Up in smoke: are we wrong about the dangers of vaping?

Inside a laboratory in suburban Southampton, a corporate display board includes a portrait of Paracelsus, the 16th-century Swiss “father of toxicology”. It sits above his most memorable adage: “All things are poison … the dosage alone makes it so a thing is not a poison.” Next to this is the logo of British American Tobacco (BAT), whose cigarettes have poisoned to death more people than it would probably care to calculate.

The lab, part of the tobacco company’s sprawling research and development centre, is a rare indoor space where smoking is legal. Marianna Gaca, a BAT biologist, shows me a robot. A dozen or so steel mouths spin on a wheel, each designed to hold a cigarette. Fat syringes draw the tobacco smoke along tubing into sealed petri dishes that contain human lung cells. The machine used to be part of BAT’s doomed attempts to make its cigarettes safer. Today, it has a different role: the smoke it draws serves as a toxic point of comparison for the new robot in the lab, which is puffing away instead on the company’s electronic cigarettes.

The devices, which BAT sells under its Vype brand, contain filled cartridges of e-liquid. The liquids are mostly propylene glycol and vegetable glycerine, organic compounds used in foods and medicines. They are blended with nicotine and food-grade flavours and turn to vapour when warmed by the battery-powered device.

Gaca reaches for three plastic dishes containing filter pads that have been exposed to either smoke or vapour. “This is from the cigarette,” she says, pointing to a pad that is thick with a muddy-brown tar. “This is from one of our e-cigarettes, and this one is just fresh air.” These two pads are indistinguishable, remaining a brilliant white. “This is such a huge evolution,” Gaca adds.

The newspaper headlines on the week of my visit seem to point to another story, however. “Is this proof vaping can kill?”; “E-cig danger ‘timebomb’”; “Vaping horror stories”, they read. A decade after e-cigarettes went on sale, we are in the grip of, depending who you talk to, a major health scare or a moral panic. Alarm is even greater in the US, where 42 deaths from respiratory illness have been reported among people with a history of vaping. More than 2,000 lung injuries have also been reported to the Centers for Disease Control and Prevention (CDC), the US health agency. While it investigates the outbreak, which began in April, and its apparent link to vaping, the CDC has advised Americans not to vape products containing tetrahydrocannabinol (THC), the main active compound in cannabis, or to use vaping products from “informal” sources.

Coverage in the UK intensified with the first reported death linked to vaping. Terry Miller, a 57-year-old factory worker from Gateshead, died of lipoid pneumonia in 2010, a rare condition in which fat particles get into the lungs. His inquest recorded an open verdict, but his widow, Glynis Miller, has always suspected her husband’s e-cigarettes. “Who says they are safe?” she asked in an interview in September.

The Medicines and Healthcare products Regulatory Agency (MHRA), which regulates vaping products in the UK, has recorded 74 reports of health problems over the past five years. The agency said this did not prove a link to vaping; only that those reporting their conditions suspected it as a cause.

In 2016, Gareth Walters, a respiratory consultant in Birmingham, treated a 34-year-old woman with lipoid pneumonia. She had used e-cigarettes for two years. “On the balance of probability, vaping was the only likely cause,” Walters says. When he wrote to the manufacturer, an obscure company, the name of which he can’t now remember, it did not respond to his request for a list of ingredients. Last week, Ewan Fisher, a 19-year-old former smoker, urged people not to vape three years after he suffered serious respiratory failure in a case his consultant also linked to e-cigarettes.

More than 3.6 million Britons vape, according to survey data collected by the charity Action on Smoking and Health (Ash). A handful of suspected health problems does not make an epidemic. But decades after the link was established between smoking and cancer, the public could be forgiven for thinking e-cigarettes are roughly as bad. “I see kids using them and I think: ‘Oh, my God. You don’t know what you are taking into your body!’” Miller said.

David O’Reilly is sitting in BAT’s windowless “R&D Live” visitor centre, a slick corporate display of devices and information. He joined BAT almost 30 years ago and sits on its management board as its director of scientific research. “We’re very concerned about what is happening in the US,” he says. “But we stand behind our products, and the work we do here to make sure that what we put into them will not lead to these acute diseases.”

O’Reilly, who is 53, is keen to point out a difference between vaping in the UK and the US. Here, MHRA regulation and EU law heavily restrict what can be sold. While several US states have now lined up to ban vaping, national regulation still barely exists. Vaping devices are being used to consume cannabis. Many of the US deaths have been linked to THC and to high levels of vitamin E acetate, an oily additive. Many suspect cartridges had been sold illicitly on a hidden market for bootleg blends that has flourished in the absence of regulation.

BAT has a big interest in protecting the reputation of its “reduced risk products”. As well as vape pens, it makes “heat-not-burn” devices, which heat a stick of blended tobacco at much lower temperatures than cigarettes. Global revenues from the products hit almost £1bn last year, a number that the company expects to rise to £5bn by 2023. BAT says it makes up 39% of the UK vape market by value. By comparison, its cigarette revenues last year (its brands include Dunhill and Camel) were £15.5bn, but most cigarette markets, including the UK’s, are shrinking. As part of a fraught transition, BAT has announced plans to cut 2,300 of its 55,000 jobs globally by January.

Yet tobacco companies are not alone in defending e-cigarettes. “The consequence of this panic [about vaping] is that people will go back to smoking and die as a result,” says Martin Dockrell, the tobacco control programme lead at Public Health England. While the agency has called for more research into the long-term effects, and advises non-smokers not to vape, it still estimates that – because the constituents of cigarette smoke that harm health are either absent in e-cigarette vapour or present at much lower levels – vaping is, in the long term, 95% less harmful than smoking. Dockrell says he has already seen case reports of vapers going back to cigarettes. “UK deaths from regulated e-cigarette products in the UK are nil,” he adds. “Smoking still kills 220 people every day.”

Deborah Arnott, the chief executive of Ash, says a colleague was advised by his GP to stop vaping because it was more dangerous than smoking. “It really worries me because GPs reflect what everyone else is seeing, which is this panic,” she says. According to Ash’s latest survey, 22% of smokers believe vaping is as dangerous or more dangerous than cigarettes, a proportion that may rise. “I’m with Public Health England,” says Walters, the Birmingham lung doctor. “If you’re trying to give up smoking, then vaping is a good thing.”

Public health experts are not easy allies of big tobacco, even if they are both pursuing alternatives to cigarettes. The tone of the scare betrays some of this tension. Before it started, the US was already on edge about Juul, a California startup that launched sleek e-cigarettes in 2015. It promoted its flavours on Instagram and connected with young people. According to one US survey last year, one in five 12th grade students (aged 16-18) had vaped in the previous 30 days.

The youth “addiction crisis”, as the Food and Drug Administration called it, intensified in December when Altria Group, formerly known as Philip Morris Companies (its brands include Marlboro), bought a 35% stake in Juul for $12.8bn (£10bn). The billionaire philanthropist Michael Bloomberg has accused tobacco companies with vape brands of “preying on America’s youth … using the same marketing tactics that once lured kids to cigarettes”.

The industry had taken a while to get involved in vaping. A Chinese pharmacist and smoker called Hon Lik is credited with inventing the modern device. The first e-cigarettes hit the UK market in 2008, a year after the indoor smoking ban. Smokers were ready to try something different (indoor vaping bans came later). Small companies met the demand and vaping spread quickly.

Fearing a “Kodak moment”, as Arnott puts it, the tobacco companies began to buy up the competition. Blu eCigs, which was founded in Australia in 2009, is now owned by Imperial Brands (which owns the Virginia, Drum and Rizla brands). BAT launched its first electronic device in 2012, and Vype in 2013. Altria’s grip on Juul tightened in September when it replaced the company’s CEO, Kevin Burns, with a previous employee, KC Crosthwaite.

As tobacco companies marched into the new market, suspicions of their intentions intensified. Their earlier attempts to create less deadly products had already failed: in the 1970s, “safer” filtered or light cigarettes only slowed the delivery of nicotine. To compensate, smokers puffed more deeply, inhaling more tar. They also continued to smoke because it felt safer. Ash described the cigarettes as “a grotesque confidence trick”.

Electronic cigarettes produce no tar at all, but for the tobacco control movement, big tobacco’s growing involvement in vaping comes with unsettling echoes. The companies have spent millions on advertising, 16 years after cigarette adverts were banned from British billboards. Instagram is the new battleground. Ash has accused BAT of breaching guidelines by using its Vype Instagram account to target young people, pairing images of cool young vapers with unrelated trending hashtags including the names of celebrities. The Advertising Standards Authority is investigating. “We have marketing principles that stipulate responsible use of social media and any complaints we take very seriously,” O’Reilly says. Juul shut down its Instagram account last November.

Arnott is also concerned about BAT’s revived interest in policymaking. Last year, it emerged that BAT was working on a pilot scheme with Birmingham city council to promote its vaping products. The MP Steve Brine, then a health minister, called it “a disgrace” that BAT was “exploiting” smokers for profit, adding: “We have a duty to protect our public health services from the commercial interests of the tobacco industry.” BAT defended the scheme as a success, “with many participants making a switch from cigarettes”.

O’Reilly says BAT is committed to developing safer alternatives to cigarettes – and shouting about it. “But for a number of people in the tobacco-control movement, it was an abhorrent idea that suddenly this industry, which had been vilified and demonised, was suddenly going to be a big part of the solution,” he says. “What I’d say to them is: we’re not running this business in the 1970s. We should be judged not on our history, but on our actions today.”

Yet tobacco firms have been accused very recently of using old tactics to push cigarettes in markets without profitable alternatives. In 2017, the Guardian exposed BAT for trying to use the courts to crush anti-smoking regulations in Kenya and Uganda. The company said it reserved the right to ask courts to intervene where it believed regulations may not comply with the law. “We would support all regulation that we think will have an effect on public health,” O’Reilly adds. Last month, the Guardian revealed that BAT faces court action in London after claims that families in Malawian tobacco fields were forced by poverty wages to use their children as unpaid labour (BAT says it had told farmers not to use child labour).

If BAT is so committed to public health and the transition to healthier devices, why not stop making cigarettes? “Well, it’s a good question,” O’Reilly says. “It is still the core of our business and we need the profits from our cigarette business to fuel the innovation and commercialisation of new categories.” He adds: “Obviously, we also have a fiduciary duty to shareholders to give them a return on their investment.” O’Reilly owns shares worth more than £1m, according to the company’s annual report.

BAT now employs more than 1,500 scientists, almost all of them working on electronic devices. Sami Haikala joined BAT last year after jobs at Microsoft and Nokia. To reach his lab, I walk through a test production line for cigarettes that reeks of sweet tobacco. The lab itself is full of electron microscopes and 3D x-ray machines. A drop test chamber containing an e-cigarette turns like a tombola, the device clunking with each turn. “If it can tolerate 200 drops, then it’s good,” Haikala says.

Back in the lab, Gaca, who is 47, recalls joining BAT 15 years ago, before e-cigarettes appeared on the horizon. “When I talked to my peers about it, they said: ‘Why are you going there? Nobody will talk to you – you’ll be the black sheep,’” she says. “They said the industry was not in a good place; that it had a bad name. But I saw real opportunities here.” She comes from a family of smokers, and says her husband used vaping to quit cigarettes. What does he think now? “We can only stand by our data,” she says.