FDA Tobacco Program Office Issues Misleading Report on Adverse Events

Status
Not open for further replies.

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
Well folks, the FDA is at it again, using subtle propaganda techniques to paint an unflattering picture of electronic cigarettes. Dr. Ii-Lun Chen, MD, an FDA employee has a Letter published in the most recent issue of the SRNT's medical journal, tobacco and Nicotine Research, titled "FDA Summary of Adverse Events on Electronic Cigarettes." Sign In

Section 909 of the tobacco Act specifies that tobacco companies should report any adverse events (AE) concerning their products to the FDA. The Act doesn't specify how these reports should be submitted. For many years, medical providers and the general public have used the FDA's Adverse Event Reporting System (AERS) to report problems with drugs and medical devices. But the FDA's page on reporting Adverse Events makes no mention of tobacco products: Adverse Event Reporting System (AERS)

Dr. Chen's article states:

Since the late 1980s, over 100 AE reports on tobacco products have been submitted to FDA (electronic cigarettes, n = 47; cigarettes, n = 36; smokeless tobacco, n = 14; other tobacco, n = 5). Notably, approximately half of all tobacco-related AE reports concern electronic cigarettes, the first of which was submitted in 2008.

The numbers of AE reports received by CTP pertaining to e-cigarettes are summarized as follows: 2008 and earlier (1 of 18 total tobacco product reports), 2009 (10 of 16), 2010 (16 of 27), 2011 (11 of 30), and first-quarter 2012 (9 of 11). Of the 47 reports on e-cigarettes, 8 reported serious adverse events.

Anyone who didn't know the whole story would think, "Wow! Electronic Cigarettes are more dangerous than any other type of tobacco product." But what is not mentioned is that the FDA did not take over regulation of tobacco products until 2009. So any report on tobacco products that came in between the late 1980s and the present would have been an off-label use of the system, so-to-speak. But even more important that until this article was published, the FDA has not asked the public to submit AE reports on tobacco products such as combustible cigarettes, cigars, or smokeless tobacco.

During a July 2009 press conference, the FDA invited the public to use their AERS surveillance system to report problems with e-cigarettes. So it would make sense that there would be more reports on e-cigarettes than on other tobacco products. In fact, if the FDA had not specifically asked for AE reports to be submitted on e-cigarettes, the odds are good that there would have been no more than a handful of such reports.

Leaving out pertinent information is a propaganda technique known as "Card Stacking."

The article concludes:

Research will inform our understanding of the design and composition of all varieties of e-cigarettes on the market and the health effects on the consumer as well as for those exposed to the vapor. When FDA regulates e-cigarettes marketed as tobacco products, the resulting quality control measures and product standards for this class of products may help to decrease adverse health events. CTP is currently developing a tobacco-specific adverse event reporting system. In the meantime, concerned consumers or the public can report adverse events for any tobacco products to MedWatch Online Voluntary Reporting, https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

Notice how the FDA is setting up an expectation that the AE reports will be used to implement "quality control" measures, by implying that there are huge problems in this area. Let's see now, 47 AE reports in three years. Is that a vast amount?

According to John Polito:

A May 19, 2011 report by the Institute for Safe Medication Practices (ISMP) revealing that the FDA has now received a total of 272 reports of completed suicides by Chantix users.
According to the ISMP, Chantix ranks first in reported deaths, more than twice as many as any other monitored drug. Total adverse event reports now exceed 35,000, of which roughly 10,000 were classified as serious, disabling or fatal, with 1,055 serious events being reported during the 3rd quarter of 2010.

Here's the score:
Chantix
E-Cigarettes
35,000 + AE reports47 AE reports
10,000 + Serious8 Serious
272 Deaths0 Deaths

Edited to correct Chantix Serious AEs: The 1005 serious events that I previously listed were only for the 3Q of 2010. The total to date is over 10,000.


NOTE: I am not claiming that there are no e-cigarette quality control issues. If anything, battery safety is a more serious problem than harmless trace amounts of chemicals in the liquid that are not even present in the vapor. And vendors do need to take care to ensure that nicotine content matches what's on the label. But I do believe that these issues pale in comparison to the safety record of products such as Chantix.

Also I find it very questionable why the FDA would keep recommending that we stop using e-cigarettes and switch to the "safe and effective" products like Chantix.
 
Last edited:

Myk

Vaping Master
ECF Veteran
Jan 1, 2009
4,889
10,654
IL, USA
As far as I know my doctors who put me on Wellbutrin were required to report the suicidal thoughts, they did not and insisted I keep on taking it.
Only my present doctor added that to my record so he would not recommend any drug like that.
So I'm very sure that Chantix report is low.
Given all the shenanigans surrounding the Zyban/Chantix testing for cessation (intentionally excluding people with possible mental issues or those that have failed quitting before) and the fact the FDA still allows it screams louder than anything.
 

yvilla

Ultra Member
ECF Veteran
Verified Member
Nov 18, 2008
2,063
575
Rochester, NY
Without hard data on the nature of the 47 alleged "adverse reports" on e-cigs, I'm even more sceptical than that Elaine.

For I distinctly remember people back in either late 2008 or 2009 reporting here that they were considering using the adverse reports system to send the FDA a message about serious "side effects" of e-cigs such as: being able to breath again, being able to smell again, etc. etc. I'm sure some people did do that too, to the extent that some of us here urged people not to do that, because we couldn't trust that all such reports, no matter how tongue-in-cheek, would not be counted against e-cigs. Don't you remember that?

I'd wager that there's an excellent chance that at least some of those 47 reports "against' e-cigs were in fact written in that vein. Who knows how many!
 

EJH

Senior Member
ECF Veteran
Verified Member
Dec 1, 2011
92
60
New York, USA
I agree that this report is misleading. However, the report makes a fine case *for* e-cigarettes. Consider that since 2008, according to CDC numbers, about 2 million smokers have died and tens of millions more are suffering "serious adverse effects." Compare to e-cigarettes: 47 "adverse effects," 8 of which were "serious" and ZERO deaths. NONE. Not. A. Single. DEATH.

If the FDA were not beholden to Big Pharma and the scientists at this agency had a shred of scientific integrity, the headline for this report should have read: "E-cigarettes 1000s Times Safer Than Smoking, Infinitely Safer for Risk of Death."

That's what I get out of this report.
 

Bill Godshall

Executive Director<br/> Smokefree Pennsylvania
ECF Veteran
Apr 2, 2009
5,171
13,288
66
Furthermore, I'm not aware that the FDA has urged anyone to report adverse events from tobacco products, or even notified the public about how to report an adverse event from a tobacco product.

In contrast, not only did FDA's July 2009 press conference encourage the public to report adverse events from e-cigarettes, but it has displayed that notice (ever since then) on the FDA's e-cigarette webpage.
 

Vocalek

CASAA Activist
Supporting Member
ECF Veteran
I've been looking through the document again and some things caught my eye.

Three of the four references are questionable.

There is a statement "Currently, there are estimated to be more than 400 brands of e-cigarettes available (Food and Drug Administration, 2011; Kesmodel & Yadron, 2010)."

Food and Drug Administration. (2011). Electronic cigarettes. Retrieved from Electronic Cigarettes

Kesmodel, D., & Yadron, D. (2010, August 25). E-cigarettes spark new smoking war. #e Wall Street Journal. Retrieved from Arts, Entertainment News, Music, Film, Television, Opera & Ballet News at WSJ.com - Wsj.com

So I tracked down those references and did a search for "brands". Not found. Then I tried "400" and got a hit on this text: "About 400,000 Americans die each year..."

So where did this "fact" come from?

For a statement such as this...

"There is concern about the apparent absence of adequate quality control oversight during the manufacturing
of e-cigarettes (Riker, Lee, Darville, & Hahn, 2012)."

...you would expect to find a report of some type of testing that was conducted by the authors of the referenced article.

But the Riker, Lee, Darville, & Hahn article is secondary research. The authors reviewed a number of published articles, some of which described experiments conducted by their authors, and some of which were newspaper articles, FDA web pages, etc. Even when a reference was a good one, they had a tendency to cherry-pick some idea from that article to paint e-cigarettes in a negative light. Example: "Cahn and Siegel,50 who support e-cigarettes as a promising harm reduction product,
acknowledge that existing research does not establish the absolute safety of e-cigarettes."

This isn't untrue. They did say that. But focusing solely on this idea gives the false impression that the Cahn & Siegel article is a cautionary piece, and nothing was said to dispel that incorrect notion.

Riker, C., Lee, K., Darville, A., & Hahn, E. (2012) E-cigarettes: Promise or peril? Nursing Clinics of North America, 47, 159–71. doi:10.1016/j.cnur.2011.10.002
 
Last edited:

rothenbj

Vaping Master
Supporting Member
ECF Veteran
Verified Member
Jul 23, 2009
8,248
7,647
Green Lane, Pa
Without hard data on the nature of the 47 alleged "adverse reports" on e-cigs, I'm even more sceptical than that Elaine.

For I distinctly remember people back in either late 2008 or 2009 reporting here that they were considering using the adverse reports system to send the FDA a message about serious "side effects" of e-cigs such as: being able to breath again, being able to smell again, etc. etc. I'm sure some people did do that too, to the extent that some of us here urged people not to do that, because we couldn't trust that all such reports, no matter how tongue-in-cheek, would not be counted against e-cigs. Don't you remember that?

I'd wager that there's an excellent chance that at least some of those 47 reports "against' e-cigs were in fact written in that vein. Who knows how many!

Totally accurate yvilla. I recall people posting that they had indeed used the system to state their improvements in health.

What also should be included in any of these statistics is AE/x number of users. Today there may be as many or more people using e cigs than are taking chantix. AE/100k users would give a bit more clarity to what we are reading.
 

Petrodus

Vaping Master
ECF Veteran
Oct 12, 2010
7,702
8,132
Midwest
Just did a Google search ... "Electronic cigarettes"
Noticed the FDA's BS is in position #3 ... just below Wiki and blu
Guess the FDA is into buying (or pressuring) Google for position
LINK

I'm sure their BS isn't ranked high based on popularity
:p

Not a lot of e-cigs in the news articles ...
No big surprise since nothing really is going
to happen with e-cigs till after the election.
 

Danny632

Full Member
Aug 10, 2012
12
3
Orlando, FL
Just did a Google search ... "Electronic cigarettes"
Noticed the FDA's BS is in position #3 ... just below Wiki and blu
Guess the FDA is into buying (or pressuring) Google for position
LINK

I'm sure their BS isn't ranked high based on popularity
:p

Not a lot of e-cigs in the news articles ...
No big surprise since nothing really is going
to happen with e-cigs till after the election.


Just to clarify & inform, not argue...

The FDA's page is ranked #3 because to a search engine (Google), the FDA's site is a prominent, national, government site (.gov sites are generally given more credibility by search engines) with heavy traffic and a huge amount of links to and from other large, prominent sites. These are key factors that search engines use to determine rankings. The FDA's position on this issue being ranked high is because the FDA website itself is ranked so high. It is because of the algorithms that search engines use to rank sites, not because the FDA bought or pressured Google for a high ranking.
If you're interested in learning more about how search engines work, you can find it all online.
 

kristin

ECF Guru
ECF Veteran
Aug 16, 2009
10,252
20,236
CASAA - Wisconsin
casaa.org
After this came out last week, I went on the site to check these reports for myself (I also remembered the reports Yvilla mentioned). First of all, it is an EXTREMELY tedious and complicated process for an "average Joe" to get the report, so all I got in about an hour was the second quarter of 2011. There was ONE e-cig report (patient reported hallucinations??) and at LEAST 20 reports for pharmaceutical nicotine products (haven't checked for Chantix yet.) That is just for THREE MONTHS! Just imagine how many that could translate to, over the same 4 years, for those "safe & effective," FDA-approved nicotine products?
 
Status
Not open for further replies.

Users who are viewing this thread