Malaysia has its shares of crowning achievements, but it is also the fattest nation in South-east Asia. Now, we have another dubious achievement to add to our record books: we may very well have the second largest vape industry in the world, after the United States of America.

This was an estimate given by Ibrahim Mohamed, the co-organiser of the Vaporizer Convention Kuala Lumpur 2015 back in June 2015. Our country boasts an industry that is worth half a billion Ringgit, and our local entrepreneurs are also exporting their products to other countries in the region, such as Taiwan and Japan. Malaysia is also the ‘proud’ manufacturer of uniquely Malaysian-flavoured e-liquids such as jagung durian, mango lassi and sirap bandung!

The Malaysian Landscape

In 2011, Universiti Sains Malaysia and the University of Waterloo collaborated on the International Tobacco Control (ITC) Malaysia Survey, which included a first study of its kind on the perception and use of e-cigarettes among Malaysian smokers.

Here are some interesting findings from the survey, which took place from 2011 to 2014 in two phases.

Malaysians are aware of e-cigarettes.

As early as 2011, both smokers and non-smokers surveyed were aware of the existence of e-cigarettes. The awareness rate increased considerably from first to second phase.

And they have tried some, too.

The number of respondents who have tried increased considerably from phase one to two.

How often do they vape?

Do they feel that vaping is more harmful compared to smoking conventional cigarettes?

Over time, more respondents believe that vaping is equally harmful or more harmful than conventional cigarettes.

Some common reasons why e-cigarettes are in fashion

“It’s cool!”

E-cigarette models are marketed as stylish props for fashionable people. They are continuously updated and improved. Just like with mobile phones, it can be easy to get caught up in the craze to upgrade to the latest model and be part of the club.

“It’s healthier than cigarettes.”

Perceived benefits include less coughing, improved breathing and absence of second-hand smoke which can affect the people around them.

“It is a ‘cleaner’ habit.”

Unlike cigarettes, e-cigarettes do not stain the teeth or leave the person smelling like a walking ashtray. Some e-liquids, in fact, can produce pleasant smells.

“It’s cheaper than cigarettes.”

With cigarette prices going up every year, e-cigarettes are perceived as the more affordable alternative for smokers to continue getting their daily nicotine fix.

“It’s a way to help me stop smoking.”

One of the marketing angles of e-cigarettes is that they are a useful and an effective device in helping smokers quit the habit. Whether this is true or not is still being extensively researched, but there are a number of smokers who turn to e-cigarettes for this purpose.

But are the purported benefits of e-cigarettes real or are they actually harmful? Read on to see what science has uncovered so far.

E-cigarettes: Friend or Foe? 

E-cigarettes have been ‘under trial’ since last year, with arguments going back and forth between the plaintiff and the defense. 

In August 2015, Public Health England, an agency of Britain’s Department of Health, made ripples – actually, ‘shockwaves’ may be a more accurate description – when it released the results of a study showing that e-cigarettes are “around 95 percent less harmful than tobacco and should be promoted as a tool to help smokers quit”.

The agency reasoned that vaping is much safer because e-cigarettes do not have most of the substances (tar, etc) that are responsible for smoking-related diseases such as lung cancer. The aerosol – the ‘smoke’ produced by e-cigarettes – is also said to be less harmful than cigarette fumes.

However, not everyone agrees with these findings.

Insufficient evidence, Your Honour

E-cigarettes may not be superior to first-line pharmaceutical interventions when used as a tool in smoking cessation, says

Assistant Professor Paraskevi Katsaounou. She is affiliated with the respiratory medicine department, Athens Medical School, Evangelismos Hospital, Greece.

According to her, there is not enough evidence at present to support the use of e-cigarettes over first-line pharmaceutical therapies such as nicotine replacement therapy (NRT, see our Special Report in the August 2015 issue).

To date, there are only two randomised controlled trials and 11 observational studies on the use of e-cigarettes as part of smoking cessation. While there are some promising data (57% of e-cigarette users reduced their cigarette consumption by at least half compared to 41% of those who were on NRT), more evidence is needed before any firm conclusions can be made. This is because the number of trials is still small.

The current recommendations of published smoking cessation guidelines, on the other hand, are evidence-based. Thus, Dr Katsaounou advises healthcare providers to continue following these recommendations.

The US Preventive Services Task Force (USPSTF) agreed, stating that the evidence regarding the use of e-cigarettes is insufficient to warrant its use in smoking cessation.

The Malaysian Director-General of Health, Datuk Dr Noor Hisham Abdullah, urges smokers in Malaysia to visit smoking cessation clinics in health clinics or hospitals for proper care and treatment, instead of turning to e-cigarettes,

The court calls WHO to the stand

When it comes to matters of health, we cannot overlook what the World Health Organization (WHO) has to say.

From their report for the Sixth session of the Conference of the Parties to the WHO Framework Convention of Tobacco Control (FCTC):

• Many e-liquids on sale still contain nicotine, which is the same addictive component of tobacco found in conventional cigarettes. It can affect pregnancy and contribute to cardiovascular disease. It also affects the normal functions of the cells involved in many of the body’s important functions, possibly increasing one’s risk of cancer in the process.
• While there is still no conclusive evidence on the effects of inhaling the aerosol produced during vaping, current evidence suggests that the aerosol still contains some cancer-causing (carcinogenic) compounds and other toxic substances found in tobacco smoke. Generally, the levels of these compounds are lower than those in tobacco smoke.

Therefore, WHO concluded that:

• There is enough existing evidence to show that aerosol from e-cigarettes is not simply ‘water vapour’ as claimed.
• The use of e-cigarettes may pose serious health risks to adolescents and foetuses.
• Vaping increases the exposure of bystanders to nicotine and other toxic substances. However, the level of exposure is generally lower compared to smoking conventional cigarettes. Just how much lower and what this would mean to the bystander’s health are still being studied.

The final verdict … for now.

When it comes to e-cigarettes, we have heard arguments for and against them flying back and forth. Who is right?

The truth is, we honestly do not know.

While this is undoubtedly an unsatisfying answer, we currently do not have the evidence to conclusively determine which side is right. To determine the long-term effects of vaping, researchers need to conduct trials and surveys that will span years, even decades.

Hopefully we do not have to wait that long to get some answers when it comes to e-cigarettes, but we should not expect quick and clear answers anytime soon.

One thing is for sure: long-term vaping is akin to taking a gamble – as of now, you do not know what it will do to you in the long run, and neither do the doctors and researchers all over the world. A scary notion, is it not?

Reference: International Tobacco Control Policy Evaluation Project. (2014). Awareness and Use of E-cigarettes (ECs) in Malaysia: Findings from the International Tobacco Control (ITC) Malaysia Survey 2011-2014. Penang: Universiti Sains Malaysia.

References: 1. Proctor, R. N. (2012). The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll. Tob Control; 21:87-91. 2. World Health Organization (2014). Electronic nicotine delivery systems (FCTC/COP/6/10 Rev.1). Switzerland: WHO.

If you like this article, do subscribe here.