Research and Vaping Concerns, Valid or Not?

Paul
News, Science

It has definitely been an interesting few days all said and done. A televised debate took place over the weekend on vaping which kicked off the usual shenanigans with many folks sending the usual tweets to the person on the negative side of the debate. Of course, this was aired on Fox which has a certain reputation for being a little unusual, to put it mildly.

Who was involved in this debate? Well Greg Gutfield obviously who, as it transpires is a former smoker through vaping, and one Doctor Nina Radcliff. Being in the UK I missed out on the show itself so I had to play catch-up on Monday after it had aired in the US (really beginning to loathe these time differences) and frankly I was stunned. If you haven’t seen it the video is below.

https://youtu.be/a5rMSulx9-U

Aside from some of the very strange, though customary commentary from Gutfield some of the commentary from Dr Radcliff was more than a little surprising and I’ll be honest, it did make me a little annoyed considering the chromium comment originated from a study performed on very old hardware, most of which were devices created by the tobacco industry and with the exception of two were all old cartridge based devices. In this case, whilst certain metals had been detected the authors concluded: “The same metals in trace amounts were detected in Nicorette® inhalator and in blank samples.”. Also, the amount of metals delivered to e-cigarette users is lower than the daily exposures permitted by the authoritative US Pharmacopeial Convention (USP) for inhalable medications.

Just a small misfire there, I hoped. Of course no debate wouldn’t be complete without mention of the gateway theory. One which, as demonstrated by the recent statistics in the UK and even the CDC’s own data throws out the window. Of course, I wouldn’t want to see never-smoking teens taking up either smoking or vaping, but given that teens will try one or the other at some point I would prefer they choose the safer alternative. They can even try a vapour product that doesn’t contain nicotine, which is one question that the FDA and CDC really need to start asking in their Youth Tobacco Surveys.

Not only did Dr Radcliff appear on Fox, she also released an article on Press of Atlantic City. At first glance of this article I was more than a little disappointed to see some of the comments made on Fox repeated in print. This didn’t do much to help my mood at all if I’m perfectly honest, but I took some time to really read the article, and to re-watch the video several times before heading on to social media and giving the good doctor a piece of my virtual mind (not that there is much left!). Before I go into that, let’s have a quick look at the article itself:

I’m not particularly sure where those figures come from considering Dr Radcliff quoted similar figures for 9th and 10th graders not the “adults under the age of 40”. I do really wish presenters and articles would stop saying “smoke e-cigarettes” though, it is one thing that irks me. As a user of vapour products, I do not smoke, I vape. This is probably one of the biggest factors of confusion, that and the fact that they are often referred to as e-cigarettes, one reason I try as often as possible to call them something else.

Sadly, in this paragraph the description can only be applied to the first generation devices which are predominantly manufactured by, you guessed it, the tobacco industry. As far as I know, the vast majority of vapers worldwide do not use this style (cig-a-like) of device, simply because they are useless. They do not provide the user with the experience they need to simultaneously enjoy and to stay away from tobacco smoking.

These are the kinds of devices used by most vapers, not one of them mimics a traditional cigarette which is why I try to call them “vapour products” or simply “vapourisers”.

Are e-cigarettes safe. The short answer to that is a frank yes, but let me expand on that. Most of my regular readers will know that there is no such thing as 100% safe in anything. By implying that vapour products need to be 100% safe is setting an unobtainable goal. One of my favourite studies to refer to when talking about Nicotine and addiction is this one from back in 2006 which suggests that the extra additives in combustible cigarettes is the primary cause of smoking “addiction”. There is also the following statement:

“Technically, nicotine is not significantly addictive, as nicotine administered alone does not produce significant reinforcing properties” – the addictiveness coming from MAOIs

– Guillem et al 2005

Two distinct sources that openly dispute the commonly held belief that nicotine is addictive. Sadly, most research into nicotine is confounded by research into smoking as that is obviously where nicotine is most commonly found. Nicotine is hardly benign, but at the concentrations used within e-liquid the effects are not as prevalent, considering that the dose received through vaping is actually lower than the dose received by smoking. Yes nicotine does have an effect on heart rate, can’t dispute that one at all, but the effects are temporary. There are also positive effects of nicotine for certain conditions such as Parkinson’s and Huntingdon’s.

For the formaldehyde, when a vapour product is over used or the voltage delivered to the coil is set too high, this has the resultant effect of burning both the wicking material and the liquid resulting in the “dry puff” phenomenon. Having had one or two of those myself, it is decidedly unpleasant and definitely not an experience I’d like to have again. Under normal use, the levels are substantially lower (30-250 times lower than tobacco smoke). This research, conducted by Dr Farsalinos is the only study performed to date that involves us the user in determining when the “dry puff” occurs.

In regard to the vapor, it initially was not believed to pose harm to bystanders, as second-hand cigarette smoke does. However, recent studies have shown that it has the potential to weaken the immune system and cause inflammation and cell damage.

The studies the good doctor refers to are the ones that exposed cells to the liquid itself, which is of course in stark contrast to how the lungs would actually react to the exhaled vapour as discussed in this study.

Actually, we know that vapourisers do indeed aid cessation, the recent Cochrane Review highlights the potential for this to happen despite the overall quality of evidence analysed being low. Since then further studies have been released which also suggest that the type of device used plays a substantial role in the success of the “quit attempt”.  Where Prof. Glantz has declared that “e-cigarettes are not needed” the evidence emerging from the UK strongly contradicts that.

Can they get kids hooked?: Although e-cigarettes are being marketed as devices to help smokers quit, one of the biggest concerns is their appeal to children. Each day in the U.S., nearly 4,000 people under the age of 18 smoke their first cigarette, and more and more are reaching for electronic cigarettes. This may be because of their appealing packaging (red, white, gold wrappers, etc.) and availability of yummy flavors (caramel, butter rum, bubblegum, etc.). The concern is that we may be creating a new generation of nicotine addicts.

Again, surveys conducted within the UK do not reflect this at all, even the Eurobarometer suggests that more smokers are turning to vapour products and the number of teens trying them once but never again remains minimal. I’m not going to touch on the addiction thing again as I’ve already covered my personal view on that here.

The popularity of electronic cigarettes is growing faster than our ability to clearly understand its effects. In the meantime, lawmakers and the public appear to be taking an abundance of precaution – warning labels, restricting access to minors, preventing indoor use, disclosure of ingredients – to avoid repeating mistakes made in the past with traditional cigarettes. After all, it did take the tobacco industry decades before acknowledging the harms of tobacco smoke, only after one too many lives were affected and lost.

This is where it gets a little more interesting. The scientific research is being far outstripped by the rapid innovation in the vaping market. A market that is predominantly driven by consumer need and desire rather than manufacturers coming up with the ideas. The market is demanding certain things with regards to safety, features and availability and the manufacturers are responding as fast as they can to that demand. A scientific study can take years to gain funding, go through the actual process, followed by delays in write-up and publication; by which time the market has already moved on a dozen steps. Research needs to be faster and more flexible, incorporating that into the ever-changing market will be difficult without the input from the actual users. A study is being performed in the next few weeks in conjunction with vapour product users and I would strongly urge anyone in and around the London area to get in touch!

After seeing the video then reading the article, I decided to try to reach out to Dr Radcliff. This is something I try with any and all medical professionals and journalists in an effort to engage and inform. Sadly, most of the time I’m met with dismal failure. Imagine my surprise and delight when I received some direct messages on Twitter from the good doctor herself!

I’m not going to go into too much detail here, but I am assured Dr Radcliff is willing to engage and is adamant that adults should be allowed the choice, though she does accept that the question on youth is more shades of grey than the black and white that legislators believe it to be; i.e. she understands that current smoking youths should have access to vapour products as a harm reduction method. Above all, Dr Radcliff is open to suggestions on how us the user, the market and science can work together to nail down some of the loose ends that are flapping around us right now.

I am hoping that as time goes on, I’ll be able to continue the positive engagement with Dr Radcliff and I’ll do my best to inform her as much as I possibly can. Being nice can be rewarding.

If you have read this Dr Radcliff, I thank you for taking the time to engage and I look forward to more of the same!