LUNG FOUNDATION AUSTRALIA (LFA) recently released an ‘E-cigarette and vaping fact sheet’ strongly opposed to vaping. However, the document is deliberately misleading and misinformed and is likely to lead to an increase in smoking and therefore an increase in lung disease.

The lack of scientific rigour from a leading health charity is very disappointing, but it is not the first time. Earlier this year, LFA CEO Mark Brookes made the blatantly false claim that vaping nicotine is at least as harmful as smoking and claimed to have references to prove it. ATHRA wrote to the LFA Board for evidence to support the assertion but received no response.

Below we summarise some of the more egregious claims in the LFA ‘fiction sheet’ on vaping.

1. The LFA claims that the ‘95% safer’ estimate for vaping compared to smoking is based solely on a 2013 workshop of 12 people, some with links to the tobacco industry

LFA knows this is not true. This commonly quoted risk estimate is derived from comprehensive, independent reviews of the scientific evidence by both Public Health England and the UK Royal College of Physicians. Both organisations came to the same conclusion, PHE in 2015 and again in its second review of the evidence in 2018, and the RCP in 2016. The US National Academies of Sciences, Engineering and Medicine in 2018 also concluded that “While e-cigarettes are not without health risks, they are likely to be far less harmful than combustible tobacco cigarettes".

The 95% figure is not meant to be an exact calculation, but rather an estimate to communicate a ballpark of relative risk that is useful to the public. The exact figure doesn’t matter. The important message is that vaping is substantially safer than smoking. This is based on a dramatic reduction in toxins and biomarkers (toxic chemicals in the body) and improvements in health and body functioning in smokers who switch to vaping.

LFA remains silent about whether vaping is less harmful than smoking. Nor does it provide its own assessment of how much vaping safer it is likely to be compared to smoking.

2. "Emerging evidence suggests that e-cigarettes increase the risk of… various diseases"

It is misleading and disingenuous for LFA to simply say that vaping increases the risk of disease. No credible expert claims that vaping is risk-free. However, vaping dramatically reduces the risk of death and disease compared to smoking. For example, the risk of cancer has been estimated to be <0.5% of the risk from smoking. Numerous studies have found improvements in respiratory, cardiovascular disease and gum disease after switching to vaping. It is the comparison with smoking that is important as nearly all vapers are smokers or former smokers who would otherwise continue to smoke.

3. "At the population level there is no strong evidence that e-cigarettes assist smoking cessation and some evidence suggests the opposite effect"

This is simply not true. Numerous population studies in the USA and the UK have found that smokers who use vaping to quit have significantly higher quit rates than those who do not. (Zhu, Jackson, Johnson, Berry, Giovenco, Zhuang, Biener, Kalkhoran) Quit attempts and successful quit rates have been increasing since vaping became popular.

The rate of decline in smoking in both the USA and UK has accelerated since 2013 after vaping nicotine became widespread. However, in Australia, where vaping rates are lower, the decline in smoking has been much slower.

The population studies confirm the randomised controlled trial evidence that vaping is significantly more effective than nicotine replacement therapy

4. "There is little evidence regarding the safety of long-term nicotine exposure via ENDS"

This is true but misleading. Like all new products, the precise long-term health effects of vaping nicotine have yet to be established. However, we already know a lot about the ingredients of vapour and biomarkers (toxins in blood, urine and saliva) and have over 15 years of real world experience and scientific studies to guide us.

The UK Royal College of Physicians estimates the long-term risk is likely to be no more than 5% of the risk of smoking.

5.  "Exposure to nicotine in adolescents may have long-term consequences for brain development, potentially leading to learning and anxiety disorders"

There is no evidence that vaping causes harmful effects on the human adolescent brain. Nicotine has been linked to adolescent brain damage in animal studies (as has caffeine) but these effects have not been demonstrated in humans). Most animal studies include chronic, high-dose exposure to nicotine which is not an accurate representation of the acute exposure that is typical in adolescent humans.

Nicotine products such as patches and gum are approved for use in smokers from the age of 12 in Australia. Why is LFA only concerned about nicotine in vaping but not nicotine in NRT?

6. "Transnational tobacco companies have made significant financial investments"

True but misleading and irrelevant. The tobacco industry did not invent vaping and does not control it. No vaping product in Australia is owned by a tobacco company. Vaping poses a huge, disruptive threat to the tobacco industry and its uptake among smokers has accelerated the decline in cigarette sales and smoking. The tobacco industry began investing in vaping in 2012 overseas and has been trying to catch up ever since. However, Big Tobacco currently controls no more than 20% of the global vapour market.

LFA’s primary focus should be on the improvement of public health. Safer alternatives to smoking will save lives, regardless of who makes them.

7. "E-cigarettes are not approved by the Therapeutic Goods Administration (TGA)"

Nicotine vaping products are not medicines, do not make therapeutic claims and should not be regulated by the medicines regulator, the TGA. They are consumer goods used to replace an existing consumer product, lethal cigarettes and should be regulated by the Australian Competition and Consumer Commission.

NO other western country requires approval of nicotine for vaping by a medicines regulator. Subjecting every nicotine vaping liquid to a rigorous medicines-quality assessment when cigarettes are largely unregulated makes no sense.

Low concentrations of nicotine liquid in child-resistant containers are low-risk products which cause minimal harm and are lifesaving for many smokers. Requiring a doctor’s prescription for nicotine is a significant barrier for smokers wanting to switch to lower risk vaping.

LFA should listen to the many Australian smokers who tried quitting numerous times but only managed to quit smoking when they switched to vaping.

For an evidence-based review of vaping and lung disease we suggest reading the British Lung Foundation submission to the UK Parliamentary Inquiry

Posted by Colin Mendelsohn, colin@athra.org.au

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