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The truth about vaping
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The truth about vaping A sudden outbreak of health problems linked to e-cigarettes has raised concerns about their safety. Jessica Hamzelou investigates
20 | New Scientist | 30 November 2019
Vaping liquids typically contain nicotine, but lack the tar found in cigarettes
LUKA LAJST/GETTY IMAGES
SINCE e-cigarettes were launched just over a decade ago, their popularity has soared. Some 3.6 million people in the UK and more than 10 million in the US are vapers. But then came the horror stories. In the past few months, 47 deaths and over 2200 cases of lung injury have been linked to e-cigarette use in the US, where health officials are now warning against vaping. The US Centers for Disease Control and Prevention (CDC) says the only way to ensure you aren’t at risk while the problem is being investigated is by “refraining from use of all e-cigarette, or vaping, products”. But UK health bodies seem to disagree, with the statement that vaping is “95 per cent safer than smoking” – taken from a report by Public Health England – widely repeated. So how safe are e-cigarettes? Why has the UK not seen the same health problems as the US? And are we unnecessarily exposing another generation to nicotine addiction? “It’s such a complex, rapidly moving landscape that it’s difficult for people to keep track,” says Linda Bauld at the University of Edinburgh, who has advised the UK government on tobacco control. E-cigarettes are handheld, battery-run devices that vaporise “e-liquids”. These typically contain nicotine, along with other chemicals and sometimes flavourings, but they are free from the tar found in tobacco cigarettes. Bauld highlights two key issues with e-cigarettes: the current rash of health problems and users’ age. So far, every US state apart from Alaska has reported cases of lung injury linked to vaping. There is no specific test for such injuries, but symptoms include coughs, nausea, diarrhoea, shortness of breath and pains in the chest or abdomen. Some people have
developed a form of pneumonia caused by substances from e-liquids getting into their lungs. E-cigarettes have been available for about 10 years, so why are we only seeing these health problems now? The cases may all be linked to a chemical typically found in illicit products, according to a
2200
The number of recent lung injury cases linked to vaping in the US
study by the CDC and other health bodies. Among a sample of 867 people diagnosed with vaping-related lung injury, 86 per cent reported having vaped tetrahydrocannabinol (THC) – the chemical that gives cannabis users
a high. These THC‑containing e-liquids were probably obtained from the black market, says Bauld. It is unlikely that THC itself is to blame for lung injury – we haven’t seen the same symptoms in cannabis smokers, for instance. But other chemicals are often used with THC in e-cigarette liquids. The CDC has flagged vitamin E acetate, a synthetic form of the vitamin, as the most likely culprit. In a recent investigation, it was found in all the lung samples taken from 29 people with vaping‑related lung injury. The eight cases of confirmed or probable lung injury related to vaping in Canada are likely to be connected to vitamin E acetate-containing products from the US, says Bauld. That might also explain why there hasn’t been the same spike in cases in the UK.
Under EU law, many e-cigarette ingredients – including vitamins – are banned as a precaution. That isn’t to say that no problems have been reported in the UK. Any suspected health effects must be passed on to the Medicines and Healthcare products Regulatory Agency. As of 15 November, the agency has received 74 notifications describing 216 health effects that may be linked to e-cigarettes, although these have yet to be confirmed. Most of them relate to breathing and lung disorders. Regarding the age of users, in the US, most lung injuries have been in people under the age of 24. A recent survey estimates that 28 per cent of high school students use e-cigarettes. Manufacturer Juul Labs has come under scrutiny for developing flavours that might appeal to young people and marketing its products as being fashionable.
School advertising In September, the US Food and Drug Administration sent the firm a warning letter, raising concerns about it having marketed its e-cigarettes in a school using terms like “totally safe” and “99 per cent safer than cigarettes” without authorisation from the agency. Within a few weeks, the company’s CEO had stepped down, and the firm promised to restrict advertising. All of the researchers contacted by New Scientist agreed that e-cigarettes shouldn’t be used by young people or people who have never smoked. Researchers in the UK said that because e-cigarettes lack the tar found in tobacco
Working hypothesis
More Insight online
Your guide to a rapidly changing world newscientist.com/insight
Numerous deaths and thousands of cases of lung injury have been linked to vaping. Reclassifying vaping products as medical devices might limit their appeal as lifestyle products and put them under greater regulatory control. They could then also be better targeted towards people who already smoke. So far, only two products in the UK have got this approval. Both were authorised as nicotine replacement therapies and could have been made available on prescription in the UK, but their owner, British American Tobacco, eventually changed tack, deciding to focus on consumer products rather than medical ones. There were moral and ethical concerns that the UK National Health Service would be subsidising products developed by the tobacco industry, says Ben Hawkins at the London School of Hygiene and Tropical Medicine. He worries that tobacco companies may rebrand as nicotine technology firms, which might enable them to get around an international treaty that limits industry representatives from lobbying governments. Sarah Jackson at University College London has another concern. Were e-cigarettes to be classified as medical devices, tobacco firms may be the only ones able to afford to put them through the expensive licensing process. “If the only provider of e-cigarettes was the tobacco industry, that would be a precarious position to be in,” she says.
cigarettes, they truly are 95 per cent safer, with the remaining 5 per cent of risk down to low levels of toxic substances in e-cigarette vapour, which may have long-term effects for health. In the US, however, the CDC is warning that nicotine can harm the developing adolescent brain. And a US survey published last year found that young people who vape are twice as likely to become smokers. This trend hasn’t been found in the UK, however. At the same time, there is evidence that e-cigarette vapour may be more harmful than it appears – for adults as well as young people. Robert Tarran at the University of North Carolina criticises the “95 per cent safer” figure because it was based on a comparison of the number of chemicals in e-cigarette vapour and tobacco smoke. “The number of chemicals is irrelevant,” he says. “No one knows what concentration these chemicals are reaching in the lungs.” Tarran’s team has found markers of lung disease in samples taken from people who vape. He says these markers are the same as those found in the lungs of people with emphysema, a condition that causes shortness of breath and shortens life expectancy. “If you vape over a lifetime, you probably have a high chance of getting it,” says Tarran. “From everything I’ve seen in the lung, it doesn’t seem to be safer than smoking.” E-cigarettes haven’t taken off among young people in the UK as they have in the US. A survey published in June suggests that 84 per cent of young people in the UK have never tried e-cigarettes. Over half who have used them have done so just to “give it a try” – only 1 per cent said they did so because it “looks cool”. The difference may come down
to the image of e-cigarettes. In the US, Juul Labs has marketed them as a trendy lifestyle product. But in the UK, young people are more likely to consider e-cigarettes as an aid to quitting smoking, says Bauld. That might have something to do with the EU imposing much stricter rules on their advertising. Television, radio and magazine ads are banned, for instance. There is an argument that classifying vaping products as medical devices could shift their image in the US, too – although this may bring other problems (see “Medical e-cigs”, left).
▲ Cybertruck Elon Musk unveiled Tesla’s electric pickup truck last week. The stainless steel Cybertruck already has over 200,000 orders. ▲ Coldplay Coldplay plans to curb its carbon footprint by not going on tour. The move should also significantly reduce noise pollution (only joking!).
“Every US state apart from Alaska has reported cases of lung injury linked to vaping” In the meantime, e-cigarettes may be a useful tool for people who are trying to stop smoking. An influential study published earlier this year concluded that the use of e-cigarettes seems to work better than other forms of nicotine replacement therapy when it comes to quitting. And, in the UK at least, it appears to be cheaper than these other techniques, too, says Sarah Jackson at University College London, who conducted a cost‑comparison survey. Epidemiologists think that smoking rates are falling faster in the UK than in Australia at least in part thanks to the popularity of e-cigarettes in the UK. They are banned from being made or sold in Australia. So, for smokers, switching to e-cigarettes as a way to give up smoking seems like a sensible choice. But anyone else might want to consider the unknown health risks of vaping. “There’s a lot we don’t know,” says Tarran. ❚
▲ Quacking Vive la France! Ducks on a small farm can carry on quacking, after a French court rejected a noise complaint by a neighbour. ▼ Word(s) A few weeks ago Collins Dictionary chose “climate strike” as its word of the year, even though it is two. Now, Oxford Dictionaries has made its choice: “climate emergency”. Can nobody count to 1 any more? ▼ Sumatran rhino
TOP: TESLA; REYNOLD SUMAYKU/ALAMY STOCK PHOTO
Medical e-cigs
Sorting the week’s supernovae from the absolute zeros
Malaysia’s last known Sumatran rhino has died. There are now fewer than 100 left in the wild.
30 November 2019 | New Scientist | 21
The truth about vaping A sudden outbreak of health problems linked to e-cigarettes has raised concerns about their safety. Jessica Hamzelou investigates
20 | New Scientist | 30 November 2019
Vaping liquids typically contain nicotine, but lack the tar found in cigarettes
LUKA LAJST/GETTY IMAGES
SINCE e-cigarettes were launched just over a decade ago, their popularity has soared. Some 3.6 million people in the UK and more than 10 million in the US are vapers. But then came the horror stories. In the past few months, 47 deaths and over 2200 cases of lung injury have been linked to e-cigarette use in the US, where health officials are now warning against vaping. The US Centers for Disease Control and Prevention (CDC) says the only way to ensure you aren’t at risk while the problem is being investigated is by “refraining from use of all e-cigarette, or vaping, products”. But UK health bodies seem to disagree, with the statement that vaping is “95 per cent safer than smoking” – taken from a report by Public Health England – widely repeated. So how safe are e-cigarettes? Why has the UK not seen the same health problems as the US? And are we unnecessarily exposing another generation to nicotine addiction? “It’s such a complex, rapidly moving landscape that it’s difficult for people to keep track,” says Linda Bauld at the University of Edinburgh, who has advised the UK government on tobacco control. E-cigarettes are handheld, battery-run devices that vaporise “e-liquids”. These typically contain nicotine, along with other chemicals and sometimes flavourings, but they are free from the tar found in tobacco cigarettes. Bauld highlights two key issues with e-cigarettes: the current rash of health problems and users’ age. So far, every US state apart from Alaska has reported cases of lung injury linked to vaping. There is no specific test for such injuries, but symptoms include coughs, nausea, diarrhoea, shortness of breath and pains in the chest or abdomen. Some people have
developed a form of pneumonia caused by substances from e-liquids getting into their lungs. E-cigarettes have been available for about 10 years, so why are we only seeing these health problems now? The cases may all be linked to a chemical typically found in illicit products, according to a
2200
The number of recent lung injury cases linked to vaping in the US
study by the CDC and other health bodies. Among a sample of 867 people diagnosed with vaping-related lung injury, 86 per cent reported having vaped tetrahydrocannabinol (THC) – the chemical that gives cannabis users
a high. These THC‑containing e-liquids were probably obtained from the black market, says Bauld. It is unlikely that THC itself is to blame for lung injury – we haven’t seen the same symptoms in cannabis smokers, for instance. But other chemicals are often used with THC in e-cigarette liquids. The CDC has flagged vitamin E acetate, a synthetic form of the vitamin, as the most likely culprit. In a recent investigation, it was found in all the lung samples taken from 29 people with vaping‑related lung injury. The eight cases of confirmed or probable lung injury related to vaping in Canada are likely to be connected to vitamin E acetate-containing products from the US, says Bauld. That might also explain why there hasn’t been the same spike in cases in the UK.
Under EU law, many e-cigarette ingredients – including vitamins – are banned as a precaution. That isn’t to say that no problems have been reported in the UK. Any suspected health effects must be passed on to the Medicines and Healthcare products Regulatory Agency. As of 15 November, the agency has received 74 notifications describing 216 health effects that may be linked to e-cigarettes, although these have yet to be confirmed. Most of them relate to breathing and lung disorders. Regarding the age of users, in the US, most lung injuries have been in people under the age of 24. A recent survey estimates that 28 per cent of high school students use e-cigarettes. Manufacturer Juul Labs has come under scrutiny for developing flavours that might appeal to young people and marketing its products as being fashionable.
School advertising In September, the US Food and Drug Administration sent the firm a warning letter, raising concerns about it having marketed its e-cigarettes in a school using terms like “totally safe” and “99 per cent safer than cigarettes” without authorisation from the agency. Within a few weeks, the company’s CEO had stepped down, and the firm promised to restrict advertising. All of the researchers contacted by New Scientist agreed that e-cigarettes shouldn’t be used by young people or people who have never smoked. Researchers in the UK said that because e-cigarettes lack the tar found in tobacco
Working hypothesis
More Insight online
Your guide to a rapidly changing world newscientist.com/insight
Numerous deaths and thousands of cases of lung injury have been linked to vaping. Reclassifying vaping products as medical devices might limit their appeal as lifestyle products and put them under greater regulatory control. They could then also be better targeted towards people who already smoke. So far, only two products in the UK have got this approval. Both were authorised as nicotine replacement therapies and could have been made available on prescription in the UK, but their owner, British American Tobacco, eventually changed tack, deciding to focus on consumer products rather than medical ones. There were moral and ethical concerns that the UK National Health Service would be subsidising products developed by the tobacco industry, says Ben Hawkins at the London School of Hygiene and Tropical Medicine. He worries that tobacco companies may rebrand as nicotine technology firms, which might enable them to get around an international treaty that limits industry representatives from lobbying governments. Sarah Jackson at University College London has another concern. Were e-cigarettes to be classified as medical devices, tobacco firms may be the only ones able to afford to put them through the expensive licensing process. “If the only provider of e-cigarettes was the tobacco industry, that would be a precarious position to be in,” she says.
cigarettes, they truly are 95 per cent safer, with the remaining 5 per cent of risk down to low levels of toxic substances in e-cigarette vapour, which may have long-term effects for health. In the US, however, the CDC is warning that nicotine can harm the developing adolescent brain. And a US survey published last year found that young people who vape are twice as likely to become smokers. This trend hasn’t been found in the UK, however. At the same time, there is evidence that e-cigarette vapour may be more harmful than it appears – for adults as well as young people. Robert Tarran at the University of North Carolina criticises the “95 per cent safer” figure because it was based on a comparison of the number of chemicals in e-cigarette vapour and tobacco smoke. “The number of chemicals is irrelevant,” he says. “No one knows what concentration these chemicals are reaching in the lungs.” Tarran’s team has found markers of lung disease in samples taken from people who vape. He says these markers are the same as those found in the lungs of people with emphysema, a condition that causes shortness of breath and shortens life expectancy. “If you vape over a lifetime, you probably have a high chance of getting it,” says Tarran. “From everything I’ve seen in the lung, it doesn’t seem to be safer than smoking.” E-cigarettes haven’t taken off among young people in the UK as they have in the US. A survey published in June suggests that 84 per cent of young people in the UK have never tried e-cigarettes. Over half who have used them have done so just to “give it a try” – only 1 per cent said they did so because it “looks cool”. The difference may come down
to the image of e-cigarettes. In the US, Juul Labs has marketed them as a trendy lifestyle product. But in the UK, young people are more likely to consider e-cigarettes as an aid to quitting smoking, says Bauld. That might have something to do with the EU imposing much stricter rules on their advertising. Television, radio and magazine ads are banned, for instance. There is an argument that classifying vaping products as medical devices could shift their image in the US, too – although this may bring other problems (see “Medical e-cigs”, left).
▲ Cybertruck Elon Musk unveiled Tesla’s electric pickup truck last week. The stainless steel Cybertruck already has over 200,000 orders. ▲ Coldplay Coldplay plans to curb its carbon footprint by not going on tour. The move should also significantly reduce noise pollution (only joking!).
“Every US state apart from Alaska has reported cases of lung injury linked to vaping” In the meantime, e-cigarettes may be a useful tool for people who are trying to stop smoking. An influential study published earlier this year concluded that the use of e-cigarettes seems to work better than other forms of nicotine replacement therapy when it comes to quitting. And, in the UK at least, it appears to be cheaper than these other techniques, too, says Sarah Jackson at University College London, who conducted a cost‑comparison survey. Epidemiologists think that smoking rates are falling faster in the UK than in Australia at least in part thanks to the popularity of e-cigarettes in the UK. They are banned from being made or sold in Australia. So, for smokers, switching to e-cigarettes as a way to give up smoking seems like a sensible choice. But anyone else might want to consider the unknown health risks of vaping. “There’s a lot we don’t know,” says Tarran. ❚
▲ Quacking Vive la France! Ducks on a small farm can carry on quacking, after a French court rejected a noise complaint by a neighbour. ▼ Word(s) A few weeks ago Collins Dictionary chose “climate strike” as its word of the year, even though it is two. Now, Oxford Dictionaries has made its choice: “climate emergency”. Can nobody count to 1 any more? ▼ Sumatran rhino
TOP: TESLA; REYNOLD SUMAYKU/ALAMY STOCK PHOTO
Medical e-cigs
Sorting the week’s supernovae from the absolute zeros
Malaysia’s last known Sumatran rhino has died. There are now fewer than 100 left in the wild.
30 November 2019 | New Scientist | 21