The late Peter Hansen

On 21 Feb 2022, ABC-TV’s 7.30 program ran a report on the death of a 70 year old Queensland man, Peter Hansen. Mr Hansen had smoked heavily until 10 years ago when he switched to vaping after his step-daughter expressed concerns about smoking around her new baby.

The program included interviews with his partner Pam Ashdown, the intensive care doctor (Sean McManus) who treated him when he was admitted three days before he died; histopathologist Sukhwinder Sohal from the University of Tasmania who has published on vaping respiratory risks, and GP Colin Mendelsohn who frequently advocates for minimal regulation of e-cigarettes and was a founding director of ATHRA, a registered charity focussed on promoting use of nicotine vaping products.

Ms Ashdown gave me her permission to publish the autopsy report (downloadable below), requested by the family.

The report makes the following key statements:

“Regarding the lung granulomas seen at autopsy, many of those are clearly peribronchial and likely to be the foreign body type. These features are consistent with a reaction to an inhaled agent.”

“The United States Centres for Disease Control and Prevention (CDC) had recently provided a definition of E-cigarette of Vaping product use-Associated Lung Injury (EVALI) … Use of vaping during the 90 days before onset AND ground glass opacites on CT AND negative testing for infection AND no evidence of alternative plausible diagnoses. A case that meets all these criteria is considered a confirmed case; a case that meets most of the criteria is a probable case.  [in previous published reports] Lung biopsies have shown a spectrum of non-specific acute lung injury patterns including accumulation of foamy and/or pigmented macrophages (most cases), organising pneumonia and diffuse alveolar damage, inter alia These 3 features are present in the current case.

The case meets the first three CDC criteria for EVALI, It is harder to be definite about the final criterion for the various reasons discussed above. In conclusion, this case is a probable case of EVALI.”

In the 7.30 item, Colin Mendelsohn appears to grant the possibility that Peter Hansen could have died from EVALI  “I think even if the worst-case scenario this was a case of EVALI, I think we need to keep it in perspective and look at the huge benefits to other smokers from vaping.”

Cigarette use exploded at the beginning of the twentieth century after mechanisation in factories replaced handmade cigarettes. This made smoking very affordable to even those on the lowest incomes. But tobacco-caused diseases didn’t start showing up in large numbers until 30-40 years later.  The US surgeon Alton Ochsner, recalling attendance at his first lung cancer autopsy in 1919, was told he and his fellow interns “might never see another such case as long as we lived”. He saw no further cases until 1936 — 17 years later –   and then saw another nine cases in six months. Since the 1960s, lung cancer has been (by far) the world’s leading cause of cancer death with 18% of all cancer deaths in 2020, ahead of the next most frequent killer, liver cancer, with 8.3%.

With vaping caused disease, we may be still quite early in the latency period between widespread onset of vaping use and appearance of disease. Dr Sean McManus’ prediction in the 7.30 item was “I feel quite passionately that there was no other clear cause for his death, but I think our worry as a healthcare community is that 10 years from now we’re going to see a lot more of this as it comes through.”

Vaping theology on disease causation

Vaping theology emphasises several articles of faith about how its adherents should discuss the health risks of vaping. These are:

  1. Never say that vaping is completely safe.
  2. Instead, pick a big number that sounds like vaping is almost totally benign, compared with smoking. Anything north of “95% less dangerous” than smoking is very memorable and most journalists will just repeat it without any understanding of how this number was conjured. “Substantially less than 5%” of the risks of smoking  can also been used.
  3. Never, ever compare vaping to just breathing air: always compare it to smoking
  4. Never talk about quitting smoking. Instead always talk about switching to vaping
  5. Because many vapers also smoke, or are former long-term smokers, any reports of alleged health issues arising should always be swiftly attributed to smoking, not to vaping.
  6. Taunt those claiming health risks by saying “Millions of people have vaped around the world, many for over 10 years. If vaping is dangerous, where are the bodies?”
  7. You can also say “There has never been a single recorded death caused by vaping”.

Vaping chatroom theology coaching classes will see this advice turbo-charged over the next few years if Peter Hansen was one of the early cases of deaths caused by vaping.

Tailpiece (10 Mar 2022) US vaping enthusiast Cliff Douglas tweeted that ecigs “are not known to have caused a single death”. I sent him this blog and, as day follows night, he ticked vaping theology box 5. You see, no vaper death can ever be attributed to vaping if the vaper ever smoked, no matter low long ago, or had any other risk factors. (full thread here)