Dr Gopal Bhatnagar Interview on Vaping

Leading Canadian cardiac surgeon and co-founder of 180 Smoke talks about the effectiveness of vaping and gives valuable insights on the implications of a flavour ban. 

 Q: As a leading cardiac surgeon, how do you perceive vaping and its role in the realm of smoking cessation? 

Dr Bhatnagar: Even a decade ago, the evidence that this was a less harmful alternative to combustibles was compelling. Multiple randomized trials have shown it to be at least equivalent, and in the most recent article, superior to NRT in smoking cessation. The work by Dr. Farsalinos has shown minimal if any cardiovascular disturbance attributable to vaping alone, but more research is required. Claims about toxic substances being in e-liquids have been disproven by liquid chromatography testing. The only way to create these volatile organic compounds like formaldehyde is to burn the e–juice at in excess of 260 degrees or by using faulty products.

Q: In relation to other smoking cessation aids, how does vaping fit in and what distinct advantages does it have? 

Dr Bhatnagar: Vaping is a tool that clinicians should consider for cessation, but many use it only as an alternative that is likely to be less harmful. Not every method works for everyone but vaping is the only modality that provides the oral-manual behavior replication of smoking.

Dr Gopal Bhatnagar (center) is the Chief of Cardiac Surgery at the Cleveland Clinic Abu Dhabi. Prior to this, he served as the Chief of Staff at Trillium Health Centre, Ontario.

Q: In regards to overall health, what are some of the risks and benefits associated with vaping/e-cigarette use? 

Dr Bhatnagar: In properly manufactured facilities both the hardware and e-liquid has been demonstrated to have much less harm than the combustibles. The recent cluster of lung disease are by the CDC’s own investigation not related to the vaping of e-cigarettes with or without nicotine but rather to adulterated THC solutions. Aside from some people having a hypersensitivity to ingredients (usually PG) leading to throat irrigation very little is consistently reported. Importantly nicotine poisoning has only occurred when highly concentrated solutions (industrial strength, not consumer strength) have been inadvertently consumed.

Q: Despite its condemnation from various media outlets, has vaping  served its purpose as a viable alternative to smoking? If so, how have you observed the health benefits as a medical professional? 

Dr Bhatnagar: Yes, the condemnation is ill founded and not factual, it is indeed the epitome of FALSE NEWS. The media has sensationalized the issue and often failed to inform the public on the differences between THC use and e-cigarettes for smoking cessation. Sadly, the catch all term of vaping pandered to the anti-vape lobby who took full advantage of the false news.

Q: What role has technology and product selection served in the popularization of vaping?

Dr Bhatnagar: The advent of more sophisticated devices allowed vaping to deliver a closer nicotine delivery profile to traditional combustibles and thus improved its smoking cessation potential. Miniaturization has allowed it to be more consumer friendly and helped in the commercial aspect.

Q: As the US and Canada continue conversations on flavour bans, how do you see this affecting the effectiveness of e-cigarettes

Dr Bhatnagar:  The ban on flavors has no basis in fact. The argument that it appeals to youth and is directed solely at them is false. Surveys on youth use do not show that so called “kiddies flavours” are popular. Adults enjoy palatable flavours and that is why they are produced. Similarly, flavoured alcoholic beverages are not designed to entice youth but are produced because they have widespread appeal in the adult market. Making e-cigs less palatable could lead to reduced usage, and hence ongoing smoking, or people trying to self-replicate flavours in an unregulated manner.

Q: If a flavour ban were to occur, how would that affect the total health of a nation?

 Dr Bhatnagar: This would be a truly regressive step in regulation. It does not protect youth as the advocates claim and only bolsters the combustible market. We know that combustible tobacco use is the number one preventable cause of disease in society. It is comparable to diabetes in long term health detriment. Anything that reduces the ability of smokers to have choice in smoking cessation therapies will cause increased societal harm. Keeping e-cigarettes away from our youth is a matter of responsible dispensing, prudent policy enforcement and education, no different than what we need to do to keep cigarettes and alcohol from them.