We appreciate the letter by Dr. Oyston.1  We do not dispute that the dangers posed by vitamin E acetate are unrelated to the use of nicotine-based vaping products. This was not the purpose of our letter.2  What is troubling, however, is that many unregulated vaping products containing dangerous contaminants have been widely available and were implicated in over 50 deaths in 2019.3  Our goal was to highlight for anesthesiologists, particularly in the United States, that patients may be ingesting dangerous vaping products and that this information may be important to consider before surgery. To our knowledge, many anesthesiologists do not routinely ask specifically about vaping, and people who vape often believe it to be distinctly different from cigarette smoking. As such, when asked about smoking, many would simply say no.

While our originally published comment did not address whether e-cigarettes/vaping may be an effective harm reduction strategy, it is worth pointing out that the quality of evidence for e-cigarettes/vaping as effective smoking cessation alternatives is “very low to low.”4  Moreover, the potential for e-cigarettes/vaping as a harm reduction tool is generally most applicable to older people unwilling to quit combustible tobacco, as opposed to younger people who never used combustible tobacco in the first place.5  Of note, this younger population has been disproportionately represented among those patients who were hospitalized and died during the e-cigarette or vaping–associated lung injury outbreak in the United States in 2019.6 

The authors declare no competing interests.

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