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November, 2017:

Five myths about e-cigs and some of the evidence that they are, well, myths

The latest e-cig love fest at the 2017 E-cig Summit in England has been bouncing around the internet, so I thought it would be worth summarizing some of the evidence debunking common e-cig myths. The list of citations is nowhere near exhaustive, but illustrates why these myths are myths.

https://tobacco.ucsf.edu/five-myths-about-e-cigs-and-some-evidence-they-are-well-myths

Myth 1: There is no gateway effect.

A recent meta-analysis shows 100% consistent evidence that never cigarette smoking youth who begin nicotine use with e-cigarettes are significantly more likely to progress to cigarette smoking than youth who do not use e-cigarettes. There have been several additional longitudinal studies published that have shown the same thing since this meta-analysis was published, including one from England.

There are also consistent data showing that e-cigarettes attract youth at low risk of beginning tobacco use with cigarettes and expanding the overall nicotine use market.

Myth 2: E-cigarettes increase smoking cessation.

A meta-analysis showed that, considering all available data at the time, e-cigarettes are associated with depressed cessation. While some of the studies published since then show increased smoking cessation among e-cigarette users, the overall pattern remains depressed cessation.

Myth 3: E-cigarettes are 95% safer than conventional cigarettes.

This assumption is based on the paper by Nutt et al that represented the opinions of a few ‘experts” without citing any specific supporting evidence. The process by which this paper was prepared has been criticized for conflicts of interest among some of the authors. More important, since then there has been a substantial literature published indicating important cardiovascular and pulmonary risks associated with e-cigarette use. Cardiovascular and pulmonary disease kill about 2/3 of smokers.

Myth 4: Even if smokers don’t quit when they use e-cigarettes they smoke fewer cigarettes and the health risks go down substantially in smokers that reduce consumption.

The claim that smokers who use e-cigarettes is also not consistently supported by the evidence. More important, even low levels of smoking convey substantial risks, especially for cardiovascular disease, where smoking even a few cigarettes is as dangerous as smoking 20 cigarettes a day.

Myth 5: Nicotine is addictive, but it doesn’t pose any other substantial risks.

Nicotine is a reproductive toxin. While not a carcinogen, nicotine plays an important role in promoting tumor progression by promoting cell proliferation and inhibiting normal cell death by activating nicotinic acetylcholine receptors and β adrenergic receptors. Nicotine also promotes the angiogenesis needed to supply blood to growing tumors. Nicotine’s effects on nicotinic acetylcholine receptors also accelerates atherosclerosis.It also aggravates lung disease and other diseases.

The Problem With E-Cigarettes

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Tobacco papers and tobacco industry ties in regulatory toxicology and pharmacology

Abstract:

https://www.ncbi.nlm.nih.gov/pubmed/29116189

We examined the relationship between the tobacco industry and the journal Regulatory Toxicology and Pharmacology (RTP) using the Truth Tobacco Industry Documents Library and internet sources. We determined the funding relationships, and categorised the conclusions of all 52 RTP papers on tobacco or nicotine between January 2013 and June 2015, as “positive”, “negative” or “neutral” for the tobacco industry. RTP’s editor, 57% (4/7) of associate editors and 37% (14/38) of editorial board members had worked or consulted for tobacco companies. Almost all (96%, 50/52) of the papers had authors with tobacco industry ties. Seventy-six percent (38/50) of these papers drew conclusions positive for industry; none drew negative conclusions. The two papers by authors not related to the tobacco industry reached conclusions negative to the industry (p < .001). These results call into question the confidence that members of the scientific community and tobacco product regulators worldwide can have in the conclusions of papers published in RTP.

Studying the interactive effects of menthol and nicotine among youth

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Recent updates on electronic cigarette aerosol and inhaled nicotine effects on periodontal and pulmonary tissues

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/?term=Recent+updates+on+electronic+aerosol+and+inhaled+nicotine+effect+on+peridontal+and+pulmonary+tissues

E-cigarette-derived inhaled nicotine may contribute to the pathogenesis of periodontal and pulmonary diseases in particular via lung inflammation, injurious, and dysregulated repair responses. Nicotine is shown to have antiproliferative properties and affects fibroblasts in vitro, which may interfere in tissue myofibroblast differentiation in e-cig users. This will affect the ability to heal wounds by decreasing wound contraction. In periodontics, direct exposure to e-vapor has been shown to produce harmful effects in periodontal ligament and gingival fibroblasts in culture. This is due to the generation of reactive oxygen species/aldehydes/carbonyls from e-cig aerosol, leading to protein carbonylation of extracellular matrix and DNA adducts/damage. A limited number of studies regarding the effects of e-cig in oral and lung health are available. However, no reports are available to directly link the deleterious effects on e-cigs, inhaled nicotine, and flavorings aerosol on periodontal and pulmonary health in particular to identify the risk of oral diseases by e-cigarettes and nicotine aerosols. This mini-review summarizes the recent perspectives on e-cigarettes including inhaled nicotine effects on several pathophysiological events, such as oxidative stress, DNA damage, innate host response, inflammation, cellular senescence, profibrogenic and dysregulated repair, leading to lung remodeling, oral submucous fibrosis, and periodontal diseases.