The risks and benefits of e-cigarettes must be weighed. PHOTO: SHUTTERSTOCK

Should vaping be banned in Pakistan?

It should be remembered that it took many years before the actual damage stemming from cigarette smoke was assessed

Sarmad Chaudhry September 28, 2019
An outbreak of 'vaping-induced lung injury' has killed 12 people and affected more than 800 people during the past month alone and the numbers are still rising. This outbreak has served as a wake-up call for major health regulatory organisations leading to numerous warnings against these products. Around the world, more than 20 countries have either entirely banned or at least restricted vaping products. In Pakistan, despite reports of the widespread use of vapes among young people, this issue is yet to be addressed at a government and community level.

The idea of vaping came about after Chinese pharmacist Hon Lik lost his father due to lung cancer caused by smoking. Lik, also a smoker, felt extremely motivated to break his smoking addiction, leading to the invention of the modern day e-cigarette.

Even though both vaping and actual cigarettes contain nicotine which is addictive, when it comes to the latter, the greatest harm comes from the paper that is wrapped around the tobacco. A smoker inhales about 7000 chemicals with each cigarette out of which at least 69 have been known to directly cause cancer. Other chemicals are responsible for destroying lungs leading to chronic diseases like COPD and asthma, while also causing permanent lung damage.

On the other hand, e-cigarettes provide the same amount of nicotine in vapor form, which lowers the amount of chemicals entering the body. To Lik and others, inhaling liquids rather than smoke seemed to be a less harmful option as no burned products were involved. Although concerns about nicotine addiction and its potential side-effects remained high; e-cigarettes were well-received by the medical community as a less harmful option.

In 2016, the Royal College of Physicians, U.K. issued a report encouraging the use of e-cigarettes as a safer alternative to tobacco products. Earlier this year, a study from the New England Journal of Medicine cited e-cigarettes as a more effective way of stopping smoking than other nicotine products.

Soon the supposedly healthier, nicotine touting e-cigarettes were seen as the biggest threat to the $900 billion tobacco industry, one that was already straining under increased taxes, strict regulations and bans on tobacco products in many western countries.

The tobacco giants sensed the potential lucrative financial opportunity in the e-cigarette market and decided not only to jump on the bandwagon, but rather to hijack it. Laced with robust marketing tools and a massive infrastructure, these tobacco giants were well-prepared to take over the e-cigarette market. From television advertisements to biased funded research, tobacco companies reverted to the same marketing tactics they have used for combustible tobacco products over the last 100 years.

Youth, especially teenagers, have always been the target for marketing tobacco products as they are easier to entice and make long term customers. The focus of e-cigarettes quickly shifted from tobacco cessation to recreational use among school-aged children. Nicotine products were replaced by cotton candy and other fruity flavors to entice kids and young adults. Tobacco manufacturers changed the shape of e-cigarettes from cigarette like shapes to pens and USBs in order to appeal to their target market - the youth. Within just a couple of years, vaping became a hit in schools in the United States.

By 2017, 2.1 million school kids were using e-cigarettes in the U.S. This number increased to 3.6 million kids in 2018, a 78% rise in only one year. A recent survey showed 38% of school kids' vape in the US.

Other than acute lung injury, multiple hazards of e-cigarettes have caused concerns among healthcare providers. At least 60 chemical compounds have been found in e-liquids including propylene glycol which is a respiratory irritant. Some of these chemicals are linked to an increased risk of cancer.

Nicotine is a highly addictive neurotransmitter that causes high blood pressure, fast or irregular heartbeats, increased respiration, nausea, diarrhea, and sleep disturbances. Nicotine affects brain development among teens and young adults and makes their brain prone to addictions later in life.

In pregnant females, it leads to still-births and preterm labor. It should be remembered that some 'nicotine-free' labeled e-cigarettes still contain nicotine. A recent survey showed 98.7% e-liquids sold on retail shops contain nicotine. E-cigarettes also give a sudden surge of nicotine, increasing the addiction potential among its users.

Research has found some e-cigarette flavors are potentially toxic and mixing multiple flavors can be more toxic to cells than exposure to just one flavor at a time. Since these products have not been on the market long enough to conclusively study their effects, the exact potential for toxicity is still unknown. It should be remembered that it took many years before the actual damage stemming from cigarette smoke was assessed.

Accidental swallowing or ingestion of e-liquids has been reported to cause serious side-effects and even death in some cases.  Defective, poorly manufactured and improperly modified e-cigarettes have been known to explode and cause injury.

Though the harm of second hand smoke from e-cigarettes is reported to be less than conventional cigarettes, exposure among vulnerable populations, including pregnant women and children, could still be dangerous.

The risks and benefits of e-cigarettes must be weighed. Though there are some potential benefits of e-cigarettes especially for those trying to quit smoking, it is evident that recreational use is the dominant trend at this time. Furthermore, studies have shown that e-cigarette users are more likely to become smokers later in life.

It should not take long for Dr Nausherwan Burki, the architect of current healthcare reforms in the country and a renowned lung doctor, to understand the extent of damage this can cause in our country. However, medical organisations and the society in general have their own roles to play. Keeping in mind the wide-scale hazard of these products, a strong awareness campaign needs to be initiated while lawmakers should be pushed to bring in legislation to completely ban these products so that we can save an entire generation from this menace.

(All photos: Shutterstock)
Sarmad Chaudhry Dr. Sarmad Chaudhry is the Diplomate American Board of Internal Medicine, Pulmonary Diseases and Critical Care Medicine. He has a keen interest in community education and creating awareness about medical problems. He can be found on Facebook at
The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.


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