This week’s “what fresh hell is this?” news comes from Tasmania where a veteran anti-smoking activist has proudly displayed her new anti-vaping banner. Like many “public health” academics in Australia, the self-described tobacco control advocate Kathryn Barnsley (“#MaskUp”, “Climate justice”, “Labor”) has switched her attention to e-cigarettes and has warned people to “look forward to unintended consequences” if they vape. According to Barnsley, these consequences include cancer, heart problems and lung disease. None of this is supported by the scientific literature but as evidence for the first claim, she has blown up a photo of a man’s mouth cancer which sadly killed him.

You can go to your GP if you need e-cigarettes to quit smoking, if you have tried everything else.

But if you want to vape for recreational reasons – look forward to unintended consequences.

This 19 year old died from mouth cancer after extensive vaping.#politas pic.twitter.com/7xlV4Ifaiv

— Dr. Barnsley – follow the evidence. #Maskup (@TassieThinker) February 17, 2024

Regular readers will know that Australia has become deranged about vaping, but this is a new low in scaremongering. Both the photo and claim about mouth cancer come from a 2021 case report in the journal Pediatrics. It was titled “Vaping the Venom” which seems a little sensationalist for an academic publication but at least has the merit of signposting the authors’ biases in advance. A further indication that the authors may not be acting in good faith comes when they assert that “e-cigarette use … has been associated with >2600 cases of severe lung injuries and >60 deaths across the nation.” This is a reference to a spate of serious health problems caused by illegal THC vapes in North America in 2019 which had nothing to do with conventional nicotine e-cigarettes. Attributing it to “e-cigarette use” is disingenuous at best.

The study looked at the unusual case of a 19 year old American man whose tongue started swelling after he accidentally bit it. This developed into a large ulceration and he was subsequently diagnosed with squamous cell carcinoma. Despite treatment, the cancer spread and he died six months later from a heart attack.

It is a horrible story but such cases are thankfully rare. The authors note that only 0.4 per cent of oral cancers occur among people aged under 20. Risk factors include HPV infection, smoking and alcohol use, but it can occur among people who have none of these. Although there is no evidence that vapers are more likely to get oral cancer, the authors of the Pediatrics study made some strong claims based on their n=1 sample, saying that it “suggests that e-cigarette use may pose a carcinogenic effect” and that it “supports the hypothesis that vaping can cause cancer”. You will note that the slight note of uncertainty in these lines is at odds with the less ambiguous denouncement of vaping as ‘venom’ in the title.  

The claim that e-cigarettes caused the cancer in this instance rests solely on the fact that the patient was a vaper. He was also a former smoker of cigarettes who took up smoking marijuana after biting his tongue, but this gets short shrift as an explanation from the authors. His alcohol consumption is not mentioned at all. 

Case reports of this kind can be useful to medical practitioners but they were never designed to identify the cause of illnesses and they are totally incapable of doing so. Although vaping cannot be discounted as a risk factor for oral cancer, any investigation should begin by asking whether there has been a rise in young people getting oral cancer since e-cigarettes came on the scene and whether oral cancer is more common among vapers who have never smoked than among other nonsmokers. A case study of a solitary individual tells us absolutely nothing and looks more like exploitation of a personal tragedy than a serious scientific endeavour. 

Perhaps tobacco control advocates like Kathryn should stick to the day job?

The authors may not have expected their little study to be used to justify the claim that “E-cigarettes Kill” on a seven foot tall banner in Tasmania, but I doubt they will be too disappointed. This is how misinformation snowballs. Academics produce obscure research making speculative claims which are amplified by unscrupulous activists who remove any trace of nuance. Before you know it, people who think e-cigarettes are as dangerous as smoking outnumber those who understand that the risks are vastly smaller.

Speaking of smoking, every country that has embraced vaping as part of tobacco harm reduction has seen an acceleration in the decline in smoking rates. In Tasmania, by contrast, the smoking rate rose from 12 per cent to 15 per cent between 2019 and 2022. Perhaps tobacco control advocates like Kathryn should stick to the day job?