E-Cigarettes & Lung Health

E-Cigarettes & Lung Health

American Lung Association tweet

Sometimes, I struggle to fathom the motives behind certain organisations. I truly do. Here we have a supposedly respectable organisation in the American Lung Association saying that e-cigarettes are a “new” tobacco product that have still largely unknown health effects. Then there’s a link to this page, which I wouldn’t click on if I were you; you’ll probably get asked to donate to them like the American Cancer Society (quick tip, don’t).

So what, according to the ALA are e-cigarettes?

E-cigarettes, including e-pens, e-pipes, e-hookah and e-cigars, are known collectively as electronic nicotine delivery systems (ENDS). According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol (vapor) containing nicotine or other substances.

Unlike traditional cigarettes, e-cigarettes generally are battery-operated and use a heating element to heat e-liquid from a refillable cartridge, releasing a chemical-filled aerosol.

In just two short paragraphs they have completely missed the point.They say “releasing a chemical-filled aerosol” like it is actually a bad thing, deodorant does the same thing albeit without the heating aspect, as does a multitude of other aerosol based products but you don’t hear them kicking up a stink about those now do you?

The main component of e-cigarettes is the e-liquid contained in cartridges. To create an e-liquid, nicotine is extracted from tobacco and mixed with a base (usually propylene glycol), and may also include flavorings, colorings and other chemicals.

Because there is no government oversight of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining what’s in them. So there is no way for anyone—healthcare professionals or consumers—to know what chemicals are contained in e-liquids, or how e-cigarette use might affect health, whether in the short term or in the long run.

The “main component”, unless I missed vaping 101, wouldn’t the atomiser be considered the “main component”? Anyway, moving on. Yes nicotine is extracted from Nicotiana tabacum simply because it has the highest concentration and is (relatively) easy to cultivate (compared to synthesising it). The other constituents of e-liquid are usually a glycerol, most notably vegetable glycerin, propylene glycol and various flavourings. Some do contain colourings, which frankly are not needed. At all. Any liquid that is artificially coloured should be treated with caution as it adds other factors that, frankly we don’t know much about.

As for the number of products, well there’s a lot brands and plenty of flavours but to be honest the majority of juice makers are reasonably responsible, there’s a few outliers of course as there are in pretty much any industry, but again where’s the outcry for those?

It does seem that the ALA are ignoring the fact that e-cigarettes in general have been under investigation for a number of years already and have been subjected to an extensive review of 198 studies. Are these folks completely missing the point of research, or are they simply not bothering to look at anything that could actually prove them wrong?

Early studies show that e-cigarettes contain nicotine and also may have other harmful chemicals, including carcinogens.

As anyone with even half an ounce of sense will tell you: the dose makes the poison. The key factor that is being blatantly ignored by the ALA here is the quantities, each one that has been detected has been at substantially lower levels than tobacco smoking. Despite “other chemicals” being detected there is little to no evidence that, in the quantities detected these chemicals pose a significant biological risk to the user or bystanders. Which makes this next statement from the ALA completely redundant:

However, in initial lab tests conducted in 2009, the FDA found detectable levels of toxic cancer-causing chemicals—including an ingredient used in antifreeze—in two leading brands of e-cigarettes and 18 various cartridges.

As noted by Fergus Mason, the fact that something could cause cancer does not necessarily mean it can cause cancer. You can say that they have similar effects as things that cause cancer - and some things that don’t - but you can not definitively say they cause cancer. That is bad science at best, and at worst thoroughly misleading to the general public.

A 2014 study found that aerosol from e-cigarettes with a higher voltage level contains more formaldehyde, another carcinogen with the potential to cause cancer.

This is the same “study” that has been thoroughly debunked by respectable scientists that actually knows how e-cigarettes work. Of course, the ALA thinks that these findings are “alarming” and as a result:

the American Lung Association urgently calls for FDA oversight of these products.

Next, they talk about poisonings, but don’t actually provide any context, nor do they provide any statistics on interventions for said poisonings. For an organisation that values evidence you would think that they would provide such context no?

As public spaces increasingly become smokefree, anecdotal reports show some people are using e-cigarettes indoors and in smokefree public spaces, including bars, restaurants and on public transportation.

“Anecdotal reports” - so it’s not OK for us to make claims as actual users, but it’s fine and dandy when they do it.

Many e-cigarette companies market their product as a tool to help smokers quit. However, the FDA’s Center for Drug Evaluation and Research has not approved any e-cigarette as a safe or effective method to help smokers quit.

Yet the very same FDA that approves varenicline which has some known, very bad side effects.

The U.S. Public Health Service has found that the seven therapies approved by the U.S. Food and Drug Administration in combination with individual, group or phone cessation counseling are the most effective way to help smokers quit. Until and unless the FDA approves a specific electronic nicotine delivery system or e-cigarette as safe and effective for use as a tobacco cessation aid, the Lung Association does not support using them for cessation, nor does it support any direct or implied claims that e-cigarettes help smokers quit.

Brings to mind a recent post about quitting, not to mention the recent e-Voke shenanigans being given a medicines authorisation which means, in the eyes of the UK MHRA there is now a licensed medicalised e-cig (which will never see the light of day) which could in theory be provided as a “safe and effective” device “for use as a tobacco cessation aid”. I’m beginning to see a pattern here.

What have we learned today kids?