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Doctors treating a deadly vaping disease have a problem: some patients lie



A person exhales while using an electronic cigarette in San Francisco.

David Paul Morris Bloomberg Getty Images

There are two people you should never lie to, says Dr. Michael Plisco to patients, a lawyer and a doctor.

A critical pulmonologist at Mercy Hospital in St. Louis thinks the patient's lie could have cost him his life when he arrived at the hospital after months of nausea. Before Plisco saw a man who was about 40 years old, his lungs were so stiff that they couldn't push out any fluid, putting him at risk of cardiac arrest.

Doctors tried extracorporeal oxygenation of the membrane, a machine that pumps blood through the human body, bypassing the lungs and heart. It didn't work. The man's organs failed and eventually he died in September.

A man who Missouri state officials refused to disclose additional details initially refused to smoke or vape, Plisco said. When he got sick, he finally admitted that vaping THC, psychoactive component of marijuana.

"In his mind he did not hurt," said Plisco, adding that if the doctors knew earlier, they could tell the man to stop vaping, which, according to Plisco, saved his life.

Patients are lying

Doctors trying to uncover the mysterious cause of fatal lung disease that killed at least 42 people encountered a problem, trying to determine the cause: some of their patients lied to them about what they raped. This further complicated the already difficult investigation.

Initially called EVALI – short for e-cigarette or vaping, lung damage associated with using the product – the disease has affected more than 2,170 people, mostly young men. What began as a few cases in the spring turned into a national public health crisis in the summer.

Doctors say that the disease is fatal, which means that almost everyone who develops it goes to the hospital, and about half to intensive care. Although the rate of the disease has slowed down, it still causes havoc in the United States, where, from mid-September, doctors found on average almost 200 new cases per week. One 17-year-old patient received a double lung transplant on October 15 after spending more than a month at three hospitals in Detroit.

Probable culprit

American and state health officials have tracked this disease as vaping, mainly THC, and have so far identified vitamin E oil as the likely culprit. There may be "many problematic substances that cause lung damage," CDC deputy director Anne Schuchat told Congress last week.

"It may be that only two types of people get this disease: those who have THC calcium and those who don't admit it," said Dr. Scott Aberegg, a critical care pulmonologist at the University of Utah Health. To date, Aberegg has treated over 30 patients with EVALI.

The Food and Drug Administration, which opened an investigation into an outbreak in the summer, has made every effort to point out that it does not pursue people who have clogged THC, even if they live in states where it is illegal.

"Let me explain [the FDA] In these cases, there are no criminal proceedings related to the personal use of any controlled substances, "said Mitch Zeller, director of the FDA's Tobacco Product Center on September 19.

Most people lie

Still, many patients were reluctant to tell doctors that they had reported THC at first.

In fact, most people at some point lie to their doctors, especially about potentially embarrassing information such as the amount of alcohol, eating habits and exercise.

Two surveys published in the Journal of the American Medical Association last year They found that between 60% and 80% of the 4,510 surveyed adults hid key information from their doctor. The most common reasons for hiding these details are a lack of willingness to judge or lecture, not wanting to hear how harmful their behavior and embarrassment are.

This explains why someone may not want to tell their doctor that they vaporize THC, despite the fact that social acceptance of marijuana is the highest in history. Two-thirds of Americans said they supported their legalization, according to a 2018 Gallup survey. According to the Marijuana Policy Project, thirty-three states and Washington, D.C., legalized medical use, and 11 states and D.C. legalized recreational use.

Negative mark

But cannabis is still illegal at federal level and far from being recognized as a mainstream. Doctors say that some EVALI patients, even those in critical care, denied using it until drug tests showed THC in their system.

Centers for Disease Control and Prevention published data on what patients were taking for 867 EVALI cases by October 15. Of these cases, approximately 86% reported the use of THC, a psychoactive compound in marijuana. Many said they used both THC and nicotine. However, 11% said they use only nicotine. Some doctors think it's possible, 11% who say they only used nicotine can lie.

"Every individual patient may have reasons why they do not want them to know that they are taking vaporization, and specifically what they are vaporizing," said Dr. Ram Koppaka, medical officer at the CDC National Center for Vaccination and Respiratory Diseases, who works in response for an epidemic.

Information Key

Koppaka said it is difficult to estimate how many patients are hiding information from doctors or how many cases are not taken into account because a person will not admit that vaping is the key information needed to diagnose EVALI.

Given that the disease is appearing in newspaper headlines across America, doctors say patients have reported more often in recent weeks about what they are raping. Doctors say that people who have calcium and experience symptoms are worried that they may be sick.

EVALI looks and sounds like pneumonia. Symptoms include chest pain, shortness of breath, fever, nausea and vomiting. But this is not an infection. Antibiotics used to treat pneumonia do not help with calcium related disease. And without knowing that the person is steaming, doctors may be giving the wrong treatment or lose the chance to get the person to stop treatment.

"Clinicians should be aware of reluctance and make sure that when assessing patients and asking about their habits, they should do so in a very impartial, but accurate manner," Koppacka said.

Drug testing

Aberegg he was treating a man in his twenties because of EVALI, who repeatedly denied he was vaporizing THC until the drug test returned. The patient claimed to have extinguished CBD, a non-toxic compound in cannabis. Without conviction, Aberegg told the patient how physicians are increasingly treating people with glaucoma-related illness and how important it is to tell him the truth.

At that moment, tears welled up in the patient's eyes. Aberegg mentioned that he had asked his parents to leave the room. The young man said he was vaporizing THC to treat abdominal discomfort. The more sick he felt, the more he stared.

Dr. Melodi Pirzada, who has treated almost 20 patients because of EVALI as head of pediatrics pulmonology at New York University Winthrop Hospital said doctors must be sure what the patients are staring at – especially those who say it's only nicotine.

"And if they actually hide, they did THC? I have concerns, "she said.

Questions without judgment

The CDC encourages doctors to ask patients if they are taking lime and what exactly they are breathing in – and even ask patients if they can test it for drug use. The agency recommends physicians to use "empathic, non-judgmental" and "private interviews with patients regarding confidential information to ensure confidentiality."

"In some situations, asking questions during hospitalization or during follow-up visits may obtain additional information about exposure, especially when trust between patients and clinicians is established," CDC representatives wrote in a recommendation to doctors.

Whatever people use, doctors say they need to have open talks with doctors about this deadly disease.

"It's very important to tell your doctor," said Plisco. "Most diagnoses are based on history. Very few diagnoses are based on laboratory tests. "


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