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Clearing up some myths around e-cigarettes (publichealthmatters.blog.gov.uk)
61 points by DanBC 42 days ago | hide | past | web | favorite | 52 comments

The amount of misinformation on e-cigarettes/vaping nicotine has been absolutely infuriating.

I went from smoking a pack a week, which was very likely to give me lung cancer at some point, to vaping nicotine. The latter is very unlikely to give one lung cancer and there have been no reported cases of lung cancer linked solely to vaping.

Furthermore, the whole debacle with THC vaping juice containing a vitamin E acetate that resulted in several deaths was reported in an absolutely disgusting manner. THC and vitamin E acetate were rarely mentioned in these reports. It was usually reported as "vaping mysteriously causing deaths" and even associated with companies like Juul who don't deal with THC at all.

The irony that we've gone from "Reefer Madness" to "Nicotine Vaping Madness" when black market THC pods were straight up killing people is so unfortunate.

Even NPR reported incredibly questionably on this.

Full disclosure - I don't think kids should be vaping or smoking, but there is no proof that vaping nicotine causes anywhere near as much damage as smoking cigarettes. I also have no problem with smoking marijuana in moderation (and perhaps less so for developing minds), but won't be touching any THC vape pods until it's clear that no one is using Vitamin E acetate in their juice.

The reason there was an uproar is that there's been a huge surge in vaping by kids. People have been working tirelessly, for decades, to lower the stats on smoking among teens and when they see vaping spread through high schools like wildfire you can see why they'd be pissed off.

>The reason there was an uproar is that there's been a huge surge in vaping by kids... vaping spread through high schools like wildfire.

The article directly contradicts this statement and says it's a myth (number 5).

>Our latest report found no evidence so far to support the concern that e-cigarettes are a route into smoking among young people. UK surveys show that young people are experimenting with e-cigarettes, but regular use is rare and confined almost entirely to those who already smoke. Meanwhile, smoking rates among young people in the UK continue to decline.

The article is denying that e-cig leads to traditional smoking. That isn't the same as e-cig usage going up among young people which is virtually undeniable. That also means the comparisons of e-cig being safer than cigarettes is less important for this group since they were unlikely to smoke without the existence of e-cigarettes.

Your argument is that vape using teenagers were unlikely to have smoked. I think it's hard to tell if vaping is diverting teenagers who otherwise would have smoked, or simply creating a new habit.

There are some intertwingled effects where increased vape use (and decreased smoker population) might be contributing to the unfashionability of smoking, both among teenagers and in society at large.

Perhaps we could compare teenage smoking rates in countries where e-cigarettes are banned / unavailable versus countries where they are available. I don't have this data or any studies to point to, but I would be interested to know more.

The evidence is pretty strong when you look at the data, https://www.motherjones.com/wp-content/uploads/2018/12/blog_...

I don't know what the facts are regarding whether e-cigarettes are some kind of "gateway" to real ones. It doesn't seem realistic to me but it's the kind of thing that should be studied properly before jumping to conclusions.

Having said that, the concept does seem very strange to me as someone who used to smoke and switched to vaping because it's better in every way. It tastes better (with so much more variety in flavors), it's not as harsh on your throat and it doesn't leave an embarrassing odor on your body that non-smokers will judge you for.

The only reasonable conclusion I personally could come to is that people are more likely to switch from smoking to vaping and very rarely the other way around.

Again, this isn't scientific. Also, kids shouldn't vape or smoke. Period.

_But_, if they do vape and get addicted to nicotine at a young age, I personally find it preposterous that they would switch to cigarettes for their nicotine in large numbers.

We actually have no long term evidence that vaping specific mixes is safe with regards to cancer and lung disease endpoints.

Maybe safer in a sense that normal bullets are safer to get shot with than depleted uranium rounds...

Even tobacco chewing is associated with (oral) cancer. Lower rates than smoking and lung cancer, but still. Could use some data on pure nicotine.

The submitted article is about the UK, where vaping seems to be limited to ex smokers.

That's not the case in the US where a bunch of non smokers, often young people, started vaping.

But if vaping isn't unhealthy, is it really necessary to reduce vaping by teens? The primary reason for reducing smoking is that it's a huge risk factor that leads to negative health outcomes and expensive treatments. If it's not unhealthy (in the sense of causing respiratory disease or cancer), while I would prefer teens not smoke, I'm not nearly as concerned about vaping (however, I don't think we have nearly enough data about the long-term safety of vaping to really say for sure).

We're talking about teenagers using and becoming addicted to nicotine. Nicotine is completely inessential to life. Nicotine addicts (smokers or vapers) don't show any benefit in life outcome from it. All it does is put a drain on their finances just to make them feel better every time they experience cravings, cravings which don't exist in non-addicts.

Did they weight it against coronary disease endpoints, of which we have numerous studies, some even with pure nicotine?


All case mortality is worse in nicotine users.

Even if vaping were 100% risk free (which I doubt) I think it's certainly better that we don't get kids addicted to nicotine (or any substance). The misinformation doesn't help things though, if kids are going to vape/smoke I'd much rather see them take up nicotine free varieties, I'm not sure why a non-smoker would take up the nicotine ones at all, maybe because companies like juul don't sell them. As someone silly enough to take up smoking as a teenager I think a non-nicotine variety would have had a huge change on my life.

I've seen some strange reactions from family about my vaping (which I've used to cut down smoking significantly). The hypocrisy award goes to my sister claiming it was dangerous and targeted at kids (due to the flavors), she said this while downing an alcopop drink and running one of those essential oil vapour machines in the house.

Nothing is risk free.

If you have a large population then any small risk means harm will be caused to a small number of people.

If people who start vaping are ex smokers we can balance that tiny risk against the huge benefits of smoking cessation.

We can't do that same balancing for young non smokers who start vaping, so from a public health point of view we'd want to avoid it.

The uproar surrounding vaping by kids was merited as I claimed at the bottom of my post. The surrounding hysteria and misinformation were not merited.

For instance - no kids shouldn't vape nicotine.

But parents also shouldn't be misinformed and think their kids could end up in the hospital and die after only a few weeks of vaping because they saw a headline about how vaping is killing people which conveniently leave out the fact that this was only a problem with black market THC vape juice.

Also, wasn't the THC illness related to a specific type of vape pen sold in the dark market? They called them "Dank Vapes" and I believe they were being promoted in some sketchy Instagram accounts.

Some more information here: https://www.npr.org/sections/health-shots/2019/09/27/7651511...

I'm not aware of the specifics but my general understanding is that there were at least a few black market sellers involved with that debacle. Basically unqualified "street chemists" saying "yo, if we add some Vitamin E to this solution it'll be fire!" Sounds like these "Dank Vapes" were one of the bigger offenders though.

Basically what was (and still is) happening is people are buying wholesale packaging (carts and boxes) off of Ebay and one of those Aliexpress-like Chinese sites (I can't remember the name right now) and filling the carts with some low end THC (usually pesticide filled) and then a bunch of fillers (vitamin e, etc) and selling them for $30-60 as $X brand. They'll usually tell you they got them from CO or whatever is near by when in reality they either have no idea where they originated or they're making them at home with god knows what.

They get them in bulk for stupid cheap, often with various names like Dank Vapes (which actually is a real company but IIRC they passed someones pesticide lab test but were still labeled low quality) or whatever else you can imagine, there's a /r/fakecartridges subreddit. Edit: I should mention, Dank Vapes is one of the most common counterfeit brands to buy from these wholesalers I mentioned. That's an immediate red flag on a cart.

So.. at this point I just wouldn't trust any carts unless you're buying them from a REGULATED shop and they're a well known brand or making them yourself. I had no idea CA/CO and I assume WA allowed unregulated/unlicensed stores or items to be sold but that's also a thing.

They'll can contain stuff like pg (propylene glycol), k2, pesticides, vitamin-e which damages your lungs, etc and who knows what else, their goal is usually to cut it down to a smooth moving and clear gold THC oil. I've seen some of these go through basically an arms race where dealers want you to keep coming back so they spike them with stuff that gets you more "high" - k2, etc. You can basically drive through any major downtown and see the effects of people on k2 "spice" which is a generic term now because the original ingredient, JWH-018 was banned in the USA a few years ago so now even "k2" is some umbrella term for just random chemicals you're inhaling to get tossed. Lots of addicts are using this stuff and when you see one passed out and covered in puke while going to lunch downtown often they've smoked some random "k2" variant. It used to be a somewhat decent chemical for people who didn't want to pop drug tests (Military, etc), it was literally a synthetic cannabinoid. https://en.wikipedia.org/wiki/JWH-018

People have been flocking to use carts instead of flower because they're just super easy to deal with. You can smoke them just about anywhere, bars, bathrooms, etc and most people wouldn't even notice.

Hopefully this isn't a scary level of detail. Anyone who is doing this stuff already knows the process, hopefully this educates people who are STILL buying these random cartridges and they stop buying them. Do NOT buy what you don't know.

edit: There are people who make legit carts at home, I don't want to sound like nobody does that.

Without looking, I often see negative findings about vaping. In the past few weeks alone we have:

"Vaping changes oral microbiome, increasing risk for infection" https://medicalxpress.com/news/2020-02-vaping-oral-microbiom...

"Vapers show chemical changes in their genome linked to cancer" https://medicalxpress.com/news/2020-02-vapers-chemical-genom...

>The amount of misinformation on e-cigarettes/vaping nicotine has been absolutely infuriating.

I wonder if tobacco companies are behind most of the misinformation about vaping. While I'm sure most if not all of them have e-cigarette product lines, the margins have to be terrible compared actual cigarettes. Folks into vaping aren't buying their nicotine and flavors from these companies.

Profit margins are terrible compared to regular cigarettes. A pack can be manufactured for $0.06. You have a built in customer base with huge profit margins and massive brand loyalty. While tobacco bought into ecigs, they can't keep up with tech. As soon as smoking is technology, then the brands can be disrupted. Better to kill off vaping.

The closed systems that "Big Tobacco" are into - the stuff that sells at corner stores and gas stations, with prefilled pods/cartomizers - is incredibly high-profit. I'd look at the tobacco industry if the push was towards closed systems, but they seem to be largely singled out as the enemy.

There are two better places to look: the pharma industry and their collection of minimally-successful smoking cessation products; and governments that are looking at enormous revenue loss, especially those that have already spent funds from the Master Settlement Agreement. (It may be worth noting, as well, that the loudest anti-smoking orgs are also getting their funding from the MSA. Don't get me wrong, I'd like to see combustible tobacco disappear, but there are people of the like of Stanton Glantz who've rather enjoyed the funding, and who have demonstrably lied in their opposition to vaping.)

Big tobacco are investing heavily, so I doubt it: https://www.investopedia.com/news/which-company-behind-popul...

Like I mentioned in my post I dont doubt they have skin in the e-cig game. However the music industry is also heavily invested in online streaming but I'm sure they would all love to go to the days of $20 CDs.

Exactly. The big tobacco companies, while playing in the e-cig space, would MUCH rather see it go away. They completely own the tobacco market. They have a never ending stream of competitors in the e-cig space.

I've considered this. There's also a huge existing industry and lobbyists whose existence depend solely on the notion that smoking is bad. If everyone stops smoking and starts vaping, they've got nothing to do anymore, no one to get donations or funding from. They're incentivized to create a new boogyman to fight against (e-cigarettes) in order to remain relevant.

I'm thinking of organizations like Truth, D.A.R.E., that sort of thing.

That's all a bit conspiratorial though and I have no evidence to support it.

To be fair, while I agree that vaping is with current evidence probably better than smoking, given the relative novelty of vaping and lag in cancer I think we won’t know if there is a risk of lung cancer with any certainty for a decade or more (unless anyone can point out some evidence otherwise which I’d be grateful for).

To be fair, Juul is a spinoff of one of the largest marijuana vape companies (Pax), so it's not a total non sequitur.

Another alternative to smoking is Swedish Snus! It also falls in the "probably not risk free, but certainly not nearly as bad as cigarettes". As an added bonus, you don't have to go outside to use since nobody else is affected (unless they want to kiss you or something).

But of course, although snus is a credible safer alternative to cigarettes, it is banned in every other EU country while cigarettes remain completely legal.

Don't forget that American tobacco companies all have "snus" products that are actually regular 'dipping' tobacco placed into pouches.

Swedish Snus is cold-cured, while other dip is heat-cured. It is well established that partial combustion of organic matter creates a bunch of different carcinogens. With cigarettes, you are inhaling partial combustion products from plant matter that has already undergone partial combustion once, and you have astronomical cancer risk. With dip, you are putting partially combusted plant matter in your mouth and have quite high cancer risks. With swedish snus, you are putting zero partial combustion, and no discernible cancer risk.

I had no idea about the difference - interesting. I thought nicotine itself was a carcinogen though?

Nicotine on its own is no more harmful than caffeine, it's other stuff in tobacco that gets you (and burning it doesn't help). So I'm still skeptical that "cold cured" snus would be safe.

> it's other stuff in tobacco that gets you

I think the evidence regarding swedish snus shows that it is far less carcinogenic than traditionally-cured oral tobacco, but still significantly carcinogenic. In particular, swedish snus has very little in the way of nitrosamines [1], a major carcinogenic element of heat-cured tobacco products.

RE: harmfulness of nicotine, my impression was that it was a little more harmful to the heart than caffeine. I suppose this would depend on dosage, which is difficult to compare.

[1] https://doi.org/10.1016/S0140-6736(07)60677-1

That (nicotine carrying non-minimal health risks) is Myth 3 in the linked article.

I recommend reading it, it's very informative!

Is that a kind of chewing tobacco? If so, sorry to be the bearer of bad news, but you may want to book a room in Mouth Cancer City because I'm afraid you might be headed there.

No chewing, it just goes under the lip.

In Sweden it used to say "causes cancer" on the tin like it does on cigarettes. But the government removed the warning and now it just carries a nonspecific "harmful to health" warning. I guess that means that there wasn't enough proof that it actually causes cancer. But of course, future research might prove again that it does.

You don't actually chew on chewing tobacco. It goes in your lip too.

Freakonomics did an excellent episode re e-cigarettes and the significant public-policy differences between the US & UK. Adds to this piece and should be interesting to anyone following this area: Episode 398 https://freakonomics.com/podcast/vaping-nicotine/

> UK surveys show that young people are experimenting with e-cigarettes, but regular use is rare and confined almost entirely to those who already smoke.

This is entirely not true in the US though, right? Curious how that can be so different.

I don't know what it's like over there (either cigarettes or e-) but here I would say anecdotally that a lot more school-age 'young people' smoke cigarettes than just-after-school (i.e. university students & early career); so perhaps 'those [young people] who already smoke' is quite a different group here? It'd be interesting to see the underlying not-anecdotal data, for sure.

To clarify - I mean that perhaps British young people that would ever experiment e-cigarettes are already experimenting with cigarettes, whereas American young people are less inclined to (I think the legal age is mostly higher, for a start?) and so the intersection with e-cigarette users has a smaller, and different, starting point.

Yeah that's incredibly interesting to me. If that's true, what the hell is the UK doing so right that America isn't?

I doubt that statistic and would like to see the survey they referred to.

Perhaps there's less appeal when parents and other old, boring people have e-cigarettes, with the approval of their doctor.

I support the right of people to be able to go wherever they want and not be exposed to smoke, to not have their kids playing atound people smoking, to be able to open their windows on a nice day and not have the smell of smoke coming in the window, and to be able to go for a walk and not feel like you have to walk around people that are smoking.

I'm sure there will be more studies about what is safe. But I don't want to be a participant in the study.

How is this relevant to the article? What you're saying is totally defensible with regards to second hand smoke.

Vapor is not smoke. Full stop.

Furthermore, this very article dispells the misconception that second hand vaping is an issue.

Apologies if you're just merely presenting your views on a related subject, but based on the context, it does seem you're mistakenly equating second hand smoke with second hand vapor.

Does this include the right to not be exposed to car exhaust?

The right not to be exposed to car exaust is just a minor corollary of the right not to have anyone ahead of you on the goddamned freeway.

The car ahead might be an EV. If it isn't, then it's gassing you.

Also, it is disgusting breathing the virus laden air that other people have already had inside their gross lungs already. It's like eating someone's food after they have eaten it already.

(Sorry, this is an Asimov reference)

As a former smoker, friends with other former smokers we have joked, in full black-humour sense, that the best way out of the smoking mess, is to reduce the cost of cigarettes for the old cohort who smoke, and let them die rapidly so the public health costs are a blip in the overall curve.

The problem is the young cohort. I guess if we let vape companies sell Disney branded pink princess vape kits, we might keep kids out of smoking, and so this really is a blip and we can continue our black-humour approach to public health and end-of-life statistics.

Here's the backstory. Everyone's kids were vaping and parents were freaking out. After all, it was "safe". But after the CDC scare, parents could tell their kids that "vaping is deadly" with a straight face.

It is obviously impossible to prove that this played a role. But anecdotally, I know many very rational people who are surprisingly antivaping -- because kids.

Should have [2018] in the title

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