Sunday, 29 March 2020

Plague

  
Quarantine instructions by... Isaiah 26:20

Go, my people, enter your rooms
and shut the doors behind you;
hide yourselves for a little while
until his wrath has passed

Oh, how things can change in a short time!  

  Just a while ago our government was recommending Bill C-7 proposing to remove the requirement for a "reasonably foreseeable natural death" to qualify for "MAID" (medical aid in dying).  
See article below  (WWW.carenotcuts.ca): Concerned Ontario Doctors.

   "Canada’s initial euthanasia legislation was passed in June 2016. In 2017, Ontario had become the only jurisdiction in Canada and the entire democratic world to violate physicians’ fundamental freedom of conscience despite it being protected under the Canadian Charter of Rights and Freedoms, the United Nations Universal Declaration of Human Rights and the Declaration of Geneva. The International Code of Medical Ethics demands a physician practice his or her profession with conscience and yet, Bill C-7 does not contain any conscience protection for physicians.

The amendments proposed by Bill C-7 have been tabled even prior to the commencement of the 5-year parliamentary MAID study. No jurisdiction in the world with legalized euthanasia has moved this quickly towards a state of unrestricted euthanasia. In 2016, Canada’s government failed to first pass legislation for the right to palliative care and assistance to live with dignity, as exists in other jurisdictions with legal euthanasia. Canada is the only nation with legalized euthanasia under a socialized single-payer healthcare system. Canadian governments have failed to plan for its rapidly growing and aging senior population: Its healthcare system is in crisis. Hallway medicine has become the norm, more than 85% of Canadians do not have access to essential palliative care, more than five million patients do not have a family doctor, and patients are suffering and dying on multi-year wait-lists for specialists.

Bill C-7 proposes to create two tracks and would remove the existing key criterion for a “reasonably foreseeable natural death”. The legislation follows a 2019 Quebec court’s decision in Truchon and Gladu. However, advocates for people with disabilities, including the Council of Canadians with Disabilities and the Canadian Association for Community Living, have said the court decision was discriminatory and sent the message that "having a disability is a fate worse than death". They urged the Trudeau government to appeal the Quebec court ruling, which it declined to do."

The Bill further proposes to remove many existing safeguards that serve to protect vulnerable Canadians, including decreasing the number of witnesses required for a MAiD request to one individual, the removal of the ten-day reflection period and the allowance of advanced consent. The Canadian government has also signaled its intention to allow for further expansion of euthanasia for children and mental illness, possibly as early as next year.
   
   Despite protests to the contrary, as I blogged previously, once descent of the slippery slope begins it quickly  gains momentum. (Free fall in a vacuum will accelerate at approximately 9.8m/s2).  It doesn't take the politicians and their satraps long to realize that the 'MAID' program liberally applied will result in huge financial savings to the health care system, since the elderly consume a great amount of the health care resources.  With the predilection of the coronavirus to obliterate the elderly, the accelerating drift into a geriatric demographic could be reversed.  Governments are well aware what that would save the declining health care system.  
   Failure of preparedness for the catastrophic situation that exists now is partly due to lack of insight and unwillingness to invest adequately in the safety of health care professionals. This impairs the efforts of those with the expertise to deal with the crisis.  The pre-occupation  of our Prime Minister with 'virtue-signalling' by sending sixteen tonnes of facial masks and other protective gear to China as the present international  coronavirus cataclysm was gaining increasing momentum left Canadian health care providers unprotected and vulnerable.  Other protective measures for health workers have also been ignored.
   We expect a great deal from our health care providers.  They expose themselves to considerable risks on our behalf, the least we can do is stand up and demand they have state of the art protection so that they can continue to look out for you.  Call your local MPP and tell him/her that's the least you expect.
   








Monday, 9 March 2020

Obesity.

Headline in the National Post a couple of weeks ago: "Unilever takes aim at obesity in kids,".
Subheading -' Won't advertise ice cream to children'' It goes on to say the company will stop advertising foods and beverages to children under the age of twelve!
The word health organization names childhood obesity as one of the most serious health issues of the twenty-first century. Obesity rates for children and adolescents have more than tripled since the 1970s. A national survey of children's health just last year reported an obesity rate in the ten to seventeen group averaged 15.3 %
Whenever I go into Chapters/Indigo to browse, I find new books on Obesity assuring desperate potential readers that the book in question is the ultimate solution to the problem. Of course if that were the case there would be only one book. That's all that would be necessary. But, when I looked up books on weight management on Amazon, I got tired after I counted up to one hundred and fifty and abandoned the task. It's a multi -million dollar industry.
When I started in general practice in the early sixties it didn't take long for me to recognize the relationship between obesity and disease. Diabetes, hypertension, gall bladder disease, cardiovascular disease were all related to obesity. Aesthetically obesity was undesirable, making exercise physically and mentally uncomfortable and in those less politically correct days obese people were often stigmatized, jeered and generally deprecated. Then as now there were dozens of "miracle" diets, programs, medications, some of which helped to lose weight, most of which tended to be regained soon after the diet or program was abandoned. Millions of dollars were spent annually by patients looking for the "magic bullet". There is no magic bullet. The bottom line is that there was then as there is now only one rule: Calories in must equal calories out to maintain constant weight. If more calories are consumed than are burnt the excess calories are converted to fat at a rate of one pound of fat per 3,500 calories. If more calories are burnt than are consumed the fat bank contributes them, Certainly there are conditions that influence the rate that calories are burnt off, exercise and activity, metabolic rate and certain other conditions. In the vast majority of cases there is no underlying medical diagnosis to account for obesity. There is no easy way to lose weight and to keep it off. I used to take some time to raise the topic with patients I thought needed help to deal with obesity when I was in private practice, but it was time consuming, poorly paid and with a poor success rate. In a busy practice it was difficult to spare the necessary time.
When I became an academic physician I thought this would provide an ideal opportunity to develop a sound nutrition and weight reduction program and introduce it into the resident curriculum. Numerous patients expressed interest in attending such a program and it made sense to establish an evening group that would accommodate a dozen or so people to be held once a week for about eight sessions. This would avoid interference with the busy daytime clinical activity. The academic department of Family Medicine was in University Hospital. There was no budget available to establish such a program despite the important educational and research potential. When I submitted a modest budget primarily to reimburse staff for their evening involvement nurse, dietitian,physio etc, I was advised that my budget would be considered for the following year and if I had the group up and running it would help. Everyone realized the important role nutrition and weight control played in promoting good health, I was reassured. The entire budget was a few hundred dollars.
Full of enthusiasm, I put together an enthusiastic team who agree to work pro bono because they realized the importance of the problem we were adressing. One of our senior nurses, who had been a pediatric nurse in her younger years and become interested in overweight children had developed an unofficial 'mini-program' directed at fat kids and their parents, that carried over into her family practice nursing. She immediately offered her services in the organization of a weight control program. She understood we had no budget and that initially at least, there was no immediate prospect of being reimbursed for her time. She didn't care and was prepared to give up her Monday nights to 'help people'. Yes, there were people like that in health care in those days.(P.J. Barnum said, 'there's one born every minute'). Within the infrastructure of University Hospital, I found a dietitian who was interested in establishing the Monday Night Obesity Group, despite my informing her that there was no U.H. Budget and possibly there never would be one. She didn't care, she volunteered to be part of the group. A couple of our office staff volunteered to do the organizational things that are essential for any group to function effectively.
Next, I found a physiotherapist, a competitive athlete herself who was interested in being part of the group.
"Oh," said she, "I'm really interested in developing general fitness programs. I'm certainly interested in getting overweight people as fit as possible!.
"As long as you realize we are not dealing with competitive athletes here, for the most part we are looking at overweight patients with health problems that would benefit from a moderate exercise program that would improve their health rather than kill them."
"Point made" she said. "Still, I'm interested". And indeed she was and contributed significantly to the program, even though I occasionally had to remind her that our objectives were relatively modest - to keep folks mobile and functioning rather than train Olympic athletes.
Next, I had to recruit a few physicians who were prepared to take on yet another evening activity. In those days before family physicians were more than eager to slough off after hours stuff to walk-In clinics, hospital emergency departments, etc, many doctors had on-call obligations one, two or three nights a week. Most took these obligations very seriously. When a physician told patients to go to the emergency department, it was to MEET them there. It was difficult - and perhaps unfair to ask them to commit yet another of their evenings, but being the suckers we were in those days I managed to recruit a few. Some of the office staff had volunteered some of their Monday nights, so we got our crew together in a relatively short time, I was sure that when the next hospital budget came around we would be allocated at least enough to give those volunteers a modest stipend for their contribution.
  We posted a few notices around the department informing patients that a weight reduction program would be commencing in a month and anyone interested should register with the front desk for further information. We thought eight or ten people would be ideal but thought we would be lucky to get four or five to start with. Within a few days we had many more requests than we could handle. Until we had the protocol nailed down it would be a mistake to take on too many folks.
We were ready to go within a couple of weeks and had a growing waiting list for the next few eight week courses. We adopted a behaviour modification approach to weight loss which may be outlined later.
The program thrived, gained some local fame but no fortune. Despite the fact that patients benefitted and residents and students learned a little about nutrition and how to treat obesity, the hospital program budget committee turned down the request for a measly $700 budget.
The program continued for several months until the warriors grew weary of working without recognition or reimbursement. I guess obesity control is not very glamorous not matter how much ill health it prevents.
At least we all got our Monday nights back!!


Thursday, 20 February 2020

Reflections of a Dumb GP. Pt.2

There was more to being a medical student than just study. But fun, when you had no money and neither did your family, could sometimes be too expensive! Even more so when you had a girl friend and were planning to get married while still a student. Tuition fees were a constant concern but life wasn't all work and one needed a little money to function even very modestly.
My fiancee , was a self taught, talented pianist and I was a self taught untalented drummer. She was in great demand at parties and family gatherings in our courting days, so I had to do something. I started off by tapping on the piano, in the hope that it would drive everyone away, so that we could have what was called some "quality time" together. ('Quality time" to me meant getting rid of the rest of the family long enough to burn off some of the normal testosterone that every young man had coursing through his veins in those days when we thought there were only two sexes -little did we know!!). I continued drumming on every drummable surface, never expecting that it would later pay off and provide a means to help finance my way through medical school and to getting married.
A classmate of mine since high school days was a talented musician. He went on to become a very successful professional musician after having graduated from medical school. His mother had been a piano teacher, so he played piano almost from birth. Sometimes, when we were in high school, I went to his home to listen to him practicing a la Oscar Peterson. He had a drum kit in his music room and on occasion I would try to accompany him on the drums. He put up with my performance and even tried to improve it. He was well known in the Dublin music world, where he was professionally sought after and he knew Irene and I were hoping to make some money doing a gig or two around town. He recommended us to apply for a gig at the "Paradiso Restaurant and Night Club - where the stars dine!" He had played there in the past and they had approached him to return but he was busy with bigger,better engagements. He had recommended us.
"There's no way I am good enough for that," I said.
He laughed. "They won't know the difference!"
I applied and the manager interviewed. "Experience?"
"Lots," I lied. "I thought Ian (my friend) would have told you."
"And the pianist?"
"Oh, she and her family have just returned from living in Miami (true). She did many gigs there (untrue). She's good!"(true)
"OK, Monday night is quiet. I'll hire you for a one night audition and if it goes well I'll give you a three month contract."
It went well. We got the job at the Paradiso and played from eight pm to midnight five nights a week. After our nightly performance we would walk home, a forty-five minute walk as the public transport ceased at 11.30pm, so we could save the taxi fare. I had to be at medical rounds at nine am, mandatory for all second year medical students.
Guests often bought us a drink and as I had to work in the morning we declined after the first drink. The tuxedo clad manager drew us aside. He was Swiss, he was dignified looking and he was mean.
"You can't decline when guests want to buy you a drink," he barked indignantly.
"Well, I have to go to work in the morning, you know I'm a medical student, and I can't turn up with a hang-over."
"You have to accept when a customer offers you a drink." he replied.
"Okay, you can just give us some ginger ale or soda in an appropriate glass and we can sip on that."
"Yes, I can do that."
"You'll have to give us the cost the customer pays for the drink, of course."
He looked aghast. "I'm not going to do that!" he said.
"Then we won't accept." A thought occurred to me. "If you won't give us the cash, then you can give it to us in cigarettes," I said.
He agreed. For the next months, for the first time in my life I always had enough cigarettes.
The Paradiso was situated in the core of downtown 

Dublin and their sobriquet "Where the Stars Dine" turned out to have more than a grain of truth. Dublin was a great theatre city, so we did play for some of the performers and theatre crowd who drifted in after the show.
We carried on playing the Paradiso until the summer break, when we got an engagement at a very fancy hotel on the west coast of Ireland, in Waterville, Co Kerry, the site of the first transatlantic cable station from St. John, New Brunswick. It operated from 1884 until 1962 making real-time transatlantic communication possible.
A drummer friend who had his own small group was offered a summer season engagement at the Butler Arms Hotel, which he couldn't accept because of his job.
" They asked me if I could suggest anyone, so I gave them your name." he informed me.
I was more than grateful. If we got this job it might just cover my university fees and have a little left to go into the wedding fund.

Tuesday, 11 February 2020

Family Medicine - RIP.


The fate of Family Medicine.


They say that Old Soldiers never die, they only fade away.
It's different with Family Doctors,
Old Family Docs never stop, they only lose their pay.
I can honestly say, that since my retirement at the age of 78, not a single week goes by without one, or often many more medical consultations. I carefully explain that I am no longer state of the art, that I no longer try to be state of the art and only follow medical progress in areas that particularly interest me. This deters no one from seeking my opinion, because when they consult me they are looking for advice other than mere medical expertise. Usually they are looking for something that before the 'Ten Minute (or less) Consult' most patients got from their family doc, a conversation with their doctor, an explanation of what they didn't understand or know, from someone who knew something about them and their background and consequently knew how to communicate with them.
The conversation often didn't take much time at all, because most patients used to have an annual history and physical examination during which the physician became familiar with the patient's medical history and background. The physician got to know a little about the patient's life style and preferences and often gave some advice that the patient found useful.  This created a bond that encouraged continuity of care and that benefited both the patient and the physician and was one of the foundation blocks of Family Medicine. Itwas also comprehensive, in that it covered almost everything.
The annual history review and physical examination has become a thing of the past, although it was inexpensive and productive. The government saw fit to rationalize it away and remove it from the fee schedule, to save money and not very much at that. Continuity of care took dedication and effort on behalf of both the physician and the patient and has lost gound to the convenience of episodic care and the ubiquitous 'walk-in' clinics where the Ten-Minute Consult (or shorter) prevails and continuity of care no longer exists. Medicine has become depersonalized and physicians have become technicians. From the physician's viewpoint it is much easier to do away with the 24/7 responsibility philosophy that many of my generation of physicians espoused, often to the detriment of themselves and their families. As one of my finest family physician mentors explained to me many many years ago when as a newly qualified physician I asked him why he had decided to be 'just' a general practitioner instead of specializing in a more esoteric area of medicine: " In another era, I think I would have become a clergyman, but that's a bit difficult when you are an atheist. I was interested in people, in families and in how to help them to deal with their health problems, diseases both physical and mental and that's why I chose general practice." I saw myself as a 'Problem Solver'.  
Sounds corny now, eh? But I believed him and still do. And when it was put to the test in regards to personal issues sometime later, he more than rose to the occasion. But that's another story. Suffice it to say he didn't sign out at 5pm ANY night.
 
Since I have become an unlicensed pro-bono physician, I do have a steady stream of patients. My latest consultation came this past week-end, when I received an email from an acquaintance who was worried about his ten year old child. It was about ten pm when I read it and this is what it said:
"This is Joe from the pen club. I was wondering if you could help me answer a quick question. My son who is 12y old and about 100 lbs has an ear infection and got a prescription yesterday for amoxicillin trihadrate in a dose of 2000 mg twice a day. Does that sound like a right dosage? It seems very high.
I was trying to contact the doctor who prescribed it, but no luck. I would really appreciate your advice."
I answered that I agreed with him and suggested what I considered the appropriate dosage.
This is his grateful reply:
" Thanks so much Stan! I really appreciate your advice! Have a great weekend."
I was glad to be able to help him out, but sad that our second rate health care system had left him in the lurch. I know many of our health care administridiots would cut in here and say that there are existing ways in which he could have checked this out - and there are. But when a well educated person has a sick child and they are not familiar with the arcane rituals of the Canadian Health Care system and they don't know what to do - something is wrong.  
In health care availability reigns supreme. Ability is not helpful if one cannot access it when one needs it. When a person needs health care expertise now, it is no use informing a patient they can have a consultation in three months time. Or in six months or in a year, if you live that long. One of the rolls of the family doctor was to assess the situation, determine how serious it was and to ascertain appropriate care was available to the patient in an acceptable time frame. Once upon a time, when that sort of situation developed, I (the family doc) could phone the specialist and say, "I have a patient here in a dire situation, could you see him urgently today or circumstances permitting tomorrow? Usually, the specialist would work him in. In latter years, I couldn't even get the specialist on the phone. Thanks to modern technology, I often couldn't even get his nurse or receptionist on the phone.  
" I am at work today and am away from my desk,. Please leave a message and I will get back to you as soon as possible!"  was the automated response.
Sometimes they did and sometimes they didn't.  
In more recent times before I retired, I had difficulty getting hold of my own nurse. Truly, the telephone has become an instrument for the avoidance of communication!
When General Practice started dying in the fifties and the sixties, a group of visionary physicians recognized the values of well informed generalists as becoming a vital component in the face of the development of esoteric and complicated specialties. The importance of interpreting and evaluating and explaining and advising patients regarding increasingly complicated procedures and treatments was recognized as being an important role of the family doc. This was, of course in addition to the daily management of the commonplace illness that beset families. Often minor, but sometimes heralding a more serious disorder or requiring immediate response. Mr Google was not yet upon the scene and patients valued a relationship with a doctor who could explain and interpret and advise them what to do.
Unfortunately, instead of following the original intent of establishing family doctors as 'specialist generalists' and interpreters and appliers of cutting edge medicine, the College of Family Physicians became pre-occupied with remodeling itself as a 'specialty' in the petrified image of the Royal College. This undermined the concept of the competent generalist whose specialty was to problem - solve and that often involved getting the patient to the right specialist at the right time. A knowledge of the patient's history, background and life circumstances had a considerable influence on management.
So where did the College of Family Physicians go wrong?  Indeed, are they responsible for the death knoll of 'Family Medicine'?

 




Wednesday, 29 January 2020

Rationed Health Care.

 
ra·tion
/ˈraSH(ə)n,ˈrāSH(ə)n/
noun
  1. a fixed amount of a commodity officially allowed to each person during a time of shortage, as in wartime.


   As I continue to scan through various medical publications I grow increasingly depressed.  Despite our technological advances stories of patient mismanagement and or neglect seem to be increasing.  I am not talking about medical mismanagement due to lack of diagnostic or management acumen, I am talking of the inability of our system  to adequately deal with the problems due to mismanagement of resources. The present method of dealing with the inadequacy of the system is to ration health care.  Let me state that in another way.  The gross inadequacies in our health care system are dealt with by rationing.  Of course no politician or administrator would call it that.  They prefer to pretend that the obscenely lengthy waiting times are due to shortage of physicians, or nurses, or other health care personnel.  Any such shortages are directly due to their policies.

   Let me give you one example of the outcome of health care rationing, published recently in a medical newspaper.  The writer is a family doctor and she refers to her patient and family by actual name indicating that they were aboard with publishing the story.  The story should be extensively shared with Canadians, most of whom are under the impression that they still have a competent, caring health care system, second to none, whereas in fact we have at best a second rate system heading to become a third rate one.  The patient, something of a minor celebrity, found blood in her urine in October of 2017. She consulted her doctor who despite her concerns could not get an appointment for her to have a cystoscopy to look into her bladder and make a diagnosis.  Incredibly, it took until spring of 2018 for this to be carried out. At that point there was too much blood to make a definitive diagnosis but an infection was thought to be the problem and the patient was put on a  six week course of antibiotics, after which she was to have a follow-up cystoscopy and a CT of the kidney. The antibiotics did not help.  She became weak and anorexic, lost weight and slept most of the day.  The family became so alarmed with the time it was taking to adequately investigate the disease that they paid for a private CT (technically illegal in Canada!) and she was diagnosed with Cancer.  Another wait for a biopsy and yet another to see an oncologist.  The final diagnosis was that she had originally had a bladder cancer, that had spread to her kidneys.  She died on October 1st 2018, quite likely due to a dysfunctional health care system.  
   No government official, even of the lowest rank  would have been treated in this manner.  So much for equality of treatment in a country that claims to provide equality of treatment for all of its citizens, but makes it illegal for people to pay for private health care.  (Unless they are rich enough to go  to the United States).  This is a gross infringement of charter rights.  A blended system works well in Australia and most of the developed countries, improves the accessibility of health care for most of the population and injects additional resources into health care.
   It's time for Canadians to get 'woke' about health care !
  You have your own story of health care failure? Share them. 
   
   

Monday, 20 January 2020

Growing old - not so gracefully!

  Growing old. is easy.  All you have to do is stick around for long enough.

  As the list of my friends and acquaintances thin out, I become increasingly aware of the fact that I am not growing old, I achieved that status years ago, I am growing ancient.   Not bad considering the genetic hand I was dealt.  My siblings too are beating the odds and my wife who is the same age as me continues a full range of household and a not so full range of other activities.  So I have nothing to complain about.   I really never realized I was getting old.  Denial is a potent therapy when used wisely and on occasion it serves quite as well as placebo.   It is not for everyone but it has served me well through real and imaginary crises.
   However, there are certain things that cannot be denied.  That my daughter will soon be getting what we crassly used to call 'the old age pension'.  That I sometimes have to work hard to maintain a look of casual insouciance keeping up with youngsters at the mall.  That schlepping myself out of an armchair I sometimes hear myself making, what I call, 'an old man grunt'. (You know what that is if you are getting your pension). That I'm not quite as smart as I think I used to be!
   Nineteen thirty-five, the year I was born was quite a year.  The world got Monopoly, a game people still play, as well as Shirley Temple dancing with Bo Jangles Robinson and Benny Goodman playing Blue Moon, the top of the hit list. (I still know all the words - it's only the important things I forget!)
   Aubie Blake, the great jazz musician said on reaching ninety, "if I knew I was going to live this long I'd have looked after myself better."  I know what he meant.
   Many years ago while making my hospital rounds I asked an older patient how he was doing.  "Great Doc" he responded.  "I've got the system beat" I asked him what he meant.  " I'm too old to die young," he grinned.
   I let my dentist who has been a friend of mine for twenty years but whose age is nearer my son's age than mine take me out for lunch every now and again.  I figure it's the least he can do in lieu of the vast amount I have invested in him over the years.  He has re-built almost every tooth in my head- painlessly (almost).  As we chatted and I happened to mention a very close friend who bit the dust not too long ago he commented, "Yes, most of your friends must have passed away by now".
   "Yes," I answered appropriately gravely and just so he wouldn't feel too comfortable I added, "even some of my younger ones."
   For years friends - and others, have been cautioning me that one should live every day as though 'tomorrow we die'.  I tell  them not to be so absurd, that thinking like that kills people.  In fact, I live each day as though as though I am going to live forever.  I might just succeed, but if I don't, I'll be the last person to know about it.

Image result for geriatric jokes

Thursday, 2 January 2020

New Vaping Hazard!

OY Vape.

Canada has a disastrous drug problem. ( More than 13,900 opioid deaths occurred between January 2016 and June 2019.) So it shouldn't surprise anyone that the government of Canada and their satraps saw fit to introduce legislation that facilitates converting the least toxic of the street drugs into killer drugs. I am speaking, of course of marijuana, now available for consumption in a myriad of ways few would have thought of until recently. The drug, which is no longer the drug your mother might have smoked has been carefully morphed into a more addicting and toxic form. The variety of presentations, make it more available and desirable to the younger segment of the population.
The latest life-threatening avenue of ingestion has seen the marriage of pot to E-cigarettes. E-cigarettes available since about 2003, were originally touted as a smoking cessation aid, the vaporized substrate was usually water vapour and some nicotine, and were a much less harmful habit than cigarette smoking, an opinion shared by many physicians. Unfortunately they were particularly popular with young people.  
It wasn't long before before the search for sensation led folks to try adding various drugs to the solution.
The Center for Disease Control and prevention in the US, as of December 17, 2019 documented a total of 2506 hospitalized cases of vaping related injuries in the US with 54 deaths confirmed on 27 States. The syndrome has been labeled EVALI (E-Vape Associated Lung Injury). These numbers represent hospitalized patients only, so we can only guess what the grand total might be. All of these patients have a history of using e- cigarettes or other vaping products.
THC, the intoxicating, psychoactive component of marijuana Is present in most of the samples tested by the FDA to date and most patients reported a history of using THC containing products. E cigs work by heating a liquid to vaporization that users inhale into their lungs. The liquid can contain anything including a combination of substances. 80% of the EVALI patients studied reported using THC containing products. 40% reported using both THC and Nicotine containing products. Some people will inject or ingest anything into themselves and have found a new delivery system in vaping. There is still a great deal we don't know about the mechanism of lung injury caused by the current vaping trends and the CDC continues monitoring the cases, testing in various ways for toxic substances and studying lung damage by biopsy and in fatalities by autopsy. They are also maintaining an aggressive educational program, including a web site, which will at least increase awareness among some of the potential victims.
The Center for Disease Control and Prevention recently announced that Vitamen E acetate, an oily chemical added to some THC vaping liquids to thicken them is a substance of concern. The chemical is a synthetic form of vitamin E that has some safe uses but that isn't safe to inhale. it is thick and sticky. It adheres to the lung tissues and interferes with their function and was found in many of the patients with EVALI. Vitamin E acetate has been found in many of the THC vaping cartridges used by patients suffering from lung disease associated with vaping. The role of the legalization of marijuana in the genesis of this new disease certainly needs clarification.