As an alternative to smoking, vaping always seemed to be something of a no-brainer. Who wouldn't want a delicious way to get their nicotine fix, with none of the ostracism and lung cancer that comes with tobacco?
As has been extensively reported, however, vaping's honeymoon period is over. In the US, thousands of vapers have reported health problems. Figures differ because the coverage is constantly updated, but Public Health England (PHE) say that 1,604 cases – of which 34 have been deaths – have been reported to the Center for Disease Control in the US. As VICE reported last month, every state but Alaska has reported vaping illnesses. Running scared, states across the country are cracking down in varying degrees on the sale of flavoured e-cigarettes, a position that even the President supported (until it was considered politically damaging).
That's the US. In the UK, panic has not set in to the same extent. But on a smaller scale, things have shifted. This month, Ewan Fisher – a 19-year-old from Nottingham who was put on life support after suffering respiratory failure – urged others not to vape. He had been using e-cigarettes for three years when he was hospitalised. His consultant co-authored a British Medical Journal paper whose conclusion said that we describe e-cigarettes as far safer than tobacco "at our peril".
This position – "whatever vaping's problems, it's better than smoking" – has for a long time been PHE's position, which maintains that vaping is 95 percent more healthy than smoking tobacco cigarettes. They directed me to their 29th of October blog on the US controversy and its implications for the UK. There, John Newton writes that the outbreak "does not appear to be associated with long term use of nicotine e-cigarettes, which have been used in the US for over ten years".
Newton also warns that alarmist coverage could lead to vapers turning back to smoking. Martin Dockrell, head of PHE's tobacco control programme, told The Guardian this week that he has already seen reports of vapers going back to tobacco in the wake of the health scare – better the devil they know. When people are voluntarily shunning one product in order to inhale tar into their lungs because they think the latter is better for their bodies, something strange is going on.
The good news for the UK is that the problems in the US have now been isolated to specific ingredients in a minority of e-cigarettes; ingredients that are not present in European e-cigarettes. The reason PHE is able to be so much more confident about vaping's safety, and the reason the US has seen a far greater number of vape-related illnesses, is because in Europe the industry is regulated tightly by the Medicines and Healthcare products Regulatory Agency (the MHRA). This regulation is lacking in the US, a country in which far greater liberties can be taken with the contents of e-cigarettes.
Lest they appear too incautious, PHE do caveat this statement: "The illicit drugs market is global, and it is possible that similar products to those in the US are available in the UK, which is why we are warning of this new and serious threat and continue to monitor carefully the situation in the UK."
I spoke to representatives from 16 vape shops in London, 15 of whom said their sales have taken a hit. One owner said the drop in sales had been around 70 percent, while two told me they have distributed material in their shops to combat the sensationalist, "scaremongering" headlines. A substantial number said that once their customers read the articles under these misleading headlines, they were reassured: the situation in the UK is different to the US.
One business owner said his shop is closing because of the reports, but also because of the rise of Juul, which is making it difficult for smaller enterprises to operate. "The whole face of vaping has changed," said Tom Collins from the Great British Vape Shop. He said he could count on his hands the number of people who came in during "Stoptober" wanting to give up cigarettes; more wanted to quit vaping.
I also canvassed opinion from a number of vapers in the UK. Each one was mindful of the dangers, but the news hasn't caused them to panic. "I was worried," said 36-year-old Pete Mallam, "but I was confident in what I researched into the topic. It's one of those things – I know it's not good for me, so I need to quit, but it's definitely better than smoking."
Pete noted that the health scares seemed to mostly have come from cheap oils containing cannabis, and he's right. Jacob George, Professor of Cardiovascular Medicine and Therapeutics at the University of Dundee, was the lead on VESUVIUS, the largest trial ever undertaken on the cardiovascular effects of e-cigarettes. "The devices that are causing the problems in America are nothing to do with the e-cigarettes that are being sold in Europe," he explained. "The devices that are causing the problems in America [contain] vitamin E acetate, which is being used as a cutting agent for cannabis oil."
The vast majority of vapers with lung problems were found to have cannabis metabolites in their urine.
VESUVIUS – whose results were only published this month – found that, within four weeks, "smokers who switched to e-cigarettes [from tobacco] demonstrated a significant improvement in their vascular health". But George wouldn't go so far as to say that e-cigarettes are safe. "Even the large US observational trials have shown that, even when you account for prior smoking, you still have an increased risk of cardiovascular disease in people who use e-cigarettes."
Axel Billingsley, 29, took up vaping in 2014 not in order to wean himself off cigarettes, but simply for its own joys. He builds his own coils and makes his own juice. "I've not noticed any detriment to my health," he said. "I think if I noticed anything like that, that would be a big indicator. I'm very, very open to the possibility that it is bad for you."
Professor George said that one of the reasons his trial tested vascular function is that it presents no symptoms but is one of the earliest detectable changes in the body: "You wouldn't know it when your blood vessel function is changing. Yes, you may be asymptomatic, but what you do not know is how your blood vessels are starting to change for the worse over time." George added that long-term data on vaping is very hard to come by, partly because people who vape also smoke tobacco or cannabis, or both.
David Allison, 43, is a good example: he was smoking a cigarette when I called him, and started vaping in 2016. He isn't fazed by the stories: "Within millions of users of anything, there's going to be a few people dying somehow." He isn't scared enough of smoking, let alone vaping, he said.
Henry, 40, wasn't smoking a cigarette when he took my call, but he was vaping. Unhappy as a smoker, he also started vaping in 2016. He knew that vaping would turn out to be more problematic than people said it was. "It's almost like being a smoker in the 1970s," he said, "in that you're aware that it's not a dreadfully good idea, but you've kind of got enough plausible deniability that you can ignore it."
The evidence suggests that vaping isn't a dreadfully good idea in and of itself. But, far more tightly regulated in the UK than in the US, it isn't killing people. And the media shouldn't say it is.