THE PROGNOSIS

Public officials are cracking down on e-cigarette use amid an outbreak of vaping-related illness and seven resulting deaths.

But pot might be more to blame than anything else.

Nearly all of the 380 patients with lung illness reported using a marijuana oil called THC in their vape pens, my Washington Post colleague Lena H. Sun reports. THC is the chemical behind most of marijuana’s psychological effects, stimulating the brain to create pleasurable feelings. It’s essentially what leads to feeling “high.”

And many people have started using illegal vape cartridges containing THC, which also contain significant amounts of vitamin E acetate. Because cannabis oil is pricey, producers use the acetate to dilute and thicken it without affecting its flavor or smell. The thought is that the vitamin E is behind the symptoms the patients have experienced, which include coughing, chest pain and shortness of breath leading to a need for hospitalization. 

“Many victims have ended up with acute respiratory distress syndrome, a life-threatening condition in which fluid builds up in the lungs and prevents the oxygen people’s bodies need to function from circulating in the bloodstream,” Lena writes.

Federal investigators caution that they haven’t yet reached a final conclusion about what caused the illnesses and more than half a dozen fatalities, including a California man who died on Monday. But the vitamin E acetate was found in almost all of the cannabis samples from victims identified in New York, according to the state’s health department.

So which industry is taking heat for the illnesses and deaths? It’s not the marijuana industry. It’s the makers of e-cigarettes and makers of alternatives to tobacco products, including Juul, Altria, Reynolds American and Philip Morris.

President Trump and his Health and Human Services Secretary Alex Azar announced aggressive action last week to ban most flavored e-cigarettes unless the products are approved by the Food and Drug Administration. Azar said the FDA will soon outline a plan for removing all but tobacco-flavored e-cigarettes and nicotine pods from the market.

“We can’t allow people to get sick,” Trump said. “And we can’t have our kids be so affected.”

First lady Melania Trump tweeted about it too:

The scope of the announcement stunned the industry, especially Juul Labs, which had done just about everything it could to cement its status in Washington.

"The Silicon Valley start-up worked to make friends in the nation’s capital," my colleagues Laurie McGinley, Neena Satija, Josh Dawsey and Yasmeen Abutaleb report, in a behind-the-scenes look at Juul's massive lobbying campaign. "It hired senior White House officials wired into President Trump and the first family. It sent politically connected officials to the West Wing to extol its products. It spent big on lawmakers in both parties....But last week, the e-cigarette giant, along with the rest of the vaping industry, was caught off guard when [Trump] decided to take drastic action,"

But concerns had been mounting around the spike in youth vaping, with increasing pressure from public health advocates, parents and educators to take action. The crop of illnesses gave officials a seemingly opportune moment to announce a broad crackdown. 

"On Sept. 11, Trump was presented with a number of options, ranging from doing nothing to removing almost all vaping flavors from the marketplace," my colleagues write. "The president, who had previously expressed no opinions about vaping, had also been reading stories about people dying from a mysterious lung disease, say White House officials. Faced with a perfect storm of worsening youth vaping numbers and fatal illnesses potentially related to vaping, he chose the toughest course.

While e-cigarettes makers say their products are harmless alternatives to traditional cigarettes, they still contain addictive nicotine and can present kids with a "gateway" to lead to a lifetime of smoking.

Yet some critics charge the action is misplaced, given that marijuana products, and not nicotine, are more likely the cause.

“The best information suggests that a recent spate of deaths from a vaping-related lung disease … had little or nothing to do with legal e-cigarettes,” Post columnist Megan McArdle writes. “Naturally, the government wants to ban legally manufactured e-cigarettes.”

"Prohibiting or restricting the legal sale of sanctioned products is not an appropriate response to the illegal sale of illegal product," the editors of the conservative National Review wrote. "We don’t take Advil off the shelves because cocaine exists and is sold."

Ironically, regulating marijuana vape cartridges just isn't an option for the FDA. That's because they're illegal under federal law to begin with. If Congress classified marijuana under the Controlled Substances Act, a whole new terrain would suddenly open up for regulating these items.

Like the feds, state officials are also going after flavored e-cigarettes. Earlier this month, Michigan became the first state to ban them. Maryland's Montgomery County announced legislation on Monday to ban vape shops and delivery of e-cigarettes to stores within a half mile of middle or high schools. 

And yesterday New York state enacted its own ban and the District of Columbia proposed a ban on flavored e-cigarettes and requiring a prescription to buy other electronic smoking products, my Post colleague Fenit Nirappil writes. The District would be the first U.S. jurisdiction with such stringent restrictions on e-cigarette sales.

“We are quite literally watching a new generation of young people get hooked on nicotine through vaping,” said D.C. Council member Vincent Gray, who chairs the health committee.

AHH, OOF and OUCH

AHH: Tennessee will be the first state to release a plan to turn Medicaid into a block grant structure, setting up a test case for how far the Trump administration is willing to go to let states reshape their Medicaid programs, our Post colleague Amy Goldstein reports.

Tennessee’s draft proposal would impact more than 1 million of the state’s 1.4 million residents on TennCare. “The block grant would be used for medical services for children, pregnant women, parents and other core groups of people such as those who are blind and disabled. Some aspects of Medicaid would be excluded from the change, such as coverage of prescription drugs and payments to hospitals that treat a large share of low-income patients,” Amy writes.

This has long been a popular idea among conservatives. Under a block grant system, the government would pay an annual lump sum to states, which would not have to comply with many of Medicaid’s rules, such as who must benefit from Medicaid and what health care is covered.

“Proponents contend the model would save money and let states run the program more efficiently; opponents contend it would strand states and vulnerable residents during economic downturns or as expensive new therapies emerge,” Amy adds.

From Larry Levitt, Kaiser Family Foundation executive vice president for health policy:

OOF: For the second straight quarter, the number of opioid-related deaths have fallen in Maryland. But they're still at nearly an all-time high in the state, our Post colleague Ovetta Wiggins reports.

In the first six months of 2019, there were 1,060 opioid-related deaths in Maryland, according to preliminary data released by state officials. That’s an 11 percent drop compared with the first half of last year.

Steven Schuh, executive director of Maryland’s Opioid Operational Command Center, said the dropping number of deaths is encouraging but doesn’t yet signal the end of the state’s opioid and heroin crisis. “Baltimore City, Baltimore County and Anne Arundel County had the highest number of opioid-related fatalities, collectively accounting for 66.8 percent of all such deaths in Maryland in the first half of 2019,” Ovetta writes. In the next fiscal year, Maryland is set to spend $747 million on opioid-related programs, up from $674 million in the 2019 fiscal year.

OUCH: General Motors stopped paying for company-sponsored health insurance coverage for 46,000 workers who are on strike, instead leaving those costs up to the United Auto Workers union that can provide the workers with COBRA benefits, the Detroit Free Press’ Jamie L. LaReau reports.

"We understand strikes are difficult and disruptive to families," GM said in a statement. "While on strike, some benefits shift to being funded by the union’s strike fund, and in this case hourly employees are eligible for union-paid COBRA so their health care benefits can continue."

—Health care plans negotiated by labor unions has become a tension point in the Medicare-for-all debate. Speaking at a forum hosted by the Philadelphia Council of the AFL-CIO, former vice president Joe Biden criticized Medicare-for-all as injurious to organized labor.

“I have a significant health care plan. But guess what? Under mine, you can keep your health insurance you’ve bargained for if you like it,” Biden said. “If you don’t, you can move it, and you can buy into a public plan.”

But Sanders highlighted the ongoing labor dispute in which health care costs have been shifted onto the union backing striking workers.

“Here you have the situation where the UAW is now on strike, 49,000 workers. I’m sure that in that 49,000, there are family members who are seriously ill,” he said. “Under Medicare-for-all, whether you’re working, whether you’re not working, whether you go from one job to another job, it’s right there with you.”

HEALTH ON THE HILL

— Senate Majority Leader Mitch McConnell (R-Ky.) pointed to a lack of direction from Trump as a reason for stalled action in the Senate on gun control.

“I still await guidance from the White House as to what he thinks he’s comfortable signing. And if and when that happens, then we’ll have the real possibility of actually changing a law and hopefully making some progress,” McConnell told reporters, adding that it’s “not unimportant to my members” what the president supports. “What I would like to know is what [Trump] thinks would make some progress and he would sign. And until we get that kind of guidance, we’re in a holding pattern, so to speak.”

The Kentucky Republican said he believes lawmakers can move forward on gun-related proposals in the wake of numerous recent mass shootings, even as the president has said he would not support the House-passed bill that would expand background checks for gun purchases. “We owe it to the American people to act,” he said. “And act means pass the Senate, pass the House, and be signed into law by the President.”

— The House Education and Labor Committee has canceled a markup on a measure to tackle surprise medical bills this week because of disagreements among lawmakers on the committee, the Hill’s Peter Sullivan reports.

“The markup had not been formally scheduled, but the plan to hold it this week has been called off. It is now unclear when it will be scheduled or when lawmakers will reach an agreement,” Peter writes. “The committee, which oversees employer-sponsored health insurance, had been planning to vote this week on legislation that was largely similar to a bipartisan bill that already passed out of the Energy and Commerce Committee, the sources said. But some lawmakers are pushing for a different approach, one that they argue works better and that treats doctors and hospitals more fairly.”

The change of plans comes one day after the House Energy and Commerce committee announced it would investigate private equity firms that have financially supported a shadowy group that has spent tens of millions on ads pushing back on certain legislation to address surprise medical bills.

REPRODUCTIVE WARS

— The U.S. abortion rate reached an all time low again between 2011 and 2017, according to a new report from the Guttmacher Institute, which supports abortion rights.

“The report estimated the abortion rate in 2017, the most recent year studied, at 13.5 per 1,000 women ages 15 to 44,” our Post colleague Ariana Eunjung Cha reports. “That compares with 14.6 in 2014 and 16.9 in 2011 and is the lowest rate since the U.S. Supreme Court legalized abortion through the landmark decision Roe v. Wade in 1973.

While it’s not clear exactly what is fueling the decline, Guttmacher said there has been a drop in pregnancies, as well as “changes around abortion attitudes and stigma, contraceptive use, sexual activity, infertility and self-managed abortion.” The 48-page report also notes 400 bills imposing abortion restrictions were passed by states.

— And here are a few more good reads: 

TRUMP TEMPERATURE
The industry leader is fighting to overturn San Francisco’s ban on all e-cigs through a November ballot initiative — and other cities are watching.
Politico
MEDICAL MISSIVES
But their chance of survival still depends on where they are born.
New York Times
College Sports
Busch Beer and Venmo have offered to match the contributions, which have exceeded $27,000.
Michael Brice-Saddler
INDUSTRY RX
Bootleggers eager to profit off unsuspecting consumers are mimicking popular, legal vape brands, pairing replica packaging churned out in Chinese factories with untested, possibly dangerous cannabis oil produced in the state’s vast underground market.
Associated Press
STATE SCAN
The approach reflected the level of desperation among families staunchly opposed to vaccinating their children.
Politico
DAYBOOK

Today

  • The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies holds a hearing on the mental health needs of children in HHS custody.
  • The House Veterans Affairs Committee holds a hearing on how barriers to hiring at VA impact patient care.
SUGAR RUSH

Cimate activist Greta Thunberg met with former president Barack Obama: