Tuesday, December 04, 2012

New Study Suggests that Electronic Cigarettes May Encourage Maintenance of Tobacco Use

A new study, published online ahead of print in the journal Tobacco Control, concludes that electronic cigarettes may encourage the maintenance of tobacco use.

(See: Cheah NP, et al. Electronic nicotine delivery systems: Regulatory and safety challenges: Singapore perspective. Tobacco Control 2012; doi: 10.1136/tobaccocontrol-2012-050483.)

The study examined 20 brands of electronic cigarettes, and analyzed the contents of their cartridges for nicotine, propylene glycol, glycerin, polycyclic aromatic hydrocarbons, and tobacco-specific nitrosamines.

The results were reported in the study abstract as follows: "Varying nicotine amounts were found in ENDS cartridges which were labelled with the same concentration. Chemicals such as PPG and glycerol were found to be present in the nicotine-containing liquid of the cartridges. ENDS varied in their contents and packaging information. Limited information was available on the contents of nicotine and other chemicals present in a variety of ENDS sampled."

The paper concludes as follows:

"While the current attention on traditional tobacco products is important, it is also necessary to focus on novelty products like ENDS, which may encourage maintenance of tobacco usage behaviour and slow down the impact of national smoking control programmes. Tobacco control policy makers and professionals are seriously urged to find ways to address the gap in the scientific understanding and the legal framework of such products, as this gap may impede efforts at curbing tobacco use."

The Rest of the Story

If you read the introduction, methods, and results of this study, and then proceed to the discussion, you will be shocked and you might think you are reading the discussion to a different study. This is because the discussion has very little relevance to the actual findings in the paper.

First, while the discussion section focuses on what the authors claim are serious health effects associated with electronic cigarettes, the paper's results actually found that there were no detectable polycyclic aromatic hydrocarbons or tobacco-specific nitrosamines in any of the 20 brands of electronic cigarettes tested, providing powerful evidence that these products are much safer than tobacco cigarettes. Curiously, this latter finding is not reported or addressed in the paper's abstract or discussion section. It is almost as if the authors are intent upon only reporting the risks of electronic cigarette use, but not the potential benefits.

Second, while the discussion section warns users about the finding of high levels of propylene glycol and glycerin in the cartridges, it fails to inform readers that propylene glycol and glycerin are the excipients used to vaporize the nicotine. They are indeed the ingredients of the cartridges, so their presence in high levels in the cartridges is not of concern.

Third, while the paper's abstract implies that the mislabeling of nicotine content is a safety concern, the truth is that this is solely an efficacy concern. In fact, the lack of consistency in nicotine delivery likely makes electronic cigarettes less addictive than regular ones.

But most importantly, the paper's conclusion - that electronic cigarette use promotes the maintenance of tobacco use - literally comes out of nowhere. There is nothing in the results or findings of this paper which provides evidence that electronic cigarette use promotes the maintenance of tobacco use. Nor does the paper cite any evidence whatsoever that electronic cigarette use promotes the maintenance of tobacco use.

It appears that the authors have simply made up this conclusion, making it appear out of thin air. This again suggests that the point of this paper was not simply to report the scientific findings, but to make a pre-ordained statement against electronic cigarette use.

In fact, it is counter-intuitive to conclude that electronic cigarette use would promote tobacco use. By definition, the use of electronic cigarettes is an alternative or substitute to cigarettes. Thus, the more electronic cigarettes are used, the less tobacco cigarettes are smoked. The majority of smoker who use electronic cigarettes are doing so because they want to reduce or eliminate their cigarette smoking. Far from promoting tobacco use, electronic cigarettes are devices designed to reduce cigarette use. Furthermore, there is abundant evidence that electronic cigarette use has accomplished exactly that: reducing tobacco use among smokers.

The only two ways in which electronic cigarette use could promote tobacco use would be: (1) if they encouraged youth (nonsmokers) to use nicotine and then to become smokers; or (2) if they caused users to smoke more.

The second hypothesis is absurd and there is abundant evidence that contradicts that notion. As far as the first hypothesis goes, there is no evidence to support it.

The rest of the story is that this is apparently another electronic cigarette smear job by anti-smoking researchers who cannot tolerate the idea that something which looks like a cigarette could possibly be helpful in reducing cigarette use.

Perhaps the most telling statement in the paper is this one: "Due to its odourless and smokeless delivery system, the e-cigarette can be used in non-smoking areas, as suggested by some ENDS product inserts. This has the potential to allow people to satisfy the smoking urge despite being in areas where smoking is prohibited."

To an objective observer, this would be seen as a tremendous benefit of electronic cigarettes. By satisfying the smoking urge in the face of increasing smoking bans, these products can help smokers refrain from smoking. Without the products, addicted smokers would be forced to go outside and light up a cigarette to satisfy their cravings. But with the advent of electronic cigarettes, they can satisfy that urge without the use of tobacco.

It certainly seems that the anti-smoking movement is out to get electronic cigarettes - a product they cannot tolerate because it simulates smoking. But their simulation of smoking is precisely why electronic cigarettes are such a promising strategy for the wide-scale promotion of smoking cessation.

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