MEDICAL DEVICE – UNSAFE PRODUCTS UPDATE #1 - JUUL

Serving nearby areas by Palm Beach and West Palm Beach, Florida

MEDICAL DEVICE – UNSAFE PRODUCTS UPDATE #1

JUUL

It is well established that cigarette smoking is horrible for your body and your overall health. Vaping has been a more modern form of it that is supposed to be safer for your health. Really? 

While vaping and e-cigarettes are a modern trend, the technique of vaping has its roots in ancient history, including Ancient Egypt, where they were known for using hot stones to vape herbs. Modern day vaping grew in the United States as a healthier alternative to cigarette smoking, a more “pure” way to get nicotine and possibly a way to help cigarette smokers quit the habit. 

Electronic or E-cigarettes are also called vapes, e-hookahs, vape pens, tank systems, mods and electronic delivery systems. The first e-cig showed up in the United States in 2007 and has taken many shapes and forms since that time, often in an effort to make its use as easy as possible for the consumer.

These devices work by heating a liquid to produce an aerosol that is easily inhaled through the lungs. If you have ever had to do or seen a typical “breathing treatment” for asthma, that is very similar in that the medication is aerosolized so that it gets directly into your lungs. Yet, with e-cigarettes, this liquid usually contains nicotine and other flavoring and additives as well as THC and CBD and other substances.

Common sense says inhaling additives and flavorings into your lungs can’t be good.  Not so much common sense considering the growth of vaping in this country and its awful effects on people, specifically young people to whom vaping has been marketed. 

Vaping related lung disease, or EVALI, was identified by the CDC in the summer of 2019 when people started showing up with varying and unusual lung issues from this habit. EVALI is the name given by the CDC and it stands for E-cigarette or vaping product use associated lung injury. EVALI has a wide range of symptoms:

    • Shortness of Breath
    • Dry Cough
    • Fever
    • Chills
    • Vomiting
    • Diarrhea
    • Abdominal pain
    • Headache
    • Dizziness
    • Coughing up Blood
    • Weight loss
    • Chest pain

As of Mid-February 2020, more than 2800 cases of people hospitalized with some form of EVALI with 68 deaths reported. The median age for these cases is 24 years old and more than half of the cases are less than 25 years old. 

Since there are thousands of different devices on the market, it is hard to really narrow down the exact cause of EVALI. So far, data suggests that Vitamin E acetate, a common ingredient in many vaping products is strongly linked to the EVALI outbreak. Vitamin E acetate usually does not cause harm when ingested as a supplement or used on the skin, however research suggests that when it is inhaled it interferes with normal lung functioning. It has been found in product samples tested by the FDA and state laboratories and in patient lung fluid samples tested by CDC from geographically diverse states. This substance has not been found in the lung fluid of people that do not have EVALI.

Evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products in some of the reported EVALI cases.

Lung Damage (Types of EVALI)

Popcorn Lung or bronchiolitis obliterans (BO) is a rare condition that results from damage to the small airways in the lungs. The name popcorn lung comes from its discovery when there was an outbreak of the disease in popcorn factory workers that was traced to diacetyl, a food additive which simulates the flavor of butter in microwave popcorn.  Symptoms include coughing, wheezing, chest pain, shortness of breath.  Treatment is to alleviate symptoms and possibly slow progression - cough suppressants, bronchodilators, corticosteroids and immunosuppressive therapies.

Vaping Related Lipoid Pneumonia is a type of pneumonia that develops when fatty acids enter the lungs.  This pneumonia is the result of inhaling the oily substances that are found in vape liquid and cause an inflammatory response in the lungs.  Symptoms include chronic cough, shortness of breath, coughing up blood or blood tinged mucus. No real treatment is available, supportive care, lungs to heal once exposure to the substance is discontinued.

Pulmonary Spontaneous Pneumothorax (Collapsed Lung) after Vaping. A pneumothorax is a collapsed lung and it occurs when there is a hole in the lung whereby oxygen escapes. Usually these are caused by an injury such as a gunshot or stab wound, however it also happens when air blisters on top of the lungs rupture creating small tears which can lead to lung collapse.  Vaping is causing this phenomenon in young people. Symptoms of a collapsed lung include sharp chest or shoulder pain, shortness of breath, difficulty breathing.  Minor cases are treated with oxygen therapy and rest while more advanced cases require a chest tube or surgery.

Juul – Marketing to children?

First and foremost, Juul has marketed directly to children and adolescents who are at increased risks from its harmful effects.  By using child friendly packaging, advertising on children’s oriented channels and websites, and using liquid flavors with fruit and desserts geared to attract children as well as devices that are easy to hide and look like computer memory sticks, Juul has caused a whole new host of lung diseases in young people. Lung Damage happens quickly and can be permanent.

Juul contains extremely high levels of nicotine whereby one Juul pod contains as much nicotine as a pack of 20 regular cigarettes.  That is a huge amount of nicotine to pack into a cute little pod that looks like a little computer memory stick. Really, that is how much this product was geared towards kids and how kids are able to hide the habit from parents and teachers.  They also do not produce a strong odor so they can be consumed under the noses of the adults. 

So, why is this so much worse for children?

Nicotine is particularly unsafe for children because it harms the developing adolescent brain which generally continues to develop until about the age of 25. That goes along with the statistic that half of the EVALI cases are in those people 25yo and younger.  This interruption of a young developing brain harms the parts of the brain that control attention, learning, mood and impulse control. Children and adolescents already have issues in these areas and interrupting it causes more harm.

How this happens is that in general, each time a new memory is created or a new skill learned, stronger synapses or connections are made between brain cells. Children and adolescent brains, specifically, do this at a very fast-paced rate compared to adults.  Nicotine interferes with and changes the way these synapses are formed, ultimately affecting many areas of their lives. 

Also in young people, nicotine has been shown to cause sleep disturbances, emotional problems such as irritability or frustration and varied mood swings. It also increases heart rate and blood pressure which can lead to increased circulatory problems. There is research that suggests that using nicotine in adolescence may increase the risk for future addiction to other drugs.

Clearly, what Juul has introduced into our society and particularly to our young children is awful. Our schools have incurred increased costs in trying to contain and police this dangerous behavior in their students. Further, they have to spend huge amounts of money on labor due to enforcement and extra suspensions and disciplinary processes. School districts and school boards have had to absorb those costs along with extra services for the behavior issues that are showing up. Funding changes based on some of these things.   Education of students and parents is also costly. Juul created all of this. Juul should be held accountable. 

School Districts and School Boards are not the only ones who have sustained damages. Cities, counties and other municipalities have had these similar types of losses due to the vaping epidemic and many places have instituted statewide bans on many of these products. 

Interestingly, Altria, Inc. the parent company of Philip Morris behind the Marlboro brand, invested $12.8 billion for a 35% stake in Juul.  Juul’s sales exploded with a 700% increase in 2017 and a revenue of $1 billion by 2018 and 3.4 billion in 2019.

Trading the health and welfare of humans, specifically children and adolescents for money is egregious behavior. Altria went from pushing cigarettes and causing horrible addiction and health issues to our society and healthcare system, to doing the same in a cleaner, prettier package targeted to our younger at risk population. Wow, if that is not horrible behavior, I do not know what is.

I have the honor and pleasure to be on the Juul litigation team here at Romano Law Group, representing school districts/boards, cities and counties for the damages they have incurred to fight this dangerous health crisis created by widespread marketing of vaping products to children. The claims in these lawsuits generally allege that Juul’s deceptive marketing geared toward minors is dangerous and promotes addiction. I am so glad to be working with this team and helping with something to fight this type of behavior in our society.

Amie 

Amie Goldberg is both an attorney and a certified APRN.  After completing a Bachelor of Arts Degree at Whittier College, Ms. Goldberg attended nursing school at Emory University.  Ms. Goldberg’s professional experience started as a Registered Nurse at Egleston Children’s Hospital taking care of children with congenital heart disease. After a few years, she continued working in all areas of the hospital while attending Kennesaw State University on weekends in order to get her Master’s Degree in Nursing with a specialty of Primary Care Nurse Practitioner/Family Nurse Practitioner.  During her time as an APRN, Ms. Goldberg decided to attend law school at St. Thomas University in Miami, Florida.   Since graduating, she has mainly practiced in the areas of personal injury and worker’s compensation, fighting for the rights of injured people. Since joining the Romano Law Group, Ms. Goldberg has been the Director of the Opioid Litigation Project.  Ms. Goldberg also practices in the area of medical malpractice and nursing home negligence, bringing an inside perspective and knowledge to help get justice for our clients. 

 

Sources:

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does-vaping-do-to-your-lungs