The Strange Life and Sudden Death of a Disease
“You see Watson, but you do not observe.”Sherlock Holmes
“Gentlemen, I have a confession to make. Half of what we have taught you is in error, and furthermore we cannot tell you which half it is.”Sir William Osler
You may have seen or heard people “vaping” small appliances having the appearance of large flash drives or fake cigarettes. The technological concept is old and relies on a power source (usually a battery), a cartridge or refillable tank containing liquid and a heating element and vaporizer to combust the liquid into a deliverable form. First patented in the 1960’s, the technology lay fallow until launched in the early 2000s in China and circa 2005-2007 in the west. Initially a curiosity with little market penetrance, colourful product lines and an explosion in flavours lead to an exponential growth phase towards the mid-late 2010’s including or perhaps especially in the youth market. Along the way and on the road to cannabis decriminalization, substances from the cannabis plant (THC and/or CBD) were factory added into vape solutions, along with many other substances by tech savvy youth retro engineering units to deliver MDMA, free base cocaine and other drugs.
And that sets the stage for 2019 and the strange case of EVALI or E cigarette/Vape Associated Lung Injury. Long before there was COPD (chronic obstructive airways disease) there was emphysema and chronic bronchitis. This is to say the evolution of an acronym does not describe the sudden emergence of a new disease known by another name. Can we say the same of EVALI? That’s a difficult question to answer, there being case reports here and there of vape associated emergency presentations in the years prior to 2019, though this was in part confounded by a) growth in risk requiring growth in vape use, and b) observation bias; the hope carried in some minds that vaping would be safer than tobacco and a gateway to abstinence (or at least the future seeing the end of lung cancer). Some doctors wanted them to be safer. The tobacco industry wanted them not to be or wanted the whole issue swept under the rug. We must recall parenthetically that tobacco toxicity was not acknowledged as a known known (where power sanctifies truth) until the work of the Sir Richard Doll in the 1950s and the Nazi’s a few decades earlier as Hitler was a motivated anti smoker (a less known known). Likewise we cannot expect any and all hypothetical toxicity of vaping to be immediately apparent. Given the extreme variability in vape products, neither can we expect hypothetical toxicity to be as uniform as that from the tobacco plant.
Whatever the case, EVALI qua a diagnosis with an acronym only became a thing in 2019 after a focus on an epidemic of US based vape associated toxicity resulting in perhaps 2,800 hospitalizations and perhaps as many as 70 deaths in young people. The epidemic appears to have taken off sometime in the US summer, peaked quickly and began to drop off in the fall until data ceased being collected in early February 2020. No US state was spared, and scattered reports also appeared in Europe. We can only wonder if the case count is the tip of the iceberg with others before or during the epidemic written off as asthma, atypical pneumonia, or other diagnoses.
This is where the plot thickens. The culprit was written off as being vitamin E acetate added in the solution to thicken THC containing solution. The logic was partly based on its commonality as an additive in 2019 and not 2018 or earlier. The verdict was also partly based on a consecutive CDC case series of 29 patients all with vitamin E obtained from broncho alveolar lavage. Presumably this could only have come from the vape. That said, we might as well question if EVALI was a crime in the making in the year or two before people took notice and if vitamin E acetate was the lone gunman in the book depository or others besides were on the grassy knoll. Even today, no one can commit to saying vit E was the only culprit. After all, there’s plenty of suspects in the solution, some in common with tobacco leaf, some not and some in this vape and not that vape. We have lead, copper, chromium, nickel, manganese and other trace elements. Propylene glycol can generate propylene oxide. Acrolein can be generated consequent to heating of glycerol. High temperatures can also generate formaldehyde. To say the lung prefers fresh air only is obvious and there’s no telling what these substances might do alone or in combination, in addition to whatever leaches out of the plastic, ceramic and foam of the hardware itself. Flavours can be present in many and varied combinations and include vanillin and cinnamon derivatives to name but two of thousands. These flavours might have their place on food, the nose and the gut but not the delicate fabric of the lungs inner sanctum.
For the conspiracy theorists of “covid” as a bioweapon, it is also to be noted almost all vape appliances are manufactured in China and vapes make excellent delivery systems for infectious and non infectious bioterrorism. But we shan’t go down that rabbit hole, as I have another in mind. The question I have is this. Why did the great EVALI epidemic end in early February 2020? True the cases began falling a few months prior. True vitamin E acetate was outlawed almost as soon as it was implicated. And true we can’t blame it on undiagnosed covid. Despite SARS COV-2 likely being out and about perhaps as early as October 2019 and despite the zillions of flights between all over China and Los Angeles LAX in the latter months leading up the first official cases of 2020, we can assume covid wasn’t at play in Aug 2019.
When covid did come along, those of us who peered out from the crow’s nest were quick to see it was almost exclusively an illness of the aged and infirm. Yet the world was propagandised to believe anyone of any age could (and probably would) die from it. When evidence of the relative safety in the young could no longer be ignored from a mortality perspective, the Covidian cult pivoted to claiming an epidemic of covid related multisystem inflammatory syndrome in children (MIS‐C). They claimed as many as 1 in 2000 youths infected by the virus would have organs shut down lest heroic moves are taken. Never mind the fact that would have amounted to many thousand youth flooding paediatric ICU’s in Japan when covid ripped through the far east and many tens of thousands of paediatric ICU’s in Europe filling up with cases of covid driven multi organ failure. It didn’t happen. This MIS-C line never even started going up. Still the statistic of risk was uncritically accepted, and the gears of the propaganda machine rolled on.
Returning to the curious question of the sudden end of EVALI, we are left with a curious piece of forensic evidence (I’ll spare the medical jargon where possible).
In covid, common symptoms/signs included fever, fatigue, respiratory distress, dry cough, loss of appetite +/- taste and smell preservation, muscle pain, gut symptoms. Guess what? The same is the case in EVALI
In covid we can have normal or elevated white blood cells called neutrophils and often lower numbers of white blood cells called lymphocytes. Guess what? The same is the case with EVALI.
In covid, other blood investigations often report increased D dimer, ferritin and fibrinogen and negative results for pulmonary embolism. Guess what? Same is the case with EVALI.
Finally, chest imaging in covid often involves a radiologist reporting “bilateral coalescent alveolar infiltrate of a so called ground glass appearance”. And guess what? Same is the case with EVALI !!!
Now I’m not suggesting all covid cases were really misdiagnosed EVALI, though I will dismiss any cases relying on patient testimony alone as to what they do and do not smoke. If a career in psychiatric medicine has taught me anything it’s that patients often only recall what they used when confronted with the evidence of the drug in urine, blood, or hair. Patients are people and people lie, all the more when incentivised to lie and dis-incentivized to speak the truth! What I am suggesting are two propositions, both of which are speculative, the latter less speculative than the first.
1) Every case of serious hospitalised covid in 2020 in young people who had the opportunity to vape might well have been EVALI unless urine was negative for THC and other drugs AND there was no nicotine and/or THC retrieved from bronchoalveolar lavage. The statistics of 2020 are irredeemably confounded. Even in PCR positive covid cases as PCR was not a measure of infectivity, viral load or disease severity. It was possible to be PCR positive without any live virus being present in the airway and without the disease of covid. But THC and nicotine does not get there unless by consumption including that via vaping.
2) The establishment wanted to end the EVALI epidemic and replace it with covid. The timing of the baton passing from one to another is all too convenient for “the narrative”. When vape use (or possible unexplored vape use) and positive PCR co-existed in the same patient, the diagnosis was always and only covid. The same small gravity of anchoring and availability bias towards EVALI and vitamin E acetate in mid-late 2019 could not compete with the tremendous force of covid in 2020.
History will forget about EVALI and vitamin E acetate long before it forgets about covid, that is of course if it ever knew about EVALI in the first place. On Pubmed, a search of covid in the title reveals literally a quarter million hits and growing as the covid cult remains in power. Interest in EVALI reached its peak growth in 2020, quickly waning to a total 146 hits to this day (only 10 articles in the last year2022-2023). EVALI and covid returns less than two dozen hits in total to mid-2023. This count too is unlikely to grow. We will never know the truth, all we can gauge is the interest in the truth and find it wanting. Enough to say that every time we look back at covid, it too objectively shrinks in significance, but only if we look back with the jaundice eye. The virus that remains is the mind virus, the psychological vulnerabilities to see what we want to see and diagnose what we want to diagnose. There’s also the establishment and its hunger to diagnose whatever constructs lead to the greatest expansion in power, funding and whatever else it is incentivized to make the next big thing. So we are reminded by Osler that half of what medicine we practice now will be looked back on as the error of the past, if not quackery. Back to the crows nest.
This article is a republication of an article originally published here on Robert’s Substack.