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The Cost of Smoking Your Socks

By Dr Helen Weber, 11 October 2019

The alternative to regular smoking, vaping, has often been considered safer than smoking tobacco.

But according to the Centres for Disease Control and Prevention (CDC) in the US, vaping has come under fire based on 380 confirmed and probable cases of a mysterious respiratory condition reported as of September 11, 2019. There are now concerns that the use of e-cigarette devices could cost you a great deal in the long term.

Dr Helen Weber, Medical Adviser at Sanlam, explores the health implications of vaping and the additional cost of insurance to underwrite these risks.

Take a Look from a Health Perspective

There have been six deaths confirmed by the CDC in the US linked to vaping. Whether there is a direct cause or whether it is the actual content that caused the deaths is still under investigation; some preliminary investigations indicated that THC (tetrahydrocannabinol) was found in the e-liquid.

Between 2010 and 2019, the Food and Drug Administration (FDA) in the US received 35 reports of seizures linked to e-cigarette use. Epilepsy has become associated with vaping, but it’s critical to note that many of the seizures occurred in people who had pre-existing epilepsy and/or were additionally using other substances, so the results are inconclusive. Some vaping solutions do contain nicotine, which raises the blood pressure and heart rate, which could potentially be related to seizures, but there’s not enough evidence at this point.

E-cigarettes can also contain formaldehyde, which could increase cancer risk. There are also reports of traces of silicone in vaping ‘juice’, which increase the risk of lung disease.

Take a Look from an Insurance Perspective

Given the health risks listed above, vapers are classified as smokers and are usually risk rated the same way. A vaper/smoker is deemed more at risk of prolonged infection, so sickness cover is highly advisable. Vapers need to declare to prospective insurers how frequently a substance is used, how much of it is used, and whether anything else is consumed alongside it – like alcohol or substances of abuse.

Dr Weber concludes, “Reinsurers and insurers like Sanlam have always applied a scientific, rational and fair approach in underwriting substance use and this remains unchanged in the context of vaping or any other substance:

We underwrite based on: (1) frequency of use, (2) history of any addiction and treatment thereof, (3) use of a single substance in combination with other substances, (4) a person’s age, (5) occupation, (6) the financial services products being applied for and (7) existing medical conditions that may impact the use of the substance.

The risk rating that is calculated considers these factors in conjunction with clinical evidence and claims experienced both nationally and internationally. Any claim will be assessed on its own merits and general exclusions on substance use will still apply to your specific plan.

This means that we have a ‘philosophy’ about smoking e-cigarettes that we review and adapt over time as new evidence comes to the fore. This allows us to remain objective and open to new research. These deaths and respiratory complaints need to be monitored and should a direct scientific link be proven, we will adjust our approach in terms of risk rating these clients accordingly.

Right now, there are lots of grey areas. We are still gathering scientific evidence about the long-term side effects of vaping but we await the final outcome of these cases in the US to determine whether an exact causal relationship to vaping could be established with these cases.”


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