Tuesday 21 January 2020

Public health, risk communication, and vaping

The editorial in the January 2020 issue of Drug and Alcohol Review worries that poor communication around illness caused by vaping illicit THC-based products in the US has risks:
The US investigation is still ongoing and the health authorities investigating the outbreak have not definitively identified the exact chemical that has caused the lung damage, which may be a chemical formed from vitamin E acetate. However, over the past 6 months, the evidence has strengthened considerably that nicotine vaping products are not the cause of EVALI. This has been reflected in the updated official communications from both FDA and CDC which have strengthened their warnings to avoid THC vaping products, particularly those purchased from informal sources. However, accurate, timely and complete reporting of these developments by the media has sometimes been lacking. The potential consequences of this misreporting include public misunderstanding, mistrust and potentially cases that could have been avoided if the correct information was widely communicated.
They worry about the risk of people continuing to use illicit THC products when much of the the media coverage was around nicotine-based vaping as potential cause.
Misreporting of the US epidemic continued after the CDC concluded that the outbreak was attributable to vaping contaminated illicit cannabis products. In Australia, the ABC television show 7:30 aired a misleading story on vaping (5 November 2019) that heavily featured nicotine vaping in Australia after a lead on the US outbreak of lung injuries 28. There was no mention that the CDC and FDA had linked the outbreak to the use of contaminated illicit THC products.

Nor did 7.30 mention the absence of cases in the UK, where nicotine vaping is widespread among smokers, but the vaping of cannabis oils is not. Dr Chris Zappala, from the Australian Medical Association claimed, ‘We've seen a significant increase in recent months of vaping‐related illnesses. Patients who, unfortunately, are becoming so unwell that they're ending up in intensive care and as I'm sure people are aware, there have been some deaths related to vaping’. Neither he nor the reporter clarified that no EVALI cases have occurred in Australia. By omitting the role of THC vaping products, 7.30 withheld critical information from the public on how to avoid these injuries.

Australian standards of press reporting include the principles of accuracy, balance, clarity and avoidance of harm 29. These principles are important given that the media is frequently cited by the public as a source of health information and influence health behaviour, however they are often found lacking 30-32. The failures of the Australian and international media to accurately convey the facts about this outbreak put public trust in the media, and the health authorities in these reports, at risk and may encourage the public to ignore future warnings in the midst of serious health emergencies. Many of the responses to the outbreak proposed in these stories, such as banning flavoured vaping products or preventing access to nicotine vaping products, do not address the cause of the outbreak identified by US authorities, namely, the vaping of illicit cannabis products cut with vitamin E acetate.
Things weren't better here, and I've been particularly disappointed in Radio New Zealand's coverage.

One fun one: on 12 November, the Science Media Centre rounded up commentary from local scientists about what was going on in the US and the results of more tests on lung tissue samples.

Their round-up included (my paraphrases):
  • Auckland University's Prof Chris Bullen, who noted that it was 'widely known' that the mess was associated with contaminated black-market THC cartridges a month earlier;
  • Dr Kelly Burrowes at the Auckland Bioengineering Institute at the University of Auckland, who noted that Vitamin E in THC cartridges could be the problem but that with more than 15,000 flavours out there in e-cigarettes, it is just too hard to tell what is to blame;
  • Dr George Laking at End Smoking New Zealand who said that everyone had known for two months that the problem was Vitamin E acetate, that the CDC was too slow to catch up, and that the reports should not raise concern for NZ nicotine vapers;
  • Dr Murray Laugesen, Adjunct at U Canterbury and long-time tobacco harm reduction advocate, who pointed to Vitamin E acetate and the need to get the regulatory framework around vaping set quickly;
  • Prof Julian Crane, Otago Uni at Wellington, who pointed to Vitamin E acetate, noted that it was a possibility since the beginning of the problem, and that there's no worry for NZ nicotine vapers.
All up, 4/5 said that nicotine vaping has nothing to do with the US problem. 

Guess who RNZ picked to talk to about it? Go on. You don't even have to click the link, do you?

I just don't have a good model of why RNZ has been like this.

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