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E-CIGARETTES HAVE HIT the headlines across the world over the past month because of a spate of lung illnesses associated with their use in the US.
There are now over 800 reported cases, including 11 deaths, across 46 states in the US.
Most of these cases resulted in the patients being admitted to hospital and several required admission to the intensive care unit with respiratory failure.
From the published studies, we know that all of the affected patients used e-cigarettes containing a range of different compounds, but we don’t know which of those compounds led people to become sick.
One line of enquiry is that some patients used tetrahydrocannabinol (THC) or cannabidiol (CBD) products, both of which are found in cannabis, purchased on the black market.
The patients may have been exposed to a mixture of compounds that had an acute toxic effect on the lungs, but it is too early to point the finger at any one agent or device.
A full investigation is underway to determine the exact cause of the outbreak of vaping associated lung illnesses across the US. Until we have more information, we remain in the dark about what the relationship is between this outbreak of respiratory illnesses and e-cigarettes.
Vaping is less harmful than tobacco smoking
Reassuringly, on this side of the Atlantic, no such reports have emerged to date and this outbreak seems to be isolated to North America.
Vaping has been commonplace in many countries for over ten years now so you would have expected to have seen similar outbreaks of respiratory illnesses across different countries prior to this current epidemic.
Smoking is still our biggest public health issue in Ireland. The Healthy Ireland Survey 2018 reported that one in five of the Irish population are current smokers.
Lung cancer remains the most common cause of cancer deaths in Ireland and tobacco-related diseases remains the most common cause of preventable deaths worldwide. Decreasing the prevalence of smoking must remain a top priority for Irish health policymakers.
E-cigarettes can help people quit tobacco smoking. Public Health England maintained their stance this week that vaping is less harmful than tobacco smoking and continue to encourage people who smoke tobacco products to switch to e-cigarettes.
However, it is apparent now that e-cigarettes are not completely harmless. Although vaping may not lead to lung cancer, it may lead to other lung diseases.
A study published last month by a research group in North Carolina reported that long-term vaping might lead to chronic lung diseases such as emphysema.
Clearly this is an evolving situation, with new research in the area being published weekly. Misinformation and myths tend to come to the fore when there is uncertainty around a topic.
Now is not the time for mass hysteria in relation to e-cigarettes.
It is important that physicians keep the public informed about the most up to date evidence available and the potential risks associated with vaping.
For ex-smokers who currently vape, the best advice at the moment is to speak to your GP if you develop any respiratory symptoms such as cough, shortness of breath and fever. It would also be advisable to avoid buying unregulated products on the black market until there is some clarity around the recent deaths in the US.
Protecting children
For those who don’t smoke, don’t take up vaping. We need to ensure that e-cigarettes are only used by smokers trying to quit. Earlier this month, a study reported that the number of adolescents using e-cigarettes in the US continues to grow.
The study surveyed over 40,000 teenagers and reported that the prevalence of vaping doubled from 2017 to 2019. The US are in the midst of a public health crisis and are considering a ban on flavouring in e-cigarettes. A number of states have also banned e-cigarettes outright.
We have no evidence that a similar picture is evolving here in Ireland so it’s important not to adopt a knee jerk reaction to the current epidemic seen in the US. However, we need to protect children from the dangers of both tobacco smoking and nicotine addiction by ensuring they never start either tobacco products or e-cigarettes.
Flavouring in e-cigarettes has most likely contributed to the upsurge in adolescence vaping in the US, so it is certainly worthwhile discussing a placing some restrictions on flavouring here in Ireland.
There is little evidence that the flavouring in e-cigarettes has resulted in more people quitting tobacco smoking. We may be able to prevent the onset of widespread teen vaping here by removing the flavours which attract young non-smokers to the e-cigarette market.
This would not hinder ex-smokers who could continue to vape menthol and tobacco flavoured products.
If someone wishes to quit tobacco smoking, they should preferably select a quitting strategy with long-term evidence-based medicine behind it and do so in consultation with their GP or HSE smoking cessation services.
Although vaping can help people quit smoking, it is not a harmless activity and we need to get this message out there, particularly to young people.
Professor Des Cox is Chair of the Royal College of Physicians in Ireland policy group on tobacco and consultant in respiratory medicine at Children’s Health Ireland, Crumlin.
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Surely if vaping is so bad then why is tobacco not banned, it contributes to more deaths by far.
@➕The Gray➕: because its easier to change something brand new than something thats decades old.
I have been vaping over 5 years and without any problems. I think the issue is using the e-cig like a cigarette or a pipe and puffing on it non stop. Just take a little puff here and there if a craving kicks in and put it back in your pocket. I suggest, and I’m no authority, what’s happening here is the abuse of a less harmful alternative to toxic cigarettes. Banning is not the solution. Educate, caution and inform and let people make their own choices.
@Gerry Hannan: Years ago I knew someone who wanted to give up smoking, so she tried nicotine gum, and it worked. But then she became addicted to the gum for years, apart from the price not the end of the world. This was the intention of e-cigarettes, that smokers would use them for a short period to wean themselves off tobacco, any possible slight harm would be offset against the major gains giving up smoking would bring. However that wasn’t what happened for many people.
Most took to e-cigarettes permanently, and as the tobacco industry saw the potential they began to market them with new sweet flavours, often clearly aimed at a younger demographic. Kids began to take up new “cool vaping” devices with flashing LED lights, quoting that they were totally safe, everyone knew that.
Event though health experts warned that we needed more time to study the effects of these devices, the chemicals used and that there was little quality control in the manufacturing process. Nobody listened. All they heard is that they were safe, but who was saying this? Even when the devices themselves began exploding it was treated as a joke. People still vaped in shops, on buses even in hospitals.
The health experts warned, like with cigarettes, it may take time for harmful effects to be revealed, and now that this is beginning to happen they’re still pointing to other harmful products, traditional cigarettes, guns etc. Vaping is not safe, the main product used in e-cigarettes and vapes is a solvent, propylene glycol, the same product they spray on airplane wings to stop them from freezing. This reacts with the other chemicals, nicotine, vanilla, cherry etc. to form new compounds.
Sven-Eric Jordt, a professor of anesthesiology, pharmacology, and cancer biology at Duke University who studied this said that, “while the FDA says many of these flavors are safe for eating, we don’t actually know if they’re safe for breathing. It turns out that there’s more than just the flavor ingredients themselves to worry about: there are also the chemicals the flavorings can produce as they continue reacting in vape juice.”
Robert Strongin, an organic chemist at Portland State University said “If you’re really interested in harm reduction, which I think we’re all interested in, you don’t want harm replacement.”
@Arch Angel: can you cite evidence of tobacco companies being behind the introduction of flavours in vaping juices? I’ve been vaping for 6 years now and depend 100% on the flavoured products. If not, I’d be back to my 30 a day habit in the morning. Tobacco companies didn’t get mainstream involved in vaping until about 4/5 years ago. And that only happened through the acquisition of existing vaping companies and then expanding those vaping businesses. Vaping is a harm reduction activity and but for the fact that tobacco companies got involved, nobody would have given a crap otherwise.
@Engine No. 9: Seriously? After reading all that your only gripe is who introduced the flavours? It’s now a fact that vaping and e-cigarettes are dangerous, the evidence for smoking make take decades to emerge, it doesn’t take quite as long with these. Both are dangerous.
It is blatantly false to say this is harm reduction, it isn’t, it’s replacing one for another and both cause harm. If you invented a filter for these in the morning that would prevent all this, with one minor problem. It uses asbestos. What do you think the industry regulators would say? Is it going to kill people? Well probably, in a few years, but hell, guns kill people and tobacco does too. They’d laugh you out the door.
No sane person knowingly creates a product and markets it knowing it may kill people, and these do. That’s established. Defending them at this point is no different than someone defending that asbestos filter.
@Arch Angel: if the problem is all of them why have there only been issues in the US where they are unregulated? It’s clearly a regulation problem. It very definitely is harm reduction when produced and regulated to a certain standard.
@Engine No. 9: They’re not behind flavours. Flavours were there from the very early days of vaping when it started to take off and the tobacco companies saw it as a threat and started lobbying against it. They realised that they weren’t putting enough of a dent in it so started to get involved.
@Arch Angel: Nope. What is a fact is that vaping is 95% safer than traditional tobacco smoking and the only thing established so far is that vitamin E acetate used on black market THC carts is behind current problems in USA.
As for the last paragraph you need to just open your eyes. World is full of stuff created by sane persons which may and do kill people.
Betteridge’s Law of Headlines: “Any headline that ends in a question mark can be answered by the word no.”
@AffordableLeather: silly suggestion.
By such logic you’d answer no to a headline if it read
“should people that sexually abuse children be brought to justice?”
@Barry Somers: would that ever be a headline?
805 deaths attributed to vaping in 2018
40,000 deaths associated with gun violence
Definitely ban the bubblegum vape juice, that’s what’s doing the damage.
@dB O’Neill: 805 deaths , that’s the first i heard .
@Gabriel Holmes: did you just pull that figure out your hole?
@Gabriel Holmes: Likewise – I’m sure a number like that would have been making the media rounds for weeks.
@Tim Adams: It wasn’t me that gave that figure of 805 deaths . As i said its the first I’ve heard.
@dB O’Neill: 11 deaths, 805 cases of illness
@Shlomo Ben-Gershon: Some people love to stay in permanent hysteria state. In his case he “Should have gone to Specsavers”…
I think cigarettes should be banned too which I know is never going to happen because governments of this country make too much money from them. They don’t care about smoking related illness so long as they get their share.
@KJmadra.: have you looked at the facts and actual costs around that ? How much the exchequer takes in on tabacco tax ? How much we need to fund the health services ? How much are alcohol related ? Trying to have the debate in ireland when you are touching the ‘sacred cows’ -especially alcohol is unbelievably difficult – or so it seems ? The ‘logical’ thing to do- albeit extreme and fraught with difficulty to implement- if you are only concerned about the tax take – would be for to ban alcohol and tobacco in ireland altogether – that way we could refuse to provide health services for people with tobacco and alcohol issues – no need to take in the high tax revenues and no need to spend them either . But you will come to realise that is not practical – and simply saying the government want the tax is equally too simplistic an analysis too. ;-)
@Dave Hammond:
The government is actually a net beneficiary of smoking, not because the revenues outweigh the cost of medical care, but because smokers generally die younger thereby saving significant care and pension costs etc. normally incurred in later life.
Great to see a logical and balanced article on this topic, given the current plethora of sensational headlines and knee jerk panic reactions to these *unexplained* illnesses and deaths. I haven’t touched a cigarette in over a year thanks to vaping, and I can feel the hugely positive difference in my breathing and general health. It may not be 100% harmless but it’s certainly a million times better than smoking, and I am tapering down my nicotine levels with a view to dropping the vape altogether eventually. I’ve tried every other quit method, but vaping is by far the easiest way to get people off cigarettes and shouldn’t be demonised like this.
As for the kids, surely better to enforce the age restriction laws instead of pandering by banning flavours.
I notice the same theme with scooters….what’s the connection between them?, both hit big business profits and also tax take….its all about money and nothing else, when it comes to money it comes first….
Question. How come these deaths are only in the US .
Answer . Because they are buying juice on the black market .
@Gabriel Holmes: real amswer: because there’s no regulation on vapes in the states.
@Dave O’Keeffe: Exactly , so why ban them in Ireland.
@Dave O’Keeffe: Not necessarily, people are buying these contaminated juice pods on the streets, so regulation would have no effect. The Juul pods which contain the juice that is causing the illnesses/deaths in the US are not designed to be refilled. You can buy a device from China for €10 that will allow these pods to be filled with whatever you want.
The issue in the US is the tax from projected tobacco sales can be paid in advance to individual States, sometimes years in advance. The problem is, tobacco sales are falling, therefore States now owe this money(which has been spent already) back to Big Tobacco. They are using these recent illnesses/deaths and ‘the kids’ excuse to ban vaping. Also on the kids, in America you can buy 50mg of Nic Salt which kids are using for ‘the buzz’ effect. You can NOT buy 50mg in the EU, the max is 20mg. Mr. Thrump own over a million shares in one of the biggest tobacco companies in the US. Would be in his interest to eliminate the competition!!!
It’s still an additive substance backed by big pharma and cigarette manufacturers.
@Eddie Mc Keown:They helped me quit a 15 year smoking habbit, I used a Vape for 2 months reducing the nicotine over them 2 months and now im completly off everything so I have nothing but good things to say about Vaping, Patches etc never worked for me
@Eddie Mc Keown: explain backed by big pharma and what you mean by that? I’m assuming you mean a product being manufactured legally for the purpose of making profit which is the aim of any company. Should all companies which don’t suit your ideas of right and wrong close up shop?
The problem here is the massive tanks and battery lung hit ecigs ,you can barely see if someone is using them
I use a normal ecig myself for the last five and from going from smoking 60 a day i feel my health is completely after improving
If the government bans e-cigarettes I will buy actual cigarettes. I was in Geneva airport not so long ago where they only sell 0% nicotine liquids. They advised I buy a packet of Marlboros with a ‘special filter!’ which ‘removes toxins’. I just got a packet of menthols which I used to smoke and lit one in the car park. Vaping provides an option. I think they can be highly regulated, even prescribed by doctors, but I don’t think they should be banned.
@James Stratford: ok so we should base our laws on your propensity for self destruction ? Hah
@Dave McCrea: isn’t that what a ban is?
“Vaping is less harmful than tobacco smoking” – are you stating this as fact?
@Jack Johnson: No, Public Health England are. Basically the NHS for England. They only provide health recommendations based on proven scientific fact, not hearsay and scaremongering.
@Jack Johnson: So would you rather breathe air from Chernobyl reactor 4 or air from an aerosol can?….no brainer when you actually think at it logically is it?….so use what is inside your skull for a change, if its present.
@Jack Johnson: Vaping data is still being gathered but the phenomenon isnt that new there is data. Most people who use vapes know they aren’t 100% safe but we’d rather stick with a vape than the proven to be lethal cancer sticks. Most vapers would welcome regulation and sufficient inquest into the dangers of vaping but banning it out right would kill more people than it saves. I say that as a person who used to smoke regularly now I don’t and haven’t in over a year due to my vape. If I didn’t have a vape due to a ban, the likelyhood is I’d be back on the cigs as I’m not ready to give the habit up entirely, yet. I will one day, but not yet.
@Gerald OBrien: Me too .
Or ban the real thing first. 500,000 smoking deaths every year in US and getting worked up over 5 deaths from vaping unregulated dirt.
When hear something must be banned for public good . You can be sure some one is looking out for his own good and dipping hand in your pocket
Filthy habit, I’m a non smoker and find the exhaled vapour obnoxious.. people who vape seem to think there is no problem with them smoking in public places, they need to be banned where people congregate.
@Charles Coughlan: ironic name!! Cough!!
@Charles Coughlan: I agree and I’m sure all responable vapers would too. You shouldn’t vape in places were you can’t smoke. Unfortunately, you’ll always get a few d**kheads who think and act differently.
So 800 cases 11 deaths 46 states in the USA, what is the number in Europe where THC oil is not widely available? I can’t see any in my quick google search but maybe I’m wrong. Now the type of pneumonia reported is Lipoid pneumonia which is caused by oil/fat in the lungs, oil or fat are not present in eliquid but are in THC oil. So why is this just a USA problem, I think the answer lies in THC! Also why are most of the patients/deaths teens or under 30, how come established Vapers probably on a 10 year stint not affected? I would imagine they are experimenting with THC and not eliquid Vapers at all. Finally eliquid flavours are possibly questionable and debatable but I reckon the marketing of such products should be scrutinised as I think nobody should should market eliquid to children!
‘ This would not hinder ex smokers who use menthol and tobacco flavours’ where do the so called professional experts get this crap. Ex smokers prefer sweet flavours once they have switched from cigarettes to vaping after initially trying to replicate the tobacco flavour.
@MaxDemons: I used to work in a vape shop and the amount of new vapers asking for ‘Benson’ or ‘Silk Cut’ flavour was crazy. I always explained to them, you should try and get away from tobacco flavours. Your brain just associated that flavour with what it really craves, nicotine. You just need to retrain your brain to associate the nicotine with a different flavour(s). It worked for the vast majority and I found the ones who stuck with the tobacco flavours were the ones who struggled or failed long term. Alcohol was another breaking point with people who stuck with tobacco flavours. Always told them to bring a stronger juice with them for nights out.
My question would be this. Why is the head of the Royal College of Physicians in Ireland going against what the Royal College of Physicians in England are saying? The UK says yes it’s 95% safer and the CDC, FDA and others have come out to say the culprit is vitamin e acetate. There’s been articles in the US about how all these cases were caused from illegal THC cartridges. But that gets swept under the rug. So before you go believing what a so called public health professional has to say, do some research
I have been vaping for a while and i do buy some liquid in euroshop. Some of them come with different ingredients, like there is some with flavours, but some have artificial flavouring. I wonder does that do any more harm, as artificial flavours are not really good for you, so how good they are to actually vape in lungs?
@Zane Silver: Nobody can say vaping is harmless BUT it is a less harmful alternative to traditional tobacco which we all know IS definitely dangerous. As current or exsmokers, we have to make the decision, do we smoke a known dangerous product or a product which has been proven to be less harmful. E-Cigs should only be used by adults who want to quit traditional tobacco. It should NOT be used by non-smokers and certainly not by under 18′s.
@Zane Silver: On the Euro shop eliquid, check where it is made. If its China or any other Asian country, be careful. They have literally no regulations over there. There’s a reason why its so cheap!!. Eliquid made in the EU has to be independently lab tested before it can be sold, so has that bit of reassurance that is at least made in a clean environment. It may cost a bit more but to me, it’s worth it.
Big vapes with clouds of smoke are bad in my opinion. The smaller pen like ones where you top up yourself with a 10ml bottle are fine if you find a good one..I use a logic one and its owed by a Japanese tobacco company. They stopped selling the one I like and replaced it with cheaper strong flavour ones called lqd and its is disgusting I cant breathe properly after vaping it..I can still get the older one in some shops.
Why the change? Maybe they make more money from tobacco.
Would they sell a product that harms people on purpose??
Tobacco is there main seller so I’m sure they wouldnt lose any sleep..
I am 30years old gave up fags 3 years ago and the only reason i tried vaping was from the smell of delicious flavours. I also like colorful vapes with flashing lights. If a flavour ban was introduced it would create a massive and dangerous black market. Adults enjoy flavour and color which is why for example cars are not all the one color and clothes are not all the same color and design example peter jones(dragons den) wears colorful socks with his suits. There is all types of flavoured alcohol eg pink gin
The greatest trick the devil ever pulled was wrapping a new addiction in the cloak of a “cure” for another addiction
@Dave McCrea: and here we have it folks. Religion is now the reason vaping is harmful. Give me strength.
@Dave McCrea: Vaping was brought mainstream by Hon Lik a Chinese pharmacist. His father died of lung cancer from smoking and he himself smoked. He created a way to consume nicotine without all the toxins. Yeah that sounds like the devil. Use your brain.
I am a 30 year old and I gave up tobacco 3 years ago using vaping and what made me switch was the flavours. I enjoy flavours and I like colourful vapes with lights. Adults enjoy flavours that’s why there is flavoured alcohol and adults enjoy color which is why clothes come in all different designs and colors.
Vaping in Ireland is already regulated under TPD. this EU wide law changed the size of bottle allowed that contains nicotine, reduced the maximum allowable nicotine, changed the allowed tank size and ensures every liquid imported is tested and the ingredients are known before a licence for sale is permitted. This may be news to some here, but flavours are designed for adults as most don’t like the taste if tobacco after a few weeks vaping.
“It is important that physicians keep the public informed about the most up to date evidence available and the potential risks associated with vaping.”
And yet Dr Des Cox says, “Until we have more information, we remain in the dark about what the relationship is between this outbreak of respiratory illnesses and e-cigarettes.”
Which is patently untrue. The CDC has stated
“The latest findings from the investigation into lung injuries associated with e-cigarette use, or vaping, suggest products containing THC play a role in the outbreak.
CDC has received data on substances used in e-cigarettes or vaping products in the 30 days prior to symptom onset among 514 patients.
About 77% reported using THC-containing products; 36% reported exclusive use of THC-containing products.
About 57% reported using nicotine-containing products; 16% reported exclusive use of nicotine-containing products.”
If thats not conclusive I don’t know what is because in an outbreak like this that’s as close to 100% confirmation as you get. Why the CDC and now Dr Cox are obfuscating this is beyond me. The CDC’s delay has already led to more deaths and Dr Coxs adding to the uncertainty is clearly an attempt to use this outbreak to attack vaping. This is not just dishonest but crosses a line for a doctor.
@Tom Gleeson: maybe you shoud go an read the article agian s-l-o-w-l-y
I vape now for a 3 years i am a 30 year old man. I enjoy flavour and cool looking vapes with lights and colours
Deaths from smoking related illness in the US last year =450,000
Deaths from vaping(black market contaminated liquid) 11
I’m not trying to belittle those 11 deaths but they were from contaminated black market liquid. They were not from Nicotine eliquid products, they were from THC oil/vitamin C oil and other bulking agents clearly NOT designed to be vaped.
These deaths/illnesses have only happened in the US. The EU has fairly tough regulations in place. I know a vape shop owner and they are regularly visited by HSE inspectors, both officially and undercover. No responable Vaper or Vape shop owner should market their products to anyone, kids or non-smokers.
The issue is in the US. Over there, the tax from projected tobacco sales can be paid in advance to individual States, sometimes years in advance. The problem is, tobacco sales are falling, therefore States now owe this money(which many have spent already) back to Big Tobacco. They are using these recent illnesses/deaths and ‘the kids’ excuse to limit/ban vaping. Also on the kids subject, in America you can buy 50mg of Nic Salt which kids are using for ‘the buzz’ effect. You can NOT buy 50mg in the EU, the max is 20mg. Mr. Thrump own over a million shares in one of the biggest tobacco companies in the US. It would be in his financial interest to eliminate the competition!!!
It’s was the above Doctor’s colleagues in The Royal College of Physicians in the UK, who were the ones who came out with the report of e cigarettes being at least 95% safer the traditional cigarettes. They now have vape shops in hospitals in the UK.
Ban them immediately- we should not have to wait to see the deaths rise from the ingested chemicals contained in these unlicensed drugs
@gerrygag: Actually they are licensed. The liquids are independently lab tested before they can be sold. There hasn’t been one death in the EU from E-Cigarettes. Should we ban Alcohol, Cigarettes, Cars, Knives, Toasters, Coconuts, Vending Machines, TV’s, Peanuts, Ladders. These have all killed more people than E-Cigs.
@gerrygag: That is a completely uninformed response, likely gleamed from a Facebook headline, or a pretend internet Doctor.
Comman sense says – after 10+ years of ejuice vaping, suddenly many people get sick and die ONLY in the USA….sound suspicious?
The cause of these illnesses and deaths are solely related to one item and one item only, illicit THC tanks using Vitamin E actetate which is a fat that will coat one’s lungs. The only reason black market tanks like this were sold is because they were such poor quality THC tanks that teh Vitamin E made trhem look better quality and thicker. It was simply a scam by black market scammers. There is nothing wrong with legit THC tanks sold in dispensaries.
Compare it to cutting Cocaine with rat poison.
All the misinformation about ejuice vaping is a travesty, and lends to the moniker of fake news. Reporters, quit being lazy, do your GD job!
Yeah ban them. No point to them at all and kids love them. Messes up your normal dopamine production
@Dave McCrea: studies have shown that computer screens and mobile phones also mess up dopamine levels. Let’s ban them. There’s no point to them and the kids love them.
How dare anyone give smoking and government loose your revenue ,joke in Czechoslovakia the government encourage smoking so you be around to collect your pension
@Gerard Heery: One too many scoops Gerry?
Yes.
have your say