E-smokers Under Fire

FOR A GOOD MANY YEARS, it appeared there was little that could keep the writer Martin Amis away from his cigarette. Laid- back interviews with him are very often filled with references to his smoking. Even in his books, characters are almost always lighting or torching a cigarette. John Self, his celebrated character in Money, tells the reader directly at one point, as if standing in for his creator, ‘Unless I specifically inform you otherwise, I’m always smoking another cigarette.’

Late last year, when Amis was in Mumbai for a literature festival, I saw him on stage reach into his jacket and pull out something shaped like a pen but with no accompanying notepad to follow. As the talk progressed, he began to chew on it like a nervous school kid. But it was only when the other end of the tip turned a warm blue-red, and a few seconds later, little tufts of cotton began to rise, did I realise that Amis wasn’t smoking on stage after all. He was vaping.

A few days later, at a lively party in Mumbai’s Andheri suburb, I felt a nudge on my shoulder. It was a friend who always sought me out at these parties so we could sneak away from the rest and facing a corner, as though ashamed, steal a few quick drags of a cigarette.

There was to be no sneaking around today. My friend’s wife, a figure of disapproval when it comes to smoking, was nearby. She had seen us but smiled, even appeared encouraging.

I followed him into a corner. And there in his hands, I saw the second vape of my life, that too in the span of just a few days. This one was slightly bulkier than Amis’.

“Oh, I love it,” he said when I asked him about it. He was drawing a colourful liquid from the device and blowing out, not smoke, but something thick and voluminous like the emissions of a hookah.

“But don’t you miss real smoking?” I asked.

“Smoking?” he seemed to ask. “That is gross, man.”

Since then, in the past year or so, I seem to see electronic cigarettes everywhere. Leonardo DiCaprio vapes. Tom Hardy vapes. Here, Ranbir Kapoor was vaping, at least until recently. One can see people smoking electronic cigarettes at house parties, in smoking chambers at airports and offices, outside bars, on Instagram and other social media platforms, where it appears to have taken a life of its own, and on occasion, even just in the middle of the day on a busy pavement. And around this tiny explosion, an even smaller but fast-evolving subculture around vaping seems to have emerged, juiced up by Instagram and other social media apps. There are people who collect ‘mods’ (or modified vapes with additional features), those who tinker with their vapes and their coils to create what they call ‘coil art’ or ‘coil porn’, and people who mix and match and come up with their own juices and flavours. There are ‘cloud chasers’ who try to produce the largest possible vape clouds. And there are ‘vape trickers’ or vapers who spend hours perfecting tricks far more complicated and grand than any smoke ring from a traditional cigarette.

Pratik Gupta, one of the directors of the Association of Vapers India (AVI), an advocacy group that pushes for the use of e-cigarettes to help smokers quit, points to the expansion of the group to emphasise his point. “When we started back in 2015, we were about 10 of us. Now we are some 5,000 people,” he says. “And there’s a lot more just out there.”

In India, the preferred method to buy e-cigarette merchandise, from the juices and the batteries to the vape itself, is through online distributors. Most of them ship these products from foreign shores, especially China, which is widely believed to be the manufacturing hub for vaping hardware. The devices themselves come in a range of options, in features and built, from a box-like device to a sleek flash drive-sized instrument that can be plugged into a computer to charge. And there are a range of flavours for the juice, from those that mimic the taste of tobacco to fruity and menthol choices. Some companies like ITC in India have also launched their own device, EON, in various versions. As the trend catches on, a few brick-and-mortar shops that exclusively sell e-cigarettes have also sprung up in cities like Delhi and Mumbai in the last few years.

Despite its varieties, every e-cigarette essentially consists of a cartridge and a battery. When turned on, a small electric heater heats up the liquid in the cartridge (a mix of vegetable glycerine and propylene glycol in which nicotine has usually been dissolved), resulting in an aerosol mist or vapour that a smoker can savour much like cigarette smoke.

E-cigarettes have actually been around for a while, at least since the 1960s. But they really emerged on the scene in the last decade, appearing first in China sometime around 2004 where a pharmacist, Hon Lik, patented the first version of today’s standard e-cigarette. The concept has since spread rapidly through Europe, the US and the rest of the world.

Its proponents often quote the US researcher Michael Russell, widely considered a pioneer in the understanding of nicotine addiction, who is believed to have said: “People smoke for the nicotine, but they die from the tar.” They argue that the electronic cigarette is revolutionary because while it provides nicotine, the addictive aspect of smoking, it delivers none of the carcinogenic tar and chemicals that get released in the combustion of a traditional tobacco cigarette.

Unsurprisingly, the primary market for vapers in India, like elsewhere in the world, seems to comprise smokers who want to quit. Gupta says he first started smoking, like a lot of other smokers, in his teens. “I would smoke like 30-35 cigarettes in one day. I tried everything, nicotine patches, gums. I even tried going ‘cold turkey’. But nothing ever worked for me. I’d be back to cigarettes shortly. But then e-cigarettes came along. And I have been clean [of cigarettes] for almost three years,” he says.

Vikas Chanana, along with a friend, Rubin Sethi, runs Vaporesso India. Their company makes and sells over 40 different flavours of e-liquids or e-juices, from Marlboro tobacco and Cuban cigar flavoured ones to those more distinctly Indian taste-specific, like mango ice and meetha paan. They also sell imported vaping hardware. A majority of their clientele are ex-smokers, and about one-tenth of them are former hookah smokers.

Chanana and Sethi themselves were addicted to hookahs. About three years ago, Sethi introduced Chanana to e-cigarettes as a way to kick the hookah habit. He also showed Chanana how different flavours can be created.

After hookahs were outlawed in several pubs and restaurants in and around Delhi and Gurugram, the duo began pushing their vapes and flavours to see if these could eventually replace hookahs among patrons of these establishments. “It worked with me. Neither of us do hookahs anymore,” Chanana says. “And anyway it is less harmful than a hookah.”

The number of vapers is growing, Chanana says, but so is competition. “There are so many shops and websites now that sell e-liquids and vapes. But we keep doing our thing, coming out with more and better flavours,” he says.

Among their e-liquids are also nicotine-free flavours, catering to those who want to switch off from nicotine completely. They have also come up with variants that produce less vapour.

There are also some that produce more vapour. But why would anyone want to be more conspicuous?

Enter the ‘vape tricker’.

Internationally, the growth of the vaping scene and existence of platforms like Instagram and YouTube have spawned their own instant vape celebrities. There are vape trickers, for instance, whose videos of eye-catching tricks from e-cigarette vapours get millions of views and shares.

In comparison, the scene here is smaller, but growing all the while. Anubhav Khurana, a 21-year-old Delhi graduate who goes by the Instagram handle ‘dripntrick’, describes his vape tricks as a hobby. Vaping, to him, is a way of expressing his individuality. Given an e-cigarette, Khurana can perform several tricks. His favourite, though, is the ‘jellyfish’. Here, a large ‘O’ is blown in the air, followed by another little cloud, which upon entry into the large ‘O’, wraps around it to resemble a ghost-like jellyfish. “People do crazy things,” he says, “but I like this the best.”

BUT THERE IS now trouble on the vape horizon. Several Indian states have banned, or are in the process of clamping down on e-cigarettes. Tamil Nadu became the latest state to ban it in June. And according to reports, even the Union Government is considering a nationwide ban. “See, the trouble is e-cigarettes are not as safe as they are made out to be. There are enough studies now in reputable journals which show it is harmful,” says Dr Vishal Rao, an oncologist and member of the High Powered Committee on Tobacco Control in Karnataka, one of the earliest Indian states to introduce a ban on vaping. “It may have fewer toxicants compared to cigarettes, but there are still some toxicants.”

According to Dr Rao, while there is still no concrete evidence that proves e-cigarettes are actually an effective smoking cessation method, what is crucial to bear in mind is that its purpose is not to offer the smoker a healthier alternative, but to expand the nicotine market and catch non-smokers young. “It’s electronic. So you see it now suddenly becomes a ‘cool’ thing. And you say it is less harmful. But then you have nicotine. So it’s the ideal way to catch a young kid and make him addicted to nicotine,” he says. “Tobacco laws worldwide are pretty strong. You are not allowed to attract youngsters. So vaping has become this new strategy to introduce a new addiction… They say chemicals and tar have been removed. And it’s safer. But then, why not remove nicotine? But that they won’t do because that’s their business. We have to remember they are not in the business of tar or chemicals, they are in the business of nicotine addiction.”

The point several e-cigarette users, however, insist on while pushing for the continued availability of these devices is not that it is entirely harmless, but that it is less harmful. Samrat Chowdhery, a spokesperson of AVI, debunks the theory of e-cigarettes being a gateway to nicotine addiction for young non-smokers. He points to a 2017 UK study, probably the largest of its kind with 60,000 teen respondents, which found that while experimentation with e-cigarettes was occurring, regular use by teens who had never smoked remains very low—at less than 1 per cent. The overwhelming majority of e-cigarette users, Chowdhery claims, are ex-smokers. “[Public health officials] see it as a novel new-age tobacco product which is targeted at the youth, not once acknowledging that it is 95 per cent safer as there is no combustion and 120 million smokers in the country, half of whom will die of smoking, can benefit. We spend over Rs 1 lakh crore every year on tobacco harm mitigation, and lose a million people… and here, these guys want a preventive measure banned,” he says.

There is still little knowledge about how harmful or harmless vaping is. Or even whether it can help smokers eventually quit the deadly habit altogether. E-cigarettes are still fairly new and evidence addressing these questions is scant. In the past few years, a few studies have cropped up. Some like The New England Journal of Medicine found e-cigarettes release formaldehyde, a carcinogen, when heated by high-voltage batteries. Another study found that daily e-cigarette use can double the risk of a heart attack, and when combined with traditional cigarettes, the risk goes up five times more. Some studies suggest that it actually makes it harder for smokers to quit, with people becoming users of both electronic and traditional cigarettes.

But there are several other studies and reports that suggest e-cigarettes in the larger scheme of things can actually prove beneficial in dealing with tobacco addiction. A 2015 report by Public Health England, for instance, encouraged the medical licensing of e-cigarettes in the UK as a form of nicotine replacement therapy, saying it is 95 per cent safer compared to cigarette smoking and that it can help people quit smoking.

Overwhelmingly though, most studies seem to suggest that e- cigarettes are a lesser evil compared to regular cigarettes. As more and more states mull over imposing a ban on e-cigarettes, AVI is holding press conferences and online campaigns in support of its claims of ex-smokers benefitting from it. The advocacy group is also part of three court cases—in the Karnataka High Court, J&K High Court (where it has filed petitions against bans in those states) and in the Delhi High Court (where it has intervened in another petition seeking to regulate e-cigarettes). The group also makes it a point to approach government and public health officials to put its views across and files RTI queries asking various government bodies and research institutes to clarify their position or report if they have carried out any scientific studies on it. “There’s a lot of misconception and strange resistance in the medical community here. Part of it is World Health Organization pressure, part of it is lack of information. Ninety per cent of them have never seen an e-cigarette, I can bet you that, and neither have they looked at the science,” Chowdhery says.

Many e-cigarette advocates suggest that the reason that several Indian states have either enforced, or are inclining towards a ban, is because the tobacco industry is threatened by vaping. According to them, smokers, although a tiny portion of the total number of tobacco users, pay the largest component of tobacco tax in the country. Several livelihoods are dependent on tobacco crops and the cigarette industry. And the use of e-cigarettes, they say, is a direct threat to them. If e-cigarettes are to be banned because they are harmful, they argue, cigarettes should be banned too, as they are inarguably more harmful in comparison.

Dr Rao reasons that if cigarettes were being introduced today, with all the knowledge we now possess on how harmful they are, then it would not be permitted. “Every country is now far more cautious when it comes to tobacco and nicotine products. Newer products like e-cigarettes are bound to go through greater scrutiny.” According to him, regulations on cigarette and tobacco products, from rules restricting underage access to cigarettes and pictorial warning signs on packets to the easy availability of banned products like gutkha, are routinely flouted. The launch of another nicotine product complicates matters.

To vapers, outlawing e-cigarettes would simply mean pushing the vaping market underground, or vapers going back to cigarettes. Chowdhery switched from cigarettes about three years ago. He used to smoke over 20 sticks in a single day, he says. “Mom was super happy, as the house doesn’t stink [anymore],” he adds, “I could finally draw deep breaths, take long walks without panting like mad, [and my sense of] taste came back. I guess that’s also what makes e-cigarettes users [such activists]. They have seen real change in their lives.”

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