Is vaping worse for you than traditional smoking?

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Moral panics rarely come out of nowhere and there is a grain of truth in this one. Dozens of people, mainly young men, have been hospitalised after vaping in recent weeks. That is not a lie, but nor is it the whole truth. They were vaping unregulated street drugs. The forces lined up against e-cigarettes in the US – and they are legion – have done all they can to obscure this fact.

The prelude to the scare came in April when the FDA reported that 35 people had suffered ‘seizures’ after using e-cigarettes. The FDA’s press release was put out just two days before its commissioner, Scott Gottlieb, left the job. Gottlieb, who now works for Pfizer, had been leading the crackdown on e-cigarettes for two years, threatening to ban e-cigarette flavours and take entire product lines off the shelves. This was his parting shot.

Details about the ‘seizures and convulsions’ were thin on the ground. It was not clear how serious they were and there was no proof that they had been caused by vaping. Nor was it clear when they took place. The 35 cases were the sum total of recorded incidents from a 10-year period between 2010 and 2019. The FDA admitted that the facts were hazy but nevertheless speculated that nicotine was to blame. The agency appealed to the public to go to its website and report more cases. This they did. Within a few months, the number of reports had risen to 127.

The situation escalated in mid-August when 22 young adults were hospitalised with breathing difficulties in Minnesota, Wisconsin and Illinois. All had a recent history of vaping. Initial news reports made little mention of the fact but most, if not all, of the individuals had been vaping Tetrahydrocannabinol (THC) oil, not standard vape juice. The majority admitted to it. The rest may have been reluctant to fess up since THC is the active ingredient in cannabis and is illegal in all three states.

It doesn’t require a deerstalker and magnifying glass to work out what’s going on here. The surge in hospitalisations for acute lung disease is real and worrying, but there is one common thread. In Winconsin, 89 per cent of cases involved people who admitted vaping THC. In Iowa, three out of four patients admitted vaping THC. In Los Angeles County, ‘almost all’ cases involved THC. In New Mexico and Utah every patient admitted vaping THC oil, as did every patient in Kings County, California. In New York State, physicians have received ‘numerous reports’ of severe pulmonary illness among people who were ‘using at least one cannabis-containing vape product’.

The finger points squarely at black-market THC cartridges contaminated with cutting or thickening agents. It is more of a War on Drugs issue than an e-cigarette issue. The sudden outbreak of hospitalisations and the initial clustering of cases is typical of what happens when a ‘bad batch’ of an illegal drug hits the streets. In all likelihood, that is exactly what has happened.

The most likely culprit is Vitamin E acetate, an additive that has been used as a thickening agent on the black market since late last year. Vitamin E acetate is not safe to inhale and has been linked to lipoid pneumonia, which can be fatal. Whatever the killer chemical turns out to be, it is not nicotine.

Alternatively, you can choose to believe that vaping ordinary, water-based, nicotine-containing fluids suddenly became extremely dangerous in parts of the US in mid-2019, despite having been used safely by millions of people worldwide for over a decade. This absurd proposition is essentially the message that has been sent to the American public this summer.

Vapers being hospitalised with acute lung diseases was a gift to the vultures of America’s tobacco-control industry. When the FDA announced the vaping ‘seizures’ in April, the agency implicated conventional e-cigarettes with the pointed warning that ‘seizures or convulsions are known potential side-effects of nicotine toxicity’. In mid-August, after a group of self-confessed THC-users had been admitted to hospital, Wisconsin’s Department of Health Services said they ‘strongly urge people to avoid vaping products and e-cigarettes’. When the first death was reported in Illinois on 23 August, the state’s public-health director Dr Ngozi Ezike said, ‘We must get the word out that using e-cigarettes and vaping can be dangerous’. An editorial in the current issue of the New England Journal of Medicine concludes that ‘efforts should be made to increase public awareness of the harmful effects of vaping, and physicians should discourage their patients from vaping’.

The Telegraph’s science editor, Sarah Knapton, believes that e-cig vapour is as harmful as tobacco smoke and has been fighting a one-woman crusade against e-cigarettes for years. Events in America seem to have given her hope that Public Health England (PHE) can be panicked into abandoning its evidence-based, pro-vaping position. On Monday, she quoted fellow fanatic Martin McKee, who said: ‘What is amazing is how PHE simply disregards concerns, almost as if people in the UK have lungs that work differently from those in the US.’ This zinger falls flat when you consider that US lungs are having to put up with a very different set of chemicals.

The CDC has been the worst offender, using weasel words such as ‘e-cigarette product use’ and ‘vaping or e-cigarette use’ to describe the behaviour which led to the recent deaths. When asked in a press conference how a product that has been around for a decade could suddenly cause an acute epidemic, CDC’s Brian King suggested that the problem had been around the whole time but was only becoming visible thanks to ‘increased diligence’. He put the blame squarely on conventional e-cigarettes, saying: ’We do know that e-cigarettes do not emit a harmless aerosol. They can include a variety of potential harmful ingredients, including ingredients that are harmful in terms of pulmonary illness… we know there’s a variety of constituents in e-cigarette aerosol that could be problematic in terms of illness.’ Again, not a complete lie, but far from the truth.

The FDA was slow to wake up to the real causes of the ‘mysterious lung illness linked to vaping’, but it got there in the end. On Friday, it published a sensible warning on its website, telling Americans to ‘avoid buying vaping products on the street, and to refrain from using THC oil’. The CDC, however, simply reiterated its advice that people shouldn’t vape anything, ever.

The CDC is playing a dangerous game. When a bad batch of drugs appears on the streets of Britain, the police do not issue a general warning against taking drugs. Instead, they describe what the bad batch looks like so that drug users can avoid it. Why? Because telling people not to take drugs doesn’t work. Telling people to avoid a particular bunch of green ecstasy pills does. By the same token, the CDC’s policy of telling people not to vape is not only a tacit instruction to smokers to keep smoking – it is also a less effective way of tackling the current spate of hospitalisations than telling people to steer clear of black-market THC cartridges.

For the ghouls of the American anti-vaping lobby, the problems of the black market is an opportunity to clamp down on the legitimate market. The phenomenally popular Juul e-cigarette has come under attack despite the near impossibility of its pods being contaminated with the substances that have caused the problem. The American Lung Association has called on the government to ban vaping indoors and tax e-cigarettes at the same rate as cigarettes. On Friday, Senator Dick Durbin told the FDA’s new commissioner, Ned Sharples, to put a stop to the ‘vaping epidemic’ or resign. ‘As acting commissioner of the FDA,’ he said, ‘you alone have the power to stop this vaping epidemic, which has now reached the point where children and young adults are getting sick and dying’. Mr Durbin did not explain how a federal regulator was supposed to control what happens on the black market.

It is a grisly mess. While anti-vaping activists use ambulance-chasing as a political tactic, lives are being lost. They are being lost here and now because young men are not being given due warning about the dangers of illicit THC products, and they will be lost in the future because smokers are being actively deterred from switching to a vastly safer alternative.

With seven confirmed deaths among nearly 400 cases of a mysterious lung disease now linked to vaping, rumors are swirling about the dangers of e-cigarettes.

In response to the spate of deaths, as well as the surge among high school students smoking e-cigarettes, two states have banned all flavored e-cigarettes other than menthol. While the deaths and rise in youth vaping are concerning, experts said the fervor surrounding nicotine devices might be misplaced.

The new bans don't capture the nuances between the cases involving people who smoked nicotine devices compared with those who vaped tetrahydrocannabinol, known as THC, the primary active ingredient in marijuana.

While some cases of lung illness occurred among smokers who used only nicotine e-cigarettes, the majority of cases were among smokers who used THC vape products, according to the U.S. Centers for Disease Control and Prevention. Other e-cigarette smokers with lung disease used both nicotine and THC devices.

"This outbreak does not appear to be associated with traditional legally-sold e-cigarettes, but with illicit and sometimes counterfeit THC vaping cartridges," said Dr. Michael Siegel, a professor at Boston University School of Public Health.

Most important, there's still a lot that we -- and the disease detectives -- don't know.

We don't know how kids are purchasing these products and what the distribution channels are," Siegel said. "We don't know exactly what component, substance, or chemical in the THC vape carts is causing the illnesses. We don't know whether there is more than one chemical or product involved."

"These are the areas in which the CDC should be focusing its investigation."

There's also no indication so far that the lung illnesses, with symptoms including nausea, vomiting, fever and fatigue, are linked to one illness, rather than a series of illness, explained Dr. Frank Leon, director of Comprehensive Smoking Treatment Programs at Penn Medicine.

While there are anecdotal cases of former e-cigarette smokers switching back to traditional cigarettes to quit vaping, Leone thinks this worst-case scenario may be a false choice.

There is a third, less-talked-about option: Treatments designed to help smokers quit, including smoking cessation help lines and nicotine patches and pills. On its website, the CDC specifically stresses that e-cigarette smokers who are trying to quit smoking shouldn't go back to traditional cigarettes while the agency's vaping investigation is underway.

The cigarette industry before and the ecigs now try to market to children, to ensure life long addicts consuming their products. Had mango flavored ecigs been available when I was a kid, I'd probably still be addicted. <joke>

Considering most sales in convenience stores consist of beer, cigs and junk food, I'm not sure why children should be allowed in at all.

... I don't like to see folk vaping but it is better than smoking from what evidence we have...