The question is how much diaceytl do we as vapers inhale per day? Dr. F. supposes it is 10 to 100 times less than the conservative NIOSH occupational standards. NIOSH responded to him and doubted his claim that analogs have diacetyl in them at all (Dr. F. responded by citing more studies to back his case). NIOSH also claimed he should not be extrapolating their recommendations for employees to e-cig users, but he responded by basically saying that's the only measuring stick available.
I don't think diacetyl in itself is a problem in e-cigs now. Many vendors have taken it out of their juices. However, other diketones can still be a problem and I suspect many
juice vendors simply switched one diketone for another. That's not to mention what other "unknowns" there are in the myriad of flavors we inhale. It is suspected that workers in flavoring plants may be exposed to
many possible harmful chemicals that may contribute to lung diseases. Diacetyl and AP may be just 2 of many.
One study done on analog cigarettes points out that the diacetyl levels found in the smoke is much higher than the NIOSH recommendations for factory workers. They note that people who smoke (but don't work in such environments) never contract "popcorn lung" even though they are exposed to diacetyl (and AP) in much higher amounts than NIOSH recommends. Their conclusion is that perhaps it is not the diacetyl at all that's causing popcorn lung but some other unknown or "confounding factor" that is in the air in these flavoring/popcorn/coffee plants. In other words, it is a mixture of chemicals and not the diacetyl or AP by themselves.
Even though most of the BO sufferers were smokers too, some weren't. The article linked in the OP's post provides interviews with several such people. We also know of the guy who "inhaled" the fumes from his bag of microwavable popcorn every day for years. He also ended up with BO. This means one of three things:
1) Pierce et al were wrong in their findings. Their samples were corrupt, their equipment was off, there was a methodological flaw somewhere, etc. This seems unlikely as there are other studies that show the presence of diacetyl in analogs.
2) The NIOSH recommendations are way too conservative. In other words, humans can in fact inhale a lot more diacetyl without (severe) adverse effects. If diacetyl by itself is the culprit, this means that the manufacturing plants must have had huge quantities of diacetyl in the air -- much more than one can get from decades of smoking.
3) Diacetyl or AP in themselves are not the problem, but are confounding factors (i.e. mix them up with the right chemicals and the resulting chemical cocktail becomes dangerous).
For our sake, I hope #2 is the right answer. If it's #3, then we are left to ask if diacetyl and AP alone don't cause BO, then what does?