There's a common refrain sung out whenever new research emerges about potential dangers associated with vaping: it's still better than smoking. This may be true, but should that stop us from talking about the possible dangers of vaping?
Last week, I reported on a Harvard study published in Environmental Health Perspectives, a peer-reviewed open access journal published by the National Institutes of Health. The study tested a selection of e-cigarette flavors (both cigalikes and individual juices) for diacetyl (and two similar chemicals), a flavoring chemical that gives food and beverage products a creamy, buttery taste. That study found at least one of the three chemicals in 47 of the 51 flavors tested, which is noteworthy because diacetyl has been linked to serious lung disease when inhaled by workers in factory settings.
But a handful of readers were unhappy with the story, and wrote to tell me as much. There were two main concerns raised: the first was that I never mentioned how much worse cigarettes are compared to vaping (both in diacetyl concentrations and overall health risks); the other was that, since we don't yet know the effects of vaping diacetyl, linking it to lung disease is premature.
I called up experts, both from the vaping industry and the medical community, to get to the bottom of these concerns and clear the air (pun intended) on this sensitive issue.
Concern #1: Cigarettes are still way worse than vaping
This point, raised by several readers, is true. Just this past summer, the UK's public health agency released a report that declared e-cigarettes to be 95 percent less harmful than cigarettes. This claim was based on a review of all of the published research to date, and while there's still much more research to be done, the consensus so far is that e-cigarettes are significantly less dangerous than smoking.
"It's about harm reduction," said Tony Mandarano, founder of ZampleBox, a vaping subscription start-up. "Over years and years of additional research, maybe we'll find it's 99 percent less harmful, maybe we'll find it's 50 percent less harmful, but the point is: right now the research shows such a large improvement between the two that we must keep going and we can't create a hysteria about this."
Some readers also pointed out that even when it comes to diacetyl specifically, smoking is still the worse option. This is also true. One 2005 study found levels of diacetyl as high as 433 micrograms per cigarette. Most of the e-cigarette liquids tested in the Harvard study were far lower than this, with even the highest concentration at 238.9 microgram of diacetyl in one e-cigarette.
"If the bar that you're setting is 'better than smoking,' then you're setting the bar awfully low."
If you're looking at vaping as an alternative to smoking—a way for lifelong, two-packs-a-day smokers to kick their habit and replace it with something comparatively healthier—this distinction between vaping and smoking is pivotal information. Mandarano (and some readers) expressed concern that without this context, smokers who were on the fence could see these kind of reports, assume e-cigarettes are just as dangerous as their current habit, and not make any changes.
But the fact that research so far shows e-cigarettes are much less dangerous than smoking is already pretty well known—so much so that I didn't see the need to repeat it. What we don't know is what negative health impacts vaping might have, and if the goal is harm reduction, shouldn't the industry be trying to make e-cigarettes as harmless as possible?
"If the bar that you're setting is 'better than smoking,' then you're setting the bar awfully low," said Russ Wishtart, host of the vaping podcast Click Bang!. "That said, some of the media that picked up on this study sensationalized it. Ultimately the main concern is that people will read the headline and smokers that may have considered vaping will say 'I'm damned if I do, I'm damned if I don't, so I'll just keep smoking.'"
It's true that smoking is more harmful than vaping, but if you're switching to vaping to improve your health, don't you want that choice to be as healthy as possible? The best way to ensure that is to know what's in an e-cigarette and what effects it could potentially have. That brings us to the second concern.
Concern #2: We don't know what vaping diacetyl does to your body
This point is also true (and one that I made in my initial story), but not knowing if a chemical has a negative effect is a long way from knowing that it's safe, and given diacetyl's history, it's not unreasonable to be concerned about it.
Diacetyl is linked to a serious lung disease called bronchiolitis obliterans in factory workers who inhaled the chemical. This is an incurable lung disease that severely restricts airflow and can even lead to death. It's probably not something you want to gamble with.
"It's very clear that diacetyl and other similar flavoring chemicals can, in some workers, cause this severe, irreversible, untreatable lung disease," said Dr. Cecile Rose, a lung disease expert at the University of Colorado Denver. "Why would we allow the possibility of that occurring and then wait until there's some dead bodies to count before something's done about this?"
Despite the relatively high levels of diacetyl in cigarettes, bronchiolitis obliterans is not well documented among smokers—a point some readers raised as evidence that diacetyl might not be that dangerous to inhale afterall. But Rose told me that's not exactly the case.
"There's absolutely no doubt that cigarette smokers are at risk for respiratory bronchiolitis, which is a different kind of bronchiolitis," Rose told me over the phone. "Whether it's from the diacetyl or a combination of all the other things in cigarettes, that's hard to say."
Rose also pointed out that bronchiolitis obliterans is difficult to diagnose because it mimics the symptoms of other, more common lung ailments like asthma and emphysema, so it could be that smokers are just misdiagnosed.
Still, that's not to say that vaping e-liquids containing diacetyl will definitely cause bronchiolitis obliterans (as some headlines suggested), it's just that there's a potential risk. So why risk it?
"You can't control what's in cigarette smoke hardly at all, but you can control what's in an e-cigarette to some extent," said James Pankow, a chemist at Portland State University who researches cancer risks related to smoking. "If the goal is harm reduction, why would you put in a chemical that's know to be a workplace hazard?"
That's a decision that's up to manufacturers and individual vapers, and the risk depends on a number of factors including the concentration in a particular flavoring and the habits of the vaper. But the only way to make an informed decision is to know that these chemicals are widely used in the first place and to insist on more transparency from manufacturers, which is why studies like the one out of Harvard are so important.
Vaping is a topic rife with contention. Those who have kicked serious smoking habits by switching to e-cigarettes are understandably defensive against any negative attention being shed on what they believe is a potentially life-saving piece of technology. Especially with potentially crushing regulation looming early next year, many vapers are worried about information being misconstrued and misrepresented. And as Mandarano point out, there are powerful interests, like Big Tobacco, that would probably love to see the entire vaping industry extinguished outright.
But knowledge is powerful too, and the best way to ensure a future where safe, responsible vaping can thrive is to continue to seek out the truth, wherever it may lead.