E-cigarettes & Danger from Tuberculosis.

After reading the following in The Cape Breton Post, I decided to write to the author of the article. The following is, first, the article, then my letter to him, and then the response.

Government must better regulate newfangled e-cigarettes
Jim Guy. Published on January 01, 2014

‘E-cigarettes may not be as helpful as their makers claim them to be’

‘Tis the season to quit cold turkey, as well as the season to quit cigarettes cold turkey.

For those committed to quitting cigarettes, there are many products out there to help them — such as the patch and nicotine gum — and lots of counselling and support options.

Some products are helpful and effective, but others need to be looked at more carefully as to what their real purpose is, how they are being marketed and what age groups they are targeting. One of the products that should concern us, as well as our governments, is electronic cigarettes, better known as e-cigarettes. They are currently flooding the markets here in North America and in Europe.

E-cigarettes look and feel like their nicotine counterparts. They are advertised as nicotine-free or containing nicotine in amounts deemed non-addictive.

The growing presence of e-cigarettes in the marketplace may require more government regulation, knowing what we know about the consequences of addiction, both to tobacco and to the behaviours associated with smoking. Governments place no warnings on e-cigarette packages and very little is regulated with respect to advertising the product.

While they are advertised as aids to help people quit smoking, e-cigarettes may in fact be a gateway risk to tobacco. They provide a positive social experience for mimicking the act of smoking.

Holding an e-cigarette, “vaping” it (inhaling its vapours) and being seen with it by friends is portrayed as a cool alternative to smoking — especially attractive to teenagers and young adults. But e-cigarettes can introduce young people to smoking and keep smokers close to their habit.

They have appealing brand names: Blu, NJOY, eRoll and Dune, Vapor Couture and Vapor Vamps.

Elegant pink and purple packaging with curlicue fonts appeal to young women. Some provide the taste of candy or fruit, which can also target teenagers. Young smokers exposed to nicotine in e-cigarettes can develop an addiction that could entice them to take up conventional cigarettes. E-cigarettes that are nicotine-free are sold over the counter and in Canada are exempt from age restrictions.

They are also promoted by celebs who act as spokespeople for these products. Jenny McCarthy, Kate Moss, Sienna Miller and Leonardo DiCaprio are seen holding e-cigarettes.

It is noteworthy that more and more tobacco companies are getting into the e-cigarette market. They certainly don’t seem offended by the idea that e-cigarettes are supposedly a tool to help people quit.

E-cigarettes are also a vehicle to enable smokers to continue smoking in places where cigarettes are banned.

Almost all print advertising of tobacco products is banned in Canada, except in publications that target an adult readership of more than 85 per cent.

Now most of the e-cigarettes sold here are made in China, where there is very weak government regulation with respect to how they are made. The Canadian government does not know if Chinese workers making cigarettes wear masks. If they aren’t wearing masks, there are increased risks associated with tuberculosis.

Some brands imported here contain small amounts of nicotine, even though they are portrayed as nicotine-free. It is illegal to buy e-cigarettes containing nicotine, but even minors can buy them online without proof of age.

Canadians have been quite successful in quitting cigarettes since the 1960s, when governments began to alert smokers to the related health hazards.

Now, only about 17 per cent of Canadians smoke, with most smokers having quit without the use of e-cigarettes. These products have not contributed to the large numbers of people who have already successfully quit.

And there is convincing evidence that e-cigarettes may not be as helpful as their makers claim them to be. Governments need to be more regulative on these imitation products. What the public does not need is an entertaining substitute for tobacco that may actually encourage people to take up or continue smoking.

Jim Guy, PhD, is professor emeritus of political science and international law at Cape Breton University.

My response and following correspondence.

Jim Guy

I read with interest your article; ‘Government must better regulate new-fangled e cigarettes,’ in The Cape Breton Post. I am sure you will agree that a product which has the potential to save millions of lives worldwide requires close attention and that any comments made regarding this product should be as accurate as possible. For this purpose, I wish to consider a number of issues that you raise through your writing.

You say; “For those committed to quitting cigarettes, there are many products out there to help them — such as the patch and nicotine gum — and lots of counselling and support options.” On the face of it, this appears to be entirely reasonable. However it contains a connotation that quitting smoking, although not easy, can be achieved and assisted through help which is readily available. There is nothing untruthful in what you say – in fact, it is what you did NOT say that I find a matter for concern. What you expressly failed to point out was the ineffectiveness of the above mentioned products. Yes, there are certainly a great many of them, and they are easy to obtain, and yes, counselling and support can be given, lots of it – and lots of it is needed. You see, you did not point out the failure rate of these products. There are a number of estimates given by different researchers and these vary widely. A great deal of the research has been funded by the pharmaceutical industry[i] and, no surprise; the figures tend to be rather inflated. In those instances, exaggerated claims of 10% / 12% (after 12 months abstinence) success are presented. This, you must agree, is a pathetic figure, but I am afraid the true number is much worse than simply pathetic. For goodness sake! 25% would still be awful. Would you go out and purchase anything which promised, let us invert the figure, a 75% chance of not working? You would have to be nuts! NRT increases the chance of success in smoking cessation by approximately 7%, and this is in people who want to quit.[ii] As for e cigarettes, these are used by people who wish to stop smoking AND by many others who wish to continue the habit, but without the dangers inherent with cigarettes. There are statistics available which demonstrate their effectiveness. Here we are not talking about a miserable 7% success rate. Here we are looking at 38% of those who wished to stop and a remarkable 29% of those who did NOT wish to stop.[iii]

However, for yourself, for any audience, the presentation of these figures is not necessary – You see, your article is far better testimony to the effectiveness of the e cigarette. Why would you, and so many others, repeat over and over again, that e cigarettes are this, are that, are the other? Why is so much effort being spent denigrating the e cigarette? The answer is a simple one, they work. And, as further proof, e cigarettes are overtaking the sale of NRT products; in fact in many places they have already done so. Never mind NRT, e cigarette sales are predicted to overtake tobacco cigarette sales very soon. So much for your comment where you say,“…and there is convincing evidence that e-cigarettes may not be as helpful as their makers claim them to be.” One question here, if the evidence is so convincing, why did you not present it? There is no evidence to that effect, and you know it!

You say: “Now, only about 17 per cent of Canadians smoke, with most smokers having quit without the use of e-cigarettes. These products have not contributed to the large numbers of people who have already successfully quit…….. The growing presence of e-cigarettes in the marketplace may require more government regulation, knowing what we know about the consequences of addiction, both to tobacco and to the behaviors associated with smoking.” Aspects of these two comments appear to cancel each other out. You state that the number of smokers in Canada is 17%. Fine!  You say that e cigarettes had little part to play in achieving this success. THEN, you argue that e cigarettes are a ‘growing presence.’ So, who is actually using this ‘growing’ number of e cigarettes? According to you, it is not those who have quit. Non-smokers do not use e cigarettes, and smokers (obviously) do not use e cigarettes, so tell me exactly, who does?

You say, “Governments place no warnings on e-cigarette packages.” I would be interested to know exactly what this warning would be. Considering that e cigarettes are more than 99% safer than tobacco cigarettes. Ah! I know! How about: “WARNING! The daily intake of nitrosamines by using an e-cigarette is 76 to 142-fold lower compared to one tobacco cigarette”[iv] I am afraid the danger in e cigarette use is negligible – you are in as much danger as you would be if……. HOLD IT…HOLD IT… STOP THE BUS… I KNOW! “WARNING! You may get TUBERCULOSIS from this product.”

Oh dear! Your comment, “Now most of the e-cigarettes sold here are made in China, where there is very weak government regulation with respect to how they are made. The Canadian government does not know if Chinese workers making cigarettes wear masks. If they aren’t wearing masks, there are increased risks associated with tuberculosis.” Is just about one of the most ridiculous I have ever come across. Pure, unsubstantiated scaremongering and an indication of the lack of care you have taken with your research.

There is a beautiful irony here. Some ‘idiot’ has reasoned that if there is tuberculosis in China, there must be a risk involved. You have decided to parrot this. And here is the irony! You see, the main ingredient in e juice is propylene glycol. Propylene glycol is a disinfectant. And, do you know what? It is used extensively in the war against… yes… come on now… Think! That’s it… Tuberculosis! And, if you do not believe me, go to the links provided in the footnotes[v]. And there is a double irony here, and I have only just come across it. (Thanks to you.) It is, “The engineering challenge associated with creating a sufficient concentration of the glycol vapours in the air have not to date been sufficiently addressed.[vi]” Maybe not, but perhaps this problem is not as problematic as it once was. I say this tongue in cheek.

How could anyone, even a professor emeritus of political science and international law, get it so very badly wrong?

You spend a great deal of time in your article arguing that e cigarettes are a ‘gateway’ to cigarette smoking. This, at least, sounds reasonable, but, it neither passes the common sense test, nor is it supported by any evidence anywhere. First of all, may I point you in the direction of ASHUK who have long argued that e cigarettes need regulating? According to ASH e cigarettes are NOT acting to encourage either young people (who do not smoke) or adults, (who do not smoke). “Among children regular use of e-cigarettes is extremely rare. Children who had heard of e-cigarettes were asked about their use and knowledge of them. What little use that is reported is confined almost entirely to children who currently smoke or used to smoke … Among adults electronic cigarette current use … remains at 0% among those who have never smoked. [vii]“ And there is more, much, much more. The ASH findings are not the only ones. One of the most widely quoted (and misrepresented) studies on the subject is the CDC study. That it is misrepresented can be seen where the CDC director announced on state-wide US television that, (Taken from a transcript) “…if you start with e-cigarettes, there’s a real likelihood that you’ll become nicotine addicted, we found in CDC studies that 20 percent of middle school kids who used some — who used e-cigarettes only used e-cigarettes, what that suggests to me, it’s not proof, but what it suggests to me is that some kids are starting with e-cigarettes, getting hooked on nicotine and going on regular cigarettes and that’s a real problem because those kids may well be getting condemned to a lifetime of nicotine addiction.[viii]” This statement was questioned by Michael Siegel[ix] and he elicited a response from the CDC which indicated that this was of no import, but that is the whole point. It is of vital importance. The CDC is putting out disinformation in much the same way as you have: Bald statements that e cigarettes are a gateway to smoking then failing to provide any evidence whatsoever. To add to the ASH survey, read, “First Study to Examine E-Cigarette Gateway Hypothesis Can Find Only One Non-smoker Who Initiated with E-Cigs and Went on to Smoke.[x]”

I mentioned earlier that the gateway effect does not pass the common sense test. If people, young or old, see others using an e cigarette, and they know what an e cigarette is, the very first thing to cross anyone’s mind is, ‘that is an e cigarette: Why not a real one?’ And, if they are normal, they answer the question for themselves. ‘It is because they do not want to smoke ‘real’ cigarettes. They are ‘hooked’ and wish to avoid the dangers of smoking.’ So much for the gateway effect!

Finally, I wish to address, “It is noteworthy that more and more tobacco companies are getting into the e-cigarette market. They certainly don’t seem offended by the idea that e-cigarettes are supposedly a tool to help people quit.” This, to me, is the most important aspect of the debate. “They do not seem offended…” You bet your bottom dollar they are not offended. The tobacco companies are in a no lose situation here. The worst case scenario for the tobacco companies is that there is no regulation. In this instance they will enter (have already done so) the e cigarette market and cut their losses by selling e cigarettes. Ultimately they will gain a significant proportion of the market, but not the largest share – this will be retained by the makers of 2nd and 3rd generation personal vaporisers. However Governments will lose out on revenues and the pharmaceutical industry will be hit for six…. So that will not do. The second option is heavy regulation, perhaps the kind envisaged by the European Union. This will see the small e cigarette producers go out of business. All 2nd and 3rd generation vaporisers will be banned with only the ‘cigalike’ type of e cigarette being produced. It is the cigalike that the tobacco manufacturers are concentrating on and if regulations demand, it is only the tobacco companies who will be able to meet the costs of regulation…. What happens next?

The first case would be that e cigarettes continue to be used. This would not suit the pharmaceutical industry in the slightest. Now pharma are big players as well as tobacco. They are and will continue to press for regulations which diminish the effectiveness of the e cigarette to the same miserable levels as present NRT products. Having succeeded there, the future is fine. People will continue to start smoking. (Despite your earlier claims, smoking cessation rates have tailed off in recent years, in Canada and elsewhere. This is particularly true if you take e cigarettes out of the equation.) With a resumption of old habits and no effective e cigarette, people will smoke, use NRT / ineffective e cigarette, go back to smoking, try to quit again using NRT / ineffective e cigarette, go back to smoking, on and on and on, until they fall ill from smoking, in which instance the pharmaceutical industry make a last ‘killing’ with drugs designed to relieve the patient in his final days.

Added to this: the Governments collect their revenues; the charities continue to pay themselves quite well, and ‘do good;’ researchers research; analysts analyse; doctors doctor, and universities, not yours I hope, God forbid, will receive huge grants to look into the problem and pay people to write silly, misleading articles in magazines and newspapers.

So yes! Advocate stringent restrictions. Demonise the e cigarette, but for goodness sake do not say it is for the good of my health.

[i] http://www.thecochranelibrary.com/userfiles/ccoch/file/World        No Tobacco Day/CD000146.pdf Page 159. [ii]http://www.patient.co.uk/health/nicotine-replacement-therapy [iii]http://www.psychiatrictimes.com/addiction/role-electronic-cigarettes-tobacco-dependence-treatment [iv] http://www.ecigarette-research.com/web/index.php/research/125-mispresenting-results-and-missing [v] http://en.wikipedia.org/wiki/Disinfectant http://www.dborthodontics.co.uk/pdfs/rensa-disinfectant-products.pdf http://www.oie.int/doc/ged/d8970.pdf http://www.dborthodontics.co.uk/pdfs/rensa-disinfectant-products.pdf [vi] http://en.wikipedia.org/wiki/Disinfectant [vii] http://www.ash.org.uk/files/documents/ASH_891.pdf [viii] http://tobaccoanalysis.blogspot.co.uk/2013/12/according-to-cdc-fact-that-some.html [ix] Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 25 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program. [x] http://tobaccoanalysis.blogspot.co.uk/2013/10/first-study-to-examine-e-cigarette.html

The Reply

He replied…… Robert. I want to thank you sincerely for this well thought-out response. It deserves my attention as soon as possible. Hopefully later today I can spend some time replying to you. Thank you.Jim And later……..

Later

Robert.. I very much appreciate the time you took to challenge some of the statements and premises in my recent column. I came to the topic quite biased, (A good reason is given but I have deleted it because it is of a private nature.). So I am personally and ideologically opposed to any untested product that portrays itself as a solution to smoking by mimicking both the physical and psychological addictions to tobacco. But also doing it to vulnerable populations.The topic is complex and challenges any opinion that must be presented in 650 words. Our columns must be written within that space limitation. The points you make are persuasive and worth every consideration by me as contrary opinion. The position I take is that we need to look closer at any new solutions that may be colonized by the tobacco industry. As a political scientist I have learned to respect the very controversial nature of journalism and personal opinion. Thanks,Jim