Listen now | Vaping is just as bad as smoking, right?

Hello Tom, I was just thinking about the last time I was in Japan and I was reminded of a horrible thing from the past.

Japan's great by the way, I'm a huge fan of Japan, but there

is 1 downside, which is they don't have a smoking ban in pubs and bars.

So when you go to a bar, yeah, when you go to a bar, you come home and your clothes smell of cigarettes.

I mean, do you remember what that was like back in the day?

I'm going to tell you what, it reminds me of something that, do you remember the song Same Jeans by some landfill indie band from the mid 2000s?

No, no, about wearing jeans as in the leg coverings, the trousers.

They sang, you know, I've had the same jeans on for 4 days now.

And I remember thinking at the time and saying to people when I was in, my colleagues, but like I've, I've worn the same jeans for like a week and I don't think anything of it.

And someone pointed out to me that that song came out just before the smoking ban was introduced in the UK, meaning that if someone was going to the pub each night and we're coming home, that jeans would stink after 4 days and people's hair would stink.

So anyway, the point is we're making that smoking is really unpleasant.

yeah, and it's our way of introducing the idea that smoking is not just a bad smell in your clothes and hair, but also it is 1 of the worst things that we know about in terms of epidemiology, you know, research on people's health.

It's 1 of the worst things for all sorts of different health conditions is smoking.

So wouldn't it be nice if there was something that would help people stop smoking?

And that is what we're gonna talk about today, which is vaping.

My name's Stuart Ritchie from the Eye newspaper in the UK.

Tom Chivers Hi, and I'm Tom Chivers from Semaphore.

I think you find, and 1 of the things that you find about vaping is that you can see absolutely diametrically opposed opinions on all aspects of vaping.

It's health effects, and it relating to pregnancy, and it relating to kids and youths, and all that sort of stuff.

You can diametrically oppose opinions just by looking in different places online, from seemingly fairly authoritative sources as well.

There are some countries that have really taken quite a harsh legal view of vaping.

So for instance, in Australia now, you can only get e-cigarettes on prescription and there's like quite a strict ban on them.

And I believe our own health secretary in the UK has said, Oh, I'd like to talk to Australia, my Australian counterpart and see if we can learn any lessons there.

The India banned them as well in 2019, I think, which and the world health organization, a consistent bait noir of the, of the studies show.

And the world health organization branded e-cigarettes harmful in 2021 and said there wasn't enough evidence to show that they helped people quit smoking, which is of course the big question.

In fact, before we ask what we do, we know what, what would we want to know?

Yeah, I think I think, yeah, the things you want to know are like, is vaping bad relative to smoking?

So we know that smoking is bad for all sorts of reasons, lung cancer and a whole range of others.

And so there's that question like is vaping worse?

How much, you know, is vaping better or worse than that?

Then there's the question of, regardless of how it is compared to smoking, how bad is vaping in an absolute sense?

If smoking had never been invented and then we just invented vaping, would we have a health panic about that?

Then there's the question of whether vaping is a gateway drug.

If kids or anyone starts vaping, does that mean that they're more likely to start smoking?

And is it actually the case that it helps people give up smoking?

And there's questions about specific populations of people like pregnant women and vaping.

And in answer to your question, your 2 questions about whether it acts as a gateway drug and helps people get up smoking, there's no, there's no sort of logical, logically necessary reason why it shouldn't do both those things in different people.

So let's, let's start then with the first thing.

How bad is vaping in a relative sense compared to smoking cigarettes?

So there's a figure I've heard, which is, which is, you know, which is that smoking the vaping is 95% less harmful than cigarettes.

Angus Well, if you look at articles in places like the Guardian article, there's an article on The Conversation, which is that website where academics write about their research.

Apparently that's debunked, that's a myth, that vapes are 95% less harmful than cigarettes.

Maulvis It does sound a very specific number.

I mean, you could easily imagine if they said 95% less impact on life expectancy or something like that, which you could flesh out to, I guess.

I mean, these numbers are often taken from 1 paper that finds maybe some vague number that's related to that, and then they're sort of spun out from that, and then it's made more general.

I don't know exactly what that means in this context.

Regardless of whether that figure is specifically 5%, it does seem to me that when you look at other sources, sensible people who have looked at the research on this, do actually make the argument that vaping poses, to quote 1 of the tobacco researchers at UCL, that vaping poses only a small fraction of the health risks of smoking.

In fact, there's government documents on this, where the UK government gathered data on the relative risks of vaping.

There's a Public Health England review that says that vaping is 0.5% the cancer risk of smoking.

MW I will say, PHE as well, Public Health England, they have put out, they have quoted that 95% less harmful figure themselves.

And I'm pretty sure Cancer Research UK and ASH, the smoking charity, They're both, I'm pretty sure they've used that 95% figure, and if they haven't, they've certainly said, you know, this is vastly less dangerous.

Mason Yeah, and they've been criticised for it, and said, no, actually, we're sticking by that.

There's a Royal College of Physicians report that I found that says, quote, although it is not possible to precisely quantify the long term risks associated with e-cigarettes, the long term health risks, the available data suggests that they are unlikely to exceed 5% of those associated with smoked tobacco products and may well be substantially lower than this figure.

So even if you don't think that it's 5% specifically, and you think that might be an over-specific number, it does actually seem like sensible people do think that, in a relative sense, vaping is way less dangerous than smoking.

Maulersen In the orders of magnitude levels, whether it's 10% or 5% or 1% or something in that area.

Steve To be honest, it's plausible to me that that makes sense.

Smoking is so bad, putting smoked tobacco into your mouth and inhaling it into your lungs seems like such a bad thing for your health.

We have so much data on that, that doing something that's quite different from that and doesn't involve inhaling loads of smoke does seem to be quite a plausible thing, that that would be less harmful.

I would, there's a sort of meme that I've heard, which is we can't know the long-term effects.

And maybe we'll get back to this, I don't know, but it feels like, actually, I remember people smoking vapes

years ago, and the rest, I feel like we're getting towards the stage now where we should start seeing what I would call long-term effects, right?

You know, it's been decades and you would expect to see a raised cancer risk from smoking within 10 years of people taking it up, that sort of thing.

I think that's, we could start saying the evidence is pretty good by now, surely.

And I think, you know, 1 response to that argument, by the way, which is the sort of thing that I hate to – I don't want to poison the well here, really.

But I mean, anti-vaxxers said this about the mRNA vaccines and covid, right?

They said these are a new medical product and we don't know what the long term health effects would be.

It's true that we don't have a hundred years of evidence following people up on this stuff, but we do have kind of toxicological understanding of what are the chemicals in these things, and what effects do those chemicals plausibly have on the human body.

And just like with the mRNA vaccines, we can say we don't think there's any toxicological, chemical, biological reason to expect that this would have a particular health effect.

I think people have looked at that and sensibly said the chemicals that you're getting from a cigarette are far worse.

They're just incredibly, incredibly horrible.

I remember writing things about, you know, you could reasonably say that smoking is more deadly than like a tour of duty in Afghanistan or something like that.

So I think it's probably fair to say that it's much less dangerous than smoking.

I mean, that is, like we say, that is a bit like saying it's less dangerous than lying down on the train tracks or playing Russian roulette or something.

But you know, it is definitely less dangerous than smoking.

Mason That's a very common 1 that people say that it's more addictive than smoking.

But actually, the evidence that I've seen, which is survey evidence, is that people who are…if you just ask people, to what extent do you think that you're addicted to smoking versus what extent do you think you're addicted to vaping, you're much more likely to say that you consider yourself very addicted if you're a smoker than if you're a vapor.

And you're and you're much more likely to say that you're not at all addicted.

Now, people might be mistaken about that.

And if you did take away their vapes, they would start to feel, you know, that they needed needed them and so on.

addicts own judgment of their own addiction is not necessarily, the question is how easy it is to quit.

If they want, for people who want to quit, how easy is it for them to quit?

And that's not shown in this study, right?

And I don't know if I've seen a quitting vaping study actually, because most of the studies tend to be quitting smoking, which we'll come to, there may well be 1 on people who want to give up vaping as well.

So my other thing is like, I am undoubtedly addicted to a stimulant.

Like I really, and you know, it won't be a massive surprise when I say that stimulant is caffeine.

I thought you were going to say that, much more interesting.

I racked up a couple of lines before I did this podcast.

If I don't have a cup of coffee by mid morning, I get a banging headache and get really grumpy.

And if I don't have 2 cups of coffee over the course of the day, in the afternoon, I'll get sleepy and grumpy.

I genuinely cannot not have a cup of coffee in the morning.

And quite often if we're rushing out of the house to go like take, you know, drive on or driveway and holidays and all that, and my morning routine gets broken, then it'll get to like 10, 30, 11 o'clock and I'm snapping at the kids and I've got a banging headache and I don't know why.

And Emma, my wife will say, well, have you had a cup of coffee?

I have genuine physical withdrawal symptoms, which are nothing to do with placebo effect because I haven't noticed it, but it doesn't, I don't care.

There's no health impact and I can live a perfectly normal, healthy life with this addiction because coffee is easily available and not bad for me.

actually, the mere fact that you can be addicted that you're addicted to something is not actually an argument against it.

Unless I suppose there is the thing where you know, coffee is easy to get, but I don't know, maybe vapes.

Like, No, if it costs lots of money that's a bad thing, right?

are spending lots of money, yeah, yeah, yeah.

But yeah, but that's a very good point which you don't see many people make because of course addiction, when you say it, is such a terrifying thing.

often very bad for lots of other substances.

I gather people again, if you get a clean supply, people lead normal lives, but I would rather not.

I almost can't really believe that, but I have heard that said.

But anyway, as someone from Scotland, I endorse.

You've never been able to get a hold of clean heroin, so you don't know.

But so, so then I think we should move to whether vaping is bad.

I think we agree that vaping is, is, is, is less bad than smoking.

As I said at the start, like if we hadn't mentioned if we hadn't ever invented smoking and then vaping came along, would we think, oh my God, this is a really terrible thing that people should be avoiding Or would we think, oh, it's a fairly harmless sometimes habit that people that people do more

Drink coffee rather than drinking like loads of alcohol or something like that.

So I think everyone agrees that there's, it's, it's not risk free in an absolute sense, right?

So there are studies and reviews of studies that point to lung problems and wheezing and all these kind of fairly low level problems that people have.

Also, some vapes have different chemicals in them than others.

That means that you can't necessarily know the health impact of this thing compared to this thing, especially if you're buying them on a kind of black market illegal basis, as people do in many countries where they've been banned.

You don't necessarily know the ingredients of them, And they can sometimes contain chemicals which we think are harmful.

I remember in 2019 there were a much publicised spate of deaths in the US, which were black market weed vapes as it turned out.

main- Yeah, sometimes they have THC in them, right?

So those were obviously, they were not the sort of the vapes that we would get in the UK, which are very much regulated.

And it was caused by some chemical, some heated oil in it, which you don't get in, certainly in UK vapes, which is banned under UK and EU law.

And so that caused something called lipoid pneumonia and it killed 6 people, Which obviously when 40, 000 people in the US were dying every month from smoking related diseases doesn't seem that big a deal.

But anyway, yeah, so it's also not very relevant because it was only in these weed vapes.

Angus Well here's something that might be more relevant which is very regularly brought up.

There's an article on the website Science Based Medicine, which has a big picture of someone's lungs and they're filled with popcorn.

Which is maybe an odd thing for a science based medicine website to have.

So there's this thing called popcorn lung.

Luke But I haven't really, but yeah, okay, let's go with it.

So it turns out, I looked this up, popcorn lung is this thing that is obviously the informal name for something called bronchiolitis obliterans, which sounds like a spell from Harry Potter.

was going to say, or like a transformer or something like that.

And, it's something which you get when you have a lung transplant.

And it's like a very serious, you know, kind of a scarring in your lungs, which, which comes from having a big, a big, very serious operation.

And apparently it can also, it has at 1 point in history, there was a popcorn factory, I think in the U S where they were using diacetyl, which is this chemical that makes a sort of buttery flavour to flavour the popcorn.

And I think some employees, 8 or something, 6 or 7 or 8 employees got this popcorn lung, got this bronchiolitis obliterans condition, the scarring in their lungs.

And people thought it was related to the diacetyl that they were using to flavor the popcorn.

Mark Blyth That's like, I genuinely have learned something there, because I've always assumed it was, you know, like, it made the lungs look

some way, like the damage looked, you know, like, I don't know.

Matthew Fletcher Contributes to the fear of the condition.

And if you look at the various websites that say, because diacetyl is sometimes used in flavorings for the e-cigarettes for vaping as well, for the for particular flavors.

And If you look at the Johns Hopkins Medical School website, which is a reliable source, it lists – under the headline, how vaping affects your lungs

The American Lung Association talks about this in great detail and says that it's an urgent issue for public health.

But the problem is, as Cancer Research UK points out, is that there have been no confirmed cases of popcorn lung linked to e-cigarettes.

And there's even a step even worse than that, which is diacetyl is like a hundred or maybe 150 times more prevalent.

But remember we're, we're now in the world where cigarettes don't exist.

But, but, but the interesting thing is that popcorn lung is not a thing that you get from smoking.

You get lung cancer, sure, but it's not particularly a thing that comes up when you talk about smoking.

It's this new thing that people have brought up from, from e cigarettes, even though there's no evidence from me.

So I really think that whole thing is a really weird scare story that is not related to the evidence whatsoever.

I'm amazed that that has become such a common talking point.

That's yeah, that is, That is absolutely bizarre.

I mean, I suppose, like, I don't know if this is a fair comparison, but do you remember there was that sort of, that 1 of those tomatoes aren't, tomatoes aren't really a vegetable, they're really a fruit type things where it goes around, but like, people said, Did you know there's actually more caffeine in tea than there is in coffee?

And actually, of course, as any, you know that's nonsense because you don't get a caffeine high from drinking tea and you do from coffee.

It's just obviously crazy and false on that.

And what it is is that pound for pound more, there's more caffeine in like a pound of dry tea than a pound of dry coffee.

But when you dissolve the coffee in water, or rather, in the tea in water, you steep them in water, loads more seeps out of the coffee than does.

So a cup of coffee has loads more caffeine than a cup of tea.

So you're just not, so you're not measuring.

I wonder if it's possible, you know, is it possible that the tobacco in tobacco cigarettes has, it somehow doesn't combust or get into the lungs.

I guess that, you know, are we comparing like with like there?

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Episode 5: Vaping (1)