A letter to the editor from a GP with special interest in smoking cessation and proponent of nicotine vaping.
Dear editor,
The scientific evidence supports vaping to help smokers quit.
Emeritus Professor Simon Chapman does not support nicotine vaping and outlines 10 issues he calls “vaping myths” to argue his case, in your story published on 11 August.
However, many of his claims are flawed and he ignores crucial evidence.
‘Vaping is 95% safer’
Professor Chapman’s claims that the “95% safer” figure was derived from a 2014 consensus panel by Professor David Nutt. This is simply not true. The estimate is based on comprehensive literature reviews by the UK Royal College of Physicians and Public Health England.
The lead author of the PHE report told the Australian Senate Inquiry in 2021, that “Our estimate was consistent with the Nutt study but was not based on it”.
Whether vaping is 95% or 80% less harmful is not the point. There is overwhelming scientific agreement that it is far safer than smoking.
‘E-cigarettes are virtually 100% safe’
No credible scientist suggests vaping is “virtually 100% safe”. The key question is whether it is safer than smoking, which it replaces. The precise long-term risks of vaping are unknown, but the UK Royal College of Physicians estimates that long-term vaping is unlikely to cause more than 5% of the harm of smoking tobacco.
Harm from nicotine
Professor Chapman raises unwarranted concerns about the risks of consuming nicotine. According to the UK Royal College of Physicians, “Use of nicotine alone, in the doses used by smokers, represents little if any hazard to the user”.
Flavours
Professor Chapman is correct that some flavours could potentially cause harm over time and this risk needs to be monitored. However, a recent report for the European Commission concluded: “To date, there is no specific data that specific flavourings used in the EU pose health risks for electronic cigarette users following repeated exposure.”
Dual use
Smoking while vaping is a normal, temporary transition phase for most smokers and many go on to quit smoking and vaping completely.
Dual use is less harmful than exclusive smoking because most dual users significantly reduce their smoking. Many studies show substantially lower harmful biomarkers in vapers and health improvements such as reduced blood pressure and improved asthma.
Vaping is effective
There is good evidence that vaping is a more effective quitting aid than nicotine replacement. A 2021 Cochrane review found “moderate-certainty evidence that electronic cigarettes with nicotine increase quit rates compared to nicotine replacement therapy (RR 1.53)”.
A 2021 network meta-analysis concluded that vaping was the most effective monotherapy, followed by varenicline and NRT.
Vaping is not a gateway to smoking
Professor Chapman is confusing association with causation. Just because some young people start vaping and later go on to smoking does not mean the vaping caused the smoking. A much more plausible explanation for the association is a common liability to risk-taking.
Indeed, many studies now suggest vaping more likely diverts young people from smoking than encourages them to smoke. For example, declines in youth smoking in the US accelerated after vaping became popular.
Dr Colin Mendelsohn is a GP practising in Double Bay, Sydney, and the founding chairman of the Australian Tobacco Harm Reduction Association.
