Clear The Air News Tobacco Blog Rotating Header Image

February 7th, 2017:

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:

“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”


Competing interests: No competing interests

Study: Toxic Metals Found in ECigarette Liquids


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

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.




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?