In the late 1950s, a new "miracle" drug, thalidomide, was prescribed to pregnant women to treat morning sickness. A couple of years later it was found to cause birth defects and was withdrawn. Sadly, by then around 10,000 babies had already been born with permanent disabilities from deformed or missing limbs.

If the authorities had properly safety tested this drug before allowing it to be prescribed to pregnant women, this would not have happened.

This lesson is what we call the precautionary principle: If we don’t know the potential harms of a drug, we find out before we roll it out to the masses.

Most countries should have learned this lesson by now but apparently they have not, going by what is happening with e-cigarettes and vaping in the United States.

In recent weeks 18 people have died, the youngest just 20 years old, and  more than 1,000 have developed mystery lung illnesses thought to be linked to vaping.

These people are otherwise healthy and young, typically in their teens or 20s. The youngest reported case of illness was just 13 years old. The mystery illnesses resemble a pneumonia which typically starts with nausea, vomiting and shortness of breath and quickly degrades into a more serious condition where they end up hooked to a ventilator.

In an estimated 80 per cent of cases, they were vaping mixtures of substances, including marijuana oil.

And it’s not just in the US. In the United Kingdom, where vaping is common, more than 70 cases of vaping-related illnesses, including heart disorders, chest pains and pneumonia, have been reported.

How did it come to this?

Let’s backtrack to eight years ago, when vaping first became popular. Many people were hopeful that e-cigarettes would be a safe alternative for smokers. Others were wary of their unknown health effects. Scientists warned that vaping might cause heart disease or permanent lung injuries.

Vaping liquids usually contain a lipid base, like vegetable glycerin, to dissolve the nicotine. Most of them also include chemical flavours and additives.

The lungs are designed to inhale air, not lipids or toxic chemicals. Something that is safe to eat, like vitamin E, might be dangerous if you inhale it especially if it’s heated at a high temperature and mixed with other chemicals.

But at the same time, many people acknowledged that e-cigarettes were probably safer than cigarettes.

As the e-cigarette debates went on, many countries were slow to regulate. Only a handful of countries banned e-cigarettes from the outset, Singapore being one of them.

Meanwhile, tobacco and e-cigarette companies were selling e-cigarettes in funky colours and designs, with fruit and candy flavoured e-liquids, and aggressively marketing them to youth on social media.

A few years later, they had started a vaping epidemic among American high school students. By 2018, over a third of 12th grade students (age 16) reported that they had vaped in the past year. Many of them were also mixing other substances, like marijuana oils, into their e-cigarettes.

If the US had regulated e-cigarettes from the outset, these vaping illnesses and deaths could have been avoided.

The outlook is quite grim for most smokers. One in two will die from a tobacco-related disease.

Only around 5 per cent of all cold-turkey quit attempts are successful. If they use an approved quitting aid, like nicotine patches, the success rate increases to a modest 25 per cent.

The rush to liberalise e-cigarettes based on the belief that they could be safer than cigarettes is therefore understandable, but it is not very sensible.

When a promising new treatment appears, like the latest anti-cancer drug, it goes through years of safety testing and clinical trials. Its efficacy is compared to standard treatments such as other anti-cancer drugs. Only after the drug passes these tests is it given to patients.

This is an example of the precautionary principle applied in practice. Yes, it means that patients who need the drug right now will miss out.

But it also avoids opening a can of worms, should the drug have deadly side effects or other unintended consequences.

Or, in the case of vaping, if it should give more than 1,000 people a deadly lung illness.

Not a single e-cigarette on the market has met typical safety or efficacy standards that apply for medicines. Little is known on their long-term safety; even less on the health effects of substance mixes like e-liquid and marijuana oil combinations.

Worse still, vaping has become extremely popular among young people who would otherwise not be hooked on nicotine.

E-cigarettes are now banned in more than 20 countries. More countries, such as India, are following suit. As it turns out, Singapore’s decision to never allow e-cigarette sales in the first place was a wise one.

This is because, as illustrated by the US’ experience, it is easier to contain a problem before it starts than it is to close a can of worms.

ABOUT THE AUTHOR:

Yvette Van Der Eijk is Senior Research Fellow at the Saw Swee Hock School of Public Health, National University of Singapore.