In 1970, the late Dr George Miller, a friend of mine working for the UK Medical Research Council in the West Indies, was asked to investigate an outbreak of a fatal lung disease in Guyana. He discovered that it was occurring in smokers who had been enhancing their experience by adding mineral oil to the tobacco leaf and wrote a famous paper on 'blackfat tobacco smokers' lung'. Inhalation of mineral oil was a rarely recognised cause of lung damage, often fatal.
In 1980, as a chest physician in Edinburgh, I was consulted by a young building labourer with a cough and an abnormal chest radiograph. Until a year previously he had been a full-time punk rock drummer and fire-breather, but had ended this career after incinerating his flat. He told me that before performances the band smoked whatever they had gathered by way of drugs in the previous week, these not being confined to tobacco and cannabis but included various pills that they had gathered, and ground into a powder. I took a sample of his lung and it was full of oil and mineral particles, leading to scarring. I recorded this case of 'punk rock drummer's lung' in the British Medical Journal
The good readers of the Scottish Review
, most having led a more sheltered existence than those of us at the frontline of medicine, would be surprised to know what tricks people get up to in order to enhance their experience of life, or at least to make it seem bearable. The most popular is burning vegetable matter containing nicotine and inhaling the mixture of poison gases, nanoparticles, carcinogens and radioactive substances known as cigarette smoke. This was once almost universal among men of my generation, as nicotine is one of the most addictive chemicals known.
Mass-addiction to tobacco proved extremely profitable to both manufacturers and suppliers and brought considerable income to governments from taxation; there has been a long battle to counter this mass-intoxication of the public, and part of this has been to find ways of treating the addiction in its victims.
Public information on risks of heart attack and cancer and exhortation by doctors initially had little effect on smoking rates in the population until governments were shamed into taking action through progressive taxation. The work of Action on Smoking and Health (ASH) was countered by the propaganda of the tobacco companies, who knew that addiction to nicotine acted to their financial advantage and they continued to entice youngsters into the habit.
A break-through in management of cigarette addiction came in the 1980s with the introduction of nicotine substitution, especially when combined with counselling. Patches, allowing nicotine to be absorbed in small doses through the skin, were proved to be an effective aid to stopping smoking in people who wished to do so. More recently, the introduction of vaping has also proved effective in the hardcore of serious addicts wishing to give up, allowing them to get something of the oral pleasure of smoking as well as the satisfying neuro-psychological effects of nicotine.
Nicotine is well known to pharmacologists for its effects on nerve transmission, in the brain and in blood vessels, the bladder and the gut, but it does not increase risks of cancer. Like many chemicals, it may have apparently beneficial effects as well as harmful ones, the balance between these being dependent on the dose taken, a well-recognised effect of most of the medicines we may have to take. Nicotine causes release of substances in the brain that are responsible for the pleasurable sensation sought by addicts, but among other unpleasant effects it causes narrowing of arteries and rises in blood pressure; it is likely that it plays a part in the increased risk of heart disease and sudden death among smokers.
The advantage of nicotine substitution is that the individual no longer craves cigarettes and thus may stop inhaling the carcinogenic substances in tobacco smoke. However, the consequences of long-term nicotine use are as yet unknown and it is probable that heart attack and stroke will prove to be among them. Moreover, there are more immediate problems to consider.
In the United States and increasingly in the UK, vaping is being promoted to young never-smokers as well as to those who wish to quit. There is clearly a lucrative market for an apparently safe, legal means of producing the pleasant effect of intoxication especially, if as with nicotine, it guarantees that the new customer will become addicted.
In such circumstances, one would expect people to overdose and experience serious poisoning. It would be expected that those so inclined would seize the opportunity of adding other chemical substances to the fluid being vaporised. Over the last two years several hundred young people have been hospitalised in the USA for serious lung problems associated with the use of vaporisers; several deaths have been reported and the evidence suggests that they have died of acute lung inflammation caused by inhaled oily cannabis-related substances added to the inhaled fluid, rather like the Guyanan blackfat smokers. It is to be expected that long-term crippling lung scarring, as in my punk rocker, may be a consequence in some survivors.
In the UK, we are used to our medicines and consumer products being certified safe and for our medicines to be tightly regulated. At present, we can purchase vaping equipment freely and manufacturers of the fluids are adding numerous chemicals to make them more attractive to potential users. It is possible to purchase any number of fluids on the web that have not been subjected to any toxicological testing.
Tobacco addiction ranks as the greatest man-made killer of people, even including warfare, and controlled use of nicotine as a medicine has been helpful in reducing this. As someone who spent part of my lifetime looking after the victims of smoke-related diseases and the other part researching the harm done by inhaled substances, I nevertheless foresee a looming problem from uncontrolled use of vaping. It is not yet too late to prevent this in Scotland; regulation of the sale and use of vaping apparatus and fluids as medicines is urgently needed.