Last month, amid the continuing swirl of the vape panic, a 17-year-year old boy received a double-lung transplant after his own lungs stopped working, wrecked from vaping. Doctors on the operating team told the New York Times that, without the transplant, the boy “faced certain death.” Before the transplant, his lungs had ceased filling with air. “What I saw in his lungs is like nothing I’ve seen before, and I’ve been doing lung transplants for 20 years,” Dr. Hassan Nemeh, who led the surgery, told the New York Times. “This is an evil I haven’t faced before.”
The case is a grim reminder that vaping’s effects on the body are still basically a medical mystery; e-cigarettes have been in widespread use for fewer than 10 years, and the ways they may or may not lead to long-term negative health effects are unknown. Though vaping has been marketed as a healthier alternative to smoking cigarettes (particularly by JUUL, which eventually ditched that slogan in late September), it’s also behind the lung illness outbreak that has, according to the CDC, affected more than 2,000 people and killed 40in the past year.
Forty deaths is, of course, a drop in the bucket compared to the number of people who die each year in this country from smoking traditional cigarettes. But the reports from people who’ve laid eyes on the lungs of sick vapers are dramatic and wild. Earlier this year, doctors described an 18-year-old in Illinois as having the lungs of a “70-year-old.” An October report from the Mayo Clinic found lung damage resembling “toxic chemical exposure,” like would be expected in someone who’d been around a chemical spill, in people who vaped both nicotine and THC. A study from all the way back in 2015—when vaping was still seen as relatively innocent—found that certain e-cig flavors were causing popcorn lung, a condition normally seen in factory workers who’d been exposed to hazardous chemicals. And then of course there’s Nemeh’s drastic classification of vaping as “an evil” he hasn’t seen in 20 years of doing lung transplants.
The regulatory reaction—from local and state governments, the FDA, and JUUL—to the spate of vaping-related illnesses at times seems more like a moral panic than an actual health crisis, given the relatively small number of patients. That the FDA is on the verge of an all-out ban on flavored products is sorta wild, given that cigarettes, a verifiably bad thing, remain readily available and probably always will. But there’s definitely something majorly suspect about a device that’s capable of doing this sort of damage. The CDC says is getting closer to finding what it is that’s causing this amount of harm (they’re relatively certain the culprit is vitamin E acetate), though there will likely be more illnesses and deaths in the coming months as we wait for definitive conclusions. As another doctor from the transplant surgical team told the New York Times, “I believe we are just beginning to see the tip of the iceberg.”
This article originally appeared on VICE US.