You cannot make this conclusion. Natural
extract flavors are often full of diacetyl, which is a naturally occurring compound in diary and some fruits. Plus they can contain a lot of other things I personally would not want to inhale (lipids, proteins, polysaccharides, etc). They cost more because they are more expensive to make than mixing synthetic flavor compounds...or they charge what their market will tolerate, or both.
Plus, the term "natural flavor" does not have the definition most people think. It only means it is a compound that is also found in the food. Isoamyl acetate is a natural banana flavor, but it is synthesized in a lab.
I am a co-author on the Farsalinos DA/AP publication (Kistler). I am also deeply involved with all things chemistry in the
e-liquid industry, mostly as a consultant for AEMSA. I can assure you that I know of several companies that do test for DA and AP, and that they have either removed or are in the process of removing these chemicals from their recipes. Some have even developed pure-flavor lines that are verified free of them, as in working with the flavor industry to formulate these flavors.
DA and AP are NOT considered flavor ingredients by the FDA. They are considered
adulterants, since they carry a known risk of serious injury or death.
The mechanism of lung damage from DA or AP is not known. We don't know if it is purely a chemical interaction, or, what is being thought now, it triggers an autoimmune response where the body essentially rejects the lung. In many cases of BO followed by lung transplant, the
new lung also gets BO and dies,
even without further exposure to DA or AP. So it may be a particular biochemistry in a person's body that works with DA to create the disease.
The rat inhalation studies show that not just the lungs are affected, but also mucosa/nasal passages. This is true with AP as well.
Bad news: these are not the only vicinal diketones used in flavorings. There are also hexanediones and heptanediones with vicinal carbonyls, and which also show lung damage in rats.
When asked what the safe amount of DA or AP could be in an e-liquid, all toxicologists that we contacted answered ZERO AMOUNT. NIOSH is for workers that have no choice with exposure if they want to keep their jobs. Defending what is essentially just a luxury flavor in
vaping is not the same thing at all. They don't need to be there, there is a known risk, and so they should not be there. I concur with this professional opinion.
The risk of a highly publicized law suit is not worth taking, regardless of its merit or the lack thereof. And companies that I work with simply do not want to sell e-liquids with these compounds, period, end of story. We were blind-sided and horrified when we found out that the term DA-free did not mean that at all in many instances. AT BEST, this meant that consumers were robbed of informed consent. Ideally it should be the flavor companies that do the tests, I agree, but I know of many e-liquid vendors that are doing this themselves so they KNOW the results.
And DA and AP are actually not that easy to test for. The limit of detection and/or quantification should be ideally about 1 ug/mL, but this is hard to create the assay for. Just squirting a bit onto a GC-MS without standard solutions to compare to will tell you they are present, but not accurately how much is present. Accurately measuring relevant levels in e-liquids is VERY hard, since there are a LOT of flavor compounds of similar size to these, and peaks overlap in the flavor matrix. I have seen commercial labs claim they will test these for cheap, but when pushed on their limits of detection do not respond. I have also seen tests from labs stating the compounds are not present, but their LOD is 100 ug/mL or more!
But these compounds are not illegal, and people are free to vape what they like. I mean that. If you want them, have at it. If you don't, you should be able to have the opportunity to buy flavors verified to be free of them. Not just words on a website, which are clearly meaningless, but lab results on finished products. This IS happening right now, and it will continue to increase, I expect. And I would support companies that are doing this. They have spent a LOT of money making sure you are getting products that are as safe as our current understanding allows.