Back to my vaping scepticism

An article at The Guardian notes this (White is director of Quit Victoria):

 White disagrees, and says the products should be taken off the shelves altogether, for not just medical but consumer safety reasons. She said there had been cases of the devices exploding, causing deaths. She also cited the death of a toddler in Melbourne after he consumed his mother’s e-nicotine liquid. Consumer safety standards were sorely lacking, she said.

“I can’t buy a bicycle helmet or toys from shops that don’t meet consumer safety standards, but I can go and buy a device for heating up liquids and inhale from that device for hours on end,” she said. “We have taken other products off the shelves that have less issues with them than e-cigarettes.”

She acknowledged her position had resulted in backlash from pro-vaping lobbyists in Australia, many of whom are supported by the tobacco companies that have bought a stake in the e-cigarette market.

“There are people who so passionately believe in e-cigarettes that they’re evangelical about it,” White says. “There is a divide across public health and tobacco control on this which is no doubt being fed by vested interests, and no-one is backing down.”

But also, The Lancet has weighed in:

On Saturday, the international medical journal the Lancet published an editorial in the wake of the US deaths, and said the positioning of e-cigarettes as a quit-aid had been “vastly overstated”.

“Data also suggest that smokers switch to e-cigarettes, then remain dependent long term,” the editorial said. “No solid evidence base underpins the marketing claims that e-cigarettes are healthier than cigarettes or that they can support quitting, but lax regulation has allowed e-cigarette manufacturers to pervert the success of antismoking public health messages and position e-cigarettes as healthy.”

OK, let's extract some that Lancet editorial directly:

Manufacturers of e-cigarettes, and some public health advocates, have supported their use as a smoking cessation tool and a safer alternative to cigarettes. However, the evidence for both of these claims is weak. No e-cigarettes have been tested or launched as smoking cessation products; all are sold directly to the consumer as tobacco, not medicinal, products. Three randomised trials of third-generation products show low rates of abstinence at 6 months. Data also suggest that smokers switch to e-cigarettes, then remain dependent long term. The very high nicotine levels delivered by some e-cigarettes could make them more difficult to quit than cigarettes. Very few data on long-term health effects are available to support the safety claims. The positioning of e-cigarettes as a viable cessation aid is vastly overstated, especially since the current first line treatment (nicotine replacement therapy under medical supervision) has a strong evidence base demonstrating safety and efficacy.

Claims that e-cigarettes are useful harm-reduction tools are further undermined by their high uptake among young people. Cigarette smoking among US adolescents had declined substantially in the past 20 years, but there has been a huge rise in adolescents using e-cigarettes, with rates of use at around 25% among 18-year-olds and 20% among 16-year-olds. The availability of flavoured e-liquids is cited by nearly a third of users as a major reason to start vaping, especially among younger adults. Concerns have been raised around the marketing of e-cigarettes to young adults and new users. Advertising featuring young, attractive models, sponsorship of sports events and parties, product placement, and direct payments to social media influencers are strikingly similar techniques to those used previously by the cigarette industry. In many cases, e-cigarette marketers have commandeered the public health message around smoking to promote a healthy and glamorous alternative. In response, the US Food and Drug Administration wrote to Juul Labs, criticising illegal marketing that claimed that their e-cigarettes were less harmful than cigarettes....

No solid evidence base underpins the marketing claims that e-cigarettes are healthier than cigarettes or that they can support quitting, but lax regulation has allowed e-cigarette manufacturers to pervert the success of antismoking public health messages and position e-cigarettes as healthy. The renormalisation of smoking in the form of e-cigarettes, not only among smokers, but also among young people and never smokers, risks population-wide nicotine use and dependence on a massive scale. Surely it is time to align the public health approach to e-cigarettes with that of cigarettes.