It was a medical miracle that didn’t need to happen: In October, Dr. Lisa Allenspach of Henry Ford Hospital in Detroit, Michigan, performed a rare bilateral lung transplant on a high-school-age boy. The boy’s lungs were so damaged that doctors were not able to sufficiently oxygenate them. It’s the first such transplant that’s been performed because of the ongoing health crisis surrounding vaping.

The surgery was a success. Last week, when it became apparent the boy would survive, Allenspach and her colleagues warned of the evils of vaping.

“Any legislation that can be passed [to ban e-cigarettes] would be a step in the right direction,” Dr. Allenspach told Digital Trends. “I’ve had colleagues all over the state tell me that they all have at least two or three cases in their intensive care units. This is really just the tip of the iceberg.”

On Sunday, as the teen faces what his doctors described as “months” of slow recovery, the New York Times reported that the Trump administration was pressing pause on a promised action to ban the sale of flavored e-cigarettes, a move that most Americans support, according to a YouGov poll. Trump had originally proposed the ban in an attempt to reduce the number of teenagers using electronic cigarettes — but according to the Times, he’s dropping it out of fear that it could alienate voters.

The best estimates, published recently in the Journal of the American Medical Association, now say that 25 percent of high school students nationwide vape regularly, along with 11 percent of middle schoolers.

Nurse practitioner Justin Gill works in an urgent care facility in Washington — one of the few states that has enacted a temporary flavored e-cigarette ban. He said he’s encountered an uptick in what look to be vaping-related cases. He added that the majority of these cases are in their late teens to early adulthood.

“It’s become more apparent and present over the past couple of months,” he told Digital Trends. “I think a lot of that is because of the public advisories and warnings coming out, people realize they are having issues breathing after using vapes for weeks and weeks or months and months.”

Part of the problem is that it’s hard to draw a solid medical conclusion that all these lung problems medical professionals are seeing in teenagers are actually directly caused by the substances in e-cigarettes. The Centers for Disease Control and Prevention (CDC) recently identified one possible culprit: Vitamin E acetate, a chemical compound that’s harmless when applied topically but can severely damage the lungs. The organization has reported 2,172 confirmed or probable cases of lung injury related to vaping, with 42 deaths attributed to the epidemic.

The science looks solid, but these types of lung injury are far from being understood. “We can’t say what’s safe,” said Allenspach.

“It’s difficult for us to demonstrate that anything occurred from any direct substance,” said a specialist at Buffalo General Hospital in New York, who asked not to be named because they were not authorized to speak to the media. “There are no long-term health studies yet.”

The specialist compared it to admitting a person to a hospital who had just shot heroin into their arm. Yes, the patient might be sick, and might have just done the drug, he said, but you can’t immediately connect the two. “I can’t document it as such in our hospital as the cause of the disease,” they said.

Vaping companies have made claims that vaping is a safer alternative to smoking, and an effective way to quit cigarettes.

Even Trump’s secretary of Health and Human Services, Alex Azar, has pushed the idea that vapes are a good way to quit cigarettes. In a conversation with Axios, Azar was asked about the president’s plans to ban e-cigarettes. “We have to try to figure out the right balance of, how do we ensure that adults have access to e-cigarettes who need to wean off of combustible tobacco, but how to do we prevent kids from getting addicted,” Azar said at the time.

He later also said the president was assessing raising the legal age for purchasing e-cigarettes, which is currently 18. Azar made this statement on the same day that Allenspach and her colleagues announced their patient was going to survive his transplant, and a mere four days before the president hit the brakes on any of these actions.

A spokesperson for the Department of Health and Human Services would not comment specifically on the proposed vape ban and could not give Digital Trends an update on whether it would still be implemented.

This message that vapes could be better than cigarettes is absolutely unsubstantiated, Allenspach said. “No way it’s a better alternative. It’s incredibly addictive,” she said. “You see kids in high school who would never have started smoking asking people for vapes. Some of them use it as a diet. They say they vape the chocolate flavor to satisfy the craving for food.”

“As far as carcinogens, yes it can be less traumatic to the lung tissue than smoking, but that doesn’t mean it’s harmless,” said Gill. “Any kind of external agent is not a good idea.”

Added the doctor at Buffalo General: “Vaping was supposed to cut down on the amount of nicotine from cigarettes, but then they give you these ultra-high-nicotine-type pods to smoke. There’s some business and some science going to the ultimate goal of getting people off cigarettes. What happened instead was this capitalistic orgy, and then some kids died because it’s unregulated.”

Allenspach says “the health implications are really only just beginning to be understood.” Michigan, where she practices, is one of the few states in the nation that has attempted to ban flavored e-cigarettes, along with Rhode Island, New York, Montana, Utah, Oregon, and Washington. San Francisco and the Pine Ridge Reservation in South Dakota have banned all e-cigarettes outright. Michigan’s own attempt was blocked by its courts.

One state, Massachusetts, implemented a four-month ban on the sales of all vaping products starting in September, and began mandating the reporting of all suspected vaping-related injuries. More than 200 suspected vaping-related lung injuries have reported since then. In November, the third person on record in the state died from vaping-related injuries.

“It’s a good idea in these cases to be a little overly cautious, especially when there’s potential for signifiant harm rather than be conservative and wait for the damage to happen,” Gill said. “You’ll do less harm by holding off on vaping and gathering more evidence.”

“What we really need is a wide-scale media campaign to change the general sentiment toward e-cigarettes,” Allenspach said. “Legislation is a step in the right direction, but it’s not the only solution.”

Correction: An earlier version of this story misstated the timing of the report that Trump would drop the vape ban. That report was published on Sunday, November 17.

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