17 June 2019
Professor Simon Capewell
Supposedly ’95 per cent safer than smoking’, promoted as a shortcut to quitting and offered in an array of flavours (bubblegum or cola, anyone?), it’s no surprise vaping — smoking e-cigarettes — is now a popular alternative to lighting up.
These hand-held, battery-operated devices simulate smoking a cigarette by heating a liquid (in a refillable tank or sealed pod). This generates a nicotine vapour, which is then inhaled.
Some three million people in the UK now vape, according to 2017 figures — up from 700,000 five years before. Many feel it is better for them and those around them, without the smell of smoke.
However, as a professor of clinical epidemiology who has spent 30 years promoting health, I am disturbed by the uncritical support for vaping from Public Health England, part of the Department of Health.
Professor Dame Sally Davies, the chief medical officer for England, recently said she finds having to breathe ‘white clouds’ of e-cig vapour offensive and that vaping should only be allowed at home — but her view is not mirrored by our authorities.
Yet there’s increasing evidence that vaping may damage the lungs, heart or brain. Researchers at the University of Birmingham recently linked the habit with chronic respiratory diseases, such as bronchitis, while scientists at Stanford University in the U.S. found e-cigs’ flavourings damage the cells lining our blood vessels.
This could lead to high blood pressure, heart disease or stroke.
Once heated, the substances in the vapour break down into toxic chemicals such as acetaldehyde.
A University of Nevada study found that significant amounts of cancer-causing chemicals, including formaldehyde, were absorbed by the lungs in a typical vaping session. Meanwhile, research from the European Lung Foundation suggests smoking e-cigarettes with nicotine can cause arteries to stiffen in a similar way to tobacco.
The U.S. Food and Drug Administration is now warning that nicotine-induced seizures could be a side-effect, with at least 35 reports of it.
In Canada, vaping is prohibited for under-19s. And in 2009, Uruguay put a blanket ban on e-cigarettes: its health minister cited toxic gases and a lack of proof that e-cigs are effective for quitting smoking.
Yet, here in the UK, we continue to gamble with children’s health. Our Government’s laissez-faire approach includes publicly funded advertising supposedly aimed at converting smokers, but which is very visible to children.
It’s a rejection of medicine’s ‘precautionary principle’ — that when a new chemical or treatment arises, control measures are usually taken until its safety is proven.
What’s more, with their sweet-shop flavourings and colourful advertising, e-cigarettes are even attracting young people who had never given smoking any thought.
This ‘gateway effect’ is a major concern. Teen vapers are five times more likely to become smokers, and the proportion of British 11 to 18-year-olds using e-cigarettes has doubled in the past five years.
The amount of nicotine in vapes varies — but can be more than sufficient to be habit-forming.
That said, around one in ten people who has successfully given up smoking has used e-cigs.
However, vapes are not medical products. So there is no associated quality control or regulation. The claim vaping is ’95 per cent safer’ than smoking is controversial. It came from a paper published in European Addiction Research by Professor David Nutt and colleagues from the Independent Scientific Committee on Drugs.
Some of those on the committee are linked to the vaping and tobacco industry — an industry that focuses on profit, not health.
They calculated the level of harm caused by different nicotine delivery systems, from cigarettes to e-cigs. But the paper itself stated there was a ‘lack of hard evidence for the harms of most products on most of the criteria’.
Meanwhile, the World Health Organisation recently recommended adults and children should not be made to breathe other people’s vapes in enclosed spaces — yet the UK ban on smoking in enclosed public places does not yet apply to vapes.
Perhaps most disturbing of all, cigarette companies are investing billions in vaping. If e-cigarettes truly helped people quit smoking, it would be a financial disaster for the tobacco industry.
U.S. surgeon general Dr Jerome Adams, the country’s public health spokesman, has expressed concern about the youth vaping ‘epidemic’, stating: ‘We must take aggressive steps to protect our children from these highly potent products.’
Those who regard vaping as harmless are allowing the industry to hide behind a smokescreen.
In my view, it’s time to ban all e-cigarette advertising and ensure money is spent on advocating smoking cessation programmes that are proven to work.
Simon Capewell is a professor of clinical epidemiology in the Department of Public Health & Policy at the University of Liverpool.
Interview: Angela Epstein