I’m quite proud that the teams in our vape stores are clued up on vaping myths. Thanks to their research, and regular updates from head office, they have the knowledge, information and confidence to deal with concerns generated by negative press.

When we visit other shops, though, that’s not always the case, and I’ve seen some vape sellers struggle to answer questions. That’s not surprising, as it can be quite time consuming to keep up with every vape store!

So we’ve put together a list of the common vaping myths that are currently doing the rounds. I hope these will help both vapers and vape shops in the inevitable debates on the safety of vaping.

Does US 'vape' illness mean UK vapers should be concerned?

1. The evidence strongly suggests that tragic illnesses and deaths in the USA are down to using unregulated cartridges. Most, if not all, of these unregulated cartridges contained THC as well as other potentially harmful ingredients such as Vitamin E Acetate. These ingredients are not found in regulated UK e-liquid (or indeed regulated US e-liquid).

Note: Some users have claimed they didn’t use THC but, when tested, had THC in their blood. This may be down to the fact that using THC is still illegal in some states.

2. This has been a sudden and tragic outbreak. It’s occurred in a very short period of time, in a specific geographical area and with a very specific age group - people in their early 20’s. Vaping has been used by millions of people for over a decade, and if it caused sudden illness we would have found out years ago.

3. Vaping is strictly regulated in the UK and vitamins and additives are not allowed for use in e-liquid. A yellow card system operated by the UK Medicines and Health regulatory authority, designed to capture issues related to vaping, has not found any link between vaping regulated e-liquid and respiratory illness.

Also see: British vapers are safe, claim health experts after deaths in US  (Source: The Guardian) | The Mysterious Case of an American Epidemic of Vaping-Related Lung Injuries (Source: Kings College London)

Are there oils/Vitamin E Acetate in UK e-liquid?

UK e-liquid uses propylene glycol/vegetable glycerine as a base, which is Generally Recognised as Safe (GRAS) for inhalation. Vitamins and other additives are banned (Source: UK Gov). Even in the US, according to ex-FDA chief Scott Gottlieb, regulated vapes do not use Vitamin-E Acetate or oils - the problem was caused by unregulated cartridges with brand names such as Dank Vapes.

The legal vapes have been actively regulated by FDA since Aug 2017. FDA has conducted thousands of inspections of manufacturers and vape stores, published manufacturing guidance, sought product removals etc. These tragedies point to illegal vapes and THC. https://t.co/DYiFGYYxmy

— Scott Gottlieb, MD (@ScottGottliebMD) August 28, 2019

However, it is important to ensure that you only buy e-liquid from reputable suppliers, and never buy it on the black market or off the street. After all, regulations can only protect you if you buy regulated goods!

Study linking mice and cancer

Media reports have claimed that vaping leads to lung cancer. This is based on studies exposing mice to vapour.

UK scientists have been quick to criticise the study. Slides from UCL scientist Dr Lion Shahab (you can see one below) claim that:

1. The mice were exposed to vapour containing 36mg of nicotine (nearly double the legal limit in the UK), continuously for four and a half hours a day, five days a week. 2. The mice used were specifically bred to develop lung cancer. In fact, it wasn't just the mice that were exposed to vapour that died - mice not exposed to vapour died too. 3. In general, we need to be very careful of animal studies - the average rate of successful translation from animal models to clinical cancer trials is less than 8% (Mak et al, 2014).

#SommetVape ⁦@LionShahab⁩ eviscerating the recent mouse-cancer study The mice were from a strain more prone to cancer, those exposed to fresh air only also died, etc pic.twitter.com/MIO9yCckHT

— Louise (@grannylouisa) October 14, 2019

The sentiment was reiterated by Dr Sarah Jackson:

On *that* #inmice #vaping study:

"FVB/N mice spontaneously have 20% lung cancer at 1yr and 55% at 2yrs . Tang chooses these mice to expose them to the equivalent of 450yrs of overheating vaping & concludes in 22.5% of cancers that it is the vape causing the cancer.Not true!" https://t.co/Yc5UNUFwOe— Sarah Jackson (@DrSarahEJackson) October 9, 2019

I’ve heard that adverse reactions linked to vaping have been reported?

In fact, it’s a very positive sign that in a country with over three million vapers, almost all of whom smoked for years before switching to vaping, we have had less than 25 reports a year of adverse effects (Source: Action on Smoking and Health Wales). For comparison, the use of paracetamol leads to 100,000 hospital admissions a year (Source: Public Health England).

It’s also worth remembering that just because someone vapes, and gets an adverse effect, it doesn’t mean they had an adverse effect because they vape. After all, almost all vapers previously smoked, and many will unfortunately experience ill-health from decades of cigarette use.

It’s the old cause v. correlation issue - if A happens, and then B happens, it doesn’t mean that B happens because of A.

[caption id="" align="alignnone" width="459"] Image from xkcd[/caption]

Lipoid Pneumonia

1. Lipoid pneumonia is caused by the use of lipoids (fat molecules).

2. Because there aren’t lipoids in regulated e-liquid, vaping regulated UK e-liquids CAN NOT cause lipoid pneumonia.

3. Professor Polosa has examined two reported cases of Lipoid Pneumonia attributed to vaping. He has found alternative causes for Lipoid Pneumonia in both of the cases. Professor Farsalinos also pointed out to me that there have been a handful of cases of pneumonia allegedly linked to vaping over the last decade. However, if vaping was in fact a cause we would have seen many more in a world where millions of people have vaped for a number of years.

However, customers should always ensure that they buy regulated e-liquid from reputable suppliers. You can see a list of registered retailers on the MHRA site here. Customers should be careful when mixing their own e-liquids, as ingredients not specifically designed for vaping may not be not safe for inhalation.

Also see: Vaping and Lipoid Pneumonia 

We don’t know about the long term effects of vaping

Rather than wait 50 years and let half of all smokers die early from something that is certainly hugely harmful, let's focus on what we do know.

1. The key ingredients in e-liquid have been well studied for decades and are considered safe to inhale. See Propylene Glycol and Vegetable Glycerine for more information.

2. There is a very encouraging longer-term study looking at the impact of using electronic cigarettes. This followed a group of vapers for three and a half years and has found no respiratory harm or signs of early lung disease. Sources: Study: Nature| Interview

Another study has shown that smokers switching to vaping experience harm reversal from some respiratory illnesses, such as COPD. Sources: Study: Discovery Medicine | Interview

Don’t forget: The science tells us that people smoke for the nicotine, but die from the tar.

I heard menthol is bad for you

One study examined menthol e-liquid and concluded it was harmful. However, the study that claimed this looked at ingredients in one e-liquid flavour, but didn’t look at what was in the vapour produced. That's important, because it's the vapour that we absorb into our bodies.

Real world data is showing there are far fewer toxins in vapers’ bodies than in smokers. (Source: NHS.)

It’s important to do what Public Health England is doing, looking not just at the headlines generated by a study but at the quality of the research.

(p.s. I'm a menthol vaper - 11 years and counting!)

I heard vaping is bad for the heart?

This could relate to one of two studies which have been reported recently in the news.

One study claimed vapers are more likely to have heart attacks, but in fact many of the vapers in the study had heart attacks before starting vaping. Source: Reason

The second, which involved a UK academic who is vehemently anti-vaping, brought together a group of studies and discarded ones which were funded by sources the researchers didn't like.

However, as we can see from the previous study, it is key to look at the quality of the research behind the studies. After all, there are many sources of bias, and much vaping research is funded by groups who are anti-vaping.

Youth vaping

Responsible retailers use online Age Verification and a Challenge 25 policy to minimise the chances of sale to children. Some independent companies want to go further, calling for a licensing system for the sale of vapes. In order to avoid a licensing system and to minimise the sales of vapes to children, it’s important that trading standards enforce existing age restrictions on all vape sellers.

Still, children manage to purchase drugs, tobacco and alcohol, so it’s unlikely we will be able to completely stop children from buying vapes. However, some children, as they always have done, are inclined to rebel and experiment. Fortunately, the data so far is very reassuring.

For example, a 2019 Action on Smoking and Health report found that of young people aged 11-18 years old who have never smoked, 5.5% have tried e-cigarettes, 0.8% are current vapers and only 0.1% vape more than once a week. Not a single young person who had never smoked reported vaping every day. Source: Action on Smoking and Health.

This may be because much experimentation is being done with zero nicotine e-liquid, or because the nicotine in e-liquid is not combined with alkaloids found in tobacco which are known to contribute towards cigarette addiction.

At the same time, youth smoking rates have fallen dramatically since the introduction of vaping. (Source: NHS.) It is possible that vaping may have a protective effect against smoking (i.e. children who would have taken up smoking experiment with vaping instead.)

Cannabis in vaping

It’s difficult to use cannabis in vapes built for nicotine e-liquid, and most users would buy specific devices built for using cannabis rather than adapting the legitimate, regulated product the responsible industry sells.Besides, you can’t demonise a regulated industry based on how a product could be misused or adapted, or you’d have to ban thousands of products including bleach, cars and flour.

Vaping causes Popcorn Lung

Popcorn lung is a serious disease which has been caused by the use of extreme levels of diacetyl in popcorn factories. Diacetyl is found in cigarettes but is not known to cause popcorn lung in smokers.Diacetyl is not allowed under the EU vaping regulations and is tested for in emissions testing. Diacetyl may be used in e-liquid sold outside the UK, but when detected has typically been at a fraction of the level of that in cigarettes.

Isn't addiction to nicotine still bad?

There are two points to mention here.

Firstly, for many vapers and smokers, the choice is not between air and vapour, but between smoke and vapour.

We know that smokers smoke for the nicotine but die from the tar and carcinogens, so just as we encourage people having sex to use condoms, we should encourage smokers who can’t or don’t want to quit nicotine to use it in its least harmful forms. Neither eliminate all risk but both are vastly safer.

Secondly, there’s evidence that nicotine on its own is not as addictive as nicotine when combined with alkaloids found in tobacco.

Some objections to vaping and nicotine use seem more based on morality rather than on health concerns. In a recent discussion at the Public Health Wales, conference one British Heart Foundation representative repeatedly told me: "But vaping delivers nicotine, and nicotine is a drug. We don't want people to use drugs." (And yes, he drank coffee.)

But it's not fair to impose this morality on other people, especially when that drug, when used in the right form, has the potential to save lives.

What to do?

With millions being pumped into a campaign against vaping, we can expect misinformation to continue. In fact, some anti-vape campaigns seem to have taken a line out of an infamous quote:

If you tell a lie big enough and keep repeating it, people will eventually come to believe it.

In order to help smokers make informed choices, rebut myths and to stop vapers from reverting to cigarettes which cost an average of ten years of life, we need to stay informed.

But to win the propaganda war, we’ll need to do more. And while we need to be able to defend vaping, we shouldn’t always be on the defence. Vaping has changed millions of people’s lives for the better, and we need to get out there and tell that story.

What other questions and myths are you coming across? Do let us know in the comments :)