You've seen this, right? People sucking back on these glowing electronic tubes, exhaling these huge plumes of smoke that evaporate into the air? That's what we're talking about.
That's vaping. It's definitely a thing. Especially in China. Where smoking in general is like a thing.
Here's a radical projection: According to various trade analysts, the e-cigarettes industry is projected to grow from what was already a 1 billion dollar industry in 2013 to a 50 billion dollar industry by 2025.
50. Billion. Dollars.
However far-fetched one might perceive that assessment to be, as the biggest tobacco market in the world, e-cigarettes are, all the same, making a huge impact on domestic smoking habits. China has 316 million smokers after all -- the world's biggest (potential) market for e-cigarettes anywhere. According to the New York Times, 53% of the men here smoke. Now, despite the fact that the modern e-cig was already invented by a Chinese pharmacist named Hon Lik, the product is just in the past year or two gaining popularity in Mainland China. How well the industry will fare in a place where cigarette smoking is ingrained in many aspects of social culture remains to be seen. However, over the last year, several "vape shops" have opened up in Shanghai, so we figured it's time to address the topic, and find out if e-cigs are as healthy (or unhealthy) as people claim.
We've split this into three sections: some background on e-cigs; an interview with a doctor in Shanghai about the health effects; and a guide to six e-cig shops in Shanghai.
What Are E-Cigarettes?
Today's typical e-cigarette contains four basic parts: e-liquid, a cartridge, an atomizer, and a battery. E-liquids (or e-juice) are man-made substances containing propylene glycol and vegetable glycerine (which are common food additives), nicotine, and some type of flavoring ingredients, depending on the type of juice and the manufacturer.
The cartridge (or tank) holds the e-liquid in a plastic or glass container. Inside, cotton, or some other absorbent material drips the e-liquid against the atomizer. The atomizer, heated by the battery, evaporates the e-liquid, producing vapor. This vapor can then be inhaled by the lungs, or smoked like a cigar.
Since the device was originally invented by Hon Lik in 2003, e-cigarettes have become increasingly sophisticated with different sizes, settings, and voltages. In the end, they all act to do the same thing: the liquid goes in, the atomizer does its thing, and the user gets a dose of clean, toxin-free nicotine in a way that feels similar to tobacco cigarette smoking.
Are E-Cigarettes Bad For Your Health?
There's already a lot of information on the internet about e-cigarettes, but not much of it comes from actual doctors. We spoke to Family Physician Dr. Leslie Bottrell of Shanghai United Family Hospital and Clinics to learn more about the health effects of e-cigarettes. She is a member of the Royal Australian College of General Practitioners, and she regularly gives talks to high schools on substance abuse, including the topic of electronic cigarettes.
Dr. Bottrell: It's a range of cancer-causing agents. There's carbon-monoxide, arsenic -- it's a sort of like a really bad pollution day directed into your lungs -- butane, cadmium... Basically a lot of harmful chemicals: methane, methanol, things that are usually used as industrial chemicals. Toluene and hexamine, which is like lighter fluids and stuff like that. Obviously, cancer gets a lot of airtime. Lung, mouth cancer, but other cancers as well, like unrelated to the direct line -- even things like breast cancer in women, pancreatic cancer, bladder cancer.
There's a whole range of things, you know: hardening of the arteries, atheroscelrosis, causing heart disease... reduced fertility, impotence, erectile dysfunction because of its effect on blood vessels. The evidence proves that the tobacco leaf itself is cancer-causing, but the reality is there's a lot of added chemicals to cigarettes, so those combine and amplify the cancer-causing and disease-causing effects of the cigarette.
Dr. Bottrell: The thing with e-cigarettes is that, so far, the evidence suggests that they are safer in that you eliminate the toxins from smoke. A real cigarette has got a lot of crap that's very harmful for the smoker, and the people around the smoker. So certainly, with the electronic cigarette, you're not exhaling the smoke, you're exhaling the vapor, so really, you're eliminating a lot of those toxic things. But, the thing with the electronic cigarette is that you're still getting a very high dose of nicotine, which is a very addictive substance -- a substance used in pesticides and insecticides. So not exactly the healthiest thing to be ingesting.
Dr. Bottrell: Nicotine in it of itself is a very addictive substance, no matter what way you are supplying it to yourself, via patch, gum, e-cigarette, what have you. So you're still getting a very high dose of nicotine in e-cigarettes, probably higher than a patch, which are formulated to give you a certain dose, whereas if you're using an e-cigarette, you can just puff as much as you want in. And in some cases you might be getting more, because people aren't getting all that smoke so they think its safer and are inhaling a lot more nicotine.
If the idea is "which is the lesser of two evils?" -- so if someone's really addicted to traditional cigarette smoking, and if they want to change to e-cigarettes, obviously, versus the two, the e-cigarette may be the better option. But the problem is we have now is a new generation of people coming in thinking, "okay, well I don't want to start smoking because that's really bad for you", but they've got this misconception that electronic smoking has, you know, you can get the high with out any of the toxins and you're home free. That's not the case.
The fact is, with nicotine, we know it's very addictive, but we don't have a lot of data on it alone, because it often hasn't been delivered alone because it's been in a form of tobacco. But we do know people can get very severe withdrawal symptoms, including irritability, depression, restlessness, anxiousness. Also it can be very dangerous with people that have preexisting heart problems, and may harm the arteries over time.
So far, what the evidence shows, they don't know the long term effects, cause they haven't been around long enough to track them. They know nicotine in itself can be very harmful. Basically, if people can't give up traditional cigarettes, then sure, e-cigarettes are better than traditional cigarettes because they don't have a lot of the toxins. And clearly the benefit is to the people around them as well because they aren't getting the secondhand smoke.
Dr. Bottrell: So the addictive substance of cigarette smoking is the nicotine, and for some, using a patch -- giving a gradual dosing of the nicotine -- [is] so they [don't experience] withdrawal. People fail with quitting [because] they experience withdrawal symptoms that make them feel really crappy and that dissuades them from quitting. So the idea of a patch, or gum, or sprays, and the e-cigarettes, is that you can still deliver that and over time you could gradually lessen the dose so that you wouldn't require it anymore.
Dr. Bottrell: Yeah exactly, but some people find that they can't just use the patch, because the addictive thing is not just the substance, it's the act of doing. Some people have little plastic cigarettes just so they can go through the motions. Like with all addictions, it's not just one aspect, it's very complex, but it's sort of offering them another option.
The risk with e-cigarettes now, is with the young generation of people coming through... and they're all of the electronic generation -- they're on iPads, iPhones, what have you, so they think "oh another electronic device that can give me a bit of a high and it's completely safe", so I guess the warning is against a new lot of people. If you don't smoke now, it's not a good idea to start smoking an e-cigarette. If you're an existing smoker, and you've tried everything, then maybe the e-cigarette is the safer option for you because nothing has worked. But the risk is because a lot of them have these flavorings, and they appeal to a lot of young people... They're targeting a really young market, and all these young people will be hooked on nicotine.
Dr. Bottrell: It has been suggested, and there has been loose evidence that it can cause problems with arteries and be harmful to people with preexisting heart conditions. Whether or not there are other links to other body systems, it's lacking. We kind of don't have a strong leg to stand on to say "don't do it -- it's not good." But common sense tells us if you're addicted to a substance, that's not good. If you can stop using it or at least reduce the amount your using, that's going to be in your best interest.
Like even with traditional cigarettes and tobacco smoke, it wasn't long [ago] in history when doctors were featured in ads, saying "three out of four doctors recommend this brand of cigarettes." We can look back on it and laugh, because the evidence is here to say look how harmful it is. So it may be a case of that, where if doctors are recommending e-cigarettes over traditional cigarettes, it might look foolish in hindsight. But right now we don't have that strong evidence to back it.
Dr. Bottrell: Look, there are other alternatives, but nothing is without risk. Even some of the medications we prescribe have been associated with risk. Things like Champix, where people hallucinate, now they're doing investigations on cases of people that have suicided while taking this medication. So to be honest, it's a real struggle for us as General Practitioners is to try to find a solution for patients. It goes down to the basics: Are people at a point in their life they are willing to consider quitting? Do they have a little willpower? Do they have positives that will assist them to quit. Normally we will advise if they don't have a mental illness, then you may consider one of these medications. Nicotine patches, gums, sprays -- that's another option. And the e-cigarette is like, alright, if nothing else is working, maybe consider that. But they might even be upping their dose of nicotine.
In an ideal world no one would be smoking, no one would be addicted to nicotine -- but that's not the case. Sure, with the e-cigarette, you don't get the secondhand smoke, you don't get as many of the toxins, but just be mindful that nicotine in it of itself is dangerous. I think it's a false idea that you eliminate all the toxins. It may be the safer of the two, but the evidence is lagging behind the popularity.
E-Cigarette Stores In Shanghai
So... game on? Maybe not so much. Maybe just make your own call.
If you are a smoker and you'd still like to try e-cigarettes after reading Dr. Bottrell's interview, there are quite a few places to buy e-cigs and liquids in Shanghai. You could do it through Taobao, but who knows what you're getting there. So if you're looking to quit those Zhong Nan Hai's, and you've tried everything else, here are six of the better e-cig stores in Shanghai.
Shanghai Vape is one of the more well-known e-cigarette shops in Shanghai among expats. They carry liquids from the US, New Zealand, and the UK. The owner, Sean, knows his products and speaks English and pretty good Mandarin. The store has a small seating area near the window where you can sit and vape. They also sell their wares in Shelter, albeit a smaller selection of them.
Price: Bottles of 20ml liquids start at 80rmb and hardware kits are around 300rmb.
Vapor Vapor Vapor USA
Vapor Vapor Vapor is run by two American guys, Bill and Eric, who also have stores in the Washington D.C. area. They have a good selection of e-cig hardware and American-made liquids. The owners are friendly guys, and if you want someone knowledgeable to teach you about e-cigarettes in English, this is a good option.
Price: A 15ml bottle starts under 100rmb and a e-cigarette kit starts around 300rmb.
The shop is a 15 minute walk from the Xujiahui metro station. The owner, Mr. Wang, started smoking at age 17, and finally quit through e-cigarettes, he says. The shop offers over 20 liquids that he selected himself. The liquids come from US and Malaysia, and friendly Mr. Wang and his staff are happy to let customers try as many as they want.
Price: Prices start at 108rmb for a 30ml bottle of e-liquid. Hardware starts around 200rmb.
Lots of rich Chinese kids can be found at this one. Someone dropped over 1000rmb on their first e-cigarette while I was there, but the prices aren't all that steep. They offer a 30rmb membership that gets you discounts on all their merchandise. The shop is the largest one here and is nicely designed inside. The ventilation isn't great though, and being one of the more popular shops, a lot of people were vaping, making the air pretty thick. Currently they sell 17 brands of e-liquids, all US-made.
They also have a satellite location in C's Bar, though they say this one isn't doing nearly as well as the main location.
Price: Liquids are 130rmb with a membership discount and 158rmb without. Hardware starts from around 250rmb.
Vapes is a kiosk counter located in the Super Brand Mall. They still pack a lot of options, with over 100 e-liquids to choose from including those made in Malaysia, the US, and China, many of which you can test out. The Chinese-speaking staff are knowledgeable, and will teach you about e-cigs while taking a few puffs themselves.
Price: Liquids start at 55rmb for a 30ml bottle. E-cigarettes start at 128rmb.
Ocean Mist is a small e-cig shop located in Tianzifang. Finding it can be a bit tricky -- it's located in one of the small dead end corners near gate 2, right next to I Love Shanghai. The place is small, and it can be hard to move around if there's a few customers. They have a decent selection of liquids coming from Malaysia, the US, and China, but compared to the other stores, they have less to try from. When we went, the owner wasn't there and the staff there didn't know much about e-cigarettes.
Price: Liquids start at 65rmb for a 30ml bottle and e-cigarettes start around 300rmb.
Know about other e-cig shops? Have specific blends to recommend (or avoid)? Leave it in the comments.