Vaping Is Still Not a Digital Health Solution

Don’t get caught with your head in the vape clouds.

This week brought the release of two much-discussed studies on the effects of electronic cigarette use — e-cigs, vaping, however you want to describe it. The results resonated with mainstream audiences, perhaps in part due to the strong, seemingly contradictory findings of each investigation. First, there was a New England Journal of Medicine article that found e-cigs are better at helping smokers quit than nicotine-replacement therapy. Then we had results from the American Stroke Association conference that linked vaping to greater risk of stroke, heart attack and heart disease.

For the public, these back-to-back findings might not be easy to digest. So, vaping is good AND bad? But for researchers, healthcare providers, journalists and anyone who’s kept up on the research, the takeaway wasn’t too exciting: Sure, vaping might help some people quit smoking, but it’s far from a safe digital health solution — just as earlier studies have suggested. Vaping is still a means of ingesting nicotine, and it’s not some cool, high-tech, revolutionary stand against cigarettes. It’s not representative of the healthcare future that so many visionaries are trying to build.

>> Digital Health Blunders & Wonders: Vaping & Seqster

I’m a strange candidate to make this argument.

From fall 2009 through this past summer, I smoked about half a pack of Camel Menthols every day. I was a 19-year-old kid, fresh out of community college and eager to make the most of Rutgers University, when I picked up smoking. As the months and years wore on, I began to grapple with the idea that I’d never quit smoking. I understood the consequences. I understood that I walked a grim path.

But then something clicked. My friend, a fellow smoker, had bought a Juul, and I noticed that his cigarette use was mellowing. Eventually, he told me he planned to quit altogether. I was shocked and impressed.

By last August, I had enough off smoking. The smell. The coughing fits. The embarrassment. The all-around assault on my health — on my future. So, one day on my lunch break I drove to a convenience store and paid just under $50 for a Juul starter kit, containing a pen and four nicotine pods.

I smoked a couple of cigarettes later that month, but I never bought another pack, and I haven’t had a real cigarette since last summer. I quit smoking, and I don’t think I could have done it without vaping.

But now I have another problem: I doubled my daily nicotine intake, to the equivalent of a pack of cigarettes per day, through vaping. I physically and psychologically crave nicotine more than ever before. And although we need more research into vaping and its effects, it’s clear that I still face increased health risks because of my usage.

I might be less doomed than if I had stuck to smoking, but “might” hardly seems worthy of healthcare industry celebration, especially as teen vaping reaches epidemic levels.

Is anyone in healthcare actually celebrating vaping as a digital health advancement? If they are, they appear to be quiet. Some healthcare writers have heralded e-cigs as a useful digital health tool, if only cautiously. Others have enthusiastically gotten behind the benefits of vaping for smokers. But we’re not seeing serious arguments from healthcare about the digital health potential of e-cigs.

On Twitter, key opinion leaders, doctors and digital health-focused accounts have linked vaping to the #DigitalHealth discussion. That’s probably because some folks, specifically vaping marketers and enthusiasts, have worked to paint e-cigs as a sort of digital health solution. It’s difficult to discuss vaping in health-tech circles without mentioning the digital health theory, even if everyone is knocking it down.

It’s even more difficult to discuss vaping with diehard fans and not hear about the products’ supposedly borderline-medical capabilities. Just ask Nick van Terheyden, M.D., who covered this topic in a video for this publication last year. And I can’t ignore the e-cig marketers who blast press releases, ads and study links to my inbox — a health-tech media inbox — every single day.

Enough.

Can vaping be useful in smoking cessation? Yes. We have evidence to support that answer, and I’ve experienced the power of vaping firsthand.

But is the vape a digital health tool? No.

Just because something looks sleek and is a lesser evil doesn’t mean it’s a health-tech innovation. Digital health doesn’t depend on an addictive substance like nicotine to be effective. Digital health is bits and apps, real-world data and patient engagement. Digital health is not a less dangerous drug delivery system.

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