The Washington Post - 30.08.2019

A2 EZ M2 THE WASHINGTON POST.FRIDAY, AUGUST 30 , 2019

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CORRECTION

l A June 23 A-section article
about a U.S. military cyberstrike
against Iran incorrectly
identified the target. U.S. Cyber
Command disabled a computer
database used by the Islamic
Revolutionary Guard Corps to
plan attacks on oil tankers and
impede shipping traffic, not
Iranian computer systems used
to control rocket and missile
launches. A Page One article the
same day also included the
incorrect information.

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BY LENA H. SUN

AND LAURIE MCGINLEY

State and federal health au-

thorities are focusing on the role

of contaminants or counterfeit

substances as a likely cause of

vaping-related lung illnesses —

now up to 354 possible cases in

29 states, nearly double the num-

ber reported to be under investi-

gation last week, The Washington

Post has learned.

Officials are narrowing the

possible culprits to adulterants in

vaping products purported to

have THC, the component in

marijuana that makes users high,

as well as adulterants in nicotine

vaping products.

The sudden onset of these

mysterious illnesses and the pa-

tients’ severe and distinctive

symptoms have led investigators

to focus on contaminants, rather

than standard vaping products

that have been in wide use for

many years.

The investigation is “starting

to point to what solvents are

being used, and that can vary a

lot” — especially in counterfeit or

black-market products, includ-

ing potentially mislabeled sol-

vents that consumers buy them-

selves to make do-it-yourself

“home brews,” said an official at

the Centers for Disease Control

and Prevention, which is heading

the investigation.

Vaping refers to the increas-

ingly popular practice of inhaling

vapor from an e-cigarette device,

which frequently involves heat-

ing a liquid that can contain

nicotine, marijuana or other

drugs. Those active ingredients

are delivered in solvents.

As the CDC prepared this week

to send out its first national

health alert about the illnesses —

a sign of growing urgency about a

health threat that has claimed

one life, while hospitalizing

scores of others — officials cau-

tion they’re a long way from

understanding what exactly is

making so many people sick. The

victims report vaping different

products, purchased in different

places and used for different

lengths of time. Many of those

who have gotten ill say they have

vaped products containing mari-

juana, but some also used tradi-

tional nicotine e-cigarettes. Some

report using both.

The last week’s dramatic in-

crease in reported cases is prob-

ably the result of increased

awareness, said the CDC official.

The official, who was not author-

ized to speak on the record,

predicted that state officials will

eliminate some of the uncon-

firmed cases.

In the meantime, federal and

state officials are urging the mil-

lions of Americans who use e-cig-

arettes to stop vaping until the

cause of the illnesses is identified.

They have suggested that those

using e-cigarettes quit smoking

conventional cigarettes and con-

tact their doctors about alterna-

tives, such as patches or nicotine

gums.

Some of those warnings have

drawn criticism from both indus-

try and health groups for being

overly alarmist and broad about

which products might be danger-

ous.

“People need to stop using

these illicit THC products now —

and it’s the CDC’s responsibility

to say what we do know,” said

Michael Siegel, a professor of

community health services at

Boston University, who believes

that e-cigarettes can be helpful to

those trying to quit smoking.

“Yes, there are unknowns. Yes,

there may be other products im-

plicated as well. But a large

number [of confirmed cases]

seem to involve THC oils pur-

chased from ‘pop-up shops,’ ” he

said, referring to unlicensed

shops that move frequently, ad-

vertise by word of mouth and

often fail to follow safety regula-

tions.

The complex investigation has

also been hobbled by the patch-

work of state and federal regula-

tory authorities involved and the

sheer number and kinds of busi-

nesses, legal and illicit, selling

vaping products. Nicotine vaping

products are lightly regulated in

the United States, although

tougher rules are due to kick in

over the next year. Ye t e-cigarette

use has surged, especially among

teens and young adults who have

embraced the sleek, high-nico-

tine model of Juul, the leading

brand.

A growing number of Ameri-

cans are also vaping marijuana,

which is legal in some states but

prohibited under federal law.

Some marijuana vaping devic-

es, such as vape pens, are a fairly

recent phenomena and among

the most popular devices for

vaping cannabis. The vape pens

are a potential target for black-

market sellers because they’re

cheap and easy to fill with coun-

terfeit substances, according to

officials and industry sources.

Former Food and Drug Admin-

istration commissioner Scott

Gottlieb, a harsh critic of San

Francisco-based Juul, said he be-

lieves it’s unlikely that Juul — or

other large national e-cigarette

companies — are associated with

the recent cases because the ill-

nesses appeared to have devel-

oped suddenly and do not appear

to be spread evenly across the

nation.

Traditional vaping products

could cause chronic problems,

Gottlieb said, but these patients

have acute illnesses.

“What’s likely causing the

harm is something that they are

putting in to make it easy or

cheap to mix,” he added.

Some state health officials and

clinicians are increasingly fo-

cused on contaminants in THC

products.

In a conference call Thursday,

Utah health officials told physi-

cians the state department is

focusing on THC products, said

one doctor who took part in the

call. The physician spoke on the

condition of anonymity because

he was not authorized to speak

for the health department. Utah

has reported at least 21 possible

cases in recent weeks. A health

department official said they are

looking at both THC and nicotine

products.

Pennsylvania’s UPMC health

system, which includes 40 hospi-

tals, including the University of

Pittsburgh Medical Center, has

treated at least 14 individuals

with acute lung injuries related

to vaping in recent weeks, doc-

tors said. Several patients told

clinicians they bought THC prod-

ucts online from a popular brand

called Dank Vapes. Industry

sources say marketers often fill

an empty cartridge with poten-

tially unsafe ingredients and sell

to unsuspecting customers.

“We suspect adulterated or

contaminated products, because

these [marijuana] products have

been out there for some time, and

we’ve not seen these cases until

this summer,” said Phillip Lam-

berty, a pulmonologist and criti-

cal care specialist at the Univer-

sity of Pittsburgh Medical Center,

who cared for three patients in

recent weeks. Two of them used

products containing THC, he

said. He wasn’t sure what prod-

uct the third was vaping.

One patient purchased his

product from an illicit drug deal-

er. Another patient told Lamber-

ty he had previously smoked

marijuana but bought an online

product and vaped THC for the

first time about a week before

falling ill.

In California’s Kings County,

all seven patients who had acute

respiratory distress syndrome re-

ported buying marijuana vape

cartridges from “pop-up shops,”

said Nancy Gerking, the county’s

assistant director of public

health.

“The patients had switched

from regular retailers to the pop-

up shops,” Gerking said. The pa-

tients “found a difference be-

tween the potency of the prod-

ucts,” she said. “They had to use

twice as much, so they were

taking twice as much of the

product into their lungs.”

State health departments are

sending samples to the FDA’s

forensic laboratory in Cincinnati,

where an initial targeted analysis

is testing for THC, CBD and

nicotine, officials said. The FDA

and other labs are also doing

more broad-based testing for sol-

vents and possible contaminants

to look for any pattern.

Among the possible culprits

are oils and “cutting agents” be-

ing added to the liquid in vaping

devices, especially those contain-

ing THC. State officials and mari-

juana industry sources said

black-market dealers appear to

be using new substances to thin

out THC oil, which is thick, odor-

less and colorless. Unknown oils,

also colorless and odorless, are

then being added back to the

mixture to give the appearance of

purity, according to Alex Traver-

so, a spokesman for California’s

Bureau of Cannabis Control,

which regulates commercial can-

nabis licenses for medical and

adult-use cannabis in the state.

“Yes, that is something that is

being considered,” the CDC offi-

cial said when asked about the

new cutting agents. During the

aerosolization process, the oil

heats up and produces the vapor

cloud. But when it cools, it re-

turns to its original state, and tiny

aerosolized droplets could be in-

haled into the lungs. “That could

be responsible for problems we’re

seeing in these individuals,” the

official said.

“People have also talked about

some of it getting into the gut,”

the official said.

Some patients have com-

plained about vomiting and diar-

rhea, and the presence of these

substances in the gut “may ac-

count for the gastrointestinal

problems that some people have

reported.”

Unlike infectious disease out-

breaks, this investigation has

been more difficult because in-

vestigators don’t have a specific

culprit, an established national

system of collecting information

or even a consistent definition of

the illness. Unlike certain infec-

tious diseases, such as measles,

which are required to be reported

to federal authorities, this illness

does not fall in that category.

States are not required to report

possible cases of vaping-related

illnesses to the CDC.

The agency hopes to establish

a data-collection system for

states by early next week. State

and federal officials are hoping to

finalize an initial definition of a

vaping-related lung injury or ill-

ness by week’s end.

[email protected]

[email protected]

Probe of lung illnesses focuses on tainted vaping products

JEFF CHIU/ASSOCIATED PRESS

A bag of vape pen cartridges await testing Aug. 16 at a laboratory in Oakland. State and federal health officials have linked at least 354

cases of mysterious lung illnesses in 29 states to vaping, nearly double the number reported to be under investigation last week.

BY LINDSEY BEVER

There is no one gene that

determines a person’s sexual ori-

entation, but genetics — along

with environment — can play a

part in shaping sexuality, a mas-

sive new study shows.

Researchers analyzed DNA

from hundreds of thousands of

people and f ound t hat there are a

handful of genes clearly connect-

ed with same-sex sexual behav-

ior. The researchers say that,

although variations in these

genes cannot predict whether a

person is gay, these variants may

partly influence sexual behavior.

Andrea Ganna, lead author

and European Molecular Biology

Laboratory group leader at the

Institute of Molecular Medicine

in Finland, said the research

reinforces the understanding

th at same-sex sexual behavior is

simply “a natural part of our

diversity as a species.”

The new study, published

Thursday in the journal Science,

is not the first to explore the link

between genetics and same-sex

behavior, but it is the largest of

its kind, and experts say it pro-

vides one of the clearest pictures

of genes and sexuality.

Ganna, who is also an instruc-

tor at Massachusetts General

Hospital and Harvard, and an

international team of scientists

examined data from more than

470,000 people in the United

States and the United Kingdom

to see whether certain genetic

markers in their DNA were

li nked to their sexual behavior.

Specifically, the researchers used

data from the UK Biobank study

and from the private genomics

company 23andMe, which in-

cluded their DNA data and re-

sponses to questions about sex-

ual behaviors, sexual attraction

and sexual identity.

More than 26,000 participants

reported at least one sexual en-

counter with someone of the

same sex. Earlier studies, the

researchers said, were not large

enough to reveal the subtle ef-

fects of individual genes.

The researchers found five

genetic variants that were statis-

tically associated with same-sex

sexual behaviors, but none had a

large effect and none could itself

predict same-sex behaviors. One

of the variants was found in a

stretch of DNA that includes

several genes related to the sense

of smell. Another one of the

genes is related to male-pattern

baldness, which the authors said

could suggest that sex hormone

regulation may be involved.

These variants, along with

thousands of others in the hu-

man genome that have even

smaller effects, together ac-

co unted for 8 to 25 percent of

variation in same-sex sexual be-

havior, the analysis showed.

Some of the variants were corre-

lated with same-sex sexual be-

havior in men, others in women,

and some in both.

Eric Vilain, director of the

Center for Genetic Medicine Re-

search at Children’s National

Health System, said the study

marks the end of “the simplistic

concept of the ‘gay gene.’ ”

“It just shows us that same-sex

sexual behavior is much more

complex than this idea of having

just one gene influencing it all,”

said Vilain, w ho was n ot i nvolved

in the study. “It shows that there

are g enetic factors, w hich we had

suspected long ago... but it also

shows those genetic factors do

not tell the whole story.”

Previous studies have suggest-

ed that sexual orientation and

same-sex behaviors may be, at

least in part, genetic. For in-

stance, research has shown pat-

terns in families with multiple

men in the same family identify-

ing as gay. There is some evi-

dence of a correlation between

left-handedness and same-sex at-

traction, and left-handedness

has both genetic and environ-

mental influences. Environmen-

tal effects may be a factor for

some people; for instance, hav-

ing older brothers increases the

odds that younger brothers will

be gay, which researchers sus-

pect may have to do with c hanges

to the mother’s immune system

in response to the earlier preg-

nancies.

Zeke Stokes, chief programs

officer for the LGBTQ advocacy

group GLAAD, said in a state-

ment that the new research on

the genetics “provides even more

evidence that being gay or lesbi-

an is a natural p art of human life,

a conclusion that has been

drawn by researchers and scien-

tists time and again. The

identities of LGBTQ people are

not up for debate. This new

research a lso reconfirms t he long

established understanding that

there is no conclusive degree to

which nature or nurture influ-

ence how a gay or lesbian person

behaves.”

There are limitations to the

new research. Vilain, chair of the

Department of Genomics and

Precision Medicine at George

Washington University, noted

that the study’s authors placed

all participants who had report-

ed even one same-sex sexual

event into the same group. “The

problem with this is that it might

dilute the efficiency of a search

for genetic factors that may be

present only in individuals who

have exclusive same-sex attrac-

tion throughout their lives,” he

said.

That said, Vilain added: “It

does capture the complexity of

same-sex attraction. It captures

real-life experiences rather than

trying to put people into bins

that are always arbitrary.”

Also, Vilain said the study,

which includes mostly European

American participants, lacks key

diversity. “It’s missing out on

what’s going on in other popula-

tions,” he said.

[email protected]

Study: No ‘gay gene,’ but genetics linked to same-sex behavior

“It shows that there are

genetic factors, which

we had suspected long

ago... but it also

shows those genetic

factors do not tell the

whole story.”

Eric Vilain, director of the Center for

Genetic Medicine Research at

Children’s National Health System

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