Issue 82

The beast of e-cig addiction, staying (slightly) basic, and IVs of alcohol—for science!

Oct. 12, 2019

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each week, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

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E-cigarettes have already screwed over some people for life.

Found during continued reporting on the US vaping epidemic.

Unfortunately, it seems like the news about e-cigarettes has only gotten worse in the past two weeks. As of Oct. 10, there have been nearly 1,300 cases of this mysterious lung illness associated with vaping, and 26 confirmed deaths.

Fear is a motivator for big action. Officials at the US Food and Drug Administration proposed banning all flavors, which are particularly appealing to teens. They have yet to make a final proclamation, but there are several state and municipal bans that have already taken effect, or will shortly.

Such a ban may get some teens to quit vaping, or deter others from starting. But really, there’s the youth vaping rates problem, and then the problem of vaping-related illness itself. While the increase in teen vaping isn’t great, it’s the illnesses and deaths that have made vaping an issue of national concern.

And even if we found a way to get some teens to quit and prevent some teens from starting with a flavor ban, there’s a huge group of people who are already addicted. As we continue to see more cases of illnesses related to vaping (which, as of yesterday, has a new acronym), more people are going to want to quit.

But here’s the problem fewer people are talking about: there’s no clear way to help anyone quit using e-cigs.

There are no regulated nicotine replacement therapies cleared for e-cigarettes. There’s no published research showing how cigarette quitting aids—things called nicotine replacement therapy (NRTs), drugs like Chantix and anti-depressants, and cognitive behavioral therapy—can work for e-cigarettes. E-cigarettes haven’t been around for that long for scientists to look into how people may want to quit.

The problem is even worse for teens who are already hooked. Teenage brains haven’t finished forming yet. Nicotine may change the way their brains develop, and it may also cause an even stronger addiction than it does in adults. Plus, a lot of e-cigs have a different form of nicotine than what’s found in tobacco cigarettes. Users may be getting way more of a hit than they thought they were (and some teenagers had no idea they were vaping nicotine at all).

Because teens were never supposed to have access to nicotine, pediatricians are winging it when it coms to helping their patients quit. There is no scientific evidence about how best to help teenagers quit nicotine. Pediatricians can prescribe off-label NRTs, which have only been approved by the FDA for adults. These treatments are likely going to be safe, but whether they’re going to be effective is unclear.

Some of the doctors I spoke with were really anxious about the long-term health of their patients. We don’t know what causes vaping-related illness in e-cigarettes, let alone the long-term effects of inhaling e-juice on a regular basis starting at a young age. I expect we’re going to hear about the health consequences of vaping for a long time now.

Bonus fact: You may have heard that there was a study published in the New England Journal of Medicine—a big name in medical publishing—that found that e-cigarettes were better at getting adults to quit smoking than other NRT’s. It’s true: 18% of nearly 886 smokers who used e-cigarettes to quit had successfully quit after a year, compared to 10% who used NRTs.

But there was just one problem: at the end of a year (the study’s duration), 80% of e-cigarette users were still vaping, compared to 9% of NRT users who were still using either a lozenge, patch, or gum.

The point of quitting smoking is that you ultimately quit your nicotine addiction. This study makes it clear that e-cigarettes were never intended to help people quit smoking. They were designed to get people hooked on something else—which may or may not be safer, and is certainly a heck of a lot more profitable for e-cigarette companies.

Your lungs play a big role in the way your body stays (slightly) basic.

Found while reporting: There’s a simple way to curb youth vaping, and it isn’t a flavor ban.

The human body is very good at adapting to new scenarios (see: this year’s Nobel Prize in physiology medicine), but there’s some stuff that has to stay constant. Like your blood’s—and therefore most of your organs’—pH. (Certain areas of the body, like the inside of the stomach or vagina are acidic, but the blood running around them is the same.)

Human blood has a pH of ~7.4. A pH of 7 is neutral; anything above 7 is basic, and anything below is acidic. So really we’re all a little basic (insert basic pumpkin spice and leggings joke here).

Our lungs play a key role in maintaining this pH. It’s their job to take in oxygen, and then to get out carbon dioxide—a waste product from cells converting food into energy they can use.

Extra carbon dioxide in the blood lowers blood’s pH. In other words, it becomes more acidic. It’s like how extra CO2 in the atmosphere leads to ocean acidification.

The lungs share the responsibility of keeping a slightly basic pH in the body with the kidneys, which collect other acids and bases formed through metabolic processes and flush them out in the urine. Although both the lungs and the kidneys can compensate for one another to a certain extent, changes in the blood’s pH need to be addressed quickly, because they can be fatal.

E-juice used to contain stuff called “freebase nicotine,” which gives users a stronger hit of the chemical. The problem, though, is that freebase nicotine has a pH of around 9—meaning it’s painful for our more neutral lungs to take in. E-juice companies got around this by adding a weak acid to nicotine to make it a more neutral salt, which made vaping go down smoother.

One researcher I spoke with was adamant that instead of a flavor ban, the FDA needs to mandate that all e-juice has a pH of 9 or higher. It’s a cool argument that brought me back to Chem 101. Similarly to my days in Chem 101, I called my dad, a chemistry professor at Drexel, a few times while writing the story to make sure I was explaining buffers and salts correctly. As always, he was wonderfully clear and patient with me. Thanks Dad!

Bonus fact: The most prestigious awards in the world still cold calls winners the morning they’re announced to the public.

I covered the Nobel Prizes in medicine and physiology this week. They’re announced at 11:30 am local time, which is 5:30 am here in Washington, DC. Surprisingly, the winners of the prize are kept so secret before the prize is announced, the someone from the Assembly simply calls the winner just before it’s announced.

For William Kaelin Jr., one of the medicine winners who is at Harvard currently, the Assembly didn’t have his number; they dialed a wrong number first, and then ended up calling his sister, and THEN finally got in touch wit Kaelin himself. You’d think they’d have a better system—especially if you’re planning on waking people up.

You can get alcohol directly infused into your bloodstream—for science.

Found while reporting this obsession email on hangovers.

The tricky thing with alcohol research is that we know it’s bad. Knowing that booze is harmful to humans means that it’s really unethical to ask people to drink. Scientists have gotten around this by asking people to report how much they drink of their own volition, which I’d guess is going to be the way vaping research goes in the future.

But still, that makes it really hard for researchers to answer questions about exactly how the body processes alcohol. And that’s an important thing to know, considering people are still drinking!

So scientists have found one way where they’ve been able to do a handful of very small studies on the ways that we breakdown alcohol over time: The alcohol clamp method. Basically, what researchers will do is give you an alcohol-infused IV (so like, the opposite of one of those $200 banana bags you get for your hangover) to get you to a certain breath-alcohol concentration that you can maintain for a few hours at a time to see what happens.

This allows researchers to get an idea of how factors like gender and genetics may affect the way we break down alcohol, without the variability of stomach contents. The alcohol clamp method also eliminates the variations in the types of drinks—like wine, beer, or spirits—and how those may change the way bodies break them down (people have reported that different drinks make them feel differently).

It’s impossible to do these kinds of tests on many people at a time. Take this study, which looked at alcohol breakdown in exactly five adults. Still, this type of work is what leads researchers to the understanding that we all break down booze differently. That idea that it takes an hour to process a “drink”? That’s an average—there’s some evidence that suggests that some people can process booze three to four times as fast as others.

Animal of the issue: Pine martins

Do you want even more animal news, on a weekly basis? (hint: there is only one right answer.) Then you should be subscribing to Kat Eschner’s newsletter, Creature Feature. Kat is a freelance science writer, and she beautifully captures our relationships with the non-human forms of life on the planet.

I had never heard of pine martins before Kat introduced me to them two issues ago, and now I love them.

Image description: A pine martin taking a piece of food from a human had. (We probably shouldn’t be feeding pine martins, to be honest.)

Pine martins kind of look like a combination of a cat and a fox. They are mustelids, which means they’re in the same family as otters and weasels, and they’ve been just about hunted to extinction in the UK—although conservationists are hoping they can recover if they breed in an undisclosed location in the Forest of Dean. As Kat points out, Brexit will likely ruin this effort. These creatures are omnivorous, and they like their space—each requires about half a square mile of woodland to call their own.

Again, if you like “animal of the issue,” you must sign up for Kat’s newsletter. You can do so here.

Stuff I learned from others:

Honeycrisp apples are the third most profitable invention from the University of Minnesota, behind a vaccine for pigs and an HIV drug (h/t Walt Hickey at Numlock News). Coroners are the last first responders. China is breeding giant pigs to overcome their pork shortage. Zebra stripes help keep flies away, which researchers confirmed by painting stripes on cows. Light could be the new treatment for carbon monoxide poisoning we’ve all been waiting for (hopefully not literally). Ferrel hogs are the fastest reproducing large mammal. About 8% of our genome isn’t ours. Sometimes, being petty is a damn treat.

That’s all for now. Stay curious, friend! <3

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Top image by E. Y. Smith, headshot drawing by Richard Howard.

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