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December 5th, 2016:

E-cigs Danger: 10 Puffs Pushes Up Your Risk of Heart Disease

Scientists at the world-renowned Karolinska Institute in Stockholm have discovered that just ten puffs on an e-cig is enough to trigger physiological changes that, in the words of one leading expert, ‘start the heart disease ball rolling’.

This study follows others which have found that – just like ‘real’ cigarettes – e-cigs raise blood pressure and promote a hardening of the arteries.

Separate research indicates that the food additives used to flavour the vapour could be dangerous when heated and inhaled.

And another hotly disputed study, published earlier this year, even suggested that those who vape are 28 per cent less likely to quit tobacco than those who do not.

Despite all this, a number of medical organisations in the UK strongly support encouraging smokers to switch from tobacco to e-cigarettes.

Public Health England has issued a statement saying the devices are ‘around 95 per cent less harmful than smoking’. And only last week the Royal College of GPs told its 52,000 members to advise those trying to give up smoking to switch to e-cigarettes.

However, critics of this approach are unconvinced by such enthusiasm.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said: ‘Many health organisations across the UK have significant concerns about promoting e-cigarettes to smokers.

‘We simply can’t know what their effect will be on health, if used over the long term, because they have not been around long enough.

‘To me, it would be sensible to take a precautionary approach and regulate them as much as possible.’

And Dr Filippos Filippidis, lecturer in public health at Imperial College, London, said: ‘We don’t know whether we may start to see diseases emerge in ten or 20 years’ time associated with some of the ingredients. We urgently need more research into the devices.’ His warning is particularly pertinent because it took decades for the link between tobacco and lung cancer to emerge.

It became clear only thanks to the pioneering work of statistician Sir Richard Doll in the 1950s – work that has saved millions of lives.

In the Karolinska study, published in the journal Atherosclerosis, Swedish researchers took 16 occasional smokers of cigarettes and asked them to each take ten puffs on an e-cigarette.

Within the first hour, there was a ‘rapid rise’ in levels of a type of cell indicating damage to the inner lining of blood vessels, called endothelial progenitor cells or EPCs, said the scientists. This increase, they wrote ‘was of the same magnitude as following smoking of one traditional cigarette’.

This ‘very short exposure to e-cigarette vapour… may indicate an impact on vascular integrity leading to future atherosclerosis’ – better known as hardening of the arteries.

Levels of EPCs only returned to normal 24 hours later.

Professor Joep Perk, a heart specialist and spokesman for the European Society of Cardiology, said: ‘It really surprises me that so little vapour from an e-cigarette is needed to start the heart disease ball rolling.

‘It’s worrying that one e-cigarette can trigger such a response.’

So will long-term use of e-cigs cause heart disease? That remains to be seen. But the Swedish team noted that the average user takes 230 puffs a day – raising the prospect that prolonged use could cause serious damage.

Nor is this study alone. In August, a team at the University of Athens Medical School claimed that puffing on an e-cigarette for half an hour led to similar levels of stiffness in the aorta – the main artery – as smoking a tobacco cigarette. Both activities raised blood pressure, too.

Study leader Professor Charalambos Vlachopulos said at the time: ‘E-cigarettes are less harmful [than smoking tobacco] but they are not harmless.

‘I wouldn’t recommend them as a method of giving up smoking.’

New research is coming thick and fast. Last month, an American study found teenagers who used e-cigarettes were 71 per cent more likely to suffer bronchitis.

On Friday, another study claimed just one puff contained up to 270 times the safe level of toxic chemicals called aldehydes.

But it is a study in the journal Lancet Respiratory Medicine – which found e-cig users were 28 per cent less likely to quit tobacco smoking than those who didn’t vape – that has perhaps caused the most dispute. This finding matters because the vast majority of e-cig users are those trying to quit tobacco.

Co-author Stanton Glantz wrote: ‘While there is no question that a puff on an e-cigarette is less dangerous than a puff on a conventional cigarette, the most dangerous thing about e-cigarettes is that they keep people smoking conventional cigarettes.’

His findings have been leapt on by e-cig sceptics, who frequently quote the headline result.

But e-cig advocates have dismissed it as unscientific and even ‘grossly misleading’.

Peter Hajek, of the Tobacco Dependency Research Unit at Queen Mary, University of London, said it looked only at current smokers who had used e-cigarettes in the past – ignoring ex-smokers who had given up tobacco thanks to the devices.

Advocates of getting smokers to swap tobacco for e-cigarettes now fear their simple message – that switching saves lives – is getting lost in a cloud of confusion.

Smoking claims the lives of 93,000 people in the UK every year – accounting for almost one in every five deaths – as it significantly increases the risk of killer diseases including cancer, heart disease, and a lung condition called chronic obstructive pulmonary disorder.

Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies at Nottingham University, said: ‘The decision to switch should be a no-brainer… There’s nothing worse you could do for your health than smoke.’

And e-cigarettes did help 18,000 people quit smoking last year, according to research by University College London and Cancer Research UK.

Scientists such as Dr Britton believe that, despite the lurking dangers of e-cigarettes, they could deliver huge benefits to the country’s overall health.

To that end, a group of 13 health bodies, led by Public Health England and including Cancer Research UK, the Royal College of Physicians and Faculty of Public Health, issued an unprecedented ‘consensus statement’ in July supporting the principle that smokers should be encouraged to switch.

They wrote: ‘We all agree that e-cigarettes are significantly less harmful than smoking.

‘One in two lifelong smokers dies from their addiction.

‘All the evidence suggests that the health risks posed by e-cigarettes are relatively small by comparison, but we must continue to study the long-term effects.’

They concluded: ‘The public health opportunity is in helping smokers to quit, so we may encourage smokers to try vaping.’

Yet this position is ‘out of step’ with opinion in the US and Europe, according to Prof McKee and Dr Filippidis, where health bodies are far more cautious.

Dr Filippidis said: ‘Only time will tell who is right, but my personal opinion is that some more caution would be prudent until the evidence is more clear.

‘Very soon, major tobacco companies will enter the market with their own e-cigarettes or similar products that promise harm reduction.

‘I would feel very uncomfortable promoting products created by companies which have caused so much death and pain.

‘I don’t think we could trust them with our people’s health.’

How Edinburgh University doctor Judith Mackay took on the tobacco industry in Asia

HER’s is a career involving death threats, secret information passed from shadowy ‘Deep Throat’ figures, being held at gunpoint, and caught up in a trial in which key witnesses were murdered or mysteriously disappeared.

But it might be surprising to learn that these are not the experiences of a spy or globe-trotting investigative journalist, instead they are the experiences of a down-to-earth public health expert from Edinburgh.

Dr Judith Mackay, who studied medicine at Edinburgh University and is a member of the university’s Global Health Academy, has spent years battling the tobacco industry in Asia.

Now, for the first time the Hong Kong-based campaigner has revealed the full extent of the threats she faced in her career, during which she was branded as the most dangerous woman in the world by the international tobacco industry.

She told the Sunday Herald how she was for many years a “lone voice” in working at the forefront of tobacco control, trying raise awareness of the health risks of smoking and advising governments.

“Somebody once asked me do you have to be brave to be a tobacco control advocate today and my answer is no, I don’t think you do,” she said. “But I was the lone voice in the wilderness – I was basically the only person in Asia working on tobacco control regionally.

“The tobacco industry had just assumed it would ride its Marlboro cowboy into Asia and there wouldn’t be any opposition at all.”

Mackay, who was born in Yorkshire, moved to Hong Kong in 1967 at the peak of the Chinese Cultural revolution and spent a number of years working as a hospital doctor.

However she began to feel like the work was a ‘band-aid’ in having to treat so many people who had become ill as a consequence of smoking.

She decided to devote her career to tackling the industry full-time in the mid-1980s after a cigarette company attacked her work.

She said: “It [the company] was making a lot of threatening statements about how I was unaccountable and unrepresentative, claiming the tobacco industry was full of good sensible corporate advice. It was one of the turning points in my life.”

Mackay outlined the experiences she has gone through in a blog written for the ‘Dangerous Woman Project’ , which is being run by Edinburgh University’s Institute of Advanced Studies in the Humanities to collate stories of women who have been labelled as ‘threatening’.

She told how she has suffered verbal abuse over the years and in 1993, a US smokers’ rights group described her as a “psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler.”

The group also threatened to “utterly destroy” her – which was investigated by the FBI and led to her being offered 24-hour police protection by the Hong Kong government.

Mackay, who is a senior policy advisor for the World Health Organisation and director and founder of the Asian Consultancy on Tobacco Control, also had a chilling experience when she was an expert witness in a major trial involving cigarettes being smuggled into China.

The chief witness was murdered and eleven others disappeared – and Mackay discovered that she was being followed.

She helped the Hong Kong government take action against the importation and sale of smokeless tobacco, such as snuff, after she learned a ‘Deep Throat’ figure associated with the US tobacco industry had blown the whistle on a plan to immediately launch these products in the country.

In 1990, while she was working in Mongolia and staying at a government guest house, she found herself being held at gunpoint by suspicious Mongolian palace guards after going for an evening walk. She also found out there had been a cabinet meeting held to discuss whether she was a spy sent from the west.

But Mackay said her experiences had not deterred her from the fight against tobacco.

She said: “I have said – even to my lawyer – that if I were to disappear or to be found under a bus, this is not of my own doing.

“I think if anything I got very empowered by all these things that happened – it made me more determined, rather than less determined.

“But I did take some practical steps – one of which was to send our two boys when they were teenagers back to Scotland to school.

“I just felt they were safer back in the UK to finish their schooling.”

Mackay, whose husband is from Lossiemouth, still spends three months of the summer every year in Edinburgh.

The recognition for her work includes being named as one of the most influential people in the world by Time magazine in 2007. She was also awarded an honorary degree by Edinburgh University in July this year.

At the age of 73, she practises tai-chi and has no intention of giving up her work.

Mackay said while much progress has been made in tobacco control, she believes she will still be tackling the tobacco industry for years to come.

“The tobacco industry is certainly as formidable as it ever was – it has just somewhat changed its tactics in terms of what it does,” she said.

“What they now do is to issue legal challenges and trade threats to governments.”

She added: “I have often said I am going to be working until I am 100 and I think that is probably true.”

8 Million Smokers Quit After Tax Hike in Philippines

Tax hikes on cigarettes have forced my Filipinos to quit, but it now seems manufacturers may be trying to flood the market before another round of tax hikes hits.

In a recent interview the president of the Philippine Society of General Internal Medicine Antonio Miguel Dans reportedly claimed that as many as 8 million locals have quit smoking due to the effect of tax hikes on the sale of tobacco.

The latest round of tax hikes on the sale of tobacco occurred in 2012, and were aimed specifically at reducing consumption of tobacco in the country.

In 2012 the estimated smoking rate in the country was approximately 31 percent, while it has now dropped to 23 percent, a drop equivalent to approximately 8 million people.

The supply of cigarettes in the Philippines between 2012 and 2015 fell by an estimated 25.9 percent.

However, over the course of 2015 the supply had risen by 9.1 percent, as manufacturers front-load their supplies now, in order to circumvent the hoked tax rates which will be enacted next year.

The Minister also said that the tax has been supplemented by new regulations requiring packets of cigarettes to be affixed with graphic labels showing the negative effects of smoking, a measure which has also had a positive effect on smoking cessation.

Vaping’s Long-Term Effects: Here’s what the experts say

The debate over electronic cigarettes rages on, despite the vaping industry’s best efforts to promote its value in decreasing the use of tobacco cigarettes. Proponents of e-cigs argue that the technology is safer than traditional cigarettes and can be used to quit smoking altogether. The scientific community is beginning to see things differently, however. Its consensus: vaping is a scam.

The myth of e-cigarettes as a safe alternative

“The evidence consistently shows that, while some people successfully quit smoking with e-cigarettes, most people using e-cigarettes have their chances of quitting conventional cigarettes reduced by about 30%,” Dr. Stanton Glantz, Professor of Medicine at the University of California, San Francisco’s Center of Tobacco Control Research and Education, told Mic. “The most dangerous thing about e-cigarettes is that they keep people smoking cigarettes.”

Dr. Glantz conceded the possibility of e-cigs as a way to transition from tobacco cigarettes, but argued that the bulk of e-cig users are what are referred to as “dual users” — consumers who smoke both e-cigs and traditional cigarettes.

That notion is backed by a 2012 study published in the American Journal of Public Health, in which researchers found that e-cig utilization was highest among current tobacco cigarette smokers at a rate of 11.4%, compared to 3.4% of the total population surveyed, 2% of former smokers and 0.8% of those who never smoked a traditional cigarette. Furthermore, a study in scientific journal Tobacco Control found that 75% of dual use smokers do not even believe vaping will help them quit cigarettes and “reported planning to quit within the next 6 months less often than adults who smoke cigarettes exclusively.” A substantial 42.3% said they never plan to quit smoking whatsoever.

That continued use means that e-cigarettes will have long-term health effects on users, but it’s still too early to tell exactly what they will be (the first e-cigarette was invented in 2003). Dr. Glantz suggests another 5-10 years are required to conduct definitive research, but his research has led him to develop an understanding of the short-term epidemiological impact, and how it relates to potential long-term risks.

Vaping’s damaging effect on the cardiovascular system

“My current thinking is that e-cigarettes are going to cause less damage than conventional cigarettes in terms of cancer, but they’re probably just as dangerous – if not more – when it comes to heart disease and non-cancer lung disease and asthma,” Glantz said.

According to the Center for Disease Control and Prevention, approximately 610,000 people die of heart disease in the United States every year — that equates to one in every four deaths. In fact, heart disease is the leading cause of death for both men and women in the United States. The spreading popularity of e-cigarettes are likely to increase those numbers.

“One of the main things about smoking that causes heart disease is the ultrafine particles that are delivered through the smoke, which trigger inflammatory processes and damage the cardiovascular system,” Glantz said. “E-cigarettes deliver as much or more ultrafine particles as the ones found in cigarettes. That’s something you can’t get rid of because of the way cigarettes work — you generate an aerosol of ultrafine particles that carry the nicotine down into your lungs where it’s absorbed. You do that by burning the tobacco.

“The way e-cigarettes work is by heating up a liquid solution — propylene, glycol, glycerol, nicotine and flavorants – and that generates the ultrafine particles that go into your lungs,” Glantz continued. “The e-cigarettes that work the best in terms of delivering nicotine generate more and smaller particles than a conventional cigarette, and the smaller these particles are, the more dangerous they are. They have immediate effects on your blood and blood vessels, which we have already been able to measure and quantify.”

“The similarities between e-cigarettes and conventional cigarettes in terms of vascular effects are extremely troubling,” Glantz said, bluntly, as he concluded his explanation.

Vaping’s influence on teenage smoking

Perhaps most troubling aspect is the e-cigarette industry’s hold on adolescents. A July 2016 study published by the American Academy of Pediatrics examined prevalence rates in Southern California and concluded that “the high prevalence of combined e-cigarette or cigarette use in 2014, compared with historical Southern California smoking prevalence, suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products.”

Dr. Glantz partially attributes this phenomenon to marketing techniques utilized by the vaping industry, as well as a plethora of enticing “flavors” which attract younger users. This is highly irresponsible because, even if these teenagers aren’t converting to tobacco cigarettes, “Nicotine is still really bad for the developing brain,” according to Glantz.

Between early use among adolescents and adults’ insistence on dual use smoking, e-cigarettes are bound to have long-term effects — both physiologically and culturally. What exactly they will be cannot yet be definitively quantified, but one thing’s for sure: they won’t be good.