The Vape Debate: Sticks and stones may break your bones but inflammatory terminology will cause more harm in the long run

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In this post, Georgia Mannion-Krase (@GeorgiaMKrase) updates us on events at the E-Cigarette (EC) Summit held virtually on the 3-4th of December 2020.


“Needles are not safe, but clean needles are safer than dirty needles.” Professor Jas Ahluwalia boils the debate down to the simplest comparison. Researchers can’t call vapes safe, much like alcohol or roller-skating there is an undeniable risk, but they are safer than smoking tobacco by far.

Tom Sheldon of the Science Media Centre, a UK charity which helps scientists communicate the evidence on controversial issues to the public through the national news media, articulates a view held by many (if not all) experts in this field, that, “The news bar is set much lower for a scare story on e-cigarettes than a piece on the relative safety of them compared to tobacco. The media are not there to inform the public and give a balanced view, they’re there to get and sell stories.” But the media are not the only recipients of Tom’s(/everyone’s) ire. The World Health Organisation (WHO) and the European Commission SCHEER report came under a significant amount of fire during the E-Cigarette Summit for their misinformation and lack of context. To continue the metaphor above, their publications went something like “Clean needles are more dangerous than no needles.” Which lacks a certain amount of nuance that you may or may not expect from such institutions. Professor Peter Hajek stated that the WHO was roundly criticised for their “history of anti-vape activism” which has damaged their reputation in this field and others.

Uncertainty doesn’t translate well to the general public, nor does it sell newspapers. Sheldon continues that “scientists need to do more to explain what this means in scientific terms. Explaining the context of that uncertainty is helpful.”

The impact of this muddy water is that for the first time since they started measuring, adult vaping has gone down due to the increased public harm perception. This might not sound like a bad thing until you consider that the people who were using or would have used a vape instead of tobacco will have gone back to tobacco. There are real implications for public health with misinformation at this scale.

This trend is not surprising to anyone aware of the “popcorn lung” or EVALI (E-cigarette, or Vaping, product use-Associated Lung Injury) outbreak in the USA. EVALI in itself is poor terminology. The cause of the conditions is vitamin E acetate added to illicit e-liquids, and would be impossible to contract using licensed products. The use of these terms are outdated and damaging. To draw a comparison to another poorly named medical diagnosis, Human Immunodeficiency Virus (HIV) was once named Gay-Related Immune Deficiency (GRID). Medical terms can be bad, can be inaccurate and damaging. They can also be changed.


Are we there yet?

No. Stefanie Miller of Fiscal Note points out that if you don’t trust someone, what they say doesn’t matter, and that trust in the organisations and figures advising the public on vaping is critical. Professor Frances Thirlway agrees that word of mouth and real-life experience are much more powerful than the opinions of researchers (like us).

Then who does it fall to, to fill the void? The answer is, all of us really. It’s on researchers to do more, bigger, better trials. We need long-term health data on the health effects of vaping, and we need the media to take responsibility for the influence they have on the real health of real people.

Vape shops may be seen as shadowy and somewhat untoward, but they are leading changes in the industry. Highly informed and run by enthusiasts, vape shops are a huge success story for independent business in the UK, and stalwart opposition to the tobacco industry who have performed poorly in all areas of the vape industry. There is room for collaboration with well-intentioned small businesses when the health of their customers is the health of the nation.

Professor Cliff Douglas says, “We must find a way to collaborate with integrity.” I believe that means all of us.


The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.

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  1. I couldn’t agree more, but I wish you would differentiate between eliquid and THC oil. The lung injury outbreak was Vitamin E Acetatate added to illicit THC oil. Tobacco Control has already muddied the waters with their intertwining terminology to the point where people are conflating one thing with another. We must communicate our message with as much clarity as possible to help clear up much of the confusion TC has already caused.

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