Tuesday, February 19, 2013

When Will Anti-Smoking Researchers Stop Lying and Telling the Public that We Have No Idea What is in E-Cigarette Vapor?

It appears that the current mantra among anti-smoking researchers who are asked to comment on electronic cigarettes is to respond something like this:

"Because the FDA has not approved these products, we have no idea what chemicals are contained in electronic cigarette vapor. Thus, we cannot recommend these products. Smokers should stick with FDA-approved smoking cessation products, such as the nicotine patch and nicotine gum, which have been proven to be safe and effective."

This mantra was re-iterated by Dr. Steinberg - the president of ATTUD (Association for the Treatment of Tobacco Use Disorders) - in a recent article in the Hudson Reporter. In the article, Dr. Steinberg was quoted as stating:

"Since none of the e-cigarette products are currently regulated by the FDA, we really have no firm information about their safety. We don’t know for sure what other chemicals are contained in the vapor, and how much nicotine is delivered. The perception is that since they don’t contain smoke, they are safe."

In the same article, the medical director of a smoking cessation program repeats the exact same mantra. He is quoted as stating:

"The e-cigarette is not regulated by the FDA. Therefore you don’t really know what the ingredients are. You may indeed be playing with fire. In the United States, tobacco is not considered a drug. Nicotine is an ingredient in tobacco. Therefore they don’t have any jurisdication to regulate the e-cigarette at this time. There’s no way to ascertain what nicotine level you are trying to achieve."

It sounds like these two anti-smoking researchers/practitioners are quoting from an identical playbook.

The Rest of the Story

The problem is that the playbook is a lie. It is simply not true that we really don't know what the ingredients in electronic cigarettes are. And it is also not true that we have no idea what chemicals are contained in electronic cigarette vapor.

In fact, we have a far more precise idea of what is in electronic cigarette vapor than we do of what is in cigarette smoke.

There have been well over 20 studies that have identified the chemicals in electronic cigarette cartridges and/or vapor. In 2011, Zachary Cahn and I reviewed the results of 15 such studies. At that time, we wrote:

"TSNAs have been detected in two studies at trace levels. The maximum level of total TSNAs reported was 8.2 ng/g. This compares with a similar level of 8.0 ng in a nicotine patch, and it is orders of magnitude lower than TSNA levels in regular cigarettes.Table 2 shows that electronic cigarettes contain only 0.07–0.2 per cent of the TSNAs present in cigarettes, a 500-fold to 1400-fold reduction in concentration. The presence of DEG in one of the 18 cartridges studied by the US Food and Drug Administration (FDA) is worrisome, yet none of the other 15 studies found any DEG. The use of a non-pharmaceutical grade of PG may explain this contamination."

"Other than TSNAs and DEG, few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns. Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products."

You can find many of the studies that have been conducted here. While there is no question that further research needs to be done to understand the exact safety profile of these products, it is also clear that the anti-smoking playbook, which instructs researchers to argue that we simply don't know what is in electronic cigarettes, is essentially instructing them to lie to the public. We do know what is in the electronic cigarette.

And what we do know is that electronic cigarette users are not "playing with fire," as the medical director of the smoking cessation clinic suggests. On the contrary, electronic cigarette users are avoiding the fire - the fire that involves the combustion of tobacco, forming tens of thousands of chemicals and more than 60 known carcinogens.

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