VAPING from electronic cigarettes could be as bad for the heart as tobacco” screamed an alarmist headline syndicated across a wide range of Australian news services recently. Unfortunately, these misleading headlines are all too common and confuse the public about e-cigarettes, a potentially life-saving treatment.

The headline was based on a small study of 24 individuals, which compared the effects of smoking a single cigarette with 30 minutes of e-cigarette use (vaping). Both products increased blood pressure and aortic stiffness by the same amount, leading to the absurd conclusion that vaping is as harmful as smoking (increased stiffness of the aorta can be an indicator of future cardiovascular risk).

However, this study adds nothing new. We already know that nicotine causes arterial stiffness and increases blood pressure transiently. But so does drinking coffee (caffeine is not a risk factor for cardiovascular disease), exercising (exercise is beneficial for cardiovascular health) and being exposed to emotional stress.

The headline grossly exaggerates the risk of vaping and defies common sense. Heart damage from smoking is caused by a wide range of toxic chemicals, most of which are either not present in e-cigarette vapour or are present at very low levels.

Furthermore, the short term effects in this study cannot predict any long term risks. The temporary changes after 30 minutes of vaping a single e-cigarette are not proof of long term serious harm, although this is implied in the headline.

These sensational stories typically ignore the other evidence from conflicting studies which would help to put any risk into perspective. Another study found that vaping had no short term effect on heart function, whereas smoking caused significant changes. A further study found that smokers who switched to e-cigarettes completely or used them to cut down had substantially lower blood pressure 12 months later. The reduction was even greater for those who had high blood pressure to begin with.

A recent comprehensive review of the cardiovascular effects of vaping concluded that “if e-cigarette [use] can be substituted completely for conventional cigarettes, the harms from smoking would be substantially reduced and there would likely be a substantial net benefit for cardiovascular health”.

No one is claiming that e-cigarettes are harmless, but they are dramatically safer than smoking. Public Health England and the Royal College of Physicians in the United Kingdom have recently reviewed the evidence and concluded that the risk to health from long term e-cigarette use is unlikely to exceed 5% of the harm from smoking tobacco.

However, based on this small study, the author, Professor Vlachopoulos, advises against the use of e-cigarettes. This is in stark contrast to the UK Royal College of Physicians which recommends that, “in the interests of public health, it is important to promote the use of e-cigarettes … as widely as possible as a substitute for smoking”.

It’s no wonder that people are confused.

In spite of the compelling evidence on safety, Australians are confused and misinformed about the risks of e-cigarettes. A recent study reported that 65% of Australians did not know that e-cigarettes were substantially less harmful than conventional cigarettes. This is surprising as combustible cigarettes are the most lethal consumer product ever made.

While nicotine is the main cause of addiction to smoking, most of the harm is caused by the thousands of chemicals created by the burning of tobacco. E-cigarettes heat a liquid solution containing nicotine into a vapour. A much lower temperature is needed, there is no combustion and minimal levels of toxins are released.

E-cigarettes are helping millions of smokers to break the deadly habit. In June 2016, a study published in the journal Addiction estimated that over 6 million European citizens have quit smoking with e-cigarettes and over 9 million have reduced their use of tobacco. In the UK, 1.3 million ex-smokers have switched to e-cigarettes.

Scientific research needs to be presented accurately by scientists and critically assessed by journalists before being plastered across news services. Sensational headlines such as this one do not accurately report the findings from the study or the overall scientific evidence. They spread fear and misinformation and can ultimately increase death and disease by discouraging smokers from switching to vaping, a much less harmful alternative to smoking.

E-cigarettes have the potential to save the lives of hundreds of thousands of Australian smokers. People need accurate and balanced information about e-cigarettes to make rational decisions. Sensational headlines sell newspapers or generate clicks, but are irresponsible and potentially harmful to public health.

Associate Professor Colin Mendelsohn is a tobacco treatment specialist with the School of Public Health and Community Medicine at the University of New South Wales. He has no personal or commercial relationship with any e-cigarette or tobacco company. He has received funding for teaching, consulting and conference expenses from Pfizer Australia, GlaxoSmithKline and Johnson and Johnson Pacific.



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6 thoughts on “Alarmist vaping headlines a hazard to health

  1. Robert Hall says:

    We have to be a bit careful about surveys purporting to show that electronic nicotine devices lead to smoking. All the surveys I have seen, including Barrington-Trimmis et al ( are simple cross-sectional surveys showing that there is an association among US adolescents between e-cigarette use and smoking. This in no way shows that the association is causal. It is at least as likely that those adolescents who are thinking of taking up smoking are also interested in e-cigarettes. A task I set my MPH students is to design an epidemiological study that would show whether e-cigarettes lead to a higher risk of taking up conventional smoking or not. It’s not an easy study to design.

  2. Joe Kosterich says:

    Indeed, how dare anyone question conventional thinking. Wonder if E-cigarettes need a black box warning?

  3. Simon Chapman says:

    Joe Kosterich, you might like to explain how your cute “turf protection” theory sits with the brakeless train achievements of public health-driven tobacco control in driving down the proportion who smoke since the early 1960s. If you are ignorant of what this has been, there are some simple graphs you could probably understand here Shouldn’t we have all been slamming the brakes on what we have been achieving decades ago if your snide remark was correct? And as for tobacco control being “ideological”, how do you account for the 180 parties (nations) which have signed the WHO’s Framework Convention on Tobacco Control. Perhaps Joe feels more affinity with some of the few which have not? eg: Cuba, Haiti, Mozambique

  4. Simon Chapman says:

    Well, we can choose between the rose coloured glasses views of Colin Mendelsohn or the most recent report of the World Health Health Organization or two senior toxicologists who just today penned an excoriating critique of the factoid that Mendelsohn repeats here. I know who I believe …

  5. Roger Magnusson says:

    If e-cigarettes are a “potentially life-saving treatment”, then they ought to be available to smokers on prescription. I don’t mind if my child grows up to drink coffee; I’d like public policies to protect her from nicotine addiction. In the United States, where e-cigarettes are freely sold, e-cigarette use by high school students has skyrocketed by 900%, from 1.5% in 2011 to 16% in 2015:

    I don’t understand why public health enthusiasts for e-cigarettes don’t have a problem with that. Evidence that e-cigarettes are a gateway from smoking is half the picture; there is also evidence that e-cigarette use makes transition to smoking more likely:

    If you think e-cigarettes are the pointy end of tobacco control, consider this:

  6. Joe Kosterich says:

    The UK and New Zealand have adopted a sensible approach to e- cigarettes. A product 95% less harmful than tobacco should be at least as available as cigarettes. Here it seems that the ideology of public health trumps science. Could turf protection have anything to do with it?

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