Response to the article, Vaping: The battle for acceptance is rising in The Toronto Star. Wed, April23rd, 2014

 

I read your article, “Vaping: The battle for acceptance is rising^[i],” with interest. I think that you have genuinely tried to give a fair and balanced view in your report; however, there are some aspects which I feel need addressing. I am taking the time to write this as the issue is so important to me personally, and because regulation will literally mean life or death for millions of smokers’ world-wide.  What follows is a response to the article which I have posted on social media. One reason for doing this is the restriction on word length in the comment section of your publication – however, I have found your e mail address, and in fairness, include a copy to you.

 

There are some comments in the article which are not fully investigated. For example, doubts about the effectiveness of e-cigarettes are raised. You quote Health Canada who state, “…But citing nicotine’s addictiveness — and a lack of evidence that smoking-cessation benefits outweigh potential risks — Health Canada has refused to approve the sale or import of devices or liquid refills containing nicotine.” And elsewhere in the article we read, ““…there is no conclusive evidence that vaping is an effective smoking cessation therapy,” and, “… presumed health improvements over burned tobacco products.”

 

These comments are hardly tested in the article. If they had been the article would have contained much more by way of responses with reference to authoritative sources…

 

So what are the risks of cigarette smoking? I think it is common knowledge that cigarettes are very dangerous indeed. The CDC states in its factsheet, Health Effects of Cigarette Smoking^[ii] “Cigarette smoking causes more than 480,000 deaths each year in the United States. This is about one in five deaths.” It goes on, “More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history” And more, as if more is needed, whole sections devoted to cardiovascular disease, lung cancer, and respiratory disease, and on and on….

 

So what are the risks involved with e-cigarette use? Well, they are not quite known yet! What? That is right, they are not quite known yet. There may be some undefined, long term effect, but in actual fact, one is not really expected. And to think this is what the ‘experts’ rely on to assert that e-cigarettes are not ‘safe.’ Talk about grasping at straws! The fact that a dangerous outcome is not expected is due to the knowledge that we already know about what is in an e-cigarette, that the vapours emitted and inhaled do not contain threatening levels of any toxicants.

 

A large number of reliable, scientific studies are available to back up this point of view; I will shortly refer to one or two of them.

 

Scare stories abound about this health effect and that. Always, they have proved to be without foundation. Let us look at some of them.

 

 

E-cigarettes Not Safe: Exposure to Nicotine from Smoking Increases Risk of Heart Disease^[iii]

The article goes on to argue that “…prolonged exposure to nicotine, either from a real cigarette or the battery operated device can damage the heart.” Oh dear! But wait! This report is based on research done by Chi Min Hai of Brown University, US, and reported extensively.^[iv] What we have here is a laboratory experiment which has no application in the real world. Yet we already know that nicotine use does not cause a measurable risk for heart disease.  We have extensive epidemiology and other evidence about smokeless tobacco use that has failed to show measurable risk. Here, It must be emphasised that epidemiology far outranks toxicology in its accuracy as predictor in human outcomes. I would also add a comment made by Carl V Phillips on this very experiment. Talking about the logic of the conclusions drawn from the experiment, he attributes the following line of thinking to the authors, “We have discovered why exposure E causes disease D, though we already know E apparently does not actually cause D.  Therefore, this E causes this D.”^[v]  

 

Not that much is actually known about nicotine, but, what we now know is very, very different to what we have for a long, long time, assumed. The truth of the matter is that research on humans was last done when Queen Victoria was still attractive. There is now overwhelming evidence that 0.5g of oral nicotine is required to kill an adult.^[vi] How very different to the scare stories that abound in the media regarding the dangers of this substance. How different to even the official statistics which were adopted on the back of a very dubious experiment conducted in 1850, and, keep in mind, this is concentrated nicotine we are talking about – vapers use liquids which, even at the higher end, contain only 24mg / ml. Evidence and links for all of this can be obtained via the footnote link. (The full PDF file with its links can be downloaded.)

 

But even more inaccuracies abound.

 

Take for example the following. “Nicotine addiction is also bad for the body. It raises the blood sugar of the body because insulin has been produced more. It can also make you jittery as it stimulates the system. This can lead to heart attacks, damage to tissue of the mouth and it can also lead to cancer as well as emphysema and stroke. There are also issues with high blood pressure, clogging of the arteries and other things such as wrinkles, reducing stamina, leading to breathing problems and dulls the taste and smell organs. So you can see why it is bad for you.”^[vii]

 

This is typical of the sensational, headline-grabbing rhetoric that is used to demonise e cigarettes. It is utter rubbish, but it captures the imagination of the general public and assists with the maintenance of the critical attitude needed in order to regulate e cigarettes out of existence, and this, the critics hope, with the public’s blessing.

 

“It is bad for you.” Is it? How do these people know? The truth is, they do not. This may be difficult for you to accept because, for years and years it has been conventional wisdom. In actual fact, it is not the case at all. Keeping in mind that to experiment on humans with nicotine is unethical, no evidence can be gleaned from that, all other data has been gained from results of nicotine intake via tobacco smoke. And this is important. Now read the following. “Tobacco smoking has been reported to be associated with increased risk of cardiovascular disease and cancer, particularly of the lungs. In spite of extensive research on the health effects of tobacco smoking, the substances in tobacco smoke exerting these negative health effects are not completely known. Nicotine is the substance giving the subjective pleasure of smoking as well as inducing addiction. For the first time we report the effect on the rat of long-term (two years) inhalation of nicotine. The rats breathed in a chamber with nicotine at a concentration giving twice the plasma concentration found in heavy smokers. Nicotine was given for 20 h a day, five days a week during a two-year period. We could not find any increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. Throughout the study, however, the body weight of the nicotine exposed rats was reduced as compared with controls. In conclusion, our study does not indicate any harmful effect of nicotine when given in its pure form by inhalation.”^[viii] Perhaps you might like to read that again! This is absolutely typical of the findings of the new research being conducted into the effects of nicotine. All that can be said is that the addictive qualities of nicotine are magnified through its combination with other chemicals in tobacco smoke – indeed ALL of the harmful effects observed through smoking are absent in the use of the e-cigarette.

 

The dangers of e-cigarette use have not been established. Critics have concentrated on nicotine because the other three ingredients are already acknowledged not to present any threat. There is no burning taking place and so, again, this confounds the critics of the e-cigarette and harm reduction as these critics are well aware of the dangers presented by burning and smoke. So, they have concentrated on nicotine. So they find themselves confounded once again. However, aided and abetted by the bulk of the media, they have people’s pre-conceptions with regard to ‘nicotine,’ and people’s prejudice with regard to smoking to work with. It looks like smoke does it not? “Oh my God, it’s nicotine!” (Your next headline perhaps?) This is what Action on Smoking and Health had to say, “(In)…switching from tobacco to electronic cigarettes nicotine exposure was unchanged while exposure to selected toxicants was substantially reduced.

 

 There is little evidence of harmful effects from repeated exposure to propylene glycol, the Chemical in which nicotine is suspended. One study concludes that electronic cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects.”^[ix]

 

“Oh my God its nicotine – it looks like smoking!” This leads on to the next strand in the argument to bring an end to e-cigarette use – “think about the young people – it is a gateway to smoking.” As plausible as this argument seems at a superficial level, it actually defies common sense. To date, all available evidence points to the fact that e-cigarette use is confined to people who smoke or used to smoke. Non-smokers account for only a tiny, tiny proportion of those who use e-cigarettes. Added to this –the common sense bit- if a non-smoker does try an e-cigarette and likes it, why on earth would he / she move on to a disgusting and dangerous conventional cigarette? No one I know of has managed to answer that.

 

Not that it needs answering because non-smokers are not being attracted to e-cigarettes. “E-cigarettes are used by both smokers and ex-smokers, but there is little evidence of use by those who have never smoked or by children.”^[x] Study after study backs this up – they make a complete nonsense of the argument that the young are being attracted to e-cigarettes and that they will act as a gateway to regular smoking. “”It didn’t seem as though it (e-cigarette) really proved to be a gateway to anything,” said Wagener, who presented his findings at a meeting of the American Association for Cancer Research, in National Harbor, Md.^[xi] (Theodore Wagener, Ph.D., assistant professor, general and community pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City) This is what The Royal College of Physicians has to say on the topic, “…the worry is that using e-cigarettes will either lead to nicotine addiction and sustained use or act as a gateway to smoking. Again, no evidence suggests that either of these outcomes is occurring to an appreciable degree. Some non-smoking young people are trying e-cigarettes, but in very small numbers, and any gateway risk should be assessed in the context that nearly one in five 16–19 year olds in Britain has already become a regular tobacco smoker. Given the small risks of exclusive e-cigarette use, progression to tobacco use will thus be a problem only if it adds to the total number taking up tobacco smoking. In practice, new users of e-cigarettes are probably most likely to come from the same population of young people who currently experiment with tobacco. The available data suggest that, in any case, young non-smokers are not keen on e-cigarettes, and data from Poland suggest that most of the interest in young age groups arises, as in adults, from those who already smoke tobacco.”^[xii]

 

“From those who already smoke tobacco…” So why are present smokers flocking to the e-cigarette. Is it because there is no benefit? Are the falls in tobacco sales and the corresponding rise in e-cigarette use a coincidence?

 

Now, at this point I will ask you, why does the e-cigarette has so many critics? One reason is the sentiment and prejudice built up over the years by the anti-tobacco lobby. Added to this, a whole industry has been created to fight the ‘scourge’ of tobacco and smoking:  Jobs depend on it; reputations are staked on it; whole economies cash in on it. And the poor old e-cigarette comes along and it looks like smoking. And that is good enough excuse for those whose jobs depend on the continuance of cigarette smoking: it is good enough for those whose reputations depend on the continuance of cigarette smoking; it is good enough for governments who rely on revenues from cigarette smoking, and most of all, it is good enough for the massive pharmaceutical industry who stand to lose billions, not just from loss of sales from cessation products, but from the huge market in drugs to treat cancer, heart disease, COPD and the myriad of other ailments caused by smoking. The e-cigarette is the most disruptive new technical innovation of the century, something which has the potential to surpass the discovery of penicillin in its ability to save lives – and the men in work, those who guard their reputations, and those who ultimately control us need to stop it.

 

Are you going to continue to assist them?

 

As for the benefits? I will leave with a quotation, again from The Royal College of Physicians.

 

 

“Despite the controversies, it is clear that e-cigarettes are far less hazardous than is tobacco. With more than a million UK smokers using them to help to cut down or quit smoking, they are proving to be valuable harm reduction and cessation products and could make a substantial contribution to reducing the burden of death, disability and poverty currently caused by tobacco smoking. Health professionals should embrace this potential by encouraging smokers, particularly those disinclined to use licensed nicotine replacement therapies, to try them, and, when possible, to do so in conjunction with existing NHS smoking cessation and harm reduction support. E-cigarettes will save lives, and we should support their use.”^[xiii]

 

^[i] http://www.thestar.com/news/insight/2014/04/20/vaping_the_battle_for_acceptance_is_rising.html

^[ii] http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

^[iii] http://www.ibtimes.co.in/articles/530772/20131217/electronic-cigarettes-smoking-nicotine-exposure-heart-disease.htm

^[iv] http://edition.cnn.com/2013/12/16/health/nicotine-e-cigarettes/

^[v] http://antithrlies.com/2013/12/17/chi-ming-hai-is-a-liar-nicotine-does-not-cause-measurable-risk-of-cvd/

^[vi] http://link.springer.com/article/10.1007%2Fs00204-013-1127-0#page-1

^[vii] http://smokingaddictionhelp.net/nicotine-addiction-is-dangerous-for-your-body.php

^[viii] http://www.ncbi.nlm.nih.gov/pubmed/8614291

^[ix] http://ash.org.uk/files/documents/ASH_715.pdf

^[x] http://ash.org.uk/files/documents/ASH_715.pdf

^[xi] http://consumer.healthday.com/cancer-information-5/tobacco-and-kids-health-news-662/e-cigarettes-may-not-be-gateway-to-smoking-study-681597.html

^[xii] http://www.rcplondon.ac.uk/commentary/what-you-need-know-about-electronic-cigarettes

^[xiii] http://www.rcplondon.ac.uk/commentary/what-you-need-know-about-electronic-cigarettes