EIGHT DEATHS FROM VAPING HAS PROMPTED A BACKLASH, BUT COULD THE PANIC DO MORE HARM THAN GOOD?

Chris Stokel-Walker
21 September 2019
Telegraph UK

Follow  The recent headlines have been as stark as they have been relentless: vaping has now been linked to eight deaths in the United States, hundreds of cases of respiratory illness and scare stories of fatal vapes abound on both sides of the Atlantic.

Certainly, the numbers of vapers are booming. In 2011, there were seven million worldwide, according to analysts Euromonitor International. By 2021, they’ll be 55 million. Worldwide, we spend more than £15.5 billion on vaping products, up from £5.5 billion five years ago. More than two new vaping shops a week opened on British high streets in the first half of this year, according to the Local Data Company.

So, how worried should we be? “Very few things in life are entirely safe, but vaping is less risky than smoking,” says Dr Linda Bauld, deputy director of the UK Centre for Tobacco and Alcohol Studies, and a researcher in addiction at the University of Edinburgh. Bauld has written reports for Public Health England (PHE) and the Royal College of Physicians explaining that vaping is “orders of magnitude” less harmful than smoking.  “It’s safer and less harmful because there’s no combustion, no burning,” she says. “What causes the vast majority of the harm from smoking is the tar that’s produced when the cigarette is burned – that has over 4,000 chemicals in it.”

The American issue is something else entirely, Bauld says: the eight people who have died, the average age of whom is around 19, have all been connected to vaping cannabis or tetraydrocannabinol (THC), the principle psychoactive component in the drug that produces the ‘high’, which is illegal to sell at concentrations above 0.2% in the UK, and in most states in the USA.  The 530 cases of a new illness across 38 states, christened vaping-associated pulmonary injury (or VAPI) by the US Centers for Disease Control (CDC), are believed to result from a unique range of circumstances, some but not all linked to vaping THC.

No-one, of course, is regulating what is going into illegal THC cannabis products, which have been linked to all but one of the vaping-related deaths, and black-market manufacturers in the US are reported to have begun using a thickening agent in the oils last year to help them work with e-cigarettes. The thickening agent, vitamin E acetate, is used in many common cosmetics and skincare products, with research demonstrating its safety in those uses, but hasn’t been tested as safe when inhaled. “We think that’s caused lipoid pneumonia and respiratory problems, and serious deaths,” says Bauld.

But the distinction between illegal and legal vaping has been lost in translation – the CDC issued a blanket warning against all e-cigarettes in the US, earlier this month.  “When you’ve got reputable government agencies giving that advice, then, of course, there’s going to be confusion and people are going to assume the risk of death or serious respiratory illness can arise from any product,” says Bauld.

UK rules, instigated by the Medicines and Healthcare Products Regulatory Agency, which regulates e-cigarettes, mean vitamins can’t be added to e-liquids here. Deborah Arnott, chief executive of Action on Smoking and Health (ASH), a public health charity funded by the British Heart Foundation and Cancer Research UK, is clear: “If serious respiratory problems were linked to vaping here, our medicines regulator and health protection authorities would take the necessary action and warn vapers.”

The United States’s speedy reaction has had a domino effect worldwide. India, where nearly 900,000 people a year die due to illnesses tied to tobacco intake, banned e-cigarettes earlier last week. The Association of Vapers India said the decision showed the government was “more concerned about protecting the cigarette industry than improving public health”. That’s something James Dunworth, chairman of E-Cigarette Direct, a UK-based vaping company, agrees with. “People have been using electronic cigarettes safely for well over a decade in the UK, and longer in the USA,” he says.

Critics would counter this is still too early to claim no long-term harmful effects; after all, it took 10-40 years for symptoms of asbestos-related conditions to appear. But while we worry about what we don’t yet know, “there are going to be smokers who aren’t going to switch to vaping,” says Dunworth, “and there are also going to be some vapers who will go back to smoking, and as a result might die younger than they would have done otherwise.” Vaping is not without its risks. Earlier this month, an analysis of 38 studies into the cardiovascular impact of vaping found worrying signs of damage in nearly three-quarters of tests. “If you don’t smoke, don’t vape,” says Professor John Newton, director of health improvement at PHE, but if you do, “the evidence remains resoundingly clear – in the UK there is no situation where it would be better to continue smoking rather than switching completely to an e-cigarette.”

Panic has also been rising in the US about the rise in teens vaping candy-flavoured e-cigarettes. Yet in the UK there aren’t vast numbers of child vapers – yet. Only a quarter of 11-to-18-year-olds in Britain have ever tried an e-cigarette, and more than one in 20 have never even heard of them, according to a recent survey by ASH. Only 1.6 per cent of children use e-cigarettes more than once a week. “There’s quite a bit of experimentation but very little regular use except in kids who regularly smoked,” says Bauld.

Lorien Jollye’s 18-year-old son was one of them, beginning at the age of 13. When he struggled to shake his smoking habit a couple of years ago, the 41-year-old café owner from Cornwall bought him a vaping device: “It was something to replace the habit,” she says. While Jollye would obviously rather her son neither vaped nor smoked, she’s a realist. “Pointing and screaming at kids and telling them it’s terrible doesn’t help,” she says. “Though we don’t want teenagers to do stuff that isn’t great for them, they do. The reality, awkwardly, is it’s better that he’s [vaping] because otherwise, he’d still be smoking.”

In the US, it’s slightly different: children are more likely to vape, even if they’re not already cigarette smokers, and a quarter of high school pupils say they’ve vaped in the last month. That’s down to a number of factors, reckons Bauld. For one thing, we have a ban on almost all marketing of e-cigarettes, unlike in the United States. (That may change, though: American advertising lobby group Common Sense has written an open letter to some of the country’s biggest advertising companies, television networks and social media websites, asking them to ban “manipulative ads from Juul and other e-cigarette companies”.) 

Although a recent *Telegraph report prompted an Advertising Standards Authority investigation into vaping being advertised illicitly through social networks such as Instagram, official marketing and public information campaigns in the UK portray vaping as a smoking replacement therapy, meaning that the imagery involved is more likely to involve middle-aged smokers with beer guts than sun-kissed teens on southern California beaches.  Still, any parent knows teenagers experiment in their formative years, and that they also like lying to authority figures, such as pollsters. Donald Trump’s planned ban on flavoured e-cigarettes, announced last week from the White House, might help tackle the teen appeal problem in the United States, where the average age of the victims of reported incidents of VAPI is just 19.

A study by Duke University found that the chemical flavourings of e-cigarettes combine with solvents in liquids to create acetals that can irritate the lungs.  “I’m not really worried about flavourings for smokers, as they’re [still] dramatically reducing their risk by vaping,” says Bauld, “but for young people or non-smokers, we don’t want them vaping because you inhale things into your lungs. There are flavourings and chemicals that are harmful, even [if] at very low levels compared to tobacco.” 

And those who adapt their vaping devices to smoke THC or cannabis are even more troubling – but their actions shouldn’t blight the vaping industry, believes Dunworth. “There are many legal products you can misuse if you really wanted. Heroin users can use spoons to heat up heroin, but you wouldn’t ban spoons because of it.” If you are going to vape, says ASH’s Deborah Arnott, “only buy from mainstream suppliers who are selling regulated products – to use black market products carries potentially lethal risks.”