Health Concerns About Vaping Are Growing—Here’s Why

3 April 2018:

On a recent visit to Vape Town, a purveyor of e-cigarettes in Manhattan’s West Village, I find a culture in flux. The store is equal parts Game of Thrones and The Matrix. One display features slender white boxes, so minimally branded they could easily house an eco-chic skin-care elixir; another is lined with squat little apothecary bottles boasting lurid labels of demonic warlords and filled with tinctures of liquid nicotine in flavors like Unicorn Milk and Ménage à Trois.

If I were just seeking any old vape shop, there’d be no need to leave my Brooklyn neighborhood. Rare is the five-borough block where one can’t be found these days. But Vape Town distinguishes itself as the site of New York City’s first Juul Workbench. The Genius Bar–like destination promises to repair your Juul, the best-selling vape on the market—and it’s currently unattended. Deep into a reconnaissance mission, I gesture toward the ponytailed clerk at the cash register for service. Vape in one hand, iPhone blaring YouTube videos in the other, he shrugs; not his problem.

Created by a pair of Stanford design students, the Juul is an e-cigarette that looks a lot like a USB drive—and not much like many other nicotine vapes, which tend to be robot-ic simulacra of a cigarette, or outlandishly steampunk “tiny spaceships”—how fashion writer Anna Gray, an enthusiastic Juuler, describes them to me. (Leonardo DiCaprio, Holly-wood’s most notorious vaper, has been known to wield the latter at awards shows.)

I’ve become aware of low-key Juuling incidents in my own life ever since I watched Dave Chappelle’s 2017 Netflix special, Equanimity, in which the comedian intermittently puffs on one throughout his set. At a recent Brooklyn apartment-warming, the type of party at which lighting a cigarette might be an eviction-level offense, a journalist I admire casually brandished her Juul, taking drags of crème brûlée–flavored e-liquid as we discussed the #MeToo movement.

The writer Nadja Spiegelman has been Juuling—and not smoking—for a year now, she tells me, and even carries a second device for curious friends who want to bum hits. This is part of the appeal of the Juul and similar gadgets, I quickly learn. Designed to heat up flavored nicotine to create an inhalable aerosol, they produce neither the smoke nor the tar that a cigarette does when tobacco is burned. Vapes can also be helpful for weaning yourself off a more insidious smoking habit, as most e-liquids come in different strengths, allowing users to titrate down. (While Juul Labs, the company behind the Juul, is working on offering lower concentrations, its nicotine pods are currently available only as 5 percent solutions—roughly equivalent to one pack of cigarettes). But adults are drawn to the Juul for many of the same reasons as teenagers, who have started sneaking them into classrooms, sparking a national debate. It’s sleek, techie, tidy, and can be discreetly used inplaces where smoking is banned. The concern among parents and legislators is that it could also hook a new generation on nicotine, providing a gateway back to cigarettes and mucking up teen-smoking rates, which have been on the decline since the nineties.

In the U.S., cigarettes are still responsible for 480,000 deaths a year, and with proven links to lung cancer, stroke, emphysema, and heart disease, efforts to vilify them are based on cold, hard facts. The data around e-cigarettes are murkier, however, and remain contested even among doctors and researchers. “There’s just so little you can do that’s worse than smoking,” says Nancy Rigotti, M.D., director of the Tobacco Research and Treatment Center at Massachusetts General Hospital. Rigotti is one of several authors of a major National Academies report on vaping released in January. Among its conclusions: “Across a wide range of studies and outcomes, e-cigarettes appear to pose less risk to an individual than combustible tobacco cigarettes.”

So they’re potentially healthier, but are they healthy?

Neal Benowitz, M.D., chief of the division of clinical pharmacology at the University of California, San Francisco, has concerns about what’s actually in the e-liquid—solvents like propylene glycol and glycerin, and certain flavoring agents that are safe to eat but may be problematic when heated and inhaled—and what metals are coming off a device’s heating coils (researchers at Johns Hopkins, for example, recently found significant levels of lead and arse-nic in the aerosol of a variety of refillable tank-style vapes). Benowitz concedes that e-cigarettes are likely less carcinogenic and heart hazardous than cigarettes, but the effects of long- term use on the lungs remain an open question. Stanton Glantz, Ph.D., one of Benowitz’s UCSF colleagues and a longtime anti-tobacco crusader, takes a dimmer view. “Most people just think about the e-cigarette as kind of like a cigarette, except it doesn’t have as much bad stuff in it. But when you heat it up, you just get a whole different mixture of toxic chemicals.”

This hasn’t stopped the fashion flock from creating a new culture around these devices. In an industry where, for decades, cigarettes have persisted as a symbol of cool way past their expiration date—even the French are now considering a move to ban depictions of smoking in movies—vaping offers both a way to curb lingering bad habits and, in some cases, a new opportunity to accessorize. At her spring show last September, the British designer Molly Goddard sent model Edie Camp- bell down the runway with a glass of wine in one hand and a very realistice-cigarette—a “cig-a-like”—in the other, while Marc Jacobs, who once called smoking and sleeping the “two best things in the world,” often documents his extravagant vape exhalations on Instagram. He’s what you’d call a “cloud chaser” in industry parlance.

“All the fashion kids are addicted to them,” stylist Kate Young confirms when I reach out after seeing a Roger Vivier bag on her social feed with a Juul tucked away in its secret cigarette compartment.

Is it your vape, I ask?

“I would never do such an unhealthy thing,” she demurs via email, adding a wink emoji.

Coyness—or, more commonly, an insistence on anonymity—when going on the record about vaping is something I encounter again and again, from models, designers, and fashion civilians alike. “Everyone does it, but noone will talk about it,” agrees a prominent jewelry designer, who will speak only on the condition of not having her name in print.

Such skittishness could easily be interpreted as tacit acknowledgment of the inherent tackiness of vaping, which has long been associated with a certain kind of flat-brim-hat-wearing bro. But in an age of wireless earbuds, fitness trackers, smartphones, and wellness-as-gospel, it’s likely truer that people are afraid to evangelize for a practice that is still so untested. “You don’t want to be in this position of being like, ‘Oh, of course it’s healthier,’ then in six months there’s an article like, ‘Death to vapers!’ ” says restaurateur Kyle Hotchkiss Carone, a smoker turned Juuler who is a partner in New York City’s Cafe Clover and adjacent health-conscious Clover Grocery.

“What I say to patients is, ‘These are new products; there’s a lot we don’t know,’ ” admits Rigotti, who adds that it’s better to wean yourself off a cigarette habit with “treatments that we know are safe and effective”—such as the patch or the gum or the inhaler, which deposit a steady flow of therapeutic nicotine into the body to relieve cravings and ease the symptoms of withdrawal. “If you want to quit, try these first until we know more about e-cigarettes, which are completely unregulated at this point.”

The issue of regulating the vaping industry, which came under FDA authority in August 2016, is only adding to the confusion. The agency first announced that manufacturers that entered the market before that date would have to submit product applications by 2018 to stay in business. Then, last summer, incoming commissioner Scott Gottlieb, M.D., pushed that deadline to 2022. The delay is troubling in light of the Trump administration’s cavalier attitude toward deregulation and its impacts on public health. Four years may tell us more about vape safety and offer temporary reprieve to small e-cigarette outfits for whom application costs are prohibitive, but it’s also easy to imagine a future in which Big Tobacco–funded vapes exist in a monopolized marketplace, sold to smokers as harm-reduction tools, posing a major conundrum for the (rightfully wary) tobacco-control community.

And yet, intrigue persists.

Having smoked one cigarette in my entire lifetime (it was a decade and a half ago, in college; I still remember the headache the morning after), I am more surprised than anyone when I ask to try my companion’s Juul at the aforementioned apartment-warming. As I take a hit, my mind searches for a rationale: Perhaps it’s that I admire her, and she makes it look cool, like a latter-day, bookish James Dean. Or maybe I’m drawn in by the novelty and the idea that everyone should try most things at least once.

Weeks later, sitting in an Upper East Side coffee shop attempting to organize my thoughts on the subject, I overhear a mother in a pale-blue chinchilla fur loudly grousing into her phone about her teenage son’s burgeoning vaping habit. Like me, she felt the need to see what all the fuss was about. “I tried it yesterday,” she tells her friend, stealing the words from my mouth: “It was disgusting.”

Source: Vogue