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Vaping is the new smoking - in more ways than one! Wisdom Wednesdays · Hardiness with Dr Paul Taylor

• 0:05
  Speaker 1: Hey, everyone, welcome to another edition of Wisdom Wednesdays. Now,
• 0:09
  Speaker 1: unless you've been living under a rock, you'll notice that
• 0:12
  Speaker 1: vaping is pretty popular these days and in Australia, New Zealand, USA,
• 0:18
  Speaker 1: and the UK between seven and ten percent of adults vap,
• 0:22
  Speaker 1: and they tend to be former smokers, But there are
• 0:25
  Speaker 1: much higher rates in our youth, who, unlike adults, are
• 0:29
  Speaker 1: much more open to experimentation and much really striking when
• 0:33
  Speaker 1: you look across these countries, it's not just the prevalence,
• 0:36
  Speaker 1: but it's the trajectory.
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  Speaker 2: Now.
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  Speaker 1: New Zealand is leading the pack in terms of daily
• 0:42
  Speaker 1: use and about twenty percent of youth in New Zealand
• 0:47
  Speaker 1: actually vap daily, but about fifty percent of youths in
• 0:53
  Speaker 1: New Zealand have actually tried vaping. Now in Australia about
• 0:57
  Speaker 1: fifteen percent currently use, but thirty have ever tried it,
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  Speaker 1: and actually it's been rapidly rising in recent years.
• 1:05
  Speaker 2: There's also a growing concern.
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  Speaker 1: In the UK, current use is about seven to ten
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  Speaker 1: percent in terms of youth, but about a quarter have
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  Speaker 1: actually tried it.
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  Speaker 2: And the USA they seem to be a little bit
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  Speaker 2: ahead of.
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  Speaker 1: Us because they have had a peak and they're declining,
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  Speaker 1: so almost forty percent have actually tried it in the States,
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  Speaker 1: but now about ten percent used daily. But this is
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  Speaker 1: pretty concerning because across the board, we are talking about
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  Speaker 1: millions of adolescents regularly exposing themselves to both nicotine and
• 1:41
  Speaker 1: the chemicals that are released from this during critical development
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  Speaker 1: years now.
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  Speaker 2: For a long time, the conversation.
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  Speaker 1: Around vaping has been framed in a particular way. Is
• 1:53
  Speaker 1: it better than smoking? Does it help people quit cigarettes?
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  Speaker 1: Is it less harmful? And the idea that vaping is
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  Speaker 1: pretty sea seems to be pretty prevalent in our youth.
• 2:03
  Speaker 1: But is this really the case? So a brand new
• 2:06
  Speaker 1: paper has just come out in the journal Cautional Genesis
• 2:09
  Speaker 1: and explored exactly that topic, looking at the cause and
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  Speaker 1: egenic potential of e cigarettes, and it's probably the most
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  Speaker 1: comprehensive review that has been done on this topic to date.
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  Speaker 1: And the paper asked an interesting question, not is it
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  Speaker 1: better than cigarettes? But can vaping itself cause cancer independent
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  Speaker 1: of smoking? And that distinction is pretty important. So let's
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  Speaker 1: unpack what the paper explored, but first a little bit
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  Speaker 1: of context. Now, E cigarettes have evolved pretty rapidly over
• 2:41
  Speaker 1: the last couple of decades. Early devices are pods and disposables,
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  Speaker 1: but the basic mechanism is pretty much the same. You've
• 2:49
  Speaker 1: got a battery of heating coil and an e liquid
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  Speaker 1: that contains nicotine and flavoring chemicals which get aerosolized and
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  Speaker 1: then inhaled. Right now, this review focuses on the nicotine
• 3:02
  Speaker 1: based e cigarettes, so not cannabis or other substances. And
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  Speaker 1: importantly they exclude what's called dual users, people who both
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  Speaker 1: smoke and vap because that muddies the waters when you're
• 3:13
  Speaker 1: trying to isolate the independent effects of vaping.
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  Speaker 2: Obviously, and that's a.
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  Speaker 1: Pretty important on what I would call strong methodological decision.
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  Speaker 1: Now here's the challenge. When you're studying cancer risk. It
• 3:27
  Speaker 1: takes decades to develop, so we don't yet have long
• 3:31
  Speaker 1: term studies tracking exclusive vapors over twenty to thirty years.
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  Speaker 1: That data just does not exist. So what the researchers did,
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  Speaker 1: and this is pretty standard in cancer research, they looked
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  Speaker 1: at three lines of evidence. Firstly human biomarkers and clinical findings,
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  Speaker 1: second with animal studies, and then the third is mechanistic
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  Speaker 1: laboratory evidence. And when you put all of that together,
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  Speaker 1: you build what researchers call a qualitative risk assessment, and
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  Speaker 1: the conclusion of this paper is pretty blunt. Nicotine based
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  Speaker 1: e cigarettes are likely to be carcinogenic and may cause
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  Speaker 1: lung and oral cancers.
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  Speaker 2: Have we heard that before?
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  Speaker 1: It was only probably forty or so years ago that
• 4:14
  Speaker 1: we were talking about that in cigarettes. Now it's a
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  Speaker 1: pretty damning statement. So let's go through the evidence. So
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  Speaker 1: the first thing, what are we seeing in humans now?
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  Speaker 1: Even though as I said, we don't have the long
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  Speaker 1: term cancer data, we do have a lot of biomarker data,
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  Speaker 1: and that's where things get interesting. For example, levels of cotinine,
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  Speaker 1: which is a metabolite of nicotine, are massively elevated in vapors,
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  Speaker 1: and that's no surprise really, but some studies show over
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  Speaker 1: one hundredfold higher levels in e cigarette.
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  Speaker 2: Users compared to non users.
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  Speaker 1: Now that tells us one thing, very very clearly. People
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  Speaker 1: who vap are absolutely being exposed to significant amounts of
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  Speaker 1: biologically active compounds.
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  Speaker 2: But it doesn't stop there. Are what we're also.
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  Speaker 1: Seeing is increased DNA damage markers in oral cell cells
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  Speaker 1: in the mouth, elevated oxidative stress inflammation in lung and
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  Speaker 1: oral tissues, and changes in DNA methylation and gene expression
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  Speaker 1: linked to cancer pathways. Now, these are not trivial findings,
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  Speaker 1: as you probably are guessing, but because these are the
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  Speaker 1: exact same biological processes we associate with the early stages
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  Speaker 1: of cancer development. So secondly, what is actually in the aerosol? Now,
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  Speaker 1: a lot of people assume that vaping is just nicotine
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  Speaker 1: and water vapor, but that is not the case. A
• 5:40
  Speaker 1: cigarette aerosols contain a complex mixture of chemicals, which was
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  Speaker 1: highlighted in this paper, and they include volatile organic compounds
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  Speaker 1: like benzene and formaldehyde, heavy metals such as nickel and chromium,
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  Speaker 1: nicotine derived nitrosamines, and flavoring agents that can degrade into
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  Speaker 1: toxic aldehyde. Now, aldehydes are things that are given off
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  Speaker 1: when you cook things like vegetable oils at high temperatures,
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  Speaker 1: and they are known to be carcinogenic compounds. Now, importantly,
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  Speaker 1: these compounds are not just present, they are actually absorbed
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  Speaker 1: into the body, as shown by urine and blood biomarkers.
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  Speaker 1: So again this is not passive exposure, it's active chemical uptake. Now, thirdly,
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  Speaker 1: let's explore what the study talked about the evidence from
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  Speaker 1: animal studies. One of the most striking findings comes from
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  Speaker 1: a long term mouse study, and mice exposed to E
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  Speaker 1: cigarette orsol for about a year showed twenty two and
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  Speaker 1: a half percent develop lung ano carcinomas and that was
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  Speaker 1: compared to just one out of forty in the control group.
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  Speaker 2: So one in forty versus one in four. That is
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  Speaker 2: a massive difference.
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  Speaker 1: Now, as I've said before, we always have to be
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  Speaker 1: cautious translated animal data to humans. But when you combine
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  Speaker 1: this with the human biomarker data, the picture starts to
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  Speaker 1: become clearer. And then when you add in mechanistic processes,
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  Speaker 1: we start to get stronger evidence. So let's talk about
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  Speaker 1: this mechanistic evidence I might vaping cause cancer. And now
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  Speaker 1: this is where it gets really interesting from a biological perspective.
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  Speaker 1: The researchers analyze the data using what's called the key
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  Speaker 1: characteristics of carcinogen's framework, and what they found is that
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  Speaker 1: a cigarette aerosols demonstrate all ten characteristics associated with coarc synogens.
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  Speaker 1: That includes, and let's not go through all ten but
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  Speaker 1: the most important ones genotoxicity that is direct DNA damage,
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  Speaker 1: direct damage to your genes, oxidative stress, chronic inflammation, epigenetic changes,
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  Speaker 1: and immune system disruption. So we're not talking about a
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  Speaker 1: single pathway. We're talking about multiple overlapping mechanisms that can
• 8:04
  Speaker 1: drive cancer development. And that's exactly what we see with
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  Speaker 1: known cos synogens. So what about real world cases? So
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  Speaker 1: the paper also explored some early case reports emerging listed
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  Speaker 1: a number of things, but examples would be oral cancers
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  Speaker 1: in long term heavy e cigarette users are ready starting
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  Speaker 1: to be shown. They talked about a young individual with
• 8:29
  Speaker 1: aggressive oral cancer and a history of vaping, and a
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  Speaker 1: case of lung cancer in a long term vapor Now
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  Speaker 1: these are just single case reports and they don't prove causation,
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  Speaker 1: but they are early warning signals and then when combined
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  Speaker 1: with all of the other data.
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  Speaker 2: We really start to see a picture emerging.
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  Speaker 1: Now it is important to be balanced here, and the
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  Speaker 1: authors were very clear that they were not quantifying the
• 8:57
  Speaker 1: exact cancer risk yet, that we don't know the magnitude
• 9:01
  Speaker 1: because we need long term data for this.
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  Speaker 2: But what they are.
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  Speaker 1: Saying is this that there is consistent evidence across human,
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  Speaker 1: animal and mechanistic studies that vaping has carcinogenic potential, and
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  Speaker 1: that is a big shift in the conversation because for
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  Speaker 1: years vaping has been positioned by the industry as the
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  Speaker 1: safer alternative and.
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  Speaker 2: Compared to smoking.
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  Speaker 1: That may still be true in certain contexts, but I
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  Speaker 1: think what this paper highlights is that less harmful does
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  Speaker 1: not mean harmless. And more importantly, vaping is not biologically inert.
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  Speaker 1: It exposes the body to a complex mix of chemicals
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  Speaker 1: that damage DNA, drive inflammation, ulter gene expression, and potentially
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  Speaker 1: initiate cancer pathways.
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  Speaker 2: And this is very concerning when I'm considered.
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  Speaker 1: With the data that I talked about earlier, with the
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  Speaker 1: huge amount of our youth who are vaping and who
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  Speaker 1: are experimenting with vaping, and the amount if nicotine that
• 10:01
  Speaker 1: some of these kids are exposed to is just ridiculous,
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  Speaker 1: and nicotine is actually very very addictive. So you have
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  Speaker 1: that that's independent eye of this stuff that's coming out
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  Speaker 1: that's suggesting that they potentially cause cancer and likely cause cancer.
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  Speaker 1: So if you know anybody who currently vaps, this is
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  Speaker 1: probably worth sharing. But if like me, you have teenagers,
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  Speaker 1: this is about the conversation, right and about explaining to
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  Speaker 1: them that the science is actually showing that this stuff
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  Speaker 1: is not passive at all and is likely carcinogenic as
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  Speaker 1: well as highly addictive as well. So that's it for
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  Speaker 1: this week, folks, catch you next time.