To vape or not to vape: is not the right question


So you’re a smoker, you’ve tried to give up, many times, but can’t.

You are well aware of the many health risks, and you want to minimize them. What do you do now?

The New Zealand Ministry of Health has just published new guidance on e-cigarettes. It is still unclear how successful vaping is in helping people quit, but in my opinion that is not the issue.

If you want to quit then use one of the methods that has been proven to increase your chances in randomized controlled trials. These include various forms of nicotine replacement products (patches, gum, inhalers), or cognitive behavioural therapy.

However, if you have tried to quit several times, then minimising the damage to your health is now the priority. Vaping could be seen as a reasonable alternative to smoking for those who cannot quit. Especially since the Ministry notes that: ‘Expert opinion is that e-cigarettes are significantly less harmful than smoking tobacco but not completely harmless.’

Other nicotine products

However, e-cigarettes are only one product in a suite of nicotine containing products that include smokeless tobacco such as chewing tobacco and Swedish snus, a tobacco product placed under the lip against the gums.

Recently New Zealand has made moves towards legalising these products as well, see here for details.

So is this a good thing for the health of Kiwis, and how harmful is ‘not completely harmless’?

The answer is that these products are almost certainly safer than continuing to smoke.

Smoking tobacco has strong causative associations with a range of health conditions including: laryngeal cancer, lung cancer, oropharyngeal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, bladder cancer, coronary heart disease, hypertension, strokes, chronic obstructive lung disease, and it exacerbates influenza and other infections. And that list is just the beginning. Smoking tobacco has positive associations with well over 50 diseases.

In comparison, nicotine-only products in various forms have equivocal associations with: laryngeal cancer and lung cancer; have not been associated with bladder cancer, coronary heart disease, pancreatic cancer, esophageal cancer; and there is insufficient evidence to determine any association with obstructive airways disease, gastric cancer, and colorectal cancer. The list goes on…

Nicotine alone is actually beneficial in ulcerative colitis, and it aids cognition.

Whether you quit smoking (or nicotine), or don’t quit, isn’t really the issue. The goal really is to be as healthy as possible. So what matters most is the health outcome data for the product that you are using.

Contrary to the Ministry’s advice nicotine does appear to have some health risks. For example, snus use has been associated in large studies with hypertension in men.

But these risks need to be weighed against the risks of smoking for those who cannot quit. And the risks to others posed by environmental exposure to tobacco smoke.

Clearly further studies are needed in this space. However, when stuck between the devil of smoking and the deep blue sea of snus, the smokeless tobacco products appear to be shallow and mostly without waves. This has got to be better for society than the status quo.

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