I advise patients on a daily basis that one of the best things they can do for their health is to stop smoking. Until recently, very few have succeeded. With the advent of e-cigarettes in 2006, “vaping” has grown in popularity and has helped many people finally to quit smoking.
When Emma, a 38-year-old woman with coronary artery disease, told me that she was pregnant, the conversation inevitably turned to her smoking habit. She started smoking at the age of 20. By the time she was 35, she had developed angina and was smoking a packet of cigarettes per day. She unsuccessfully tried the nicotine replacement therapy available on the NHS, and paid for hypnosis, but to no avail. Her pregnancy motivated her to try again and she finally weaned herself off tobacco by vaping. She used JUUL, an e-cigarette introduced in the UK in 2018. One afternoon she proudly showed me a gadget that resembled a sleek USB flash drive, unlike the traditional devices used by many to vape.
Of the 7.4 million adult smokers in the UK, 2.8 million of them vape, according to the Office for National Statistics. JUUL is one of many brands of e-cigarettes and uses pods containing a nicotine salt. It aims to provide the same nicotine “high” as traditional cigarettes. But it gained notoriety in the United States, where there has been a dramatic increase in underage vaping, with JUUL at the forefront of use. While the number of school children in the US who have tried vaping has doubled in recent years, there has not been the same level of use in the UK because of stricter regulations on the advertising and the sale of e-cigarettes.
According to Public Health England, vaping is 95 per cent safer than smoking combustible cigarettes; e-cigarettes do not contain tar or produce carbon monoxide. Dr Aaron Scott of the University of Birmingham has challenged this figure, however, and said that Public Health England failed to acknowlege the potential harm of e-cigarettes.
He has shown that vaporised e-liquid fluid has similar cell-damaging and pro-inflammatory properties to cigarette smoke on the lungs. “Public Health England is forcefully pushing the message that vaping is a safe alternative to smoking,” he said. “We know that in the short term e-cigarettes cause some harm and we simply do not have the long-term data to advance the idea that they are entirely safe.” In addition, e-cigarettes often contain nicotine, which is not only highly addictive, but also causes an increased heart rate, the opposite effect of many drugs that are prescribed for patients with heart disease.
Emma vaped throughout her pregnancy and found it impossible to stop. I noticed that she held her vaping device in her hand throughout our consultation and I wondered if there would be any long-term consequences for her or her unborn baby. Studies on foetal and adolescent brains have shown that nicotine may cause poor concentration and impulse control, and that it may lay the foundations for future addiction to other recreational drugs.
While JUUL, for its part, does not recommend the use of its product during pregnancy, the NHS advises that vaping for expectant mothers is still safer than smoking cigarettes.
As a cardiologist, I treat the devastating effects that smoking has on my patients and I see the difficulty they have in quitting. And I am astounded by the speed with which many patients switched from tobacco to e-cigarettes and, as a result, have significantly reduced their chances of developing lung cancer or cardiovascular disease.
Emma gave birth to a healthy baby and through vaping has managed to abstain from smoking. The harmful effects of cigarettes were fully understood only after decades of widespread use. One wonders, too, what the long-term health risks of vaping will be for people such as Emma and her baby.
Nishat Siddiqi is a cardiologist based in south Wales
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This article appears in the 26 Jun 2019 issue of the New Statesman, Restraining order