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JUDY WOODRUFF: States around the
country continue to crack down
on flavored e-cigarettes and

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other vaping products.

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Much of that is in response to
the deaths and illnesses that
began coming to light this

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summer.

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But even as lawmakers are
trying to determine what to do,
researchers are still trying to

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better understand the
cause of these illnesses.

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Miles O'Brien has been looking
into that very question for our
regular series on the Leading

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Edge of science.

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MILES O'BRIEN: Like at least
five million young Americans,
18-year-old Adam Hergenreder

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started vaping electronic
cigarettes two years
ago, because everyone
else was doing it.

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He loved all the flavors.

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ADAM HERGENREDER, Former
E-Cigarette User: Mint
tasted just like a mint.

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Mango tasted just like a mango.

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Cucumber tasted just
like a cucumber.

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So I didn't really know
that it had nicotine in it.

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MILES O'BRIEN: It is
an extremely potent
punch of nicotine.

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He preferred the strong
pods made by Juul.

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Each carries as much of
the highly addictive drug
as a pack of cigarettes.

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E-cigarettes, or vape pens,
use a battery to heat a coil,
which turns a nicotine infused

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liquid into an aerosol.

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Before too long, Adam was
inhaling a pod-and-a-half a day.

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ADAM HERGENREDER: I was hooked.

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I mean, I knew I was addicted,
but I just couldn't quit.

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MILES O'BRIEN: Eventually,
the nicotine rush from
Juul wasn't enough for him.

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So he bought some
black market vape pens
containing cannabis oil.

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And, soon, he was enjoying head
rushes from both nicotine and
THC,the psychoactive ingredient

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in marijuana.

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ADAM HERGENREDER: The Juul
lasted about 10 seconds.

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The THC product
lasted about an hour.

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That's why I switched
over to that.

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MILES O'BRIEN: But at the end of
August, he got sick, very sick.

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ADAM HERGENREDER: I started
to experience some tremors.

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And then that was
for about a day.

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And then the next three days, I
started throwing up violently,
again, throughout the whole

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day.

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MILES O'BRIEN: He ended
up here at the Advocate
Condell Medical Center in
Libertyville, Illinois.

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Pulmonologist Stephen
Amesbury showed me Adam's
initial chest X-ray.

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All that haziness
is inflammation.

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When you see a 17- or an
18-year-old with a chest X-ray
like that, what is the next

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step?

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What do you do as a doctor?

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DR.

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STEPHEN AMESBURY, Advocate
Condell Medical Center: Many
months ago, the consideration

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would primarily be pneumonia
or some possible toxins or if
they have taken some drugs.

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Nowadays, in light of all the
vaping illnesses, that's one of
the first questions we ask young

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people when they come in
with breathing problems.

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MILES O'BRIEN: Adam had EVALI,
or E-cigarette or Vaping Product
Use-Associated Lung Injury.

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The condition emerged in
Illinois and Wisconsin in April.

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As of December 3, it had
sickened nearly 2,300 mostly
young people nationwide.

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Half of them, like Adam, end
up in intensive care, many
attached to ventilators.

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One young person required
a lung transplant.

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And 48 have died.

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Adam came close.

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It's killed some people.

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Could it have killed him?

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DR.

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STEPHEN AMESBURY: If he hadn't
come in, and just tried to
stick it out at home a few more

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days, absolutely.

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MILES O'BRIEN: All those
young people with very
sick lungs triggered a
series of investigations

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by state health authorities
and the Centers for Disease
Control and Prevention.

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REAR ADM.

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DR.

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ANNE SCHUCHAT, Centers for
Disease Control and Prevention:
What we know now is that the

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vast majority of individuals
have a history of using vaping
products that contain THC.

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MILES O'BRIEN: Anne Schuchat is
the principal deputy director.

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REAR ADM.

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DR.

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ANNE SCHUCHAT: So, our
laboratory tested 29
samples from 29 patients
from 10 different

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states around the
country and looked at 12
different chemical tests.

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And we found 29 of 29 patient
specimens had vitamin E acetate.

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MILES O'BRIEN: Vitamin E
acetate, the nutritional
supplement is inexpensive,
unregulated and

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widely available.

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It's fine to ingest or use
topically, but when inhaled,
the sticky substance interferes

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with normal lung functions.

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It nevertheless became a favored
choice in the black market as
a way to dilute pure cannabis

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oil, which has a similar
color and viscosity.

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Testing labs in states where
cannabis use is legal analyze
marijuana for its potency

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and screen for
contaminants, heavy metals,
pesticides and mold.

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But, before this crisis,
they weren't looking
for vitamin E acetate.

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MICHAEL KAHN, President,
MCR Labs: We don't have
screen for everything.

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We're not "Star Trek."

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We can screen for
specific compounds.

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MILES O'BRIEN: Michael
Kahn is president and
founder of MCR Labs in
Framingham, Massachusetts.

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As EVALI emerged, he and his
team quickly developed a way to
screen for vitamin E acetate.

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MICHAEL KAHN: It was an
immediate public health
concern to us, so we
offered it for free,

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and we still do, to anybody
who needs to bring in samples
just to make sure they're safe.

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We have received 56 samples
from regular walk-in citizens.

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MILES O'BRIEN: They found
nine of those cannabis
oil samples were tainted
with vitamin E acetate.

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MICHAEL KAHN: Every instance
of vitamin E acetate was from
somebody who walked in, not

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through the marijuana
establishment regulated market.

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MILES O'BRIEN: But the EVALI
case is still not closed.

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Twenty percent of
patients afflicted do
not admit vaping THC.

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There is evidence
other substances could
pose a danger as well.

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And so some urgent
research continues.

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Pulmonologist Jeff Gotts
is an assistant professor
at the University of
California, San Francisco.

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He has built a device that
systematically exposes the
aerosols from e-cigarettes to

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cells cultured from donor
human lungs rejected
for transplantation.

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The work is ongoing, but, so
far, cells exposed for an hour
a day, three days in a row, to

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the chemicals used to dissolve
nicotine in Juul e-cigarettes
show preliminary signs of

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damage.

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DR.

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JEFF GOTTS, University of
California, San Francisco: It
may be the case that this had

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been going on for a while in
different forms in a low level,
and we're going to be able

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to see a lot better what the
real incidence of disease
from all of these exposures is

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now that we have
everybody's attention.

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MILES O'BRIEN: First touted
as a smoking cessation
tool, e-cigarettes got
very popular very quickly,

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with virtually no
regulatory oversight,
and no research on its
implications to human health.

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DR.

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JEFF GOTTS: In many
senses, it is a horrifying
experiment that people are
performing on themselves

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with these different
inhalational exposures,
that we have absolutely
no sense of their

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long-term safety.

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MILES O'BRIEN: With THC vaping
oil, not only is there the
same lack of safety data, but

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there are extra daunting hurdles
to filling the research gap.

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The federal government still
considers marijuana a controlled
substance, in the same legal

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category as heroin and LSD.

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It means scientists can only
procure marijuana for research
from one federally sanctioned

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site in Mississippi.

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And it doesn't produce
the sort of cannabis oil
products people are inhaling.

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To what extent is this a
result of the confusion
and the discontinuity
in all the laws and

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regulations across this country?

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KATE PHILLIPS, Cannabis
Community Care and
Research Network: Oh,
I think it's a direct

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result.

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MILES O'BRIEN: Kate Phillips
is director of education for
the Cannabis Community Care

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and Research Network
in Massachusetts.

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KATE PHILLIPS: We have an
industry that's supported by
the state, and then everything

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after that's hands up.

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So, when a problem like
this happens, everyone's
scattered, and nobody
really knows who's the

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point person to go to,
who needs to collaborate,
who needs to lead on this.

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And, again, it's up
to the companies.

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It's up to the public health
officials in each state.

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And that's where we got
to where we are today.

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MILES O'BRIEN: Meanwhile, the
vaping trend keeps growing,
especially among teens.

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Public health experts worry,
if no action is taken, this
health crisis will only get

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worse in the short
and long term.

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For the "PBS NewsHour,"
I'm Miles O'Brien
in Gurney, Illinois.

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JUDY WOODRUFF: Such
important reporting.