Before there were vapes, there was sulfanilamide. One of the first great medicines of the antibiotic period, sulfanilamide was a miracle drug at a time when antidote pneumonia with a quick trip to the pharmacy seemed akin to walking on liquid. When a sweet, raspberry-flavored liquid version appeared in stores in early September of 1937, it was a no-brainer prescription for doctors whose sick young patients were still picky enough they might reject even Jesus himself if he returned in the form of a bitter-tasting pill.
By the end of October, more than 100 of those patients had died and regulators were clambering to figure out why.
All of this has happened before, and all of this will happen again. Today, medical experts and federal regulators are struggling to understand a mysterious lung illnes linked to the use of electronic cigarettes. As of Sept. 17, 530 people have been diagnosed across the country, seven members of whom have died. Neither the Centers for Disease Control and Prevention nor the Food and Drug Administration can definitively say what is causing the illness or why a device that was supposed to help people stop smoking cancer-causing cigarettes has, itself, turned deadly.
Regardless of why e-cigs have turned toxic, historians and buyer law preaches ascertain lessons in the sulfanilamide catastrophe of 1937 — ones that go beyond the obvious surface similarities of poisonous, fruit-flavored liquids. Both examples highlight the way consumer protections in this country are reactive, cropping up in response to disease and death, rather than preventing it.
“There’s insanely heartbreaking letters from these physicians who had prescribed[ sulfanilamide elixir] and then watched kids die, ” said Deborah Blum, writer of “The Poison Squad, ” a journal about the founding of the FDA. Those extinctions were pain and prolonged, stretching out over days and weeks of convulsions, nausea, kidney failure and stupor . “No one had any idea what was going on. The FDA was urgently mailing scientists around the country, ” she told me.
Eventually, a Kansas City FDA inspector confirmed that eight children and one adult who died in his area had all taken the same medication, prepared by S.E. Massengill Co ., based in Tennessee. Chemist broke the concoction down, molecule by molecule, and discovered that Massengill had merged its antibiotic with diethylene glycol. In other terms, it had taken medicine and raspberry flavoring and mingled it up with antifreeze.
A similarly desperate cross-country investigation is happening now with the vaping-related lung extinctions, but pinning down a cause is proving harder in this case. There’s no tell-tale chemical turning up in every sample. Eighty-four percent of the 53 patients whose examples were reported in a study published by the New England Journal of Medicine did admit to using e-cigarette pods that contained THC, the chemical in jackpot that gets you high. But that’s a small and geographically isolated sampling. Other than vaping, itself, there’s no single behavior all the victims share. There’s no Massengill in our modern story , no single corporation glowing ominously like a lighted cigarette in a dark alley.
More frustratingly, said Anne Schuchat, principal deputy director of the CDC, the authorities have several reasons why patients might not be giving physicians an accurate report of what they’ve applied and how. Some are too sick. Some might not want to talk to the government about their THC use. The commonwealth of Illinois has begun an anonymous survey of healthy e-cigarette consumers, said he wished to spot some differences between the people who have gotten sick and those who haven’t. It’s likely there’s more than one poison at play .
Meanwhile, there’s also not a clear trail of what was sold, who sold it and who they sold it to. That was true in the 1937 calamity, as well. But examiners knew Massengill had built the product and tried to recall it. E-cigarettes, in comparison, are more of a mama and pop affair. Heaps of people are making and selling e-liquids and some of them are amateurs, working off the books. That’s especially true of liquids containing THC.
But this isn’t just about a contaminated black market. Even the e-liquids with the most professional pedigrees haven’t been subject to stringent safety regulations, said Desmond Jensen, an attorney with the Public Health Law Center at the Mitchell Hamline School of Law. In 1937, Blum said, pro-regulation preaches had already been warning people for years that there were too many loopholes in FDA principles. And the same is true in this case. There were no FDA regulations at all on e-cigarettes until 2016, and the rules and that exist now are more like swiss cheese than solid cheddar, Jensen said.
“When you say a product is regulated, the average person thinks about pesticides, food or medications, ” he “ve been told”. “There’s someone stimulating sure it’s not defiled, or building sure it won’t attain us sick. That’s not what it means here.” Instead, the FDA necessitates vendors and manufacturers of e-cigarettes and e-liquids to register with and disclose ingredients to the agency. But that isn’t the same as quality or safety testing, Jensen said. And a lot of companies haven’t registered in the two years those regulations have been in effect. Safety testing regulations do exist — but their implementation keeps getting scooched back under pressure from vaping corporations. Currently, products that were on the market before 2016 won’t have to be reviewed for safety until May of 2020. Manufacturers who don’t sell immediately to consumers haven’t had to register or disclose ingredients at all.
In 1937, it was completely legal to sell antifreeze-sweetened medicine to children. The only crime the Massengill company could be charged with was misbranding its liquid as an “elixir ,, which legally had to contain alcohol, rather than as a “solution, ” Blum said.( In fact, such a distinction was the only thing that allowed the FDA to get involved and recover the tainted drug from consumers to begin with .) The sulfanilamide disaster changed everything about customer security. Within a year, we had a brand-new Food, Drug, and Cosmetic Act that, for the first time, made the FDA the power to demand companies prove a drug was safe before it could be sold.
And that’s effectively the problem we have with e-cigarettes today, Jensen said. The pre-sale approval process exists, but there are thousands of products it doesn’t yet apply to. Meanwhile, it’s legal to sell e-cigarette liquids that contain compounds we’ve censored as food additive, or that contain substances nobody has even thought to list in a database because they form in the parcel after the ingredients ought to have mingled together. And while states have begun to ban flavored e-liquids for responding to the lung disease outbreak( and the federal government may do the same ), that doesn’t solve consumer protection troubles that aren’t related to flavoring, such as liquid nicotine that contains much more of the narcotic than is claimed on the label, or e-cigarette devices manufactured in China that aren’t placed on hold to any kind of safety standards.
But it’s no real amaze we’ve objective up here, said Marian Moser Jones, a prof of history and ethics at the University of Maryland. Our laws aimed at stopping products from poisoning people have usually come in reaction to deaths and illness, rather than before.
Ultimately, Moser Jones said, you can look on both historical poisoning cases and the current vaping crisis as a direct result of consumer product safety policy that often kindness a privilege to sell over a right to know that what is being sold is safe. “In non-eu countries there’s less of a question about whether the government has a right to interfere with commerce, ” she said. When the careful balance between retailers their entitlements and buyers tips too far to one side, people die.
Read more: fivethirtyeight.com