Is it Safe to Say, ‘Safe?’

 

It would appear that there is no such thing as ‘safe.’ If we are to believe what we are told, particularly with reference to Harm Reduction, there is no such thing exists as safe. We are told this repeatedly. We are warned against using this ‘dangerous’ term – that it leads us into an area that can be exploited by our opponents – I beg to differ.

 

I suppose, at a superficial level, nothing actually is safe: the water we drink; the air we breathe; the paste we brush our teeth with; the cat we love, who purrs contented on the sofa – they all bring with them that tiny element of risk: They may bring, toxins, allergens, teeth and claws.

 

So there is no such thing as safe?

 

Yes there is.

 

But first, with regard to Harm Reduction and electronic cigarettes, why is the word, ‘safe,’ considered by so many advocates to be, ‘dangerous?’ And why, I will also ask, do the opponents of Harm Reduction also want so very much to prevent us from saying that Harm Reduction safe? Odd, is it not – vapers do not want to say the word because of the risks involved in its use, and opponents of Harm Reduction do not want the vapers to employ the word either?

 

In their flight from using, ‘safe,’ advocates of Harm Reduction have turned to, ‘safer than tobacco cigarettes,’ in their discussions on the topic. They are intimidated by the, ‘nothing is safe’ argument. They feel that bodies, such as Tobacco Control, will jump on them: heap criticism on them; use this weakness to exploit the vague, unsubstantiated fears that Tobacco Control are trying to nurture in the ‘uninformed.’ As soon as , ‘safe’ is used to describe the electronic cigarette, many advocates and activists throw their hands up in horror and scream warnings that this will be exploited to the detriment of Harm Reduction.

 

What a tight little corner the advocates of Harm Reduction have been backed into. Safer than cigarettes…  it is correct, Harm Reduction is safer than smoking, but look  at what Harm Reduction is being compared to – cigarettes, one of the most dangerous killers anywhere. Walking down a quiet country road blindfolded and deafened is safer than walking down a motorway during the rush hour, blindfolded and deafened, but, of course neither are safe. To use the, safer than, terminology, I am afraid, does very little to assure the listener as to the relative safety of Harm Reduction. To add, ‘by orders of magnitude,’ might have meaning to scientists, but has little effect on the majority. They think, ‘safer than cigarettes… but that means they might still be dangerous.’

 

And Tobacco Control now sit back rubbing their hands with glee.

 

But allow me to assert, Harm Reduction and electronic cigarettes are safe.

 

You see, ‘safe,’ is a relative term. It is very rarely used as an absolute. The meanings of words depend on their use, and this is why, over time, language changes: To demonstrate that ‘safe’ is relative, try different comparisons and look at the way the connotations change. As I have already stated, when compared to tobacco smoking, ‘safe’ can end up not feeling very safe at all. At the other end of the scale, let us look at, lollipops. Now lollipops have killed, in one year alone, in the US, a hundred children. Are lollypops safe? What about peanut butter? No! Surely not…Eh! What about a hot dog?^[i] So armed with the knowledge that even these ‘safe’ items present risk, if you are told that electronic cigarettes are safer than lollipops, are safer than hot dogs, are safer than your morning cup of coffee, you get a very different perspective than you do when you are told that electronic cigarettes are safer than smoking.  Oh, and electronic cigarettes are actually safer than breathing in the morning air (in huge areas of the developed world), they are safer than consuming drinking water, safer than brushing our teeth, from using mouthwash, and they are safer than the deceits being forced upon advocates of Harm Reduction through the outrageous demands and accusations  spewing from Tobacco Control.

 

However, the preamble above is simply lightweight preparation for the main point.

 

The linguistic argument that ‘safe’ is relative and not absolute is interesting and correct enough, but ‘safe’ is also often legally defined and accepted as relative: ‘Safe’ comes in scales, relative to dangers. Interestingly, one of the main areas where we find definitions of ‘safe’ is in Health and Safety, and on environmental issues – we are on home ground.

 

 

‘Safe’ is used; in legal terms with regard to atmosphere, and what we breathe, and that there are legal safe limits for different environments. That cannot be if there is no such thing as ‘safe.’… It follows that if e cigarettes’ toxicity and emissions are below these levels, they too must be, in legal terms, ‘safe.’ (And if it is possible to set levels for medical permissions and use, it must therefore be possible to set those same levels whether it is for medicalization or not)

 

“In the UK, under the CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH REGULATIONS 1999 (COSHH regulations) the Health and Safety Executive (HSE) sets occupational exposure limits (OELs) and publishes these in a document entitled EH40. These lists have legal status and similar legislation exists elsewhere; COSHH takes into account the European Commission Directive 80/ 1107/EEC. COSHH covers all toxic substance… The best way of controlling a risk is to prevent exposure but if this is not possible, a process may have to be enclosed or ventilation and extraction equipment used or special handling procedures employed. It should be possible for most people to work in a safe environment day after day and HSE publishes Guidance Note EH40 to help employers to control their processes adequately so that workers are not exposed to levels of toxic materials above the recognised safe levels.”^[ii]

 

So ‘safe’ can be equated with controlled risk. A risk can be controlled to a ‘safe’ level.

 

Now, I would suggest reading the wealth of information available on the web regarding the toxicity of electronic cigarettes. A good starting place is, Peering through the mist.^[iii]

 

So there it is, ‘safe.’ It is measurable. It is relative to other risks. It is something that we can and should use. Advocates have made an error by avoiding the use of the word, ‘safe’ in that they (and we) have been shoehorned into using a form of terminology that suits Tobacco Control just fine and dandy. Where we are talking about, ‘safe,’ our audience is thinking about danger.

 

We should be fighting this and repeating over and over again, harm reduction is the ‘SAFE’ alternative to cigarette smoking. And if Tobacco Control wants a fight – give them one.

 

 

 

 

 

^[i] http://www.health.ny.gov/prevention/injury_prevention/choking_prevention_for_children.htm

 

^[ii] http://www.crowcon.com/service-and-support/monitoring-for-toxic-gases-in-areas-where-people-work-and-in-the-general-environment.html

 

 

^[iii] http://www.biomedcentral.com/1471-2458/14/18

 

 

Fire in the Madhouse

Existentialists challenge you to buck conventional wisdom – I am not sure about, ‘conventional,’ but Tobacco Control certainly bucks wisdom. However, there is an area of existentialism which asserts that one is anything that an individual thinks she/he is. I think that this is the principle that this collection of organisations are following. Take for example…

Nicotine is deadly and very, very bad, unless, it is, ‘my’ nicotine.

Up until very recently, nicotine was thought to be highly addictive, a dangerous poison, and some (still) argue that it is carcinogenic: This, I suppose, is understandable given its close association and cofuscation with tobacco smoking, but, for the most part, it is accepted that nicotine does not cause cancer, is not so highly addictive as once thought, and, as far as the levels contained in e cigarette liquids are concerned, is  no more toxic than dishwashing liquid (and that is only the higher concentrations).  There are studies which do indicate a theoretical connection between nicotine and cancer, but they are far from conclusive.  For those of you who wish to read more about nicotine, smoking and harm click here.

Moving back a couple of years: when e cigarettes started to become popular; when the pharmaceutical giants began to feel threatened; when governments realised the impact these infernal newcomers would have on their revenues, the Tobacco Control machine ground into action. Using the funding from Pharma and governments and using their bought politicians – and bought / deceived doctors and scientists, the nicotine scare was promoted.  (For an indication of the power and influence of the pharmaceutical industry within the UK Government see, here,)  (For a general outline of the pharmaceutical industry and its methods and influence, see here. [My own blog I am afraid])  Add to this Tobacco Control links to the media and nicotine was further demonised.  For example, “Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes,” was the headline in the New York Times of March 23, 2014.  The paper intimates that e cigarette liquid spilt onto the skin was life-threatening.  Typical of the scare stories and dramatic headlines was, “A New Warning about E-Cigarettes and Heart Attack Risk.”   This headline was generated after Chi-Ming Hai of Brown University unveiled his findings at the American Society for Cell Biology’s annual meeting in New Orleans (2013) after publication in the journal, Vascular Pharmacology.  Headlines from single studies appear to be replicated on a huge scale, from serious medical publications all the way down the line to the tabloids. The aforementioned study generated, “ It’s Not The Smoke, It’s The Nicotine: E-Cigarettes May Damage Arteries.”  And moving into 2014, still the story persists with the headline, “E-Cigarettes: Tobacco-Free, But Your Heart May Still Be at Risk: Electronic devices still carry the dangers of nicotine.” The same study was being presented as evidence:  The repetition of headlines all over the world was not slowed by the counter arguments of some of the world’s leading experts on the topic – was not slowed by the irrefutable evidence provided over many years of snus use in Sweden, but I am afraid that the facts do not seem to matter when weighed against the power of the media and the ability of industrial giants to fund both the ‘research’ and then the subsequent, massive media campaigns. Carl V Phillips sums things up very succinctly, here.

 

But the debate over the issue of potential risk by nicotine is secondary: the objective here is to demonstrate the hypocrisy ingrained in the pharmaceutical industries’ campaign against e cigarettes, via, of course, Tobacco Control.

Who or what is Tobacco Control?

Following on from the work of Richard Doll who publicised the causal link between smoking and lung cancer in 1952, there were moves to curtail smoking but this was not wholly satisfactory.  This was followed by the creation of the World Health Organization Framework Convention on Tobacco Control or FCTC for short. This is a treaty where nations have signed up to follow certain protocols. For an overview, click here. The FCTC control and encourage most of the myriad of research, educational, publicity, medical and governmental activities to do with the ‘intended demise’ of tobacco products. This, in short, means that any organisation whose stated aims are ‘seeing an end to the use of tobacco products,’ particularly if they are influenced and / or funded by government, or, are influenced and/ or are funded by organisations who are influenced and / or funded by government.  Complicated, is it not? But it means that just about any organisation that stands in opposition to tobacco use is part of Tobacco Control. But where does this leave the pharmaceutical industry? Never forget the pharmaceutical Industry: never leave them out of the equation.

National governments provide funding, but there is a great deal more… in fact, so complex it cannot be addressed by me effectively, however, if you wish to examine the money trail, click here. Enough said that the pharmaceutical industry pumps billions upon billions into Tobacco Control. In fact, I would go as far as to say that Tobacco Control groups ARE the pharmaceutical companies: Well, maybe not, but pharma certainly appears to be the puppet master. But here is the odd one – the tobacco companies also support Tobacco Control. Here.  And, back to the pharmaceutical industry, they support cigarette smoking – that’s right…. Pfizer had the following to say about its relationship with Heartland, “Our company and its stakeholders derive significant benefits from our involvement with these organizations, which help advance our business objectives related to healthcare policy.”  You can read about heartland’s stance on smoking here. It is a right old mess, but I will leave you to work out for yourself why pharmaceutical companies support both anti-smoking and pro-smoking organisations.  Now back to nicotine.

The American cancer Society had this to say about nicotine in e cigarettes, “We do know that electronic cigarettes are designed to deliver nicotine, and nicotine is addictive. This strongly suggests that e-cigarette use will lead to dependence, unless the user weans him or herself from them. Fair enough comment, I suppose, if, nicotine is ‘highly addictive.’ But look at what the same article goes on to say, “There are proven methods available to help people quit, including pure forms of inhalable nicotine as well as nasal sprays, gums, and patches.”  So, it would seem that e cigarette nicotine is addictive, BUT NRT nicotine is not. Warning! The article also contains the usual rubbish, i.e. Anti-freeze found in e cigarette:  It quotes the CDC study on youth usage – That is the one where the headline was a huge increase of young people using e cigarettes but forgot to mention a huge corresponding decrease in cigarette smoking. Well, they did mention it – a year after the headlines. Similarly we read about youth e cig usage in 2014, here. The CDC press release can be found, here.  I have added this to demonstrate how unreliable much of the criticisms about e cigarettes are.  The same applies to warnings about nicotine’s effect on the lungs and the heart. How is it possible for warnings to be issued about nicotine in e cigarettes on one hand, and claims of safety on the other when applied to their own products?  According to the opponents of e cigarettes – sorry – the pharmaceutical industry via the opponents of e cigarettes, nicotine is very, very bad, unless it is their nicotine.

Propylene glycol is harmful and very, very bad, unless it is, ‘my’ propylene glycol

This substance is used in many products and is generally considered to be safe. However regular inhalation via e cigarettes is a new phenomenon and opponents of e cigarettes, Tobacco control – sorry – the pharmaceutical industry via Tobacco Control have made it sound absolutely terrifying.  Right from the beginning the organisations and groups under the Tobacco Control umbrella have screamed (and yes, ‘screamed,’ is the operative term) that e cigarette liquid contains anti-freeze. Here they are talking about propylene glycol.  On the 22^nd July, 2009 the FDA issued a warning that e cigarettes contained antifreeze. From that point, to this day, approximately six years later, the story persists. This is despite the truth of the matter having been revealed.  

One of the most outrageous examples of the demonization of propylene glycol was when Chest Journal, the official journal of the American College of Chest Physicians, published a report entitled, “An Unexpected Consequence of Electronic Cigarette Use.”  Here, e cigarette use was blamed for causing lipoid pneumonia. This was totally rubbished as was a second similar report from Spain.

Now, I am not a scientist or doctor, in fact I have only a modest education, yet, if you look closely at the Chest report you will see that the doctors make the ‘schoolboy’ error of thinking glycerol is a lipid (and I would not have known that) but, they fail to find the real cause of the illness.  Now (again) I think I can – I am not saying this because I wish to boast, though I am feeling rather smug. I am using it to point out that the doctors did not just make one glaring mistake, they made two. I am using it to demonstrate how prejudice can blind, even an expert mind, where something can be so very obvious, but is missed.  The Chest article states, right at the beginning….

Any scientists and doctors reading this will see in an instant the potential cause for the woman’s condition – I had to work my way through them.  I wish they had put, ‘albuterol metered dose inhaler,’ at the beginning of the list. Here, on investigation I came across one of the ingredients… oleic acid… a lipid.  So how did these doctors make a silly mistake in classifying glycerol as a lipid and on top of that, fail to see the real cause (if it was such)?

It happened because they were so blinded by their prejudice they failed to see what even a rank novice, worse, someone with no scientific training whatsoever could see. The article ends with the comment that the woman’s condition cleared after withdrawal from e cigarettes, but, would her inhaler not have been withdrawn as well?  It appears to me that the woman’s recovery was down more to good luck than anything else.

Nonetheless, the story hit the headlines

It would therefore seem that medically approved devices with propylene glycol can result in lipoid pneumonia but they are ok,however, e cigarettes which contain propylene glycol are not… unless… they are medically approved e cigarettes or similar. For example, the new Voke produced by a tobacco company and making its way, so far with success, through the MHRA maze of regulation, and, the existing NRT spray.

Using devices where one looks like smoking is setting a bad example and very, very bad unless it is, ‘my’ device one is using.

I am tempted just to write, ‘ha-ha, ha-ha, ha…,’ here but I will go one better.  It would appear that Tobacco Control, sorry, the pharmaceutical industry through Tobacco Control, have not got the intuition / common sense of primary school children. A recent, albeit, small study was conducted in New Zealand where young children were asked what they thought when they were shown e cigarettes being used. At first they confused the devices with smoking, but many did note differences such as the fact that they were not being lit up before use and that they were being placed in the users pockets in between puffs. The net result of the study was that when the youngsters understood what the devices were and why they were being used, they thought that e cigarettes were a good thing: “they should normalise quitting behaviour.”

I have mentioned the Voke which is soon to be presented as a medical device and, in all honesty it cannot be mistaken for a tobacco cigarette. This is the Voke

As you can see, it is nothing like a real cigarette.Here, on the other hand, is an e cigarette of the kind the regulators and Tobacco Control, sorry, the pharmaceutical industry through Tobacco Control, will see an end to. You will note the similarities of the device and a tobacco cigarette.

“Looks like smoking” – are they nuts?

 

 

 

Toasters are very, very bad and must be banned unless the toast is produced without first heating the bread.

One of the main selling points of the Voke is that it operates without heating. In the advertising blurb this is emphasised. It is no coincidence that some (very bad) studies and articles have been appearing lately arguing that formaldehyde and metals have been found in e cigarette vapour.

A report was published in the New England Journal of Medicine claiming that, at high temperatures, more formaldehyde was produced by e cigarettes that from conventional tobacco cigarettes. And, once again the media latched on and the news was spread around the globe.  There were, however, a number of weaknesses and these were highlighted by Dr. Konstantinos Farsalinos. Here.  Without going into the detail (the link is there for you) no one in their right mind would use an e cigarette at the temperatures suggested in the original study.

 

This is the equivalent of what the researchers produced and vapers would no more use e cigarettes at the temperatures needed to produce the toxins discovered any more than you would eat burnt bread like this. But the results of studies like this, and I include inaccurate conclusions and fear inducing tabloid style headlines as, ‘results,’ are part of the case being made against e cigarettes and vaping.

Products of an established level of safety are not safe and very, very bad because they are not proven to be such:  The medical product is of a proven level of safety, because we say so.

Medicalised devices are approved in the UK by the MHRA. Many countries have similar organisations to control medical products. The claim is that licencing by the MHRA ensures safety – does it really. On the other hand e cigarettes have been adequately demonstrated to be 95% – 99% safer than conventional cigarettes. They are nearly always used by cigarette smokers looking for a safer alternative.

Virtually every single study conducted by world experts either establishes a relative level of safety or fails to establish any real danger. I have not come across anything which would prevent me from vaping and I have read a great deal over the last two or three years.

I would go as far as to say that the MHRA cannot be trusted any further than the FDA and CDC in the US on their commentary about e cigarettes.  The pharmaceutical industries’ hold on government is just too great: their pockets are just too deep; history demonstrates a catalogue of errors and sometimes even deliberate deception by pharma in order to sidestep the regulation supposedly supervised by regulatory bodies – indeed these organisations designed to protect us have been subjected to so much ‘creep,’ I do not consider them to be anything more than extensions of the pharmaceutical industry itself.

A 1914 UK Government Select Committee had this to say,

“After careful consideration of the evidence laid before them your Committee find: That there is a large and increasing sale in this country of patent and proprietary remedies and appliances and of medicated wines. That these remedies are of a widely differing characters, comprising genuine scientific preparations;  unobjectionable remedies for simple ailments; and many secret remedies making grossly exaggerated claims of efficacy… That this last-mentioned class of remedies contains none which spring from therapeutical or medical knowledge, but that they are put upon the market by ignorant persons, and in many cases by cunning swindlers who exploit for their own profit the apparently invincible credulity of the public.  That this constitutes a grave and widespread public evil…”

And nothing much has changed.

The 2014 UK Government Select Committee has this to say,

“These problems … reflect its (Pharma’s) influence. People have been taking ineffective and harmful medicines for centuries. However, there is reason to fear that the industry has positively nurtured anxieties about ill-health. The fundamental problem, it is alleged, is that the industry is increasingly dominated by pressure from its investors and the influence of its marketing force and advertising agencies rather than its scientists. The industry is hugely influential, affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it. Its influence in Parliament is extensive.”

For a humorous overview of pharma high jinks, click here.

And when a regulatory organisation claims ‘safety,’ is it really: This from the US. “The FDA buries evidence of fraud in medical trials.” Here

Or how about, “The extent of industry influence over drug regulation, at the expense of other interested parties suggests that the current system could be more robust.” ‘Suggests … could be?’    Well, it is The Lancet after all. Here

Then we have, “Institutional Corruption and the Pharmaceutical Policy.” This from Marc A. Rodwin Professor of Law, Suffolk University Law School: Here.

There is so much more but I think the above is enough to establish that, ‘safe,’ from the MHRA or other regulatory organisations does not actually mean, ‘safe.’

 

A tobacco product is a medical product when something which is not a medical product has to be considered a tobacco product, (Not too sure which one, or both, or none, is very, very bad, but, in the spirit of the madhouse, who cares!) but if the product is not a medical product, OR, a tobacco product it must be very, very bad, because it is neither, OR, it is very, very good. (For much the same reason)

I am still trying to work out what I mean by this. It has to do with early attempts to maintain that e cigarettes were medical products with the subsequent legal challenges and the realisation that they could not be classified thus, then the claim that they are tobacco products which they are patently not, and now the production of a tobacco product, which it is patently not, where the MHRA are classifying it as a medical product – see what I mean?

Anyway, it is a consumer product. Simple really!

A pharmaceutical company is still a pharmaceutical company even when it is a tobacco company, or is it the other way round?

A little dig at pharmaceutical companies which have interests in tobacco companies and vice versa.

 

ANYWAY

 

Would someone call the emergency services, there is a fire in the madhouse.

“Lovejoy’s Law”

Or, when used by health advocates against the use of e cigarettes, the twisted nature of the cry, “Think about the children.”

In 1996 Helen Lovejoy, a character in the TV programme, ‘The Simpsons,’ pleaded, “Won’t someone please think of the children!” This has become known as Lovejoy’s Law.  This is a plea which has been made repeatedly, not just in the TV programme, but by individuals and organisations opposed to the development and public use of e cigarettes.

There are two purposes for the use of the plea, ‘think about, or, what about the children.’ One is legitimate for use in reasoned debate – the other is not. It is legitimate to use the question to draw attention to the plight of children:  It is not legitimate to use it to detract from logical argument and where it becomes an appeal to emotion.  So when Anti-Smoking organisations and health bodies take up the cry, “Think about the children.” How exactly is it being used? Is it part of a reasoned debate on the topic of e cigarettes, or is it an appeal to emotion – a logical fallacy?

The history of the appeal goes back, back before the popularity of e cigarettes had been established, in fact, before the opponents of e cigarettes had even heard of them, and, ironically, to a time where they were wishing that they did exist. That is correct: The very same people who object to vaporisers now, when they were dreaming as if they were something out of science fiction, had once placed them at the top of their wish lists.[i]

In October 2008, Action on Smoking and Health, produced a document called, “BEYOND Smoking Kills.” It was funded by The British Heart Foundation and Cancer Research UK. It was endorsed by a mass of health organisations and charities, and by many local authorities.  It is, however, the sub-title I find interesting: “PROTECTING CHILDREN, REDUCING INEQUALITIES.”

This is where they, and we, I am afraid, get into a bit of a muddle. You see, based on conventional wisdom – based on what was truly believed to be the dangers of smoking cigarettes (and second hand smoke)[ii] by ‘those in the know,’ to demand that we, ‘think about the children,’ was legitimate, rational and logical. However the same document advocates… as a future means to protect the children… the e cigarette… but not in so many words.  So, if, now, the e cigarette is a threat and we must, ‘think about the children’ in the face of this threat, how can it be that the people advocating this were, at that time, praying for the very thing that has been developed to fit their criteria[iii],… the e cigarette… as a means of protecting the children?[iv]

So the e cigarette was a means of protecting children then, and is a threat to them now? Hardly!

In fact, what we have is the same argument being presented in favour of two very different scenarios. The problem is that it just does not seem like two different scenarios.

And this is the crux of the matter. This is why I have presented to you what is contained in the document, “Beyond Smoking Kills.”  The appeal, “think of the children,” was based on a genuine desire to save countless lives where young people were being attracted to a deadly habit. However, when applied to e cigarettes the same does not hold true.

Children are not being ‘attracted’ and the activity is not ‘deadly.’ There is no evidence to suggest that children, who are never-users of cigarettes, are taking up and using e cigarettes. We have to be careful with statements like this, for two reasons. There is an important difference between the terms, ‘using,’ and, ‘trying,’ and that never-users of tobacco cigarettes, may, in the future, begin to use e cigarettes.  I wish to deal with these separately.

That there is a difference between, ‘using,’ and ‘trying:’ to see the importance of making a definition between the two words, look at an early CDC report which confused the two. On the 5^th of September 2013, the Centres for Disease Control & Prevention (CDC) issued a press release. The headline and sub-heading screamed, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012. More than 75 percent of youth users smoke conventional cigarettes too.”[v]  (You will note that I used the word, ‘screamed’ here. It is an emotive term, and, as previously stated, emotion is a powerful tool when trying to convince someone about something – the question you have to ask is, ‘is the use of the device justified?)

Well, in the case of this headline, I think I can justify the use of the word, ‘screamed.’ The first reason is that this press release was taken up world-wide by the press. The story was a dominant one. Newspapers, television and radio all over the world featured it. But it was the emotion which carried the story, not the substance. The report itself did nothing to support the headline. As Carl V. Phillips stated, “The biggest lie is that they report nothing about use.[vi]  All the reported statistics are about trying the products.” There is a great deal more wrong with the headline but the confusion between, ‘using,’ and, ‘trying,’ is my main concern here. Enough to say that e cigarette use had not doubled as the headlines claimed, but the news was out, and it was believed. The emotive message had carried the day.

That young people who have never smoked but who might, in the future, take up e cigarette use is not really a concern either. I would argue that it is to be expected. It is just common sense. It is common sense to expect that among the young people who might be attracted to smoking cigarettes, some will prefer the safer option – but this does not mean that they will go on to smoke tobacco. In fact, why would they? If they enjoy the experience of using e cigarettes, why move over to something which is less enjoyable, and a damn sight more dangerous, and, if they do not enjoy the experience, why try something worse? But the public, generally speaking, cannot see this – they are blinded by emotion: the e cigarette in many minds IS smoking; IS evil; IS dangerous. That e cigarettes might be replacing tobacco smoking actually does seem to be the present trend, though be careful, just because one set of figures is rising does not necessarily mean that this is the reason for the fall in the other – but it looks that way.

I think that one of the better arguments that I have come across is contained in Kristin Knoll-Marsh’s blog which compares the emotion surrounding young peoples’ use of e cigarettes to the furores over sex education and use of condoms. As she states, “They also wring their hands over youth use, worrying loudly that kids will try e-cigarettes and then move on to the more risky behaviour of smoking. (Like anti-safe sex folks argued kids learning about safe sex would lead to more un-safe sex, leaving many people scratching their heads with that logic.) However, after 10 years on the market and increased use by (mostly smoking) youth being widely reported, CDC statistics show that youth smoking continues to decline significantly: Worrying over increased youth use of e-cigarettes while smoking rates are declining is akin to worrying about more teens having sex using condoms while STD and unwanted pregnancy rates are declining.”[vii] (Highlight mine)

But, as it used to be the case with the issues surrounding young people with regard to sex, so it is the case now with the young and e cigarette use.

The users of the phrase, ‘think about the children,’ when applied to smoking, and then to vaping, have found themselves lost in an ethical maze. Happily some are beginning to find their way out. Some of the major anti-smoking organisations and charities are now speaking out against the imposition of banning use in public places[viii]

But we must, ‘think about the children.’ Well, when thinking about children, is it not an idea to see what they think, or do you see them as mindless, naïve and in need of guidance for every step they take? This image of children certainly does not show in a recent New Zealand study which looked at the perceptions of Maori junior school pupils with regard to e cigarettes.[ix] The result of this small but very important study, demonstrates that far from seeing e cigarettes as something that could act as a gateway to smoking, they were seen as the opposite. It was recognised by the little ones (and they were little and not older children)that e cigarettes were being used as an escape from smoking – where does this leave the argument that e cigarette users should be hidden from sight to protect the children?

It is always a temptation in the face of the, ‘think about the children,’ demand to respond by arguing that e cigarettes do not present the children with any threat, however, there is actually no need to do this. As stated at the beginning, there are only two reasons for using the phrase; one is a genuine desire to protect the children from a threat, and the other is to cover up the fact that a threat does not exist. I hope you can see the problem here – if a threat does not exist, how you establish something which is not there? This being the case, one is forced to discuss the alleged danger. All the opponents of e cigarettes have to do is exactly what we have witnessed them doing right from the start, produce a string of unfounded claims, irrespective of the fact that they are not evidenced and use the media to publicise it. A newspaper does not need evidence, just someone to say something… but the damage is done.

The tiny apology, months after the initial publication of the story, does not undo the damage. Here, the readers of the original article have not seen the apology and are convinced that e cigarettes do harm, and added to this they feel the heavy weight of responsibility to protect the vulnerable little ones in our society from this danger. There is no debate now. Any argument to say that e cigarettes do not present danger must not be tolerated, and the ‘evil’ advocates for e cigarette use must be silenced. We must, ‘think about the children.’

Whenever you hear or read, we must, ‘think about the children,’ ask yourself, why this demand is being made. Is it genuine, or is it an attempt to cover the fact that no real danger or threat exists and that the ‘children’ argument is being used as an emotive red herring?

[i] The harm of tobacco can be reduced by helping smokers to quit, reducing exposure to secondhand smoke

and preventing people from starting smoking in the first place. For heavily addicted smokers who are

currently unable or unwilling to quit, there is also the possibility of switching to pure nicotine products (which,

like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives).As smoking is responsible for half the difference in deaths across socio-economic groups, tobacco control also has a major role to play in reducing health and social inequalities. These aims are profoundly inter-linked. Children who live with parents who smoke will breathe cleaner air, and be less likely to become smokers themselves, if their parents quit or switch to pure nicotine products. Poor families will also benefit from the financial savings of quitting.

http://www.ash.org.uk/beyondsmokingkills

[ii] For those who do not agree with the argument that second hand smoke presents a danger, do you see how powerful the emotive argument becomes? The same will hold true for those who do believe in the danger from second hand smoke. My wording casts doubt on this and I would ask you to think about your response when you read it.

[iii] A commercial nicotine products designed for long-term use as a replacement for smoking. http://www.ash.org.uk/beyondsmokingkills Chapter 8.

[iv] Smoking prevalence is declining but not fast enough. Too few people successfully quit every year and too many people start smoking. New ways of driving down smoking prevalence are needed. Smokers are addicted to nicotine but are harmed by the tar and toxins in tobacco smoke. It is therefore possible for smokers who are currently unable or unwilling to quit to satisfy their nicotine craving at much lower risk by switching to pure nicotine products (which, like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives). Although these products are not 100% safe, they are many orders of magnitude safer than smoking. Given the higher levels of addiction among the most disadvantaged smokers, the promotion of wider access to pure nicotine products as an alternative to smoking is an important means of tackling health inequalities.

Currently pure nicotine products are not attractive to smokers as direct replacements for cigarettes as they do not mimic the speed and intensity of nicotine intake that a cigarette provides. Regulation difficulties inhibit the development of more efficient and effective pure nicotine products. As a result, the most toxic nicotine products – cigarettes – are barely regulated while the safest products – medicinal nicotine – are highly regulated.

If they are to compete with tobacco products, pure nicotine products must be sold on equal terms or better: pricing should favour pure nicotine products over tobacco. Public education is also needed as many smokers (and health professionals) have a poor understanding of the relative safety of pure nicotine products including nicotine replacement therapy.

Recommendations

➣ Develop a strategy and an appropriate regulatory structure to improve the acceptability, attractiveness and accessibility of pure nicotine products for use as an alternative to smoking for those who are currently unable or unwilling to quit.

➣ Encourage commercial development of pure nicotine products designed for long-term use as a replacement for smoking.

➣ Develop a communications strategy to counter public misunderstanding of the health impacts of nicotine. This should promote nicotine replacement therapy for quitting and encourage the longer-term use of pure nicotine products as alternatives to tobacco.

➣ Tax pure nicotine products at the lowest rate of VAT.

➣ Evaluate the cost-effectiveness of providing pure nicotine products free on prescription to smokers for as long as they are unable or unwilling to quit.

➣ Increase investment in research into the long-term impacts of nicotine.

http://www.ash.org.uk/beyondsmokingkills Chapter 8.

[v] http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html

[vi]The headline of the press release manages to fit in one lie and two misleading claims, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012″.  The biggest lie is that they report nothing about use.  All the reported statistics are about trying the products, perhaps only once, which is obviously not the same thing (and CDC knows this).  Some statistics reported are for “ever having tried” and the others are “tried at least once in the last 30 days”.  They misidentify anyone who has tried in the last month as a current user, which is a rather blatant lie.  (Of course, some of those who tried recently may well actually be users, but there is nothing in the report that lets us conclude that even one single student is actually an e-cigarette user.)

The second sneaky lie was listing “middle school” ahead of “high school” even though the results for the former are trivial.  But it is scarier to imply that this is mostly about 12-year-olds and not 18-year-old high school students, isn’t it? http://antithrlies.com/2013/09/07/cdc-lies-about-kids-using-e-cigarettes/

[vii] http://wivapers.blogspot.co.uk/2014/12/are-e-cigarettes-are-new-condom.html

[viii] ASH recognises that whilst efforts to help people stop smoking should remain a priority, many smokers either do not wish to stop quit or find it very hard to do so because of their addiction to nicotine. For this group, nicotine containing products which have been properly regulated to ensure product safety, quality and efficacy should be available as an alternative to tobacco.

Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe. Electronic cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are a safer alternative to smoking.

In addition, electronic cigarettes reduce secondhand smoke exposure in places where smoking is allowed since they do not produce smoke. Nonetheless, nicotine is an addictive substance, electronic cigarettes currently available are highly variable in terms of delivery of nicotine and product quality, and smokers are uncertain about the effectiveness of the product. There are concerns, as yet unsupported by evidence, that these products may provide a gateway into smoking for children and young people. The regulation of these products, in particular with respect to their advertising, promotion and sponsorship needs to be undertaken with these factors in mind.

In the UK smokefree legislation exists to protect the public from the demonstrable harms of secondhand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation, but that it should be for organisations to determine on a voluntary basis how these products should be used on their premises

http://www.ash.org.uk/files/documents/ASH_715.pdf

[ix]Methods

Two structured focus groups and twelve individual interviews were conducted with twenty Māori and Pacific children (6–10 years old) in low socioeconomic areas in Auckland, New Zealand. Children viewed short video clips on an iPad that demonstrated an actor smoking a tobacco cigarette, sucking a lollipop or using an electronic cigarette or a nicotine inhaler.

Results

Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the ‘smoking’ behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker’s inability to quit.

Conclusions

In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874641/

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

 

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

Evil and the Opponents of the E Cigarette

‘Evil’ can be regarded as something which has the quality of being morally bad or wrong; … Or that which causes harm, misfortune, or destruction: a leader’s power to do both good and evil. It can be regarded as an evil force, power, or personification. It is something that is a cause or source of suffering, injury, or destruction: (Adapted from, http://www.freedictionary.com/evil )

Often, when encountering the arguments of those people who wish to stifle… Oh! There is a pun here. …Who wish to ‘snuff’ (sorry) out the fledgling e cigarette industry: when I  read their lies; when I finally work my way through their twisted logic; when I am numbed by their repetitions, I think, ‘this is evil.’ Of course, it is just an expression. But there again, is it?

“Evil can be regarded as something which has the quality of being morally bad or wrong.” On the face of it, if so many advocates are correct in their assertion that e cigarettes can save countless numbers of  lives, if they can prevent disease  and suffering, then anything that does this must be a good thing, and anything which stands in the way of it, must be ‘bad’ and ‘morally wrong.’ It must be ‘evil.’  There again, are the advocates correct in their assertion, and, more importantly, are those who stand in the way aware that e cigarettes are life savers, that they will prevent unnecessary suffering?  And the answer to both points is an emphatic, YES.’

Linda McAvan, MEP, stated in her recent Facebook chat, “No. I believe e cigs could help smokers reduce their habit and bring health benefits… No one was arguing to ban them! We are debating how to regulate them.”

This simple little statement demonstrates that she, a least accepts the benefits that e cigarettes can bring. However, look at the second part of the statement. This is sleight-of-hand. You see, the regulation she, and her EU supporters, is proposing is, in effect, a ban. How?

The e cigarette industry is made up of many small, individual companies. They are not big enough to be able to afford the costs of regulation – they would go under. This, in turn, would leave the way open for the remaining ‘big players’ and these are the e cigarette manufacturers owned by the tobacco companies. So regulation will guarantee profit for the very people that the anti-tobacconists claim they are opposing.  The future becomes clearer. I am not the Brahan Seer (a predictor of the future who lived in the 17th century.) but, in this case I do not need to be.  1) E cigs are regulated. 2) Tobacco companies control the market. 3) The Medicines & Healthcare Regulatory Agency (MHRA) through the politicians dictate the strength and make up of e cigarettes, reducing then to the same level (or less) than present NRT products. 4) People stop using e cigarettes and go back to tobacco cigarettes OR if not already using e cigarettes, turn to… 4) NRT, used in quit attempts with only a 6 – 10% chance of success. 5) People go back to tobacco. 6) NRT. 7) Tobacco. 8) NRT. 9) Tobacco. 10) Illness and premature death. The tobacco companies cannot lose if regulation goes ahead. The pharmaceutical companies WILL lose if it does not.

There are two points in the above that require further clarification. The first is the assertion I have made regarding the effect of regulation. The second is, even if I am correct about the effect of regulation, there are more people involved in the decision making process than just the MHRA and Linda McAvan at the EU. There are others who will gain. Who are, ‘the others,’ and what have they to gain from regulation?

Am I correct in assuming that regulation would destroy the e cigarette industry? Well, yes. First of all, take the ‘light touch’ regulation which we are told is being proposed. To do this we need to see what the MHRA has said, then compare it to the claims made by the politicians.

This can be done by going to, and reading the following link. It speaks for itself and after reading you should be painfully aware that the intention of ‘light touch’ regulation is to strangle the young electronic cigarette industry.

http://www.ecita.org.uk/blog/index.php/cost-of-medicines-regulation-in-the-real-world/#comment-118068

And that is just the cost… If you can suffer it; because- yes- it is heavy going… Read….

http://www.ecita.org.uk/blog/index.php/analysis-of-the-mhra-guidance/

So, small and medium sized companies will go under: That is the intention and the above gives the lie to those who claim, ‘light touch.’

The latest attempt to apply ‘light touch’ regulation is seen in the activities of some of our MEP’s who are conniving  in secret / plotting behind closed doors to circumnavigate the will of the European Parliament who recently voted an amendment to the TPD which prevented much of its damaging aspects. This is a real shocker, not only to the e cigarette community, but to any who value democracy. Read please…

http://www.clivebates.com/?p=1655

and…

http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/139-the-european-union-ignores

The first paper is written by Clive Bates who was a former director (and if I have got this wrong I will soon be corrected) of ASH.  The second is by Dr Konstantinos Farsalinos a highly respected, researcher of world renown.

If you are not convinced then here is the actual document prepared by the plotters…

http://nicotinepolicy.net/documents/policy/Article%2018%20-%20Electronic%20cigarettes%20-%20Commission%20proposal%2022%20Nov%202013.pdf

That said, my second assertion was that Linda McAvan and her cronies plotting at the EU, and the MHRA, are not the only players to be considered.  There are two important groups. The professional grouping, and, I am very much afraid to say this, but I will – the second grouping is the mass media, and possibly, as its audience, you.

The profession’s group consist of, firstly, the BMA and the charities – Cancer Research, ASH, and the like. Under the BMA banner I will include medical bodies such as, Royal Colleges, etc. as far as I know; they all copy and parrot what the BMA says, or rather, repeat what the pharmaceutical industry instructs them to say. Ok, ok, ok, this is another assertion. Right, how do I go about establishing this as a truth? First of all what is the BMA’s stance on electronic cigarettes and is it credible? And once again, I point you to Clive Bates who has looked at and written on the topic of some of the advice the BMA is issuing.

http://www.clivebates.com/?p=1602#more-1602

Right! Enough said!

As for the charities, well, I will just come out with it – it is in their financial interest to see an end to e cigarettes. It is in the arena of their machinations that we begin to see how the application of the definition of ‘evil’ is a fitting one, at least to my mind. I find it difficult to see things any other way.

Cancer Research UK, in their blog, licensing e cigarettes: the unanswered questions, is very revealing.  This must be a record breaking blog for Cancer Research with hundreds upon hundreds of responses. It is worth looking at and it demonstrates the attitude of Cancer Research UK towards, not just e cig users, but the public at large. Take time to trawl through the comments, page after page of them. Hopefully the link I have provided will begin at page one, so you will not have to look at them in reverse order.

http://scienceblog.cancerresearchuk.org/2013/06/12/licensing-e-cigarettes-opportunities-and-risks/comment-page-1/#comments

It is very difficult for me to pin down the reasons for this blind approach because 1) I am not trained in research and 2) information is not so easy to obtain in this country as it is in the USA. However, our charities do have sister charities over the sea, so let us take a ‘gander’ at what is happening there.  To do this I will direct you to the writing of Michael Siegel who uncovered something very interesting.

http://tobaccoanalysis.blogspot.co.uk/2012/09/anti-smoking-groups-that-opposed.html

Do I need to say any more?

“…it is in their financial interest to see an end to e cigarettes” What exactly am I referring to with this comment? Notwithstanding the above, it is with charities like Cancer Research that you can see the close links that these organisations have with the pharmaceutical industry.  You and I (Used to) give money to the charity who, after paying huge salaries to their CEO’s (Around the quarter million mark – and that is just the CEO) and a large scientific, technical and administration compliment, spend the rest on advertising and research. What happens to the research that you and I have paid for? It gets handed over to the drugs companies. They then produce a drug which is sold back to us at immense profit for the company who tell us that the drug is so expensive because of research costs… hang on, WE PAID FOR THE RESEARCH IN THE FIRST PLACE!

What though happens if e cigarettes are allowed to flourish?  Well, it is so simple. Hundreds of thousands, if not untold millions of people, will no longer fall ill and die as a result of smoking related diseases. The pharmaceutical companies will suffer crippling loses and the charities, particularly ASH and Cancer Research will be left to twiddle their thumbs. Oh! And the ‘high heed yins’ (Scots for those at the top of the tree) at the BMA will lose face – and lecture fees?

It is a complicated, dirty mess, and those who would advocate an end to e cigarettes are taking full advantage of this. They use people’s ignorance on the topic to get away with making wild and inaccurate claims about the ‘dangers’ presented by e cigarettes.

Now, I want to take a look at you.

You are the only really important party here, but you are a disparate (not desperate) bunch.  There are just so many of you and you have to be controlled. This is where the media come in. News is manipulated by politicians, industrialists and many others. Manipulation of information and misinformation is a whole industry in its own right.

In the UK, papers like the Daily Mail were at the forefront of the media campaign against e cigarettes. Some of the reporting in this particular paper was absolutely appalling.  In fact, at one point they were forced to issue a retraction. Once again I turn to Clive Bates. Read…

http://www.clivebates.com/?p=1459

It is not though just the Daily Mail. The BBC for example had a gentleman from the organisation N.I.C.E. (National Institute for Health and Care Excellence) explaining why a smoking ban is justified in and around hospitals in England. Not a mention of e cigarettes and the important role they have to play. He just plugged over and over again the ‘value’ of NRT. Many messages were sent to the BBC about the lack of mention of e cigarettes but this was completely ignored. And this is still going on. The media are still reporting on assertions which have long been discredited as if they are still hot topics. And as for accuracy, one report I have just read stated that many of the e cig juices come from China and we all know what the water there is like. Now I am not sure if water is a constituent or if it is used in the manufacturing process. If it is the former, the researcher should have done research, and if it is the latter, the process involves superheating, so those oriental ‘beasties’ will hardly present any risk.

But this is what the opponents of e cigarettes play on: Our lack of knowledge on the topic. We are exposed to one scare story after another, the latest being that e cigarettes provide a gateway to tobacco use and that young people are being introduced to smoking through e cigarette use.

Surprisingly I now turn to ASH to demonstrate that this is not the case – but read carefully. Learn the lesson pointed out earlier where Linda McAvan states that e cigarettes present no real danger but need to be regulated to ensure safety. Where she assures us with her platitudes that ‘light touch’ regulation is her aim where she is poised to deliver a hammer blow. Something very similar is happening with the ‘young people’ argument. First of all read the following.

http://ash.org.uk/files/documents/ASH_715.pdf

So, no real harm; young people and those who have never smoked are not being attracted to them.

NOW look at the recommendation that they fall under the MRHA’s regulations – Huh! If you have forgotten, those are the very regulations which will destroy the industry. Why? The logic here is that they acknowledge there is no harm and that lives will be saved…  so get rid of them. Young people are not taking them up so they present no threat… so get rid of them. New victims of tobacco and nicotine are not being created so let us get rid of this very dangerous product… which we acknowledge is safe. Now that really is speaking in two tongues.

• There is now overwhelming evidence that e cigarettes present no danger to users in the short term and that although the long term needs looking at there is no foreseeable threat at present
• Young people are not being attracted to the tobacco habit by e cigarettes.
• E cigarettes are not attracting non-smokers.

Now let us take a look at you. Where do you fit into all of this? This is the most important piece in the jigsaw yet it is the part I will just gloss over.

Do you have an attitude towards e cigarettes because they are so like smoking? If you do then my efforts here will have been in vain.  It is as simple as that!

If you are unsure, read the following

http://www.rstreet.org/wp-content/uploads/2013/11/RSTREET11.pdf

So there you have it: A whirlwind tour of the e cig debate and an indication of why I find that the definition of evil fits the opponents of e cigarette development. We lose track of the fact that millions can benefit from e cigarettes. This will not happen if the murderous efforts of some go ahead.

“Murderous…?”  Of course, it is just an expression. But there again, is it?……..

For a more complete view of the topic, go to and brows the following sites. (Not in any particular order)

http://www.ecita.org.uk/blog/

http://www.clivebates.com/

http://tobaccoanalysis.blogspot.co.uk/

http://www.ecigalternative.com/ecigarette-studies-research.htm

http://josefk1925.wordpress.com/2013/07/11/whither-e-cigs/

And last but by no means least… in fact this is a must read…

http://www.ecigarette-research.com/web/

Apologies to the many other first class sites which I have failed to mention.