Dear Editor,

I would like to make a couple of points in response to Dr Suranga Senanayake’s opinion piece entitled, “Vaping crisis: an unfolding public health disaster” (IMT, March 2020 p12). Vaping is a relatively new phenomenon; it has only been around for about 10 years.

In that time there have been up to 60,000 deaths due to cigarette smoking in this country and seven million deaths in Europe. There have been no deaths from vaping in Europe in that period. Dr Farsolino’s study in the US looked at over 69,000 vapers. Less than 1 per cent of those had been non-smokers before they started vaping, so it is safe to assume that most vapers are people trying to quit or lessen their smoking habit.

The Health Service Executive, in its report “Healthy Ireland”, announced a 6 per cent fall in smokers since 2015. Vaping accounted for 39 per cent of this fall compared to 15 per cent for all nicotine replacement treatments and pharmaceutical products combined — will power accounted for the remainder.

Cancer Research UK showed vaping to be 83 per cent more effective than nicotine replacement products in helping smokers to quit. In January, when people are making New Year’s resolutions, your UK equivalent, Pulse, carried a piece from Cancer Research UK, advising GPs on how to encourage smokers to switch to vaping.

Public Health England suggests that vaping is up to 95 per cent safer than smoking. No one has ever suggested that vaping is 100 per cent safe; it isn’t. Its role is in harm reduction. New York recently banned fruit-flavoured vaping although Dr Farsalino’s study showed that 98 per cent of vapers used them. More recently New York has permitted the sale of alcoholic ice cream!

In his piece, Dr Senanayake quotes an article in The Journal of the American College of Cardiology from May 2019 claiming that vaping exacerbates endothelial dysfunction.

A more recent article in that same journal last December by Jacob George et al showed a marked improvement in endothelial function within a month of switching from tobacco smoking to vaping.

I would also add that there is little value in comparing vapers health to non-smokers, they should be compared with smokers.

If I was still in practice, I would advise any patient who did not smoke that he or she should certainly not take to vaping and any smoker that they should, assuming going cold turkey hadn’t worked.

Dr John Madden,

MICGP,

Tiernaleague, Carndonagh, Co Donegal