Humberto Choi, MD: Vaping Health Misconceptions


How should physicians navigate the public belief that vaping is less harmful than cigarette smoking?

A discussion held by representatives from the US Centers for Disease Control and Prevention (CDC) this week at the CHEST 2019 Annual Meeting in New Orleans discussed the current public and clinical health understanding of vaping-related respiratory disease and deaths to have occurred this year.

Though the research into the long-term health effects of e-cigarettes and vaping products is ongoing, physicians are tasked with navigating questions raised by their patients on their effects—particularly when compared to cigarette smoking.

In an interview with MD Magazine® while at CHEST 2019, Humbert Choi, MD, a pulmonologist with the Cleveland Clinic, explained how the clinical understanding of the trending products is still developing—but that shouldn’t stop physicians from advocating for patient cessation.

MD Mag: Is the public’s understanding of risk associated with vaping as good as it needs to be?

Choi: I think so. And I just like to be very careful with that idea—I think a lot of the cases we hear on the national news are connected to the fact that some of the liquids or oils that were in those devices were altered, manipulated somehow. But with that idea, it’s easy to assume that maybe if someone uses a device that is not altered, that could be maybe safer, and I would not make that assumption as of now.

Even in the CDC data, there are cases that people are just using regular branded devices that still developed a lung injury. So I don't think we know enough to make that conclusion. Although we don't know what specific substance or maybe the way that someone is using these devices is directly causing all these illnesses, I always tell people that the only thing that they all have in common is vaping itself.

So it’s not recommended, and nobody should be using them. And there are so many different ways they can be used and submitted. It will be very difficult to isolate just one or a few substances, because one can be manipulated—and also because there are different liquids and products that are available for consumers.

We are learning more and more about the short-term risk of vaping. Unfortunately it will take a while to learn about the long-term consequences of vaping.

And this strategy of selling the product as something safe is nothing new. We've seen this before with cigarettes—we see those ads from the late 40s and 50s. There are even doctors on those ads trying to promote cigarettes, specific brands that are ‘safer’ than others. And it’s the same technique, again, for vaping.

A few weeks ago, I did go to a high school to give a talk to students and their faculty about vaping. And I had a long Q&A session, and a lot of the questions of the students were addressing that they were weighing the risks and the benefits of vaping compared to other things like cigarettes.

So for me, some of the questions were almost like they were really tempted to use it, and were really waiting to see which one is the lower risk, and then they would try that one—which for me is very dangerous. And this is what we are seeing now: companies trying to sell something that's something that is safe or safer, because they know that there is a group that will give it a try. And then after a try or a few more, they are already addicted to nicotine, and then they have consumers for years, if not decades.

And I think for several reasons, that is dangerous.

MD Mag: How should physicians navigate a patient’s belief that vaping is safer than smoking cigarettes?

Choi: You know I feel that the medical community is being a little pressured to say out loud which one is a winner—which one has a lower risk. I think, first of all, we don't have enough information to say which one is safer, and it depends how you see it, too—what the outcome is.

Now, we know about more and more about the short-term risk of vaping. We still don't know about the long-term risk of vaping. Right now the one that we know the most is the nicotine addiction itself. So if we compare the addiction between vaping and cigarettes, I'll say probably they are the same—if not even worse, because the electronic cigarettes may contain higher amounts of nicotine compared to a regular cigarette.

So I would definitely stay away from trying to give an answer of giving one winner. It's vaping versus cigarettes. You know, being very candid about an answer, I asked a colleague once, “Which one is worse for cirrhosis: beer or vodka?” So it's really hard to say which one is safer to drink. Well, you shouldn't drink at all.

I think the answer is, I've always advised not to smoke, offered treatment for nicotine dependence that is related to cigarette use or vaping use. So I think that's my best advice.

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