Vaping’s Achilles’ Heel

Blowing smoke: Newspapers often report lurid stories about vaping that turn out to have been misleading.
(Photo: Oleksandr Suhak |

Calls continue for banning popular e-liquid flavors despite evidence that such measures are negative for public health.

By George Gay

As I start to write this piece, I’m under a lockdown imposed because of the spread of Covid-19 infections, which means I am not allowed to leave my house and garden except in limited circumstances. I’m not alone in this. Since Nov. 5, everybody in England has been subjected to restrictions on their movements, though the precise restrictions governing individuals vary. The lockdown is due to end on Dec. 2, a month or so before this story is due to be published, though it could be extended.

England is not alone in having to resort to national lockdowns, and, as in other countries, here there are groups of people, many of them comprising self-styled libertarians, who believe that it is unjustified and, in some cases, counterproductive, to restrict the rights of people to move about as they were free to do before lockdown legislation was introduced, or to require them to wear face coverings. But in England we have a particular issue that perhaps does not arise in many other countries. Our prime minister, who has ordered what is England’s second lockdown, is a self-styled libertarian. This means, I assume, that he is both not in favor of, and in favor of, the lockdown: that is, he is a libertarian and not a libertarian. No wonder he, his cabinet and advisers seem to have a problem acting coherently.

I think, however, that it is not difficult to see through these apparent contradictions. It is necessary only to understand that there is no such thing as a libertarian; only people who have libertarian views about certain—often pet—issues. For instance, a person might take a libertarian stance on smoking and drinking but oppose taking a libertarian line when it comes to allowing people to wander the land spreading contagion among their fellow citizens. Others, on the other hand, might believe that smoking and drinking should be banned while not agreeing with the idea of pandemic lockdowns.

One argument has it that citizens should be relied on to do the “right thing” when faced with circumstances such as a pandemic rather than being subjected to restrictions brought in on the back of new laws; but, in the real world, this wouldn’t work, at least not in the short term, as a pandemic is raging. But there is no doubt that people can and do do the “right thing,” though this usually occurs where they are making choices that largely affect only their own health rather than where they make choices that have wider implications. For instance, many smokers are making rational choices—doing the “right thing”—by switching to vaping—though only when they are not fed a diet of misinformation about the health effects of vaping and only when they can obtain vaping products that satisfy their needs, including in respect of flavors.

In any reasonable society, the threat posed to a nation’s health by smoking would mean that both of these conditions would be met, but I’m afraid often they are not. There are many people who, for a variety of reasons, would like to see the most popular and effective vaping flavors banned, something that would be likely to have significant negative consequences for the health of individuals and society at large. According to a recently published report, Use of e-cigarettes (vapes) among adults [those over 18] in Great Britain, which was based on data taken from an annual survey, Smokefree GB, carried out for Action on Smoking and Health by YouGov, in 2019 researchers asked current e-cigarette users what they would do if flavors were no longer available. In part, the findings were that about one in four would still try to get flavors and just under one in 10 would make their own e-liquid, neither of which options should be encouraged by responsible governments. The most worrying finding, however, must be that just under one in five said they would either smoke more or revert to smoking.

These findings are broadly in line with those of other surveys investigating the same issue. In releasing the results of a recent survey it carried out, the European Independent Vape Alliance (IEVA) highlighted two findings:

1) More than 80 percent of smokers who switched to e-cigarettes had completely stopped smoking.

2) About 65 percent of vapers in Europe used fruit or sweet liquids.

In further commenting on the results of the survey, in which more than 3,300 European e-cigarette users took part, the IEVA said the variety of flavors available seemed to be one of the most important factors in decisions about e-cigarette use. Forty percent of vapers used fruit-flavored e-liquids and 25 percent preferred other sweet flavors. Thirty-five percent chose to use tobacco-flavored e-liquids.

When the IEVA asked the participants how they would react if all e-liquid flavors except tobacco flavors were banned, 20 percent said they would switch to tobacco flavors. But 31 percent said they would buy e-liquid flavors on the black market while nine percent said they would start smoking again.

“Our survey confirms previous research that e-cigarette flavors are crucial for adult smokers,” said Dustin Dahlmann, president of the IEVA. “A flavor ban must be avoided at all costs because it would lead many vapers to buy unregulated products on the black market or to start smoking again. And this would endanger the great opportunity that many more smokers will stop smoking with the help of the e-cigarette.”


Safe for hypocrisy

The evidence seems overwhelming that bans on popular e-liquid flavors would be negative in respect of public health. But there are a lot of people calling for such bans. The major problem here is that flavors are seen as vaping’s Achilles’ heel by those opposed to smokers switching from smoking to vaping. Flavors can be attacked on the grounds that they appeal to young people, and, because of the emotions elicited by the very mention of young people, these attacks hit home, no matter how feeble the evidential artillery is. People who are happy to sit alongside pavements with the engines of their motionless vehicles running and pumping out toxic fumes from exhaust pipes set at child-buggy height would be horrified at the thought that a young person might try vaping. As somebody almost once said, we have a tendency to make the world safe only for hypocrisy.

Another problem is one that stems from the fact that, as H.G. Wells was once said to have observed, a newspaper is a device incapable of distinguishing between a bicycle accident and the end of civilization. Newspapers often report lurid stories about vaping and, especially, e-liquids, that are based on “scientific” findings—stories that often turn out to have been misleading or plain wrong. Sometimes the science itself is flawed and sometimes the flaws are inserted in a newspaper’s attempt to try to simplify the science and its findings for a general audience. Often, this attempt at simplification does more harm than good, especially given that it will be based too on a need to make the bicycle accident look like the end of civilization.

An apparent example of how unhelpful science can be was pointed out recently in a story by Diane Caruana in the Vaping Post. Apparently, after reports appeared in the Italian press of vaping flavor presentations made by scientists from the U.S.’ Duke and Yale universities at a meeting of the European Respiratory Society, the National Association for United Vapers issued a statement that included a quote from Fabio Beatrice, director of the ENT department of the San Giovanni Bosco Hospital in Turin and the Nosocomio Anti-Smoking Center, who said that the study seemed to have been designed in such a way as to expose “predisposed subjects” to extreme situations to support a thesis. Studies such as these had the serious side effect of causing consumers to relapse into traditional cigarette addiction, he added.

At the same time, Caruana highlighted two “expert reactions” to the presentations. One from Jacob George, professor of cardiovascular medicine and therapeutics at the University of Dundee, included the following comment: “Data presented here is of in vitro cell work and not human clinical trials. Therefore any extrapolation to whole system human physiology is tenuous at best.” The other, by Nicholas Hopkinson, reader in respiratory medicine at Imperial College London, included the comment: “As there’s no information presented in these studies about relative concentrations compared to those seen in cigarette smoke, it is not clear what, if any, significance the findings have.”

What’s essential?

Of course, the Duke and Yale scientists will have their own take on their findings, and it is natural that people disagree on such subjects and how to approach them, which brings me back to the lockdown mentioned at the start of this piece. There was something typically waggish about the prime minister’s ordering that the lockdown should start on Nov. 5, the day that we in England commemorate the foiling of a 1605 plot to blow up the House of Lords and, with it, the then king. Here again was one of those disagreements in which a certain section of society felt that their rights were being trampled on: a dispute that became somewhat overblown—or not, as it turned out.

During this second lockdown, however, there is one thing that is common to everybody who is not infected with Covid-19: we can all leave the house for essential supplies—which, of course, raises the question, what is essential? I have some sympathy for those having to answer this question because, even just taking supermarkets, where do you draw the line? Since they sell food, do you allow them to open all their food aisles, or do you allow the vegetable aisle to open but not the aisle selling chocolate biscuits? After all, while a vegetable might be essential to sustaining you in a healthy physical state, a chocolate biscuit is not essential. Although, on the other hand, might a chocolate biscuit provide for your mental well-being as you start to climb the walls during your third week of lockdown?

Opening all the aisles, even those selling nonfood products, raises questions of fairness since some of the nonfood products will normally be available in specialist outlets that have been forced to close. But it is another anomaly that is relevant here. As things stand, it would be possible for me to head to the supermarket right now and buy a bottle of gin—and only a bottle of gin, which for most people could hardly be considered essential. Indeed, according to an advert I saw recently, I could go to the supermarket and buy a bottle of chocolate orange gin “packed with flavors of cocoa, silky vanilla, sweet orange and juniper.”

When did this start making sense? We, as a society, accept as a given that chocolate orange gin is an essential product at the same time that we are arguing the toss over whether people should be allowed to vape fruit-flavored e-liquids in order to allow them to quit smoking.

It’s at this point I become a semi-detached libertarian. I’m willing to stay at home if people in the know have determined that my doing so will help prevent the spread of Covid-19, but I want people to be able to buy chocolate orange gin and fruit flavored e-liquids if that is what they feel they need to get them through the day, whether we’re in the midst of a pandemic or not.