Is vaping dangerous or not? And is the World Health Organisation misrepresenting evidence?

"E-cigarettes can damage the brains of teenagers and harm growing foetuses, the World Health Organisation has warned."

This was but one “scary” headline to appear following an unusually forthright press release from the WHO on the subject of e-cigarettes/vaping. And, notably, the odd format of its press document, in a question and answer style, was not backed by any new research or high-powered commission report.

For those of us who follow and interact with the WHO on a weekly basis, it is an unusual move for the UN agency. More PR than medical science. But there can be no doubt about the damning message: it said the electronic nicotine delivery devices (ENDS) are harmful to health and not safe – adding that it’s not clear whether they even help people quit smoking.

Here’s a flavour of the document: “ENDS increase the risk of heart disease and lung disorders. For pregnant women, ENDS pose significant risks as they can damage the growing foetus. ENDS also expose non-smokers and bystanders to nicotine and other harmful chemicals. The liquid in ENDS can burn skin and rapidly cause nicotine poisoning if swallowed or absorbed through the skin. There is a risk of the devices leaking, or of children swallowing the liquid, and ENDS have been known to cause serious injuries through fires and explosions.”

Election 2020: Questions to ask canvassing candidates on health

---

My teenager can’t bear the sound of us chewing at dinner

---

‘Pilates made me more aware of how my body works’

---

Making ‘outsiders’ feel at home is child’s play

---

Invented in 2003 by Chinese scientist Hon Lik, the electronic cigarette delivers nicotine through an aerosol of propylene glycol and glycerin, rather than via the combustion products of dried tobacco leaves. Battery-powered, the earliest devices incorporated an LED which glowed red like a cigarette when the user inhaled. Despite subsequent changes in size and design, e-cigarettes are essentially made up of a chamber containing soluble nicotine, an atomiser and a sensor which activates a heating element causing the nicotine to be vaporised ready for inhalation. The consumer is referred to as a “vaper”.

A significant transatlantic divide had opened up about the harms or benefits of e-cigarettes. But the chasm grew even wider last week when the new WHO warnings promoted a strong reaction from public health experts in the United Kingdom, who argued that the WHO was spreading "blatant misinformation" about the potential risks and benefits of e-cigarettes.

Language like that is not part of usual scientific discourse. It reflects a growing divide between some US scientists and public health experts in the UK about the value of e-cigarettes and the risks they pose, in particular to young people. The US experience has been markedly different, it must be said. After an outbreak of severe lung disease that's still ongoing, the Centre for Disease Prevention and Control in the United States now recommends that e-cigarettes "never be used by youths".

The acute lung disease epidemic has killed more than 50 people and made over 2,500 ill in America.

Across the Atlantic, however, the WHO press document was labelled “particularly malign”.

"There is no evidence that vaping is 'highly addictive'," Peter Hajek, director of the tobacco dependence research unit at London's Queen Mary Hospital, said. "Less than 1 per cent of non-smokers become regular vapers. Vaping does not lead young people to smoking – smoking among young people is at [an] all-time low. There is clear evidence that e-cigarettes help smokers quit," he added.

According to John Britton, director of the UK Centre for Tobacco & Alcohol Studies and a consultant in respiratory medicine at the University of Nottingham, "WHO misrepresents the available scientific evidence".

I have to say I am surprised at the WHO's one-sided intervention against a background of genuinely different views held by respected medics on both sides of the Atlantic. I just hope that whoever was behind the initiative sought backing from the office of WHO director general, Dr Tedros Adhanom Ghebreyesus. Watch this space – the vaping wars have just begun.

[ mhouston@irishtimes.com ]