Smoke and Vapour

Originally published in the Informanté newspaper on Thursday, 7 September, 2017.

During the past week, the Cancer Association of Namibia has responded to requests for information about the habit of ‘vaping’ or e-cigarette use, and appears to have only furthered the cause of the tobacco industry by creating even more fear, uncertainty and doubt. I rather doubt this was their intention, and rather attribute this to a rather convoluted message that did not clarify the facts they wished to present. As such, allow me to clear up the smoke and vapour surrounding this subject more clearly. 

Smoking is a serious health risk to Namibians. It is estimated that about 11.5% of females and 39% of males in Namibia smoke. Smoking increases the risk of coronary artery disease and stroke by 2 to 4 times, and the risk of developing lung cancer 25 times. This is a significant burden on any healthcare system, and specifically for a developing country such as Namibia. Any potential solution to reduce this burden should be strongly promoted. 

The health effects of tobacco smoking is thought to be well known, but even the Cancer Association does not make it clear that it is not the nicotine in cigarettes that cause cancer! After all, if that was the case, why would nicotine-replacement therapy devices be sold as an alternative? Nicotine patches, chewing gum – these have all been sold as ways to cut down on smoking. However, lest I be unclear – NICOTINE IS EXTREMELY ADDICTIVE. It is the reason why smokers keep on smoking. DO NOT TRY IT! 

Rather, it’s the other components of cigarette smoke that cause cancer – the so-called ‘tar’ in cigarettes, which in reality contains over 7000 different chemicals, some merely additives, some proven cancer-causing chemicals, and of course, the by-products of combusting the tobacco to consume it, namely carbon monoxide. The inhalation of carcinogenic substances is the obvious cause of the increased risk of lung cancer, but what about carbon monoxide?

Well, it’s rather well known that inhaling high concentrations of carbon monoxide is lethal, but low levels? Research indicates that carbon monoxide competes with oxygen to bind with haemoglobin, the cells that transport oxygen through the blood. Thus, with carbon monoxide binding to haemoglobin, there is less oxygen available to the body. Even worse, when haemoglobin releases the oxygen to myoglobin in the muscles, this causes carbon monoxide to be released instead, reducing the amount of oxygen the muscles can absorb and decreasing their ability to contract. This might not sound like much of a concern, until you consider that the heart is a muscle as well, and that this is how heart disease can gain a foothold. 

Now let us consider e-cigarettes. These devices work by heating a liquid containing nicotine until it vaporises, and can be inhaled. Notably, this still delivers nicotine, and I cannot stress this enough, NICOTINE IS EXTREMELY ADDICTIVE. It is considered as addictive as heroin. And it is the reason why smokers can transition from smoking cigarettes to smoking e-cigarettes – the core of the addiction is transferred.

But what about the other health effects? Let me then refer you to a paper – “Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study,” by Lion Shahab, PhD; Maciej L. Goniewicz, PhD; Benjamin C. Blount, PhD; Jamie Brown, PhD; Ann McNeill, PhD; K. Udeni Alwis, PhD; June Feng, PhD; Lanqing Wang, PhD; Robert West, PhD, and primarily funded by Cancer Research UK. 

Their conclusion: “Former smokers with long-term e-cigarette–only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.”

In other words, e-cigarettes, which do not combust tobacco to deliver nicotine, and as a result also don’t produce carbon monoxide, also significantly reduces the amount of carcinogens and toxins relative to smoking, as without combustion, it also does not deliver the ‘tar’ which contains said toxins. In other words, as reported by Public Health England’s 2015 report that the Cancer Association cited, e-cigarettes are 95% less harmful than tobacco. 

Note, however, that this does not mean SAFE. A 95% reduction in harm is significant, but that still means 5% of the harmful effects are still present. If you are currently a non-smoker, this does not mean you should try starting with e-cigarettes. As a reminder, NICOTINE IS EXTREMELY ADDICTIVE. E-cigarette still contain nicotine, and will leave you just as addicted as if you had started with cigarettes. It is here I believe the Cancer Association stumbled. In their attempt to discourage non-smokers from starting up a habit via e-cigarettes, they did a massive disservice to current smokers and, ironically, their own bottom line. Because, yes, if you’re currently a non-smoker, e-cigarettes are NOT something you should try. 

HOWEVER, if you are currently a smoker, for Celestia’s sake, PLEASE CONSIDER SWITCHING TO E-CIGARETTES. They are not completely safe, yes, but they SIGNIFICANTLY reduce the health risks associated with smoking. If you have smokers in your family, encourage then to rather switch to e-cigarettes for their health. Smoking cessation is difficult – after all, as we’ve established, nicotine is as addictive as heroin. I believe even the Cancer Association of Namibia would welcome a 95% reduction in lung cancer cases, and the public health infrastructure in Namibia would welcome a reduction in their caseload as well. 

Yes, cessation would be the best solution, but we do not live in an ideal world. We cannot do nothing if the best solution fails. Tobacco harm reduction is becoming an acceptable strategy worldwide to deal with the adverse health effects of smoking. Let us apply it here, in Namibia, as well – after all, if we can reduce the 1 700 estimated yearly tobacco deaths in Namibia to a mere 85, we’d have saved a lot of lives. A quit or die approach helps no-one.