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A form of vitamin E has been identified as a “very strong culprit” in lung injuries related to vaping THC, health officials reported on Friday, a major advance in a frightening outbreak that has killed 40 people and sickened 2,051. Many patients with the mysterious illness have wound up hospitalized in intensive care units, needing ventilators or even more desperate measures to help them breathe. Most are young, male adults or even teenagers. (Grady, 11/8)

In a telephone briefing on Friday, Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention (CDC), called Vitamin E acetate "a very strong culprit of concern" and referred to the discovery as "a breakthrough" in the investigation. She cautioned that more work is needed to definitively declare it a cause, and said studies may identify other potential causes of the serious injuries as well. (11/8)

Vitamin E acetate has already been identified in previous testing by the Food and Drug Administration and state laboratories in vape products that contain THC. New York state’s Wadsworth Center lab was the first to discover it about two months ago in samples from sick patients. Of 595 vaping-product samples linked to patients that have been tested by the FDA, 70 percent contained THC. Half of those THC-containing products also had vitamin E acetate, with concentrations as high as 88 percent, the FDA said Friday. (Sun, 11/8)

Adding the oil can increase profits, because each product won’t need to have as much THC. The substance is safe to ingest but potentially dangerous to inhale, the CDC said. New York state health officials highlighted vitamin E acetate as a substance of concern in early September, when they found high concentrations in THC products submitted by lung illness patients. Investigators from at least one other state, Utah, have also noted finding the substance in THC-containing products. THC is the psychoactive ingredient in cannabis. (Abbott and Maloney, 11/8)

During the press briefing, CDC's Dr. James Pirkle described vitamin E acetate as "enormously sticky" when it goes into the lungs, and it "does hang around." Pirkle said it wouldn't be unusual for THC to be absent from some of the samples because it leaves the lungs faster. He added finding THC in 82% of the samples from 28 patients was "noteworthy." (Christensen, 11/8)

Jim Pirkle, director of the laboratory science division at CDC’s National Center for Environmental Health, described vitamin E acetate found in the lungs as a sticky coating that was like "honey" in the lungs of sick patients. (Spicuzza and Rutledge, 11/8)

Schuchat said Friday that the number of lung illness cases appears to be declining, but added some states are still being hit hard and public health officials continue to be very active in the investigation. The CDC is recommending that consumers stop vaping, particularly THC and especially anything bought off the street. Until the relationship of vitamin E acetate and lung health is better characterized, it is important that the compound not be added to e-cigarette or vaping products, the CDC said. (Lovelace, 11/8)

Since the outbreak started in March, scientists have struggled to find a shared cause. The lung injuries have been most commonly linked to products containing THC, but some patients became ill after they reported vaping only nicotine. (Aubrey and Kennedy, 11/8)

It isn’t clear how widespread the use of vitamin E acetate is in e-cigarette and vaping products. Schuchat said the substance might be unintentionally introduced to vaping products or intentionally added to dilute vaping liquids and cut down on the amount of THC added to a product.(Silverman, 11/8)

Regulators had signaled in recent weeks that the outbreak was likely tied to the use of black-market vaping products containing THC, though they hadn’t drawn a direct link to any one product, behavior or ingredient. There are hundreds of devices and ingredients at play in the vaping market, and not all are legal, which has made identifying the source of the outbreak much more difficult. (Cortez, 11/8)

The United States plans to raise the age limit for vaping to 21, U.S. President Donald Trump said on Friday, adding that his administration would issue its final report on such products next week. Trump, speaking to reporters at the White House, did not give further details about the administration's regulatory plans or give a specific date for any announcements. (11/8)

The White House is still working out the details of a policy to pursue legislation raising the minimum purchase age for e-cigarettes, according to a person familiar with the matter. It could include traditional cigarettes and other tobacco products, the person said. Senate Majority Leader Mitch McConnell earlier this year introduced legislation that would raise the minimum age to purchase all tobacco products to 21, a move that public-health advocates and tobacco companies hope would curb the use of e-cigarettes among teens. Similar bills have been introduced in the House. More than a dozen states have passed or enacted laws raising the minimum age to 21 for all tobacco products, including e-cigarettes. (Maloney and Leary, 11/8)

Trump and top health officials said in September that the administration was readying a ban on flavored e-cigarettes. Trump’s comments Friday suggest the administration may be backing off those plans amid intense pressure from vaping advocates who say flavors help adults stop smoking cigarettes and that removing flavors would force vape shops around the country to close. “We have a lot of people to look at, including jobs, quite frankly,” Trump said. “Because, you know, it’s become a pretty big industry.” (LaVito, 11/8)

Conservative groups, the owners of small vaping shops and vaping enthusiasts have been warning the White House that a prohibition on all flavors could result in small businesses closing and would risk alienating some Trump voters. The groups are lobbying the administration to exclude adults-only vaping shops from the flavor ban, and limit restrictions on flavors to e-cigarettes sold in places like gas stations and convenience stores that are not age restricted — products like the e-cigarette Juul, which is disproportionately popular among teenagers. (Siddons, 11/8)

Several cities and states, including California, Oregon, Virginia, Massachusetts and others, limit sales of tobacco products to people age 21 and older. In April, Democratic Rep. Diana DeGette introduced the Tobacco to 21 Act, which would prohibit the sale of tobacco products to people younger than 21. In May, Senate Majority Leader Mitch McConnell introduced the Tobacco-Free Youth Act, which would increase the minimum age for sale of tobacco products to 21. (Kounang, Howard and Gumbrecht, 11/8)

Regulating tobacco is a waste of time for the U.S. Food and Drug Administration, a top White House official said, as the Trump administration prepared to unveil new measures designed to curtail an alarming surge in nicotine vaping by teenagers. Joe Grogan, the head of the White House Domestic Policy Council, called the FDA’s regulation of tobacco “a huge waste of time” and said the agency should focus on approving and monitoring new drugs. He said the agency had been “sucked in the mud” dealing with tobacco rather than approving more drugs or focusing on serious illnesses. (Grogan, 11/8)

“I hate tobacco issues, I always have,” Grogan said. “And FDA shouldn’t be regulating this stuff in the first place.” Tobacco products should be regulated, Grogan argued — just by a different agency, though he did not specify an alternative. But he drew a line between therapeutic medical products and vices like tobacco. Tobacco “shouldn’t be regulated by a health agency,” Grogan said, since it has “no redeeming qualities.” Grogan clarified that the remarks reflected his personal views, not formal administration stances. (Facher, 11/8)

As U.S. health officials and lawmakers continue to sound the alarm on vaping-related illnesses, Baltimore area vape shop owners say their businesses have unduly suffered, and they blame what they say is misinformation. For Mike Becker and Lisa Barkhorn, owners of B&B’s Vape Café in Parkville, selling e-cigarette and coffee products is a second job. In the past five or six months, Becker said business has dropped by at least 20% to 25%. (DeVille, 11/11)