Lethal vaping: the mysterious epidemic caused by electronic cigarettes

• Health: Nicotine-free electronic cigarettes are also harmful to health
• Regulation: US declares war on electronic cigarettes flavored with flavors

The story of Adam Bowen and James Monsees is one of those success stories that he likes to tell. It did not start in a garage but almost: two friends smoking a cigarette while they were turning to their final degree project, until they took the happy idea when they took their final draft: What if they designed a healthier cigar and, who knows, one that even allowed them to quit smoking? Thus was born Juul , the leading electronic cigarette company, of vaping. But sometimes dreams are truncated and become a nightmare. The US investigates almost half a thousand cases of a new serious lung disease not described so far, which has already claimed at least six lives, which is directly related to the use of electronic cigarettes and which is especially affecting young people.

"We believe that these cases are just the tip of the iceberg," explains Francisco Lozano, president of the European Network for the Prevention of Smoking, aware of the alarm raised by the news but also that "electronic cigarettes have been presented as harmless. And they are not. What they expel is not water vapor: it is full of toxic . The problem is that they are so new that we do not have yet on the table evidence of all the diseases that they can cause and that we will see in a few years ”, especially cancers that may take years to appear.

The alert in the US has caused the White House itself to announce yesterday its intention to restrict the sale of electronic cigarettes with flavors. «We have a new problem in this country called vaping, especially among innocent children. It is causing a lot of problems and we are going to have to do something about it, ”Trump announced.

César Minué, president of the Spanish Society of Smoking Specialists (Sedet), details that the new vaping disease has started with “respiratory symptoms, such as cough, shortness of breath, chest pain, accompanied by nausea, diarrhea, malaise or fever ». In Spain no cases have been registered yet. And the cause is still unclear. According to Esteve Fernández, director of Cancer Epidemiology and Prevention at the Catalan Institute of Oncology, "the latest reports from the FDA (the US drug agency) indicate that the people affected had vaped a derivative of THC (a cannabis component) purchased on the black market, which also contained vitamin E acetate, ”he says. "There is still no certainty as to what is the compound that has unleashed the disease."

Although a good part of the cases seem to be related to cannabis derivatives and the manipulation of burdens on the black market, the research does not rule out a widespread problem with vaping. Electronic cigarettes are in the spotlight, after years presented as a healthier alternative to conventional tobacco.

Esteve Fernández acknowledges that it is true that “in principle, electronic cigarettes contain fewer toxic substances [than conventional tobacco, as the industry defends] because they contain no tobacco and no combustion. However, they are not without risk, because the compounds used to vaporize nicotine and the flavors at low temperature become some toxic substances ».

They have presented themselves as harmless and they are not. What they expel is not water vapor: it is full of toxic.

Collage of Luis Parejo on an image of Che Guevara.

Something similar occurs in the case of new heated tobacco devices, type iQos. In these, instead of using a kind of liquid with nicotine and flavorings as is done in electronic cigarettes, tobacco is used, but only heated without allowing combustion to occur, which is the time when more toxic They are released. According to Esteve Fernández, «the aerosols of electronic cigarettes and iQos devices contain toxic substances that are not in pure air» and that affect not only those who use them but also those who live with vapers. Esteve explains that "we have detected nicotine, cotinine and nitrosamines derived from tobacco (substances that are carcinogenic), in the urine and saliva" of people living with vapers.

Very graphically, Minué explains that less toxic also does not have to imply much less mortality: «The concentrations of these toxic compounds are lower than in conventional tobacco smoke, but to what extent this minor release is specified in less damage we do not know . For example, smokers who reduce their consumption by half are exposed to less toxic, but mortality is not reduced . Even if vaping were less toxic, its expansion at the population level, with new vapers or consumers who smoke both electronic and conventional cigarettes could lead to a greater occurrence of diseases. For example, when the relationship between tobacco and lung cancer was known, filter cigarettes appeared, which could reduce the risk of lung cancer by half; the result was that false security caused more people to smoke and the number of lung cancers to skyrocket ».

His fear is not trivial. Sales of both electronic cigarettes and new heated tobacco devices do not stop growing. In Spain the iQos heated tobacco system, which has been the longest in the market, has already sold almost 200,000 devices, the Juul vaper has exceeded 50,000 electronic cigarettes in its first year in Spain and MyBlu, the other great brand of electronic cigarettes, has gone to the Spanish market involved in an aggressive advertising campaign that has lined the walls of meters and billboards giving image of a design and fashion product.

It has been precisely this aggressive advertising campaign that, even before knowing the deaths by vaping in the US, has aroused the alarms of scientific societies, which in unison have called on the Ministry of Health to act against it before the attractiveness it can represent to young people and the possibility of encouraging former smokers to reengage.

A legal change is needed to prevent the normalization of tobacco, be it traditional, vaping or heated tobacco

Carlos Jiménez, president of the Spanish Society of Pneumology and Thoracic Surgery (Separ), explains that the Ministry “has been sensitive to our request, but the reality is that there is a legal vacuum that allows them to make this publicity. A legal change is needed to prevent the normalization of tobacco, be it traditional, vaping or heated tobacco. In the meantime that change comes, which partly also depends on how Europe considers this type of products in the directives, the Ministry has chosen to try to counteract the aggressive campaign of the vapers with its own advertising campaign, in which it warns that vaping Kills just like tobacco .

Javier Valle, general director of Juul, leader in electronic cigarettes, denies the greatest danger about these products as a gateway to nicotine dependence for young people: «Since Juul we have established the strictest processes, going beyond current legislation, so that our product never reaches minors. We are an alternative for all those adult smokers who want to quit combustion tobacco ».

To this same idea the so-called Platform for the reduction of the Damage by Smoking is clinging. His spokesman, the oncological surgeon Fernando Fernández, insists that "most consumers of electronic cigarettes were previously smokers and use it precisely to quit smoking, including young people."

Strongly, Minué denies the arguments of the vapers: “There is no conclusive evidence that the new electronic devices help to quit smoking. On the contrary there are other treatments that have proven it. And in any case, its usefulness would have to be in a healthcare context, of help with healthcare professionals, not in a free commercial sale ».

And, far from helping seem to be hindering the abandonment of snuff.

There is no conclusive evidence that new electronic devices help quit smoking

Ángel López Nicolás, Professor of Economics at the University of Murcia and a specialist in tobacco economics, explains that «what studies published so far show is that a majority of consumers of these products also consume tobacco [traditional]. It is also estimated that about a quarter of young users of electronic cigarettes would not have started consuming nicotine if these systems did not exist . Scientific evidence suggests that electronic cigarettes attract smokers who want to quit smoking, but at the same time reduce the chances of success ».

The tobacco industry has seen its market die prematurely and has had to reconvert and invent something to engage young people. "It is clear that when they take out electronic cigarettes with mango and lime flavor, they are not targeting the adult market , but the youth market," says the president of the European Smoking Prevention Network. .

In Spain, the latest student drug survey (Estudes) shows that 21% of adolescents aged 14 to 18 have tried electronic cigarettes . And the most serious, even among those who have not tried it, more than half (63%) say they see no health risk in vaping, which gives an idea of ​​the misperception that is penetrating society.

Given this situation, scientists are clear: 60 medical societies have signed the so-called Declaration of Madrid, promoted by the National Committee for Smoking Prevention, which urges to equate these products for all purposes with traditional tobacco. This would imply banning their advertising (the current vacuum allows devices to be advertised because they are not tobacco as such) and prohibit vaping throughout the hotel industry - currently iQos type heated tobacco devices cannot be used in bars but electronic cigarettes can be used to vape with or without nicotine. Medical societies also ask for a tax increase. “In other EU countries, special taxes are applied to electronic cigarettes,” says López Nicolás. "The formula could be a specific tax per quantity of liquid". For heating tobacco, however, experts recommend adding a tax on the amount of tobacco.

And, above all, they ask to do it before the nightmare of Adam Bowen and James Monsees becomes the nightmare of the whole society.

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