An excellent radio program from earlier this year called ‘Inside Health’ discussing the implications of electronic cigarettes. For once, this discussion is actually very fair. Just so you know, the ecigarette discussion ends at about the 20 minute mark.

BBC Radio 4 Electronic Cigarette Broadcast

So what do you think? What are your views about ecigarettes, whether positive or negative? Let us know.

Electronic, or e-cigarettes, are battery-operated devices that generally contain cartridges filled with nicotine, flavor and carrier chemicals. The contents of the cartridge are heated to a vapor, which the user inhales.

The U.S. Food and Drug Administration decided in April not to challenge a U.S. Court of Appeals ruling that e-cigarettes are not drugs or devices unless marketed as such, but can be regulated as tobacco products. That means the devices aren’t subject to the testing requirements of pharmaceuticals.

The FDA has done no formal, large-scale tests on the products, but did release a statement in 2009 saying it had analyzed the ingredients in a small sample of cartridges from two leading brands.
The analysis detected diethylene glycol in one sample – a chemical used in antifreeze that is considered toxic to humans – and detectable levels of carcinogens in several others.

“Because these products have not been submitted to the FDA for evaluation or approval, at this time the agency has no way of knowing, except for the limited testing it has performed, the levels of nicotine or the amounts or kinds of other chemicals that the various brands of these products deliver to the user,” the statement says.

The Electronic Cigarette Association, a group of private companies involved in the production and sale of the product, disputes the finding, saying in a statement on its website that the FDA’s analysis is “too narrow to reach any valid and reliable conclusions” and ignores efforts by member companies to ensure the products include health warnings and are marketed only as an alternative to smoking by current tobacco users over 18.

According to the Centers for Disease Control and Prevention, tobacco smoke from regular cigarettes contains more than 7,000 chemicals and chemical compounds, including more than 70 that are known carcinogens.

by Dr. Elizabeth Whelan, President of the American Council on Science and Health.

At a time when the government is ostensibly trying to cut health costs, why is it trying to ban something that might help people quit smoking tobacco, perhaps the most devastating health problem in the U.S.?

The Food and Drug Administration (FDA) held a press conference late last month to scare Americans about the so-called “e-cigarette” — claiming it was loaded with harmful “toxins” and “carcinogens.” The agency was implicitly saying: Stay away from these newfangled, untested cigarette substitutes — better to stick with the real ones, the ones that we are more familiar with, the ones that cause over 450,000 deaths annually in the U.S.

In making its distorted, incomplete and misleading statement, FDA was violating its long-cherished tradition of sticking to sound science as the basis for its policies. And in doing so, it is putting the lives and health of millions of Americans at risk.

The truthful part of the FDA statement was that e-cigarettes have not been through formal efficacy and safety tests at the FDA, and they have only been around a few years. But in the press conference, here is what the FDA did not tell you but should have:

- Traditional cigarettes are lethal not because of the trace level presence of specific “carcinogens” and “toxins,” but because by using them, smokers inhale enormous amounts of smoke — otherwise known as “products of combustion.” It is the inhaled smoke that kills in so many ways — from cancers, cardiovascular and lung disease, and more.

- The cigarette was a relatively obscure product in our society until the invention of a cigarette rolling machine, and sales rose quickly prior to World War I.

Before that, tobacco was used relatively safely — in chew, pipes, cigars — because little if any smoke was inhaled. Cigarettes changed all of that.

- The e-cigarette — a cigarette-mimicking device made up of a battery, an atomizer and a cartridge — allows smokers to inhale, getting a dose of the nicotine they crave, and then sending steam out the other end (with little or no odor) to mimic the ritual and feel of smoking normal cigarettes.

- The FDA complained that the e-cigarette was a “nicotine-delivery system.” Well, it got that much right. But again, it’s the smoke that kills, not the nicotine. Yes, nicotine is highly addictive, and it is what keeps the smoker hooked. But getting the nicotine without the smoke is an enormous health advantage for cigarette smokers (the nicotine inserts come in various strengths and the users can adjust them downward as they wish).

- The FDA has approved other nicotine-delivery systems in the form of gums and patches — and they have been abysmal failures. The smoking cessation rates using these devices is less than 15 percent after one year, condemning millions of addicted smokers to a lingering death. We desperately need other alternatives. But the FDA has now joined a long list of so-called public-health organizations — including the Campaign for Tobacco Free Kids and the American Lung Association — whose collective motto seems to be “quit or die.” Not only do they reject e-cigarettes, but they also condemn other smokeless products like snus, which have a mere fraction of the health risks associated with smoking cigarettes.

- More than 1 million smokers are now using the e-cigarette — a product that offers some, if not all, of the “social amenities” of the real thing — holding the cigarette, taking a drag, seeing a plume of “smoke.” The FDA, lacking data that e-cigarettes pose a health hazard, was so desperate, it called on consumers to phone in adverse side effects of e-cigarettes so they could begin to build a case against them and proceed with their intended ban. They neglected, however, to request smokers who successfully quit using the e-cigarette to also call in.

Cigarette smoking remains the leading cause of preventable disease and death in the United States today. Any alternative acceptable to addicted smokers should be taken seriously. Instead of condemning the e-cigarette, the FDA should be sponsoring studies to evaluate its safety and efficacy — leaving it on the market in the interim.

A recent episode of the popular television series “THE DOCTORS” named the Top 10 Health Trends of 2009, including the revolutionary and still relatively unknown smoking alternative device – the Electronic Cigarette. This is pretty big news and a positive sign for people who ‘vape’ all across the U.S., as mainstream exposure can only help further the success and acceptance of these products.

The doctors on the panel stated that for the millions of people addicted to smoking, there may be some hope in a safer alternative. The ecigarette is a high-tech device that gives the sensation and impression of smoking, but does not emit the 4,000+ chemicals that combustion tobacco products produce.

The only chemical that enters the user’s system is nicotine, and the “smoke” produced that can be breathed in and out is actually water vapor.

“For some people, this may be a big help to get them to quit smoking,” Dr. Ordon says. “We don’t want to get people on nicotine; that’s not good, either [because it] constricts your blood vessels, but it’s a lot better than consuming all that tar and charcoal and carbon monoxide [that is in cigarettes].”

Dr. Ordon fails to mention, however, that cartridges are also available without nicotine if that’s what the customer prefers. And indeed, many users are also able to enjoy lower-density nicotine cartridges with the eventual goal of quitting the habit altogether.

Moreover, the doctors on the show seem to believe that e-cigs are only available in the UK and China, while in truth there are a number of U.S.-based companies offering a variety of products. Electronic cigarettes are not and have never been illegal, so it is unclear why many people seem to think they can’t get them stateside – most likely a result of FDA and Big Tobacco propaganda.

On the topic of the FDA, it is also mentioned on the show that electronic cigarettes haven’t yet been approved. While this is true, regular combustion cigarettes have never been and will never be FDA approved, either, so it’s something of a moot point. On top of that, all of the individual ingredients of e-cigs are FDA approved, the agency just hasn’t put the time and money into clinically testing the kits as a whole.

There are a couple of other misstatements and misleading information the doctors state within the show – such as starter kits will cost you $150 (much cheaper versions are widely available) – but all four of the hosts did try the e-cigs themselves and spoke with a smoker who also gave a positive review of the product.

It would have been nice if The Doctors more faithfully did their homework before airing incorrect information, but the exposure was a good start and a small step in the right direction toward the mainstream embrace of this excellent smoking alternative.

Dr. Michael Siegel has said, “When you write an op-ed, you essentially become an authority on the topic you are writing about and you take on the responsibility of researching the topic to make sure that you are providing accurate information.”

By perpetuating propaganda and demonstrating an unwillingness to gather the facts and to listen to her readers, the author of the blog Ethic Soup sets a poor example of ethical conduct. Sharon McEachern has consistently failed to provide accurate information on the topic of e-cigarettes. Most of McEachern’s assertions are, as she freely admits, only guess work. In her March 24, 2009 post she wrote, “So, if the marketers of the electronic cigarette want to help smokers quit, how come they don’t conduct clinical studies and toxicity analyses? My guess is that they already have conducted these tests and not only do they not have evidence of safety, but probably have evidence that the opposite is true — e-cigs are toxic and dangerous to one’s health.”

Her guess is wrong. The original manufacturer of electronic cigarettes, Ruyan Group Limited, sponsored research conducted by Health New Zealand (NNZ) to study the safety and toxicity of its product. Health New Zealand’s October 2008, “Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol” concluded “Ruyan® e-cigarette is designed to be a safe alternative to smoking. The various test results confirm this is the case. It is very safe relative to cigarettes, and also safe in absolute terms on all measurements we have applied.”

The American Cancer Society Cancer Action Network, the American Heart Assn., the American Lung Assn. and the Campaign for Tobacco-Free Kids urged the FDA to remove ecigarettes from the market. But were these anti-tobacco groups—some of which have a mission to protect public health–really fearful that smokers would be harmed by the new products?

The truth lies well outside questions of health. “Is it Ethical to Re-create Smoking Culture?” McEachern asks in one of the post subheadings. She admits that anti-smoking groups fear that the ecig will bring back a “smoking culture” and that ex-smokers will “be lured back into the smoking trap.” This fear has proven to be unfounded. Two published surveys of e-cigarette users have found that 100% were smokers when they turned to the e-cig as an alternative.

In April 2009, HNZ presented the results of its research on e-cigarette safety and toxicity as a poster in Dublin at the 15th Annual Conference, Society for Research on Nicotine and Tobacco, (SRNT). Many employees of the health organizations calling for a ban on ecigs are members of SRNT. Nevertheless, the HNZ research either was not brought to the attention of the FDA, or the FDA knew of this research and purposely ignored it.

McEachern’s July 28, 2009 post gleefully reported on the FDA’s press conference announcing the results of testing that “found carcinogens and other toxic chemicals dangerous to humans.” By the time McEachern wrote her follow-up blog post on September 9, 2009, the FDA’s lab report had already been widely denounced as incomplete and misleading, due to the lack of a quantitative analysis of the so-called carcinogens and toxins. The truth is that the quantity of Tobacco-specific Nitrosamines (TSNAs) in electronic cigarette liquid is equivalent to the amount contained in FDA-approved nicotine replacement products. There are no warnings on a nicotine patch that it could cause cancer—because the quantity of “carcinogens” is too miniscule to present a danger.

Subsequent testing by an independent lab has revealed that there are no carcinogenic TSNAs present in the vapor. Furthermore, the amount of diethylene glycol (DEG) that FDA found in the liquid of one cartridge is thousands of times below the Minimal Risk Level. DEG has never been detected in the vaporized aerosol by any lab.

Nevertheless, McEachern continued to praise, as well as misquote, the FDA’s findings. She wrote, “As reported by Ethic Soup in past posts, the FDA and numerous health organizations have shown that e-cigarettes present an extensive variety of potential dangers to users (and maybe also to those around them) who inhale a mixture of nicotine — both dangerous and addictive — and propylene glycol which is an ingredient in antifreeze.”

Really? Then perhaps you should check out here, here, here, here and here. And here’s the results of an actual nicotine study: Nicotine Study.

Need more proof? I have plenty more reliable sources I can publish, if necessary. Given all the research already undertaken on the subject, to say that “e-cigarettes present an extensive variety of potential dangers to users” is patently untrue.

Yes, of course, users inhale nicotine. The reason the FDA allows this addictive substance to be added to gum, lozenges, patches, and inhalers is so that smokers who crave the nicotine in cigarettes will find these “NRT” products to be an acceptable substitute for smoking. Initially, some smokers do, but when the NRT is discontinued, so is the smoking abstinence. In the final analysis, only 10% of NRT users achieve smoking cessation. The vast majority of smokers would never make the initial switch away from traditional cigarettes to an e-cigarette if the vapor contained no nicotine. But some e-cigarette consumers eventually do taper down to zero-nicotine liquid part of the time (35%) or all of the time (6%).

It was DEG, not propylene glycol (PG), that the FDA linked to antifreeze. At one time, ethylene glycol was the main ingredient in antifreeze, but many animals and children were being poisoned by the sweet-tasting liquid. Ethylene glycol has been replaced with PG because PG is non-toxic.

It’s a problem that I have to correct these factual errors in my own blog. Had McEachern not cut herself off from the comments of her readers, we might have been able to help her separate fact from fiction via the comments section in her own blog. On the September 9 post, she allowed one comment.

She responded to the comment, “Hi Joey! Glad you responded to this post. I have several thoughts/questions to share. How do you know that e-cigarettes are 100 to 1,000 times less harmful than smoking tobacco cigarettes? Can you scientifically disprove that the following groups are all wrong about e-cigarettes being “poisonous?” — American Cancer Society, American Heart Assn., American Lung Assn., the World Health Organization and the FDA.”

Apparently these are meant to be rhetorical questions, since McEachern immediately closed the comments option. Nevertheless, I do have answers.

We know that ecigarettes are orders of magnitude less harmful for two reasons. First, we applied common sense. Smoke contains tar, carbon monoxide, heavy metals, and particles of ash. Vapor does not contain any of these. When any substance is burned, a chemical reaction takes place. In the case of tobacco, it has been found that 4,000 chemicals are generated, most of which are toxic and many of which are carcinogenic.

In contrast, vaporization is a physical process that changes the state of the substance from liquid to gas. No chemical changes take place. However, some substances have a higher vaporization temperature than others. Thus, some of the substances that are found in the liquid don’t always make it into the vapor.

Second, we observed the effect that switching to vapor had on our own health. Over 90% of users consistently report improved health across multiple surveys. In my own case, I have observed that I am no longer kept awake at night by the sound of my wheezing. I no longer cough up a gob of phlegm in the morning. Like many other e-cig consumers, I have now passed the one-year mark for being abstinent from smoking. My lungs couldn’t be happier.

Can I scientifically prove that the named groups are wrong about e-cigarettes being poisonous? If e-cigarettes are poisonous, why are users growing healthier? Shouldn’t they be dropping like flies? The named groups did not conduct any research of their own. They consistently refer to the FDA’s flawed report as “proof” that the products are dangerous. The FDA proved no such thing. Furthermore numerous tests by organizations other than FDA have found nothing poisonous or cancer-causing in the products. http://www.casaa.org/resources/lab.asp

U.S. District Court Judge Richard J. Leon wrote: “Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes have endangered anyone. Nor has FDA cited any evidence that electronic cigarettes are any more an immediate threat to public health and safety than traditional cigarettes, which are readily available to the public.”

I will leave the comments to this post open, allowing Ms. McEachern, the FDA, and any of the organizations and people she has admired in her blog posts about e-cigarettes to defend the ethics of using disinformation to sabotage the recovery of almost a million former smokers and to prevent the recovery of millions more. Why on Earth would anyone work so hard to perpetuate smoking-related disease and death?

Originally posted by Elaine Keller at Nicotine Truth blog: http://nicotinetruth.blogspot.com/2010_07_01_archive.html