Quitting Aid Or Slippery Slope? Experts Divided Over Health Risks Of Vaping
Unsubstantiated claims linking vaping to health problems are "misleading", a public health expert warns, as Australia's peak medical body maintains e-cigarettes are a “slippery slope”.
This week, it was reported an 18-year-old student in the U.S. underwent emergency surgery for a collapsed lung he claims was caused by vaping, or using electronic cigarettes (e-cigarettes).
Chance Ammirata, from Florida, said he began using a Juul -- a popular, sleek vape containing nicotine -- about 18 months ago after believing it was a safe alternative to smoking cigarettes.
After noticing pain in the left side of his body and struggling to sit down in a chair, he went to hospital where he was told his left lung had collapsed.
“When they did the actual major surgery to re-inflate my lungs, the surgeon said, ‘whatever you’ve been smoking has been leaving these black dots on your lungs’,” he said.
Sharing photos of his lung damage and time in hospital, Ammirata urged others to stop using e-cigarettes, saying, "You thought Juuls were safe. So did I".
Electronic cigarettes are battery-powered devices designed to mimic smoking, but do not contain tobacco nor create smoke -- and they’re a contentious topic among public health experts in Australia.
Responding to the U.S. case, Colin Mendelsohn, chairman of the Australian Tobacco Harm Reduction Association, warned against jumping to conclusions.
He told 10 daily it reflects a pattern of exaggerating the health risks of vaping and making links to causation.
"This gentlemen happened to have vaped. In this instance, there is no evidence provided that vaping caused pneumothorax (a collapsed lung) and there's no reason it would," he said.
It's misleading to claim it's linked, unless you have evidence.
Mendelsohn, a former GP and now Conjoint Associate Professor at University of New South Wales' school of public health, supports regulating liquid nicotine in Australia to encourage smokers to transition to what he says is a less harmful product.
But other groups, including the Australian Medical Association (AMA), argue the opposite and claim the products are a possible gateway to smoking for young people.
How are e-cigarettes used in Australia?
The tobacco industry has in recent years introduced a range of e-products, including electronic nicotine delivery systems (ENDS) which diffuse a liquid containing nicotine, a mixture of chemicals such as propylene glycol or glycerine and flavouring. That liquid is heated into a vapour, which the user inhales.
While the vaping device is legal in some states, the purchase, possession or use of liquid nicotine is not, unless consented by a doctor for therapeutic use. However, they’re easy to purchase illegally online.
According to the most recent National Drug Strategy Household Survey, about nine percent of the population reported having ever used an e-cigarette, with the highest usage among those aged between 18 and 24.
In 2016, 1.2 percent of ex-smokers were using e-cigarettes, compared to 0.6 percent of those who have never smoked.
Meanwhile, smoking rates in Australia have hovered around 12 percent for the last three years, despite the rate halving since 1991.
Mendelsohn said smoking rates among young people are falling “faster than ever before” in the U.S. and the U.K. where vaping is legally available.
“Australia is the only western democracy which bans the use and sale of nicotine, yet we can see how it is helping smokers in other countries,” he said.
Can e-cigarettes help smokers quit?
E-cigarettes are marketed as “smoking cessation” aids with less risk than smoking. Some research backs up this claim, including one 2016 study which found evidence from two trials that e-cigarettes help smokers to quit long term.
“We know that vaping is the most effective quitting aid -- more effective than nicotine replacements such as patches,” he said.
But Dr Chris Zappala, Federal Vice President of the AMA, disagreed, saying the evidence is “variable”.
“You might come across the odd person who will say it works for them, but there isn't sufficient evidence at the moment that vaping should be used or recommended as a population-wide cessation technique,” he told 10 daily.
The National Health and Medical Research Council (NHMRC), the Therapeutic Goods Administration (TGA) and the World Health Organisation (WHO) hold a similar view. In its 2019 report into the global tobacco epidemic, the WHO said there is “insufficient independent evidence” to support the use of e-cigarettes in helping people to quit smoking.
Are there health risks?
Zappala said there is increasing scrutiny around possible health risks of e-cigarettes as it becomes more prevalent in some areas.
Just this week, the U.S. Food and Drug Administration announced it has received 127 reports of seizures or other neurological symptoms which could be related to e-cigarettes, though investigators are yet to determine whether this is a direct link.
In the U.K, current evidence collated by government agency Public Health England (PHE) maintains vaping is 95 percent less harmful than tobacco, with some existing studies indicating they deliver a much smaller range of toxins at much lower concentrations.
“It makes no sense to ban a much safer alternative and leave deadly cigarettes on the market,” Mendelsohn said.
He pointed to a recent international review, led by renowned tobacco harm advocate Professor Riccardo Polosa, which supports the relative safety of e-cigarette aerosols for the respiratory tract -- throat, airways and lungs -- compared to tobacco smoke.
But the AMA claims they are not without adverse risk.
“It is true to say that many of the cancer-causing agents in standard cigarettes are missing from vape liquids, but those agents are still harmful,” Zappala said.
“We can measure the effects of inflammation and damage to the airway and we still don’t know what the impacts are long term.”
Some research has indicated eye and respiratory irritation are possible risks, while preliminary research from the U.S has found e-cigarette flavourings such as menthol may also be linked to increased risk of stroke, heart attack or heart disease.
"We can’t draw a line to pneumothorax or seizures, but why wait for that?" Zappala asked.
Ultimately, the WHO concludes the scientific evidence on health risks is inconclusive.
E-cigarettes a ‘gateway’ to smoking?
The AMA is concerned vaping could “glamourise” a potentially harmful behaviour among young people.
“Once you normalise the behaviour, people think it is safe,” Zappala said.
“There is some suggestion in the literature that as once teens create the habit of using e-cigarettes, its a quick step to taking up smoking.”
"That is a slippery slope.”
Mendelsohn rejected this, saying the literature proves otherwise.
“Smoking precedes vaping in most cases,” he said.
“Kids shouldn’t be doing either. But if they’re going to experiment, I’d much rather they do that with vaping, not smoking.”
Featured image: Getty
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