/10/11/id/936690/ Dray Moorman: Vape Vote Could Outweigh Impeachment Damage in 2020]. In part, it said: "Smoking black market oil is called danking. THC oil made in a drug dealer’s kitchen has nothing to do with e-cigs. Yet, opportunists and mainstream media are exploiting tragedy to attack vaping. And by doing so, they may be trying to force President Trump to alienate 12 million voters."
+*Did those consumers have a lasting impact? While it was a thrill to have an influence on the narrative, most of them felt it wasn't big enough. But, perhaps, it was bigger than they thought. A 2025 WRTV Indianapolis article suggested the term may have had more staying power than consumers realized. In [https://www.wrtv.com/news/local-news/vape-shop-owner-shares-tips-to-avoid-black-market-products Vape shop owner shares tips to avoid black market products], Eskenazi Health Pulmonary Physician Graham Carlos said health officials haven't seen incidents like this since 2019. "People were what's called 'dabbing and danking.' That's when you add things to the pens and there was no regulation,"
-===2022: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak]===
+<br>
+[[File:Danking Today.png|center]]
-===2022: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00694-6 Analysis of state portrayals of the risks of e-cigarette use and the cause of the EVALI outbreak]===
-===2021: [https://www.ingentaconnect.com/contentone/trsg/trs/2021/00000007/00000002/art00004 Vitamin E Acetate is not Soluble in Nicotine E-liquids]===
+===Ongoing misinformation and loss of trust===
-*[https://twitter.com/KozlovichS/status/1373116501130051587 Twitter thread]
+Consumers are still struggling to trust the CDC. They are left wondering why it was they who had to take to social media to warn the public about the danger of unregulated THC carts cut with vitamin E acetate. They are also left wondering why vape shops had to tell customers that their cannabis use was their own business, but that until things got sorted out, they should smoke cannabis instead of vaping it. Why were consumers and shops quicker at getting the word out than the CDC? Those consumers are left wondering if that was the right time for the CDC to practice the "precautionary principle?"
-===2021: [https://pubmed.ncbi.nlm.nih.gov/34694926/ Lessons Learned From the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020]===
+To this day, consumers and academics use up considerable amounts of their free time, pushing back against misinformation that is keeping some people trapped in smoking tobacco. "EVALI" is still something weaponized, fueling a moral panic about nicotine vaping, and encouraging policymakers to raise taxes and/or ban the products. The CDC's lack of urgency in addressing the source of the misinformation means the word "EVALI" keeps consumers from trusting anything the CDC says.
-===2019 and Beyond: The CDC, the FDA, and others: EVALI===
+='''Suggestions to add to this page'''=
-*Article: [https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187 The CDC’s EVALI screwup]
-**Making a mistake is one thing. Failing to correct it is worse.
-**But there is no evidence–none at all— that anyone got sick with EVALI from using e-cigarettes.
-*Twitter thread by [https://twitter.com/mikepesko/status/1468932559098757127 Mike Pesko] about the [https://drive.google.com/file/d/1o0mlqZaMMUeD7Eapc1H0CdSsTz4HsuxE/view letter to the CDC] requesting them to change the name of EVALI, and the CDC's [https://drive.google.com/file/d/13QvkPs5oK8MF_CWmO5SL9mCwUcTmFMwR/view refusal] to do so. This letter was signed by 75 international tobacco control / public health experts.
-*Paper: [https://www.ingentaconnect.com/content/aips/trs/2021/00000007/00000002/art00004 Vitamin E Acetate is not Soluble in Nicotine E-liquids]
-**Vitamin E acetate is not soluble in formulations of nicotine e-liquids and if mixed into a nicotine e-liquid will form a visibly distinct layer. Therefore, it is unlikely that nicotine-only e-cig users will be exposed to vitamin E acetate.
-*Paper: [https://www.qeios.com/read/ZGVHM7.3 The outbreak of lung injuries often known as "EVALI" was nothing to do with nicotine vaping]
-**An examination of the evidence shows that EVALI cannot have been caused by nicotine vaping. The characteristics of the lung injury outbreak are consistent with localised supply chain contamination. The contaminant has been identified and is known to be Vitamin E Acetate.  This had been used as a thickener or cutting agent in illicit Tetrahydrocannabinol (THC) cannabis vape pens. This agent cannot be mixed with nicotine vaping liquids and would serve no useful purpose if it could be.
-*Article: [https://morningconsult.com/2020/02/05/electronic-cigarettes-increasingly-blamed-by-public-for-lung-illnesses-even-as-evidence-points-elsewhere/ E-Cigarettes Increasingly Blamed for Lung Illnesses, as Evidence Points Elsewhere]
-**CDC identified THC vapes with vitamin E acetate as culprit, but 66% of adults blame e-cigarettes for vaping deaths
-*Tweets by [https://twitter.com/ScottGottliebMD/status/1217893624353980416?s=20 Scott Gottlieb, MD]
-**An e-cigarette is an FDA regulated electronic nicotine delivery system (ENDS). It delivers nicotine. What CDC seems to be trying to refer to here are illegal vapes or “dabs” that contain THC. We develop precise regulatory nomenclature for a reason. It helps differentiate products
-**CDC should reconsider the name it ascribed to these illnesses (EVALI) now that it seems to be definitively linked to THC vapes and dabs. By not speaking with precision it could leave a false impression as to the clear causal relationship between the tragic illnesses and THC vapes
-**The public health risk is that kids using these illegal and dangerous THC products may not know that the CDC warnings relate to the THC products they’re using; since the CDC is not using a precise nomenclature to more clearly describe the THC vapes and dabs
-* Tweet by [https://twitter.com/ScottGottliebMD/status/1177704654068748293?s=20 Scott Gottlieb MD]
-**My point is simply if you know a THC product hurt someone, don’t call it an e-cigarette, call it a THC vape or THC vaping product. Nomenclature matters in helping consumers properly identify which products are causing which kinds of risks. That’s why we develop naming systems.
 [[Category:Studies, Surveys, and Papers]]
 [[Category:Media - Movies, Videos, Vlogs, Blogs, OpEds, News, etc.]]