Vaping misrepresentations

Sir, we read with interest a recent research paper¹ and ‘Research Insights’ summary² on the erosive potential of ‘vapes’.

We were disappointed to see several basic errors and misrepresentations. We would like to correct the five most major errors:

• E-cigarettes do not contain tobacco and should not be categorised as such³
• The authors incorrectly claim that nicotine causes a ‘high risk of oral and whole-body health complications’. They cite a WHO poster which presents the effects of whole tobacco smoke on health, not the effect of nicotine. Nicotine has been used in the form of NRT for over 30 years, including in pregnant women, and is regarded as extremely safe, even for long-term use
• The authors claim that e-cigarettes are associated with cancer. The supporting reference does not make this claim and in fact states ‘no long-term evidence related to oral and systemic health effects exist’
• The authors state that ‘diacetyl is found in most flavoured vapes’. Again, the supporting reference is inappropriate and did not assess diacetyl levels in any way. Moreover, diacetyl is banned as an ingredient from e-cigarettes and e-liquids in the UK
• The authors grossly misrepresent the public health guidance on e-cigarette use as a smoking cessation device. For example, they cite a 12-year-old WHO document (a lifetime in e-cigarette policy!) There is a lack of balance in the material cited; the positions of PHE and NICE on the usefulness of e-cigarettes in smoking cessation, and their relative safety compared to tobacco cigarettes, are not acknowledged.