Clear The Air News Tobacco Blog Rotating Header Image

Health Risks

Vapors Of High-Powered E-Cigarettes May Cause Cancer

http://www.sciencetimes.com/articles/10054/20170309/vapors-of-high-powered-e-cigarettes-may-cause-cancer.htm

People might have to stop powering their e-cigarettes to the highest level as scientists have found out that its vapors can cause cancer. There are significant levels of cancer-causing benzene in the vapors of those e-cigarettes in the highest power, stated Portland State University scientists.

The result of the study was published on March 8 in the online journal “PLOS ONE”. The chemistry professor James F. Pankow led the research team, reported EurekAlert. The level of benzene they found from the high powered e-cigarettes was thousand times higher than in the surrounding air. It also depends greatly on the device itself. If it is not at its highest level, the benzene levels are not that high.

When the e-cigarette fluid additive chemicals benzoic acid or benzaldehyde is present it added so much to the benzene levels. However, of course, the level of this is nothing compared to the level of a conventional smoke from a cigarette. Benzene is one component of gasoline. It is very bad for people.

It has been linked to a number of illnesses that are very grave and can cause death. Diseases like leukemia and bone marrow failure are few of the examples of diseases a person can acquire with benzene. Benzene is usually found in the urban areas where industrial emissions are very rampant plus fuel tank leaks. This chemical has been deemed as the largest single cancer-risk air component in the U.S.

Meanwhile, according to Science Daily, the smoke that conventional cigarettes release is affecting the natural healing process of lungs. The blocking then leads to chronic obstructive pulmonary disease or COPD. Cough, bronchitis and breathing difficulties are the major signs of COPD. The findings were published in “American Journal of Respiratory and Critical Care Medicine”. It was from the researchers at the Helmholtz Zentrum München, a partner in the German Center for Lung Research (DZL), and their international colleagues.

An individual with COPD does not heal its own lungs anymore. Researchers are now trying to find out why.

Vaping Is Less Terrible For You Than Cigarettes (Still Not Great For You, So Don’t Start)

Over time, people who smoke e-cigarettes seem to pile up fewer toxins in their bodies than people who smoke traditional cancer sticks.

https://www.fastcoexist.com/3068010/vaping-is-less-terrible-for-you-than-cigarettes-still-not-great-for-you-so-dont-start

Vaping devotees, you have been vindicated: In the first long-term study comparing e-cigarettes with regular old cigarettes, researchers found that e-cigs aren’t quite as bad for you as the tobacco they replace. In fact, transitioning to vaping may end up being a good way to help people quit smoking altogether.

The study, funded by Cancer Research U.K., found that people who switched from tobacco to e-cigarettes for at least six months “had much lower levels of toxic and cancer-causing substances in their body than people who continued to use conventional cigarettes.” The conclusion: e-cigarettes are less toxic than tobacco.

The study followed 181 participants over a six-month period. The participants were split into five groups: “combustible” cigarettes users, e-cigarette users, users of nicotine replacement therapy (NRT) like patches or gum, and people who smoke combustible cigarettes while also using either e-cigarettes or other NRT products.

Most studies up until now, as noted in the report, have examined the toxins in the actual vapor of the e-cigarette and compared that to the toxins in tobacco. But because the actual absorption levels of substances from e-cigarettes are not known, this may not be an accurate way to determine actual toxicity. Also, different vaping devices may deliver differing amounts of chemicals to the body.

This study instead examined the levels of toxins and carcinogens in the body over time, and found that they are lower in users of e-cigs than in regular smokers, and comparable to those found in people using other NRTs.

This is a big deal. While taking up vaping from scratch is still a bad idea, regular smokers who switch to e-cigarettes could do themselves considerably less harm than if they keep smoking tobacco. Ideally, e-cigarettes would be, like nicotine patches, used as an aid to eventually wean yourself off nicotine altogether, but even if you switch permanently to vaping, you’ll be healthier.

Vaping is still a young phenomenon—e-cigarettes were only patented in 2003—and the research is still scant. Even this study only looks at 181 individuals, and is funded by an organization that has a vested interest in reducing cancer. But really, it seems that pretty much anything is better for you than smoking. Apart from sitting down, that is.

E-cigarettes may pose the same or higher risk of stroke severity as tobacco smoke

Electronic cigarette (e-cigarettes) vaping may pose just as much or even higher risk as smoking tobacco for worsening a stroke, according to a preliminary study in mice presented at the American Heart Association’s International Stroke Conference 2017.

https://eurekalert.org/pub_releases/2017-02/aha-emp021517.php

Researchers found:

Mice exposed to e-cigarette vapor for 10 days or 30 days had worse stroke outcome and neurological deficits, than those exposed to tobacco smoke.

E-cigarette exposure decreased glucose uptake in the brain. Glucose fuels brain activity.

Both e-Cig and tobacco smoke exposure for 30 days decreased Thrombomodulin (anti-coagulant) levels.

From a brain health perspective, researchers said, electronic-cigarette vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity.

Use of e-cigarettes is a growing health concern in both smoking and nonsmoking populations. Researchers said rigorous studies are needed to investigate the effects of the nicotine exposure via e-cigarettes on brain and stroke outcome.

Ali Ehsan Sifat, Graduate Student/Research Assistant, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, Texas.

Clean Indoor Air Act – Use of Electronic Cigarette Devices – Prohibition

Download (PDF, 393KB)

E-cigarettes users have lower carcinogen and toxin levels than smokers, study finds

Although this is a relatively small study, as the authors acknowledge, it indeed helps to elucidate some clarity on some central issues. One such issue is that that the study contributes to confirming that the continued use of both e-cigarettes and tobacco cigarettes, i.e. “dual use”, does not appear to significantly reduce the harms of smoking. Arguably, this is not “news”. One very large longitudinal study (1), followed 24 959 men and 26 251 women, aged 20–49 years, screened for risk factors of cardiovascular disease in the mid-1970s, screened again after 3–13 years, and followed up throughout 2003. The authors of this substantial longitudinal concluded that:

http://www.bmj.com/content/356/bmj.j651/rr

“Long-term follow-up provides no evidence that heavy smokers who cut down their daily cigarette consumption by >50% reduce their risk of premature death significantly. In health education and patient counselling, it may give people false expectations to advise that reduction in consumption is associated with reduction in harm.”

In retrospect, therefore, it have been somewhat misleading for an important evidence review like the 2014 Cochrane Review of E-Cigarettes (2) to make one of its primary outcome measures: a 50% reduction in tobacco consumption. Some observers are still, erroneously and misleadingly, publically claiming that “when people vape, they smoke less, even if they don’t manage to quit altogether. In other words, harm is reduced” (3). This claim, in fact, does smokers a significant dis-service.

Other reviews (4; 5) have highlighted, indeed, that even the so-called “light smoking” of only one to four cigarettes per day still risks producing significant harm, so, the results of this new study, in respect of dual use are, arguably, not that surprising. As the authors state, users of e-cigarettes must appreciate that, for there to be an appreciable benefit to their health, they need to fully switch away from tobacco cigarettes.

Unfortunately, it appears that, currently at least, the significant majority of e-cigarette users: firstly, either stop using them, finding that the devices fail to satisfy their cravings, are “not like smoking” a cigarette and are “messy fiddly devices” (6; 7); or, secondly, continue to dual use (8) along with tobacco cigarettes. Thus, the technology and chemistry involved needs to improve, if e-cigarettes are to fulfil the promise that some believe they have in truly competing with tobacco cigarettes.

The results here confirm, however, that a full switch to e-cigarettes, or nicotine replacement therapies, should significantly reduce exposure to the important cancer-causing toxins tested in this study – clearly, good news, in terms of cancer. However, the claim in the Cancer Research UK Press Release that “the long term effects of these products will be minimal” (9) is premature, and arguably, unscientific. The study could only test for a relatively limited number of the total of known relevant harmful substances: almost entirely related to cancer. It did not test for, for example, other important biomarkers, related to oxidative stress and the vascular system, that other studies using human subjects have (10), and which have indicated to expert toxicologists a “substantial exposure” and a concerning potential for harm, although, still less than from tobacco cigarettes (11).

Still other studies using human subjects, looking at different issues than this new study, have identified suppression of a significant number genes related to immunity and respiratory risks (12), and more recently, findings suggestive of inflammation and subsequent cardiac risk (13; 14).

This new study under review here, though helpful, is only part of the puzzle that is “e-cigarettes” – further, long term studies, following e-cigarette users for a prolonged period of time, tracking not just issues mostly related to cancer, but other specific respiratory and cardiac risks, are still required, before anyone can confidently claim that the harmful effects of switching purely to e-cigarettes are “minimal”. Further, as the authors indicate, it tells us nothing regarding the efficacy of e-cigarettes, which can currently only be described as either: very weak, at best (15): or detrimental to chances of cessation, at worst (16).

One of the observations regarding this new study is that, probably due to the predominant interests of the funder Cancer Research UK, its primary outcome measures were related to risks of cancer. Therefore, what the study did not consider are the potential cardiovascular effects of e-cigarettes, and the non-cancer respiratory effects. CDC data (17) demonstrates, importantly, that basically as many people die prematurely from the cardiovascular effects of smoking tobacco (160,000) as from cancer effects (163,700), so, if we then add on the premature deaths of the non-cancer lung disease (113,100), it becomes clear that the health effects of smoking are, unfortunately, very much more than those purely related to cancer.

‘‘All views are my own and do not necessarily reflect those of my employer”

1) http://tobaccocontrol.bmj.com/content/15/6/472.long
2) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010216.pub2/full
3) http://www.theglobeandmail.com/opinion/the-health-hazards-of-vaping-are-…
4) http://circ.ahajournals.org/content/121/13/1518
5) http://tobaccocontrol.bmj.com/content/14/5/315.full
6) http://substanceuseresearch.org/wp-content/uploads/2017/01/Pleasure.pdf
7) https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntw102
8) https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntw102
9) http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2017-…
10) http://journal.publications.chestnet.org/article.aspx?articleid=2518226
11) https://blogs.otago.ac.nz/pubhealthexpert/2016/07/04/what-does-recent-bi…
12) http://ajplung.physiology.org/content/311/1/L135
13) http://jamanetwork.com/journals/jamacardiology/article-abstract/2600166
14) http://www.atherosclerosis-journal.com/article/S0021-9150(16)31378-8/pdf
15) http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-…
16) http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00521-4/abstract
17https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/t…(15)00521-4/abstractco_related_mortality/index.htm

Competing interests: No competing interests

Study: Toxic Metals Found in ECigarette Liquids

FIVE METALS, TOXIC AND POTENTIALLY CARCINOGENIC WHEN INHALED, FOUND IN LIQUID OF LEADING FIRST GENERATION E-CIGARETTE BRANDS

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found high levels of toxic metals in the liquid that creates the aerosol that e-cigarette users inhale when they vape.

The study, believed to be the first to examine a cross-section of metals in multiple e-cigarette brands, analyzed the liquid in five brands of first generation e-cigarettes for cadmium, chromium, lead, manganese and nickel.

The liquid is the component of e-cigarettes that, when heated, delivers ingredients, often including nicotine and flavors, to the user. In first generation e-cigarettes, the liquid is stored in the cartridge in close contact with the heating coil. The researchers found all five heavy metals – which can be toxic or carcinogenic when inhaled – in all five brands, though levels varied by brand. The main source of the metals, the researchers believe, is the coil that heats the liquid that creates the aerosol, which is often but erroneously referred to as vapor. The study did not look at the possible presence of metals in e-cigarette aerosol.

The findings appear in the January issue of the journal Environmental Research.

“We do not know if these levels are dangerous, but their presence is troubling and could mean that the metals end up in the aerosol that e-cigarette users inhale,” says study leader Ana María Rule, PhD, MHS, an assistant scientist in the Bloomberg School’s Department of Environmental Health and Engineering. “One of the things that is troubling is that the metals in e-cigarette coils, which heat the liquid that creates the aerosol, are toxic when inhaled, so perhaps regulators might want to look into an alternative material for e-cigarette heating coils.”

The Food and Drug Administration began regulating e-cigarettes last year, but has not yet issued warnings. Ecigarettes may be less harmful than cigarettes for current smokers who switch completely to electronic cigarettes. A serious concern is the appeal of e-cigarettes to young people who have never smoked, since ecigarettes might be habit forming, and might not be totally safe as emerging research shows that nicotine can adversely affect the developing adolescent brain. Last fall, then-U.S. Surgeon General Vivek Murthy called ecigarette use by young people a serious concern. E-cigarette use among high school students jumped 900 percent between 2011 and 2015.

For their study, the researchers selected five leading brands of so-called first generation e-cigarettes, which are referred to as cig-a-likes because they resemble traditional cigarettes. (Newer ones look like small cassette recorders with a mouthpiece. In the newer devices the liquid is added from a dispenser prior to use. In contrast, the liquid in first generation e-cigs is stored in the cartridge together with the coil, which increases the liquid’s exposure to the coil even in the absence of heating.) The five brands are sold across the United States in bigbox retail stores, convenience stores and gas stations, as well as online. Three of the five brands constituted 71 percent of total market share in 2015. If a brand came in more than one flavor, the researchers chose one flavor for consistency’s sake.

To test the liquid for metal levels, the researchers extracted samples of the liquid; the liquid had not been heated by the coil prior to extraction. The liquid is a mixture of propylene glycol, glycerin, nicotine and flavorings. Because liquid volume varied considerably from brand to brand, the research team tested for concentrations of metals in micrograms per liter.

The five metals – cadmium, chromium, lead, manganese and nickel – were present in all five brands, with cadmium markedly lower than the other metals and with a considerable range of concentrations among the brands. For instance, one brand had a high concentration of all five metals. In that brand, the concentration of nickel, which is considered the most serious carcinogen when inhaled, was 22,600 micrograms per liter, 400 times that of the brand with the lowest concentration of nickel. In that same brand, the one with the highest concentration of all five metals, the concentration of manganese was 690 micrograms per liter, or 240 times that of the lowest concentration in yet another brand.

“It was striking, the varying degrees to which the metals were present in the liquid,” Rule says. “This suggests that the FDA should consider regulating the quality control of e-cigarette devices along with the ingredients found in e-cigarette liquids.”

For now, FDA regulations require e-cigarette makers to submit ingredient lists as well as information about potentially harmful ingredients, including four of the five metals analyzed in this study – nickel, lead, chromium and cadmium. The FDA has yet to issue proposed regulations on e-cigarette labeling. In addition to the coil, the researchers believe some of the metals may come from the components of the e-cigarette device or the manufacturing process.

“E-cigarettes as a source of toxic and potentially carcinogenic metals” was written by Catherine Ann Hess, Pablo Olmedo, Ana Navas-Acien, Walter Goessler, Joanna E. Cohen and Ana María Rule.

This study was funded by the Institute for Global Tobacco Control, Johns Hopkins School of Public Health; National Institute of Environmental Health Sciences Training Grant T32ES007141-31A1; National Institute on Alcohol Abuse and Alcoholism Training Grant T32-AA014125 and the Alfonso Martín Escudero Foundation.

Alert: Just 10 Puffs Of an E-Cigarette As Deadly As a Regular Fag

“Quitting smoking is the easiest thing in the world. I know it because I’ve done it thousands of times. Mark Twain

https://www.thequint.com/fitness/2016/12/21/just-10-puffs-of-e-cigarette-are-as-deadly-as-regular-cigarette-vaping-is-not-safer-than-smoking-quit-smoking-2017

Bang on! Science says that 9 out of 10 people who try to kick the butt fail miserably. Perhaps that is why, practically overnight, e-cigarettes have come into their own as the new in thing.

And now an independent study done by USA’s biggest child health body, the American Academy of Pediatrics, finds that e-cigarettes could be the gateway to lifelong nicotine addiction, hinder brain development, give you ‘popcorn lungs’ (an irreversible and fatal condition where the airways are narrowed and weakened) – and all this combined can threaten decades of anti-smoking gains.

If you think that e-cigarettes are an American phenomenon, smoke on this: In the last 3 years, the e-cigarette market has shot up to a $3-4 billion industry and the US contributes to only a quarter of it. In 2014, ITC started manufacturing e-cigarettes in India when most of the Chinese e-cigarette brands were readily available, and obviously, the cigarette giant will not invest millions in a tobacco cessation tool.

Before You Start Vaping, Here’s What You Need To Know

An alarming new study by Swedish scientists found that just 10 puffs of an e-fag can set the heart disease ball rolling, just like a regular cigarette.

It increases the risk of high blood pressure, hardens arteries and makes it harder for people to quit smoking. All this for the popular perception that e-cigarettes are a smoking cessation tool, but contrary to popular perception, it does contain nicotine.

Nicotine is as addictive as heroin, precisely why these vaping devices will never help anyone wean themselves off smoking.

An e-cigarette is a terrible alternative to smoking. In fact, they are much more sinister than tobacco cigarettes – even the World Health Organisation doesn’t buy it.

Nicotine poses several health hazards of varying severity and promotes the growth of tumours.

Dr Pankaj Chaturvedi, Senior Oncologist Surgeon, Head and Neck Cancer Surgery, Tata Memorial Hospital

According to Dr Chaturvedi, e-cigarettes also pose the threat of nicotine poisoning – if you inhale three cartridges in a row, you can die. One cartridge has roughly 11 milligrams of nicotine, three would be over 30, which is a fatal dose. The World Health Organisation says reports of nicotine poisoning have increased manyfold in the US and UK where the popularity of e-cigarettes is soaring.

vape-01

vape-02

vape-03

Where Does India Stand On E-Cigarette Regulations?

Like with most subjects to do with ‘health’, India does not have a national policy on e-cigarettes yet.

The problem is that e-cigarettes are not mandated by law, and they don’t come under the jurisdiction of the Drugs and Cosmetics Act or fall in the Cigarette and Other Tobacco Products Act. Companies can openly flout the tobacco control provisions, which means they can sell it to kids under the age of 18, skip the gory pictorial warnings on packaging, and openly advertise it.

In 2013, the then Union Health Minister Dr Harsh Vardhan called a closed door meeting of public health activists and FDA officials to completely ban the sale and supply of e-cigarettes in the country.

He was motivated by the news that 13 of the 59 countries that regulate e-cigarettes banned them after compelling scientific evidence that these sticks do more harm than good. But since then, the Health Minister changed and the issue has been put on the back-burner.

A new drug is being freely and openly being sold to people and that drug is nicotine. We don’t know how healthy or unhealthy these are over the long term. But the question is this: if in the next 5 years, we find out these are as deadly as cigarettes for your health, what happens then?

Dr Pankaj Chaturvedi, Senior Oncologist Surgeon, Head and Neck Cancer Surgery, Tata Memorial Hospital

The problem is that Big Tobacco has not revealed exactly what kinds of chemicals there are in the vapour liquid.

And that is concerning.

Health experts don’t trust them. Nobody should trust them. Their only motive is profit. Will you be naive enough to think that big tobacco firms want to help smokers quit?

Twelve myths about e-cigarettes that failed to impress the TGA

Australia’s Therapeutic Goods Administration (TGA) last week rejected an application to liberalise the scheduling of nicotine (see from page 71).

http://theconversation.com/twelve-myths-about-e-cigarettes-that-failed-to-impress-the-tga-72408

This prompted the predictable round of protests from proponents of e-cigarettes who have long touted them as the next public health wonder of the world, even as important as antibiotics.

But unlike antibiotics, which are heavily regulated, require a prescription, and must demonstrate both safety and efficacy to regulatory bodies, e-cigarettes and the liquids used in them are virtually unregulated.

Tobacco harm reduction has had a history of monumental failures. It started with the global multi-million dollar promotion of filters. One of these was the infamous asbestos-filtered “micronite filters” in Kent cigarettes. More recently, we saw the now outlawed consumer deceptions of the light and mild cigarette fiasco. And on the way we even had “reduced carcinogen” brands.

These were designed to keep people smoking and slow the mass exodus that began in the early 1960s. Millions did just that. Only quitting and the decreasing incidence of smoking (ie. never starting) have dramatically decreased the tobacco disease epidemic.

It would be wonderful if e-cigarettes were finally a harm reduction holy grail. But there are many reasons to remain cautious.

Here I look at 12 mantras about e-cigarettes that seem to have failed to impress the TGA.

1. Vaping is ‘95% less harmful than smoking’

A hand-picked group of 12 produced this magic number when asked to rank the health risks of 12 nicotine delivery products, including cigarettes. Several of the group had no research record or expertise in tobacco control; some had histories of financial connections with manufacturers of e-cigarettes and tobacco companies. There were no toxicologists, cancer or cardiovascular specialists among the authors.

The “95%” number was uncritically repeated in a Public Health England report, which even described e-cigarettes as “around 95% safer [not less dangerous] than smoking” (my emphasis). Incredulous toxicologists have since pointed out “there is no evidence for the 95% estimate”.

The extreme pro e-cigarette activist Carl Phillips, who has a long history of support from tobacco manufacturers, summed it up beautifully:

This specific point estimate (synonymous with “5% as bad for you as smoking”) has rapidly evolved into “fact” (in the political sense of that term). It is repeated in a large fraction of popular press reports and widely used in arguments, snipes, and broadsides from vaping advocates. It seems to have emerged from nowhere when the Public Health England report asserted the figure. That traced to what was actually a huge misinterpretation of what was only a made-up number, from one junk-science journal article.
Phillips may be unique in believing the number is closer to 1%. His supporters in the tobacco and vaping industries are probably very happy with the PR potential of that estimate.

2. Vaping is orders of magnitude less harmful than smoking

Because vapers don’t inhale smoke, with its toxic cocktail of carcinogens, irritants and carbon monoxide, this is almost certainly going to be the consensus when sufficient longitudinal data emerge, particularly when it comes to cancer. However, the already mentioned “group of 12” has claimed that “The paucity of evidence for serious harm to users of e-cigarettes over the years since they were first marketed in 2006, with millions purchased, in itself is evidence” of vaping being all but benign.

Even perceptive vapers have seen through this nonsense. It took several decades for the full effects of smoking tobacco to emerge. Worrying evidence about cardio-respiratory effects is already mounting. These highly respected researchers estimated the long-term effects of vaping may equate to 50% of the risk of cardio-respiratory harm that tobacco causes, what they call a “substantial” exposure.

Tobacco-caused cancers may well reduce in people who only vape. But cancer deaths represent only 37% of all tobacco deaths: cardio-respiratory deaths make up most of the rest.

3. Nicotine in vaping is benign

While some make facile comparisons of the risks of nicotine with drinking coffee, the International Agency for Research on Cancer recently noted “evidence has indicated the potential for nicotine to cause DNA damage” and “inhibit apoptosis, and stimulate cell proliferation and angiogenesis …”, declaring that evaluation of electronic cigarettes and nicotine is a “high priority”.

The recent US Surgeon General Report highlighted the adverse effects of nicotine on brain development in young people and in pregnancy. A recent study has further revealed previously unrecognised negative effects of nicotine, and vaping, on the heart.

4. Vaping has caused 6.1 million European smokers to quit

This factoid was megaphoned from a paper authored by a researcher with a history of funding from e-cigarette manufacturers. It was a secondary analysis of a cross-sectional survey since pilloried in the journal Addiction, where it was published. As any epidemiology student knows, causality can never be claimed from cross sectional studies. Among other criticisms, the critics asked:

How many of those who claim that they have stopped with the aid of e-cigarettes would have stopped anyway, and how many of those who used an e-cigarette but failed to stop would have stopped had they used another method.
They also noted the questions asked would have allowed those who quit for only a short period to say they had “stopped”.

Longitudinal studies with a minimum of 12 months follow-up of randomly selected cohorts have shown sobering results, a long way from the hype of vaping having the equivalent efficacy of antibiotics. One such follow-up reported:

Daily use of e-cigarettes while smoking appears to be associated with subsequent increases in rates of attempting to stop smoking and reducing smoking, but not with smoking cessation.
A companion paper reported daily use of tank-system (refillable) e-cigarettes were the only type of e-cigarette to show a significant improvement in smoking cessation. The very latest data from England show about half of daily e-cigarette users are also smoking (slide 9) and the rate at which English smokers have tried to stop is the lowest in 2016 (30.9%) than it has been since 2007 (42.5%) when the study began (slide 22).

This raises important questions about whether e-cigarettes may be keeping many smokers smoking, while helping others to quit.

5. Just cutting back smoking (rather than quitting) significantly reduces risk

It’s obvious, surely, if you don’t quit but only cut down the amount you smoke, the reduced smoking is going to reduce the harm you are doing? Obvious that is, until you actually look at very large studies that have looked at the death rates down the track in those who reduce but don’t quit.

First, two examples followed 479,156 men for 11 years and found no association between smoking reduction and all cancer risk but a significant decrease in risk of lung cancer, with the size of risk reduction “disproportionately smaller than expected”. Second, a study of 51,210 people followed from the 1970s until 2003 found no evidence smokers who cut down their daily cigarette consumption by more than 50% reduced their risk of premature death significantly.

Vaping advocate and Addiction editor Professor Robert West puts it succinctly:

I think as far as using an e-cigarette to reduce your harm while continuing to smoke is concerned there really isn’t good evidence that it has any benefit.
And as we saw earlier, a large proportion of people who vape, continue to smoke.

6. Vape is just like water vapour and (often) nicotine

But let’s not forget some 8,000 beguiling often kiddie-friendly flavours in e-juice that help the nicotine go down (with apologies to Mary Poppins) have mostly been approved as food additives but have never been approved for inhalation. Here’s what the US flavouring industry said:

The manufacturers and marketers of ENDS [electronic nicotine delivery systems], and all other flavored tobacco products, and flavor manufacturers and marketers, should not represent or suggest that the flavor ingredients used in these products are safe because they have … status for use in food because such statements are false and misleading.
And then there’s the liquid propylene glycol in which the nicotine and flavour chemicals are vapourised. Dow Chemical, which manufactures it, says unambiguously, reflecting human data:

… breathing spray mists of these materials should be avoided. In general, Dow does not support or recommend the use of Dow’s glycols in applications where breathing or human eye contact with the spray mists of these materials is likely …
Vapers average about 200 inhalations a day, with this study finding a range of 6 to 611 puffs. That’s an average 73,050 deep lung bastings a year, and right up to 223,168. Like cigarette smoke, vape mist contains fine, ultra-fine and nanoparticles, including metals and silicate. It is anything but just like inhaling steam in a shower.

Put simply, we have no data on what happens to people’s long-term respiratory or cardiovascular health when they pull these nanoparticles deep into their lungs daily, over many years, at the above rates.

7. Nicotine-free cigarettes contain no nicotine

E-cigarette advocates were excited about a recent study reporting many US teens did not vape for nicotine, but for the flavours. In NSW, it is illegal to sell vape liquid containing nicotine. But a NSW Health random check found many samples contained it. Other examples in the US, and elsewhere, of alleged “non-nicotine” refills turning out to contain nicotine exist, hence the headline “‘Nicotine-Free’ E-Cigs Still Deliver the Juice”.

The US Food and Drug Administration (FDA) summed up:

Testing also suggested that quality control processes used to manufacture these products are inconsistent or non-existent.

8. Second-hand vape is harmless, so it should not be restricted

I’d rather sit next to a vaper than a smoker. But those vape clouds we see and then don’t see don’t just vanish. They can be measured. This study of a vapers’ meeting where 59-86 people were vaping found counts of PM2.5 airborne particles (fine particulate matter, 2.5 micrometers or less in diameter) 125-330 times higher than in the same room when empty. This is higher than particle concentrations recorded in bars where cigarette or waterpipe smoking are allowed. That will likely explain the other real-world experiences reported by vapers like this.

If vaping were allowed in bars, restaurants and planes, we all would face behaviour like this scene. Try imagining workable regulatory wording that would allow “discreet” vaping by a few, but prohibited exuberant “clouding” by a group of vapers drinking in a bar.

If vaping emissions were really benign, indoor vaping advocates should take courage and call for it to be allowed in classrooms, crèches, hospitals and neonatal wards. The fact they don’t rather suggests they know well such a position would be irresponsible.

9. There’s no good evidence for e-cigarettes being a gateway to smoking in young people

In England, this appears to be the case. But in the USA, there’s a rapidly growing body of evidence suggesting a possible effect. Centers for Disease Control data from 2015 demonstrate a concerning sudden cessation and plateau in the previous decline of US high school students smoking tobacco, while e-cigarette use is skyrocketing.

Smoking was plummeting in young people in the USA and UK long before e-cigarettes appeared. Today, more young people in the US are using nicotine than ever, which may signal health and brain developmental problems down the track.

10. E-cigarette explosions are overrated

E-cigarette advocates point out other lithium battery-powered items like mobile phones and laptops have exploded, so we should all calm down about dramatic explosions.

However, vapers have noted explosions tend to take place, not just during re-charging, but during use, leading to mounting reports from hospitals of terrible burns and injuries.

When mobile phones explode, we see global recalls as happened with the Samsung Galaxy Note 7. The lack of regulatory standards for e-cigarettes and their components stands in stark contrast to these other products. I’m very pleased e-cigarettes are banned on airlines, but wonder about what would happen if one exploded in stowed luggage.

11. Big Tobacco really wants its smoking customers to switch to e-cigarettes

If this was true, how do we then explain the companies continue to do all they can to wreck effective tobacco control policies like plain packaging, graphic health warnings and significant tobacco tax hikes?

In Hong Kong in December 2016 British American Tobacco was still lobbying against graphic health warnings. And Philip Morris was threatening Uruguay over its advanced tobacco control policies, until it lost its case at the World Bank’s International Centre for Settlement of Investment Disputes in 2016.

Surely, if they were sincere here, they should be pleased governments are trying to get smokers to quit? Philip Morris has been running targeted advertising campaigns with major youth appeal. And new evidence collated from its own documents demonstrates its interest in e-cigarettes, as long ago as 1990, was only ever for them to be used as a complement to cigarettes.

Big Tobacco has heavily invested in e-cigarettes, with all major tobacco companies now having them in their portfolios. The big picture here is that Big Tobacco wants people to smoke and vape, not vape instead of smoking.

12. Leading public health agencies encourage ‘light touch’ regulation

This is mostly the case in England, but very much not the case in many other nations. Advocates constantly point to two e-cigarette “friendly” reports from the UK Royal College of Physicians and Public Health England, which had several common authors.

But 18 nations ban e-cigarettes outright, with more having various degrees of restrictions. Among leading agencies with strong concerns about e-cigarettes are the US Surgeon General, the World Health Organization, the FDA, 31 mostly major health agencies that petitioned the FDA to regulate e-cigarettes, Australia’s National Health and Medical Research Council and now the TGA.

E-cigarettes have been generating a huge wave of research interest over the past few years. The next decade promises to throw the light of much needed evidence on many of the issues above. In the meantime, the Australian TGA’s caution should be respected.

One Way e-Cigarettes May Up CV Risk: Altering HR Variability

http://www.medscape.com/viewarticle/875253

Habitual e-cigarette use may increase the risk of cardiovascular disease by shifting the cardiac autonomic balance toward greater sympathetic activity and increasing oxidative stress, according to new research[1].

“The central message for cardiologists from our study is that habitual e-cigarette use is associated with altered heart-rate variability in the same pattern seen in tobacco cigarette smokers,” Dr Holly R Middlekauff (David Geffen School of Medicine, University of California, Los Angeles) told heartwire from Medscape.

“This pattern of heart-rate variability has been associated with increased risk of myocardial infarction and sudden death in patients with heart disease, as well as in populations without known heart disease. Furthermore, habitual e-cigarette use is associated with increased susceptibility to oxidative stress, a critical component in the development of atherosclerosis,” she said.

Middlekauff and colleagues conducted a study involving 23 self-identified otherwise-healthy e-cigarette smokers and 19 otherwise-healthy nonusers between 21 and 45 years old in 2015 and 2016.

Using electrocardiography and blood tests, they analyzed heart-rate variability by high-frequency component, which signals vagal activity, low-frequency component, which mixes vagal and sympathetic activity, and the ratio of low frequency to high frequency, which reflects the cardiac sympathovagal balance.

The researchers found the high-frequency component to be significantly decreased in e-cigarette users compared with nonusers (standard error of the mean [SEM], 46.5 nu vs 57.8 nu; P=0.04). They found the low frequency and the low–to–high-frequency ratio to be significantly increased (mean [SEM] 52.7 nu vs 39.9 nu; P=0.03; mean [SEM] 1.37 vs 0.85; P=0.05) in e-cigarette users, which they write as being consistent with sympathetic predominance.

They found plasma cotinine levels to be significantly related with each heart-rate variability components, inversely to high frequency (P =0.04) and directly to low frequency (P=0.03) and low–to–high-frequency ratio (P=0.03).

They also found LDL oxidizability to be significantly increased in 12 e-cigarette users compared with 18 nonusers (mean [SEM] 3801.0 U vs 2413.3 U; P=0.01). Paraoxonase-1 tended to be lower in e-cigarette users, which they write as being consistent with less protection against oxidative stress.

The researchers pointed out that both increased cardiac sympathetic activity and increased oxidative stress are known mechanisms of how tobacco smoking increases the risk of cardiovascular disease.

“We can conclude that habitual e-cigarette use is associated with physiologic effects. Nonetheless, we cannot confirm causality on the basis of this single, small study; further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted,” the researchers write in an article published online February 1, 2017 in JAMA Cardiology.

Middlekauff said cardiologists should be telling their patients, “E-cigarettes have real, physiologic, adverse effects. If you don’t already smoke tobacco cigarettes, don’t start using e-cigarettes. They are not harmless.”

As for further research, she added, “We need to know whether the cardiac risks associated with e-cigarettes are as great as those associated with lethal tobacco cigarettes. We need to know which component of the e-cigarette aerosol is driving these adverse physiologic effects.”

In an accompanying editorial[2], Dr Aruni Bhatnagar (University of Louisville, KY) writes that the nicotine in e-cigarettes “is a strong vasoactive drug that can profoundly affect cardiovascular function and health. . . . It has been shown that smoking e-cigarettes increases heart rate as well as diastolic and systolic blood pressure to levels comparable with those observed with conventional cigarettes.”

He praised the researchers involved in the new study: “Such investigations are critical for evaluating how harmful e-cigarettes are and whether their widespread acceptance will decrease the incidence of cardiovascular disease or, by renormalizing smoking and promoting nicotine addiction, erode public-health gains made by evidence-based tobacco control and regulation.”

Outside supporters of this research included the American Heart Association, the National Institute of Environmental and Health Sciences, and the Irma and Norman Switzer Dean’s Leadership in Health and Science Scholarship program. The authors and editorialist reported no relevant financial relationships.

Study adds to evidence that electronic cigarettes are not harmless

http://www.alphagalileo.org/ViewItem.aspx?ItemId=172149&CultureCode=en

A study published in JAMA Cardiology has added to growing evidence that electronic cigarettes (e-cigarettes) are not harmless.1

“Studies like this give further confirmation that e-cigarettes are not harmless,” said European Society of Cardiology cardiovascular prevention spokesperson Professor Joep Perk.

“If I was a minister of health I would put my efforts into public anti-smoking campaigns especially directed towards the younger generation, and not promote e-cigarettes as an alternative to smoking,” he continued. “There are studies also showing that people that start with e-cigarettes have a tendency to become persistent tobacco cigarette smokers as well.”

The 2016 European guidelines on cardiovascular disease prevention flagged up the need for further research on the long-term effects of e-cigarettes.2

The current study included 23 habitual e-cigarette users (used most days for at least one year) and 19 non-users between the ages of 21 and 45 years. It found that habitual e-cigarette users were more likely than non-users to have increased cardiac sympathetic activity (increased adrenaline levels in the heart) and increased oxidative stress – known mechanisms by which tobacco cigarettes increase cardiovascular risk.

The authors said the findings “have critical implications for the long-term cardiac risks associated with habitual e-cigarette use” and “mandate a re-examination of aerosolized nicotine and its metabolites”. They added that causality could not be confirmed on the basis of this single, small study, and that further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted.

“Nicotine stimulates the central nervous system, so it’s not at all surprising that people continuously taking nicotine get this sympathetic stimulation,” said Professor Perk. “This then might lead to irregular heartbeat and raised blood pressure, and probably has long-term deleterious effects on the blood vessel walls.”

“It is too large a step to say that these negative effects are proof that people are going to die early because they used e-cigarettes,” he continued. “To prove this you have to put people on e-cigarettes for 10 to 15 years and see how many die early – a study that will not be done for ethical reasons. The weakness of all studies in this field is that they are observational and small, and they look at indicators of vascular wall damage rather than incidence of cardiovascular disease or death.”

Professor Perk said that, even after this study, e-cigarettes could still be used to help people stop smoking tobacco cigarettes, but they should be used with caution and other methods should preferably be tried first.

He said: “E-cigarettes are one of the tools we have in nicotine replacement therapy but as clinicians we should be cautious of putting people on large amounts of central nervous system stimulant drugs. Other smoking cessation schemes, such as chewing gum or patches, always include the decision to taper off use and eventually stop. This is not in general the case with e-cigarettes, which tend to be seen as a replacement and not a weaning off nicotine addiction. In fact they prolong the addiction.”

“This is an area where we need more knowledge,” continued Professor Perk. “The more data we collect, the more it seems that nicotine replacement strategies that taper off and ultimately end nicotine use are the way to go.”

“At the end of the day the best thing is simply to prevent people ever getting into the vicinity of nicotine,” he concluded.