The Great Vape Debate – understanding e-cigarettes

Published: 03 March 2020

In our most recent Spotlight on Science event, a St George’s audience heard from experts and advocates on the evidence behind vaping, in a bid to understand the impact these products might have on people’s health.

Chaired by St George’s Professor Deborah Baines, presenters including Dr Lion Shahab from UCL, Professor Robert Tarran from the University of North Carolina and Martin Cullip, Chair of the New Nicotine Alliance, were all invited to speak.

Professor Baines opened the session highlighting the controversy of the topic at hand. “There is a huge amount of debate about vaping,” she said.

Sharing headlines reading ‘Research shows vaping is far less harmful than smoking’ to ‘Dozens of vaping deaths could just be tip of iceberg,’ Professor Baines posed the question whether there was sufficient evidence for people to make the right lifestyle choices, and introduced the event’s speakers.

Each one considered aspects including: whether e-cigarettes are effective in helping people stop smoking; if they are harmful to people’s health; whether they are a gateway to tobacco smoking; and if appropriate regulations are in place.

What is the impact of vaping?

Dr Lion Shahab began his talk by considering the effects of e-cigarettes on tobacco smoking rates and uptake among youth. Referencing randomised controlled trials and population research showing that e-cigarettes are effective, rarely used by non-smoking adolescents and may have contributed to an additional 18,000 long-term ex-smokers in a year, he explained their potential usefulness as a tool for stopping smoking.

Moving on to discussing the health impacts, Dr Shahab shared some of his own research demonstrating a decrease in a range of known cancer-causing and toxic chemicals in the body of vapers who don’t smoke, compared with smokers.

“Switching to e-cigarettes should result in long-term reduction of risk – certainly for cancer,” he said.

“However, there are unknown unknowns and we need to look at never smokers who vape long-term and follow them up for a number of years to establish the absolute risk that e-cigarettes pose.”

Professor Robert Tarran also explained that there is a lot we still don’t know. His own research is focused on understanding the effects of vaping on lung function.

“Smoking is known to cause devastating lung conditions like emphysema and bronchitis, as well as cancer,” he said. But any damage from vaping is less well understood.

Professor Tarran’s own research has shown damage done to the cells lining the lungs of vapers. Finding an increase in harmful molecules called proteases in the lung and higher levels of inflammation has given Professor Tarran cause for concern that e-cigarettes aren’t as safe as some people believe. He also showed that vaping changes the characteristics of the cells in the lungs that help fight infections.

“If vaping is better than smoking, it could save a lot of lives,” he said. “But from the lung perspective, vaping doesn’t appear to be safer.” Professor Tarran added that his work wasn’t designed to assess the impact of vaping on heart conditions or cancer.

A vaper’s perspective

The audience then heard from Martin Cullip, Chair of the New Nicotine Alliance, an organisation that advocates for safer nicotine products for people looking to stop smoking.

Martin, who used to be a 30-a-day smoker, stopped smoking tobacco cigarettes when he picked up an e-cigarette. “Quitting happened accidentally,” he said.

“I found myself using the device more and more, and I asked my wife how long I hadn’t smoked for. She said it had been four or five weeks.”

Since then Martin has gone on to advocate for changes to e-cigarette regulations in this country. “It’s not more regulation, but better regulation, that is needed,” he said.

The ideas suggested by Martin include changing the limits to the sizes of e-liquid bottles that can be bought from the current 10ml maximum to a larger size, and having standard descriptions on bottles of what’s contained. He also put forward his thoughts about vaping etiquette and people being mindful of others so they aren’t subjected to large clouds of vapour.

With research, the future will be less cloudy

The event closed with a survey, checking in on how the audience now felt about e-cigarettes. For many, the event raised even more questions, with many still unsure on the potential harm from e-cigarettes and their use as a tool to stop smoking.  Interestingly, most of the audience agreed that further regulation was required.

The NHS website states that “many thousands of people in the UK have already stopped smoking with the help of an e-cigarette,” and that the devices are “far less harmful than cigarettes.” But the questions around potential long-term harms still remain and it could be many years until definitive evidence arrives.

Meanwhile, for those looking to stop smoking, more information can be found on the NHS Smokefree website.