What is the real science of electronic cigarettes? There are so many claims being bounced back and forth by anti smoking groups and by ecigarette supporters that it's hard to know what is fact and what is myth.
This is a collection of articles on the medical science of ecigarettes, the claims made by both sides and some interviews with doctors and scientists discussing electronic cigarettes.
On its website, Action on Smoking and Health makes a number of claims regarding smoking, including that the very breath and smell of smokers, even when they are not smoking, can be extremely hazardous to people's health.
E Cigarette Direct asked three respected Professors of Medicine to examine these claims.
ASH's Health Claims | Professor Brad Rodu | Professor Michael Siegel | Professor Carl Phillips
1. 30 minutes of exposure to drifting tobacco smoke can trigger a fatal heart attack.
ASH states that: "...someone else’s smoke can kill you if even if you can barely smell it, and even if you can’t smell it."
2. E Cigarettes pose dangers for both smokers and non-smokers.
According to ASH, electronic cigarettes are dangerous both for smokers and non-smokers.
3. Third hand smoke can pose serious risks for non-smokers.
Proven or not, this claim has been used to:
4. Smoker's breath can be harmful to health, especially to children, the elderly and those especially sensitive to many chemicals.
John Banzhaf says:
"We've always known that a smoker's breath stinks. Now we know that it also creates indoor air pollution which can harm children and perhaps some adults."
Brad Rodu is a Professor of Medicine at the University of Louiseville, and holds an endowed chair in Tobacco Harm Reduction Research. He also runs the Tobacco Truth Blog.
Quite simply, these statements are either gross exaggeration or pure fiction.
With respect to exposure to second hand smoke, it is true that it can initiate some subtle changes in blood chemistry and other factors, but it is a specious exaggeration to claim that it causes heart attacks. There is a general consensus that the important risk factors for heart attacks are primary smoking, diet, high cholesterol and triglyceride levels, low physical activity, hypertension and family history. Compared with these, brief exposure to secondhand smoke is insignificant.
The ASH statement about e-cigarettes is wishful thinking. With respect to smokers, there is substantial and compelling scientific research documenting that consuming the ingredients in e-cigarettes (nicotine, propylene glycol, water and flavors) is vastly safer than burning tobacco and inhaling 3000+ toxic by-products. Claiming that e-cigarettes are dangerous for non-smokers is about as credible as claiming that air travel is dangerous for people who never set foot in an airplane.
Third hand smoke is an invention by Harvard University anti-tobacco extremists; it consists of “breathing air today in a room or car where people smoked yesterday.” The Harvard extremists collected “evidence” for the dangers of third hand smoke, which were the survey responses from 1,500 non-scientists from the U.S. who believe that it can harm babies and children. Third hand smoke has as much scientific credibility, and carries about as much risk, as third hand rain.
John Banzhaf’s comments about the harm related to smokers’ breath has no medical rationale, but it is an excellent example of the increasing marginalization of smokers using pseudoscience. Extending Banzhaf’s logic, non-garlic eaters may be able to absorb the possible health benefits of garlic by moving into the vicinity of garlic aficionados.
Also see Professor Brad Rodu's letter to E Cigarette Direct.
Formerly a physician who specialised in preventative medicine, Professor Michael Siegel is now a Professor in the Social and Behavioral Sciences Department, Boston University School of Public Health. Michael also has 20 years experience in Tobacco Control, primarily in the field of research, and runs the Tobacco Analysis Blog.
1. 30 minutes of exposure to drifting tobacco smoke can trigger a fatal heart attack.
It may be true, on theoretical grounds, that 30 minutes of tobacco smoke exposure could trigger a fatal heart attack, but this would only be the case for individuals with severe pre-existing heart disease. A healthy person is not going to die from a heart attack due to 30 minutes of secondhand smoke. ASH makes no attempt to qualify its statement. Even worse, ASH gets even more specific in its claim, asserting that the risk of a fatal heart attack in a nonsmoker exposed for 30 minutes is the same as that of an active smoker. This latter claim is factually inaccurate.
2. E Cigarettes pose dangers for both smokers and non-smokers.
There is no existing evidence that e-cigarettes pose a risk for nonsmokers. The nicotine exposure from the exhaled vapor produced the the vapor is likely to be extremely small and there is no reason to think that it poses a danger for nonsmokers. But there certainly is no evidence to suggest that it poses a hazard.
3. Third hand smoke can pose serious risks for non-smokers.
While there is evidence that there are detectable levels of tobacco smoke constituents in exhaled tobacco smoke of smokers after they have finished smoking and on surfaces in rooms after smoking has been completed, there is no evidence that the levels are high enough to cause demonstrable harm to most individuals. The only potential side effect is likely an adverse response among individuals who are exquisitely sensitive to tobacco smoke.
4. Smoker's breath can be harmful to health, especially to children, the elderly and those especially sensitive to many chemicals: "We've always known that a smoker's breath stinks. Now we know that it also creates indoor air pollution which can harm children and perhaps some adults."
As above: There is no evidence that the levels of exposure to tobacco smoke constituents are high enough to cause any problem. The only potential problem could be an adverse response among individuals who are exquisitely sensitive to tobacco smoke.
Note - You can also read our interview with Professor Michael Siegel.
First, as an overview, all four of these statements are clear examples of a phenomenon that we have documented in several of our studies: Most major anti-tobacco (and now also anti-e-cig) political actors, including those who are (mistakenly) trusted by the public, demonstrate a willingness to make whatever pseudo-scientific claims they think will further their worldly goals, regardless of the whether they are true, apparently unconcerned with the damage that such claims do to people and to science itself. I have written about this.
1,3,4 on the list are out-and-out scientifically false in the sense that there is no evidence to support them. That is, these are epidemiological claims (claims about actual human health effects) but there is absolutely no epidemiological evidence that supports the claim.
If they had made claims about "detectable levels of chemicals that are known to cause...." or something like that, as many others have, it would be a different kind of lie -- an attempt to take advantage of scientific ignorance to be dishonest without actually making an explicitly false statement.
But given that purely speculative epidemiologic claims were stated as if they were facts, this has to be seen as explicit falsehood. Keep in mind that a scientific hypothesis about a phenomenon needs to be supported before it can be claimed as true; simply finding some reason to propose a particular hypothesis (e.g., a particular exposure might be harmful because there are tiny quantities of some chemical) and then declaring it to be true without evidence is not just unethical - it also damages the public's ability to make sense of science.
Again, these people try to take advantage of scientific ignorance to claim whatever strikes them as expedient without regard to the science. Points 3 and 4 are particularly absurd since the "study" that gets cited as the basis for saying "third hand smoke" is harmful was actually an unethical push-poll that manipulated lay people into saying they feared the effects. This obviously offers no useful information at all.
Point 2 is a bit more complicated of a lie.
Since the claim is juxtaposed with discussions of ETS, it is a clear attempt to imply that the spillover from e-cigs is just as bad as people think ETS is. This is obviously false, since ETS is not even as bad as people think ETS is, and e-cig vapor is, beyond much doubt at all, less harmful still.
It is conceivable that e-cig vapor poses some small risk, but this is speculative since there is no epidemiology and not even any chemistry/physiology to support it.
The claim that the trivial amount of nicotine in the vapor would be much of a risk seems ridiculously far-fetched. That said, the headline statement is literally true if we consider the risk to children of certain e-cig products that are contact poison or swallowing risks.
Of course, referring to such risks (which should be reduced through product engineering!) to try to trick readers into thinking that there is a substantial externality from the vapor is clearly a lie.
What do you think?
Article courtesy of ecigarettedirect.com
State legislatures considering banning electronic cigarettes have now heard the advice of their doctors, namely the Tobacco Control Task Force of the American Association of Public Health Physicians, an organization of physician directors of state and local health departments, who say bans are going too far and that this new product may actually be of great benefit in their fight against cancer and smoking related deaths.
The AAPHP is recognized by the American Medical Association as a medical specialty society and even has formal representation in the AMA House of Delegates. These are just the people one might think politicians should be turning to for recommendations on proposed legislation affecting the public health.
However, prompted by a strong lobbying effort from groups like the American Cancer Society, the Campaign for Tobacco-Free Kids, the American Heart Association and the non smokers rights group Action on Smoking and Health, which critics claim is largely funded by drug companies out to protect their profits, many states like New York, Utah, Illinois and New Jersey have recently introduced legislation that would ban or restrict the sale of E-cigarettes or their use in public spaces.
In a two page statement issued April 02, 2010 outlining their recommendations to state lawmakers, Dr. Joel Nitzkin, chairman of the Tobacco Control Task Force says the AAPHP doesn't agree electronic cigarettes should be banned and "favors a permissive approach to E-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years."
"Conventional cigarettes account for about 80% of nicotine consumption in the United States, but more than 98% of the illness and death. This harm is not caused by the nicotine, but by toxic products of combustion." says Dr. Nitzkin who advises that smokers "could cut that risk by 99.9% or better by switching to a nicotine-only delivery product like one of the pharmaceutical products or E-cigarettes."
While the anti smoking lobby claims the only effective way to quit smoking is by using FDA approved smoking cessation products manufactured by the large pharmaceutical companies that donate millions each year to their cause, Nitzkin points out that only about 3% of smokers successfully quit each year and that "the current pharmaceutical products fail 93% of those who try them, even with the best of health education and counseling."
Dr. Nitzkin says e-cigarettes, or personal vaporizers as some users prefer to call them, "may be more acceptable to smokers than currently available pharmaceutical alternatives" and that "smokers can secure almost all the health benefits of quitting if he or she transitions to an E-Cigarette." But, says Dr. Nitzkin "The only feasible way to achieve this remarkable public health benefit will be to inform smokers of the differences in risk posed by different categories of nicotine-delivery products."
The FDA and the anti smoking lobby claim there has not been enough research into electronic cigarettes and that the risks are, as yet, unknown. After a small study conducted by the FDA in 2009 of 18 cartridges from two different manufacturers suing the government over the seizing of their products by customs, the FDA and anti smoking groups issued warnings regarding e-cigarettes claiming "tobacco-specific impurities suspected of being harmful to humans -- anabasine, myosmine, and B-nicotyrine -- were detected in a majority of the samples tested."
But the American Association of Public Health Physicians points out to lawmakers that "E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA"
And indeed the FDA and lobbyists chose to leave out the exact quote from their own report which said that "Tobacco specific nitrosamines and tobacco specific impurities were detected in both products at very low levels." levels so low they couldn't quantify them while other impurities were found in the FDA approved Nicotrol inhaler at very quantifiable levels. Namely: Cotinine: .5%, Myosmine: .5%, Nicotyrine: .5% and these same impurities are found in the patch, the gum and many other nicotine replacement therapies that derive flavors or nicotine from tobacco.
Long time anti-smoking researcher Dr. Michael Siegel of the Boston University School of Public Health pointed out in his blog on tobacco control "the rest of the Story" that the levels of these tobacco impurities added up to the following:
Electronic Cigarettes: 8.18 nanograms / gram (ng/g)
Nicotine Patch: 8.00 ng/ patch
Nicotine Gum: 2.00 ng/ piece
Marlboro Cigarette: Eleven thousand one hundred and ninety ng/g
Dr. Nitzkin and the American Association of Public Health Physicians have, as doctors must do each and every day when prescribing drugs and courses of treatment that might have unforseen and possibly dangerous side effects, come to the conclusion that for users of electronic cigarettes, in the words of modern drug commercials, "the benefits outweigh the risks."
State legislatures, however, are and should be concerned about the effects of second hand smoke on the health of non smokers. After all, this has been the catalyst for the smoking bans in public and work places and even the more recent bans on smoking in private homes and automobiles. Some research suggests second hand smoke can cause cancer or induce heart attacks and lawmakers, confused by the anti smoking lobby's constant references to "second hand vapor", worry that e-cigarettes may pose a similar hazard even though there has been no scientific evidence of this.
So the AAPHP advises legislators that "Propylene glycol and glycerin are used as carriers of the nicotine. These cause the visible vapor. These substances are generally recognized as safe. They are commonly used in theatrical fog machines, asthma inhalers and air fresheners. There is no smoke, and no products of combustion." and surprisingly even goes so far as to say "All this creates a situation in which we can confidently state that the risk to others sharing an indoor environment with one or more vapers (E-cigarette users actively using this product) is almost sure to be much less than 1% the risk posed by environmental tobacco smoke."
But, they also admit "we cannot rule out the possibility that some individuals who may be extremely sensitive to indoor air irritants or to minuscule concentrations of nicotine in indoor air might be adversely affected by E-cigarette (or pharmaceutical nicotine vaporizer) vapor." and recognize that "Some worry that sight of E-cigarettes in non-smoking areas will make smoking restrictions harder to enforce", a situation known as 'modeling.' Nitzkin points out though "It is important to note that, on second glance, E-cigarettes are easy to distinguish from tobacco cigarettes."
So, instead of taking a stand one way or the other, the AAPHP says "We therefore recommend that research be done to address these two issues (possible hazard to a very small number of highly sensitive individuals and modeling). The problem here is that, with end points so difficult to document, such research could cost millions of dollars and take many years to complete. For the reasons noted above, we do not offer a stance in favor of or against banning E-cigarettes in non-smoking areas."
There is some common ground between the recommendations of the doctors, retailers, manufacturers and those of the anti smoking lobby though. Everyone agrees with the doctors that "Sales to minors should be prohibited. If someone does not become addicted to nicotine as a minor, it is unlikely that he or she will ever become addicted."
Even the retailers of these devices own lobby group, the Electronic Cigarette Association, demands of it's members that "online vendors must verify to reasonable certainty that their customers are of legal smoking age; and retail vendors must verify that their customers are of legal smoking age by inspecting the customer’s state-issued photo identification."
So what is the advice those physicians who run our state and local health departments have for lawmakers considering electronic cigarette legislation when you boil it all down?
Ban the sale to minors but allow the sale to adults. "E-cigarettes can and should be marketed as a substitute for conventional cigarettes for smokers unable or unwilling to quit. State legislatures and, hopefully the FDA should see them in this light and regulate their marketing to reflect this purpose." while research continues.
Only time will tell if the state legislatures listen to their doctors or their lobbyists.
"Tracking the Rise in Popularity of Electronic Nicotine Delivery Systems", a recent study published February 8th in the American Journal of preventative Medicine, says people are searching the Internet for electronic cigarettes, or ENDS as they call them, at a far greater rate than nicotine replacement therapies and drugs like Chantix.
In the study, John W. Ayers, MA, Kurt M. Ribisl, PhD and John S. Brownstein, Phd monitored Google searches for electronic cigarettes between January 2008 and September of 2010 in Australia, Canada, the UK and the United States and found during that time ecig related searches grew to out number "several-hundred-fold" those for other smoking alternatives and drugs like Chantix and Champix.
Results: From July 2008 through February 2010, ENDS searches increased in all nations studied except Australia, there an increase occurred more recently. By September 2010, ENDS searches were several-hundred-fold greater than searches for smoking alternatives in the UK and U.S., and were rivaling alternatives in Australia and Canada. Across nations, ENDS searches were highest in the U.S., followed by similar search intensity in Canada and the UK, with Australia having the fewest ENDS searches. Stronger tobacco control, created by clean indoor air laws, cigarette taxes, and anti-smoking populations, were associated with consistently higher levels of ENDS searches.
While they admit "it is unclear whether search queries indicate curiosity or shopping" they did find that shopping searches accounted for 50%-75% of US electronic cigarette related searches and 25%-50% of searches in Canada. This suggests to them that search trends do indeed indicate a large proportion of Internet users are shopping as well as simply looking for ecigarette information.
The study does note that stronger tobacco controls may have lead to this rise in popularity as people seek smoking alternatives that will allow them to circumvent smoking bans, cigarette taxes and anti smoking sentiments in society saying "in part, the association between ENDS popularity and stronger tobacco control suggests ENDS are used to bypass or quit in response to smoking restrictions."
In the end they conclude: "It is an open question whether ENDS popularity indicates a hope for harm reduction or a threat to public health. In either case, rapid expansion of both novel and traditional methods of assessing ENDS popularity and use is required."
No financial disclosures were reported by the authors of the papers.
Read the entire study here: Tracking the Rise in Popularity of Electronic Nicotine Delivery Systems