Vaping: A dangerous habit or a misunderstood alternative to cigarettes?

This article represents the views of the author, and should not be regarded as medical expertise or advice.

The use of e-cigarettes or vaporisers (vapes for short), as they are commonly known, is a concept that has been around for some time now. At least, the technology has. But the industry has drawn some seriously negative attention over the past year or so, and that’s partially—probably, largely—down to the emergence of a mysterious lung disease, since christened by the Centers for Disease Control and Prevention (CDC) as EVALI (e-cigarette or vaping product use-associated lung injury).

Amidst the ensuing panic over an increasing death toll, politicians in the U.S. have gotten involved, and advertising practices by certain brands have come under severe scrutiny for allegedly unethical practices. These include the portrayal of e-cigarettes as a “safe” alternative to conventional tobacco products, and the marketing of vapes towards the youth—the latter, in particular, drew criticism for the use of “youth-oriented content” for marketing purposes.

In fact, vape company Juul has become so notorious in this sense that their social media practices have been the sole subject of a study by researchers at Stanford, who found that #juul posts still increased in numbers, even after the company halted social media marketing—indicative of an issue that has expanded beyond a commercial one. New guidelines that restrict Juul’s reach to the youth have now been implemented, but the lawsuits against the company are still continuing to add up.

But the unease felt by many at the vaping industry’s aggressive growth finally came to a head recently when thousands of EVALI cases were reported in the U.S., with multiple casualties confirmed as well. At the time, the most apparent common denominator between victims of the lung disease was the fact that all of the individuals concerned regularly used vapes. And with a thorough investigation conducted—led by the CDC—the culprit of EVALI has now been identified: vitamin E acetate.

But first, what is vaping?

Electronic cigarettes, as they’re called in full, were originally introduced as smoking cessation tools, with much simpler pen-like designs and less complicated flavours available at the start. The way they work, liquids are heated up, and the resulting vapour (hence, the name) is then inhaled. Many of these “e-liquids” are made up of a combination of propylene glycol, glycerin, flavouring agents, and of course, nicotine.

On one hand, the camp that advocates for vaping argues that the habit is basically a harm-reduction method for smokers who want to kick the conventional tobacco habit. But on the other, others have questioned if its attractive, multi-flavoured, “lower-risk” nature might create a gateway into nicotine addiction—which is certainly a valid concern.

As the years have gone by, the variety of products available from the vaping industry has also grown tremendously. Consequently, the perception of vapes has steadily morphed from an alternative to cigarettes (known as “analogs” in the community), into a harmless, fun, recreational activity for enthusiasts. You get multiple colours, designs, and we’re even starting to see vapes that can be controlled via Bluetooth with smartphone apps—temperature, power, and so on.

Then, things started to go downhill

In August of 2019, the Centers for Disease Control (CDC) began investigating a mysterious, sometimes fatal, lung infection in cases of individuals who had otherwise been healthy. As more cases were reported, doctors discovered that many of the cases shared something in common: the patients used vaping products.

Over the ensuing few months, more confirmed cases were reported from all 50 states of the U.S., along with the District of Columbia and two U.S. territories. And as the hysteria continued to grow, politicians—as they always do—waded into the whole affair, with President Donald Trump even announcing a temporary ban on the sale of all flavoured vaping products.

Cue the domino effect: Apple removed all vape-related apps from the iOS App Store, while Instagram began implementing new policies that prevents social media influencers from any sort of content marketing/branded content that involves vaping products. And, as mentioned, the advertising practices of vape companies came under the spotlight in a major way—which isn’t a bad thing at all.

But then came a breakthrough. In November of 2019, the CDC announced that the investigating team had narrowed the search down to one substance: vitamin E acetate.

Vitamins aren’t always good for you

Vitamin E acetate is an additive found in many food products—meat, fruits, and vegetables, along with cosmetic products that are often used in skincare routines. In general, the substance doesn’t cause harm when ingested as a supplement, or when applied to the skin. However, research now indicates that vitamin E acetate interferes with normal lung functioning when inhaled, with the CDC confirming that EVALI can be caused by the use of vapes.

The additive is mainly used in vape liquids containing tetrahydrocannabinol (THC), and the CDC has been calling for increased public awareness of the risks involved with THC-containing vaping products. THC is a cannabinoid found in cannabis that provides users with a euphoric high)—a highly illegal substance in Malaysia, which might explain why Malaysia didn’t have quite the epidemic that the U.S. did.

Apparently, vitamin E acetate is used as a thickening agent to give these THC liquids the appearance of potency—which is why the CDC warns against using unregulated vape liquids.

“CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers.”

“Additionally, people should not add any other substances not intended by the manufacturer to products, including products purchased through retail establishments.”

What we need, is more regulation and research

The evidence doesn’t point in any definite direction just yet, although vaping, as a whole, is undoubtedly an unhealthy habit to pick up. Lest we forget, 64 people actually died from a vaping-related illness—and what’s scary is that it was a simple additive that caused all of that panic.

Which makes it pretty obvious that we need more regulation, both in Malaysia and abroad. Or at least, better enforcement of regulations; it’s still fairly unclear how it works in Malaysia, with regards to vaping laws. The general consensus among the public is that it’s entirely legal, unless you’re vaping within the vicinity of eateries. But a quick search reveals contradicting reports: this one says that the sale of nicotine-liquids has been illegal in Malaysia since 2015, while new legislation to govern tobacco and smoking could be tabled within 2020.

As it is, reports suggest that laws are already being put in place that will prohibit the advertising of vaping products in Malaysia, which should be enough to deter brands from any unethical advertising practices across traditional mediums. Juul, as a case study, is a clear example of how a lack of regulation—or at least, lack of enforcement—can lead to unethical results.

And yet, vaping product stores are a dime a dozen in Malaysia. You can even find them on e-commerce marketplaces. Which basically means two things: one, we need more enforcement of regulations. And two, we need more awareness and public education.

It’s certainly not a matter to be handled lightly. As of 18 February 2020, there has been a total of 2,807 confirmed cases, with 68 deaths reported. Authorities and health bodies didn’t actually say vapes were harmless—in fact, the CDC warns that there isn’t enough evidence to rule anything else that might be potentially dangerous out, even in non-THC products.

But I will say this. The original e-cigarette was a simple device that delivered nicotine in a perceived “less harmful” way than that of a conventional cigarette. It had a lot in common with nicotine replacement therapy (NRT), which is basically a fancy way of categorising nicotine gum, patches, or medication. The biggest difference here is that vapes involve the act of “smoking”, which isn’t exactly friendly to the human lung.

Still, studies do show some positives. According to the NHS in the UK, e-cigarettes are twice as effective at helping smokers quit tobacco than other forms of NRT. Arguably, the positives prove that there’s enough of an upside for the authorities to conduct more research, and to regulate the entire e-cigarette industry—and competently so.

What do you think about the use of e-cigarettes/vapes? Are you on team outright-ban? Or is there a better alternative? Leave your thoughts in the comments section below.

Photography by Zachary Yoong with the Sony A7 III.