Vaping is still causing a deep divide in the scientific community. Picture: 123RF/ARTHURHIDDEN
Vaping is still causing a deep divide in the scientific community. Picture: 123RF/ARTHURHIDDEN

Are you a “vaper”? That makes you effectively “a human guinea pig in one of the biggest experiments in human medical history”, some health experts say.

They base this on new evidence of serious health risks associated with vaping and the increasing use of e-cigarettes in SA and globally. Chief among these risks are lung disease, gum disease, erectile dysfunction, hair loss and some cancers.

Other health experts say vaping fears are “emotionally driven” and based on “flimsy evidence”.

It’s a perennially deep scientific divide.

On one side, some countries and US states have banned e-cigarettes or just those with nicotine. Others promote e-cigarettes as effective and “safe enough” to get people to stop smoking.

In SA, the local e-cigarette market generated more than R1.16bn in sales revenue in 2017. Projections are that it will triple over the next 10 years.

The Heart and Stroke Foundation of SA (HSFSA) has come out strongly against vaping. HSFSA CEO Pamela Naidoo says evidence shows that vaping is “a health gamble” with odds heavily stacked against you.

“The truth about vaping is still in the air,” says Naidoo.

Studies are not long enough to determine the long-term health consequences, she says. The most recent short-term studies show that vaping is “very far from risk-free”.

It’s possible that vaping may turn out to be healthier than smoking, but it may also turn out to be far worse.

Vaping is fast becoming the common way to introduce people who have never smoked cigarettes to a lifetime of nicotine addiction
Pamela Naidoo

“We just don’t know,” Naidoo says.

She says Big Tobacco as an industry “built on exploiting the addictiveness of nicotine”. It puts people’s health at high risk and creates one of the major global causes of disease and death.

Worldwide, there’s significant investment in marketing e-cigarettes and vaping culture, especially through social media channels with high youth appeal, Naidoo says.

“Vaping is fast becoming the common way to introduce people who have never smoked cigarettes, particularly young people, to a lifetime of nicotine addiction.”

Smokers who want to quit have healthier alternatives available, she says. The HSFSA promotes the Alan Carr method that has helped millions globally to stop smoking.

Richard van Zyl-Smit, of the University of Cape Town’s pulmonology division and Lung Institute, is working on a vaping presentation for the SA Thoracic Society. “More data shows that vaping is not harmless,” Van Zyl-Smit says.

Recent data on flavourants used in vaping products, particularly popular vanilla and cinnamon, supports health concerns, he says. The “Juul-related, e-cigarette epidemic” in the US is a result of heavily addicted teenagers, and it is spreading in this country.

Juul is a vaping brand available in SA that uses a nicotine salt instead of a nicotine-free base. It has turned out to be “particularly addictive because it is so rapidly absorbed”, Van Zyl-Smit says

Juul CEO Kevin Burns recently took to US media to apologise to parents for their teenagers’ addiction to the product.

Van Zyl-Smit offers qualified vaping support for smokers. He says the risk of cancer, premature death and stroke is “very high with tobacco products”. Based on chemical composition and constituents, vaping “probably provides a safer alternative — at least in the short term”.

The absence of long-term safety data makes it impossible to claim that e-cigarettes are safer overall than tobacco products — until researchers have 50 years of data, he says.

US-based, SA public health specialist Derek Yach staunchly supports vaping.

Countries and jurisdictions have banned e-cigarettes based “on flimsy evidence and emotionally driven concerns”, Yach says. “That will inevitably send users back to cigarettes, where their health outcome is well-known.”

Yach is founder and director of the Foundation for a Smoke-Free World with initial funding from Phillip Morris International (PMI). That industry link can look compromising.

However, the foundation’s website carries full disclosure and states that by US law and policy, it operates “completely independently from PMI, and cannot engage in activities designed to support PMI’s interests”. PMI can also have “no involvement or say in [the foundation’s] work”.

The range of tobacco harm-reduction products available offers adult smokers ways to reduce their risks of premature death and, in many cases, quit completely, Yach says. Products now include “snus”, a Swedish smokeless, moist powder pouch that users place under their top lip, and heated tobacco products.

The only way to cut deaths from tobacco over the next 20 years is cutting adult smoking through switching or cessation
Derek Yach

“Tens of millions of smokers from Japan, Korea, Europe, US and New Zealand have switched off combustible cigarettes to these cleaner, nicotine-delivery devices over the last five years,” he says.

“Major studies, many used by US and UK regulators, show that [smokers’] exposure to cancer-causing ingredients drops by 95% plus,” says Yach.

Critics are right to call for stronger regulations to stop youngsters smoking or vaping — including not using Juul, Yach says. But they should learn from the UK’s Public Health England approach, which actively encourages smokers to switch to e-cigarettes while protecting youngsters.

“The only way to cut deaths from tobacco over the next 20 years is cutting adult smoking through switching or cessation,” Yach says. “A sole focus on [young people] will lead to health gains only well beyond 40 years.”

The key insight underpinning the science, says Yach, is: “Nicotine does not kill, but burning cigarettes do.”

Van Zyl-Smit has the last word. He is particularly sceptical of claims that vaping is “95% safer” for smokers. For non-smokers, his message is “even more absolute”: “Don’t vape. It’s not safe.”

What we do — and don’t — know about vaping:

  • Countries where your trip of a lifetime could go up in a puff of vape: Thailand, Singapore, Brunei, Taiwan, Cambodia, Vietnam, parts of India, Lebanon, Philippines. All have strict vaping bans with harsh penalties for those who flout the law.
  • In SA, provisions in the proposed tobacco control law subject e-cigarettes to the same strictures as traditional products, with tight control on use and sales.
  • Vaping’s flavours, e-cigarettes and “clouding” culture are all brilliantly designed to appeal to teenagers.
  • Vape clouds are aerosols, not water vapour many users think they are exhaling.
  • Vape juices have a variety of chemicals that compound when exposed to heat and turn into an aerosol. The big cloud vapers exhale is a combination of unknown, largely unregulated chemical compounds.
  • Research shows that smoking cigarettes decreases the expression of 53 genes that fight viruses and bacteria. Vaping affects 358 genes. We have no idea what this means for long-term health.
  • Second-hand vaping may be risky. Evidence shows that exhaled aerosol clouds contain cancer-causing chemicals, such as aldehydes, that are potentially dangerous to everyone around vapers.

• Source: Heart and Stroke Foundation of SA, Lonely Planet