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Medical morals

Vaping could be a trojan horse for real cigarettes

You can vape in Wal-Mart, but should you? rpavich, CC BY

The American Surgeon General published the first federal government report linking smoking and ill health 50 years ago. The report also demanded that the American government take appropriate remedial action to reduce the harm caused by smoking.

Since then the percentage of Americans who light up has fallen from 42% to 18% and in some states the percentage of regular smokers can almost be counted in single figures. Similar reductions have occurred elsewhere. Almost half the UK population smoked in 1974. Now, less than a quarter do. The figures in Australia are even healthier.

This is very good news because smoking causes a number of different diseases and is the primary cause of preventable deaths in many countries. Indeed, smoking may have killed as many as 100m people in the 20th century and the World Health Organisation estimates that the figure for the 21st century could be a mind-boggling 1 billion.

About 50 years ago another significant “smoking related” event happened: the first e-cigarette was patented. This was a device that produced vapour from tobacco without combustion. For many decades “vaping” remained a minority activity. But over the past few years these not-quite-so newfangled nicotine delivery devices have become rather popular. And concern has been raised over their use and particularly uptake among young people. While figures from Ash suggest a negligible number of e-cig smokers, a recent US-based study found that the proportion of middle and high school students in America who had ever used an e-cigarette more than doubled between 2011-2012. Some analysts have even predicted that vaping may become more popular than smoking within a decade.

Modern e-cigarettes are battery-powered devices that vaporise nicotine for inhalation. They normally consist of a cartridge containing liquid nicotine and a heating element designed to produce an aerosol. Many also include flavourings like menthol – a fact which has been criticised on the grounds that flavourings may make e-cigarettes more appealing to children.

Although vaping (and passive vaping) may well be safer than smoking (and passive smoking) a number of toxicological analyses have shown that e-cigarettes contain many dangerous chemicals. The good news is that e-cigarettes are primarily used by people as a popular smoking cessation aid. But it’s far from clear how effective e-cigarettes are in helping people to quit smoking in the long term. More worryingly, some studies have shown that a number of “never smokers” have tried vaping. This is of particular concern because e-cigarettes could act as a “gateway drug” to conventional cigarettes.

The relative lack of evidence about the safety, effectiveness and ultimate impact of e-cigarettes has led to the adoption of radically different approaches to the import, production, sale, distribution and advertising of these devices. Some countries, such as Argentina, effectively prohibited them. But most jurisdictions allow e-cigarettes to be sold and consumed subject to varying degrees of regulation. The EU, for example, has taken a relatively hard line, but it is unclear at this stage what impact these new rules will have.

Ethically speaking, it would seem wise to be wary. E-cigarettes may not represent a modern day Trojan horse, but the recent interest shown by tobacco companies in these devices should give us all pause for thought. This does not mean that vaping should be entirely proscribed. Quite aside from the fact that our liberty rights dictate otherwise, there is, as noted above, good reason to think that e-cigarettes are less dangerous than regular cigarettes and so the net impact on health (and longevity) may well be positive.

But given the serious risk that vaping might re-glamourise smoking, especially amongst the young, a cautious regulatory approach is warranted. This should include a ban on the sale of e-cigarettes to children and a New York City-style ban on vaping in public indoor spaces and private office buildings. It also seems eminently sensible to put in place regulations to ensure that the marketing of e-cigarettes is restricted to current smokers.

Many will complain that too many restrictions on the sale and consumption will be counter-productive. Some experts have even claimed that quality control regulation is, more or less, all that is needed, and that vaping might make smoking redundant. But this approach seems overly lax. After all, there’s (usually) no vapour without fire.

This article was amended to include a report on the prevalence of e-cigarette use among young people in the UK.

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