The EVALI outbreak makes a strong case for better regulation of all vaporizer products

We agree with our commentators that the EVALI outbreak in United States demonstrates need for better characterization and more effective regulation of all vaping products thank colleagues their thoughtful commentaries on article [1]. Pacula [2] thought we were unfair accusing Centers Disease Control Prevention (CDC) confirmation bias its public advice about causes they describe initialism (e-cigarette, or vaping, product use-associated lung injury). She argues CDC was appropriately cautious attributing primary cause to vitamin E acetate from illicit tetrahydrocannabinol (THC) basis ‘a 2% convenience sample identified vaping-associated injury cases’ when both nicotine cannabis e-liquids readily available there a lack information ingredients [2]. it reasonable suspect e-cigarettes possible outbreak, given high rates reported by cases. also caution required making causal inferences early case control studies, but nonetheless argue exhibited two main ways. First, much slower than Food Drug Administration (FDA) attribute agencies had access same data. The FDA did so 6 September 2019; not do until end October 2019, after date continued advise consumers against vaping. Secondly, even finally concluded 2020 contaminated oils retained potentially misleading ‘EVALI’ label instead substituting accurate expression such as ‘cannabis oil related injury’. injuries ‘e-cigarette-related’ this term is typically used contain nicotine. Australian health authorities have CDC's equivocal language justify sales bans electronic delivery systems (ENDS) [3]. strongly St Helen [4] tighter products, i.e. those cannabis. While implicated illicit, licit markets would provided greater confidence at an earlier stage these unlikely be cause. Helen's analysis concluding ban sale open (refillable) blunt counterproductive regulatory response [4]. Cox & Notley [5] are well-understood -described products. accordingly support proposal develop e-cigarette ontology will facilitate ‘scientific consensus coherent systematic way defining relevant entities’ ‘indexing research methods findings field’. An widely accepted may reduce media misreporting over-reactions evident during outbreak. None.