Welcome to The Great De-Vape, a three part series from The Latch‘s News and Culture Editor Jack Revell, drug policy nerd and author of the Drugs Wrap newsletter.
In part one, we looked at the changes to vaping laws that are coming this Friday, 1 October and why they are being made.
In part two, we examine just how dangerous vaping is.
While tobacco has been consumed by humans for thousands of years, it wasn’t until the 1920’s, with the advancement of industrial manufacturing techniques and subtle marketing campaigns, that cigarette smoking really took off.
It wasn’t until the late 1950s that research really began to demonstrate that cigarettes were a major cause of serious diseases and health conditions.
Tobacco companies, some of the most profitable businesses in the world, spent the subsequent decades muddying the waters and denying the science with claims that because the science wasn’t “conclusive,” it shouldn’t be the basis for public policy — fossil fuel companies would later copy these tactics over climate change, but that’s a different story.
The delay in public health messaging over the dangers of tobacco cost untold millions of lives, the effects of which are still being felt today. In Australia, roughly 24,000 people died from cigarette smoke in 2019 alone.
It is against this backdrop that much of the debate around vaping takes place, with fears that this is simply cigarettes 2.0 and that we ought to learn from our mistakes.
While these fears aren’t totally unfounded, they’re also not substantiated by the evidence we have. In part two of The Great De-Vape, we look at just how dangerous vaping really is.
How Dangerous is Vaping?
If the TGA and the Ministry of Health have decided that restricting access to vaping is the right thing to do then there must be something to the argument that vaping is harmful or at least worthy of restriction.
One of the often touted health concerns around vaping is the risk of ‘popcorn lung’, or bronchiolitis obliterans. This is a rare condition caused by breathing in a chemical used to artificially flavour microwave popcorn that became prevalent amongst factory workers in Missouri in the early 2000s.
The chemical itself is called diacetyl and while this was used in some early vaping liquids as a flavouring, it’s has widely been dropped, with most manufacturers explicitly stating they don’t use it.
The other big fear is that vapes contain nicotine. This is where we bring in our old friend Paracelsus, the 16th-century Swiss physician and father of modern toxicology.
“All things are poison, and nothing is without poison, the dosage alone makes it so a thing is not a poison,” Paracelsus is often quoted as saying. This adage is rolled out in many debates around drug usage and harm reduction.
Dr Alex Wodak, board member of the Australian Tobacco Harm Reduction Association, favours the quote from British Professor Michael Russell, a leading figure in tobacco harm reduction: “People smoke for the nicotine, but they die from the tar”
“This gives them a nicotine without the tar,” Wodak added.
While the drug does temporarily raise blood pressure and may have an impact on cardiovascular health, the UK Royal College of Physicians conclude that “nicotine alone, in the doses used by smokers, represents little if any hazard to the user”
Indeed, nicotine has actually been shown to increase cognitive performance — the reason you’ll see ‘biohackers’ and supplement obsessives sticking nicotine patches to themselves to get a boost — despite what the TGA state.
According to their website “Nicotine is a poisonous substance” with “significant health risks associated” which stands in direct contrast to the UK’s Royal College of Physicians statement and the NZ Ministry of Health’s statement that “nicotine itself is low-harm” with “little or no long-term health effects”.
The discrepancy is interesting and a skeptic might be inclined to suggest that the TGA is playing politics with science and data in the need to justify a sweeping policy change.
Of course, nicotine is not the only substance that is found in vapes. Curtin University in WA ran a study on the chemical composition of 65 different e-liquids available in Australia and found that “every e-liquid tested contained one or more chemicals potentially harmful to health.”
Some contained nicotine when they said they didn’t, others contained chemicals found in household disinfectants, cosmetics, paint, and something called eugenol, which is used to euthanise fish. All of them were incorrectly labelled and all of them contained chemicals with “unknown effects on respiratory health”.
Mark Brooke, CEO of Lung Foundation Australia, one of the sponsors of the research, told The Latch “you can’t have it both ways and say it’s safer than traditional cigarettes.”
“When we put forward evidence that shows — and this is a chemical analysis, we can’t fake that — that it’s clearly not, you can’t object to more stringent measures and regulations that ensure the manufacture and the distribution are consistent with community expectations”.
In response to the study, Dr Colin Mendelsohn, Founding Chairman of the Australian Tobacco Harm Reduction Association, told The Latch that “of course there are toxins in vaping devices.”
“What they don’t tell you is that there’s over 7000 chemicals in tobacco smoke, including 79 known carcinogens in high doses,” he said.
“When you analyse the emissions from vaping products, there’s no more than 100 measurable toxins. Public Health England says that almost all are less than 1% of the concentration of what they are in smoke.
There’s arsenic in tap water and there’s formaldehyde in the air. You can frighten people with these statistics, but we’re talking about very small amounts of a very small number of chemicals”.
He notes that vaping is highly unregulated in this country and that proper regulation of the e-liquids and devices on sale would be a good thing however that is not something that the upcoming ban will achieve — more on that tomorrow.
So, while it would be wrong to say that vaping is 100% safe, doctors and serious medical bodies are as close to certain as science likes to stand that vaping is 95% less harmful than smoking cigarettes —which should be the main concern for anyone who wants to see fewer Aussies die from smoking.
Is Vaping the New Cigarettes?
Pitting two relative unknowns against each other — the efficacy and the dangers of vaping — is a difficult task for any health body, particularly when there are lives on the line. The TGA, as a medicines regulator, is highly conservative by nature and has appeared to take the line that if we don’t know the consequences of long-term vaping, why take the gamble? Particularly when the spectre of the tobacco industry looms in the background.
It’s a fact that the world’s largest tobacco company, Phillip Morris International, has taken a keen interest in vaping. They own a minority stake in Juul, the US vaping brand that is the source of much parental anguish over there, and manufacture their own lines of vaping devices.
20 percent of the global vaping trade is controlled by big tobacco industries, although none of the Australian market is. That rightly rings alarm bells in the heads of anyone who is concerned about a repeat of the 20th century.
“Would that be a bad thing?,” Wodak asks. “It would give them a means of exiting from making deadly cigarettes”.
“In 2015, reduced-risk options [vaping and heat-not-burn tobacco products] accounted for less than 1% of Philip Morris Internationals profits. In the second quarter of this year, they accounted for 29% of their profits.
“PMI wants to get out of cigarettes. They say so publicly and it’s very clear that that’s what they want. But, can they be trusted?”
Vaping was not invented by big tobacco companies like Phillip Morris. Instead, the industry have been bystanders, moving into the space only in the last few years as they identified it as an opportunity, not a threat.
Accounting for about 1% of the international economy, Wodak argues that, while he “hates big tobacco as much as anyone” and that their historical actions have been “beyond reprehensible”, we ought to be encouraging them away from selling their traditional toxic products.
For Brooke and the Lung Foundation, that’s not something they’re willing to allow with what they see as the gamble on vaping. When asked if he saw the present moment as a repeat of the 1920s, he replied: “To be blunt, I bloody hope not, but that’s my fear”.
“Short answer is, I don’t want to be here in 30 years from now talking to 50-year-olds living with lung disease because of vaping. That’s not our mission,” he said.
“Are worried that something is going to come out about the long-term health impacts of vaping, 10-20 years down the line?,” I ask Wodak.
“Something will come out about the risks of vaping,” he replies.
“The question is whether that risk is going to be greater or lesser than the risks of smoking”.
Wodak explains that science in the 1920s was nowhere near as perceptive as science is in 2021. With huge advances in toxicology and medical research, Wodak argues that if cigarettes were invented today, we would know within five years exactly how dangerous they are and the deaths of millions would have been avoided.
“The crux of the problem is that the safer options in Australia are incredibly restricted and about to become even more restricted on October first. That’s insane,” he said.
“Cigarettes are available from 20,000 outlets across the country, some of them 24/7. They’re expensive, but they’re readily available. If you want to get a product that, as far as we know, hasn’t killed anybody yet, anywhere in the world, that’s harder to do. You’ve got to jump through a lot of hoops and that’s the opposite of what should it should be”.
“Cigarettes are considered a consumer product while vaping is considered a medical intervention doesn’t make sense. No other advanced democracy does that”.
Stay tuned for part three where we examine the fall out of this new legislation and what the impacts might be for smokers, people who vape, and society.
And, if you missed it, check out part one which explains why all this is happening anyway.
Read more stories from The Latch and subscribe to our email newsletter.