Flawed report on vaping will harm public health

Posted on April 6, 2022 By Colin

Researchers at the Australian National University published a detailed report today on vaping for the federal Health Department. As expected, the report  Electronic cigarettes and health outcomes: systematic review of global evidence, delivered what the paymaster wanted and is seriously flawed.

The report exaggerates the risks and potential risks of vaping and fails to compare them to the far greater risks of smoking. It makes unsubstantiated claims of harm and downplays the effectiveness of vaping as a quitting aid.

By misinforming the public about vaping and discouraging its use, this report supports continued smoking and will only lead to overall harm to public health

The report will undoubtedly be used to justify and strengthen the government's anti-vaping agenda.

Risks not compared to smoking

The major flaw in the report is that it highlights the potential risks of vaping without comparing them to the far greater risks of the deadly alternative.

Vaping is not risk-free but it is far less harmful than smoking. It is a legitimate substitute for adult smokers who are otherwise unable to quit with other methods and would otherwise continue to smoke. Up to two in three long-term smokers will die prematurely from a smoking-related disease.

Switching to vaping has been shown to lead to substantial health improvements and should be encouraged. The UK Royal College of Physicians concluded in 2021

E-cigarettes are an effective treatment for tobacco dependency and their use should be included and encouraged in all treatment pathways

For example, the report states that vaping causes cardiovascular disease, blood pressure and harmed lung function. However, these harms from vaping are small and far less than from smoking. The evidence indicates that when smokers switch to vaping, these conditions improve.

Flawed claims

Some of the more egregious claims in the 361-page report are listed below.

• It lists numerous risks of vaping, but fails to quantify them. Many of the risks are very small and of no clinical or biological significance, such as the concern that smoking causes 'arterial stiffness' (so do exercise, caffeine and scary movies)
• It falsely claims that nicotine vaping by non-smokers increases the risk of smoking. This 'gateway theory' has now been discredited. The ‘common liability’ explanation is far more plausible.
• Youth vaping is framed as a ‘serious public health risk’. Young non-smokers should not vape, but the  evidence suggests that vaping is overall diverting young people away from smoking.
• It questions the effectiveness of vaping as a quitting aid. However, the evidence is now persuasive. There is moderate evidence from randomised controlled trials that vaping is more effective than nicotine replacement therapy and this is supported by the better-quality observational studies, population studies and accelerated declines in smoking rates in countries where vaping is readily accessible.
• It falsely claims that nicotine vaping causes EVALI because some patients denied using THC vapes. However, self-reports of THC use are unreliable and many EVALI patients who denied using THC were later found to have done so.
• Some risks are exaggerated. For example, it states that vape malfunctions can cause serious harms and death. There have been two deaths from exploding vapes globally in the last 15 years.
• It refers to a significant number of accidental poisonings, but poisoning is rare and serious outcomes are very rare.
• It wrongly claims that dual use is the dominant pattern of use, ie that most vapers continue to smoke. In the US, only 27% of vapers are also smoking (NHIS 2020). In the UK, 38% of users also smoke (ASH 2020). Dual use in Australia was 53% in 2019, but evidence from other countries shows that dual use reduces over time as more users switch to vaping only.
• It claims that vaping can cause seizures, however this claim has been discredited.
• The report claims that vaping increases the risk of relapse, when the evidence suggests it helps to prevent relapse.
• It claims that e-cigarettes can result in nicotine toxicity. However, there is no evidence for nicotine toxicity with normal use.
• Important studies are ignored. The report claims that there is no available evidence on the relationship of e-cigarette use to cancer risk. However, several studies have assessed the cancer risk as very low and only a tiny fraction of the risk from smoking.
• It claims there is limited evidence that vaping is less addictive than smoking. There are numerous studies that show vaping is less addictive eg here  here  and here

Overall benefit of vaping

The report says that for current smokers, there continues to be insufficient evidence that the benefits of e-cigarettes outweigh their harms. This ignores the numerous modelling studies which show that by replacing smoking, vaping averts smoking-related death and reduces harm.

For example, one study found that if most smokers in the US switched to vaping, there would be up to 6.6 million premature deaths averted and 86.7 million fewer life years lost.

More information is needed, but there is sufficient evidence to support a positive population benefit versus harm for vaping.