‘Proof it could kill’
They’re supposed to be safer than smoking. Yet e-cigarettes — promoted by health bosses — are being blamed for a British man’s death and 13 fatalities in America. Now this investigation asks . . .
TERRY MILLER believed the hype about vaping and it may well have cost him his life. The 57-year-old from gateshead swapped his 20-a-day smoking habit for e-cigarettes — hailed by UK health officials and anti-smoking campaigners as the safer alternative — only to die of the lung disease lipoid pneumonia (when fat particles enter the lungs) eight months later.
Doctors said oil from vaping fluid was found on his lungs.
Mr Miller, who died in 2010, is thought to have been the first British vaping fatality. Although the coroner delivered an open verdict, his widow, glynis, thinks he would have been better off continuing to smoke.
‘He would have been in ill-health but he’d have lasted a lot longer,’ she said. ‘Who says vaping is safe? It lulls people into a false sense of security.’
Americans such as Adam Hergenreder hardly need to be told that. When the 18year-old from Illinois was rushed to hospital in August with a severe vaping-related respiratory sickness, his doctor told him he had ‘the lungs of a 70-year-old’.
Adam had started vaping when he was 16. A year and a half later he was in intensive care. Doctors blamed vaping.
‘I had the shivers. I would randomly convulse,’ he said. ‘I knew it wasn’t a stroke, but it felt like that because I couldn’t control myself.’
After being sick continually for three days, he sought medical help and an X-ray revealed the full extent of the damage to his lungs. Doctors said if he’d been admitted to hospital two or three days later, his breathing might have worsened to the point where he died.
Once a keen athlete, Adam now finds even walking upstairs makes him breathless.
With 13 deaths and at least 805 other cases linked to vaping in the U.S., where politicians including Donald Trump have moved to clamp down on e-cigarettes, experts across the Atlantic cannot understand why their British colleagues are so complacent.
Stanton glantz, director of the Centre for Tobacco Control Research and Education at the University of California, said it is ‘ridiculous’ that Public Health England (PHE) can maintain that vaping lung disease is ‘an American phenomenon’.
PROFESSOR glantz highlighted an under-reported case in medical journal The BMJ last year in which four Birmingham doctors revealed they had identified lipoid pneumonia in a young female vaper. She developed ‘insidious onset cough, progressive dyspnoea [laboured breathing] on exertion, fever, night sweats and was in respiratory failure when admitted to hospital’.
UK health officials, who promote e-cigarettes as ‘far less harmful’ than tobacco, blame the U.S. crisis on the vaping of cannabis rather than nicotine, while UK anti-smoking charity Action on Smoking and Health (ASH) urges smokers to ‘give vaping a try’.
But UK watchdog the Medicines and Healthcare Products Regulatory Agency, has linked vaping to 100 health problems including heart disorders and pneumonia. It has recorded 74 cases of illness, 49 of them serious, since 2014.
Whatever anti-smoking and public health officials in Britain say about the virtues of e-cigarettes, in the U.S. vaping has been hit by two linked crises: first, the rash of cases of serious lung illness; and second, the explosion in teen vaping, which experts fear could create a new generation of nicotine addicts.
British health officials are, at least, correct in saying it is not yet clear what, precisely, about vaping is causing the deaths and illnesses. But that hasn’t stopped the U.S. acting swiftly to prevent the crisis escalating, while doctors and scientists try to understand the mysterious lung condition.
Officials warn that hundreds, possibly thousands, more people may also have been affected, but doctors have never linked their illness with vaping. In more than half of confirmed cases, the victims were aged under 25.
President Trump, usually averse to tying up U.S. businesses in red tape, has announced plans to ban the sweet-tasting fruit and mint-flavoured e-cigarettes that are popular with teenage users.
Many experts believe they may contain an ingredient that is causing the lung disease. It is estimated that more than five million children in the U.S. vape, almost all of them using nontobacco-flavoured varieties.
A growing number of states, including New York and Massachusetts, have already imposed bans on flavoured vapes. Others, such as California, have issued a blanket warning to everyone to stop vaping. Retail giant Walmart has stopped selling them.
The billionaire former New York mayor Michael Bloomberg is funding a £130million programme to counter the emergency, saying ‘the e-cigarette companies and tobacco companies that back them are preying on America’s youth’ and using the same marketing tactics that ‘once lured kids to cigarettes’.
Ned Sharpless, commissioner of the U.S. government’s Food and Drug Administration (FDA), admitted to Congress last week that his agency ‘must do more’ to stop the deaths and teen addiction linked to vaping.
Almost simultaneously, the chief executive of Juul Labs, the country’s biggest e-cigarette manufacturer, left the company amid growing outrage over Juul’s role in soaring teenage vaping.
ANTI-VAPING activists smiled ruefully when the Juul boss was immediately replaced by an executive from Altria, a tobacco giant which owns 35 per cent of Juul — a company that is also flexing its financial muscle to dominate Britain’s e-cigarette market. The appointment, say critics, reveals the truth — denied by e-cigarette makers — that ‘Big Tobacco’ runs the vaping industry.
In the U.S., Juul faces a criminal investigation into whether it intentionally marketed to minors.
It was also forced to scrap its Make The Switch campaign after the FDA condemned it as an illegal attempt to portray its vaping products as safer than traditional tobacco cigarettes.
E-cigarettes still deliver a hit of highly addictive, tobacco-derived nicotine but through liquid in a cartridge, usually refillable, that when electronically heated turns to vapour which the user inhales.
Something in the liquid — an oil or other substance in the cloud of chemicals produced — is entering
users’ lungs and causing severe and, to some extent, irreversible damage. The symptoms, which progressively worsen, include a cough, shortness of breath, fatigue, chest pain, nausea, vomiting and diarrhoea.
Many of those taken ill have been diagnosed with lipoid pneumonia, which involves harmful oils or fats entering the lungs. Doctors say that is consistent with vaping, as different types of oil are used in vaping cartridges. However, lipoid pneumonia usually affects elderly patients, so experts have been shocked to see it in teenagers. ‘Vape juice’, as the e-cigarette liquid is called, often includes compounds containing tin, lead, nickel, chromium and manganese. And while propylene glycol — used in the flavoured vapes — is a harmless chemical also used in asthma inhalers, in cheaper vapes a substitute is sometimes used: diethylene glycol, a toxic industrial solvent.
Another possibility is that the powerful nicotine ‘salts’ which are increasingly put in vapes may be the culprit.
Some experts instead believe the lung disease may be caused not by any particular ingredient but simply by the vaping process of inhaling an aerosolised liquid.
And there is a lot of inhaling involved. E-cigarette enthusiasts trumpet the fact that they contain far less nicotine per puff than an ordinary cigarette. Consequently, to get the same nicotine ‘hit’ as from a cigarette, users have to puff on them for much longer and more often.
Vaping proponents in the UK, where flavoured vape juices are also widely available, have latched on to the high number of U.S. vaping illnesses in which the victim had been vaping THC, the psychoactive ingredient in cannabis, which is legally available in much of the U.S.
However, many of the victims hadn’t touched cannabis and had only been using nicotine.
The first e-cigarette — or electronic cigarette — was invented by a Chinese chemist in 2002 to help smokers kick the habit of carcinogenic tobacco. The terrible irony in America is that before e-cigarettes arrived (Juul launched its first vape sets in 2015 with a glossy ad campaign featuring young-looking models), teenagers had almost stopped smoking.
Now, the latest data shows 27.5 per cent of high school students had used e-cigarettes in the past 30 days, up from 20.8 per cent in 2018.
Juul, whose elegant vape pens look like elongated USB sticks, accounts for more than 70 per cent of the U.S. vaping market. The £31 billion company dominates the industry and much of its success came from its appeal to teenagers.
Juul and its competitors insist they have never intentionally targeted minors, yet the market has been flooded with vape juices in flavours including bubblegum, gummy bear and candy floss. Its marketing has leaned heavily towards capturing teenage interest, recruiting social media ‘influencers’ to ‘juul’ on Instagram and Facebook. Vaping celebrities such as Johnny Depp and the model Bella Hadid have reinforced the notion that e-cigarettes are cool.
Juul staff even managed to infiltrate U.S. schools in the guise of anti-addiction campaigners.
Meredith Berkman, one of three New York mothers who founded the pressure group Parents Against Vaping E-Cigarettes, told me she was prompted to act the day her 14-year-old son came home from school saying a Juul representative had told his class that the firm’s products were ‘totally safe’ and were the ‘iPhone of vapes’.
The current health crisis over e-cigarettes is a consequence of U.S. health officials failing to regulate vaping in the past and allowing products on to the market before they had been properly tested, she claims.
Miss Berkman acknowledges that UK e-cigarette regulations are tighter — the maximum nicotine content, for instance, is 2 per cent, while in the U.S. it is as high as 7 per cent.
However, she says: ‘British parents should be aware that Juul and its copycats are clearly Big Tobacco 2.0.’
In the UK, where Juul sells its vaping ‘starter kit’ for £29.99 online, the company’s managing director, Dan Thomson, boasts grandly of its ‘global mission to eliminate cigarette smoking’ and help Britain’s 7.2 million smokers kick the habit.
UK vaping opponents such as the Campaign for Tobacco-Free Kids have pressed Westminster to act now to stop e-cigarettes hooking British children, too.
But Public Health England continues to applaud vaping for weaning smokers off tobacco.
Downplaying fears that the U.S. nightmare could spread to Britain, it stresses that UK e-cigarettes contain much less nicotine, cannot be advertised in print or broadcast, and cannot be sold to under-18s (though the same age restriction also theoretically applies in the U.S.).
NHS Scotland says on its website that the current evidence suggests vaping e-cigarettes is ‘definitely’ less harmful than smoking tobacco.
In a statement it says: ‘Although most e-cigarettes contain nicotine, which is addictive, vaping carries less risk than smoking tobacco. Thus, it would be a good thing if smokers used them instead of tobacco.
‘To be absolutely clear, e-cigarettes are useful for public health and health service purposes only as a potential route towards stopping smoking.’
It adds: ‘There is still a lot we do not know about e-cigarettes. They are not risk free, but based on current evidence, they have a much lower risk than tobacco.
‘We need to carry out research to understand these risks but in the meantime we need to make the best use of the situation to reduce tobacco smoking further.’
ASH says ‘regular’ vaping among British children is ‘rare’, although 67 per cent of 16 to 18year-olds have tried it. Other recent studies have confirmed that more children each year are having a puff to try it.
ASH estimates there are 3.6 million adult e-cigarette users in the UK, a ‘significant growth’ on the 700,000 who vaped in 2012.
HEALTH campaigners complain that the UK tobacco industry is using the same cynical tactics to attract teenagers to e-cigarettes as are employed in the U.S.
The Advertising Standards Authority is investigating claims that British American Tobacco uses social media platforms such as Instagram, Twitter and Facebook to promote its Vype e-cigarettes to minors.
In the london Underground, an anti-smoking poster campaign is running — curiously, funded by the U.S. tobacco giant Philip Morris International.
Why would the maker of Marlboro cigarettes be encouraging people to stop using its product? The answer becomes clear if you go to Change Incorporated, the website advertised on the posters, which offers advice on giving up smoking interspersed with subtle promotion of vaping.
Even so, if the experts can’t find out why e-cigarettes are killing people, they may be facing their last gasp.