We ignored evidence linking cigarettes to cancer – Let's not do that with vaping | Hacker News Reader

We ignored evidence linking cigarettes to cancer – Let's not do that with vaping

theguardian.com

73 pointsDanBC91 comments

I don't think anyone's ignoring evidence with vaping.

Rather, vaping is (from what we know so far) legitimately a far, far healthier alternative to smoking cigarettes. The biggest health risk by far isn't the nicotine, it's the smoke, which vaping doesn't have.

It's been framed as a public health question since the very beginning: do the population-wide large health benefits of smokers who can't quit then switching to vaping, outweigh the (as currently understood) much smaller potential health problems with vaping, but which may be taken up by many people who otherwise wouldn't smoke at all? It's a balance of harms.

What I've heard about Juul addiction among college-age kids sounds a little scary. (But then in my generation it was scary binge drinking, and that's fallen significantly over the past 10 years.)

But at the same time, I've seen friends finally be able to give up smoking for vaping, which can only be a good thing given what we know right now.

Vaping causes nicotine addiction which has the secondary risk using of tobacco products later in life. In other words ecigs is a gateway to smoking.

Youth Who Use Vaping Products Are More Likely to Smoke Cigarettes, Increase Use of Both Over Time

https://www.rand.org/news/press/2018/10/02.html

Specifically, vaping with nicotine causes the nicotine addiction. But there's a really awesome alternative: you can vape nicotine free. Any decent vape shop will let you pick out the strength that you like, and 0% is an option. One of my roommates did just that, because he liked the social benefits: getting to pretend he was a dragon, hanging out with his other friends during their smoke breaks, etc.

Of course this doesn't solve any potential other problems with the practice (the popcorn lung scare from a while back comes to mind) but in theory, if you simply must smoke, it's possible to do so without any nicotine at all.

The real long term danger here might be to get an entire generation hooked on vaping as a safer alternative, then remove vape devices from the market. That's a whole lot of potential new customers (nicotine addicts) for traditional cigarette companies.

If vaping is ever removed, I would think cigarettes would go with them.

In what world would vaping devices not be sold, but cigarettes?

Recent comments about regulation lead me to believe it is possible. The government has already pushed to remove Juul from gas stations while leaving cigarettes. Maybe it is far fetched to say this approach could be expanded but I’m not so sure anymore.

Vaping is illegal in Thailand, but cigarettes aren't

Vaping is banned in Thailand. And guess why? Right, because cigarette companies were threatened and they lobbied the government.

Correlation, causation. That link provides nothing to say that vaping leads to smoking apart from the say-so of their analyst. It’s equally possible that their smoking leads to vaping.

> vaping is (from what we know so far) legitimately a far, far healthier alternative to smoking cigarettes.

Cigarettes kill 50% of long-term users. It's reasonable to use that as the comparison if you're discussing smokers switching to vaping but it's crazy to use that as the basis of comparison for new vapers.

I am having trouble believing this figure. Lung cancer incidence for heavy smokers is 20%. Where do the other 30% of deaths come from?

Perhaps emphysema and heart disease?

It's mostly cardiovascular disease. The CDC has a breakdown of yearly smoking deaths[0]. And the 50% number comes from the WHO[1].

[0] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

[1] https://www.who.int/news-room/fact-sheets/detail/tobacco

Respiratory diseases under the umbrella term COPD (which includes emphysema) are another large category represented in that table. And alas, in my family.

The highest risk of death from smoking is due to coronary artery disease. The chemicals irritate the vessels, causing atherosclerosis.

One would think, might even have been taught, that the tar clogs arteries. But the "chemicals" also lead to cramps, tension, increased heart rate, shallow breath. Perhaps that's one "stimulating" effect of nicotine, so vaping wouldn't help.

PS: I still think that nicotine alone isn't responsible for the addiction, but the warming, though consequently chilling effect, and the oral stimulation, that may affect neural pathways related to eating and drinking. And, arguably this counts all the more if it can be made to taste like apple, though cigarettes get flavors add from vanilla over cinnamon, honey, licorice and I don't wanna know what else, too.

Funny how people want to insist that vaping is not good but “less bad than smoking.” You know what’s even better than vaping? Not vaping.

Cutting off your finger is not as bad as cutting off your arm. But I prefer not cutting off my finger.

> vaping is (from what we know so far) legitimately a far, far healthier alternative to smoking cigarettes

> given what we know right now

You are making assumptions and drawing conclusions based on what you don't know. That's exactly what doctors used to do when they smoked in hospitals and what vocalists did when they claimed that smoking gave their voice a rich, deep sound.

It doesn't seem like the effects, good/bad are being ignored. A little over a year ago, the british ministry of health conducted a very large study which concluded that vaping is not health, but its approximately 95% less harmful than cigarettes.

Care to share a citation on the study?

https://www.gov.uk/government/news/e-cigarettes-around-95-le...

There's an update to the 2015 report from Public Health England (PHE) published in 2018:

PHE publishes independent expert e-cigarettes evidence review https://www.gov.uk/government/news/phe-publishes-independent...

This video demonstration from PHE provides a striking comparison between smoking and vaping. Perhaps unintentionally, the video might make people who vape to view it as a relatively safe practice (it's much safer than smoking, but still detrimental to health):

https://www.youtube.com/watch?v=RisBe5sLGPc

PHE are doing a pretty good job I think.

They're telling smokers that vaping is much better than smoking. They're telling shops not to sell vaping supplies to people who were not previously smokers, and that self-regulation while inconsistant seems to be working okay at the moment.

Indeed, if we judge by discussion in the news and proposed legislation, people are falling over themselves to warn about the risk of vaping (often barely mentioning that we have very little data and strong theoretical arguments that the risks should be much less than for cigarettes).

the risk for a non-smoking teenager who picks up vaping definitely increases because there was not any risk before (as the article points out, we went from 0% vaping teens to 20%), and the nicotine will likely produce some fraction of smokers down the line.

And we all know that Juul styles itself as a tech brand that looks cool for a reason, and they're being investigated by the FDA for their teen targeting social media campaigns already.

So really there is a false dichotomy in this discussion where vaping risks are compared to smoking. They should be evaluated in the light of not inhaling toxic substances at all.

> the risk for a non-smoking teenager who picks up vaping definitely increases because there was not any risk before (as the article points out, we went from 0% vaping teens to 20%), and the nicotine will likely produce some fraction of smokers down the line.

Are you just pointing out that since some activity that didn't exist before has a non-zero risk, one class of risks are going up? This is not a good argument for saying that total risk is going up, or that that activity should be suppressed.

> And we all know that Juul styles itself as a tech brand that looks cool for a reason

Starbucks tries to loop hip and trendy, but really they're just selling an addictive drug too: caffeine. And they sell it to children. They even sell hot chocolate, which is a sweet drink that appeals to children who wouldn't normally drink coffee, but is served very similar to coffee and is derived from some of the same ingredient. Once Starbucks gets them in the habit of getting hot chocolates, they graduate to coffee as they get old.

> They should be evaluated in the light of not inhaling toxic substances at all.

Caffeine and nicotine are both addictive stimulants, and nicotine is stronger, but neither are "toxic" in any reasonable sense.

It's most telling that the two writing this piece are from the US. British medical opinion, and previous Guardian pieces, seem to boil down to it's good as it's not tobacco and that vaping is far more successful at getting people to quit whilst dramatically less harmful.

The "common knowledge" around vaping is dramatically different on each side of the Atlantic

The British have skin in the game via the NHS. In the USA, adverse health affects due to smoking are masked via higher insurance premiums while states reap sin taxes; in the UK reduced smoking is a public cost savings measure. It makes sense that the views would differ due to different self interests.

Good point, hadn't looked at it quite like that. Does the surgeon general still put out scary warnings?

It's fair to say vaping has had huge and surprising impact on smoking in the UK, it's now become really rare to see a smoker. It's now an occasional surprise when you catch a whiff of tobacco in the street.

It helped that cigarettes have been progressively taxed to nearly unaffordable (not sure, but I think a pack of 20 is now comfortably over £10). At the same time tobacco has been hidden in ugly packaging and no visibility is allowed in stores.

Yeah, a 20 pack is now well over a tenner. It’s great. I do not smoke at all in the uk now, where I currently predominantly live, as the cost is just nuts. £4000 a year or so if you’re on a pack a day, which is where most active smokers sit. I now vape, spend about £200 a year on it.

I will confess that I do still smoke if I find myself in a country where vaping is illegal and the cigarettes are 50p a pack, as I am still a nicotine addict, but I would much rather vape. Cigarettes make my lungs hurt. Vaping doesn’t.

So, unless it turns out that vaping is somehow worse than smoking, this is a resounding public health policy success. My behaviour and the scarcity of smoking you note underscores this.

In Australia, a pack is around $25!

Taxation helps, but states are loathe to tax so much that they actually decrease demand more, they are addicted to the extra revenue and don’t want to see that go down. But society still loses out in the long run, whereas in the UK and Australia, the costs of smoking are all socialized, so sin revenue isn’t as appealing.

That's innacurate. The US government spends more on healthcare per person than the UK; so the public cost saving would be higher in US, despite the lack of universal healthcare.

I don’t think that is true either, as 50% of healthcare spending in the USA is private. Actually, you could be right, but I would want to see some evidence before I was convinced.

Having lots of people take up e-cigarettes is not a bad thing if they are moving away from smoking tobacco. On the other hand, if lots of teenagers take up e-cigarettes (with nicotine) then that is a public health disaster; and will cost millions of lives. So there could be an actual difference in health effects in different countries, which would be a reasonable basis for the difference in perception.

Note that the UK has active public health campaigns to quit smoking [0] and tougher laws on advertising than some parts of the world [1]. Having said that, an awful lot of UK teenagers have smoked e-cigarettes[2], so perhaps we're just complacent.

[0] https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes

[1] https://www.asa.org.uk/advice-online/electronic-cigarettes.h... http://www.bbc.co.uk/newsbeat/article/38978119/santa-claus-v...

[2] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan... 2017: 16 to 24 year olds: 32% had experimented, 17% had previously smoked e-cigs, 5% were current users.

Edit: I forgot to add that there are different limits on nicotine content.

> if lots of teenagers take up e-cigarettes (with nicotine) then that.. will cost millions of lives

That's quite a claim. Based on what? Can you point to any deaths reasonably believed to be caused by nicotine consumption from vaping?

There will be two main mechanisms:

The first is the direct effects of nicotine (and possibly the vaping mechanism). The figure being bandied about on this thread is that vaping is probably 5% as directly dangerous as tobacco.

The second is that teenagers and young people who vape (with nicotine) will get addicted to nicotine and are more likely to smoke tobacco.

Smoking currently kills more than five million people a year[1], 5% of that would be more than 250,000 deaths a year and so a million deaths every four years. If vaping is taken up by young people on the scale that smoking tobacco is then millions of premature deaths is a conservative estimate, given what we know now.

[1] https://ourworldindata.org/smoking

edit: typo

> an awful lot of UK teenagers ... 16 to 24 year olds: 32% had experimented

That's not so surprising - when vaping was newer, even many non smokers tried a hit or two of that strange blackcurrant flavoured thing a friend was using. Without taking up the habit later.

> 17% had previously smoked e-cigs, 5% were current users

Compared to something like 20 or 25% UK school leavers smoking previously? That seems like a clearer win than would have been predicted, or even hoped for as best case. Wouldn't surprise me if 5% is lower than weed use in the same age group. Zero is surely unachievable, as some kids are always going to use something - ecigs will be far better than tobacco or sniffing solvents.

I spoke to a number of researchers several years ago before vaping really became so mainstream.

To be honest a number had a rather surprising view: if it has nicotine in it then it must be bad.

I formed my own opinion back then: the researchers did not seem that inretested in the effects of vaping and preferred to instead just associate it with cigarettes.

This article talks about us not knowing the long term effects (which is true) but then goes on to regulating vaping. Why not advocate for more research instead?

I don’t think vaping is without side effects but it’s my personal view and I have no scientific basis for it. But we should be doing more research before we clamp down on it.

Given that nicotine has been known to have harmful effects since the first time it was isolated, nearly 200 years ago [1], that is not an unreasonable approach to take. Just because it is being delivered in a slightly different mechanism doesn't mean that the previous research in entirely inapplicable. If I know that banging my head against a brick wall hurts, it is reasonable to assume that banging my head against a wooden wall will also hurt.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

Articles like this always ignore the other side of the issue. Assuming half of vapers would be non-smokers, then every time we eliminate two vapers through clamping down on vaping we generate a cigarettes smoker.

And cigarette smoking is one of the worst public health hazards.

Nicotine itself is bad.

Yes, it's probably much better for you to not inhale hot smoke particles in your lungs and all the other ancillary chemicals from cigarettes, but if vaping is undermining decades of hard-fought progress against the single largest preventable cause of death globally (responsible for ~30% of cancer deaths) by bringing in new smokers and reducing the urgency to quit among current smokers I can see how public health officials would be cautious about embracing it.

Smoking-related cancer is mostly due to nitrosamines. Nicotine can have adverse effects on heart, pancreas, and blood vessels, but replacing sooty nicotine inhaling with non-sooty is less cancer-risky.

Addiction aside (looking at you too caffeine)... how is nicotine bad exactly?

Nicotine itself promotes tumor growth and metastasis. It increases your risk of getting cancer.

This is dumb because I vape thc or cbd but never nicotine. I still want to know if it's harmful.

Why is that surprising? The negative effects of nicotine are well known and extensively documented and tested. It's not hard to find, see https://en.wikipedia.org/wiki/Nicotine.

Smoking is worse than getting nicotine from other than tobacco related substances like a juul. But n. on it's own is a deadly substance. Please see this article:

Increased clotting tendancy, atherosclerosis, enlargement of the aorta, passes into the milk to infants, also: (didn't copy all the references)

"Nicotine induces both behavioral stimulation and anxiety in animals.[4] Nicotine addiction involves drug-reinforced behavior, compulsive use, and relapse following abstinence.[18] Nicotine dependence involves tolerance, sensitization,[19] physical dependence, and psychological dependence.[20] Nicotine dependency causes distress.[21][22]"

Someone wants this?

I think we are going to have much better evidence on e-cigarettes, and by association, vaping, soon. NIH recently established and started producing a standardized nicotine and placebo e-cigarette for researchers to use. A big barrier to studying health effects was not being able to compare studies.

https://www.drugabuse.gov/funding/supplemental-information-n...

People should just learn these 2 simple facts and stop focusing on just one of the pair: 1. vaping is not healthy. 2. vaping is much healthier than smoking (as long as you use a liquid that doesn't contain nasty chemicals that cause popcorn lung syndrome, e.g. diacetyl).

Whoever smokes and doesn't consider quitting as an option should try switching to vaping, whoever vapes should consider quitting as whoever smokes should, whoever doesn't smoke and doesn't vape should better avoid starting either.

> use a liquid that doesn't contain nasty chemicals that cause popcorn lung syndrome, e.g. diacetyl

The levels of diacetyl found in (certain) vape liquids are probably not a concern. Cigarette smoke contains much higher concentrations of diacetyl and popcorn lung doesn't appear to be endemic in smokers.

Indeed most of the cases in medical literature seem to involve factory workers who were exposed to high amounts of diacetyl, plus a handful of people who consumed massive amounts of microwave popcorn. Are there any observed cases of popcorn lung in smokers?

Interesting. Thanks. Perhaps the idea of particular vaping liquids causing popcorn lung is a myth too. Here's an article I've found that includes some references to research: https://www.snopes.com/fact-check/vaping-causes-popcorn-lung...

I’m not a scientist but I simply can’t imagine that vaping a full JUUL cartridge and smoking a pack of cigarettes is even remotely the same.

Does the factor matter, if both are unhealthy enough to be a problem?

Of course degree matters. Healthy and Unhealthy are not binary categories.

Both alcohol and meth are harmful to health, but the degree makes one manageable and the other not.

Obviously? Dosage makes the poison.

Yes, it matters because the government has an interest in improving the public health. When you reduce access to vaping that decreases the number of vapers and increases the number of smokers. So the relative risks of each are important in deciding how much you want to promote/restrict access to vaping.

If vaping is just as bad as cigarettes than you probably want to make vaping really expensive and hard to get. If it's completely risk free you'd want to subsidize vaping and make sure it's available at every store. The best evidence looks like it's 5%-10% as deadly as smoking which means we probably don't want to restrict it too much.

If 60 people get addicted to juul, and only 20 gets addicted to cigarrets, there is a problem.

Cigarrets are so strong and disgusting that it is really hard to start. You really need to want to look cool as a teen to start smoking cigs.

Juul is just so easy to smoke, and the flavors make it awesome. It's insane how different the two products are in term of awesomeness.

So if juul is bad for health, the next generation is in deep deep trouble

Inhaling nicotine is very harmful to your heart. Repeated doses of a stimulant can cause heart disease, and about as many smokers die from that as lung disease. With vaping, even more nicotine is delivered immediately to the system. It seems that this would have the same negative consequences on cardiac and vascular health. Why is that not more often discussed? It seems like this risk alone is enough to declare vaping to be unsafe.

Because most of the cardiovascular risks of smoking aren't related to nicotine.

How do the CO risks compare with the nicotine risks? Because nicotine on its own does raise your blood pressure substantially.

This article argues that nicotine barely increases blood pressure, and nicotine replacement therapy is therefore safe in hypertensive individuals.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1524-6175...

What would they be related to, then? Other chemicals, or degraded respiration?

The chemicals produced from burning the tobacco and additives.

Combustion in general produces a bunch of nasty chemicals.

And do you know of any specific chemicals that would be? Don't we have to prove that they harm you, same as nicotine?

Interesting, could you link some research where I can dig in more? I have read that nicotine itself is not harmful, about on par with caffeine. I’m interested in reading more about the risk of inhaling it.

I don't research this professionally or as a hobby. Your googling would be as good as mine.

I tried to find evidence for your claim and could not. So, I downvoted you.

Gosh, that's personal. I'm going to assume you mean that you downvoted my comment.

Here, I found this after approximately 15 seconds of research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

"Nicotine poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is decreased immune response and it also poses ill impacts on the reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents. The use of nicotine needs regulation. The sale of nicotine should be under supervision of trained medical personnel."

The ease of locating this leads me to believe it would be simple to find additional support for the idea that nicotine is not entirely benign. I am not going to take the time to do this, even though that risks a downvote on HN.

> about as many smokers die from that as lung disease

Heart disease is the leading killer in the US. Are you saying the number of excess deaths among smokers (over the baseline in the non-smoking population) is roughly equally distributed between heart disease and lung disease? Can you give a cite?

Around a third of smoking related deaths are from any cancer (not just lung disease), a third from heart disease, and a third from COPD. The most recent attorneys general report has the exact estimates.

Overall though, cancer is what I’d be by far the least concerned about with respect to vaping.

Can you cite any sources for this? AFAIK nicotine is not too different from caffeine as far as stimulants go. It’s demonized due to cigarettes.

Nicotine is far worse than caffeine.

It basically works as an accelerant, stimulating and encouraging tumor growth and metastasis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915512/#S7titl...

"Nicotine, which is the addictive component of tobacco smoke, is unable to initiate tumorigenesis in humans and rodents; at the same time, nicotine has been shown to promote tumor growth and metastasis by inducing cell cycle progression, epithelial-to-mesenchymal transition (EMT), migration, invasion, angiogenesis, and evasion of apoptosis in a variety of systems (8–13). In addition, nicotine has been shown to induce secretion of growth factors and cytokines altering the physiology of multiple organ systems (8–13). These observations suggest that nicotine likely contributes to the progression and metastasis of tumors that are initiated by tobacco carcinogens."

Caffeine would be far worse for you if inhaled versus oral ingestion due to how quickly it affects your body. The same is true for cocaine or amphetamines, all of these drugs falling under the category of CNS stimulant. Oral cocaine would be far safer than the ways it is commonly used. Similarly, oral nicotine would be much safer.

Then where is the similar outcry against caffeine consumption? It's a stimulant too, so if we're going with the unscientific theory of "stimulants cause heart disease" then coffee consumption should be an alarming public health crisis.

There is concern about coffee for various reasons. But the main difference here is that you don’t smoke coffee, or caffeine in general. See info on meth for why smoking stimulants is worse for your heart than oral ingestion.

Not everyone vapes with nicotine though.

Agreed. I doubt if there’s much risk in vaping CBD, for instance.

well, seems like it’s not true with coffee.

my understanding of the risks of heart disease and stroke affiliated with smoking is that they’re primarily due to the fact that regular smokers are living their lives in a permanent state of mild carbon monoxide poisoning. CO has a time course on the order of about 10 hours, so if you have more than two smoke breaks a day, your hemoglobin supply is semi-permanently compromised ...

People don’t smoke or vape coffee. When you ingest a drug orally, it typically takes many minutes or even hours to take effect, versus minutes or seconds for smoking. This principle is well known in studying things like cocaine abuse. Slower onset is less damaging to your body systems and also less likely to create addiction.

I vaped for 6+ months as a "nootropics" stimulant to augment caffeine intake.

Could I code/work one more hour per day? Yes, usually.

But the trade-offs were insomnia, irritability, and anxiety.

It wasn't until I quit cold turkey that the effects of nicotine withdrawal really kicked in. I felt like crap for days.

Sure, e-Cigarettes are a far better alternative than their counterpart. But the addictive quality, and recurring financial investment are very real.

I feel that the culture that builds up around things like vaping, marijauna, etc. are far more overreaching than the health effects itself on the individual. Because a culture has built up around it, easily influenced people, especially those who are younger, willingly take part in something that can/will worsen their health just because it is trending and 'everyone else' is doing it and it's 'safe'. Yes, marijuana and vaping are not as bad as cigarettes and other things. But I find using that as a justification is concerning since they can still bad right? Weed may have not ever killed anyone, but have you seen stoner culture? Let's say marijuana itself doesn't make you dumber or lazy, but stoner culture certainly will.

You can justify anything if you have something worse to compare it to. Now it's weed or vaping, in the future it may be something else.

Reminder that mainstream media pieces and non profits against vaping are being funded by tobacco companies.

In my opinion, way too many people bend over backwards to defend the rise of vaping through the lens of "better than cigarettes" equating to "healthy".

My view - just like my view with marijuana - we need to do a better job of quantifying the negative impacts of addiction. It is fundamentally a bad thing for your body to be addicted to something, and we normalize that view by engaging in whataboutism; oh, it's just coffee, it's just sugar, it's better than cigarettes and on and on.

There hasn't been enough research on it, it's certainly more opaque for consumers to really know where the ingredients are being sourced and how much nicotine they're actually receiving. These are all bad things, even if it's "better" than combustibles.

That's of course in addition to the extreme shittiness of these companies blatantly advertising to kids, but that's another argument altogether.

What blatant advertising to kids, tho? The only time I ever see vape ads, it's in store promos for Juul and the only copy is along the lines of "Satisfying alternative for adult smokers"

Also GMO, 5G, advert effects of vaccination, misprescribing and overprescribing of drugs, bad diets, lack of exercise... lets not ignore.

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