The author is Associate Professor of Cardiovascular Health at the University of Exeter and chairs the board of BMA Science
smoking kills. In a world where doctors can’t achieve a consensus on other major health threats, this unequivocal fact is something we can all agree on.
Tobacco use is the biggest cause of preventable disease in the UK and is exacerbating the health gap between rich and poor. It damages blood vessels and increases the risk of coronary heart disease, stroke and dementia, while it is responsible for about 70 percent of lung cancers – as well as cancers of the mouth, throat, esophagus, bladder, intestines, kidneys, liver, stomach and pancreas. Secondhand smoke increases the risk of lung cancer by about 25 percent, with devastating effects on the health and development of children and a disproportionate impact on the already disadvantaged.
Helping people to quit smoking is one of the most beneficial things we can do and we use whatever tools are available. Sitting in my acute stroke clinic, I discuss why people smoke. If that’s the taste, we give the gum a try. For cravings, nicotine patches. And if this is the whole ritual, including the “blow” received from the drawing on the cigarette, then electronic cigarettes are recommended. Vapes are one of the best modern treatments for cigarette addiction, but I am concerned about the lack of long-term data on e-cigarettes, which were only introduced to the UK market in 2007. Have we moved patients from a lifetime of tobacco exposure to a lifetime of exposure to a delivery method Nicotine with unknown long-term consequences? And compared to the 5,000 or so chemicals and 70 proven carcinogens in tobacco, I’m confident the switch is a positive health move.
But at no time in the stroke clinic did I feel the need to discuss flavored gum. No patient recovering from a heart attack rejected the need to quit smoking until he was offered a cherry-scented medicine. The color of the packaging is never the deciding factor in getting someone to focus on the effect their habit has on their children. Quite the opposite, in fact.
An individual looking to overcome his or her addiction to smoking for the benefit of his or her family is unlikely to want the weaning technique he or she chooses to be more attractive to children than to them. However, the commercialization of vaping, rather than the medical one, has led us down a strange path: these products are now a devastating mass phenomenon everywhere.
There is no reason to produce flavored e-cigarettes with bright packaging designs, unless they appeal to children. Highly addictive and nicotine-containing products should not be marketed to anyone, let alone young adults. In 2020, menthol cigarettes have been banned in legislation focused on discouraging young people from smoking. But at the time, it was perfectly legal for companies to give kids free, single-use flavor samples to entice them. That these “starter packs” are nicotine-free is little consolation—they can serve as a gateway to long-term nicotine use. Prime Minister Rishi Sunak announced this week that the loophole will be closed.
My public health colleagues tell me that vaping is one of the greatest threats to future generations. Given the level of marketing and promotion of vapes, they are also one of the most easy to handle. They report an increase in e-cigarette use in 11- to 15-year-olds from 6 to 9 per cent over four years, and a doubling in use in 11- to 17-year-olds since 2014. The availability of illegal products in the UK is also concerning. . The children were found in possession of illegal fumes, with potentially carcinogenic levels of lead and similar volatile organic compounds.
The £3 million Illegal Vape Enforcement Squad is a welcome start to getting this under control. We welcome in-school wellness programs and stop free samples for kids, but it’s not enough. The BMA calls for the same restrictions on packaging as for tobacco products, mandating a single color and font and making it illegal to display products at points of sale. Flavors should also be limited, in line with regulations for tobacco products.
E-cigarettes must have appropriate health warnings. Vaping is not without risks. At the very least, we know that nicotine is highly addictive. It has been shown to impair attention, learning, mood and impulse control in children and young adults. Many of the flavors, although safe for oral consumption, have an unknown effect when inhaled deeply into the lungs. Some legal products contain nickel, tin and lead in very small doses: in the long term, when inhaled, this may be linked to lung disease.
The effects are unknown at this point. For smokers, encouraging the swap to vaping undoubtedly reduces health risks. But here’s another unequivocal fact: We need to discourage people from vaping and completely stop them from being marketed and sold to children.
