Vaping has become remarkably popular in the UK over the last few years. Estimates now suggest that over 2.5 million people in the UK use e-cigarettes and that number is rising. However, as a recent conversation with my wonderful sister-in-law showed me, people are divided over whether this is a good thing or not.Smoking is one of the most damaging habits we can choose to take up, being the single biggest cause of preventable death in the UK (as I described in a previous blog). We have known for years that people “smoke for the nicotine, but die from the smoke”; standard cigarettes burn tobacco, generating over 7,000 different chemicals, at least 72 of which are known to cause cancer.In contrast, e-cigarettes vaporise nicotine to allow it to be inhaled. This difference is perhaps the biggest argument for vaping that can be made, as most current evidence suggests that it is far safer. Public Health England (a UK governmental body) estimates that e-cigarettes are “around 95% less harmful that tobacco”, leading 53 experts to recently write a letter to the WHO, urging them not to classify e-cigarettes the same as regular cigarettes. Furthermore, the Royal College of Physicians has also called for e-cigarettes to be marketed as a less harmful alternative to smoking.However, it is important that e-cigarettes are seen as the lesser of two evils, rather than as something “good” or “safe”, a fact that seems to be ignored by advertisers, who benefit from a lack of marketing regulation that applies to other addictive substances like cigarettes, alcohol or gambling.There is pretty good evidence now that several cancer causing agents can be found in e-cigarettes. Some of the flavourings added to e-cigarettes have been found to contain high levels of chemicals known to cause lung cancer. Furthermore, the well-known carcinogen formaldehyde has been identified at levels 5 times higher than in normal cigarettes. This study has not been replicated however, but it is worth keeping an eye on.Additionally, nicotine itself is a poisonous substance, particularly in pregnancy, as it can both cross the placenta and is present in breast milk. While the dose of nicotine supplied by an e-cigarette is lower than that supplied by a regular cigarette, it is overwhelmingly clear that people should neither smoke or vape during pregnancy.Finally, it is important to discuss the potential of vaping as a gateway drug to smoking. Do people who would otherwise not smoke take up vaping? There isn’t a huge amount of data to answer that question right now, and the data we have is mixed.Some studies suggest that this may not be the case, and the increased e-cigarette use is resulting in a decreased in the number of new smokers. However, other studies have shown the opposite, that many teens that use e-cigarettes do so for the novelty and flavour. The two biggest studies show that only a subset of those considered “gateway smokers” will move on to be regular smokers however, meaning that it is likely that further follow-up studies “will be unable to demonstrate a major gateway to heavy tobacco use”.E-cigarettes have only been on the market for a few years, so it is impossible to tell what the long-term effects of their use will be. While there still isn’t sufficient evidence to be sure, indicators suggest that vaping is a lot less dangerous than smoking, so it probably makes sense to market e-cigarettes as a safer alternative for nicotine addicts.However, making e-cigarettes attractive to teenagers and children should obviously be banned. It is extremely worrying that many flavours currently available are targeted at kids (including “cotton candy” and various fruit flavours). After all, nicotine is an extremely addictive substance, so the normalisation of vaping in this group should be prevented.This current lack of regulation needs to be corrected, but it must be acknowledged in any regulation that e-cigarettes are less harmful than regular cigarettes, and that excessive regulation may drive people to smoking in order to get their nicotine fix. Given the horrendous toll of tobacco smoke, this is something we cannot allow.
