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Medicine Interview Hot Topics: Vaping & E-Cigarettes
E-cigarettes, or vapes, have become increasingly popular in recent years, especially with teenagers. Initially billed as a much healthier alternative to smoking, recent discoveries have raised question marks over the truth in this claim. With their addictiveness, often containing higher amounts of nicotine than one would get through normal cigarettes, and potential to cause a raft of new lung diseases, public opinion has recently begun to shift away from e-cigarettes.
Do They Help to Quit Smoking?
It appears that e-cigarettes do help people that want to quit smoking. A randomised controlled trial of 900 people found that quit rates increased from 9% to 18% with the use of e-cigarettes vs other nicotine replacement methods. Public Health England estimates that 20,000 people are able to quit smoking each year due to using e-cigarettes. In the US, 3 million people have managed to quit smoking, and started to vape instead. Given that cigarette smoking leads to more than 7 million deaths per year, this is undoubtedly positive news.
Are they Healthier?
Public Health England also made the claim that vaping was ‘95% safer’ than smoking traditional cigarettes - a claim that was seemingly made by looking at the amount of noxious chemicals within e-cigarettes vs traditional cigarettes, without making adjustments for the potential of new chemicals in e-cigarettes to harm the body over time. There are no long-term studies of e-cigarettes and their potential to cause harm. Many of the ingredients in e-cigarettes’ ingredients are found in smoke as well.
The issue, of course, is that there will be no meaningful data until the bodies of those that smoke e-cigarettes have had time to react to the chemicals that they are inhaling.
That said, more than 2000 people in the US have already been diagnosed with EVALI (e-cigarette or vaping associated lung injury). Of these, 47 have died. It has been predominantly seen in otherwise young and healthy patients, and one in three patients have been found to require admission to an ICU. It appears that vaping THC oil may be responsible for acute lung injury, and recent research by the CDC has identified a synthetic form of vitamin E, used as a thickening agent in THC oil for vapes, as a potential causative agent. Non-THC e-cigarettes are likely damaging as well, and the deputy editor of the Canadian Medical Association Journal recently claiming that, ‘it is… very unlikely that any single compound, contaminant or e-liquid brand is responsible for all [different lung pathologies].’
We should likewise be aware of the risk of young people becoming addicted to nicotine through their seemingly-harmless e-cigarettes. Around a quarter of high school students are vaping with some regularity (in the last 30 days). JUULs, which are by far the most popular e-cigarette with teenagers, contain three times as much nicotine per cartridge as the limit for e-cigarettes in the EU would permit. Most teenagers using e-cigarettes have never smoked traditional tobacco products before - and in fact 15% of e-cigarette smokers in generaal have never smoked before. Those that smoke e-cigarettes have a far higher risk of going on to smoke traditional cigarettes than those that do not. Teenagers are far more likely to smoke e-cigarettes in the US than Europe, by a factor between 3 and 4 to 1.
What causes this disparity is up for debate, but it likely revolves around different advertising standards, and greater public health efforts in the UK.
As we begin to learn more about the risks associated with e-cigarettes, we must be mindful of the ratio of smokers that they convert to non smokers, versus non-smokers that they convert to smokers (of traditional cigarettes).
Potential Questions which may be Asked in the Interview
- What do you know about the risks of e-cigarettes?
- Are e-cigarettes healthier than normal cigarettes?
- Why are e-cigarettes so popular in the US?
- Would you advise a patient to quit smoking through the use of e-cigarettes?
- Would you let your son or daughter smoke e-cigarettes? What might you say to them if they started smoking them?
- What are the problems that we currently face with evaluating the risk of e-cigarettes?
- Do you think that e-cigarettes are a public health benefit overall?
- How would you tell a patient of yours that quitting smoking is in their best interests?
- What damage does traditional smoking do to the lungs?
- What damage does smoking a vape do to the lungs?
How to Answer Questions on Vaping & E-Cigarettes
Ensure that you have a strong scientific foundation on the damage that traditional smoking does. Be aware of the risks of e-cigarettes, and the inherent risks in something being little-studied and poorly understood.