COMMENTARY: Panic over e-cigarettes not supported by the evidence
I don’t smoke and I don’t vape, and if that also describes you, I would argue that it would be good advice to keep it that way.
If you smoke, I would urge you to stop doing so. If you find it difficult to do so, I would argue that it would still be good advice for you considering shifting to e-cigarettes.
If you currently vape, then you have a decision to make about whether to continue to do so. On this, I wouldn’t be comfortable giving advice. Hopefully, though, that decision will be guided by facts and evidence.
Frankly, it would appear as though there is a need for the broader public discourse to also be guided by facts and evidence. This is a situation that requires a circumspect response, and instead we’re getting a lot of emotion and hysteria.
There is a very real and valid concern around a cluster of vaping-related respiratory illnesses in the U.S. — now linked to at least three deaths (no cases have been reported in Canada). This is clearly something that urgently needs to be investigated and understood.
Obviously any product that is conclusively linked to illness or death should be recalled or pulled from the shelves altogether.
However, as much as there is a rush to make this a story about e-cigarettes and their associated risks, there is a lot more to the story that is being overlooked due to this hastily constructed narrative.
Vaping and e-cigarettes have been around for years and nothing like this has occurred before. So it’s unlikely that this is a sudden and dramatic appearance of a hitherto unknown side effect. It seems rather apparent that something unusual and specific has occurred here.
Therefore, at this point, calls for people to stop using e-cigarettes altogether are an overreaction.
For one thing, most of these cases don’t appear to involve e-cigarettes at all, but rather vaping cannabis, specifically black market THC oil. Dr. Michael Siegel at the Boston University School of Public Health compiled some numbers showing that in the documented cases of illness in California, New Mexico, and Wisconsin, almost all involved THC oil.
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Furthermore, health officials in New York State may have unlocked a major part of this mystery. All of the reported illnesses in New York involved patients who were using at least one cannabis-containing vape product. Subsequent lab tests revealed high levels of vitamin E acetate in nearly all of the cannabis-containing samples that were analyzed.
New York State Department of Health notes that “Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products” and that its “oil-like properties could be associated with the observed symptoms.”
This is not the final word on the matter, but it may point us in the direction of an explanation. If nothing else, it’s strong evidence in favour of having our public health messaging being much more targeted than it has been.
It would be more accurate and credible to be warning specifically about black market cannabis oils — or even black market vaping products in general. If a knee-jerk reaction to this story ends up leading to restrictions on e-cigarette products, we might actually end up pushing more people toward the black market. From a public health standpoint, that would be rather counterproductive.
The other danger in issuing a blanket warning about all e-cigarette use is that it might discourage more smokers from making the switch, which could also have negative public health consequences. There is compelling evidence about the benefits and effectiveness of this harm reduction approach.
There is indeed a balance to be struck when it comes to vaping. It’s not harmless and we don’t want non-smokers — minors especially — to take up the habit. However, we should want smokers to switch to a less harmful source of nicotine.
However, it’s hard to strike a balance in the midst of a panic. We need to dial the rhetoric back a notch and let the evidence guide us.
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