20 | New Scientist | 30 November 2019
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 havedeveloped 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 astudy 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 usersUnder 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 tobaccoThe truth about vaping
A sudden outbreak of health problems linked to e-cigarettes has
raised concerns about their safety. Jessica Hamzelou investigatesVaping liquids typically
contain nicotine, but lack
the tar found in cigarettesa 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.HealthLU
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LAJST/GETTY^ IMAGESNews Insight
2200
The number of recent lung injury
cases linked to vaping in the US