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Has the time come to quit vaping forever?

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Allegations of illegal marketing tactics. More than 500 cases of severe lung illness in 38 states. Eight deaths. A proposed federal ban of most flavoured e-cigarettes, and new efforts in many states to counter an epidemic of youth vaping.


There’s been an avalanche of vaping news this month, which leaves many users facing a crucial question: Is it time to quit? Here’s a look at the issues.


First, how big is vaping?


E-cigarettes swept onto the market about a decade ago. They’re now a $2.6 billion industry in the United States, and roughly 20,000 vape and smoke shops have sprung up across the country in the past few years. There is also a thriving black market for vape pods. A survey last year found that 10.8 million American adults used e-cigarettes — and that more than half were also smoking cigarettes.


E-cigarettes have become especially popular among teenagers. Preliminary results from an annual survey sponsored by the National Institute on Drug Abuse and released on Wednesday found that one in four 12th graders said they had vaped in the previous month, a sharp rise from the previous year.


Young people are especially susceptible to nicotine addiction and may be more likely to take up regular cigarettes once they are hooked.


Is vaping safer than smoking?


There was an idea for a while that e-cigarettes, because they don’t generate smoke and tar, were safer than smoking cigarettes, or at least that they could help a smoker shift to a less dangerous alternative. But the mysterious spate of illnesses thrust concerns about vaping’s health effects into the spotlight. Many of the people who got sick were vaping THC, and the authorities are investigating what else black-market pods contain.


Albert Rizzo, chief medical officer for the American Lung Association, noted that the organisation’s opposition to vaping predated the outbreak.


He disputed the perception that e-cigarettes are a safer alternative, and pointed to the lack of information about what chemicals they contain and the paucity of research about the effects of vaping.


“To say that something is safer than a product like cigarettes that kills seven million people in the world each year because of tobacco-related disease, and half a million people in this country, is not saying a lot,” Rizzo said.


“We have no evidence of whether it’s safe at all. There’s just no scientific basis for that.”


A new generation of young people addicted


The rise of vaping comes after at least two decades of great success in decreasing smoking rates across the country, and has health experts concerned that those gains could be reversed.


Most e-cigarettes contain nicotine, which is highly addictive and especially harmful to young people, whose brains are still developing. (The human brain is still developing until you turn 25 or so.) Nicotine can harm the parts of the brain that handle memory, attention and learning.


It’s also illegal for minors to vape. (A growing number of states have even raised the vaping age to 21.) And using e-cigarettes may make teenagers more likely to smoke real cigarettes in the future. Rizzo noted that the vast majority of current smokers became addicted before they were 18.


Some people may not realise how much nicotine they’re ingesting as they puff away. A typical pod made by Juul can contain as much nicotine as a pack of cigarettes and is designed to last for about 200 puffs.


“We have a new generation of young people in high school and middle school that are now nicotine addicted,” Rizzo said. “We don’t know what the dangers of e-cigarettes are.”


What about THC?


While many people use e-cigarettes to inhale nicotine, some use it for THC, the high-inducing chemical found in marijuana. A large portion of the recent cases of lung illness were in patients who vaped THC.


The Food and Drug Administration said that a significant subset of samples of vaping fluid used by sick patients also contained a compound called vitamin E acetate, which has been a subject of further investigation. The FDA has warned people to avoid vaping THC.


A minority of the people who got sick said they had used e-cigarettes containing only nicotine — but there were also concerns that some young people were not being entirely forthcoming about their vaping habits.


Public health officials are warning people against vaping


Public health officials at the Centers for Disease Control and Prevention have recommended that people refrain from vaping as the agency investigates the illnesses. They stressed that young people, pregnant women and nonsmokers should never vape. They also cautioned people who do use e-cigarettes to monitor themselves for symptoms of lung illness, like coughing and chest pain.


An editorial in The New England Journal of Medicine this month stated bluntly that doctors should discourage people from vaping and reiterated that e-cigarettes should never be used by nonsmokers.


The acting commissioner of the FDA, Ned Sharpless, has said that the issue of tobacco control in the e-cigarette era keeps him up at night. The agency got authority over what it calls “electronic nicotine delivery systems” only in 2016, and is now working on new research and regulations.


In a statement, Sharpless noted the inherent paradox of e-cigarettes: While they were pitched as a way to get smokers to stop lighting up, they hooked a new generation that may end up smoking traditional cigarettes to get that fix.



The New York Times


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4 of 5 Indian children do not survive cancer. What led to this sorry state?

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How long does a cancer diagnosis take?


Six months, according to Bipin Jana, 45, whose eight-year-old son Parmeshwar has stage-4 Hodgkin’s lymphoma. That is how long it took the family, travelling 2,000 km across West Bengal, New Delhi and finally, Mumbai, to get an effective diagnosis and start treatment.


Parmeshwar is currently undergoing chemotherapy at the Tata Memorial Hospital (TMH), Mumbai, India’s foremost

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Vitamins and omega-3 fatty acids may help children with autism

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Children with autism who take supplements of vitamins and omega-3 fatty acids may have fewer symptoms than kids who don’t, a research review suggests.


Researchers examined data from 27 trials involving a total of 1,028 children with autism spectrum disorder. Kids were randomly selected to take various dietary supplements, including vitamins or omega-3s, or to take a dummy pill instead.


Omega-3s and vitamin supplements were more effective than the placebo pill at improving several symptoms, functions, and clinical domains, researchers report in Pediatrics. Gains varied in the trials but included improved language and social skills, reduced repetitive behaviours, improved attention, less irritability and behaviour difficulties, and better sleep and communication.


“These results suggest that some dietary interventions could play a role in the clinical management of some areas of dysfunction specific to ASD,” said David Fraguas, lead author of the study and a researcher at Hospital General Universitario Gregorio Maranon and Universidad Complutense de Madrid in Spain.


Even though the analysis was based on controlled experiments — the gold standard for testing the effectiveness of medical interventions — the individual studies were too varied in what supplements they tested and how they measured results to draw any broad conclusions about what type or amount of supplements might be ideal for children with autism, researchers note in Pediatrics.


“The underlying mechanisms involved in the potential efficacy of dietary interventions in autism spectrum disorder are unknown, Fraguas said by email. “Our study does not assess this important question and current literature is inconclusive.”


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New transplant research aims to salvage infected donated organs

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Retired subway and bus driver Stanley De Freitas had just celebrated his 70th birthday when he started coughing, tiring easily and feeling short of breath. He was diagnosed with pulmonary fibrosis, a severe scarring of the lungs, and put on the wait list for a transplant.


“Life became unbearable. From the time I got up in the morning until when I went to bed at night, I struggled through every breath of air,” De Freitas, now 74, told Reuters by phone from his home in Toronto.


After two years, De Freitas was offered a lung, with one significant downside: The donor had hepatitis C.


In October 2017, he became the first patient enrolled in a just published study conducted at Toronto General Hospital testing a technique that aimed to flush out and inactivate the hepatitis C virus from donor lungs before a transplant.


The research comes amid a spike in available organs linked to the opioid overdose crisis, meaning many are contaminated by hepatitis C as the virus is commonly spread by sharing needles. Since it can easily infect an organ recipient, those organs are usually discarded despite the urgent need.


Data from the United Network for Organ Sharing (UNOS), which matches donors with recipients, shows that 97 percent of people waiting for a lung in the United States last year were unwilling to accept an organ from a donor who tested positive for hepatitis C.


While hepatitis C causes serious liver disease, the virus can be present in the blood in other organs.


Researchers are testing different approaches to salvage infected organs.


A study published in April showed that giving patients antiviral therapy just hours after transplant surgery can successfully attack the virus before it gains a foothold in the recipient.


Eliminating the virus prior to transplant would simplify the procedure for patients, said UNOS Chief Medical Officer David Klassen. It could also significantly cut down on wasted donor organs.


The technique used in Toronto, known as ex vivo lung perfusion, keeps organs “alive” outside the body by pumping them with a bloodless oxygenated liquid. They used ultraviolet C light to irradiate the solution, aiming to deactivate the hepatitis C virus and make it non-infectious.


Perfusion allows doctors to evaluate and potentially rehabilitate organs for transplant, and buys them more time than storage in ice boxes, which can cause tissue damage.


Toronto researchers used a solution from Sweden’s Xvivo Perfusion AB with the hospital’s own ex vivo lung perfusion system, a bubble-like machine made from off-the-shelf components and an intensive care ventilator.


The study of 22 patients, published in The Lancet Respiratory Medicine on Wednesday, had mixed results. Adding light therapy significantly decreased the amount of virus, but all but two of the patients contracted hepatitis C, which is now curable.


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