A pair of journalists who work for The i newspaper have attempted to work out what is true about vaping. Tom Chivers and Stuart Ritchie both cover science stories and have been confused by the polarised and conflicting information when it comes to vaping. They wanted to know why there are diametrically opposed opinions on vaping – and all coming from “seemingly authoritative sources”.
“Some countries have taken a harsh view on vaping,” Tom and Stuart say. They point to Australia and India, both of which have implemented bans on vape products. They highlight how the World Health Organisation congratulated India for its anti-vape measures and states there’s no evidence to show vaping helps smokers to quit.
This situation couldn’t be further from the UK’s position, so to find their way through the mess of contradictory statements they posed themselves three major questions.
“Is vaping bad relative to smoking?”
People repeatedly question the claim that vaping is at least 95% safer than smoking. The British Medical Journal went so far as to attack Public Health England in 2015 over the figure and American billionaire-funded lobby groups have been happy to smear the researchers who came up with the figure.
“But ‘sensible’ people say that vaping only poses a small fraction of the risks of smoking,” Chivers and Ritchie say. How can the 95% figure be questioned when independent researchers at British universities, Public Health England, government studies, Action on Smoking and Health and Cancer Research UK all contend that it holds true?
The Royal College of Physicians says electronic cigarettes “are unlikely to exceed 5% of the harm from conventional smoking”, “and maybe much less”.
“It sounds plausible to me”, says Stuart Ritchie, that something that doesn’t involve inhaling smoke and its related toxins would be less harmful.
Tom Chivers mentions the popular meme “We don’t know the long term effects” in relation to potential risk.
Tom said: “I remember people [using] vapes fifteen years ago, we’re getting to the stage now where we should start seeing what I would call long-term effects – you would expect to see a raised cancer risk from smoking in ten years of people taking it up. We could start to say the evidence is pretty good by now, surely?”
And there is no recorded elevated cancer risk from vaping.
Stuart Ritchie pointed out that we may not have 100yrs-worth of evidence regarding vaping, “but we do have a toxicological understanding.” We know what chemicals are in vape and we know what impact these chemicals have on the body.
Consequently, he argues, we can say with a large amount of certainty that we don’t expect there to be a posed risk. So, the pair agree that it is fair to say from the evidence that vaping is much less dangerous than smoking.
“Regardless of its relation to smoking, is vaping bad in and of itself?”
For this part of their discussion, Chivers and Ritchie pose a thought experiment: if smoking didn’t exist and vaping was invented, would people say that it is a bad thing?
Is it a problem that nicotine is addictive? Tom says that he is addicted to coffee and exhibits severe negative effects if he goes without. But if something doesn’t impact how people lead their day-to-day lives when being used then is the addiction bad?
Stuart says the research evidence shows you are much more likely to say you’re heavily addicted to nicotine if you’re a smoker than a vaper…and if you’re a vaper you’re much more likely to say you’re not at all addicted.
“Everyone agrees [vaping] is not risk free,” they say, and there are studies that point to “low level issues like coughing”. But then there are those people who claim ecigs cause lung disease, popcorn lung, and heart attacks.
This sounds bad.
They point out that once you begin to delve into the science, the medical issues aren’t actually related to vaping.
Chivers and Ritchie say that illegal black market vapes containing vitamin E acetate caused the lung problems in the USA. And popcorn lung? The pair express incredulity that anyone makes such a claim given that CRUK says “There have been no confirmed cases of popcorn lung reported in people who use e-cigarettes”
Moreover, Stuart Ritchie pointed out that cigarettes have 150x the level of diacetyl found in illegal eliquids and there has been no recorded case of someone getting popcorn lung from smoking either.
“I think that whole thing is a really weird scare story and not related to the evidence whatsoever,” Stuart Ritchie. “I’m amazed that it has become a common talking point. It’s massively irresponsible for people to say that vaping causes popcorn lung.”
Then, there is the oft-cited Stanton Glantz study that found vaping causes heart attacks.
“But the majority of people had their heart attacks years before they started vaping! Vapes are so bad that they go back in time to cause people to have a heart attack in the past,” Stuart explained.
“That’s just crazy,” said Tom Chivers.
The American Heart Association was forced to retract the published study.
On balance, they agree that vaping does pose minor risks but that adults should be free to enjoy things and allowed informed consent.
“Is vaping a gateway into smoking?”
Tom says this is a common topic of conversation, be it video games causing violence or YouTube videos inspiring extremist views.
Post hoc ergo propter hoc: does the act of vaping mean that someone will smoke because of it?
Stuart explains that he has found studies which claim to find a correlation showing a gateway effect.
But, Tom says, people have personalities – and one personality trait is risk appetite, a psychological predisposition to seek sensation from risky behaviour. “I would not be surprised to find that vaping also correlates to driving too fast,” he adds.
Surely, if vaping led to smoking, then it would show up as an increase in smoking rates? Yes, agrees Stuart.
Or rather, it doesn’t.
Ritchie says his investigations have unearthed a striking result: “If you look at smoking in the UK, smoking has gone down and down and down. The graph of people who smoke [the same for adults and kids], the graph has just gone down and down and down. In the 1970s, 45% of the adult population smoked, but now it’s down to between 10 and 15%. In 1980, 50% of kids had ‘ever smoked’. Now – 12%, down from 16% in 2018, so it’s been dropping and dropping and dropping with low single figures for kids who say they are regular smokers.”
The pair agree that there is no evidence to support the argument that vaping leads to smoking.
They added a fourth question to the discussion:
“Is there evidence that vaping works to help smokers quit?”
“Yes, amazing amounts of evidence,” Stuart Ritchie says. “I was really surprised. I looked up the latest Cochrane collaboration review which said, ‘there is high certainty evidence that e-cigarettes increase smoking quit rates compared to nicotine replacement therapy’.”
Tom Chivers added, to see ‘high certainty evidence’ on a Cochrane Review is a very rare thing.
Stuart Ritchie concluded: “It seems like e-cigarettes are the best things we have to help people quit smoking – and given how bad smoking is that seems like a really, really good thing.”
Tom Chivers finished up by saying: “If people who enjoy smoking are able to switch it for something that has a fraction of the health risks, this seems a ‘good thing’.”
Action on Smoking and Health and Cancer Research UK agree that vapes are a smoking cessation tool, they work and they are far, far safer.