Vaping: The evidence that suggests it may not be safe – Professor Harry Burns

Amid concerns over vaping, the US Centers for Disease Control is investigating hundreds of cases of severe lung problems associated with the habit, often promoted as a safer alternative to smoking, writes Professor Sir Harry Burns.

The American stand up comedian, Bob Newhart, had a routine in which he pretended to be Christopher Columbus’s financier. Talking to Columbus on the phone, he asked if any discoveries were going to make him rich. “So, Chris, what have you got for me? Toe-back-oh? What’s that ... a leaf? We’ve got plenty leaves over here, Chris. What’s so special about this one? You chop it up, roll it in a piece of paper then you stick it in your mouth ... then you do WHAT? You set it on fire?? You’re crazy. They’ll never fall for that!”

But, fall for it they did. A whole generation of young men were addicted to tobacco in 1914 when they were given free cigarettes as they marched off to war. By 1950, 85 per cent of Scottish men smoked and, of those born in the first decade of the 20th century, 23 per cent died of lung cancer.

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People woke up to the deadliness of tobacco and smoking rates started to fall. But people still craved nicotine and cigarette companies had to do something with all those leaves. Some genius came up with the idea of extracting the nicotine, mixing it within flavoured chemicals, vaporising it and letting people suck the chemical vapours into their lungs! The idea that a cocktail of chemicals must be safer than tobacco tar encouraged smokers to become vapers.

The line on vaping in the UK is that it is safer than cigarettes. It may be, although, in the US, the view is that the jury is still out. It is advocated as a way of helping people to stop smoking altogether. However, there is not much evidence of that yet.

In fact, the reverse may be true. In 2015, the US Surgeon General reported that e-cigarette use among high school students had increased by 900 per cent, and 40 per cent of young e-cigarette users had never smoked regular tobacco. Concerns about vaping as a step to cigarettes have prompted the state of Michigan to ban flavoured vaping products. The city of San Francisco has already enacted a total ban on vaping.

Is vaping safer than cigarettes? I’m sceptical. It took decades for the full extent of harmful effects of tobacco to become apparent. It is too early to say vaping is safe. Evidence from the US suggests we should be worried. The US Centers for Disease Control is currently investigating over 400 cases of severe lung problems associated with vaping. Some patients have had to be ventilated in intensive care. Five patients have died. The exact cause of the illnesses is still a mystery. No viruses or bacteria have been found to explain the problem. Inevitably, the vaping industry is eager to blame the problem cases on “black market” products. However, researchers at Pennsylvania University found that smoking even one nicotine-free e-cigarette can be harmful to a person’s blood vessels. US authorities are investigating reports of neurological symptoms, such as convulsions, fainting and tremors apparently related to vaping.

The US Health Secretary, Alex Azar, tweeted on Wednesday that “we will be finalising policies that will clear flavoured e-cigarettes from the market. New provisional data show that youth use continues to rise rapidly, and we will not stand idly by”.

Other serious health questions persist. Recently published studies have suggested that, while e-cigarette liquid may be relatively harmless, the vaporisation process can transform the molecules into substances which are toxic and the heating of the element can release particulates which lodge in the lungs.

If you smoke, the best thing to do is stop. My mother who started in the 1940s, smoked for over 50 years. One day, over 20 years ago, she decided to stop. She has never smoked since. Today is her 96th birthday. Happy birthday, Mum.

Professor Sir Harry Burns is director of global public health at Strathclyde University