Experts React to EVALI Correspondence

Posted 4th March 2020 by Dave Cross
A correspondence piece, published in the New England Journal of Medicine (NEJM), discuses an animal model of inhaled vitamin E acetate and EVALI-like lung injury. Experts have responded to the findings and the CDC now accepts that Vitamin E Acetate is the primary cause of EVALI.

The letter “An Animal Model of Inhaled Vitamin E Acetate and EVALI-like Lung Injury” was submitted to the NEMJ by:

  • Tariq Bhat (Roswell Park Comprehensive Cancer Center)
  • Suresh G. Kalathil (Roswell Park Comprehensive Cancer Center)
  • Paul Bogner (Roswell Park Comprehensive Cancer Center)
  • Maciej Goniewicz (Roswell Park Comprehensive Cancer Center)
  • Yasmin Thanavala (Roswell Park Comprehensive Cancer Center)
  • Benjamin Blount (Centers for Disease Control and Prevention)

The authors wrote: “This study contributes to our understanding of EVALI through the development of an animal model that can be used to evaluate the potential role of the suspected toxicant vitamin E acetate.”

“A limitation of the study is that the aerosols generated by an e-cigarette may contain by-products of the thermal degradation of vitamin E acetate after heating. A chemical evaluation of the generated aerosols would be required to identify such by-products. Another limitation is that we did not expose animals to aerosols that contained tetrahydrocannabinol (THC) or nicotine in a dose-dependent manner.”

“Finally, it is possible that aerosols generated from other lipophilic solvents may produce outcomes similar to the outcome seen with vitamin E acetate in this study. Future studies are needed to address these issues. Our findings, coupled with previous research identifying vitamin E acetate in BAL fluid from patients with EVALI and in samples of case-associated product liquids, provide additional evidence for vitamin E acetate as a possible cause of EVALI.”

Professor John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine, University of Nottingham, said: “This study, based in an animal model, provides further evidence that vitamin E acetate in vaping fluids causes cases of EVALI, and reinforces advice to vapers to source their vaping solutions from reputable suppliers.”


Professor Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London, added: “In August last year, an outbreak of acute lung injuries has developed in the USA, affecting mostly young people who vaped illegal marijuana (THC) cartridges. A small proportion denied using marijuana, but this could be e.g. in states where such use is a criminal offence or where parents were present during their hospital visit.  Indeed, it later turned out that all laboratory samples taken from people with confirmed diagnosis, of whom some denied THC use, contained a contaminant found in these cartridges (Vitamin E acetate, used to improve THC viscosity).”

“This new study demonstrates in an animal model that inhaling Vitamin E acetate indeed damages lungs. To the extent that the findings generalise to human exposure, the study provides further evidence on the links between the outbreak and the THC contaminant.  Some have conflated nicotine and THC vaping, which risks scaring some vapers back to smoking, but this was a false alarm. The chemical is not used in nicotine e-liquids. Switching from smoking to vaping remains a good option that removes almost all risks of smoking.”

At the same time, Public Health England’s Martin Dockrell has noted that the CDC has confirmed Vitamin E Acetate is the “primary cause” of the lung injury outbreaks. Clive Bates commented: “This was never anything to do with nicotine vaping. The questions are:

  1. Why did the doubt persist longer than August 2019, when this was already obvious?
  2. Were the public taken for a ride and were the media played?”


  • “An Animal Model of Inhaled Vitamin E Acetate and EVALI-like Lung Injury” by Tariq Bhat et al. – [link]

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker
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