Vaping: what people are getting wrong | The Economist

E-cigarettes could be a game-changer in public health… …helping millions of people to quit smoking Something in the region of 7m people a year… …are dying because they smoke E-cigarettes can provide a route out of smoking for many of those people More than 40m people worldwide are vaping …e-cigarettes are more controversial than ever before There was yet another death connected to the use of e-cigarettes Nicotine exposure during adolescence… …can uniquely harm the developing adolescent brain 30 countries have banned e-cigarettes outright But the facts have gone up in smoke The death toll linked to vaping is climbing tonight His infected lungs nearly collapsed Colorado’s first case of a rare, vaping-related illness America has been in the grip of a health scare over e-cigarettes Because of a deadly outbreak of what is being called “EVALI” EVALI is electronic cigarette, or vaping, product-use associated lung injury People were complaining of respiratory symptoms… …really having trouble breathing and in some cases it was fatal Since April 2019, 60 deaths and over… …two-and-a-half-thousand hospital cases have been reported in America The American Medical Association and the Centres for Disease Control… …advised the country’s 11m vapers to quit Seven states proposed partial or total bans Some politicians called for a national ban on all e-cigarettes Yet the health scare isn’t down to nicotine-based vaping… …but illicit cannabis-vaping products Tetrahydrocannabinol, THC, is the… …ingredient in cannabis that makes you high And so people have been vaping THC for a long time But at some point Vitamin E acetate was cut in with THC… …and that became a contaminant that people were inhaling Vitamin E acetate thickens the THC… …and makes it seem like it’s more high quality than it actually is There are over 40m vapers across the world… …but this outbreak of EVALI is unique to America In the United States, you’ve got a market that is really not well regulated It’s possible for manufacturers to put these… …dangerous chemicals into the liquids But in addition to that, you’ve got this varied legalisation of cannabis… …and heavy usage of cannabis oil Put the two together and you’ve got a very dangerous situation The misconception that this EVALI outbreak… …is caused by vaping nicotine products… …could have dire consequences Globally more than 8m people die every year… …from smoking tobacco but also inhaling second-hand smoke Almost half a million of these in America alone Come to where the flavour is, come to Marlboro country The concern is that e-cigarette users… …who have used an e-cigarette to stop smoking will go back to smoking If that happens, many lives will be lost There’s a fair chance I’d be dead right now if it wasn’t for electronic cigarettes I started smoking when I was nine. I smoked for 41 years The last 30 of those trying to quit I poked my head in the door here at 906 Vapor… …and 20 minutes later I walked out a non-smoker Then Marc Slis went one step further He decided to buy the vape shop in Michigan… …that had introduced him to e-cigarettes My customers come from a wide variety of backgrounds, ages The average customer is a middle-aged professional… …but they do have one thing in common and that’s a desire to quit smoking Do you want another? Yet there is major concern that vaping is appealing… …to increasingly younger customers The device has now hooked countless teenagers In 2018 the Food and Drug Administration reported… …an alarming increase in high-school students vaping A 78% increase in 2018 alone I am officially declaring e-cigarette use among youth… …an epidemic in the United States The reaction we’re seeing in the United States is a kind of mass hysteria The problem is nothing like what it’s being portrayed as… …by public-health officials in the United States The evidence doesn’t support that kind of language A national youth tobacco survey in America revealed… …that there are many more teenagers trying e-cigarettes But the number using them more regularly, nearly every day, is far smaller And the vast majority of those previously used tobacco products What you see is actually that among never-smokers, e-cigarette use is rare The use regularly on a daily or nearly daily basis is extremely rare And among all of those… …the reports of cravings and signs of addiction is very small Whereas with a cigarette, you see the conversion rate… …from trying a cigarette to becoming a regular, addicted smoker… …is really quite high. In people who just use an e-cigarette… …and have never smoked, is really quite low The e-cigarette phenomenon has really called into question… …whether it’s just nicotine on its own that is highly addictive… …or whether there’s something else going on This goes against decades of widely held beliefs… …around the addictive nature of nicotine Nicotine is the chemical that causes addiction It can change the way your brain works causing you to crave more nicotine Combustible cigarettes are far more addictive… …than vaping products because they deliver… …many other chemicals, along with nicotine What we call monoamine oxidase inhibitors When you use nicotine, that causes release of dopamine… …that dopamine is part of the dependence process Now, if you’ve got a monoamine oxidase inhibitor that you’re inhaling as well… …and that’s preventing that dopamine from being broken down… …it’s amplifying the effect of nicotine Cigarettes are actually giving you a cocktail of psychoactive drugs And bingo, you’ve got a highly addictive product… …when if you had nicotine alone, not so much If nicotine is more addictive in cigarettes than vapes… …then is it harmful on its own? We’ve conflated nicotine with cigarettes, so nicotine was the devil Really it’s not nicotine that’s causing the damage In the doses that you get it from a cigarette, the risks are minimal And the reason we know that is because… …there is a part of the world which takes in a lot of nicotine… …in a form that isn’t smoking Scandinavians have been using snus, a form of chewing tobacco, for centuries Frequent users receive high concentrations of nicotine… …on a daily basis, for decades Now, if nicotine were causing the kind of consequences… …that smokers suffer from… …we would definitely see it and we don’t see it But the myth still persists It’s a myth that is driving health campaigns… …in America and around the world… …especially focusing on teenagers Scientists say it can change your brain There’s a narrative going around now born out of the United States… …around nicotine being damaging to the adolescent brain This is based on studies in animals in their… …version of the adolescent stage of development But the epidemiology itself is not backing up what they are trying to assert People have been using nicotine for centuries If nicotine in adolescents were causing this lasting damage to the brain… …would we not have seen it? What critics will say to this… …is that absence of evidence is not evidence of absence And that is a good point That said, we should be careful about getting too hysterical about… …the long-term impacts of children vaping nicotine British public-health experts say that e-cigarettes are around… …95% less harmful than tobacco That’s only a back-of-the-cigarette-packet calculation So other than nicotine, what else is in them? The liquid contains glycerol or propylene glycol… …which is the substance that makes the visible vapour Basically what we use in stage smoke There’s a lot of studies done on it and we know… …what effect it has on the lungs As far as we can tell, it doesn’t cause an inflammatory reaction It causes a local dryness in the membranes Also, trace amounts of heavy metals… …from the heating elements can be inhaled Heavy metals are not the sort of thing… …you want to be inhaling in any amount It’s fair to say that we don’t really know the long-term effects… …that these are going to have on anyone who vapes Indeed, for any of the components of e-cigarettes But the point about vaping is you’re supposed to use it to stop smoking… …which is really harmful, and then use vaping to help yourself quit In 2018 the global e-cigarette market was valued at $15.7bn dollars It’s expected to almost triple by 2023 Appealing flavours have helped the vaping industry to flourish I’ve got a blue raspberry candy, a strawberry kiwi custard One of my favourites—whipped peanut butter and caramel… …it tastes great and it helps people to quit smoking Yet the many flavours have caused an uproar in America Cherry crush! How can you sit here and say you’re not marketing to children? Today Michigan will become the first state in the nation… …to ban flavoured e-cigarettes and vaping products Marc Slis gave testimony to help block… …an emergency flavour ban in his state of Michigan The numbers in my shop are that 99% of my customers use flavours The flavours are absolutely necessary and they are the key to quitting smoking In early 2020 President Trump banned almost all flavours… …of e-cigarette cartridges across the nation And globally e-cigarettes are now entirely banned in 30 countries For many of us that sounds crazy because in those same countries… …you’ve got high smoking prevalence… …and they’re not really doing very much about it In Lebanon, for example, where e-cigarettes are now banned… …the World Health Organisation says… …almost 26% of all male deaths were tobacco related in 2017 My concern is that forbidding e-cigarettes is going to deter smokers… …from switching to something far less deadly Countries should regulate e-cigarettes very tightly… …rather than banning them Public Health England, they are now currently opening up vape shops… …in their hospitals. They know it works, they know it saves lives Governments need to think about tightly regulating e-cigarettes Take a leaf out of the book of the EU What goes into them, the quality of the devices… …and tightly control how they’re marketed What you want from a public-health perspective is to capture… …the benefits of e-cigarettes as a tool for helping smokers to quit… …whilst not appealing to young people who never would have smoked at all


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